Month: June 2020

Post-COVID, virtual care will be about stability, quality of service, and agility.

Episode #50

Podcast with Aaron Miri
Chief Information Officer
The University of Texas at Austin, Dell Medical School, and UT Health Austin

"Post-COVID, virtual care will be about stability, quality of service, and agility."

paddy Hosted by Paddy Padmanabhan

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In this landmark 50th episode of our podcast, Aaron Miri discusses contact tracing and UT Health’s contribution to prevent the spread of COVID-19 through their public-private partnership with city of Austin, TX.

Austin Public Health has partnered with Dell Medical School and UT Health Austin to prevent the spread of COVID-19 by doing contact tracing on behalf of the city of Austin. Besides contact tracing, the University is also using emerging forms of healthcare delivery such as symptom checking, COVID-19 drive-through testing stations, home monitoring, and nurse triage to control the spread of the current pandemic. Currently, the medical school has over 200 contact tracers working remotely and have successfully performed one-third of the contact tracing in the city of Austin.

Due to the current COVID situation, healthcare consumers are adopting virtual care technologies that are changing the way healthcare is being delivered today. To ensure smooth delivery of care post-COVID, Aaron discusses how virtual care should be a flawless experience for clinicians and patients.

On data interoperability, Aaron suggests three major areas of focus: Identifying and capturing data for public health; the need for the entire continuum of care to be on some sort of a digital system. According to Aaron, healthcare organizations need full data transparency, governance, and internal communication working together to advance interoperability. Take a listen.

Aaron Miri, Chief Information Officer, The University of Texas at Austin, Dell Medical School, and UT Health Austin in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Post-COVID, virtual care will be about stability, quality of service, and agility.”

PP: Hello again, everyone, and welcome back to my podcast! This is a special episode, our fiftieth episode of The Big Unlock podcast. It is a real privilege and honor for me to have as my special guest today, Aaron Miri, CIO of the University of Texas at Austin, Dell Medical Center. I am really thrilled to have him join us. Aaron, thank you so much for setting aside the time and welcome to the show.

AM: Thank you very much. Congrats on your fiftieth episode!

PP: Thank you very much. For the benefit of our listeners please tell us a little bit about UT Health Austin and the Dell Medical School and the focus areas for your institution.

AM: UT Health Austin is one of the top global universities in the world. About five or six years ago we decided that we really needed our own medical school, our own teaching institute, our own clinical enterprise, and really help Austin and Travis County in the state of Texas out by bringing out some of the world’s best physicians through Austin. Our goal here has been, number one, first and foremost, putting out the best medical students possible, prepare them to enter residency. Number two, having a clinical practice really grounded around value-based care in the principles of community and community impact. And three, what UT Health Austin is known best for, which is research. How do we do some game-changing research in genomics and sequencing and really take it to the next level? So, it is that every aspect of an academic health care delivery network that you could possibly imagine and then some. And then now, you throw in COVID into the whole situation and it grows even more so.

PP: I know you are a thought leader and you’ve written and spoken extensively about advanced technologies and digital transformation in healthcare. And you are a practitioner of all the same principles in your institution. I want to start by asking you about the acceleration of digital transformation in light of COVID-19. We are seeing that healthcare is going virtual – telehealth and all other forms of virtual care, digital front doors and so on. What are you seeing in your conversations with your peers across the healthcare industry as the high priority initiatives for digital consumer engagement in a post-COVID-19 scenario?

AM: A couple of things. Number one, if you look at it from the CIO’s perspective, it is ensuring smooth delivery of service. So, all the way from the clinician experience, the patient experience, and the entire continuity of care virtually should be flawless. So that there are no hiccups in terms of workflow, orders, medical record, what not. Telehealth experience has been one that we continuously refine, even though now our practice is that majority of it is telehealth, although we’re slowly up ticking the in-person again. So, to the degree of it has been about stability, quality of service, execution, agility. There are new workflows.

I mentioned earlier that we are big believers in value-based care. That’s a team-based approach. So, how do you use a virtual lobby to be able to do a pre-staging of a virtual care team, where you have a social worker, a musculoskeletal worker, and a pain management worker altogether visiting. And then, they are able to meet with the patient as a team. Those kinds of virtual workflows we have been innovating because we are not going to stop our principles, which is, we believe, cohort and value-based care. So that’s from a CIO perspective, making sure that your health systems are able to make that leap and suddenly go from in persons up in the dozens to over the virtual telemedicine into the hundreds, if not thousands of sessions daily. So, you have that component.

From a policy perspective, what we’re seeing is this question mark from the CMS. We even saw last week with Seema Verma stating publicly that it’s her intent or her desire to want to leave a lot of the statutes in place that reimburse at even parity level. So I think as that decision comes out, it’s going to obviously affect the landscape, because if they’re not paying and reimbursing at a level that’s sustainable, our health systems will have to make some tough decisions. Most of my peers I’m speaking with are trying to keep the lights on, making sure that they are able to shake and bake to whatever the requests are coming in and ensuring that their staff, be at their remote or in person, are feeling secure and safe and what not. And so, we’re able to deliver medicine remotely without an issue.

PP: In terms of virtual care, in a post-COVID-19 context, some of the things that I’m seeing through our work in my firm is the emergence of newer forms of healthcare delivery. And a couple that come to mind immediately are contact tracing as an example, and COVID-19 apps in general. Of course, it’s kind of hard to unpack what a COVID-19 app means when there are so many technology providers out there saying they have a COVID-19 app. But then contact tracing is something that is a little more tangible. Could you unpack these things a little bit?What should one be thinking when somebody comes up and says,I have got a COVID-19 app that I can help or a contact tracing app that can help you? How are you going about it?

AM: Let’s talk in generalities now, talking specifically about what we’re doing here with UTH Austin. So in generalities, when I mentioned a COVID-19 app, I applaud the vendor community for trying to pivot, especially a lot of startups out there and say how can we apply our platform, our tech, our algorithms towards something related to COVID-19. The majority of the market seems to be leaning towards temperature indicators, whether your home monitoring for temperature checking, whether you are able to baseline an individual based on questionnaires to say, are you potentially symptomatic. Because you were out on Memorial Day weekend on a lake without a mask around 10000 people and probably at a high-risk to catch COVID-19. A lot of what you are seeing on the market are symptom checkers, home monitoring type platforms, algorithms. I have seen RTLS vendors make a pivot towards trying to say, hey, our Wi-Fi, our TLS system can now track your patients that are positive – where they are and ensure that they are maintaining quarantine procedures, that sort of thing.

What we did here at UT Health Austin is a couple of things. Number one, Austin Public Health asked us to partner with them formally and via that delegation of the public health authority, we were able to do contact tracing on behalf of the city of Austin. So, we stood up an app that does that. We have over 200 or so contact tracers all working remotely, calling into a central call center, and accessing this app that we partnered with a startup based out of Seattle to deploy quickly and robustly. These contact tracers are able to enter any information, such as, where was Aaron? Did Aaron go to the barber? Who was at the barber? Let’s call them. Are they symptomatic, that whole lineage of contact tracing?

Believe it or not, Paddy, contact tracing has been done for quite some time with numerous disease states. COVID is not new but this is the first major disease state I’ve seen a public drive towards. How can we digitize contact tracing? And it’s difficult because the CDC is constantly evolving their data sheets based on what they learn. Obviously, more that we learn from the disease, the more types of data they want, and specificity collected. So, we are constantly having to evolve the product that we put on the market here to help. But I just read some stat last week that we’ve successfully done one third of all the contact tracing for the city of Austin. If you think about the 11th largest city in the country, that’s pretty darn impressive. We did this here at UT Austin on behalf of the city of Austin. So, to the degree that there’s a number of components that go into this, but overall, I’d say from our position here, what we’re doing is number one symptom checking. Number two, we have our drive through COVID-19 testing stations. Number three, we’re doing contact tracing, as I mentioned. Number four, we are doing home monitoring. We’re also doing nurse triage, because a contact could quickly say, hey, I have symptoms, I can’t breathe. We need to triage them so we can escalate into that triage and then immediately either enrolling in-home monitoring if it’s manageable or ask them to be present at the emergency department as soon as possible. So, we’ve been phenomenal at getting in front of this and really wrapping our arms around it and taking it very seriously in partnership with the city because UT Austin has those kinds of resources to bring to practice.

PP: You make a very important point in your comments, which is this emerging public-private partnership, public health agencies partnering either at a state, local, or federal level with the private sector. And we’ve seen some efforts to do that at a national level like Google and Apple have gotten together to develop this API, which they’re making available to the federal health agencies at the national level. Then we’ve seen state-level or city level initiatives where public-private partnerships are getting a handle on this whole contact tracing and controlling the spread of infections. What are the one or two things that are truly important for this kind of a public-private partnership to work effectively to ensure that there is public safety, ensure that there is accuracy in all of the testing and tracing and everything that goes on and that at the end of the day, the desired outcomes are met? What are the one or two things that came out of your experience?

AM: I would say these are the top three things for anybody navigating these hurdles. Number one, full transparency, i.e., partnership at a fundamental level of what are you doing, how are you doing. What are our shared objectives? What are our shared populations that we’re going to focus on? Case in point, UT Austin is really focused on indigent care for the city of Austin, which has been fascinating to learn about. So, making sure that there is transparency, there’s constant communication between myself and my counterpart with the city of Austin, the CIO for the city of Austin, who’s excellent. Our data teams are constantly talking to make sure that the data is being shared appropriately, securely, and that there, again, is full transparency on dashboards that we’re building. And so, the data that we’re putting out and that they ultimately published for the public has validity. That there is data provenance behind it. A lineage that anybody can say – how do you know how many tests you’ve given? So those kinds of things are very important because that’s what takes transparency.

Number two is governance. Making sure that just because somebody wants something doesn’t mean that your two teams and two organizations go out and just do it right. It’s got to have a benefit objective and particularly when you’re dealing with public health, you have to have a hyper-focus on ensuring that these are the objectives laid out by the mayor, by the governor or whatever else as appropriate.

Last but not the least, is internal communication. What has happened with COVID is you have a number of practitioners that are logged in from home using Zoom or whatever. So, we are communicating and having standups routinely with them to understand what the shifting landscapes are, what’s going on here in Austin, and the experience of COVID positive patients walking through the emergency department. Are there new protocols, are there new surveillance problems to stand up based on comorbidity? Is there different demographic that we need to be able to focus on a little differently? We had a discussion this morning on how to if we needed to start monitoring neonates, what would we do? How would we handle that issue? We’re trying to get in front of potential questions that come up.

So those are the kinds of things you need to be doing. There really is that hand-in-hand approach and that there is no one institution blazing down a trail inadvertently because of a lack of communication.

PP: What has been your experience with regards to false positives and false negatives in your application and your program with the city of Austin?

AM: I think the false positives, and what not really stemmed from the types of testing that are available, whether it’s serological, whether it’s swab, whether it’s saliva, and all of those components, I think that the general public is learning more about the accuracy of those various COVID-19 tests. Subsequently, if we get the data back from the lab saying – Aaron is COVID positive, but it was a saliva swab. Looking at the level of validity around that, it has downstream effects. So, as the general public learns more, we’re learning just as fast along with them because we can now have more experience. The world has more experience with COVID-19, and so the CDC modifies their approach on a lot of things as to what’s going to happen there, which affects our day to day planning. But that is really where the rub is then, and it’s not around contact tracing or issues with that. I’m actually impressed with the general public’s willingness to partner. I would say the consensus of folks out there, if you call them and say, hey, Aaron, you may have been exposed when you went to the grocery store over the weekend. Do you recall who you’ve been around the past 48 hours? We haven’t had people like, who would spat out and say, you’re invading my privacy. Generally speaking, people want to help, and people want a partner, and people want to do the right thing. So that’s been really positive.

PP: You mentioned the public’s cooperation in these programs, which is extremely critical for you to get a handle on the spread of the infections. In general, when you talk about virtual care models, going back to the earlier comment that you gave us about digital transformation initiatives, virtualization of care, telehealth models. What are you seeing as the public’s acceptance of those kinds of care delivery modalities, if you will? Are they comfortable with it? Are they happy with it or are they just tolerating it in the short term because there’s no other option? What are you seeing with your population?

AM: What’s important is to understand the population you are trying to serve. So, let me give you a few examples here. One of the populations we take care of, beyond obviously the commercial population, is indigent care, disconnected is another terminology I have heard, using an epidemiology sense. People that maybe do not have access to a smartphone or a stable home or resources to care, they may be live in a food desert. All those social determinants of health type issues. So, we have really had to spend a lot of time to understand that population of the kinds of modalities they do want to engage with. Specific to Austin what we have noticed a few things. Number one, most of the indigent population, English is a second language for them. So how do we put apps in front of them that they feel more comfortable engaging with? In our case, it is predominately Hispanic speaking individuals.

So, we put out a Spanish version of the apps. There is an iOS app, also in Spanish, there is an Android app, also in Spanish. And a responsive web form that’s also in Spanish. This is where they can upload their own contacts, they can do their own home monitoring, they can engage the app. The app lets us know who they’ve talked to, all these kinds of dynamics, which are very important when looking at contact tracing. And then, of course, consent. We spend a lot of time getting consent from people. And that’s explicit consent. So you understand that you were sharing with me, your family members at home and who was around you, and you’re consenting to tell me that you’re giving me permission to go ask those questions on your behalf. I never want people to feel like even though this is a public health crisis, they don’t know what’s going on. And those components of, again, transparency and putting applications of tech in front of people they understand and seeking first to understand have been the acceptance criteria over the general public. And we see most people, because we’re taking the time upfront to do these things, are natural to them. We’re not forcing them to jump through hoops or we’re not forcing them to have to not understand, but yet still share information. People want to help. We have not seen that pushback. So those are important components to understand.

Something I found interesting about the population, a data fact for people out there building apps, is that a lot of the indigent care actually do have a smart device of some sort. They’re just disconnected from the app store. They don’t have a way to download an iOS app or an Android app. Or they don’t have a data plan. They just simply go free Wi-Fi to free Wi-Fi as they walk around the city. So, it is interesting, the other types of connected behavior that we’re seeing, and I think there’s an entire ecosystem at some point that needs to get in front of this. Perhaps this is what you could do now with Elon Musk’s Starlink. He’s putting up with the ubiquitous coverage of Wi-Fi. Those kinds of industries are going to crop up to help connect the disconnected.

PP: We’re doing some work with some health system in New York City. Of course, the population is very similar to what you’re describing, indigent population, but a diverse, ethnically and linguistically. You mentioned the need for multilingual apps, and then you also mentioned that everybody has a smartphone, but they don’t necessarily have access to the app store because they live in either bandwidth deserts or they just cannot afford it or for whatever reason. And so, a related concern that seems to be arising is the notion of inequalities in access to healthcare by virtue of these inequalities in access to bandwidth as an example. Hopefully, all of that will be addressed through initiatives like the one you just talked about, where you’re giving people access to bandwidth so that they can go and download their apps. The apps that they need or being prescribed to them by their physician and so on.

AM: That’s right. And I would also say one more thing is that we have phenomenal teams of clinicians, family medicine docs that are helping us to do all of this. So, they encountered somebody, say, in a food desert. They’ll also set them up with a connection back to local and state resources that help identify may be meals on wheels. Other programs out there that maybe they didn’t have access to or even know about. So, you can use your COVID-19 programs to help populations of people beyond COVID. In our case, we’re giving them resources and access to state resources that they didn’t know existed and say, look, you don’t need to sit there in hunger, or you don’t have electricity. There are ways we can help you navigate these things. It just takes a focus on public health and it takes your team caring, and I’m very proud of the UT Austin team.

PP: Everyone I’ve talked to have come a long way in the last few months. In March, we really didn’t know what hit us and we had to scramble to get things in place. So, that we’re going to take care of the infected population and at the same time make sure that our regular population doesn’t deteriorate in their conditions and so on. I’m going to come to that in a minute. But it also seems to me like over the three or four months, a tremendous amount of knowledge sharing has happened and people are learning from each other’s experiences and really come a long way in terms of understanding how to address a situation like this in future. We’re a long way away from the current crisis itself. We don’t have a vaccine yet and so many other things, but it seems like we’re much more informed today. What has been the kind of collaboration among your peer groups, across your peers, CIOs in other health systems who are doing similar things? Do you have a forum platform where you share ideas, best practices?

AM: There’s been a couple of things. Number one, across all of the UT system – these include all the CIOs of UT South-Western, M.D. Anderson, myself, others – we are all constantly collaborating on what our institutions are doing across the state to take care of Texans and things that we’re learning, whether it’s data, whether it’s processes, whether it’s how do you set up thermal imaging cameras the whole nine yards across. Across CHIME there are numerous discussion boards and information sharing forums where CIOs are talking, there’s a group of about 40 of us that converse via email asking general questions, asking how do you return to work? Thermal camera discussion, like I mentioned, data, data provenance issues, all sorts of things.

At a federal level, I also am a congressionally appointed member of the HITECH. There has been some phenomenal data and idea-sharing exchanges between the CMS, which would just cross all of HHS, and with the payer side and the provider side to understand what is happening boots on the ground and they make modifications. I recall very vividly there was a couple of emergency discussions with HITECH in March and April in which I was very vocal. In couple of Modern Healthcare articles where I stated pretty emphatically that CMS and others needed to help us, they needed to help us immediately. Our cellular lines are getting overrun, there were all kinds of issues. If you recall that timeframe, people thought what was happening in New York was about to happen across the country. And to the credit of HHS, they mobilized.

Whether it’s helping to make sure that data was more quickly, readily available, and normalized, whether it was making sure that CMS was relaxing telemedicine rules as fast as possible. I’m not saying that the HITECH meeting made that all happen. I am saying the right people were listening and they committed to changing it. So, I give a lot of credit to the administration for listening and for making changes that really benefited boots on the ground. So those are the kinds of things that are happening. It is not happening in isolation where you’re sitting at a hospital and you don’t know who to talk to. The whole healthcare community has rallied together to really get behind this. And I haven’t found one person unwilling to help or dive in or lend a hand if you need it.

PP: Yeah, in a way, the pandemic has accelerated the future. And that’s kind of what Ed Marx, my co-author for our upcoming book on Healthcare Digital Transformation pointed out, which is that consumerism and technology are already changing the way healthcare is being delivered and being accessed and experienced. The pandemic has accelerated all of that and by an order of magnitude is what it seems like. Would you agree with that?

AM: I would agree with that. I would also say that consumerization has always been here. The problem with healthcare is that it’s an industry that has always been focused on reimbursement first. And that’s from the early days when Medicare and Medicaid first came out in the mid-60s. That has just become the focus of how do you submit claims for payer reimbursement? And so, because we thought that telemedicine was never reimbursed at a parody level or whatever, that there was never going to be mass adoption, and yet the consumers actually want it. I will give you a specific example. We do net promoter score – scoring for all of our patient encounters on top of age caps and all other things you have to do. We want to know in real-time -How was your experience? Would you recommend a friend? Then, tell us something, in free text form, about your experience that we should know. You usually get the whole, “Aw! Traffic is abysmal on Austin or parking was hard in a garage.”

OK! I’m (Austin) a city. I can’t change the traffic situation. Austin, Texas. I wish I could write for beyond healthcare purposes. However, our NPS was always in the 80s, which is really good looking at the net promoter score. However, since we’ve gone to telemedicine, our net promoter score is now in the 90s. People don’t have to put up with those headaches of traffic and parking anymore. So, consumerization has always been a desire. The problem is the healthcare industry just wasn’t going fast enough for what the general public wants. And so, my hope is now this COVID, as bad as it is, has highlighted the fact that you can be thought blazing with health care and people will adapt to it. They’re not stuck in the 1980s. They want to engage with you via a face time, communication or whatever. They want that. I want that right. I don’t want to drive unless I absolutely have to.

PP: Another topic, the whole notion of data interoperability and how we are set up today versus how we need to be set up for the future. You mentioned CMS finalizing interoperability ruling back in March. And so, we’re going to hopefully see an improvement in data interoperability and all the information blocking practices. But having said all that, the way data is structured today within our primary repository, a system of record, which is the electronic health record. The pandemic has exposed some serious limitations, and this is what I hear everywhere I go. What are your thoughts on that? What should we be doing now from data interoperability and just data management standpoint, knowing that we have what we have, which is a current electronic health record landscape, but our needs are now evolving very, very quickly?

AM: So, without getting overly technical and starting to talk about standards and other formatting and data issues, I will talk about the generalities. Number one, we are still learning about COVID, particularly in public health. We’re still learning what data elements we need to track. This is why the recent issues cropped up about race and ethnicity. And gaps of care, because not everybody mandates those fields to be filled out or we are not capturing it accurately. So, I would say, number one is we need to get a general baseline field for public health criteria. What are the standards that need to be tracked every single time? Is it race and ethnicity and of course, age and comorbidities? What is it? We had the same issue with Zika a few years ago with pregnancy. We weren’t able to track people who were pregnant because pregnancy status at that time was not mandatory. Now it is a required field. So, there are these things we need to learn. I would say, number one, a general baseline of definitions and data capture for public health that everybody must adhere to, rights that standards formation and you could put it through the USCDI process that was developed into 21st Century Cures Act that we did in the HITECH so that we can adopt those criteria.
Number two, I would say that we need to make sure that we do not forget other types of care across the care continuum. Right now, rehab, nursing homes, SNFs, they all need to be on some sort of digital system. They are not, obviously, with the American Recovery and Reinvestment Act of money was allocated towards digitizing the inpatient and acute care market. Not a bad thing. That is where people are the sickest. I totally get it. But we have to go back and make sure those care locations are just as digital and just as regulated as the inpatient facilities are. So, we have a continuum of discrete data.

And number three, a better partnership between public health and private sector. Again, I’m blessed here to be with Austin and UT Austin, which have a great relationship. I do not think the same exists in every locale, in every city. So how do you reboot and have those types of didactic discussions so that in the event of a pandemic, in the case of COVID 19, there’ll be future COVIDs. How do we make sure that those tenants we spoke about earlier are in place of transparency and governance and communication? You’ve got to have all those components working together. It’s not just standards, but that’s how we’re going to advance interoperability. I do think that 21st Century Cures Act, that is the law, as you just mentioned, was finalized, I believe it was beginning in March, should help. But we still have a long way to go because just because I put the tool in front of you doesn’t mean it’s going to be used appropriately.

PP: Well Aaron, we’re coming up to the end of our time here. I had just one last question related to the innovation ecosystem and their role in driving healthcare forward, especially from a digital transformation standpoint. And I know that as part of CHIME, you are also launching a series of webinars related to digital health innovation. What are you trying to address there? What are you seeing in the marketplace and what are you trying to address with this new series? What’s the expectation?

AM: I am a big believer in partnering especially with startups and young companies, on how do you and in a very agile manner, deal with a problem that you’re facing, whether it’s COVID related or not. There are companies out there that are hungry to want to innovate with you, and not that the large companies are bad. We have great partnerships with major companies here, too, at UT Austin. But it’s sometimes a lot easier to partner with a startup and solve a problem. And so, this innovative series that CHIME has started is around that. How do CIOs partner with a startup, a young startup to solve a specific problem? And the session that we have coming up is specific around contact tracing and home monitoring and the whole issue of COVID I just spoke about. When we were faced with this in March, the request comes to you as a CIO. Hey, what do you do for home monitoring on patients? What do we get? How do we build it? Do we build it in Redcap? Do we build an app ourselves? Hey, we need to do contact tracing. We don’t want to do it in Excel. Do we want to build an access database and do some crazy requests? You get like stop. Right. I can do the same old thing over and over again and not really advance the problem. Or I can partner with someone and really knock us out of the world and really benefit the society as a whole, which is the route we went. That’s what this series is about, its about thinking different, stepping outside your comfort zone and feeling OK to break a few rules, because it’s at the end of the day, you have a much more robust delivery of care and care processes. Also, your physicians are a lot happier and your patients, too.

PP: We never really got to talk about remote monitoring, and that’s a whole different maybe another podcast sometime in the next few weeks. Thank you so much for joining us and I look forward to participating in these webinars that you’re doing with CHIME. That is going to be very interesting for those who are listening. I would strongly recommend it. It’s got Aaron moderating them, so it’s got to be an interesting discussion. Well, Aaron, thank you again for joining us and I look forward to being in touch.

AM: I appreciate very much. Thanks, Paddy.

We hope you enjoyed this podcast. Subscribe to our podcast series at  www.thebigunlock.com  and write to us at  info@thebigunlock.com

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity

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About our guest

Aaron-Miri-profile

Aaron Miri is the Chief Information Officer for The University of Texas at Austin, Dell Medical School and UT Health Austin. He brings more than a decade of healthcare experience driving growth and innovation, leading both provider and commercial healthcare enterprises, and providing thought leadership and close collaboration with state and federal representatives. As the CIO, Aaron is passionate about humanizing technology by collaborating with clinicians, technology partners, and business champions to truly transform healthcare delivery for consumers, patients, and providers.

In 2018, Aaron was congressionally appointed to the Health and Human Services, federal Health IT Advisory Committee (HITAC), established under the 21st Century Cures Act. Previously, Aaron was federally appointed by HHS Secretary Sylvia Burwell to serve on the HHS Health IT Policy Committee established under the American Recovery and Reinvestment Act of 2009. He is the prior Chair of

the HIMSS National Public Policy Committee and serves as an expert adviser to the United States Senate Committee on Health, Education, Labor, and Pensions (HELP) and to other congressional panels engaged in numerous Health IT policy topics. Aaron also serves as an advisor to the National Academy of Medicine on the topics of healthcare privacy, secure, and data.

Aaron is a well-known international thought leader and he brings a deep understanding of how to leverage digital health and the latest technology to accelerate healthcare delivery across the continuum of care. Prior to joining U.T., he served as the Chief Information Officer for Imprivata, the Healthcare IT security leader, where he helped to build and transform a global commercial enterprise focused on healthcare cyber security. Prior to Imprivata, Aaron was the Chief Information Officer for Walnut Hill Medical Center, lauded by Forbes Magazine as the hospital that Steve Jobs would have built. He has successfully led organizations that achieved the HIMSS Nicholas E. Davies Award, HIMSS Level 6 and HIMSS Level 7 EMRAM status, HITRUST CSF designation, and led the first provider organization to receive the SECURETexas Health Information Privacy and Security certification awarded through the Texas Health Services Authority (THSA). Aaron is also a proud member of the CHIME CIO Boot Camp Faculty and routinely mentors’ early careerists through CHIME, HIMSS and other national associations.

Aaron received his MBA, with honors, from the University of Dallas, and his Bachelor of Science in Management Information Systems from the University of Texas at Arlington. Aaron is a Certified Healthcare Chief Information Officer (CHCIO) through the College of Healthcare Information Management Executives (CHIME), a distinguished Fellow with the Health Information Management Systems Society (HIMSS), and he is a Project Management Professional (PMP) with the Project Management Institute (PMI). Aaron is a nationally recognized 2020 “CIOs to Know” by Beckers Hospital Review and was honored with the 2016 Computerworld Premier 100 Technology Leaders award, 2017 Texas Health IT Leadership Award, and the 2019 Constellation Research Business Transformation 150 award. He serves as a board member in the not-for-profit Cartwheel Health, serves as a CIO board advisor for Dell Inc., and as an advisor for numerous healthcare startups and leading venture capital corporations.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

If telehealth is our first peak of digital medicine in COVID, the second will be digital monitoring.

Episode #49

Podcast with Ashish Atreja, MD, MPH
Chief Innovation Officer, Medicine
Mount Sinai Health System

"If telehealth is our first peak of digital medicine in COVID, the second will be digital monitoring."

paddy Hosted by Paddy Padmanabhan

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In this episode, Dr. Ashish Atreja, Chief Innovation Officer, Medicine at Mount Sinai Health System discusses how virtual care technologies – remote monitoring, video visits, telehealth, and digital medicine – will bring value to health systems by decreasing cost, increasing efficiency, and improving healthcare outcomes.

Dr. Atreja’s role at Mount Sinai Health System is to enable digital health for value-based and patient-centric healthcare. He states that COVID-19 has been the most significant technology transformation agent in the healthcare industry. According to Dr. Atreja, the next technology after telehealth that will rise out of the current pandemic is digital monitoring.

Dr. Atreja is also the founder of non-profit Network of Digital Medicine (NODE.Health), that promotes evidence-based digital medicine by bringing together a network of societies, foundations, and health system associations to enable digital transformation in healthcare.

Ashish Atreja, MD, MPH, Chief Innovation Officer, Medicine, Mount Sinai Health System in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “If telehealth is our first peak of digital medicine in COVID, the second will be digital monitoring.”

PP: Hello again, everyone, and welcome back to my podcast. This is a Paddy, and it is my great privilege and honor to introduce my special guest today, Dr. Ashish Atreja, Chief Innovation Officer of Mount Sinai Health System in New York. Ashish, can you share a little bit about your role at Mount Sinai and what you are working on today?

AA: Currently, I’m the Chief Innovation Officer in Medicine at Mount Sinai Health System. My goal is to really enable digital health together for value-based healthcare and healthcare efficiency. My foundation was laid in Cleveland Clinic where I did my Residency and Informatics Fellowship. I led on to implement an electronic health record for the hospital. And that got me to innovation bandwagon where I got a chance to go to the first web-based paging application way back in 2006. Really good to see the value in being licensed out and implemented across the clinic health system. And then Sinai hired me for a role where we can combine the best of digital health with the electronic health record to make it a wholesome, patient-centered experience for healthcare. So, it has been just a fascinating journey, learning from everyone in the community, from startups to my partners in NODE.Health and trying to make a difference.

PP: Can you tell us what NOAD.Health is about?

AA: One of the major gaps we see in our ecosystem is there is so much going on in digital health. But who puts it together in terms of saying, these are the best solutions that we have to look for? But really taking a scientific approach to that. So, we created this concept of evidence-based digital medicine or EMDM where we can trust really what is working, what is not working. We create a framework for people to evaluate the technologies because then we feel comfortable in advising and bringing them to the health systems. NODE.Health is a nonprofit network of societies, foundations, and health system associations. It is followed by a consortium of health system leaders and the goal is to first promote evidence for digital health and then enable transformation. We do that through our validation network we have. We also do that through annual conference we have as an education way for people to learn from the case studies and learn from each other.

PP: In my work with health systems today, we see that digital transformation is accelerating and largely as a result of competitive pressures. It seems to me that the focus is primarily today on telehealth and digital consumer engagement. Obviously, because of the high revenue dollars attached to improving access to care. Is that a fair observation? Can you talk of some of Sinai’s digital investments in the near-term and from the longer term as a consequence of the pandemic?

AA: With the COVID phase, COVID has been the biggest transformation agent for us, I would say the progress we saw which would take a few years happened in months. But I think the COVID phase is actually parallel. The transformation technology that has been happening, the access was a big issue and initially, we got it to rise because of the bots. The bots happened to screen patients because we did not have much triage capacity with our personal thing. But then because we had to convert rapidly our in-person visits to video visits, telehealth really become mainstream. I think consumer engagement telehealth became mainstream because of we could not see in person. Post-COVID or the tail of the COVID will take us to a world that is going to persist. If telehealth is our first peak of digital medicine in COVID, I feel the second peak is going to be digital monitoring. Nearly every patient can be monitored through a software or a hardware that will dovetail into a population health approach. That is where I see the biggest gain as well happening from the technologies.

PP: How are the consumers responding to the shift towards telehealth? Are you seeing not just the volumes showing an uptick because that is to be expected, but also the kind of satisfaction levels? Are they happy with the experience, are they going to stay with it when things come back to normal?

AA: My wife is practicing cardiology and she was saying all my patients are coming back as a re-open for the physical thing. And we are going to see a variable pattern. I call it a blended approach. You are going to see some patients who have tasted telemedicine and may not require that heavy physical examination or heavy touch, maybe completely ok with preferring telemedicine. Some people would be equivalent. And some people would still like to come in. I think where it becomes really tougher is now the practice, patients who tasted telemedicine will demand a mixed approach. Some patients will lean towards telemedicine continuation and some will actually go to physical. So, you have to actually take all of those aspects into account. So, it creates an additional layer of complexity than telemedicine only.

PP: In this whole new world, there’s a lot of startup activities that are trying to address opportunities with digital engagement touchpoints in this new virtual care environment. How do you see them holding up from your standpoint? Do you see them pivoting their businesses? Are they staying the course? Are they doing something different? You have a unique perspective by virtue of being the Chief Information Officer. Can you share your observations on that?

AA: I think there are many startups who are suffering if they are in a unique niche area and they are in a research skill or something. And your entire business model was dependent on that. You certainly are in a no man’s zone and don’t know where to go. I have seen many startups evolve and rapidly kind of support virtual care. I can give examples for the Mount Sinai spinout Rx.Health, which I continue to guide. And they have a platform approach to prescribe digital medicine directly from EHR and unify the entire ecosystem. They rapidly extended a partnership and got a whole virtual care tool kit with national societies to support health systems. I think startups, which already have the ecosystem and the infrastructure and the platform, like in case of Rx.Health, it was just adding additional tools to it, will rapidly able to do that and evolve themselves. And that is like one million lives within three months. And startups who are very early are startups who have a unique niche area were struggling. So, we are seeing both patterns, but irrespective we are seeing a pattern where consumer engagement and more than AI engagement really has become pivotal. And patients are able to see what a health system, what a good patient engagement looks like.

PP: In the wake of COVID-19, startups, by definition, they’re meant to be opportunistic. They’re nothing if not opportunistic. One thing that we are seeing is that there’s a lot of emerging opportunity in addressing the immediate needs of the COVID-19 pandemic. And it is a lot of apps, a lot of new solutions, and a lot of existing platforms. They have now either built or launched “COVID-19 applications.” I read a study recently, I think it was done by the University of Illinois in Urbana Champagne, which looked at some 50 different apps, and they raised a lot of questions about the evidence of the effectiveness of some of these tools. They also raise questions about things like the privacy of the consumer data that they are going to access. What do you make of all those that you, as the Chief Information Officer, especially in the NODE.Health? How do you really adjust to all of this? I mean, make recommendations about what tools are going to work and what will not?

AA: I think in terms of COVID, it’s tougher because we don’t have a legacy or a history. We don’t have the time to evaluate. So here you will have to really just see what is happening in real-time and just make some conclusions out of that, which can sometimes be wrong. So, I can take the example of contact tracing apps, which I have been engaged with a lot. And it is just a no-man land right now. This is not like South Korea or China or in some cases India, where you have a government-mandated app that everybody is using. This is free for all and there are so many apps in the market. Most of them are not talking to each other. So, what is the value in terms of public health? There can be value in personal health by guiding. But what is the valid public health space is uncertain. I think what you also have to take into account that you do not have the luxury of evaluating everything. When it comes from a health system perspective my recommendation will be, we look at patterns, look at problem first approach later than what’s out there as a shiny object syndrome. COVID has also accentuated the problem of shiny object syndrome. I think we have to say where your health system is really struggling with. Is it getting new patients into telehealth? Is it as you are reopening getting patients back into surgeries or appointments? Is it your ACO population that is really getting hospitalized a lot? Is it post-discharge care where you are struggling? Or all of that? And then which are other solutions which actually fit into that our platform solutions, which can serve all of them. My recommendation would be to not go with one isolated partner like a point and get solutions. But look at COVID solution as a strategy to evolve post-COVID. So, take the solution that you would really like to evolve and play with post-COVID because it is so much time in security as has been integration and of diligence and other staff. You want to leverage it for the long term, not just for the next six-nine months or so.

PP: Yeah, you mentioned contact tracing. That was the other thing that I was going to talk about. My firm’s been following this, and I’ve been following this. Google and Apple came together and launched the API but then ran into a few challenges because, you know, the public health agencies wanted location data, and they don’t want to share that. So, you know, there is questions about reapplication that wouldn’t be built on top of the API and how effective they’re going to be. Having said all that, despite all of the challenges, it seems to me like some of these new technologies, contact tracing, for instance, have a lot of potential in the future, regardless of whether it is to deal with COVID-19 as a concept, as a theme. Seems like there’s a lot of potential for that. And from my experience, it looks like some health systems are doing their own contact tracing within their own populations in a very limited way. Do think that’s the way to go right now, look at your own population, focus on that, and try to make it work, and then we’ll see about what happens in the broader scheme of things?

AA: I think its elementary. In fact, I’m working closely with MITRE, which is a nonprofit which works with federal agencies a lot, and the presentation was completely focused on we need to have a complementary approach for health systems and public health agencies. And I’m talking with the New Jersey Public Health in New York City as well. And if we just limit the stuff to contact tracing to public health agencies, they don’t have their own patients. So, they’re going to be just putting something out there, but that adoption can be very, very variable. I’ll take the example of Mount Sinai Health System, we launched an initiative called STOP COVID NYC. We were able to reach out to close to one million New Yorkers. Within a few weeks, and we were able to actually digitally monitor 55000 people. I think there’s a value in having five million patients in your network, which you can reach out to and get to engage with them and protect fifty-five thousand employees. So, there’s a lot at stake for health systems and for self-assured employers as well. I do think at least in the U.S. there is more federal approach and data sharing issues and privacy concern, we cannot wait for nine months to actually have a mainstream contact tracing app universally if at all that happens. We have to still look at and within weeks or within days, protect our population and patients.

PP: I think New York is a great example of public-private collaboration, especially in the wake of the COVID-19 crisis and New York is also one of the most heavily impacted areas in the country. Back to the patient experience, consumer experience when it comes to digital engagement. There is no dearth of digital health tools that can solve some problems in the entire patient care continuum, especially in the context of digital engagement. At the same time, I hear all my clients and everyone, they’re saying that they are struggling with creating the seamless experience that people look for and something that you might be used to in an Amazon type of experience or your personal banking experience, for instance. That kind of experience seems to be very, very challenging in healthcare. Why is that? Is that because apps do not talk to one another? Is it because we are not designing them properly? What are your thoughts on that?

AA: I think there are two potential reasons. One is the EHR. The APIs is now opening up. So if that’s your system of record and that’s where your physicians are living, the patients are completely living in a patient-centered world, you have to have an open API to share the data to actually enable that seamless thing. If you can’t have open API, even if it is said they have open APIs and it’s not easy to do that, then you can’t create a customized experience because your record is completely in a proprietary system and you are not able to unlock that. That has been the number one major stumbling block. With FHIR and other standards, I work in FHIR at the scaling committee for ONC FAST Committee, and I think they have in progress. But still daggered what is possible to what is actually a really feasible what people are doing. It like a O gap. The other part is there are differences in operations, whether it’s underserved or not, digital disparities, and also disease-specific differences. Getting a primary care doctor visit is very different than having a surgery done on new for orthopedics, for example, or getting a heart attack or being in a stroke or being in a nursing home. So, the context, the people around you are very different, the length of the time is very different. So, there is enough variability on the patient level, on the system level, on the electronic records level, to be able to orchestrate that in a meaningful fashion and make it universal requires time and effort and investment. And look at the investment Amazon has to make it a seamless thing, people undercount. They just see the expenses here. Hey, let me get it without investing 100 dollars per year and do it, while I am a five-billion-dollar health system. So, I think there is something to be said about investment, but also something to invest in investment, getting things together to make it unified in unison and rather more fragmented.

PP: We’ve had the final interoperability ruling come out in March. And leaving aside the information blocking aspects of it, when we talk about creating these seamless patient experiences, you think that’s going to make a difference? Do you see improvements coming about in the experience directly as a consequence of the ruling?

AA: Yeah, I think that we are going to see a lot more applications, patient-centric applications, leveraging that. And I think we have been waiting for that for a long time. But I think that would become much more mainstream now. There’ll be definitely value. I think the data exchange between EHR’s to EHR’s will still be less. But I think at least the patients will have it, hopefully, and then they can be a whole ecosystem that has to be developed around it.

PP: We’re now in the midst of COVID-19 or somewhere in the journey. But clearly, there is a shift to virtual care and virtual care models of have accelerated, telehealth is mainstream, digital front doors are all the rage, and remote monitoring is gathering steam. We did not talk much about the remote monitoring piece. Do you want to spend a couple of minutes talking about how that is going to change the healthcare experience in the future?

AA: Yeah, I think remote monitoring is probably going to become the dominant way to manage patients. And continuously manage patients. Whether its chronic disease and the reason I am saying that till date the remote mountain has been suffering from two things. One is hardware only play and the patients may not have an easy way to set it up and link to the Wi-Fi. But with 4G devices, which can actually implement hardware, we do not have anything to test or connect makes it very easy. The second was reimbursement for that. So that’s why there’s limited mostly to ACO or post discharge. Now with reimbursement coming from RPM and CCM codes. I think we’re going to see a lot more mainstream implementation of that. I think any chronic disease patient as cardiovascular to others will require digital monitoring. And we are doing it a lot for even many devices which do not have devices by doing software, only digital monitoring. And that is even much more affordable than the hardware on the disk monitoring where you can access patient symptoms and other things to track them and schedules and logic for them. So, I think this combination whether its value-based healthcare, whether it is the readmission reductions, whether it is payer, and then you can automatically set up triage rules or alerting rules to convert those people who are digitally being monitored and can load them into virtual visit or in-person meeting as needed, as we saw with COVID-19. I think we are going to see a lot more push on that and becoming things to scale and getting a lot of value for health systems to decrease the cost, increase efficiency, and improve outcomes.

PP: I think the reimbursement environment is definitely improving, as you mentioned. We saw that for telehealth they made some significant changes and those changes may possibly stay on for the longer term. And we see the same kind of positive momentum on the remote monitoring side as well. So, all that is good news for virtual care models. Well, Ashish it’s been such a pleasure speaking with you. And thank you so much for taking the time to join us and look forward to following all of your work at Sinai and Node.Health and of course, Rx.Health. Thank you again.

AA: It’s been a pleasure, Paddy. Thank you for having me.

We hope you enjoyed this podcast. Subscribe to our podcast series at  www.thebigunlock.com  and write to us at  info@thebigunlock.com

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

About our guest

Dr. Atreja is a healthcare executive with board certification in internal medicine, gastroenterology, and clinical informatics. As the Chief Innovation Officer, Medicine, he leads the Sinai AppLab (http://www.applab.nyc) that is one of the first collaborative hub within academic medical center to build and test disruptive mhealth technologies.

As an intrapreneur, Dr. Atreja has won innovation awards at Cleveland Clinic and Mount Sinai, successfully licensed technologies from academic centers and advises startups, accelerators and Fortune 500 companies in digital medicine. He was first gastroenterologist to get board certified in informatics and one of the first to develop virtual pager and messaging application. Dr. Atreja serves as Scientific Founder for Mount Sinai Spinoff, Rx.Health that brings first enterprise-wide app curation, prescription and engagement platform to risk sharing hospitals and payers in an affordable and scalable manner. Recently, Dr. Atreja established non-profit Network of Digital Medicine (NODE.Health) to connect innovation centers worldwide and share best practices for digital medicine innovation and implementation between industry, payers and health systems. Dr. Atreja is a member of many professional organizations, has published 70 academic papers, presented more than 200 abstracts and has been a keynote speaker globally on topics related to digital medicine evidence and health system transformation. Dr. Atreja was nominated among the Top 40 HealthCare Transformers in the US.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

We believe that a business model of payer-provider partnership is best for patients and communities

Episode #48

Podcast with Ceci Connolly, President and CEO, Alliance of Community Health Plans

"We believe that a business model of payer-provider partnership is best for patients and communities"

paddy Hosted by Paddy Padmanabhan

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In this episode, Ceci Connolly, President and CEO of Alliance of Community Health Plans discusses the findings of their recent survey on how COVID-19 has shifted consumer behavior towards healthcare and tripled the use of telehealth and other virtual care technologies.

Ceci shows concern about the existing health inequities and hopes that we close the fundamental gap of the digital divide affecting certain sections of the society. She believes that in a post-COVID-19 era, healthcare payers and providers will focus more on virtual care for better patient experience. Ceci further hopes to see virtual care at the core of value-based model in the future.

ACHP is a non-profit organization that brings together innovative health plans and provider groups delivering affordable, community-based, high-quality coverage and care.

Ceci Connolly, President and CEO, Alliance of Community Health Plans in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “We believe that a business model of payer-provider partnership is best for patients and communities”

PP: Welcome back to my podcast and it is my great privilege and honor to introduce my special guest today, Ceci Connolly, President and CEO of the Alliance of Community Health Plans. Ceci, welcome to the show. Would you tell us about the ACHP and your work?

CC: The Alliance of Community Health Plans is a group small but selective group of health plans that are nonprofit, community-based, and aligns with providers. They’re either part of an integrated system or they have these very close partnerships in their communities with physicians and hospitals. We believe that the model of the health plans and the providers being really aligned around the patient and the community makes for a very successful approach in healthcare today. Our work really grows out of that belief and that view that a business model of payer-provider partnership is best for patients and communities. We see better health outcomes, often at a lower cost. Here in Washington, D.C., where we are based, we advocate for that at the federal level, in Congress and in the administration. We also do a lot of work with our clinical innovation department around best practices, shared learning, and research. And we also have a market competitiveness team that looks at that model and really tries to document the great success stories, does a lot of benchmarking, comparative analysis, et cetera. So that is a bit about ACHP and our wonderful members.

PP: What is the size of the members and how many such health plans are there in the country that are closely affiliated with the community health systems?

CC: We have 25 member companies. They range in size from a couple that have enrollment of 100000 covered lives all the way up to Kaiser Permanente with the 11 or 12 million covered lives. We and our members are present in 35 states plus the District of Columbia, representing now about 22 million covered lives.

PP: Your organization recently published an interesting survey on how COVID-19 has shifted consumer attitudes towards healthcare. Would you care to discuss one or two findings? Was there anything that surprised you?

CC: This was a national survey of adults 18 and over across the entire country, a good demographic mix, if you will, to really represent the nation. And we were most interested in the way in which the COVID-19 pandemic has altered patients’ views about going to a doctor’s office or hospital, how they are interested in receiving healthcare services now and in the future. And in many respects, the data validated what we have been hearing anecdotally, but it’s always so powerful to get the data. A very sizable 72 percent of the respondents said that the pandemic had dramatically changed their use of healthcare services over the past few months. What we saw consistently was that through the early months of the crisis and for at least the next three to six months, high levels of anxiety about going to a doctor’s office, a hospital, an urgent care clinic, any of those in-person sites for elective procedures, diagnostic procedures, tests, et cetera. We heard from those individuals who said they had chronic conditions and senior citizens in our survey had even higher levels of reluctance to return to in-person facilities for probably at least the next six months. As you can imagine, that has very important implications for the health sector and potentially large implications for individual’s health. The good news flip side of that is that we saw a remarkable tripling of use of telehealth or virtual care in that time period. And even more impressive was that the satisfaction rate, customer satisfaction with telehealth was just terrific. Of those that had a telehealth experience, whether it was phone or internet in that short time period. Eighty-nine percent said they were satisfied or highly satisfied with the experience. And the individuals in the survey that reported using a smartphone app to manage an existing medical condition might think in terms of diabetes, sleep problems, heart conditions, 97 percent of those individuals describe that as valuable or very valuable.

PP: This is really very interesting data. My firm does a lot of advisory work in this space. So we work with a lot of health systems and help them with their digital health and digital transformation roadmaps. And obviously over the last three months in the wake of the pandemic, telehealth and virtual care models have become front and center in their overall business strategies. The numbers that came out of your survey are just validation for what we’re seeing on the ground. Interestingly, I also saw another survey that was published recently. I think it was by FAIR Health were the increase in total health claims is on the order of 4000 percent over the last one year. And, there are regional differences and some regions are higher and the others are not as high. But you mentioned anxiety. Some of the claims also reflect the fact that there’s a lot of anxiety among patients and were unable to take care of themselves using conventional access to healthcare. So, we are clearly in the middle of a very interesting transition is what it looks like. And I hear that 80 to 90 percent of outpatient care could potentially shift to some kind of a virtual care model. Some of your survey results seem to be indicating that we are headed in the direction. So what are your views on this shift specifically as it relates to access to care for the population served by your member health plans?

CC: I am happy to report that several our members were really in the vanguard of this movement. If you think about UPMC and Pittsburgh or Select Health, which is part of intermountain in Utah or of course, Kaiser Permanente, they have been very early adopters of the technology options and really helped spark ACHP to lobby successfully over a year ago for inclusion of telehealth in Medicare Advantage. And so, we are so pleased to see much of the rest of the world now seeing what we have long seen in terms of the convenience, the lower cost that is available. And I think that the COVID-19 crisis really drew sharp relief as we saw people that otherwise could not get access to medical services, finally could have it with a click of a button on a device. That said, we have also seen that inequities in our society play out in this area as well as so many others today. So, the number of individuals that do not have broadband, that do not have smart devices. Right now, CMS has put in place waivers for audio only services. But there are concerns about whether or not that will hold, especially if it would be factored into what’s known as risk adjustment calculations in the future. So, there are some unknown questions there. We certainly hope that Congress will finally move forward with broadband legislation is one step in terms of closing the digital divide. But there are other things that need to occur, certainly. We are worried that some providers will hurry back to the in-person visits, in part because they have bricks and mortar businesses that rely on the fee for service payments, not just of the visit, but often a lot of additional tests and checks and things that can be run in person, whether critically necessary and appropriate or not. So as much as we see public attitudes moving very quickly and being very pleased with these alternatives, we are not certain yet about the providers. And we know from our own health plans that they really needed to approach this as a partnership with clinicians every step of the way in terms of what areas of care are best suited to virtual versus the ones that are better in person. One of it shouldn’t be a surprise, but many seem surprised that behavioral health or mental health care is specially affective done virtually. These are populations that maybe are not as comfortable out in society at any time, let alone when there is the threat of a corona virus infection. They may have transportation issues or other chronic conditions that make in-person visits challenging. And many of our health plans report that patients sticking to scheduled appointments virtually is higher than the rates that they were seeing pre pandemic in person.

PP: You mentioned the policy environment as a business for telehealth. But there are other aspects of costs that are stranded that come into play when things go back to normal from the patient or the consumer standpoint. There’s also the question of you mentioned it as a digital divide, and especially if we’re underserved populations with broadband connectivity issues and so on. That is the affordability aspect, the transparency to the costs of care or costs of other enablers for cares such as devices. Where do you see all that today and how do you really support your member populations in sort of wading through this thicket of these new tools, technologies, modalities and get the care that they need, but also not find themselves at the receiving end of unexpected costs?

CC: We always try to start with evidence and the wisdom of clinicians when it comes to appropriateness of care. What care being delivered, when, how, where, etc., clinicians talking to their patients. So that is always the starting point for these conversations. As far as the Alliance of Community Health Plans is concerned, we very quickly want to layer on the value discussion. There’s been talk and effort in this country for an awfully long time about moving from our volume based fee-for-service system to a value-based system that rewards outcomes as opposed to just number of procedures, and I would certainly put virtual care into the value-based model approach. And again, clinicians and patients are going to guide much of this. But if a clinician has a diabetic patient, they should be able to think through how much of that can be remote monitoring, emailing, the occasional video check-in. And then when does the patient really need to come in for certain lab work or tests or procedures? So that’s just one tiny little example. But it’s probably going to be a mix. And ideally, you want that clinical team, not just an M.D., but an entire team, to be paid a certain amount of money to care for that diabetic. And they work out sort of the best formula in a value-based arrangement. We have seen that so many of the delivery systems, physician group practices, hospitals, et cetera, that we’re so heavily reliant on volume-driven revenue and fee-for-service that they encountered very severe cash shortages very quickly in the crisis. If you were to talk to clinical teams, physician groups that were in more of the value-based arrangements, they continued to receive those steady payments throughout the crisis. And it meant that they were able to focus on patient care during a crisis as opposed to their revenue stream.

PP: What about price transparency? Do you have any specific thoughts on that, especially as it relates to all the new modalities of care in a predominantly virtual care environment, digital health tools and devices and the like?

CC: We are bullish on price transparency and we have several members that have been far out in front with consumer tools for very personalized price and quality information. I’m thinking about priority health in Michigan and health partners in Minnesota, Presbyterian in New Mexico and many others where a consumer is not only looking up a potential price of a service, but it’s there out of pocket cost and it factors in their own deductible where they are in that deductible. It tells them different locations where they could go and get the service so they can think about travel time and convenience, where if there is a virtual option and many of these tools also marry in quality data so that they can shop for value. And in fact, we are seeing that happening in all the plans that I mentioned. And its terrific news because the patients want to go to those higher value sites and offerings and options, and both the plan and the individual member end up saving dollars. So when you then come over to a policy discussion, what we have put forward for the policy community is a framework for transparency tools that would be along these lines of geared toward the individual consumer where they are with respect to their own coverage options. Where they are located, giving that quality data, et cetera. So, we have put out a framework for certifying an independent certification of those tools. What we are doing over the next several months is inviting many other stakeholders to help us refine this and move it forward in the hopes that we could really offer an innovative, flexible, independent certification as a way to help consumers make their own choices.

PP: The certification presumably will really help consumers kind of navigating their way through all the multiple options that have been offered to them. I want to go back to the point that you made about the digital divide and these are the underserved sections of our population. One topic that keeps coming up in these conversations is social determinants of health. Is your association doing any work in this regard? Could you share any highlights, any of the research that you’ve done or any of the successes that you’ve had in using social determinants of health to better serve your member populations.

CC: It all ties to what our own member companies are doing in their communities. And that is where we learn and identify best practices that we can then share much more broadly. ACHP members have long understood the connection between unmet social needs and disparity in health outcomes. The evidence is very clear. A couple of the areas that our members have really got an out in front. One is around food insecurity and a number had programs dubbed food pharmacy or food as medicine, because the data is overwhelming in terms of your health and nutrition. And it is actually one of the areas in the social needs space where you can have a significant impact in a very short period of time. And I think now with unemployment of 40 million or, so Americans and we are seeing the tragic long lines at the various food pantries that this is so important. So UCare are a member in Wisconsin, which has a significant Somali population and has long also had very culturally appropriate meals, or Geisinger in central Pennsylvania, which not only has the food offering and get your healthy food. But they pair that with things such as cooking classes for individuals to make certain that it’s fun and enjoyable and they know what to do with these vegetables and things that they might be getting. Several of our members are also partnering in their communities around the homeless population. UPMC is a real leader in that and being able to partner with other social service agencies where UPMC comes in and helps to coordinate and manage care for those individuals. So that is another good example. Just since the pandemic specific source out in the Pacific Northwest has turned its entire 20-20 grant-making program to funding healthcare services for the vulnerable populations most impacted by COVID-19, which of course we see across the United States communities of color in particular, that have really in the victims of this awful pandemic. So those are a few of the different very successful approaches that we see in one of our members. And then often we can help to carry it across to others, share it with the policy community, etc.

PP: I am much familiar with the Geisinger example that you talked about, the fresh food pharmacy initiative and how just making fresh food available for populations that are at risk is the ones that have multiple comorbidities and so on. And the evidence is clearly documented. One of my earlier guests on this podcast was the CEO of the Corporate Center of Clinical Relation in Dallas has done something similar with regards to prenatal care and young mothers. Nutrition fresh food has been clearly demonstrated as a factor in improving the health of those populations. What are your members doing today in terms of planning for a post-pandemic era? What kind of long-term shifts are they planning for, especially as it relates to digital health and social care models?

CC: Well, I can tell you they are very committed to the virtual care option for patients, and they are now working to ensure that the areas are good, safe and secure and private guardrails included in all of those communications and that it’s going to sync up nicely with a person’s electronic medical records, that everything is kind of tied together in a coherent fashion for the patient and the clinical team and other technology investments that they may need to expand those services. Working an awful lot with the provider community, especially perhaps some of the specialty areas that might not have had much exposure or experience prior to the outbreak and are really quite hungry for the education and the training and the best practices to continue that. We’re working on the policy level to think through those issues, around reimbursement over the long term and the regulatory environment, hopefully in a value-based setting. We do not believe that it advances health in this country or affordability. If at the end of this crisis we simply have a whole bunch more fee-for-service codes, that will not get us for word in our health care progression. So, we’re very focused on that. Some of the other things are companies are thinking about is their own workforce and more flexibility for their workforces. Of course, they are giving a lot of thought during what will clearly be an economic slowdown, if not recession, for an extended period of time. Growth in Medicaid, growth in the individual market, as well as some number of uninsured. Our plans are focused a great deal on being able to serve those individuals who find themselves in a different coverage situation than maybe they were just a couple of months ago.

PP: Ceci it’s been such a pleasure speaking with you. Thank you so much for joining us. I look forward to following all the great work that the ACHP is doing.

We hope you enjoyed this podcast. Subscribe to our podcast series at www.thebigunlock.com and write to us at info@thebigunlock.com

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

About our guest

Ceci Connolly is President and CEO of the Alliance of Community Health Plans (ACHP), the trade association for nonprofit, community health plans. A prominent voice in healthcare for more than a decade, Connolly has served as a national correspondent for the Washington Post and a leader at international consulting firms, including PwC and McKinsey.

She is coauthor of LANDMARK: The Inside Story of America’s Health Law and What it Means for Us All and has been published in numerous publications, including the New England Journal of Medicine. Connolly was included on Business Insider’s inaugural list of “DC Health Care Power Players” and was also the first non-physician to receive the prestigious Mayo Clinic Plummer Society award for promoting deeper understanding of science and medicine.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

In future, 80% of healthcare needs will be addressed by digital health tools.

Episode #47

Podcast with Tom White, Founder and CEO, Phynd Technologies

"In future, 80% of healthcare needs will be addressed by digital health tools."

paddy Hosted by Paddy Padmanabhan

In this episode, Tom White, Founder and CEO of Phynd Technologies discusses why digital front door technologies and interoperability are the key to the healthcare delivery ecosystem. He also talks about the company’s evolution and the marketplace needs they address.

Digital front door technologies are being adopted extensively by healthcare systems and are practical and useful for the industry, especially in the current pandemic situation. Tom believes that 80% of healthcare should be driven through digital means and 20% through phone calls, unlike the current situation.

Phynd Technologies’ platform focuses on the provider data, defined as people, places, and services, and simplifies provider data management for healthcare systems.

Tom White, Founder and CEO, Phynd Technologies in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “In future, 80% of healthcare needs will be addressed by digital health tools.”

PP: Hello, everyone, and welcome back to my podcast. It is my great privilege and honor to introduce my special guest today, Tom White, Founder and CEO of Phynd Technologies. Tom, thank you so much for setting aside time. And welcome to the show.

PP: Tom, could you start by telling us briefly about the company and its evolution and what the marketplace needs you’re trying to address.

TW: Phynd technologies is a little over seven years old. The core thesis that we started with is still the same concept in that we believe that health care systems need a central hub of provider information that can flow into their clinical, marketing, and claims systems that keep everything in sync from a data perspective. But then also enables output into areas that can drive consumer experience and better operations through better provider data. The marketplace need that we focus on was that EHR is fantastic in managing the patient journey, but not designed as much to focus on the providers themselves and providers really defined as people, places, and services. It’s a broad term that means that basically some products, the health care system can offer to the consumer population. So, it literally is the doctors. It’s the locations even nowadays a COVID testing site would be a place to the services that the healthcare system can offer, whether it’s telemedicine, e-visit, virtual visit, those types of things. Historically hospitals manage data on people, places, and services in different places in EHR. From the clinical perspective, marketing typically has its own that drives its patient engagement strategies. Claims have their own system, their own database. What we’ve done is we’ve merged everything into one profile. So, following the Epic model of one patient, one record, we really focus on one provider, one profile, and that profile can be people, places, and services.

PP: You’re right now in the middle of a very exciting time and a transition for healthcare. COVID-19 has accelerated telehealth adoption and virtual care models. So, I imagine that the need for having the ability to go online, triage your own symptoms, find a provider, and schedule an appointment. All of that is coming together in a way that potentially is beneficial for a company like yours. Many health systems are also having financial challenges because of the unexpected costs of COVID-19. How has the market environment changed for you from pre-COVID-19 to now and what does it mean for Phynd in the marketplace now?

TW: Yes, we’ve seen an acceleration in interest from prospects across the country because of the digital front door ecosystem, whether it’s symptom checkers, smart waitlist, appointment reminders, self-scheduling, providers search all these different things. That ecosystem is certainly right now very, very practical and useful. And it’s really being adopted across the industry. What all those systems need is a provider data solution and the central hub idea back to the original question of provider information that people, places, and services that can feed all these different types of systems. Because there’s lots of vendors out there and hospitals, it’s competitive. So, there’s a lot of startups and hospitals are looking at buying different types of solutions. But what they need at the bottom of that is that foundational level is this provider data management platform, the central hub that can keep those. And so, we’re seeing a lot of interest in what we do because it really is that basis for the digital front door. We call it the digital house; we are the foundation for that house. The front door is the web site and the consumer experience. But that notion is going to change and shift as patient engagement tools get adopted. It is maybe the web site for the narrow network that the health systems partnered with. It could be a pop-up microsite on COVID testing tents that are in the city. It could be a payer health care system, the partnership web site really exposed, some value-based care entities, whether it’s ACO, CIM. And so, the notion of a digital front door, we think is going to be expanded to include windows, another door, a front door, back door windows and all those kinds of fun things. The house framework itself is the provider data that’s going to see those different types of systems. And then you have got apps, you’ve got mobile applications, everything’s going to end up being kind of done on your phone anyways.

PP: That’s a very interesting way of looking at the digital front door concept. And I agree with you that there is no single universal definition of digital front doors. That means different things based on the context, based on the entity and so on. And of course, you are obviously approaching it from the point of view of provider data, patient data as the other side of the coin, which is also something that health systems are focusing very heavily on in order to get a unified view of the patients. So, all of this is converging in a way that I think is going to make for some very interesting times for all the companies that are active in this space. And that actually leads me to my next question to you. Where do you see yourself in the context of the entire ecosystem of solution providers that are operating this whole space that for want of a better term, we call the digital front doors? You’ve got the EHR companies – Epic, Cerner, and so on. You have got big tech firms who are trying to have some kind of role play in this. And then, of course, your compatriots in the digital health ecosystem. Where do you see yourself and how do you see yourself kind of maximizing your opportunity in the coming quarters?

TW: So we see ourselves side by side with the EHR, we sit next to Epic or Cerner in that we integrate by directionally where we are the partner with both of them. We have unique applications on provider enrollment with those systems. As the clinical area is engaging with patients, they need provider profiles to actually run the claims and do care coordination, and then that we act as the backbone again the central hub. And so, the provider profile flows from Phynd into the EHR when the patient encounters start. If they’re in the EHR that data is being essentially managed inside Phynd and it’s bidirectional with EHR. So, what’s in Phynd is also in the EHR. If the providers not in the EHR, which happens about 20% times, then we embed ourselves in the EHR workflow so that the registration scheduling folks which are thousands of people in the hospital, can onboard a provider via the EHR that really using the Phynd platform to pull that data and create that provided profile inside the EHR. And then once they’ve created that provider profile in the EHR, its in Phynd. We call it IPASS. It’s integrated. It’s an integrated platform as a service. So again, one to one relationship, then the Phynd application is used across the enterprise. And one of our clients, we have 12000 end users. And these are all staff inside the hospital systems that are changing data on the providers real-time inside Phynd. And then that’s updating Epic as an example or Cerner. But then it’s also going downstream to the marketing team to give them the updates. So, marketing knows what the latest information is and the providers that they’re publishing now on their web site are web sites. And then it pushes down into the claims so when the claim is processed, that the hospital system actually gets paid faster because they have better data in the system on the provider itself.

PP: Are you, therefore, looking to become the single source of truth, if you will, for provider data?

TW: We are the single source of truth is a touchy word. I guess it’s a political word in that, credentialing they manage the privileging in the onboarding of privileged doctors into the hospital. So, they are the source of truth for that process. Whereas from a clinical side, the EHR typically is the source of truths for certain parts of the record of the provider. And then if you look at marketing, marketing is going to have to go to be they’re going to have their own, you know, their own information, whether it’s a bio video, clinical taxonomy, those things, that is a source of truth for marketing. So, we don’t want anybody to think that we’re replacing what they do from a process perspective. But what we do is we integrate all that data into one profile. So, there’s one profile on you, for example, that would have all your clinical information that’s relevant for Epic, all your credentialing information that’s relevant to the credentialing system that the hospital uses. All the marketing data and all the claims data. So, everything’s managed inside one profile. And then what you can do with that because you’ve got it to download one location versus 20 different silos, which is what the way it works now is that you can then point that profile to different things to optimize the operations at the healthcare system. You can make Epic actually work better. You can make marketing have a better search for the providers and scheduling experience for the consumer. And then on the claim side, you can get claims very faster.

PP: Who is your primary target audience within our health system? You mentioned so many different stakeholders. Is it the Chief Marketing Officer, Chief Patient Experience, Chief Medical Officer, who is it?

TW: The CIO is always involved. Some of your past guests on the podcast are clients of ours. Its CIOs, CMIOs, certainly marketing. The marketing officer is heavily involved as well. But in a lot of ways it’s a technology purchase. It’s a data platform that transforms the healthcare enterprise and it can make marketing a lot better. But what is interesting, in the market there is been a lot of vendors for a while that have made marketing-focused solutions. And we think that those were good transitional technologies. But as the pandemic happened and as healthcare systems have focused in on the notion that fewer vendors doing more platform focused concepts like what we do. We think that it makes sense for healthcare systems to really look at things like Phynd and say how can we optimize and operationalize provider data across clinical marketing claims, these different areas versus having these independent systems. So, we end up selling to everybody in a typical environment, we will have a CIO in a room, even CEO, CMIO, Chief Marketing Officer, certainly Chief Digital Officer as well. We have a lot of those clients because we speak their language. We kind of talk to all of them at the same time.

PP: What is your kind of sales cycles look like? I imagine that you have to get multiple stakeholders on board before somebody signs your purchase order, right?

TW: So, it’s certainly enterprise software sales. So, it’s our sales team is a very experienced professional, a consultative team that focuses on the issues and the problems that our clients have. So, the sales cycle could be four months, it could be twelve months to 18 months. It just depends on where the client is. So, I think that it’s just a matter of time that this notion of this digital house, the digital front door certainly has accelerated some conversations we’ve had. The Epic relationship and the EHR relationships are accelerating right now because it’s interesting a lot of our clients when the pandemic happened, they said, we need to bring back retired doctors, nurses and all these folks that we’re not in the day to day health care workplace. They said, how can we find folks that are either retired, maybe taking a sabbatical, those kinds of things. We have all that data. So, it just depends on the event or the opportunity to really say, hey, we really need provider the data front and center in our core IT strategy. Where we are standing up right now is a microsite where one of the biggest clients showed all there COVID testing tents because those testing sites move based on where the hotspots are in their geography. And right now, there’s no way to go for a consumer to go to the web site and say, show me where they are today or where they were yesterday. With Phynd, you can in real-time say, we want to show these 20 or 30 different tent sites and we want to show the hours of operation. And they can change the hours of operation to their web site at a moment’s notice so they can really expand the offering to consumers, just like what you’re used to when you get at Nordstrom’s or any other kind of retail operation that a consumer-focused. We’re helping our clients do that right now. So back to your question. It’s the cycles based on the need in the event of our clients. But we think this universal need for it is just a matter where they all kind of get there and the thought process.

PP: Tom, the digital health ecosystem has been receiving billions in VC money over the last several years. By all indications, it is a thriving ecosystem. A lot of innovative products that are coming out, such as yours. And firstly, I’d love to get your thoughts, on how you’re funded, are you VC funded. Are you in a position to share any of those details just to get a sense of what your profile is, what Phynd’s profile is? And then generally, what do you see as the opportunities and challenges for digital health startups in light of the COVID-19?

TW: We’re VC funded. We have a traditional kind of tier-one VCs. But then we also have some health systems as investors. So Memorial Care based out of Long Beach, California. So, it’s the system that runs from LA down to San Diego. They have an innovation fund. They’re a significant investor in Phynd. The University of North Carolina health care system, they have a venture fund. They’re an investor in Phynd. And so is Orlando Health as well. When we did or our funding, we said let’s blend together both top-notch VS operational experience with top-notch healthcare strategic experience and on the board level. And so every board meeting is really interesting because we get both the VC and put around risk finance, operations and then the healthcare side really driving into things like what we’re experiencing right now in what’s happening to them because we get we kind of get access into what their CEOs and their boards are talking about, triaging their own business over the last couple of months because it’s blocking revenue, because of, elective surgeries and all the things you heard about and talked about. We’re really happy with our mix of investors. Since the pandemic is still a tremendous amount of investment in the patient engagement area. And there’s a lot of great solutions that are out there. And I do think that there needs to be a coming together of them. There’s just going to be too many choices for healthcare systems to have to kind of weed through to buy things. And so, I think that there’s got to be some level setting eventually, whether it’s consolidation, M&A activity, or partnerships as well. But there’s going to be some consolidation. There are just too many vendors kind of chasing some of the same ideas. I think right now and, you know, we help our clients, really. We’re agnostic when it comes to other vendors. And so, we’ll integrate with any of them. But they’re certainly asking us a lot of the questions that you get asked a lot, too, as well. As you know, there are five people that do this one thing. How do we just differentiate?

PP: That’s kind of what we do as a business. We really help our client’s sort through their technology choices when it comes to implementing the digital roadmap. We start by helping them figure out whatever the roadmap even needs to look like for them. And then we go to the technology layer and then the actual partner selection process. But you’re right, that is certainly one of the questions that we get asked a lot, because, there’s so much so little public information about many of the startups. And there’s not a lot of evidence either, especially if you’re a young startup, you don’t have a whole lot of clients and you may have a great product. What are the risks and rewards involved here? How do we manage to all of those become very interesting questions in the context of digital health? These are questions that were never asked. They’re talking to one of the big tech firms. But there’s a whole different set of questions there. Let’s just coming up to the close of our time here. Tom, I just want to get your thoughts on what the emerging healthcare experience looks like for regular consumers like you and me. And what are some of the emerging technologies that you think are going to play a big role in that experience of the future?

TW: I think that’s the future is bright for consumers. When our clients are doing and what my local healthcare system is doing, they have an app that I can message my doctor, my PCP right now. I can do evisits. Those are all great starting points. I do think that they need to get deeper into digital, into the digital diagnosis, that there’s that mystery in science about healthcare, where you think you either have a common cold or you’re really sick. It’s like people tend to be hypochondriacs. I feel really sick when they may not be. And so, this notion that the industry should do a better job of saying, no, no, you can do a digital diagnosis and you’ve got to come call whatever it may be. So kind of really taking some of the mystery out of the diagnosing certain issues. I do think that the digital front door in the technologies will hopefully expand the learning and the use of consumers across the board. There are just too many phone calls, right? I mean, I don’t know your experiences, but I still have to call into my providers sometimes not my PCP, but other providers to schedule, whether it is colonoscopy or whatever, radiologists and. Yeah, and those things need you to know, it needs to flip. I’d say that 80 percent of health care is driven on phone calls and 20 percent digital and needs to be 80 percent digital, 20 percent phone calls.

PP: That’s so well. So, I think that is the headroom for growth. So, if you were half empty or half full, you would look at it differently. But that whole picture there that you just painted. I see that as the opportunity landscape, just inverting that mix going from 80 percent phone calls to 20 percent phone calls. That is the Holy Grail, I imagine. And I hope that we see it in the foreseeable future. And I’m kind of confident companies like yours are going to play an important role in that I guess.

TW: Yeah, I agree with you. I’m a glass half full person in general and I’m just being a startup person. It just kind of comes with the territory. The other point I want to make is that interoperability integration is key. We talked about a tremendous amount of patient engagement vendors that are coming to market in that that you have to be integrated into the IT topography, the landscape. So, the data has to be bidirectional, it has to create this feedback loop. So, if you’re doing digital diagnosis, what are people asking about? What are the conditions? What are the hotspots as far as illnesses? And so, this notion that the digital data feedback loop needs to be there. And so, I just think that’s important for when health systems are looking at vendors that they ensure that it’s bidirectional into their core clinical systems because of the ideas are that of patient care. And so, you just need that data feedback loop.

PP: I generally tend to like startups and especially digital health startups that have a very focused offering and they go deep into it and they do it really, really well, as opposed to a company that might want to do the multiple things and not do any of them really well. I am a half-full kind of guy, I’m an entrepreneur like it comes with the territory. I feel like the digital engagement touchpoint in a typical consumer journey today are not only many, but they’re also expanding. A year ago, you might have thought often, or twelve touchpoints that you would consider high priority focus areas or opportunity areas. Today I can name 25 or 30 such touchpoints. And who knows, a year from now there may be 60 high value, high impact digital touchpoints. And in an ideal situation, you would have a handful of companies that do exceedingly well in one of those touchpoints. And that is what would open up the opportunity landscape for buyers, namely the health systems, in order to really transform the experience of healthcare today. I think part of the challenge also is to your point. A lot of people are pursuing the rainbow, some think that triaging is the cool thing or COVID-19 is a cool thing. But you’ve got to really take a step back and commit yourself to the longer come and pick the sport for you and go deep into it more likely than not to come out successful. But it is a long, hard journey.

TW: Yeah, it’s a journey for sure. And it’s definitely a movement. So, I think that the industry is moving in the right direction, but it’s going to be a long-term process. And it’s going to be great for consumers. So, I’m excited about it. As a consumer of health care on the telephone.

PP: Tom, such a pleasure speaking with you. I look forward to staying in touch and following the progress of finding all the best to you and your team.

We hope you enjoyed this podcast. Subscribe to our podcast series at www.thebigunlock.com and write to us at  info@thebigunlock.com

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

About our guest

Thomas-White

Tom is responsible for day-to-day management decisions and for implementing the company's long and short-term plans.

Prior to Phynd, Tom co-founded healthcare IT company Vocada (now part of Nuance Communications; NASDAQ: NUAN) and Newscast, Inc. He also serves as a mentor to the start-up accelerator Health Wildcatters.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

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