"COVID-19 has given us an opportunity to reset and create a better healthcare system"

Sara Vaezy, Chief Digital Strategy and Business Development Officer, Providence Health in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “COVID-19 has given us an opportunity to reset and create a better healthcare system”

PP: Hello again and welcome back to my podcast. This is Paddy and it is my great privilege and honor to welcome back Sara Vaezy, Chief Digital Strategy & Business Development Officer of Providence Health. Sara is very well known and a thought leader in the space and she has just published a series of highly interesting reports on the current state of the healthcare market, especially from a digital transformation standpoint. Sara, welcome back to the show.

Let’s start from the top! Seattle was ground zero for COVID-19 in the U.S. and one of your hospitals treated the first patient. And you had come on this podcast right about the time in the early days of the pandemic to talk about the response effort. I urge our listeners to go back and listen to that episode. Now, you have published a series of papers called – COVID-19 Digital Insight Series and you have titled the series – Journey Toward to the Next Normal. Tell us how the series came about and how you went about putting this together.

SV: Back in February and early March, when we had the first wave of COVID-19 outbreaks in the regions where we serve our patients in the western United States. We had to mobilize our assets across the organization very quickly. That was the topic of our conversation last time, Paddy. As we continued throughout this process, we realized that not only from a build standpoint, we have a significant product development organization that can build technology to address these needs. Everybody had mobilized across the country. Healthcare IT, digital, and technical services needed to address and tackle the challenges that we were all collectively facing within COVID-19. Healthcare systems’ challenges are on full display now. How we are struggling with the business model for healthcare and the strange incentives that it puts in place and creates for providers and for health systems, for instance, in a fee-for-service environment. All these things came on full display, and we saw an opportunity for us to reset and use what is out there and create a better system. So that was sort of the goal that we had. How do we process all that is happening? What are the key trends? What are the things that will be accelerated because of this unique catalyst of COVID, like telehealth, for instance?? What are the potentially new opportunities? What we’ve realized is it’s mostly going to be about acceleration of new paradigms and new ways of caring for people and business models that actually prioritize health and well-being. This was about taking all the stuff that was happening and trying to think about how does this actually contribute to a reimagined system that works better for our patients and our providers.

PP: You have not only looked at what was happening within the Providence system, but also looked across your peer group health systems. You interviewed several people who are in your peer group. Is that correct?

SV: Yes, so it was not just focused on Providence. We did not even stick with just our peer group. We interviewed over 100 individuals that spanned different segments of the industry. We talked with other providers and with payers. We talked with folks in private equity and venture. We spent quite a bit of time with policy makers and folks who had deep expertise on the regulatory environment. We spoke with clinicians. So, we really took a broad approach to this and interviewed folks from as many segments as we possibly could of the industry to get a holistic view.

PP: I read several of the reports, and it’s outstanding stuff, it was very informative and I learnt a lot of new things about what was really going on in the market and the changes. Your first report of the series starts by calling this – The end of the beginning – is kind of an ominous Churchillian reference from the World War II. This quote goes back to the very early years of World War II. We knew that in hindsight that the war was then extended for a few more years. So, I hope your comment doesn’t imply that we’re going to have another four or five years of COVID-19 upon us. The report goes on to talk about COVID-19 and the response effort. But then interestingly, it talks about the first order and the second order impacts. It’s a really interesting framework. Can you help us unpack the structure of the report? How did you go about setting it up this way?

SV: We made that Churchill reference, as you’ve articulated, of course, in hindsight changed our view of how we look at that statement. I would say that probably the same applies in this situation. When we finally published that initial piece, we thought we were at the end of the response phase or the mobilization phase. I think that depending on which region folks are in, there are some still in that mobilization phase. So, there is a bit of hindsight for us in terms of not being 100 percent accurate. Hopefully, to your point, we don’t have another four to five years of this. Knowing that because the situation is evolving so rapidly that it’s likely that some of what we’ve proposed in this is incorrect. So as your listeners engage with the reports and have thoughts, we would love to hear from them and engage in that conversation around how things are evolving post what we’ve already articulated and perhaps proving us wrong or bringing into light new information that would be informative. So, the way we thought about the report was, when COVID started, it was a catalyst. It wasn’t necessarily the reason why things happened, but it was a catalyst for sort of two paths of activity. The first was all COVID related. How do we rapidly adjust to this very acute situation? That was the mobilization phase, so the acute phase dissipates, but its not going away permanently. So, we must continue to manage and mitigate and monitor the situation. So that’s one stream around mobilization and mitigation. The other stream is, in the interest of responding to a very acute situation, what we are now dealing with is that our business has been fundamentally disrupted within providers. Most of the providers had to shut down facilities, brick and mortar facilities, at least for some time because of the unknowns and the risk of exposure. It disrupted our business fundamentally. And then we had to travel down the path of recovering from that. So, it’s not COVID specifically. It was catalyzed by COVID but any other kind of major catalytic event that would have caused us to shut down our clinics would have had a similar sort of consequence. That actually makes way for this sort of next possibility where we have an opportunity to take a good, hard look at how to evolve from where we are. We have to immediately get back to recovery and understand how we can, in the near term, get back to business. But then in the long term, this fee-for-service model, for instance, isn’t necessarily working for us. How can we evolve pass that and use this as an opportunity to do so? It’s really not a COVID-related path of work. It’s more about continuing to serve while evolving. It’s that sort of classic refrain of changing the wheels on a moving car or something like that. And then both kinds of paths result in a bunch of different ultimate consequences. Mental health, behavioral health, for instance is a hugely impacted area. The second-order impacts and outcomes in this report were not intended to be lower priority, but just that they are impacted by these two streams and everything that’s happened across the industry. So that’s how we thought about it in terms of the most fundamental drivers of change. And then other impacts and outcomes that were a result of that.

PP: So, there is an underlying theme of an industry in transition, transformation and everything that you have taken for granted about the fundamentals of the business now up for discussion. The report talks about business model transformation, new norm for patient safety, such as contactless experiences that you were alluding to in the context of COVID-19, and about industry consolidation and what is common. Obviously, financial distress is the reality for many health systems. Then you’ve got the whole supply chain and you’ve got a lot of other things going on. The underlying theme that permeates through all the reports is that of an industry in transition, and how do we get business back to some level of immediate normalcy. But really, It is about how do we prepare for what is inevitably going to be a very different normal, which is what you’re referring to as the next normal. Can you share a couple of big insights that came out of this work that you do?

SV: I’ll give you one that’s very relevant in the context of a lot of change happening, and that’s around telehealth. So, we’ve been talking as an industry about telehealth for twenty-five years, possibly more. But the industry and we haven’t really paid for it. We haven’t had the underlying enablers to make it a success. For instance, we have not had the legislative or regulatory framework underneath to ensure that telehealth was viable from licensure, from a reimbursement standpoint. There are just a lot of the underlying enablers that haven’t been there. Another aspect of it is that we haven’t had a lot of adoption. Most folks had not experienced telehealth as patients and our providers weren’t really using it. Providence itself did not have telehealth as a common modality available to our physician enterprise to serve our patients in our ambulatory network prior to COVID. And what we saw was that now millions and millions of individuals have experienced it for the first time. One insight that we got was that folks are online now, which means that they are more susceptible to not being our patients anymore. There has been this general trend toward patients not being quite loyal to one system or one provider. And with the sort of proliferation of all of these potential telehealth solutions out there, coupled with the fact that folks are now actually utilizing them. They are much more open to being grabbed by a really great experience that’s provided by the 98point6 or an Amazon care. This whole opening it up is like our biggest strength and our biggest weakness at the same time. We now can do telehealth at scale. And unfortunately, if we don’t move quickly enough, it could work to our detriment. So that’s one piece of it. In addition to that, the notion of scale, we built a system that was able to scale, but a lot of the providers really struggled with scale. What we learned was that the industry, from a telehealth standpoint, had been very feature oriented. Because of which the investments did not happen across the board to scale up these technologies. And scale became the most important thing in delivering high-quality telehealth experience that didn’t require hours of waiting. As a result of that there was a lot of the big providers of technology came into telehealth as providers of telehealth, for instance Zoom became a very prominent player as it relates to telehealth. Microsoft increasingly looks at these kinds of things. We think that over time, the actual video conferencing will likely be largely commodities. It’s going to be more about the value-added services and things that you can layer on top of that experience to make it really worthwhile for the consumer.

PP: I actually just published an article in CIO magazine where I explore telehealth in detail. It focuses on the limits of telehealth because ultimately, as administrator Seema Verma said on one of her blogs recently, telehealth is not going to replace the gold standard in-person care in totality. There are several aspects of healthcare that are going to turn towards a virtual care model. But there are limits to that. Those limits are determined by what types of care you are talking about, what kind of populations you’re talking about, and a variety of other things. I have also seen data that suggest that even though telehealth visits, virtual consults in particular and real-time video consults and video visits, dramatically went up in the wake of the pandemic, those volumes have dropped off a little in the last month or so. And there are several reasons for that. There are also obviously the uncertainties around the waivers that are going to stay in place and whether the reimbursements are going to continue and so on. Do you think we are still a long way away from reaching some kind of a natural limit for telehealth penetration in healthcare, or do you think that we’ve kind of tapped?

SV: From a Providence standpoint, we have seen a similar trend where there was a peak and then decline. And now we’ve stabilized. What we are seeing is a result of a couple different things. One is that the experiences for telehealth still aren’t great. As practices started to fill back up and could open with physical visits, it’s difficult to maintain and sustain the peak progress and momentum when the experience is challenged from a telehealth standpoint. It is incumbent upon us to make that experience better, to drive adoption. This is not about all telehealth. I think there is always going to be a mix. And where we have a long way to go is to identify the mix and the kinds of use cases, that work for telehealth because we are still sort of new to this. As an industry, we still don’t know exactly what are the great use cases that we have demonstrated value in. But we have some indications and the more that we can kind of hone the experience and get more data around those use cases, for instance, certain types of chronic disease management can be done really well remotely. Certain maternity care can be done well remotely. Now that we have some folks that have adopted the technology and have experience with it. I think we can start to gather data around how to make those experiences more efficacious and more value added for customers. That’s where we have the biggest runway or ramp up that we still need to engage in. The technology and the experience still need to improve as well. But how we utilize it for which use cases that are most appropriate, is the biggest kind of body of work that we still need to do.

PP: I think that is great insight because there’s so much that is broken or suboptimal in the telehealth experience today that even by just streamlining it can make it a little bit more seamless. Can you tell us what do you plan to do with this body of research ? Firstly, of course, you’ve done yeoman service in sharing with us, which I think is fantastic. What do you plan to do with the reports themselves or the insights that you gained from them?

SV: These are not one and done kinds of things. What we were hoping to do is get the industry kind of talking and start identifying opportunities either for individual systems or individual sectors, also opportunities for partnerships and just collaboration around common themes. That was the big objective, to get the conversation going and make room for collaboration around specific areas. Paddy, you had talked about public-private partnerships that have emerged as a result of this on LinkedIn. I absolutely think that is very interesting and important area where we could accelerate those private public partnerships and make them effective. The second is we are going to use this as a basis for our own strategy. And we are taking a long, hard look at our digital strategy and identifying where we need to pivot, where we need to sort of double down, for instance, as it relates to business model evolution. How can we really support the movement of our organization, to managing risk with specific populations like those folks who are on Medicare advantage? And a unique, interesting wrinkle is that they are older patients. So how can you really make digital work for them? So, we are going to use it in that way. And then finally, we were not intending these to be just one report. We are going to continue to monitor all these trends and update them. And when we are wrong, we are going to write about it. And when there’s new information, we’re going to synthesize it and continue to drive the conversation so that as an industry our learning can accelerate, and we can work to solve these really big problems more efficiently.

PP: Fantastic. That is so well summarized once again for our listeners. For those who could not catch it earlier on in the conversation, the series of papers is titled – COVID-19 Digital Insight Series and it can be pulled off the Providence Health web site.

SV: Yes, you can go to our Providence Digital Innovation Group, Resource Center, which is providence-digitalinsights.org and you can download them all there.

PP: If there’s anyone out there who wants to really understand, get a finger on the pulse of what is going on in digital transformation, especially in this post-COVID-19 era. There’s no better place to start. Sara, thank you so much for coming back on the show again. I look forward to staying in touch.

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