Month: September 2020

It is important to understand how tech enables healthcare keeping people and processes in mind

Episode #60

Podcast with San Banerjee
VP of Digital Experience, Texas Health Resources

"It is important to understand how tech enables healthcare keeping people and processes in mind"

paddy Hosted by Paddy Padmanabhan
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In this episode, San Banerjee, Vice President of Digital Experience at Texas Health Resources, discusses how they create a connected ecosystem to provide a seamless digital experience for patients wherever they are through digital channels that includes virtual health.

Texas Health Resources completed 100,000 virtual visits in the first ninety days of the pandemic. San says that as we move forward in healthcare, people will get accustomed to using virtual care delivery mechanisms, which will increase its acceptance further. He defines digital front doors as an access mechanism for patients to get services they are looking for. On the other hand, from a consumer perspective, it is all about managing the consumer point of view to access the services that providers can offer.

Healthcare is not just about technology; it is a people-based business. San advises digital health startups to understand how technology enables the healthcare business while keeping in mind people and processes. Take a listen.

Our Partner:

San Banerjee, VP of Digital Experience for Texas Health Resources in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “It is important to understand how tech enables healthcare keeping people and processes in mind”

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, San Banerjee, Vice President of Digital Experience for Texas Health Resources in Dallas. San, thank you so much for setting aside the time. And welcome to the show.

SB: I am glad to be here, Paddy. Always a pleasure talking to you.

PP: Thank you so much for that. So, let us start with this.

PP: Tell us a little bit about your role. What does the role of the VP of digital experience mean at THR?

SB: So, my role is responsible for creating seamless digital experiences for different channels through which our consumers and patients interact with us. And it also includes virtual health, which is the new dimension of care that we have embraced since last couple of years in terms of delivering care through virtual channels. So, at the end of the day, my role encompasses everything that Texas Health does on the digital side, including virtual.

PP: So, when I talk to health systems, the digital function sits in different parts of the organization and the roles are also defined a little bit differently in each health system. So, would you say your role is more focused on the marketing side of the digital experience? Or is it much more encompassing than that?

SB: It is more encompassing than that. It is like thinking about the channels as the avenues through which our consumers come and interact with us both on the consumer experience side and the clinical side of the house. So, think about this as a little broader than just the marketing side of the house.

PP: Right. Could you share maybe one or two examples of some of the big programs that are within the purview of your role just so that we get a sense of what the world looks like?

SB: Sure. So, a couple of programs that I have personally led and something that we are pursuing at this point of time. One is Hospital2Home program, an SMS text-based service for patients who are in hospitals. And then when they go back home, we really want to follow them to their home as well so that they can reach out when they need help. And behind the scenes, we have emergency physicians that are available on a text service along with them to provide the service. So, this is really trying to meet the patients through a digital channel, which is SMS and texting. Also, there are other programs that we are doing at this point. And we have kind of enabled many providers on the virtual channel, both on the virtual consults in the hospital as well as virtual through a direct to consumer kind of play. It is something that we are doing from a digital perspective to ensure that we become more and more relevant, especially in the COVID days when we want to distribute care, which is more convenient from a consumer perspective. Apart from that, we are kind of looking at where the world is going. So, if you look at the digital ecosystem, the ecosystem comprises of things like remote patient monitoring, which is needed for chronic care management, as well as a lot of capabilities around care coordination that can be done in digital way as well. So, we are looking at clinical coordination through digital channels. We are looking at consumer experience interactions or digital channel to make them better and creating those products and services so that it is more meaningful to our consumers and patients.

PP: Right. And these all seem like the sort of high value, high impact programs that we are seeing other health systems investing in as well. In the wake of COVID-19, have you started seeing a significant sort of shift and a long-term shift towards virtual care models? Or do you think that some of it is going to kind of go back to more of an in-person kind of an experience? In other words, is this a long-term shift that you’re anticipating and proactively preparing for?

SB: Yeah, the answer is yes. We have been anticipating this for some time now. And we are prepared really well because we have been working on this for a while to ensure we put the right interventions that are needed to be able to come really good out of this pandemic. As you probably know, pandemic came in and we adopted an approach of relooking at what we have in our toolkit to bring all the things together in service of our patients. So it was less of getting new technology from outside, but looking at the technology that we already have and tried to put all those things together in the right order to be meaningful to our patients. And that’s what we did. Eventually, we will probably reconcile a lot of things so that we create our own state as far as a lot of those initiatives are concerned. But the first order of business was to really create something very quickly. And I always say that when you are in a pandemic, you have to look at bringing some technology in a meaningful manner so that it can be created and ensure that it kind of delivers what you need at that point of time.

PP: Right. And of course, this is technology enabled without a doubt. And all the virtual care models are going to have a significant implication in terms of technology investments, making the technology work seamlessly and so on. So, how does THR go about assessing your technology choices and implementing your digital programs? What do you see as the role of enterprise IT and more specifically, EHR systems in driving your digital journey and your digital road at THR?

SB: I think it is a very integrated way of looking at this. So, the enterprise IT team pretty much worked very closely hand-in-hand with the digital team because it is a connected ecosystem, if you think about it that way. We keep in mind in terms of the EHRs that we have and how does our digital initiatives work and operate without each other in the right order? Because that has a lot of single source of truth. And in many cases, as well as and there are changes happening on that all the time. So, we have a pure said governance in the way that we can work with the IT team. And the IT team and digital team kind of complements each other to that extent to ensure that we created a connected ecosystem. So, all this process is in service of getting a connected ecosystem, which basically starts with a consumer standpoint. It also connects all the clinical workflows that basically goes into EHR. And this is a strategy that we believe in. And we kind of bring the people in that can complement each other both the digital side which is just sitting on the business side of the ideas so that we can achieve this objective.

PP: Yeah, it’s probably a segue into something that I was going to ask here anyway. Everyone acknowledges that healthcare has traditionally been behind other sectors when it comes to consumer engagement. The work that my firm does with health systems, in particular seems to indicate that, even within healthcare, health systems are probably a little bit behind let’s say health plans. And then you can tell me that because you have a background in health plans as well. And we’ll talk about that. But what makes it so hard to create these seamless experiences? Is that the fragmentation of the technology solutions landscape? Is it more the fragmentation of the way the efforts are coordinated within a health system? Not speaking specifically about THR, but in general what do you see as the big challenges of creating these seamless experiences that we are so used to when we talk about Amazon and Starbucks and Apple and all of that?

SB: I think it is a couple of things. Number one, the information sharing between the payer and the providers. I think there’s a lot of opportunity there in terms of how information gets shared. And these are two worlds and rightfully said, because that’s how the whole ecosystem and the value chain really works. The second is the ability for keeping patient outcomes in mind, between both the ecosystems, is very important. So, when you talk about connecting between a payer and a provider, it has to happen with some objective in mind. If we all keep patient outcome as an objective in mind, then obviously the integration becomes a lot simpler and easier. And the third thing is that the focus on value definition in terms of what value does it bring to the payer and the provider and the patient? We have to keep all those three things in perspective. And many times, there is misalignment of those objectives because of either the way the incentives really work, the way the reimbursement really works, the way the claims really work across the system. So, it is important that those objectives are aligned. And if those objective alignment, can be done, I think then the integration becomes a lot easier in terms of the payer and the provider work. And obviously, from a consumer perspective, they don’t care whether it is a payer problem or a provider problem. They need to get a service and they want the ease of service and the way it happens. For them, a retail works. So, I think there are some serious conversations that are needed in terms of how that interoperability really works between payer and provider. And I think those things are already started from CMS and other agencies. And this will become more and more better as we go by.

PP: Right. And interoperability, of course, is unfinished business. And you alluded to the CMS the final ruling, I believe, which comes into effect next year. And they had to push it back from this year. Well, we’ve come a long way from what it used to be maybe three years ago. But there is still a lot of unfinished business when it comes to interoperability within the provider landscape. And now you’re talking about provider payer collaboration as well. What is the view like from the payer side? I know you spent many years on the payer side. What is the view like and what gives us hope today that this current sort of friction, if you will, in payer provider collaboration is headed in the right direction in terms of a resolution in favor of patient outcomes?

SB: Paddy, I think it is a couple of things. One is the move towards value-based care, which is getting pushed by the payer side of the business, will really help active collaboration on patient outcomes. That’s one dimension I see being more and more. The second is, payers are really getting into a place where they are embracing a lot of patient engagement strategies where they want providers to participate as well. So, creating those narrow networks, for example, where it is close interactions with providers, ensuring that the right metrics are aligned, which means data sharing on both sides. And also, the payers are looking at getting more and more accustomed to doing partnerships beyond that ecosystem, whether it is a health and wellness partner or any other ecosystem partner. So, it is not a foreign concept of being able to share data outside the premises. So, with all of that, three things that I’ve talked about, I think I’m becoming more and more hopeful that this will become more on a progressive path in terms of how we see the interactions happen between the payer and the provider. And I think we will improve more and more going forward.

PP: Right. Let’s talk about the consumers themselves, because they are the third leg in the stool, if you will. Based on all the research that you do as part of your role. How are consumers perceiving the shift towards virtual? Do you see differences between demographics or parts of your own area served? How are consumers responding to this sort of dramatic shift, if you will, towards the virtualization of care? Are they ready for it? Do they appreciate it?

SB: I think I would say that the adoption of those kind of care delivery mechanisms is increasing day by day. I think among patients and consumers, because of COVID-19 the pandemic, the acceptance of new care delivery avenues have definitely increased. I will also say that it is also a mixed bag. There are consumers that can adopt this pretty quickly and there are consumers who really like to go back to an office setting. So, and this is purely consumer preference at this point of time. But the percentage of people that have adopted virtual really well and keeping themselves safe by staying out of offices is definitely a very positive percentage from an increase standpoint. And I see that going more and more. And I think it is also letting consumers to shift their preferences as well. I go back to that example of Apple, when Apple brought their phone nobody knew how to use it. So, Apple trained people to use the phone. In the same way, virtual will follow the same path. People will get trained to use a different delivery mechanism, which is virtual in this case. And people will get trained more and more. Once they get more and more trained, acceptance will go high as well. Because now they know how to use it. They’ll become more comfortable with it. And influence other people to adopt as well.

PP: And the training aspect of it applies on the caregiver side as well. Right? From everything that I’ve seen as part of our work, implementing a telehealth technology and expecting everyone to use it. Just not very realistic, because you have to know there’s a whole bunch of protocols to get on virtual care platform to initiate contact, to make sure that, both parties have access to the tool and they’re coming along on at the same time. And then training caregivers to be able to use the platform. There’s a lot of work behind the scenes. It sorts of gets missed in this in this whole discussion around. Hey, the technology is cool, don’t know why we didn’t we do this before? But then there’s so much heavy lift that happens in the background. Is that a fair statement?

SB: Yes, that’s a very fair statement. That is what is happening on the ground at this point in terms of how consumers are interacting and behaving.

PP: Right. So, when we talk about consumers and their adoption rates for telehealth or virtual care models, the term that often gets mentioned is digital front doors. And that is kind of your world. So, if we talk about digital front doors, firstly how would you define the term digital front door because I hear different definitions, although everyone uses the term. And what do you think are maybe the top two or three high impact engagement opportunities in a digital front door program in your experience and your view?

SB: So the way I define digital front door is a kind of a access mechanism that consumers really can come through, whether it is a known consumer, unknown consumer, and through that particular channel of the door and basically get access to the services that they are looking for. And I think the key perspective of digital front door is to ensure that whatever services and whatever conditions any health system provider really can service, they are all available in there in terms of how consumers are going to use it. So, this is more from a consumer standpoint than a provider standpoint. Typically, most of the provider groups and even health systems put out things which are primarily a reflection of what services that they have. So, if you put your lens in terms of looking from a consumer perspective, we have a very different definition to it. So, digital front door is all about managing or balancing that consumer point of view of what they’re looking from an access standpoint and matching that with what providers really can provide and creating that seamless experience. Another part of your question was what is the most important thing from a digital front door? The most important thing from a digital front door, in my mind is the ability for somebody to schedule an appointment. And basically, providing them the access to the provider that they are looking to really get in a very easy way in a consumer term. And consumer terms can be defined as different types of consumers you have and based on that; it is not a one size fit all. So, you’re now creating this a la carte set of services that you have to create to really address all the consumers so that they can get access to the providers. That’s the basic minimum thing that you need to have on the consumer front door to be able to be relevant to the consumers.

PP: Right. So, find a doctor, make your payment online, schedule the appointment. All of that happens very, very seamlessly. And then potentially you actually even do the consult through a telehealth platform. Is that kind of what your reference to?

SB: That is correct.

PP: Right. And that kind of aligns up to what we’re seeing. And of course, I think COVID -19 as a black swan event, has accelerated the adoption of these modalities for both consumers and healthcare providers alike. And it was coming along at a certain pace but it looks like it has accelerated. And people tell me that what was supposed to happen over the next five years suddenly got compressed to a five-month sort of timeframe. Is that experience you went through at THR as well, or were you’re already well ahead of the curve and you didn’t really have to kind of bend over backwards to stand up these capabilities?

SB: Well, that’s the exact experience we went through. So, we probably achieved so much in the first 90 days that we have not achieved in the last three years. So, just to give you some examples here. We completed hundred thousand virtual visits starting March and ending in August. A hundred thousand virtual visits and everything was created. More than 2000 providers were onboarded. All this happened within 90 days.

PP: How did this compare with the same period last year? I’m just curious. I know the numbers are going to be wide but I’m just curious.

SB: Last year, it was it was pretty non- existent. Right. We did not have a lot of virtual visits last year like it was in tens and hundreds. Right. Compared to 100,000 that we did this year.

PP: Wow, that is a wild story. And the funny part is that you’re not alone. It looks like many health systems across the country went through that exact same experience. All of a sudden, their worlds have transformed completely over the last six months or so. So, let’s just talk a little bit about the competitive landscape for healthcare services. I just want your views on what’s going on with your own marketplace. We have a number of nontraditional players that includes nontraditional, traditional enterprises. So, I’m talking about Walgreens, Walmart, those kinds of entities that are suddenly making a bigger play in the primary care space. And then you’ve got technology firms that are kind of getting into this space in their own ways. Examples of that being, Microsoft partnership with Epic, for instance, to launch telehealth visits from right inside Microsoft teams, which was announced just a couple of days ago. And then you’ve got Apple. And now Amazon everyone making their own place. What is your general assessment in terms of, what that implies for health systems such as THR in terms of changing the way you engage with your patients? And do you think that the primary care pie is going to get kind of redistributed among the broader set of participants that goes well beyond traditional health systems.

SB: Well, I think definitely that’s the way I look at it, that is definitely a market dynamics and a pressure in terms of how the market is going to change. Obviously, all these new players bring in new dimensions and skills into the market. And the way I look at this is, there’ll be a lot more fragmentation in terms of how the services will be provided to the patients and which has a good and a bad side. The good side is fragmentation leads to not being able to create seamless experiences. But the good side is it creates a lot of cost pressures on the traditional players, which can be really better on a payer and the consumer side. So, I think it is a pretty real thing in terms of how some of these players can disrupt.

But again, it is also in terms of how they are able to bring in some of those skills that can help integrate some of the services that is being talked about to really having a meaningful impact on the existing markets. And I think there will be a shift in terms of how convenient care, value-based care are going to be structured in the marketplace. And some of these players may have a higher advantage because they are coming into the business with pretty less overheads in terms of how they are structured. So, it will be interesting to really see how things shape up over a period of time. But at this point of time, it is a real market dynamic which we are all looking at.

PP: Right. We are coming up to the end of our time here, and I wanted to touch on one more topic. In your role, I’m sure you’ll get calls from a lot of innovative startups that have built tools, that can help you improve your patient engagement and patient experience and specifically from a digital front door standpoint. Now I have a two-part question. The first part of the question is, do you look at EHR as your default platform first before you look outside for a tool that could, perform a certain functionality? And the second question is, what is your advice to startups that have an innovative tool that can improve your patient experience and want to do business with you? What is your advice to companies like that? When should they come to you and how should they go about engaging with you?

SB: Well, great questions. So, the answer to the first question is yes, we look at the EHR to start with. And many times, we know the answers. And many times, many things are not addressed by the EHR because the way EHRs are set up from a business perspective. We look at either point solutions that really can bring what we are looking for or solutions that can integrate with each other to deliver what you’re looking for. That’s the kind of approach we use. In terms of my advice to any startup, I think healthcare is not just tech, it has people and process. I think whenever somebody is thinking about a product which is primarily a tech product, they also think about those two dimensions as well. A good product in my mind, which is meaningful for a provider like us, is a product which really has thought through all the three dimensions. And holistically kind of connects everything together to really kind of deliver the value that we need. Otherwise, it becomes a tech product. It cannot be integrated. There is a longer lead time to sell and stuff like that. So, that would be my advice. And healthcare is a people-based business, and it is very important to understand how tech enables this business where you have to keep people and process in mind.

PP: Right. That’s well said. In fact, one of the things that I tell people as part of our workers, digital transformation is IT enabled. But it’s not an IT project. It’s not necessarily IT led either. And, someone told me, one of the CEOs I talked to, digital transmission is like 80 percent people, 15 percent process and maybe 5 percent tech. And that’s kind of what you essentially said and they put numbers on it. But directionally, those are the two important dimensions and the tech is almost easy in comparison. Is that something you would agree with?

SB: That is, I agree with. Yes, absolutely.

PP: Fantastic. San, it has been such a pleasure talking to you. Thank you so much for sharing your insights and your experience. And wow one hundred thousand visits in 90 days, going up from zero to hundred thousand. That must have been a wild experience and I’m sure that experience alone puts you in a really, really strong place for the future. All the very best to you and your team and the work that you’re doing. We’ll be following very closely and maybe we’ll get back together and talk about it in another six months from now.

SB: That sounds great Paddy and I really appreciate you reaching out and always a pleasure talking to you and thanks for sharing this. As I said, if there is any question that comes and anyone wants to reach out, I can be reached at LinkedIn as San Banerjee and my Twitter handle is @banerjee_san.

PP: Thank you.

SB: Awesome. Thank you so much. Bye.

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 claritytechnology

About our guest

san-banerjee-profile

San Banerjee is VP Digital Experience for Texas Health Resources and leads the Digital Health experience for the health system, its subsidiaries, and joint ventures. He has more than 20 years of experience in digital transformation, product development driving digital business, information technology delivery, and management consulting, across regulated industries including healthcare and financial services.

Prior to Texas Health he served as the Head of Consumer Digital Solutions of Humana where he led the execution of Humana’s digital strategy through innovation and creating cross-channel digital capabilities/experiences with consumers, providers, agents/brokers, and associates. Under his leadership, Humana launched its first healthcare rewards program for Medicare and group members with more than a million members on the platform. He also led a major initiative to drive e-adoption among prospects and members by digitizing plan, insurance, and care documents, which resulted in significant operating expense savings.

San has many years of experience in financial services prior to Humana where he has worked for Barclays Bank, SunGard Financial Systems, Infosys, and Goldman Sachs.

San holds a Bachelor of Computer Science Engineering, as well as a Master of Business Administration with specialization in marketing from Southern Methodist University. He is also a certified consumer experience professional (CXP) and SAFe® Agilist. San has penned several research papers, and has even filed a few patents on mobile technology, digital channel, and payments.

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.

To succeed with digital health is to become really good at technology integration

Episode #59

Podcast with Marc Probst, Former CIO of Intermountain Healthcare and CIO of ELLKAY

"To succeed with digital health is to become really good at technology integration"

paddy Hosted by Paddy Padmanabhan
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In this episode, Marc Probst, who served as CIO of Intermountain Healthcare for 17 years, speaks about digital health technologies, telehealth, virtual visits, and how these will determine the future of healthcare.

According to Marc, the top technology trends that will define the future of healthcare are interoperability and digital health technologies. He says that technology in healthcare should meet the needs of the population that we serve; they should communicate with each other and responsibly share data. Marc describes digital health as facilitating what we do today using digital mechanisms like telehealth and moving towards full interaction with technology, where technology will provide knowledge, capability, and expertise.

COVID-19 has accelerated healthcare industry’s adoption of digital capabilities such as telehealth. Marc suggests that the health systems need to ‘become really good at integration’ for a seamless digital health experience.

Our Partner:

Podcast with Marc Probst, Former CIO of Intermountain Healthcare and CIO of ELLKAY in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “To succeed with digital health is to become really good at technology integration”

PP: Hello again, and welcome back to my podcast. This is Paddy, and it is my great privilege and honor to introduce my special guest today, Marc Probst, former CIO of Intermountain Healthcare and currently, CIO of ELLKAY. Marc, thank you so much for setting aside the time, and welcome to the show.

MP: Paddy, thank you very much. Appreciate the opportunity.

PP: You’re most welcome, Marc. So, let’s get started with this. You were CIO of Intermountain for a very long time and you’ve experienced your own share of technology changes. What do you think are the top two or three technology trends that are now going to determine the future of healthcare?

MP: Well, one of those may sound kind of self-serving, but I think interoperability is going to be a key requirement as we move forward for any of these things to succeed, because the second thing I would add would be digital health. And we will go into that, you will know what I mean by that in a second. But none of that really meets the needs of the populations that we serve, if our systems can’t talk together and share data in a responsible way. So, I think interoperability will continue to be really important. I’ve got a lot of history with that and why I think interoperability, I think digital health. I was just talking to a group at ELLKAY about that. They asked what I thought about digital health. And my answer was, there’s kind of two phases to digital health, from my perspective. One is just facilitating what we do today, using digital mechanisms like telehealth or even some of the handheld, iPhone-based kind of services and apps and that kind of digital health. And, of course, telehealth, our ability to communicate with physicians and other care providers through the digital means. So, it facilitates what we’re doing today. And I believe what we’re moving to is a digital health that is full interaction with the technology versus with human beings, where the technology will provide a lot of knowledge and capability and expertise to us as the consumers of healthcare. So those would be the two that come top of mind to me Paddy.

PP: We will unpack some of that in the course of this conversation. And, of course, you mentioned interoperability and you mentioned digital health. Those are kind of related to one another, one kind of drives the other, I guess. Also, I think alluded to the data and insights and we will come to that. Intermountain has done a lot of work in these areas. I do want to explore some of your thoughts on that. But before that, you’ve recently retired from Intermountain and have taken a role at a health IT firm. And I realize it’s early days yet, but I’d love to hear your first impressions on the view from the other side of where you’ve been all these years.

MP: Well, because of the organization I’m working with, my view is one of great excitement and opportunity. I love ELLKAY, I love the people there. I was a customer of theirs. And so, it’s something I’m very excited about and I think has a lot of potential. I spent 23 years actually in professional services serving the healthcare industry. So, I was a partner with ELLKAY and a partner with Ernst and Young. So, I wasn’t completely naive to what we affectionately called the dark side, when I was a CIO of our industry. I don’t mean that from dark is in mean, but, you know, we always are constantly looking for improvements.

But I am really excited about the potential of the organization I’m working with and just the kind of people that are there and leveraging. I felt I was valuable for twenty-three years. I kind of proved it to myself just how little value I was actually providing when I was a CIO. And now I think I have a richer skill set that hopefully, I can be of more value to the industry.

PP: Well, I wish you all the best in your new role. I want to talk a little bit about your experience at Intermountain since you were with Intermountain until very recently. Let’s talk about what you mentioned at the outset of this conversation, which was, digital health and interoperability. Let’s talk about digital health. Intermountain, to my knowledge, is one of the early adopters of telehealth. And you’ve had great success, especially with rural populations. And it’s well published. And there has been widely published articles about some of your work in that space. What do you see today as the general level of preparedness for this coming era of digital health and virtual care among your peer health systems? Can you also in that way, comment on the gap between what the top tier health systems may be doing and what the next tier is doing?

MP: Yeah, a lot of use of technology has to do with the sophistication of the health systems itself. And I don’t mean the sophistication of the technologies, but the actual care providers in the health systems itself. And Intermountain is remarkably sophisticated and courageous in taking technology and trying new things and what to do with it. So, we started really early on with telehealth. In fact, I remember our first foray into it was a good 15 years ago and the technology was incredibly young. But we decided to put it in an urgent care center and see how many people we could get the call in. And I think you could count on two hands how successful we were with that? The industry wasn’t ready, our people weren’t ready. But the thinking was there. And so, we kept a very close eye on the capability. And as it became more sophisticated, we started down the road of telehealth. We also had the advantage, like you just said, Paddy, of having a lot of rural healthcare facilities where we couldn’t afford to have all the specialists out there. So, if we wanted to provide care in those rural settings and not force the patients to come into one of the urban centers, we needed to get involved in telehealth and we did. So, we really started on the kind of B2B telehealth services and then ventured into the more retail kind of urgent care services. I think Intermountain is ahead not because, again, of our technical prowess, but because we developed a lot of playbooks and capabilities and people and getting them used to it. I don’t think the gap is massive between an Intermountain Healthcare and a much smaller facility that’s just getting started. Being a pioneer doesn’t mean you’re always going to stay ahead. It means you took some arrows and maybe you’re ahead for a while. But you also created a path that lots of other people could follow. I believe the gap isn’t that small and that it will get filled very, very quickly.

PP: Now, of course, COVID-19 has accelerated the shift towards digital and especially virtual care/ telehealth models. In this context, what do you think are or should be the top priority areas for health system CIOs, in that, not just dealing with the current situation, but also positioning the organization for what might be coming as their future state?

MP: Yeah. So, there’s always two sides to a coin. COVID had a silver lining in that. It got us really quickly involved in leveraging these digital capabilities, whether that was increasing our communications through texts or through other tools with our constituents or bringing in telehealth or just televideo to do meetings and the kind of things we’re doing right now. So, it means there was that bright side that a lot of technology got brought in very quickly and a lot of people got more sophisticated using it. But there’s the other side of that coin, the difficult side of that coin is the way we did it because we are forced to do it so quickly. In some instances, hours, but certainly in days, doctors moved home, administrators moved home, teams moved home. We would deploy just about any kind of technology to facilitate doing that. So now we find ourselves in an environment where a lot of disintegrated tools are out there that need to either be brought together or brought to a more singular platform to really make it efficient and effective for both, us as an organization providing the service, and for the patients or members or families that we serve. I think one of the big challenges right now that CIOs will be going through, I know they are doing it. So it’s you know, this is a novel that is to get this kind of quagmire, this cobbled-together solutions to something that is much more seamless, much more easy to maintain, secure, share data across. So, I think that is going to be one of the challenges that we have as we move more rapidly to this digital age. I feel kind of strongly about I don’t know how broadly this is shared, but you wrote the book so you can tell me is we’re creating non-native applications to facilitate communication or data sharing with the people that we serve. And what I mean by that is, if I want to text a doctor, I end up going into an application, signing into it outside of my phone, and then I can text within this very secure environment. And I believe more and more the challenge we’re going to have as technologists is not having these separate applications, but using tools that are native to the heart, the solutions that we have in our hands. So texting will be just like texting anyone else or looking up data like, I can ask Siri about my medical record versus having to log in into a separate application to do it. That creates challenges, but that’s when it’s really going to make this digital interaction much better for those that we serve.

PP: Yeah. You’ve covered several themes that we actually discussed in detail in the book, and you covered the fragmentation of the technology landscape and the need to integrate them in order to create a seamless experience for the patient. You talked about non-native application and that’s an interesting one, because when you say non-native, I’m hearing non-native to let’s say the electronic health record system and lot of health systems are kind of growing beyond their EHRs and are looking to best in class tools for certain kinds of functionalities. And I get the sense that they are doing that because the EHR system cannot be everything to everyone, which they also acknowledge. And so, it’s kind of forcing a certain best in class approach, which requires the EHR platform or the system of record whatever it is to be wrapped by best in class tools and solutions. And of course, the fragmentation and the use of best in class on top of the system of record creates interoperability issue, which is unfinished business. We have come a long way in the last few years. But it’s still unfinished business and we’ve still got a way to go. So, what will be the big takeaway from this is it that health system CIOs should avoid fragmentation of technology as much as possible or get better at integrating it, so they get a bit more seamless experience. What is your recommendation?

MP: No, I think they’re going to have to get better at integrating it. I mean, it would be naive to think that even the EHR vendors want to do, like you said, all the things that need to be done. And so, we can either depend on them to integrate solutions which will limit our options, or we can get really good at integrating and really good at creating the right kind of environments that allow us to plug and play solutions that we know. I mean, they’re going to change annually, maybe more often just because that’s how quickly the landscape is changing for us. So, I think the only way we succeed is become really good at integration.

PP: And what are the risks with that? If I can just stay on that point for another minute or so, you’ve got these best in class solutions or ostensibly the best in class solutions, but they are in many cases, small companies. They’re VC funded. They don’t make profits. They are very often new and not necessarily road-tested technologies. There are risks involved. And I’m sure you’ve taken your share of the risks as a CIO. What is your advice for not just the CIO, but also for tech firms that are trying to build a business in this kind of an environment?

MP: That’s probably a long conversation, but to boil it down, we’re going to make mistakes. I mean, we’re going to have like you said, we’re going to have to take some risks and place some bets. You know, you can do your homework so that they’re less risky, but there’s still risk out there. And I really think, again, these solutions are going to change rapidly. So, I need to be able to as a CIO, as a technologist or a technology team, I need to architect my overarching solutions in a way where I can plug and play these pieces in and out. And, that maybe I put certain requirements in place that the interfaces have to be FHIR based or some other kind of standards put in place that I’m going to do it, but that I don’t build these really difficult to build and unravel integration services, but that I have things that are much simpler to do so that I can change. I can take a chance with a certain AI-based solution. And if that company goes under or which would be the worst case, that if there’s something better that comes up that’s going to provide more value, that I can go ahead and make that change. And I really think that’s a skill set that we haven’t been tremendously strong on. We used to buy integration engines. And that was going to solve a lot of the problems and it didn’t. But we’re going to have to be good at this whole process of how to integrate things and be willing to change. I mean, we’re not going to sit on solutions like we do EHRs, a twenty-five-year-old solution, a solution would be a year or two.

PP: Yeah. It’s interesting you mentioned that, my firm is actually living through this with one of our clients where there is exactly this decision point just come to them with the firm that they’ve committed themselves to and it’s been going well for two or three years. And all of a sudden that firm is in difficulty. You know, there are financial difficulty. There is turnover among key staff. And then all of a sudden deadline have been missed and product is not coming out as quickly. So, I’m sure you’ve seen this movie before. And so, your advice is timely and makes a lot of practical sense. But that’s a nice Segue to my next question is kind of related to this. One of the reasons why you do choose to go out and acquire this best in class tools and platforms is in order to create a competitive differentiator for yourself with your population, the patient populations, give them better experiences, improve the quality of care in the process, improve productivity and all of that. Now, in the emerging landscape for health systems, the competitive landscape. How important do you think this is in order to compete against the CVS and Aetnas of the world on one hand, or maybe some tech firm that comes from left field and has got an entirely new way of doing things? Is this now becoming table stakes for health systems that you have to go out and work with best in class leading-edge technology solutions?

MP: Yeah. So, I’m a real believer that you have to be able to select good partners and work with those partners, whether those be technology partners or business partners in other ways. A strength that a CIO really needs to have is the ability to build those partnerships and maintain them and have them thrive. There’s no way, it’s just so complex. Everything that’s going on and it requires very fresh talent. And having been a CIO, it’s not easy to constantly refresh the talent on your team. You kind of have a team and you work with them and they’re excellent and they do great things. But to think that I can continually keep the most up-to-date skill set within my team is, again, kind of naive. So, you have to have the right kind of partnerships to help you solve those problems. And if you do that, then I think you can solve a multitude of problems. And you are going to have good partners, just like we were talking about, you are going to take risks on one that aren’t going to be that good a partner. That’s the skill that a CIO has to happen. That’s what we need to be able to do as CIOs.

PP: Just curious about one follow up thought on that. Do you think as a consequence, CIOs are going to become more technical in their personal abilities? Or do you think it’s going to be more to do with managing partnerships and having them all play well together?

MP: So, I think you’re going to see a bit of bifurcation. Those skills all need to exist, whether building those partnerships and technical skills. I do see a track for a very technical CIO. And the reason that’s going to happen is because the business itself is becoming so much more tech savvy. So where 20 years ago we had to convince people that a mouse was an OK thing and that this was a keyboard, this was a CRT. Because we were the only ones. We were the only nerds out there that were paying much attention to it. Today people are very sophisticated around technology. And what many organizations are going to need is someone that can get deeper into the technical aspects of it. And they’re going to have CIOs to do that. I don’t think you can get away from the skill set of being a good people person, a big builder of those relationships. So, it’s going to vary. It’s going to vary by the situation and what else exists in the leadership team of an organization that both skill sets are going to be very important.

PP: So I’m going to talk about digital health and digital transformation, Marc, switching topics here. So, one thing that I pay a lot of attention to as part of my work and part of my firm’s work as to how are health systems organizing themselves to drive digital transformation. What does the org model look like? Who owns the digital transformation function? And I see that there is no straightforward answer to this. By default, it seems like, it is the CIO in a lot of organizations. But with a lot of the leading health systems, you have these dedicated roles for Chief Digital Officers, many of whom have come from outside the industry as well. So, what is your sense today of where ownership for digital health and digital transformation lies today? And what, if anything, should change for accelerating transformation?

MP: It’s owned by the CEO; it is what it’s owned by. And again, pretty naive to think that’s not where we’re going right. That we can just continue to operate the way we’ve operated for the last 40 years. So, the CEO owns digital transformation and how we’re going to deliver services going forward. We all play different roles. So, at Intermountain Healthcare, we had a CIO and we had a Chief Digital Officer. And Chief Digital Officer was much more of a marketing type person. And that’s actually the background that he came to Intermountain with. But it served us really well because we were focused on digital and how are we going to change the way we did things and how are we going to change our perception within the community that we are more of a digital service? The technology work around that. That was mine, that was my team. That’s what we did. But CEO owned the problem and the CEO drove it. And that’s why Intermountain has been and will be very successful in this space. There are going to be places where it’s the CIO that’s going to be a much slower transition for that organization. They may even ultimately fail, not because the CIO is bad, but because it’s coming from the wrong place. Technology, it’s a tool. It can facilitate that shift. But the actual shift is people making that shift. And that takes the leadership of an organization and operations and ultimately CEO.

PP: Yeah, one thing I like to say is digital transformation is technology-enabled, or IT-enabled, it’s not necessarily IT led. The difference may sound insignificant to some, but what I see in the market is that CIOs don’t necessarily have to do it all. In some cases, I have seen a great collaboration, just like you described at Intermountain, which really makes the difference. And of course, you’re right about the fact that it has to come from the very top, the CEO and indeed the board, for that matter. We are coming up to the close of our time here, Mark, I just wanted to touch on one of the things in the immediate context of COVID. We have seen the results come out. The financial performance of health systems for the first six months has not been great. And in an environment of declining operating income, how do you see it impacting the pace of digital transformation, but also the level of technology investments? And what is your advice for tech firms in this context now that your part of a tech firm as well who are likely seeing reduced IT budgets and longer sales cycles as a consequence?

MP: Yeah, so the broad thing that comes to my mind is a race to the bottom makes everyone a loser. So, there’s no possible way that healthcare is going to cost cut itself to being successful or thriving. And so, it’s where investment gets made. And like just about every other industry, it’s come through investment in technology and using that technology to create efficiencies and better solutions for those we serve. So, I believe there’s a lot of wise people in leadership positions in healthcare, that those investments are going to continue to get made. That doesn’t mean we won’t see cost-cutting because there will be and there has to be. But there also has to be this investment in technical solutions, particularly digital solutions, digital health solutions that will allow the industry to thrive and will allow a much more ubiquitous set of solutions. You know, again, right now, it’s regional. I mean, healthcare is so regional and it’s so different. I mean, the level of care and the outcomes can vary by zip code. That’s because of the way we’re currently formed. But moving forward, technology is going to level the playing field not just across our country, but around the world. And that’s when we know we’re going to be successful. So, if I were, which I am involved in a technology company in healthcare, I’m very bullish on the future. However, to thrive, we have to show that value. And we can’t just be talking about it. We have to show the value that we can provide. And I think there’s a very white field out there just ready to be harvested.

PP: Oh, that is so well said Marc. That’s a perfect note on which we can end this podcast. Thank you so much for coming on the show. And I really appreciate your comments and your insights. I wish you all the very best to you.

MP: Thank you very much, Paddy. Appreciate the time. And congratulations on your book and 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

About our guest

Marc Probst is the Chief Information Officer of ELLKAY. Before joining ELLKAY, he served as the Chief Information Officer and Vice President at Intermountain Healthcare for 17 years. 

Marc has been involved with Information Technology and Healthcare services for over 35 years. Prior to Intermountain, Marc was a Partner with two large professional service organizations. Marc has significant interest in the use of information technology to increase patient care quality and lower the costs of care. He is experienced in information technology planning, integration, design, development, deployment, and operation. 

Marc was appointed to and served 7 years on the Federal Healthcare Information Technology Policy Committee assisting in developing HIT Policy for the U.S. Government.

He has also been a Board Member of numerous Healthcare Information Technology organizations and served as the Board Chair for the College of Healthcare Information Management Executives. Marc currently serves on several HIT company boards and is a board member of Nemours Children’s Hospitals. In early 2020, the College of Healthcare Information Management Executives (CHIME) and the Healthcare Information and Management Systems Society (HIMSS) jointly recognized him as CIO of the Year.

Prior to living in Utah, Marc and his family have lived in Reston, Virginia and Tampa Florida. Marc is married with 5 children which span in age from 35 to 17 years old. Marc is a graduate of the University of Utah in Finance and earned an MBA from George Washington University.

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.

Telemedicine will become a fundamental aspect of care delivery because of its effectiveness

Episode #58

Puneet Maheshwari, CEO
DocASAP Inc.

"Telemedicine will become a fundamental aspect of care delivery because of its effectiveness"

paddy Hosted by Paddy Padmanabhan
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In this episode, Puneet Maheshwari, CEO of DocASAP discusses their platform and their recent survey on consumer experience and attitudes to telehealth/ telemedicine.

Puneet believes that frictionless patient access is critical for reducing costs and improving health outcomes. COVID-19 has been a very high impact phenomenon for the healthcare industry. Their recent survey on telehealth consumer experience reveals that the telemedicine adoption rate increased by 92%. However, we cannot think of telemedicine in a silo; we need to blend it into the overall care delivery continuum, which is a foundational piece that must be solved by healthcare providers in the future.

According to Puneet, the reason telemedicine is here to stay and become a fundamental aspect of care delivery is because of its efficiency and effectiveness. The biggest takeaway from their recent research is that telemedicine is opening the door to the digital practice of medicine and a digital-first care delivery model.

Puneet Maheshwari, CEO DocASAP Inc. in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Telemedicine will become a fundamental aspect of care delivery because of its effectiveness”

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, Puneet Maheshwari, Founder and CEO of DocASAP. Thank you for setting aside your time to join us on his podcast. Welcome to the show.

PM: Thanks for having me.

PP: Wonderful. So, let’s kick this off Puneet. Why don’t you tell us a little bit about your company and the product platform that you’ve developed over the years.

PM: Sure. DocASAP is an access engagement platform. We are pretty unique in the sense that we were both with the payers and the providers. From the very beginning, the mission of the company has been fairly straightforward, which is to streamline and reduce the friction when it comes to helping the patient find the right provider in the right setting at the right time. And while it sounds cliched over the course of the last several years that we have been doing this, we have come to realize that frictionless patient access is critical for reducing costs and improving health outcomes. What we’ve also realized is that payers and providers both lack meaningful solutions for effectively engaging and navigating patients to optimal care providers. What this results in is decreased quality of care with suboptimal outcomes and increased population risks, increased costs with consumers ending up at suboptimal care providers, and purely from the sense of and the side of the patient, fragmented access, which is uncoordinated, leading to frustrations and suboptimal outcomes overall for all parties involved. With that in mind, we evolved the DocASAP platform to have key three core capabilities. One is what we call navigation and matching. We have only one in the industry who will really go deep to fully understand the clinical and operational intake protocols of the providers. We translate those protocols then into decision trees that can be laid or end to end organization’s delivery model and use those decision trees then to help the consumer navigate to the right provider. Over the course of the last five months, particularly while we supported this before, setting or getting the consumer the right setting has become even more important. And that has been one area where we have doubled down over the course of the last five months. The second part of our platform is around accurate scheduling and the operative word there is accurate. We connect real time to the underlying practice management system and then also take into account all the considerations that the providers put in terms of managing their time and how they want to fill their appointment slots. With that information in real time access to that inventory, we then enable consumers to book their appointments instantaneously across all pathways that they use and trust. And the third part of our platform is what we call actionable engagement. And again, the operative word here is actionable, which is pre, peri, and post of an encounter. How do I enable the consumer to be prepared for that appointment, how do I remind them for that appointment, how do I make it easy for them to reschedule or cancel? And then post appointment how do I engage them for follow up care, which may be pertinent for the last encounter that they just had? And the key really is taking this platform and then touching the consumer across the care journey from when they’re searching for a provider, helping them select the right one, helping them schedule for a timely appointment across all different kinds of care settings that may be pertinent helping them prepare for that appointment and then engaging them for all the follow up care that may be needed from thereon. Where we’ve taken significantly farther is how we deploy this platform, because what they’ve come to realize further is that consumers use diverse and heterogeneous parts for finding care. On one side we power all sorts of digital channels, such as providers owned web and mobile properties or their digital front doors. We work with some of the largest health plans in the country to power their member engagement and doctor finder applications. We power search and social sites like Google, my business pages or embed our capabilities across other social sites. But then we also realized that there are other established pathways that the consumers take which are not digital, such as we enable access centers to have this capability so that they can help the consumer to help them get to the right provider within their health system. The power of similar capabilities for community providers or ambulatory providers so that they can refer patients into a specialty care, radiology lab, et cetera. And then we accentuate our capabilities in acute discharge settings. So, the discharge teams of hospitals or emergency departments can streamline, follow up care for the patients out there getting discharged from the acute settings.

PP: You’re in an interesting space. And by the way my firm, which is a digital transformation advisor firm that works with a lot of health systems and health plans, we are on the other side of the equation. We actually look at patient journeys and we look at all the different digital engagement opportunities or touchpoints and what kind of tools and platforms that are there that can enable that. And clearly the doctor finder is now getting more important than ever because consumers or patients are getting access to care and doing a lot of the things related to that access online and as. So, it’s kind of a mode. We are seeing this gaining importance. Let me ask you a couple quick questions about the landscape you’re in and then we can switch to other topics. When I look at the technology provider landscape for a situation such as yours, firstly, you’ve got the core systems of record, if you will, the big electronic health record platforms and have some of the functionalities that you just talked about. And then you have at least on the health provider side. And then you have the competitive landscape where there’s multiple tools out there that could be competing with your core platform. This is a find a doctor kind of capability. So, when you put yourself in that mix. Do you see your platform as something that complements what EHR systems do on the one hand? Is it a replacement, maybe a better tool compared to what they have native to their platforms? And what else is it that makes you a little bit different and unique? If you could just point out one thing that makes you different and unique.

PM: Let me touch both of those points because those are separate entities in terms of how to think about the overall problems. So, when we think about EHR or electronic practice management systems, what we’re realizing, working with several of our large enterprise healthcare delivery, clients that, EHR systems are built with providers in mind. So, they are more inward facing. And the solutions that have been developed are also developed with an inside out mindset, which tends to have platforms and solutions that do not really work and direct to consumer settings. You really need to apply an outside in mindset when you’re looking at how to engage the consumer and how to really engage the disengaged consumer, if you will. And that has been one big differentiation, that we have been able to bring to our provider clients. Another thing to think about is the space overall. While EHR organizations and practice management organizations by definition are health records or tools for managing practices, they are not really digital tools for enabling access and engagement for the consumers. So, it’s a completely different category in that sense. And some EHR service providers are looking to play in that category. But in most cases, they are still focused on their core business, which is around robust health record systems and robust practice management systems. Now, coming to the competitive landscape that we play in, particularly in the context of that digital front door, I would say that there are two core differentiations that we bring to bear compared to anybody else in the industry. One, we are not a point tool, we are a much broader platform that takes into account the overall patient journey and not just finding the doctor and help the consumer in that journey across all pathways that they use and trust. So, the holistic nature of the platform is one thing which has been a big differentiator for us as we have worked with large health organizations. The second piece, which is highly differentiated for us, is the ecosystem that we have been able to bring together as we solve this complex problem of helping the consumer get to the right provider, right setting the right time. And what I mean by ecosystem in this context is how do you really bring the payer and the providers come together and do and achieve the results in a collaborative way and deliver the coordination that is needed for the patient or the member? Whichever way you look at it, for better outcomes and reduce cost structures. And so, on that side, on one way we work with the large provider groups. But then we also work with large payers and then connect them together through our platforms such that at the end of it, consumers get what they need to get from an access and engagement standpoint. And that ecosystem is a very unique thing that we have been able to bring to bear, both for our provider clients as well as our payer clients.

PP: Very interesting. And that is actually a perfect segue to the next topic that I wanted to explore with you. Your firm recently did a fairly significant survey of consumer attitudes and consumer preferences as it relates to online engagement with their providers. And in the wake of COVID-19, we know that many things have been forced upon us. And I think your report goes into aspects of this new normal that consumers have adapted to very well and some that they have not particularly adapted well to. You want to touch upon some of the highlights of this. What was the driving force for doing this survey and what did you hope to accomplish? Tell us a little bit about some of the key findings from the survey.

PM: Yes. COVID-19 has been a very high impact phenomena for the healthcare industry and Paddy you are seeing this from your vantage point. And we are definitely seeing it from ours. I would say we are seeing close to five years’ worth of innovation acceleration happening in three to five months. And that is creating a significant disruption, if you will, at a pace that has otherwise not been experienced by the healthcare industry. And that brings me to the survey that we did and why we did that. As we were seeing that disruption happening. It was important for us to start understanding the underlying themes that were driving that disruption. And where should we then expect the new normal to fall was equally important for us to understand. The underlying themes essentially fell in three broad categories. One was around contactless access, and that theme was there before the pandemic and which got dramatically accelerated during the pandemic. I think we were already on that journey. But as I said, we saw that five years’ worth of acceleration in three months. The second piece that we wanted to understand was how this is really affecting consumer behavior and provider behavior overall. And the third piece was around looking at what are the foundational pieces that would need to be put in place to help our customers be the payers or the providers aligned better to those major trends that will be coming out of this pandemic. So that was the fundamental premise for doing the survey in the first place. So, we did survey around thousands U.S. adults those who had used healthcare provider in the last 12 months. And the learnings are pretty interesting. So, one no surprise there was this massive utilization of telemedicine beyond what it was. And the adoption was kind of increasing 92 percent of our respondents who have had a telehealth appointment said that they were satisfied, and their overall telehealth appointment experience was positive. When asked to describe their telehealth appointment experience, the top three descriptors were easy, efficient, and convenient, if you will. And those are fundamental themes, again, that we have to understand to say ‘Ok where the pick is going to be. Eventually, consumers, stations, members are looking for convenience, efficiency, and ease. And as a healthcare solution provider helping the healthcare providers overall. We need to think through what will help the consumers get that ease, efficiency, and convenience. But what was also very evident was the anxiety where in-person visits, at least in the short term. We heard loud and clear that respondents were not comfortable going back to see a health care provider in person until at least the fall. And there was a proportionate number that said they are not comfortable going back to a doctor’s office until early 2021. It’s pretty amazing when you start comparing the results and see that the respondents felt safe for going to a grocery store or a hospital or a doctor’s office and in a doctor’s office or somewhere around 26 percent compared to a grocery store, which was 42 percent. And those things are pretty eye-opening as you start thinking about how we going to go back to normal and how will we convince these consumers around the safety of the care that can be delivered within in-person premise. And as we started kind of taking that and talking to our customers, we started realizing that telemedicine is here to stay. And if you look at, you know, secondary searches done by firms like McKinsey, you’re seeing a massive shift of care delivery dollars going through telemedicine. But there’s also a realization that you cannot think of telemedicine in a silo. It’s not just about, you know, on-demand acute care. It’s about how do we blend telemedicine into the overall care delivery continuum. And how do we then make sure that the consumer, based on their specific needs, is navigated to the right care settings? So, if it’s a first appointment, which requires an in-person visit and you’re helping them get that in-person visit. But if it’s a follow-up, which can be done remotely through a video visit or a phone call. The consumer’s navigator to that. And enabling that streamlined, flow of care delivery across those different care settings is one foundational piece that has to be solved by the care providers as we move forward. I would say the biggest takeaway, which shouldn’t be any surprise to anybody, was that telemedicine is opening the digital front door to the digital practice now. So, the world is moving to digital-first when it comes to health care. And you would see a massive acceleration towards that mindset both from the consumers as well as the providers as we get out of the pandemic and start thinking about what the new normal is going to look like.

PP: Yeah, everything that you said makes a lot of sense, especially in the immediate wake of the pandemic. I want to unpack that a little bit. So, what I do like about your earlier comments is the B2C focus that’s never been part of how healthcare operates in the past, at least. And now, in fact, my latest book, which of healthcare digital transmission, the subtext to the title as how consumerism, technology and pandemic are accelerating the future. We already covered two of them. Consumerism and pandemic and of course, we are in this podcast is all about technology and how it is driving transformation in healthcare. The consumerism aspect of it is the unfinished business. It’s still in early stages. We found the same thing that you talked about, which is that yours were the transformation effort has now been compressed into a matter of months and is putting an enormous amount of strain on organizations while dramatically altering the ways in which healthcare is access to consume. At the same time, the more recent data that’s based on our research, it tells us that we swung a little too far to one extreme in terms of virtual care models, telehealth, telemedicine, real time, virtual consult things like that. In the immediate wake of the pandemic because there was no option. But now it’s all pulling back a little bit. And, you know, there’s some kind of a variety of reasons, some kind of care cannot be done remotely, whether you want to or not, whether the technology is available or not. And then, of course, there’s a question of all of the revenue dollars. And in healthcare, you know, everything you need to follow the money right. Now, where the reimbursement is coming from, what are the puts and takes in terms of lost revenue versus what you can gain from telehealth visits and so on? So my question is, do you feel like you’ve reached some kind of an equilibrium? And if not, how long do you think if you were to look out a little bit, how long do you think, before we get to a point where we say, you know what, this is going to be a 60-40 split for all primary care visits between telehealth and in-person visits. Something like that. Can you share your thoughts on that?

PM: I don’t think we have gotten to an equilibrium right now. I think we are still in the middle of the pandemic. The surges are still happening, and members are still kind of going back and forth in terms of our level of comfort around whether it’s behind us or not. So, till the time that’s going on, I don’t think there’s going to be a very meaningful equilibrium that is reached. Having said that, there is an equilibrium eventually. And when I think about that, I think in two big parameters, if you will, one parameter is the disruption that is happening. And if you look at the new normal, I see the disruptions happening both on the business model side as well as on the technology side. And, you know, it’s easy to manage one disruption when it’s happening. And this is a bit of a perfect storm of sorts where we are having these still disruptions happening at the same time, which means that there will be winners and losers and organizations will have to really embrace these disruptions and navigate through them with the nimbleness and ingenuity. The second piece is around, you know, what are these disruptions really driving? And in my mind, the reason why telemedicine is here to stay and become a fundamental aspect of care delivery, if not the preferred health care delivery, is the efficiency and effectiveness aspect of delivering care to that pathway. And you touch the effectiveness part of it by highlighting how certain aspects of the care cannot be delivered in a virtual setting. But I think that’s a moving target in my mind. I think what we have come to realize is that more and more care can be done in a remote setting that doesn’t always mean that it has to be over a video call or a phone call. It couldn’t be through remote monitoring. It could be through shipping diskettes to individuals so that they don’t have to come to a lab and get exposed to other kinds of infections. It could be about augmented reality in future. I think the theme has to be consistent and till the time theme is consistent. The technology will catch up to that and one way or the other. And the theme really is that when you deliver care in a virtual setting or in a setting which is at home for the consumers, more efficient for the consumer and the provider. It’s more cost-effective. It’s less risky. And those three points are critical as you think about delivering ambulatory care of the future. So, in my mind, the world is moving to digital-first care delivery. The pandemic was a very strong impetus to push us in that direction. And you’re right, we probably swung a little too far on that side. But what it has also done is it has opened the eyes of the consumer and the providers, I would say, on the benefits that come out of it around efficiency, around cost, around the overall risks. And what that means is now the technology is going to be following that trend and we’ll be solving things that we haven’t seen solved till now. And you and I will both be very surprised end of 2021 on the amount of care that can be delivered in a home setting.

PP: Yeah, I think I agree with you there. What are you seeing in terms of the demand environment coming down to the real situation on the ground, if you will, for one of your own products and services? But in general, for digital health capabilities and the kind of tools and platforms that health systems in particular have to invest in order to prepare for this new normal or next normal and really position themselves for the inevitable digital future that you just talked about.

PM: Yeah. So, again, I would put it in, you know, two horizons. One is the immediate horizon. Another is the more midterm horizon. The immediate horizon is about helping our customers in my mind. Many of our customers are really struggling financially, given what the pandemic threw at them. Ambulatory visits dropped almost 50 percent for several of the providers across the country. And when the pie shrinks, you can only a vendor. You have to be a partner. And that is the approach that we are taking. What we are also realizing is the opportunity that this crisis is creating for our customers and for ourselves, which means that we have to double down in the investments that we are making for that midterm to long term growth that we can expect in the digital capabilities that are going to be used in the market. So, till the time we keep that set of horizon and mind, I would say at this point in time, yes, we are seeing a lot of demand in terms of providers realizing that they are behind the curve on some of these capabilities. But we also understand that they themselves are struggling financially. So, we are approaching it a very partner-oriented mindset. And then we also realize that nobody really knows where technology is going to be in two years, three years from now. And the companies that are going to be successful or companies who make their investments listen to their customers, keep their ears to the ground and execute. So those are the two ways we’re looking at the market and we believe that we are pretty strongly position with partners and customers that we have. We have been able to associate ourselves over the course of the last several years, and it’s going to be a very exciting ride as we move forward. I wish we didn’t need a pandemic for all of this to happen. We all would have been happier without it, I’m sure. But if there is a silver lining to any of this is the fact that we all are becoming more open to change and change is the name of the game if we want to move the needle on cost and quality in the U.S. Healthcare.

PP: Right. Never waste a crisis, as a wise man said. Well Puneet, it’s been a fantastic conversation. I’m afraid we’re going to have to leave it there. We’re coming up to the end of a time. But I wish you and your company and all the very best. You guys are in the right place at the right time. It looks like and I look forward following your company and the progress that you make. Thank you again for coming on the show.

PM: Thank you so much for having me, Paddy. It has been a pleasure.

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

puneet-maheswari-profile

Puneet is the CEO of DocASAP. He is a technologist with more than 17 years of experience working in various Silicon Valley technology startups and in the business technology office of McKinsey & Company.

Puneet earned his Master of Business Administration in Finance and Entrepreneurship from the Wharton School of Business, University of Pennsylvania.

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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