"Our mission with digital health is to provide guidance and choice to consumers in an easy, frictionless way."

Q. Ashis, can you tell us about BS&W and your role there? 

Ashis: We’re the largest not-for-profit healthcare system there, servicing 46 counties with 52 hospitals and a completely integrated delivery network — inpatient, outpatient, and all types of physicians. We have roughly 7300 physicians in our system and 49,000 employees. I have been with BS&W for 11 years now. I came in as and still practice as a Pediatric Gastroenterologist. I’ve had this role — Clinical Lead of Digital Health — for the last two years. 

Q. You’ve been with and seen the digital health program evolve over time, so, give us an overview of the digital health capabilities that you’ve implemented at BS&W over the last couple of years? 

Ashis: Baylor Scott & White Health were early in the digital health game for incumbents and so, we’ve had a digital front door – it’s an overused term today – since 2016-17. That’s separate from the one on MyChart and we are an Epic shop. Our digital studio envisions becoming the most desired consumer-centric partner for people’s well-being. So, that’s a critical vision we base our decisions and the products we roll-out, on. We want to think of ourselves as a very consumer-centric organization. The digital health office then, obviously plays a major role in that vision. Its features and capabilities are really focused on five strategies revolving around our digital front door to accord us unprecedented convenience, personalization, and accessibility. 

This also involves a big CRM tech stack that drives consumer engagement with the right message at the right time. 

We also look at innovative products that can get us closer to the consumer. We incumbents probably have something that the disruptors don’t necessarily do and that is brand permission that enables proximity with our consumers as of now. We need to capitalize on that. One line that we like to say internally, in that context is — we want to build Netflix here and don’t want to just make blockbuster lines faster. So, the key lies in not being iterative in what we’re building, but really thinking differently in our products. 

I’ll rattle off a few others here – creating systems of intelligence. We look at data and engagement and Epic, which is our EHR, a system of record. We look at other products and partners that can really envelop the EMR to enable us to get closer to the consumer automation. Lastly, we’ll call it a digital practice, which is building a platform to orchestrate care. We’re certainly providing care but in the new normal, because of all the partners in the ecosystem, the disruptors and, as seen in big tech, we are turning from providing everything to everyone to really orchestrating the journey. We want to put that together as a trusted partner. 

Q. Healthcare is not necessarily known as a consumer-focused industry so it’s refreshing to hear this. Now, you’re at the forefront also because your mobile app is rated very highly. Tell us about the genesis of the app and what it does for your consumers, today? 

Ashis: Thank you for calling that out since it’s really important to who we are. The consumerism aspect of things — and as a physician especially, I will just say — when I speak to physicians and we say “consumer,” there’s a little cringe or some kind of negativity. I just remind them that consumer or the definition I have around it, is actually the “patient,” plus the context of who that individual is outside of their healthcare. Once you really kind of level-set this, it seems to resonate. 

We’re very proud of our mobile app, which is very highly rated. Its genesis can be traced to another terms not usually seen in healthcare – Agile. We came together and made a decision to be more agile so, our app was based on a kind of agile methodology. It’s taken five versions, 40 sub-versions and considerable stakeholder involvement to really get to where it is, today. It was certainly a platform before platforms were cool. 

I’ll give credit to our Chief Digital Officer, Nick Reddy, who had this idea that, our brand is important, and we must unload our digital front door from our EMR. He had a bigger vision of being able to truly have a platform that could be customized to ensure a personal experience for all of our members. This was something we could use for our whole integrated delivery network, which includes a lot of joint ventures, specialists and hospitals that aren’t in our medical posse. So, they don’t have an Epic MyChart. Then, how could we take in full, consumer experiences, have every part of their journey — whether they’re in or out of our medical group — and really create an app while integrating it with the EMR? MyChart was really the only way to do that. So, it’s a fantastic app because it does let you sign-up without having ever walked into any of our clinics and to consume care. 

Q. Based on your experience with the app, what can you tell us about how consumer preferences have changed and how BS&W responded? What did the pandemic tell you and what changes have you made since? 

Ashis: That’s a great question. A couple of words come to mind. One, is guidance. Our users want to know if they need a doctor, when do they need them, where should they go and who should they see. These simple questions lead them to Google and other websites rather than their healthcare system. When we learned that consumers want their doctors and systems they know and trust to answer these, they’re looking for guidance, we saw it as our mission to provide that in a very easy, frictionless way. 

Once we’ve guided them, they’d also want choice, right? With price transparency and a lot more cost-sharing. This is a big reason why healthcare is beginning to look a little more like retail. So, our consumers get a choice same as they’re expecting in retail for where to go to consume care. 

Q. You have created a best-in-class mobile application and set the benchmark within healthcare enterprises. In 2022, what are your big investment priorities and where does your focus lie?

Ashis: I think that when moving into the orchestration of care space, scale matters. So, growth and using our digital and virtual tools to really grow as a system and move to markets that we may not have a physical footprint in, will be big priorities for us. You’re seeing that with a lot of large health care systems, today. 

Q. What would be an example of that — going beyond your current footprint, using your virtual means? Give us an example. 

Ashis: So, we see a lot of people moving into virtual primary care and so our virtual-first primary care product allows us to get into many markets and geographies that are not necessarily where we have a physical footprint. So that’s an example. 

I think other examples are around a lot of talk about home. We’re really leaning this year into home and hospital-at-home care. Home convenience, like vaccines-at-home labs, and some other home convenience products are what we will roll-out. 

The other thing is really creating a retail-like experience for all of our consumers, whether you’re in our physical geography or not, much like an ecosystem connector, right? So, if you’ve done genetics through 23andMe and if you are an avid Peloton rider, you know where you have these other retail-grade experiences that are part of your health or your wellness that we want to know about. People expect their health systems, their doctors to know them for who they are and again, other things that they’re doing regarding wellness. So, we’re working to connect to their whole world if they allow permission for us to do that. 

Q. What kind of challenges have you addressed along the way – tech, data, integration, internal culture-related? Talk to us about a couple of the big ones you’ve worked through in the last couple of years. 

Ashis: I’ve heard you say many times that, it’s 10% tech, 90% people, right? You’re absolutely right when you say that. The tech isn’t terribly hard now. The caveat to that is we’re short-staffed — on the nurses, tech, data people, engineers, designers’ sides – and talent is hard to find to really create this wonderful team. So that is a challenge today that we didn’t have as much, a few years ago. 

That being said, I’m a physician, so, we doctors don’t really move at speed with new technology. Working on the physician side of the house and getting things to really move at scale is why my position exists. I do think it’s important to find a physician champion that really understands both sides of the equation and moves a lot of these digital tools to help health systems become scalable and operationalized. 

Then, the other thing I’ll say is that a major challenge is, legacy healthcare systems have had this culture of a vote by veto. Typically, here, you have one stakeholder that just says “no, we can’t do that” and the whole thing falls through. That’s another challenge. We’re really working hard to change the culture as such to say “yes” versus “no” and then, really letting something fail. 

Q. In an abundant yet fragmented technology landscape you have to take a lot of different technology — Epic, which is your core system — and layer on other stuff including your homegrown mobile app. How do you make all that work together to create a seamless experience for your clients? 

Ashis: It’s what we wrestle with every day. It takes a large team and a lot of resources to really do it, especially since our app and video visits platform are homegrown. We’re quite blessed to have a very talented team — engineers and designers — as dedicated resources for digital health at Baylor Scott & White Health. They’re very passionate about healthcare.

I don’t think that in healthcare we always sell ourselves really well to the outside world as far as our mission is concerned. But if I talk to these teams every day, they have the same passion for healthcare that I do as a doctor taking care of my patients. Once they’re invested and in, we realize that the work they are doing is improving health care and health outcomes. They find a lot of value in being in health care versus other industries, so, the other aspect of that is that we really try to spend a lot of time on that internal culture within the digital health office to really be able to see the outcomes of other products. 

Q. You made such an important point – it isn’t the money but the sense of mission and purpose – that’s something I’ve observed across every health care organization I’ve worked with. You mentioned data and how you’re using it to drive experiences, understand your consumers etc. Talk to us about data and analytics and in that context, about you, as a member of the Truveta Consortium – a group of health systems coming together to pool data assets to drive insights that can collectively improve healthcare outcomes.

Ashis: Thank you for bringing up the Truveta Consortium. They’re adding health systems every month now, which has been wonderful because there’s a lot of data and there’s big data. They’re up to 16 percent of all U.S. healthcare data, which is certainly a large percentage. 

Talking about data, one term that gets thrown around a lot is personalized care. But to get to that end of the spectrum where we can predict people’s outcomes and be prescriptive in their care, we need data. I love to give the example of a particular patient I meet in office to who I say, “It looks like in a year’s time, you have a 40% chance of developing diabetes.” Now, if I left the conversation there, the person walking out of that door wouldn’t be happy. So, if I can then, take it a step further and say, “If you do these three things, then you can reduce that risk by 50%.” How do we get to that place in healthcare? 

I certainly don’t think Truveta alone will solve for everything but having that big data and being able to utilize 16% percent of the U.S. healthcare and leveraging the diversity of data that Truveta brings – that is important. 

We talk a lot about big data but data also needs to be diverse. One stat that appalled me when I saw it was — only less than three percent of research data is comprised of Hispanic and African American patients. We make so many decisions on incomplete data that does not represent the patient that’s sitting in front of us. To get to a point where you can actually personalize care to then say, for example to a Filipino, 50-year-old lady with breast cancer, “A thousand patients just like you underwent this therapy and had the best success and are now in remission.” I think that’s a lot more powerful than what any study that maybe had 95% Caucasian women in it. Truvada really does allow us to get to that level of care because of that diverse data. 

Q. It’s interesting you mention that. Two of my recent guests were the folk from Epic who’re on the Cosmos dataset which is similar to what Truveta is trying to build. But what’s always bothered me is the Balkanization of the data landscape in this country. The data’s sitting with different people, they’re all trying to do the same thing, but they’re not doing it at scale. For me, one vision of utopia, is where all this data gets consolidated with access granted in some way that allows everybody to do the kind of things that you talked about, because quite frankly, it’s not happening and it’s hurting caregivers, healthcare economy, and healthcare consumers. However, these initiatives are underway, involve innovative solutions that have been put together by startups. While the perspective is fresh, there are risks. How have you gone about identifying digital health startups to work with and what is the process you follow? What’s your message for startup founders listening in? 

Ashis: I get pinged a lot by start-ups looking for a door in and so, this is a wonderful call-out. I’ve heard this on your podcast as well that our systems are slow and the cycle at which we do things is slower. So, I’d imagine that’s very frustrating. 

One thing I was speaking about with a start-up CEO, recently, was, “How or what can we do better for you?” What he said was really enlightening for me. He said, “We spend a lot of time guessing what it is you want us to solve for. We spend money, resources and time but want more transparency to solve the pain point identified. Let us know we’re putting our time and resources in the right place.” If anyone’s listening on the incumbent healthcare side of this, I think that was a learning lesson for me. I’ve used that and it’s worked out quite well to make sure that end product we iterate and come together for, really solves the problem that we’ve both agreed upon. 

That being said, it is a tough atmosphere for start-ups because different healthcare systems of different countries have their own culture and things just run very differently. I don’t think anyone startup can go to Intermountain and say, “I’m going to use the same technique and same product to solve the same pain point for BS&W, and it’ll scale just the same as it may have done at say, Intermountain.” 

Taking some time to learn the strategy, the system KPIs of that particular health care system, looking at the ecosystem in which it lives — is it living a value-based care, is it living still in the fee-for-service role, is crucial. And because what we’re solving for is sometimes different as we really learn, so I’d say take the time to just learn and understand what the ecosystem of that system is, and go from there. 

Q. I had a startup founder who recently told me that the biggest challenge for them is surviving the sales cycles in healthcare. If a start-up has limited funding from venture capitalists, and run out of money pretty quickly, its shut down. In which case, where does that leave the health system that signed-up this innovative start-up? 

Ashis: I’m right there with you. And I think that for the startup, I would also suggest one tip — identify a business owner so when going into the healthcare system, you have an individual that you’re really talking to about trying the use case, doing a point solution. To scale, you need a business owner that’s truly passionate about the problem that you are solving for, because there is nothing more powerful in the health system than someone who’s going to take that, run with that torch, and really sell it for you. It’s such a large system that if you try to be that person within the system, often, it just doesn’t get the message across. 

Q. That is really valuable advice. How do you keep score of how well you’re doing with digital? What are the one or two metrics that you track? 

Ashis: Sure. We really believe the future is digital and we know where consumers are going. We certainly know that the digitally native consumers are going to be the largest part of the workforce going forward. And so, one metric, for example, is we’re tracking how many consumers are into interacting with us — more digitally than even in person — through phone calls or coming in, in person. So, virtual video visits, care journeys, and care navigation tools are what we use to track that.

I mentioned before, growth through digital channels is what we call digital-first growth. We ask, “did you actually interact with BS&W through a digital mechanism, first?” And then, on the back end, it’s our job to engage you in a personalized way, navigate you to the right care. We’re not just visually engaging with you once, but actually turning that into a sustained relationship.

Q. That’s good to hear. Are there one or two best practices or learnings that you would like to share with your peers who may be listening to this podcast? 

Ashis: At Baylor & Scott and White, one of the books that we have to read — this is our Chief Digital Officer who asks us to do so — before we sign on, is “Who says elephants can’t dance?” The IBM story, right? And so, yeah, Lou Gerstner. 

Q. Yeah, that’s right. I know Gerstner turned around IBM in the 90s. 

Ashis: Being agile and taking it the right way is important. We know that agile can be masquerading. But we’ve really changed our culture internally at all levels — all stakeholders — to really take on agile. 

My other advice would be to go from being a supply-driven company to demand-driven one. We need to spend time and resources on the voice of the consumer to learn what the demand is, where it lies and what consumers need and want. We think we know the pain points and that’s probably part of the paternalism in health care. So, that is not true. 

We have learned that as we go out, spend time and resources on the voice of the consumers, that often, what they want, need their pain points are very different from what we assume. 

So, my advice would be — really spend those resources, that time to truly learn the voice of the consumer because we’re never going to get to the retail level of care and experiences if we don’t spend that energy and time there. 

Q. That is so refreshing to hear again. Ashish, it’s been fantastic having you on this podcast. Thank you so much for setting aside a time when we look forward to following your progress and all the very best to you. 

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