Month: July 2020

Emerging healthcare technologies will enable higher level of care delivery with fewer resources

Episode #53

Podcast with Jeff Short, Vice President and Chief of Staff, Montefiore Health System

"Emerging healthcare technologies will enable higher level of care delivery with fewer resources"

paddy Hosted by Paddy Padmanabhan

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In this episode, Jeff Short, Vice President and Chief of Staff at Montefiore Health System describes how Montefiore prepared for one of the biggest surges of COVID-19 cases in the country, and how they used emerging healthcare technologies to manage capacity and deal with the crisis.  

By end of April this year, 80 percent of all patient visits in Montefiore were being managed through telemedicine. Telehealth visits volumes have fallen back a bit since then. Jeff believes that face-to-face visits in certain specialties will always remain essential, however, with the ease of working with patients digitally, we will continue to see an increase in telehealth visits. Jeff defines digital health as the use of technologies such as digital front doors and telemedicine to improve patient engagement and access to care delivery. He further states that once we get efficient at delivering digital care and leveraging emerging healthcare technologies like chatbots and AI, we will be able to treat more patients at a higher level of care with fewer resources.

Montefiore Health System is one of the leading medical centers with 11 hospitals and over 300 ambulatory locations. They mainly serve the populations in the Bronx and Westchester counties.

Jeff Short, Vice President and Chief of Staff, Montefiore Health System in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Emerging healthcare technologies will enable higher level of care delivery with fewer resources”

PP: Hello again, everyone and welcome back to my podcast. This is Paddy, and it is my great privilege and honor to introduce my special guest today Jeff Short, President and Chief of Staff of Montefiore Health System in New York. Jeff, thank you so much for setting aside the time and welcome to the show.

JS: Thank you, Paddy. I really appreciate the opportunity to be here. I want to congratulate, as you recently completed your fiftieth podcast. So, congratulations! That’s really a great milestone and I’m also looking forward to reading your new book, Healthcare Digital Transformation. It’s where we are, so I can’t wait!

PP: Thank you. I greatly appreciate that. So, Jeff tell us a bit about Montefiore and the patient populations you serve.

JS: As you mentioned, we’re in New York. Montefiore Health System and Einstein College of Medicine form one of the nation’s leading academic medical centers. We have 11 hospitals, approximately 3000 beds, and over 300 ambulatory locations. We serve mainly the populations in the Bronx and Westchester counties. We are major employers in both geographies, we serve a diverse population both ethnically and socially. And it’s been an incredible experience working with Montefiore and seeing all the good that we do in the communities that we serve.

PP: If I’m not mistaken, you also serve possibly one of the most ethnically and linguistically diverse populations in the country, if not the most diverse population. Is that correct?

JS: Yeah, depending on how you measure it. But definitely one of the most diverse populations in the country.

PP: New York has been one of the hardest hits by the pandemic, and Montefiore was featured in this fascinating TV program on CBS. Those who haven’t seen it, I strongly recommend it. It’s called ‘Bravery and Hope’, which took viewers like me to the frontlines of the COVID-19 crisis and was an eye-opener to see what really happened in the frontlines of a crisis like this. So, Jeff I know that Montefiore stood up telehealth operation practically overnight. Can you tell us a little bit about that experience?

JS: CBS did an incredible job of capturing what it was like during the surge of the pandemic. In the days prior, we spent a lot of time preparing. One of the things our network performance group did was to regularly update predictive models based on what was going on in Italy and around the world and in New York. When we looked at the numbers, we realized it was not going to be a linear increase. It was going to be an exponential increase. I remember one day looking at those projections and realizing that we could be out of capacity in a few days and out of our surgeapacity a few days after that. It really hit home how we needed to change. We knew we were going to have a wave of patients coming, we didn’t have steep, but it looked pretty daunting. Our facilities team did a great job by extending capacity. We put new rooms in our ORs, cafeterias, auditoriums. We redeployed a lot of our clinical staff. But the real question was, how are we going to leverage our intensivists to treat all those patients. We knew we’re going to need that level of care. One of the people featured in that video, Dr. Michelle Gong, who is our Chief of Critical Care, worked with our team and with IT and bioengineering. In a span of a few days, the team stood up a 24/7 ICU command center. My team put together a new server to feed healthcare information and healthcare records to a central location – Bioengineering linked, real-time, vital signs, ultrasound results, electrocardiograms. To all the physicians in our ICU command center, we gave iPads out to each unit. This way they could do bidirectional communications by the command center. So, when we were done, essentially what happened was a clinician anywhere in the facility could connect with one of our critical care pulmonology specialists in the command center for assistance with the patient. In a span of mere days, we went from nothing to a fully functional ICU command center, that really helped us deal with the surge capacity.

PP: That is an incredible story. What about the patients? What about those who wanted to either come in because they felt they had symptoms or others that were in your care, like the chronic population and so on, because you obviously locked down the entire facility for a period of time like everyone else did in order to deal with the COVID-19 cases. Did you already have or were you able to turn on a telehealth/ virtual concept kind of capability to help your patients?

JS: Yes, absolutely. In the early days, no one wanted to go see the doctor for elective care. Nationally, over 70 percent of in-person visits were canceled and we saw the same experience here. Lucky for us, the CMS approved 80 new services within a few weeks of the pandemic hitting the US, which was really fantastic. But what we needed to do is create a new solution. So in about a week, March 11th was our first patient, we started to get things in place to create the ability to deliver contactless care to our patients. By March 26, our team built the infrastructure to enable us an Epic to schedule document and bill for a telemedicine visit. We identified our partners to help us build a platform and an app. By April 1, we had launched what we call Montefiore First, which is an app platform that is in Android and the Apple store. And by June, it was among top 100 medical download on the Apple store. So, by the end of April, 80 percent of our visits were in telemedicine. Right now, it is shifting back a bit. But in the last 12 weeks, we have had 250000 telemedicine visits. In February, we had zero. We went from zero to doing most of our visits in telemedicine quite quickly. And, we’re really not alone, across the industry, we have seen 50 times to 150 times increase in telemedicine.

PP: I want to go back to one comment you made very briefly, that is you’re seeing telehealth visits kind of fall back a little bit. We know that the acceleration of telehealth and specifically virtual consults and everything took off in the immediate wake of the pandemic. But I am hearing from across the board that those volumes are now kind of going down a little bit, either because patients are coming back into the hospital or because there is not that much need. What is driving that? Why do you think telehealth is going down? Was it because pent up demand for in-person visits is now coming back? Or are people not happy with Telehealth as an alternative? What do you think is the reason?

JS: I think it is in part of patients that needed to be seen face-to-face. We’re putting off care. So, they’re definitely rushing back in. I think for certain clinicians and certain patients, there’s a comfort level with face-to-face. But I do really think that things have changed permanently, and the change is here to stay. Before the pandemic, a survey done by McKinsey stated, 11 percent of patients were interested in telemedicine, post-pandemic 76 percent, the same survey updated. We’re interested in using it going forward. We will always have face-to-face care and certain specialties will remain that way. But as we get better and more comfortable working digitally or remotely with patients, those numbers will continue to increase. Also, as adopters become more comfortable, as technology providers create more in-home devices that are linked through your smartphone and operate effectively, we’ll be able to do a lot more remotely. But I do believe it’s here to stay.

PP: You mentioned digital, digital health is all the rage now. We talked about telehealth, digital front doors, and just virtual care in general, which is enabled by technology. How are you defining digital at Montefiore and what has been your digital transformation journey so far? Can you share some of that?

JS: Digital health can encompass a lot of things. For me, in this context, it’s basically using technology to enhance the quality of access or the delivery of care. But to be more specific, the general areas that we’re looking at our digital front doors using technology are to improve patient engagement, to enable contactless interaction to increase access, the use of telemedicine, which we just spoke about. It has profound opportunities to reduce the cycle times of care. With remote monitoring, there’s so much we can do that you don’t need to come back in just to monitor condition if we can check in with you remotely through technology. In tele-consult, the ICU example creates incredible ability to keep patients in a regional hospital, a local hospital and deliver top level of care remotely. Artificial intelligence: Dr. Parsa Mirhaji in our team has made incredible strides in using artificial intelligence to predict things like respiratory failure. What we see is that opportunity to use AI in many more ways and build those into systems. We stood up a chatbot to answer COVID-19 questions. We see a lot of new startups using that technology in front of visits to help the patient and the clinician get to the root of the problem and also improve their interaction. We see huge opportunities to leverage AI. And then the same deal with inpatient. So, hospitals around the country are looking at doing central stations, whether there is AI and other technology to better run their hospitals. And we see this as a huge opportunity. We’ve made a ton of progress in a short amount of time, especially on telemedicine, digital front doors, and also some of the remote monitoring on the inpatient side. We really have a long way to go. But it’s very exciting.

PP: You’ve covered most of the high value, high impact initiatives. And the focus areas you talked about remote monitoring, digital front door, which is growing as digital engagement touchpoints become more and more amenable to digital engagement, online tools and so on and so forth. And, of course, telemedicine and virtual care. How do the patients perceive it? One of the things that I hear from all the health systems and the Chief Digital Officers and everyone that I talk to is that it’s extremely challenging to create the kind of seamless experience that we are used to, like e-commerce Amazon or your personal banking site. It is very difficult to create that kind of experience in healthcare. It seems to me that there’s a lot of standalone best in class type tools. Then there’s a dominant EHR system in the background that does a lot of things, stitching it all together and creating those experience journeys which feel seamless and can delight patients just from an experience standpoint that seems extremely challenging. Is that consistent with your understanding of the challenge as well? What are you seeing in terms of how patients are reacting and responding to your digital front door initiatives, for instance?

JS: Telemedicine has struggled for years to really get adoption. COVID-19 has changed the landscape through which now clinicians and patients were encouraged or forced or compelled to give it a try. Obviously, the ultimate goal is to have that seamless experience. But it’s something we’ve been working on in healthcare and made a lot of improvements over the last few years. I think it is somewhat like when I traveled a lot and the first time I encountered an airline kiosk, when I arrived at the airport, I was really unhappy with the change, not being able to deal with the person, but probably the second time I never really wanted to interact with an agent again unless I had a major, complex problem that I needed to deal with. As long as we continue to seek out clinician and patient feedback and very closely monitor where the pain points are and where our opportunities are to improve and build those in very quickly adapting to the patient experience, but also meeting the patient where they are. So, whether you want to do an asynchronous visit, a synchronous video visit, or you want to see a physician face-to-face, it’s really seamless. And if you want to speak to someone on the phone or go at 2:00 in the morning, do something on your cell phone or your laptop, no matter what we’re meeting the patients where they are and like you said, giving them a seamless experience. It’s just going to be like any other customer experience. It is really going to be listening very closely and getting good data on how patients feel. And again, just iterating to make things more seamless and more effective.

PP: You mentioned a couple of examples of digital initiatives that you’ve launched, chatbot, for instance. Have you done any research into what your patient populations value or what your own caregiver’s value and need? When you look at the digital engagement opportunities, can you talk about one or two of those that you think have high impact possibilities in the short term?

JS: Sure. We’ve done a number of surveys, interviews. We have active working groups that get together every week and walk through their experiences and their problems. We’re adding on to our application ways to get customer and clinician feedback at the moment to better understand their experience. When we look back at our priorities, telemedicine has drastically changed the way we deliver ambulatory care and that is just a key opportunity. We are able to actually bring care into the patient’s homes at scale effectively and efficiently. The digital front door, the ability to gain access from wherever you are to a clinician in a smart way is top of the list. I believe that on the inpatient side, telemonitoring, tele-ICU is a better way to deliver care. And we experienced that during the pandemic and the surge.

PP: You also mentioned contactless experience, which I think is a new beast that we have discovered as a result of the pandemic. But what about your patient population? You are in New York, part of your operations is in the Bronx area, which is kind of a low-income area in the least in some parts. Does your patient population have certain preferences? Do you think you need to tailor your strategy, keeping in mind what are the limitations that maybe with your patient populations, or do you think that is not a factor at this time?

JS: It’s an absolute factor. I mean, the access to and comfort level with cell phones or computers is definitely something we’re looking at. And where there may be disparities in how we can actually address that. Also, access to data that seems to have been an area where patients are concerned about data charges. We’re figuring out other ways we can improve access. Living in a city this could be a great infrastructure type project to provide broadband access to patients for healthcare and could be an absolutely incredible opportunity. We realized little things that people not wanting to download apps. Are there ways we can get them broadband access, even just comfort level using a mobile phone for this purpose? And we’re kind of combining all these things to really create different options and then monitor which options are most successful. And then doubling down in those areas. We’re expecting it’s going to be different by different groups, different age groups, different specialties. And we’re just going to keep listening and looking for opportunities to improve.

PP: The digital divide that you talked about. This an interesting point, because clearly not all sections of the population have the same access to bandwidth or the affordability aspect of it as well. In Chicago where I live, there’s a public-private kind of collaboration that is emerging where there’s going to be a program to make sure that the coverage of the entire population in terms of their access to broadband is going to be uniform. So that there’s no digital divide, there’s no sort of disparity. Are you seeing anything like that emerging in New York? During the pandemic itself, there was a lot of public-private collaboration. Can you talk a little bit about that? I think it’s an interesting trend that is emerging. What your experience has been collaborating with local authorities.

JS: Absolutely, it was really one of the incredible things to see. From the start, the governor’s office essentially stated that we are one healthcare system, they really lined up everything essentially around the same goal, which was the surge that we were going to see, that did a pretty good job of predicting how things were going to play out in the early months. That spirit of collaboration really ran through a lot of things that we worked on. We worked with local vendors, we worked with other hospitals, it was really incredible to share the knowledge and ideas. And we were on the phone with colleagues understanding and sharing best practices, sharing how we’re working together. So, that spirit of collaboration continues. It was always there somewhat in academic medicine, but it’s kind of expanded more to people caring for their communities and can be defined in a number of different ways. We’ve got a couple of discussions going on with companies really trying to bridge that digital divide, because there’s so much evidence out there that does exist. And it is an equalizer that if we can bridge that gap, we can do a lot of good and create a lot of value, not just in healthcare, but also in education, etc. I’m hoping that’s an area where we can really collaborate and do public-private partnerships in order to create a lot of value.

PP: Everything in healthcare is linked to reimbursements in some way. And you did make reference to the fact that the CMS has brought telehealth visits on par with in-person visits. There are still some gaps in the reimbursement model. The broader question is, all these investments that you talked about, the digital front, the tele-ICUs and all of that have to be paid for in some way, shape, or form. So, you have to demonstrate some kind of ROI. How does a health system approach this typically, especially if you are predominantly in a fee-for-service kind of a model?

JS: It’s one of those things we’ve always struggled with as an industry and some of those unintended consequences of how incentives are structured. I guess where we start with is really what’s right and best for the patient. And then we figure out what options we have. The nice thing about our size and our scale is we have a couple of ways economically to get to create value for the business model. So sometimes because it’s the right or efficient way to use resources, it may take a haircut on revenue. But try and take a step back and look at the whole picture. What kind of value we can curate for our patients? Where are these gaps and maybe how the incentives are structured? And then what can we do to kind of either countermeasure to deal with those gaps, work on waivers, try to be creative in trying to deal with those gaps. But it’s something we’re constantly working on, constantly looking for new ideas and new innovations to address those gaps. I think ultimately around the reimbursement for digital health needs to be about equity and payment. I think once we get much better and efficient and effective at delivering digital care, we’re going to find ways to leverage technology like chat technology and AI and be able to treat more patients at a higher level of care with fewer resources. I think at some point what we want is our payment models to recognize that and balance that. So, yeah, and that’s why that’s one equity, I think is really what we want to get to and try and get away from the gaps that we have that cause some of the barriers to innovation and to delivering care.

PP: There’s a saying that never waste a crisis and we are going through an unprecedented crisis because of the pandemic. Are you seeing COVID-19 as an opportunity or as a long-term threat for your system?

JS: I think it’s both. It’s a tremendous threat. I mean, we had a tremendous loss of life. We had employees, colleagues who passed away from this awful disease. Our industry has taken a real hit. The local economy and national economy have taken a tremendous hit. But all those things are done. So within that, there’s an incredible opportunity to do better. To accelerate change, to challenge the status quo. I mean, look at all the things that we have been able to really make progress in the industry. We’ve made so many improvements and we’ve had so much innovation last few months. We have to take advantage of this crisis. We’ve paid the price; might as well take advantage of the opportunity to really accelerate the innovation in healthcare and really bring it forward. So, the answer is it’s both, unfortunately.

PP: Jeff, it’s been such a pleasure speaking with you. Thank you so much for sharing your thoughts and look forward to following all your progress and all the best with your digital transformation program.

JS: It’s been great speaking with you and I look forward to catching up soon.

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

Jeffrey-Short_pic-profile

Jeffrey B. Short is Vice President, Chief of Staff of Montefiore Health System and the leader of Montefiore’s Faculty Practice Group. Montefiore is one of the leading academic health systems in the country with 11 hospitals, 300 ambulatory locations, 35,000 employees and 6 million unique patient encounters. Montefiore’s Faculty Practice Group is one of the largest in the country with over 1500 physicians.

Jeff received his BS in Accounting from the University of Scranton, and his MBA from the NYU Stern School of Business. He came to Montefiore from NYU Langone Medical Center, where he served as the Department Head for Strategy and Business Development. Earlier, Jeff worked as a management consultant for 13 years with both Deloitte and PricewaterhouseCoopers. At PwC, Jeff was a Director and regional leader in the strategy and enterprise growth practice, working with clients such as the Cleveland Clinic and John Hopkins Medicine. He also spent 3 years in Europe leading business development and healthcare engagements with clients in the Middle East and Europe.

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.

The nation needs an automated, real-time, effective syndromic surveillance system to detect COVID-19.

Episode #52

Podcast with Mike Alkire, President of Premier Inc. and Dr. Jonathan Slotkin, Vice Chair of Neurosurgery and Associate Chief Medical Informatics Officer of Geisinger

"The nation needs an automated, real-time, effective syndromic surveillance system to detect COVID-19."

paddy Hosted by Paddy Padmanabhan

In this episode, Mike Alkire, President of Premier Inc. and Dr. Jonathan Slotkin, Vice Chair of Neurosurgery and Associate Chief Medical Informatics Officer of Geisinger discuss how technology and data is helping public health officials to keep a balance in opening the economy versus managing the spread of COVID-19 virus.

Premier recently launched a syndromic surveillance tool for COVID-19 which they are piloting at Geisinger to improve the quality of medical interventions and prevent the spread of the virus. Mike believes that there is a need for syndromic surveillance system, contact tracing, and performing tests with higher accuracy rates.

According to Jonathan, siloed information and disparity in EHRs across health systems limits the scope of innovation and in case of COVID-19 it is affecting patients directly. He further states that, as part of a public-private partnership, Geisinger is performing contact tracing and have followed up on 1,600 COVID-19 positive patients, benefiting patients, providers, and communities.

Mike Alkire, President, Premier Inc. and Dr. Jonathan Slotkin, Vice Chair of Neurosurgery and Associate Chief Medical Informatics Officer, Geisinger in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “The nation needs an automated, real-time, effective syndromic surveillance system to detect COVID-19.”

PP: Hello again everyone, and welcome back to my podcast. This is Paddy and it is my great privilege and honor to introduce my special guests today, Mike Alkire, President of Premier and Dr. Jonathan Slotkin, Associate Chief Medical Informatics Officer and Vice Chair of Neurosurgery at Geisinger. Dr. Slotkin also has a dual role with Contigo Health as the Chief Medical Officer. Gentlemen, welcome to the show. Tell us a little bit about the COVID-19 surveillance tool that Premier has just launched, and you’ve started piloting it at Geisinger.

MA: Paddy, over the last year or so, we have been building out technology to help with the PAMA guidelines, which are guidelines that CMS is implementing to get after high-cost images. The focus has been on building up these pipes to Epic and Cerner and these electronic medical records to ensure that patients were appropriately utilizing these high technology images. So when COVID hit, we sort of pivoted the technology. And because we already had the pipes built into all the EMRs, we found out that if you looked at the symptoms of patients, there are a number of characteristics around the symptoms that you could see that there is a high probability these patients were COVID patients. And we thought that it was incredibly meaningful because we could do it in real-time. So, at the point when the physician is meeting with that patient, we can identify somebody that has those critical symptoms. Given that data, we can dive down into the zip code level. We can use that data or get that data to organizations that are interested to understand where surges are occurring or where there is a high prevalence of the disease. Also, there’s obviously a lot of interest on behalf of the federal government and the states to understand where surges are happening. The whole idea is to provide this real-time data mechanism to inform these public health officials around “do I open the economy” or “do I keep it shut” or “open in some degree, but I see a surge, am I putting the appropriate resources in those communities?” We think it’s very, very critical and it’s part of a three-legged stool. We think, to manage the virus you need this syndromic surveillance. We obviously think you need this contact tracing. And we need to do a better job of rolling out testing with higher accuracy rates.

JS: Paddy, the problem we all wanted to solve for is that existing syndromic surveillance in 2020 is dramatically lacking. I think it will surprise many of your listeners when they hear what those systems actually consist of. So existing state and federal syndrome surveillance consists largely of reactive, non-real time reporting of disease diagnoses. And by the way, that are picked up mostly by emergency departments. These tools run on 20-year-old technology and are not automated. And in some areas, clinicians and public health officials actually need to print data from EHRs, manually fill in, and fax reporting forms to public health officials. Some of these forms take up to 30 minutes to fill out. And in some instances, the lag between a patient receiving a positive test result and the reporting of that data can be as long as seven days. And Paddy, you’ve spent a lot of your career on this problem. We’ve troves of important data like positive COVID results, signs, symptoms, but sitting in siloed EHRs across different hospital systems in care settings across the country. So, the nation desperately needs an automated, real-time, effective national surveillance system, and that was the major impetus for this work. The team set out to build exactly that and the goals were to build an application that can be used by a health system, states, and federal government, just like Mike said, to perform several really important tasks like to know when and where COVID is surging before the numbers tell us that, to better determine which patients are more likely to become profoundly ill, and to provide healthcare systems with risk and severity adjusted information to predict findings. So the tool uses natural language processing and machine learning to scan free-text notes and orders for hundreds of phrases like trouble breathing, or loss of taste, and other free text and discrete data for signs, symptoms, and other indicators of infection. By using this approach, the system is able to rapidly identify patients who are presenting with signs and symptoms of COVID-19.

PP: This is very interesting and of course very timely as well given everything that we are going through today. The tool is essentially an NLP algorithm that mines clinical notes and information in the form of text, and unstructured data essentially sitting inside electronic health records systems. And this is the route that many COVID-19 apps are taking in the context of dealing with the pandemic and having early warning surveillance systems. Jon, can you talk a little bit about how you use this information as a decision support tool not just to flag patients at risk of infection, but in terms of closing the loop? What do you do with that information? What happens next? How do you adjust your care management or treatment and how do you integrate it with your reporting requirements?

JS: We and other health systems are very eager to start using this application. In addition to Geisinger, Atrium, Community Health Network, Advent and I think over 30 other systems are coming online with the application shortly. There are some really valuable ways that health systems can use the information from this application, even above and beyond this important work of syndromic surveillance. I think that systems can identify flare-ups based on health systems’ zip codes. We think often it will be one to four, even more days, before lab test results come back in some instances. In some patients that don’t even get tested or wouldn’t have been tested, usually a week or more before hospitalization based on symptom progression. With this kind of foresight, systems can do things like plan decrease and elective procedures well in advance of being just reactive to public numbers, forecast equipment that an ICU needs based on incidents and even the severity of disease that the tool picks up in the outpatient setting. The tool can also identify patients in the ambulatory setting that are high risk for admission or maybe are more appropriate for a home care environment with home pulse oximetry or other programs. It is important to call out two really powerful features that are coming to the app in the next several weeks. One is that the system will present a pre-test probability based on symptoms to help providers interpret negative diagnostic test results, which we know can be inaccurate, sometimes significantly inaccurate, and both true negatives and false negatives, for that matter. This is where you get to the action at the point of care which Premier always thinks about. The team has also embedded the NIH COVID treatment guidelines right into the CDS tool. I think it’s important to point out that Stanson tool has over 300 hospital system customers. So, this affects and is live and can be live at over two to three hundred thousand providers systems. In this way, with treatment guidelines at the point of care, you can support providers with real-time interventions and to translate evidence into practice, which I think is a core mission for Premier.

PP: One of the things that I read about when I saw the news release on the tool is that it works across different EHR systems. And we all know that interoperability has been a challenge for a long time, it’s getting better, we have got the CMS final ruling that’s going to affect 2021. We are going to see more seamless data flow, but it is still a significant challenge. Can you talk about how do you look across Epic and Cerner as an example or other systems out there? How is this different from other COVID-19 tools that are out there?

JS: Paddy, siloed information and disparity in EHRs across different health systems, not only limits innovation, but in a situation like COVID-19, it’s affecting patients immediately right now. Thankfully, in the last few years we have all seen significant progress in these areas. But this tool, ADAM, which is Advanced Detection Analysis and Management, works well with Epic, Cerner, and I think it’s going to be live over the next couple of weeks or month or two in MEDITECH. As Mike mentioned, the rapidity of getting those solutions live across multiple EHR vendors comes from the fact that the backbone of this solution is Stanson’s PAMA tool that is live at 300 hospitals. So what this then brings is, from growing machine learning standpoint, you’re going to get the combined experience and data of all of these hospital systems across three and now soon to be 40 EHR vendors that will allow powerful improvement of the systems’ machine learning algorithm, not just from one system, but from all of them. This data is never going to be sold to pharma companies and device companies, but there is power in the aggregation of this data. Mike can elaborate, the advanced discussions with several states and parts of the federal government. But important to be clear here, and we know at Geisinger that this data that Stanson and Premier have will never be shared with any outside parties like a state or federal agency without the provider systems written permission, which I think many providers systems, given the mission that we’re trying to accomplish here, would be open to.

MA: The only thing I’d add here is that Premier has taken a pretty significant focus from an advocacy standpoint for interoperability. For all the reasons that Jonathan said, we obviously want the ability to track a patient throughout the progression of the disease, no matter where they’re actually getting care provided. We spent a lot of time working with various datasets to integrate those and work with these EMR vendors, and other vendors to ensure that they have got open data sources. To Jonathan’s point, I do want to sort of make sure to tie this all together from a COVID standpoint. So the reason it’s so meaningful for the states and the feds to sort of step up here and really look at that three-legged stool of controlling the virus is that there is such a high false negative testing depending on when you test versus when you actually get the disease. There were a couple of few articles three weeks ago, one from the Annals of Internal Medicine, the other from the New England Journal of Medicine. They talked about significantly high false negatives. That’s really an issue if you think about somebody’s on their way saying – you don’t have the disease and in fact, you have the disease. Those articles actually presented the fact that the further away you are from being tested when you actually acquire the disease, obviously your false negatives go down. So, you’re waiting, often times, two or three days to get decent results. And what we’re saying is we have the ability to do that real time looking at the symptoms.

PP: I want to dig a little bit deeper into this Stanson tool that you mentioned and how that creates synergies for not just the business, but at the level of the tool itself.

MA: The whole thesis for Stanson, for our investment from a capital standpoint really was, we’re a performance improvement company. We’re all about helping healthcare systems drive improvements from a cost reduction standpoint and a quality and safety improvement standpoint. What we had been doing over the years is obviously taking our best areas or amounts of data in the clinical settings and safety and operations, which is labor and supply chain, integrating those data sets and creating insights into performance improvement for the healthcare delivery systems. And that was great because those insights drove a ton of value. But what Stanson allows us to do is to really create an impression of those improvements. So, Stanson actually writes into the Epic and the Cerner and the Athena EMRs, the appropriate protocols that should be followed that are maximizing high quality, great safety, and low cost. That was the whole initial thesis. We wanted to hardwire those improvements to the point of care into the workflow at the EMR.

PP: It’s all about having the decision support tool at the point of care and being able to act on that. That is kind of the holy grail or the mantra for any kind of decision support tool. You pointedly mentioned that you are very careful about data privacy. I read a study recently, I think it was done by the University of Illinois in Urbana Champagne that looked at some 50 different COVID-19 apps and they were very concerned about the lack of clarity on what is really going to happen to the data. How are you explicitly providing assurances to your patient community that data privacy is going to be maintained, how do you ensure that? How do you execute that? When there are so different people getting access to it?

MA: Premier is an organization that’s been in clinical data analytics, labor data analytics, health information, patient health information for years. So, we have been at it for probably more than twenty-five years. We’ve got a very rigorous and consistent process to ensure that data rights are appropriately being followed. And our ability to deidentify data, we’ve been doing it for years. So, if there is an institution out there that has the ability to do it and has been doing it and that has processes and technologies to do it, it’s us.

JS: Paddy, I think for all of us it’s a fascinating time to think about balancing public health needs and privacy in our own minds and also even what each of us is willing to tolerate in our own personal lives during a worldwide pandemic. As Mike said, the Premier team feels that if it doesn’t have the trust of its partners and their patients, we don’t have anything; and Geisinger certainly feels that way. A lot of the apps that you mentioned are often going to be consumer-facing apps. It’s important to call out for anybody that kind of just dips into the surface of this, that this is not a patient consumer-facing application. This is a robust clinical decision support tool that’s been live for years and has been repurposed and sits with health systems’ EHRs. So what that means, is it sits with extensive BA’s and other agreements that all of Stanton’s existing work is covered by. It’s the type of software and activity covered by HIPAA and has privacy literally protected by law. It’s important to point out that existing syndromic surveillance in our states and country, as I mentioned, involves printing documents, filling some aspects out by hand often, manually keying certain forms, and sometimes even faxing results. That is absolutely a system which is not only not modern but is also insecure from a privacy standpoint. We think that this kind of automated, fully digitized, secured solution to disease surveillance, it leads with privacy and is a significant improvement over the existing model.

PP: What triggers the tool itself since this is more like a surveillance tool. What is the event that triggers this tool?

JS: So, for the informatics wonks there are three, and it started with one and then Stanson came and Geisinger helped and others have worked with Epic and other EHR vendors for the rapid expansion. And I should call out Epic and Cerner. But Geisinger is an Epic shop, so that’s the one I can speak to, has been a tremendous partner here. Understanding that during a national emergency, we need to always move smartly, and we need to move quickly. So, three triggers really fire the tools, ability to take a look and give actionable insights. One is the ordering of an imaging test and of course, in COVID that’s critical and is the backbone of what Stanson’s functionality always was. The other is the order of a COVID test, which is another great place to fire functionality that takes a look at natural language processing on free text and also does analysis on discrete data at the time. And the third is that when COVID test is resulted and the charts opened to analyze the COVID test. That’s a moment when there’s a dip-in and a look-in and Epic’s helped with this, done extensive analysis on the overhang time associated with this. And these are times significantly less than half a second in the hundreds of millisecond time frame.

PP: You mentioned false negatives a couple of times. Have you had a problem with false positives?

JS: Not really. False negatives are the big enemy right now, in terms of what have we seen, how do you validate a tool like this? Early testing that the team has done has found that when we look at symptoms using the methods that we’ve talked about and compare to a later positive PCR viral test, to answer your false positive question, probably about four percent. And so that’s really good but the team’s making it better. I think one really important way to make it better and also to validate it is something that’s ongoing with our health system now, and that’s retrospective cohort evaluation. So, we, and everybody, have months of medical records on patients who later go on to test positive and negative. And folks that do well clinically or unfortunately in some cases do not do well clinically. What we are doing is looking back at a cohort of patients who went on to test positive where they know how they did clinically, and also, a group went on to test negative. So not only does that allow validation but have a very big history in the machine learning and AI area. In fact, we can not only validate the tool there, but also do data driven research to tune and improve the algorithms to significantly increase the sensitivity and specificity of the tool with a known data set and tuning.

PP:: A related question on that, obviously, is evidence. And you are kind of going there at times. Are you building the evidence for this tool as you go along?

JS: Well, some of those initial looks that I mentioned have already occurred and led to that data I mentioned. The other studies that I mentioned, like the retrospective validation and the tuning is happening as we speak, from quality improvement and research perspective, because I do think it is quality improvement work. But as far as the machine learning algorithms tuning is concerned, that’s an ongoing iterative process that’s consistent.

PP: One of the things that has really impressed me is the level of public-private collaboration that COVID-19 has brought about. I have seen many examples at the state-city level. One of my guests on this podcast talked about what they’re doing in the city of Austin for instance. And I see many great examples of how public and private sector are coming together to really address this. Can you talk a little bit about how this tool is being used for public health in general? Let’s say in Geisinger you’re in Pennsylvania, you talked about how this is contributing to public health efforts and especially contact tracing and all that, which is not really a big thing.

JS: There’s a ton of important opportunity in this area. We know that contact tracing, etc., usually falls under local and state health departments, but they’re all spread thin. I think we all saw the study that Ars Technica wrote up that we would actually need three hundred thousand contact tracers to do this job right. Geisinger quickly realized that it’s already expert in managing testing, communicating results, and treating those who test positive. So, Geisinger is performing contact tracing as a public-private partnership and now has twenty-four employees spending significant parts of their workweek on contact tracing. As of a few weeks ago, the team had made over twenty-seven hundred phone calls to follow up on sixteen hundred positive patients. This directly benefits patients, providers, and communities. And how do you take the Stanson tool and actively connect that to states; Mike, I’m sure can elaborate on.

MA: I think at the end of the day, these health officials that we’re having conversations with are trying to really have these decisions from a public health standpoint, be informed by data and science. The idea is if you have what we suggested, which is that three-legged stool of testing and more advanced testing and getting more refined testing and better testing, plus contact tracing, which we always think is going to be something that is going to be debatable. Jonathan made a great comment early on about the debate of positive societal impact versus liberties being sort of tightened. But we do know there are a number of countries that are using iPhones and those kinds of things to track as to where folks have been that have the virus and to be able to alert people that they may have been exposed to the virus. That’s a very meaningful discussion that we need to have and the debate that we need to have in the U.S. around the importance of that. And then finally we have been talking about this syndromic surveillance and the reason it’s so critical is that if you’re the governor of a state, early on, governors of huge states decided to shut the entire state down when maybe there was only a surge in eight, nine percent of all of the counties that represented, 60 or 70 percent of the population. But those other counties were very limitedly impacted. So, all we’re saying is that there is technology and there is data that at the zip code level can provide a great deal of information around how to balance public health versus open the economy, that’s number one. Number two, we have heard a lot of conversation about how this is disproportionately affecting the cultures of color, people of color in the urban settings. Our technology has the ability to identify those issues. And for public health officials to sort of think through what’s the best way to provide capabilities and services to those parts of the population. So, we think there’s a couple of incredibly important use cases that public health officials should leverage for.

PP: Well, John and Mike, it’s been such a pleasure speaking to you. Thank you so much for sharing your thoughts on this. I think this is a very important initiative. And I hope to get you, folks, back again on this podcast maybe a few months down the road when you have more learnings to share from the tool as work on the field and again all the very best.

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

Mike J. Alkire is the President of Premier. As President, Alkire leads the continued integration of Premier’s clinical, financial, supply chain and operational performance improvement offerings helping member hospitals and health systems provide higher quality care at a better cost. He oversees Premier’s quality, safety, labor and supply chain technology apps and data-driven collaboratives allowing alliance members to make decisions based on a combination of healthcare information. These performance improvement offerings access Premier’s comparative database, one of the nation’s largest outcomes databases. Alkire also led Premier’s efforts to address public health and safety issues from the nationwide drug shortage problem, testifying before the U.S. House of Representatives regarding Premier research on shortages and gray market price gouging. This work contributed to the president and Congress taking action to investigate and correct the problem, resulting in two pieces of bipartisan legislation.

Jonathan R. Slotkin is the Vice Chair of Neurosurgery and Associate Chief Medical Informatics Officer at Geisinger. Dr. Slotkin is board certified in neurosurgery by the American Board of Neurological Surgery. His clinical interests include care for back and neck pain, as well as sports-related spine injuries, and he has particular interests in consumerism and the digital transformation of healthcare. His research interests include post spinal cord injury regeneration. Dr. Slotkin has expertise in spine outcomes, caring for degenerative and congenital spine conditions, spinal tumors and spine/spinal cord injury. He earned his medical degree from the University of Maryland, and completed his residency at Harvard University, Brigham and Women's Hospital. He completed his fellowship in spine surgery at New England Baptist Hospital. Dr. Slotkin is director of Spinal Surgery for Geisinger and also serves as associate chief medical informatics officer.

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.

For a frictionless digital consumer experience, healthcare providers and payers must work together.

Episode #51

Podcast with Bill Krause, Vice President of Experience Solutions, Change Healthcare

"For a frictionless digital consumer experience, healthcare providers and payers must work together."

paddy Hosted by Paddy Padmanabhan

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In this episode, Bill Krause, Vice President of Experience Solutions at Change Healthcare, talks about removing friction points in healthcare – finding, accessing, and paying for care – throughout the consumer experience journey.

According to Bill, COVID-19 created a big explosion of interest around the role digital can play in the healthcare system. He states that there are several barriers that consumer experiences while accessing care through digital means. To accelerate digital patient experience, healthcare providers must understand the role of payers in a patient’s journey and work together to provide a frictionless digital consumer experience.

Recently, Change Healthcare collaborated with Adobe and Microsoft to launch a connected consumer health suite that enables healthcare providers to create a more streamlined digital health experience throughout the patient journey. Change Healthcare is one of the largest independent healthcare technology companies in the U.S. Take a listen.

Bill Krause, Vice President of Experience Solutions, Change Healthcare in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “For a frictionless digital consumer experience, healthcare providers and payers must work together.”

PP: Hello everyone, welcome back to my podcast. This is Paddy, and it is my privilege and honor to introduce my special guest today, Bill Krause, Vice President and General Manager of the Connected Consumer Experience Practice at Change Healthcare. Bill, thank you for setting aside the time, and welcome to the show. Do you want to spend a couple of minutes talking about Change Healthcare, what does the company do, and what are your focus areas today?

BK: Change Healthcare is one of the largest independent healthcare technology companies in the U.S. We provide a variety of data and analytics-driven solutions and services that focus on clinical, financial, and patient engagement outcomes. We really occupy a unique space in healthcare with our focus on connecting the broad ecosystem. For example, we have deep and broad networks across financial and clinical areas that improve decision making, simplify billing, help with payer and provider processes, payment processing, and generally, help enable better consumer experiences.

PP: On this podcast, we focus mostly on digital transformation. What that means to healthcare enterprises, as well as to the technology provider community that serves the needs of healthcare enterprises. Change Healthcare recently announced a new platform that you have just launched. Can you tell us a little bit about what is the platform called? What kind of marketplace needs you are looking to address with the platform?

BK: Recently, we announced the availability of our connected consumer health suite. The solutions Digital Patient Experience Manager, Shop Book and Pay, Virtual Front Desk, and other capabilities, they really help providers to create more consumer-style digital healthcare experiences. We like to say we are helping providers with this platform power, the connected digital journey for consumers, from internet search through to the exam room. And our focus is around removing as many of the friction points that are typical with today’s healthcare experience across finding care, accessing, and paying for care.

PP: Let us talk a little bit about these suites of solutions that you have launched. In the Shop Book and Pay, you mentioned digital experiences and consumer empowerment and so on. When I look at the digital health solutions landscape, I see that you already have the big electronic health record vendors such as Epic, for instance, and their MyChart platform. And then you have a whole marketplace, called the digital health innovation, an ecosystem of startups that have identified an opportunity relating to any one single touchpoint in the online consumer experience. So, it looks like what you’ve done is taken many of those features, many of those needs, looked for the touchpoints, and kind of aggregated them all into a one-stop platform. Is that a fair way to state that? How exactly would you describe that?

BK: What I would say is our insight and what’s behind the solutions we announced is that what we see as the need is to remove, as I mentioned, like many places where consumers hit barriers in accessing care and using great digital to do that. So really, the analogy is we think about our examples, such as Rocket Mortgage or Carvana, Amazon Go, and others that have taken technology, and to your point, there are existing technologies out there serving different points in the healthcare consumer journey; but the unique insight was bringing these together dramatically, simplifying the process that a consumer goes through really to access the services or products that they need, and to do that in a way that works within the context of healthcare.

PP: So, give me an example of how this would work if I am a healthcare consumer. First of all, would I even be accessing your platform directly, or is your platform kind of sitting underneath maybe a health systems front end portal? How does this work as a consumer, what would the experience look like for me?

BK: There are a number of ways and a number of on-ramps for a consumer to enter this digital journey that we make available for providers. We have partnered with Adobe here and Adobe is a leader in digital experience. As a result of that, we have a variety of capabilities that can really customize the experience to fit the brand and styling and many of the other factors that our provider customers need to really reinforce their strategies. It’s never really been more important now in light of COVID-19 and the dramatic shift towards digital. But most consumers today are really struggling to understand what their financial responsibility is going to be, and their struggles with healthcare. They are struggling to connect together with the steps they need to take. So, a consumer would start the journey, perhaps on the web site of their local provider and they will be able to search for care, understand what care is available to them based on any number of services that are increasingly more shoppable if you will. And by that, we mean where consumers are more actively involved in the decision making around those services. So, they’ll enter through the provider’s web site. They’ll enter into the Shop Book and Pay experience, which is branded for the provider. They’ll locate the provider and the services that they need within their local area. They’ll be able to understand their out of pocket responsibilities, schedule care, and complete the pre-service journey in as simple a way as possible.

PP: And you mentioned Adobe as one of your partners. You also partnered with Microsoft in building the platform. Am I correct?

BK: That’s exactly right. This is bringing together the best of three very complementary companies that are leaders in their respective domain. Bringing together Microsoft’s leadership with cloud hosting and regulated industries and significant capabilities around making it scalable and serviceable across the market. So, one of our objectives here is to make these solutions available for the largest providers, but down to the smallest independent practices as well. And Microsoft has a great role to play in making that scalable. As I mentioned, the role of Adobe and really leading many consumer industries and powering the digital experiences that we all know and love and then change healthcare. And one of the important insights here is in order to make great progress in consumer experience and consumer digital transformation, you have to get access to the workflows and data and other backend systems that are necessary to bridge those silos, if you will. And that’s a great capability that Change Healthcare brings to this partnership on behalf of the customers we serve.

PP: So, staying on the consumer experience for a moment, I imagine that you have your first few clients or deployments already live or in the process of really going life. Can you maybe describe what the architecture looks like? You know, let’s say you’re working with a healthcare provider who is on one of the major electronic health record platforms, Epic or Cerner or one of them. How does your platform fit in that architectural construct? And also, are all the capabilities that you talked about, are they all built native in your platform or do you also have components that are maybe a white-labeled with other startups? How is this whole thing architected? If I look at it from an enterprise standpoint as a healthcare executive.

BK: Certainly. So, it’s architected in a cloud-native structure and with an architecture that allows us to on behalf of our provider customers, to integrate into their systems of record. If you think about just from an overall philosophy and approach standpoint, we view the provider has a number of systems of record that house data needed to support these consumer journeys, be it their electronic medical record or their revenue cycle system. Change Healthcare equips many providers across the industry with some of those systems like revenue cycle management. But those systems of record then interact with the systems of engagement. And that’s really where the Connected Consumer Health Suite plays the role it’s delivering to those providers – a scalable, cloud-hosted architecture that integrates with their data sources and powers for them those digital experiences that they need to support for finding and accessing care.

PP: One last question on the topic. Who pays?

BK: There’s a very simple model to this, which are the customers the providers pay for. And I also want to address another question you asked around third parties as well. But I’ll come back to that. But yeah, it’s a simple subscription model based on consumption that providers pay for and the benefit to them is multifold from operational efficiencies to really and most importantly, attracting and retaining their consumers. And that is really where the value that they receive out of this solution. But back to the other question. We have architected our platform in such a way as to incorporate third parties into the journey. We recognize that healthcare journeys can take many different avenues and providers need the flexibility to be able to accommodate those third parties we’re working with. For example, M.D. Safe, which is a great innovative early-stage company that helps to create a single billing experience for consumers prior to when they need care. So, it just dramatically simplifies what a consumer sees and understands their responsibility to be able to satisfy that responsibility. So, we’ve incorporated that capability into our Shop, Book, and Pay. And we’ve built our architecture and that’s, again, back to the role that Microsoft plays here as well with us and in a very flexible manner. So, it can be extensible over time-based on our customer’s needs.

PP: And it seems to me like the platform you built is one of the early examples that I see in the market of a comprehensive digital consumer experience platform. I see a lot of standalone solutions and one of the big challenges that my clients and all the others that I talk to face is about creating this seamless consumer experience. For the most part, the standalone solutions, they are kind of glued together in a somewhat brittle way and building the seamless consumer experience that we are used to from the Amazons of the world or in our personal banking experiences. Is that a fair statement and how do you think a platform like yours changes that?

PP: That is a fair statement and that’s very much been front and center of our strategy. And really the reason why we’ve partnered with Adobe to utilize the Adobe Experience cloud within this architecture. And our view on this is, again, our customers cannot be locked into perhaps more brittle, single service solutions that don’t allow them to really create and expand on the experiences their customers need. So, if I get underneath the covers of that statement, we’ve made a lot of investment to enable our providers. The use of a content management system that really is world-class and allows for a lot of flexibility. Again, back to customizing, to branding, to be able to create different experiences, to be able to deliver those experiences across any variety of endpoints that consumers will pursue and really bring all of that capability that’s instrumental in a digital experience platform approach, but also campaign management, the analytics to instrument all of the endpoints and engagements so that we can match across the channel and understand consumer behavior and how better to serve it. Again, tying back to the earlier point here, about how to remove frictions. If we don’t have those analytical insights on how consumers are interacting with those digital experiences, then it’s not possible to really effectively remove the friction points and optimize the experience over time.

PP: Yeah, interesting. So, switching to more general topics, what are you seeing in the market in the wake of COVID-19 in terms of acceleration of virtual care models, digital experience related investments in your client communities? Can you talk a little bit about what you’re seeing in the market in general?

BK: Certainly. And I would that there are the near-term imperatives that the market has been responding to, and then there are the medium and longer-term realities that our customers are now positioning themselves to address and all. And what I mean by that is the near-term imperatives, things like enabling virtual care so that patients could be served from that standpoint. I think we’ve all talked about that uptake in the industry, but also things like touchless check-in and minimizing any contact with staff where possible and moving things like forms, paper forms to electronic and delivery, etc. So, there’s been a lot of effort to really identify those gaps in the workflows and really plug those gaps as quickly as possible among our provider base. So that’s the near-term that we see. And I think that’s really true across all different types of providers. And then there’s the medium term, and by medium term I might mean 12 months. You know, for some people, medium is six months or so. But at the end of the day, that medium-term is around reimagining those, the pathways that consumers have got access to care and, how to deliver those digitally. And that ties back to a recognition that any barriers that the health systems or providers can see with regard to enabling easier access to care for their consumers. Those barriers now take a higher priority in terms of where their investment dollars, talent, and resources are going. So, we’re getting a lot of inquiries around consumer experience, strategy, and how to rethink the digital front door. The digital front door concept has expanded beyond perhaps the patient portal to other channels and modalities. So, I think it really created a big explosion of interest around the role digital can play in the healthcare system.

PP: One of the big things that people don’t talk about is that along with this shift to virtual care which has been brought on by a lot of restrictions on people coming into a clinic or a hospital for care. There is a big concern around how to take care of the population in their homes and the chronic care of patients, for instance. And we see that remote care and remote monitoring technologies are also having some sort of a renaissance if you will, or if not a renaissance, maybe accelerating. Is that also happening in what you see, along with improving access to care through virtual modalities?

BK: The short answer is yes. And there are few drivers of that. So, the recognition that increasing scope of care can be delivered in the home setting from the standpoint of now more consumers are being accustomed to that, just given the realities of COVID. But there’s been a growing body of evidence related to shifting care to the home and the value that delivers in terms of benefits to consumer’s quality of life, health outcomes, as well as benefits to the system from an efficiency standpoint. So those drivers as well, I think just continue to encourage that trend. So short answer is yes. We’re seeing that and it goes back to that reevaluation of the predominant models that our provider organizations are really funding and developing. And I think that will continue to play an increasingly large component of how consumers receive care and then how those providers are going to need to retool their system to support that.

PP: What do you see as the one or two big challenges that providers are facing today as they make this transition, as they get ready to accelerate? Because the acceleration of the transformation is kind of inevitable. You either accelerate or you get left behind. What are the one or two big challenges you’re seeing providers struggling with as they try to make this transition?

BK: You know, there’s a few things. One is the organizational capacity to support that transformation. Increasingly, providers are understanding their roadmaps that they want to pursue from a digital transformation standpoint. But the IT departments and teams are just taxed with a number of priorities on a number of fronts. So just that overall transformation burden and fatigue, that’s a reality that the industry faces. I think also, if we play this out a little bit, there’s a dichotomy around how or what maybe good looks like and really a recognition on what is the path forward. So, everybody recognizes the growth of telemedicine is needed and some of the other more tactical areas have to be addressed in the short term. But our industry has a record of adopting many different solutions. And in fact, you know, it’s not healthcare. It’s many consumer industries. But at the end of the day, I’ll come back to those models that were really breakout and drove substantial benefits, were the ones that brought together the journey and really streamlined the consumer journey. So, that’s a different paradigm. So, I think there’s an opportunity and there’s a challenge around that. And the challenge is really what does that look like? And when you start to get underneath that, you realize that a number of the steps in the consumer journey fall on the payer side. So, we can’t forget the payer’s role in this, whether it’s understanding from a consumer standpoint what doctors are in my network, and what are my insurance benefits for particular service, or any number of steps where the consumer is left with a fragmented journey. So, for provider organizations to address this holistically, they have to think about the role of the payer in this and how they can work together.

PP: Interesting. It’s been a real pleasure speaking with you. And I wish you all the best with the launch of your new platform. It sounds very, very interesting, and I will be following what is going on with the progress as you kind of make public statements about it. I look forward to having you back on the podcast, maybe a few months down the road, and maybe you can tell us more about your learnings from the launch of the platform.

BK: Thank you, Paddy. And I really appreciate you having me here today.

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

Bill Krause is the Vice President of Experience Solutions at Change Healthcare. Serving the healthcare industry for over 12 years, Bill leads innovation and solution development for patient experience management at Change Healthcare. In this role, he is responsible for the development and execution of strategies that enable healthcare organizations to realize value through leading-edge consumer engagement capabilities.

Previously, Bill provided insights and direction into new product and service strategies for McKesson and Change Healthcare. He also managed business development planning, partnerships, and corporate development across a variety of healthcare service and technology lines of business for those companies.

Prior to McKesson, Bill worked at McKinsey & Company as a strategy consultant, serving a variety of clients in healthcare and other industries.  He received his MBA from Harvard Business School and his undergraduate degree from University of Virginia. He also served as a lieutenant in the United States Navy.

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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Sign up to get Paddy’s Newsletter that is personally curated by Paddy along with analytical notes on the developments for the week.