Month: July 2022

The most important technology you can apply for digital health is human

Season 4: Episode #127

Podcast with Emily Kagan-Trenchard, SVP and Chief of Consumer Digital Solutions, Northwell Health

"The most important technology you can apply for digital health is human"

paddy Hosted by Paddy Padmanabhan
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In this episode, Emily Kagan-Trenchard, SVP and Chief of Consumer Digital Solutions at Northwell Health in New York, discusses a range of topics related to the new focus on consumers, patient data, technology, and analytics infrastructure required to drive consumer and patient engagement in this coming era of digital health.

Patient access is not just about capacity management and appointment scheduling but also about getting questions answered between different encounters with physicians, identity management for patients, and patient engagement. Emily suggests digital health startups take the time to do user experience research and strategic planning to understand the problem at the human level. Take a listen.  

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Show Notes

00:30 Tell us about Northwell and your key priorities this year.
05:51Tell us about some of the successes you've had and what you consider as unfinished business or work in progress.
14:42In the context of healthcare, how is Northwell approaching this from a tech standpoint? How does the governance work to bring the tech and the program together?
20:06 How are the consumers responding to your recent cloud partnership? Where have you seen the impact of all your investments within your patient population?
23:14 You mentioned access as one of your priority areas. How do you tackle that and the enhanced digital abilities for consumers to take advantage of?
27:55 What do you think of the present moment for digital health companies in the context of all the pullback and risk funding?
31:20 What’s your advice for your peers in the industry who’re not as big as Northwell but equally interested in making the kind of progress that you've made?

About our guest

Emily Kagan Trenchard is a much-needed voice from within the American medical system: A spoken-word-poet-turned-healthcare-executive, she is on a mission to remix the human in healthcare, challenging entrenched assumptions about what it means to give and receive care in the digital age. As SVP, Chief of Consumer Digital Solutions for New York state’s largest health system, Northwell Health, Emily leads the digital patient experience teams that push the limits of how we use technology to make healthcare seamless and steeped in humanity, while keeping the company competitive at a time of radical change. The team's transformation efforts have given patients a single key to the digital front door - enabling online booking, bill pay, digital forms and consents, telehealth, test results and more, all from within an award-winning native app. Emily also launched Northwell’s first User Experience (UX) department to ensure that patient and staff perspectives drive the design of digital tools and systems.

Prior to joining Northwell Emily led web systems for New York City’s Lenox Hill Hospital where she led the development of many early consumer health tools, including the first-ever implementation of the ZocDoc scheduling platform for a hospital. Outlets ranging from The Wall Street Journal to TechRebublic and CMS Wire turn to her for a fresh perspective on emerging technologies and the future of healthcare. She is also a nationally recognized poet, essayist, and speaker; recent speaking engagements include the Cleveland Clinic’s Empathy and Innovation conference and WebSumit in Lisbon. Emily holds a master’s degree in science writing from MIT and a bachelor’s degree from the University of California at Berkeley.

Emily Kagan Trenchard is a much-needed voice from within the American medical system: A spoken-word-poet-turned-healthcare-executive, she is on a mission to remix the human in healthcare, challenging entrenched assumptions about what it means to give and receive care in the digital age. As SVP, Chief of Consumer Digital Solutions for New York state’s largest health system, Northwell Health, Emily leads the digital patient experience teams that push the limits of how we use technology to make healthcare seamless and steeped in humanity, while keeping the company competitive at a time of radical change.

The team’s transformation efforts have given patients a single key to the digital front door – enabling online booking, bill pay, digital forms and consents, telehealth, test results and more, all from within an award-winning native app. Emily also launched Northwell’s first User Experience (UX) department to ensure that patient and staff perspectives drive the design of digital tools and systems. 

Prior to joining Northwell Emily led web systems for New York City’s Lenox Hill Hospital where she led the development of many early consumer health tools, including the first-ever implementation of the ZocDoc scheduling platform for a hospital. Outlets ranging from The Wall Street Journal to TechRebublic and CMS Wire turn to her for a fresh perspective on emerging technologies and the future of healthcare. She is also a nationally recognized poet, essayist, and speaker; recent speaking engagements include the Cleveland Clinic’s Empathy and Innovation conference and WebSumit in Lisbon. Emily holds a master’s degree in science writing from MIT and a bachelor’s degree from the University of California at Berkeley.

Q. Emily, tell us a little about your role at Northwell and what are your key priorities this year?

Emily: I’ve been at Northwell for about 15 years. I started in the consumer-facing digital marketing division focused on websites, digital signage, and social media. About four years ago, the organization recognized that we needed to look at the consumer digital space with a little more focus and spun out a program that I ran. This was the Digital Patient Experience (DPX).

As it really gained legs, DPX and many other digital initiatives around the health system in other areas, not necessarily just consumer-facing, witnessed a growing recognition. What was happening in pockets previously for digital transformation needed to come together into something that was more consolidated so we could move to that next level of maturity. This past year, they created a division—Enterprise Digital Services—for which there are five functional leads: Clinical Digital Solutions, IT Operations, Business Analytics, Innovation, and then, Consumer.

My role at Northwell recently expanded and at Consumer Digital Solutions, we’re putting arms not only around the things I was doing for Digital Front Door as well as the consumer-facing websites and other digital touchpoints, but starting to say, “Where do we have initiatives where it’s critical that we start to think more holistically about how we’re connecting with patients and enabling care for them in a digital world?”

A good example of this is there are plenty of utilities out there for folk who want to gather information from our patients and some sort of patient-reported outcomes. We have a ton of different tools in the market that can do various versions of these questions. But how can we stop bombarding people with surveys and start being smarter about the utilities in which we gather this information so that we can truly exhibit a kind of institutional memory when someone tells us things?

When you start to think about those kinds of initiatives, they really broaden the perspective of the consumer’s role at the table. The real intention behind making a Consumer Digital Solutions title on par with a Clinical Digital Solutions title was so they could be equal partners in this conversation. Where do we have issues that we need to tackle together? The biggest challenge that we’re focusing on this year is, access. At its most base, it’s something around capacity management and making sure that people can get into the appointments when they need them with the providers that are best to see them in the right level of care for whatever’s going on. But access is about much more than that. It’s about getting questions answered, the back and forth in between encounters, getting prescriptions refilled, but asking a question about changing dosage. There are all the interim things that occur in the course of the space between an existing doctor’s visit which we can do so much better with different types of communication channels. Clearly, it’s a concerted effort on the operations and the consumers’ sides. That would be one example of something that has a number of projects that we’re now able to pull together into a more comprehensive program that we can run in this more agile and matrixed way.

This year, I have a really big focus on identity and identity management in order to form a real, truly master consumer index. When I say that, I do mean more than just patients. I mean caregivers, as well. We really need to have a centralized way of codifying information we know about people so that it can traverse more than just what’s in an EMR, across all sorts of engagement touchpoints. That’s a very big one for us.

The final piece that we’re spending a lot of time focusing on right now is where do we need to mature some of our channels. We’ve started with a lot of channels that are the standards— websites, apps, email, text messaging, etc.—but the chat functionality is huge. There’s so much you can do there with IVR and voice automation. It’s a lot of opportunity to not just have those types of channels in pockets for small bits of experimentation, but truly make them a part of core platform infrastructure—for the providers, staff, communications back to patients, and care givers. That’s a big rounding-out of our omnichannel portfolio, which we’re also focusing on this year.

Q. You’ve covered all the key elements that must come together seamlessly. Where are you in that journey? Tell us about your successes and what is work in progress.

Emily: There’s the notion of orchestration writ large. Then, there’s the notion of in-specific omnichannel orchestration. Let’s take the larger concept, first. When we’re talking about this type of orchestration, sometimes we do truly mean it in the “Do you send the text message before the email?” sense. If they open the email, do you even bother with the text message in that sort of a comms level orchestration? If a foundation wants to send something out asking about a donation, don’t send it to this person who just had a patient complaint. There’s that level of orchestration, which maybe is a level one of just understanding who’s trying to talk to the patient at any given time. Is it appropriate? Whose “go” is it?

The other type of orchestration we’re starting to see is the importance of trying to orchestrate—in-patient or in-person engagements with online engagements. Where do you have someone starting a task but not finishing it that you pick up now in an office? Where do you start a task in an office that now you complete online? Where do you have a customer service call that came in and then, follow-up with a billing question? When it hands off to billing and their rate, can the office know about that the next time they show up there? That’s an orchestration around engagement that really needs to traverse the online and offline worlds. I’d say that is the place where we know the work to be done. It’s truly about putting in the tools to enable that to occur and you can start in some places.

What we’ve really done then, is to say, “How can we do this at the customer service and call center levels, first?” I think that’s one of the easier places to start to go back and forth at. In health care, especially for those of us who have ambulatory networks, you can consider the front desk as a part of that, too. That truly becomes a customer service desk as well as a call center touchpoint. How do you at least get those folk to understand where someone last left off?

This gets into broader CRM strategy, now. This is obviously not just what happens in marketing. This is a larger CRM philosophy. That’s a really important concept and if we bounce off of that one, one click further out from what you would traditionally consider, you can start to do that with providers as well.

When you start to think about your referral management strategy and your network growth, how do you take this concept of consumer relationship management and think about your consumer as your providers? As people who you want to grow relationships with to find patterns of referral, improve capacity, and improve collaboration, can you take those utilities, use them on behalf of a provider network and take the connective threads you build there to unlock capacity, across network support for complex patient care?

I’d say the next generation of where our heads are at in terms of taking an incredible CRM strategy which we’ve really matured via our marketing department and expanding that concept out for that online offline transition as well as over into the provider space is really the bigger orchestration question. You can cascade that into a whole lot of other places.

Q. What are the basic enablers that you absolutely need to have in place before you can really make any of this a reality?

Emily: I would say patient identity is one of them. For instance, do not click $200 first steps, etc. Then, there’s nuance within that. When we start with patient identity, we ask—Do you even know who is your patient? Do you have an email address for them? Do you have a cell phone on file? Do you know if it’s working? Do you have the right consents and permissions to communicate? That’s even before you talk about preference. I prefer a text message over an email, so, that’s just on the individual patient level, but truly, where my focus and interest lie is actually not just for the patient but for the caregiver, too.

That’s where you start to get interesting because you will now want to have an identity that is not just for the people who have an MRM. You want to have an identity for anyone who comes and is responsible for someone’s care in your organization in order to communicate. Start with your identity and mature your concept so you can build a larger framework. Let’s say you’ve got the identity piece locked or you say, “You know what? I got it for patients.” Let me just start there.

Second, folk really need to be sure that they have some sort of communications backbone that’s going to allow you to do omnichannel. Let’s just start with email and text message. There’s a lot more channels you can talk about but let’s start there. When you’re talking about any CRM worth its salt, it’s going to have email and text messaging capabilities. The power is not whether or not you can send any one of those kinds of cards. The power is in deciding which one to send and when.

When you send an email, do you need to send a text? The name of the game here is really trying to find economies, scale, and cost efficiencies in that communication. If I send someone an email, ask them to confirm that appointment, and I don’t have to send that follow-up text message, I might have saved myself $0.04 a message. That’s not a big deal on an individual level, and way cheaper than getting a cancelation certainly to send that out. But I’d rather not spend anything if my email costs are already baked into my CRM contract. If I’m not responding with that automated text message, perhaps, I’m going to an IVR or sending them to a chase list where I have a human pick up the phone to call. If I can handle all that before a human pick it up, even better.

What you’re really looking for then, is something that’s going to have that sort of dynamic intelligence. Someone responded. Not only did I fire off a message, but here’s what happened to that message when it went out into the world. Here’s how I’m going to change my messaging behavior based on that input. That can be on a case-by-case basis for an individual or that can be an aggregate as you learn about what helps campaigns perform better. That can be on a cohort basis when you start to identify different groups of people who should have different messaging cadences.

But that is really where you can start to do level one multichannel communication customization and not just recognize the benefit of having any digital comms, but having those that can be intelligent, learn, and be dynamic with one another to truly optimize your spend in that area.

Q. In the context of healthcare, how is Northwell approaching this from a tech standpoint? How does the governance work to bring the tech and the program together?

Emily: Let’s talk about what tech pieces are there and then, we can ask, what this may mean for one of the heads to come in and be involved. When we talk about having that sort of backbone, who are we talking to? Where are the data elements coming from? Obviously, my partner who leads the Business Intel and Analytics Division is critical because we’re looking at all these different data sources.

From a marketing standpoint, at a healthcare institution, not only are you going to have sources such as, your EMR and reg systems, etc., but also, third-party data. When we look at our marketing utilities, that’s an important thing. We need a little bit of Church and State from first-party and third-party data. So, what marketing does is reach out to the addressable market which is different from those who might already have an MRM, be engaged or are caregivers. We need to find ways to have the right levels of not just governance but segmentation in the data domains.

Also, we need to make sure that when we’re thinking about what traverses where we understand the intended use of the data so that we’re using things in ways that are appropriate, aligned with people’s consent especially, with all of the new laws around like GDPR and Right to be forgotten, etc. There are certain types of information that can be forgotten and others that can’t because of regulations. Level one then, is all about—Do you know your sources? Do you know how to segregate your sources? Do you know how to clean them? Do you know how to map, match, and do them?

When you’ve got these data elements, you want to talk about doing fun things with that. How do you mix and match? How do you add additional data from different domains? How do you do the analyses that put segmentations on top? Or do predictive modeling on top of these things? That’s where you can take data to the next level. For that, what you want to do is keep things tight and clean in the beginning. Then, when you want to do the fun stuff, you want to be able to bring in as many different variants and flavors as possible.

Our philosophy and strategy are heading towards—and again, let me say that we have CRMs today, which do a really fantastic job and are pretty mature as things are considered—a Consumer Data Platform (CDP). This is really an omnivorous kind of platform where you don’t have to have structured data, necessarily. You don’t need to know what you’re going to put into it to put things in and then, crosswalk, and make it referenceable and available to a number of different end consumers. That’s where our roadmap is taking us. Getting to a CDP is a 2023-24 initiative for us.

When you talk about a CDP, you talk about infrastructure. Here, I would involve my partners from IT because we really do need this to be a backbone that different end consumers—our lab system, call center, marketing for example—can reference, put information back into, gain insights for the data science teams, and apply back out. That’s where we really need to ensure that they’ve got a hand in making this a truly functional utility inside the organization and it does become an engine for us.

Now you’ve got the clinical and innovation pieces, so, of course you want to do data science and interesting data products. You can stand it on the backbone, take the same types of layers of intelligence and say, “Okay, talk to me about someone, the social determinants of health. Overlay that with these risk factors coming out of the EMR and put together an engagement model that’s customized specifically for this person in this neighborhood.” For that true one-to-one, you’ll need to be able to overlay the data sets which can then talk and learn from one another, even though their governance as source data points might be in different areas. That’s why we talk about domains. It starts to get into some of these concepts around data mesh that a lot of us are starting to think about.

That would really be the evolution of where we’re thinking towards. How we really need all these different areas within an enterprise digital view to be sure that we’ve got the parts and pieces required to not just do the basics, but to make this one of the most transformative engines that we can have inside a health system.

Q. Data infrastructure is critical and Northwell just announced a cloud partnership to power some of this. How are the consumers responding to it? Where have you seen the impact of all of your investments within your patient population?

Emily: We’ve had a number of different areas where we’ve taken digital tools and made self-service capabilities that are the bread and butter of any first engagement. I’ll talk a little about where you see things that really end up feeling a little bit more game-changing.

The first is probably around online payments. We think about paying every other thing in our lives, online. Not only do we think about the ability to pay it because you don’t have to sit there, find the checkbook, and write something out but who even has a checkbook anymore? Write in the credit or get on the phone.

But the minute that you enable somebody to pay a bill online, you also have the ability to pull other bills in so that you can roll up charges. You have the ability for people to do it while they’re in a meeting at work or while they’re bored because it’s right there. And you have the ability to put in front of people different payment options. So, if they’re concerned or perhaps embarrassed about struggling to pay something and if you can enable right then in there an option to sign up for a payment plan, you’re using a degree of discretion with something that is deeply emotional, personal, and quite frankly, a huge pain points inside of healthcare, to help people meet their financial responsibilities.

We’ve already seen about 30% of all bill payment volumes offloaded from phones and mail on to digital. With that, we’ve seen a commiserate increase in the speed to pay. By about three weeks, there’s greater speed to pay through digital channels. We have seen a huge uptick in the number of people who are self-servicing on payment plans, which they used to have to call a Call Agent to get set up. We have about 85-87% patient satisfaction with the entire experience. If you think nobody’s happy to pay a bill rate for health care, especially when you have 87% patient satisfaction in something that used to be the primary complaint for the organization, it’s a huge success.

Q. You mentioned access as one of your priority areas. How do you tackle that with all the infrastructure created and the enhanced digital abilities for consumers to take advantage of?

Emily: When you talk about online scheduling, the very first thing to consider is, “Can you have those provider templates made available for online scheduling?” We’re in an effort right now where we are looking at a lot of providers and trying to make sure that just because they have it available doesn’t mean that there’s a spot for the next three weeks. What do we do in order to get that availability to be much sooner so that when you’re scheduling, you’re not clicking the forward button four, five, or six times before you find the next available date and time to see the provider you want to see, online? Of course, this presumes you can book online. But where do you go from there?

When we talk about freeing up capacity for providers, part of what we want to talk about is, what really needs to be an in-person visit versus what can be telehealth. This is the world after the pandemic where telehealth is a foundational part of how people are going to get care and we’re learning how best to use it. Where are the opportunities to actually say, “The provider doesn’t have an in-person visit, but you can do this one via telehealth?” We’re looking at opportunities where we can actually take telehealth volumes, roll it with in-person volumes, and see what kinds of questions you can ask ahead of time in that scheduling flow to identify patients who are good candidates for a telehealth visit instead. Again, we’re unlocking some of that capacity. We’re also taking advantage of telehealth by asking, “Where do you have patients who are coming in for certain things for which a telehealth consult is maybe most appropriate and it doesn’t need to be with their specific doctor?

We have two programs running right now. The first is called ED on Demand, essentially an after- hours program for our Emergency Departments. There’s a rotating call schedule of ED physicians who can take urgent matters in off-hours so you don’t actually have to go into an urgent care or into an ED, but you can talk with an emergency medicine professional via telehealth and really get that assessment before you go anywhere else. That is a great way to take what otherwise may be urgent calls into primary care, stops at the urgent care or into the emergency departments themselves, and take a first round pass of that, virtually. Patients love it, providers love it. It really is a win.

The variation on that is what we’re doing right now. We call it, Same Day Sick. If you’re sick and need to see a provider, today, is it because you actually need to see your provider and they’re only the ones who really deeply understand your case? Or is it a UTI and you just need to get a script? Is it a sinus infection? Is it just a cut? Do you need to know if you can put the antibiotics on? It’s the same concept of a virtual pool of providers who can take calls for Same Day Sick. This is rolling out in our primary care division and it’s fantastic because it’s taking this volume which otherwise would have gone into the pool for the patients who need to actually get in for maybe a true in-person same day visit or an annual well and whatever else is taking up our capacity for our primary care network. It’s offloading some of that volume into a care setting that is still appropriate for the need, but takes advantage of telemedicine in ways that are that next turn of the crank. We’ve got these tools all built and up and running since the pandemic.

Q. Great examples. Obviously, a lot of these solutions are enabled by technology providers that cover the whole spectrum—EHR vendors, enterprise class platforms, CRMs etc. How do you tap into innovation in the marketplace? What do you think of the present moment for digital health companies in the context of all the pull back and risk funding?

Emily: First, we have a new person starting on August 4 to lead our Innovations pillar. Rebecca Call will be joining us from M.D. Anderson, formerly at UPMC. We’re super excited to have an incredible innovator who, I think, will take our innovations approach to the next level. What does that mean? Where do we want to go? We definitely have a huge appetite for investing in new technologies. We have spun companies out of our own employee solutions. We do a lot of customer development here inside of Northwell, too, but I think that the name of the game right now is getting specific about what problem you’re trying to solve because everybody and their brother has gone through these consolidations. Everybody in the bubble is going to promise they do everything under the sun. Where do you see vendors that are going to add, quite frankly, as you said, niche, specific, enhanced capabilities that you can plug into existing platforms? The number of people who are going to be running health systems without some base platform infrastructure is shrinking by the day, so, if you’re there looking at these solutions and your answer is, “We’ll just rip and replace yours and put in mine, (whatever the product’s going to be),” it’s a non-starter.

If you’re talking instead about coming with products that have very mature SDK and APIs, logic engines which can be consumed by other delivery endpoints, and nestle well into other existing platform infrastructures, you’re going to see a whole lot of excitement to take those and really extend these platforms that we’ve all invested in way past the speed at which those vendors can actually move. We can move internally, especially in places where there are types of capabilities that are truly commodity in other industries. We can take best-of-breed and bring it back over into health care. That, to me, is a really exciting space. I think it’s really about a retooling of where these companies were headed in the past, which is, everybody wanted to be everyone’s everything. Everybody wanted to be your full engagement suite and solve every problem under the sun for you. But what’s your core workup? What is your core capability? Where is truly the thing that differentiates you? How do you make that as light, fast, and flexible so that you can go and play with these organizations in recognizing full well that they have platforms that you’re going to seek to accelerate?

Q. What’s your advice for your peers in the industry who’re not as big as Northwell but equally interested in making the kind of progress that you’ve made?

Emily: I think the most important technology you can apply is human. When you take the time to actually undertake user experience research and strategic planning to understand the problem at the human level, take that proverbial step back without getting excited just by what the technology is going to offer and not just get excited about what all of your peers are doing, but slow down and genuinely say, “What am I hearing from my staff? What am I hearing from my patients? Where can I make the biggest improvement?” then, nine times out of ten, you’re already going to have the tech in hand.

It’s just going to be about optimizing workflows, lighting something up that you hadn’t turned on before, and solving problems that might not be sexy. But they are the ones that are going to make the biggest impact. If you start there, you are going to gain the traction you need to then, go back and ask for the investments for the bigger, sexier things.

It all starts with human centered design. If you don’t have a human centered design practice, or one that involves that research and analysis into your strategic planning, and particularly the product planning for these sorts of MVP’s—your first crack at these things—do yourself a favor and get that baked in. Then, what you really start to do is evidence-based transformation. That’s what your senior leadership is going to want to hear and see when you’re proving the value of these efforts.

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 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.

Incrementalism is not a bad thing in digital health

Season 4: Episode #126

Podcast with Tarun Kapoor, MD, SVP and Chief Digital Transformation Officer, Virtua Health

"Incrementalism is not a bad thing in digital health"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Tarun Kapoor, MD, SVP and Chief Digital Transformation Officer at Virtua Health talks about the diverse population segments they serve in Southern New Jersey and how they drive digital health priorities and investments. He also discusses how to drive digital health programs in an incremental fashion and gain stakeholder buy-in within the organization for digital health.

Tarun discusses the current state of the digital health startup environment, the longer-term technology solutions landscape, and how to make smart decisions with limited resources. Take a listen.

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Show Notes

00:36 Tell us about your background, how you got into this role, and the populations you serve at Virtua Health.
04:22What are your key priorities for the organization? How does the digital transformation function fit into those?
07:15As the Chief Digital Transformation Officer, how are you directing your investments? Also, how are you factoring in your populations’ expectations from a digital enablement standpoint?
16:29What challenges did you have to deal with when you implemented the tech, the data, or the infrastructure?
18:59 There are thousands of solutions to pick from once you’ve designed the experience. Right from the native EHR system, nimble young startups to enterprise-class tech firms and everything in between. How do you make that technology choice?
23:12 What's your advice to startups who are listening to this episode?
25:53 Is there a rubric that you use when it comes to building a case for a new solution where there isn't adequate data for you to say whether it's going to work or not, especially in a margin constrained landscape like health care providers?
28:05 Is there something you’d like to share with your peers?

About our guest

Tarun Kapoor, MD, MBA, is senior vice president and chief digital transformation officer at Virtua Health. In this role, he oversees Virtua’s Digital Transformation Office and orchestrates Virtua’s enterprise-wide master plan in support of an intuitive care journey for all consumers.

Previously, Dr. Kapoor was the president of VirtuaPhysicianPartners™ and the senior vice president and chief medical officer for Virtua Medical Group (VMG), a clinician multi-specialty medical practice. Dr. Kapoor joined VMG as a hospitalist in 2008, where he was the associate director of the Virtua Hospitalist Group, helping grow the practice from 12 physicians to its current size of more than 110 clinicians.

In addition, he joined Virtua’s Medical Informatics team in 2010, helping to develop and implement its inpatient electronic medical record, including full deployment of CPOE and electronic Medication Reconciliation. Prior to joining Virtua, Dr. Kapoor was regional director for EmCare’s Mid-Atlantic Hospitalist Division. During his tenure with EmCare, Dr. Kapoor developed 16 inpatient care programs for Clinical Staffing Solutions, which was subsequently acquired by EmCare. Dr. Kapoor trained in internal medicine at The George Washington University Hospital, where he stayed on an extra year to serve as chief resident and clinical instructor. He obtained his medical degree from Rutgers Robert Wood Johnson, his undergraduate degree in government and chemistry from Cornell University, and his executive Master of Business Administration from the Fox School of Business of Temple University.

Tarun Kapoor, MD, MBA, is senior vice president and chief digital transformation officer at Virtua Health. In this role, he oversees Virtua’s Digital Transformation Office and orchestrates Virtua’s enterprise-wide master plan in support of an intuitive care journey for all consumers.

Previously, Dr. Kapoor was the president of VirtuaPhysicianPartners™ and the senior vice president and chief medical officer for Virtua Medical Group (VMG), a clinician multi-specialty medical practice. Dr. Kapoor joined VMG as a hospitalist in 2008, where he was the associate director of the Virtua Hospitalist Group, helping grow the practice from 12 physicians to its current size of more than 110 clinicians.

In addition, he joined Virtua’s Medical Informatics team in 2010, helping to develop and implement its inpatient electronic medical record, including full deployment of CPOE and electronic Medication Reconciliation. Prior to joining Virtua, Dr. Kapoor was regional director for EmCare’s Mid-Atlantic Hospitalist Division. During his tenure with EmCare, Dr. Kapoor developed 16 inpatient care programs for Clinical Staffing Solutions, which was subsequently acquired by EmCare. Dr. Kapoor trained in internal medicine at The George Washington University Hospital, where he stayed on an extra year to serve as chief resident and clinical instructor. He obtained his medical degree from Rutgers Robert Wood Johnson, his undergraduate degree in government and chemistry from Cornell University, and his executive Master of Business Administration from the Fox School of Business of Temple 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.

We are building an intelligent automation platform that seeks to transform how patients access care

Season 4: Episode #125

Podcast with Pranay Kapadia, CEO and
Co-founder, Notable

"We are building an intelligent automation platform that seeks to transform how patients access care"

paddy Hosted by Paddy Padmanabhan
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In this episode, Pranay Kapadia, CEO and Co-founder of Notable Health, discusses Notable’s value proposition in the automation space for easier patient access and reducing friction in patient access processes. He also talks about the trends driving digital health investments, what clients are looking for, and the opportunity landscape for automation and digital health startups.

Most health systems think of automation as a cost-cutting endeavor and not as how they can tackle the change in how patients engage with their healthcare provider. According to Pranay, automation is about marrying patient experience that is ADA compliant, in any language, and that works on any device for any human on the planet, with the best workflow integration.

Pranay also talks about how at Notable they are working to navigate the uncertain economic environment and shares his thoughts on the current digital health startup and environment. Take a listen.

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Show Notes

00:31 Tell us about your background, how did you start Notable Health and what does it do.
02:56Where do you see automation gaining the most traction and where is a health system looking to deploy it the most, today? Can you share your own client examples?
08:45Are you a robotic process automation (RPA) company? How do you categorize yourself when you look at automation technologies at large?
12:33 What does your competitive landscape look like? There’s the startup ecosystem vs. the traditional EHR companies vs. the enterprise class companies that are non-EHR but have a powerful enterprise class workflow platform.
19:06How are you seeing your clients? Do the trade-offs matter when they have to choose between a truly innovative solution from you vs. one that may not be best-in-class yet easier to deploy, integrate, work with and have lower overheads?
23:31 There is an emergence of a mindset around treating digital health as a product management function. How do you create value for the end customer? How do you back into what you need to do to build it out?
26:19 Its an uncertain time for digital health funding now. What does that mean for a digital health startup and what’s your advice to them? How are you preparing your own company to work through the next four months or longer?

About our guest

Pranay Kapadia is Co-founder and CEO at Notable. After years of hearing his family of physicians objecting to the state of technology in healthcare, Pranay founded Notable to enrich every patient-provider interaction and eliminate manual burdens for staff and providers.

Pranay has focused his career on tackling problems at the synapse of data, finance, and user experience — defining and building products that simplify ease-of-use while reducing financial paperwork within highly regulated industries. Prior to Notable, Pranay and his co-founding team worked to revolutionize how millions of people file for mortgages. As Vice President of Product Management at Blend, a technology company reconstructing the mortgage and lending industry Pranay worked with customers like Wells Fargo, US Bank, and Fannie Mae to bring simplicity and transparency to consumer banking. He also held multiple roles at Intuit, leading Mint.com, Quicken and QuickBooks.

Pranay Kapadia is Co-founder and CEO at Notable. After years of hearing his family of physicians objecting to the state of technology in healthcare, Pranay founded Notable to enrich every patient-provider interaction and eliminate manual burdens for staff and providers.

Pranay has focused his career on tackling problems at the synapse of data, finance, and user experience — defining and building products that simplify ease-of-use while reducing financial paperwork within highly regulated industries. Prior to Notable, Pranay and his co-founding team worked to revolutionize how millions of people file for mortgages.

As Vice President of Product Management at Blend, a technology company reconstructing the mortgage and lending industry Pranay worked with customers like Wells Fargo, US Bank, and Fannie Mae to bring simplicity and transparency to consumer banking. He also held multiple roles at Intuit, leading Mint.com, Quicken and QuickBooks.

Q: Pranay, tell us a bit about your background. How did you start Notable Health? What does it do?

Pranay: At Notable Health, we’re building the intelligent automation platform for healthcare; one that fundamentally seeks to transform how patients access care and how health systems get paid for providing that care. Very early on, when we studied healthcare, what we actually found was from the time that a patient, a mere mortal like myself, actually seeks care to the time that that care is built, it takes anywhere between 22 to 35 sets of hands that are touching data in some way. It’s old, archaic, and manual.

It turns out EHRs digitize the health records but not the workflow around those at all. At Notable, we believe that healthcare workflow automation is going to be just as important over the next 5 to 10 years as ours have been over the last 30 years. That’s what Notable does.

A big part of the thesis was actually bringing our experience from our scars, skills, and priors from fintech. We spent 15 years transforming what it looks like to actually do your taxes, to use Mint — and quicken on the personal finance side — the check scanning capabilities that you may have used way back when, all the way to powering a large portion of this country’s mortgages and transforming that to a seven-minutes’ experience in the palm of your hand.

We’re bringing a lot of that experience in healthcare. It’s just been an incredible five-and-a-half years of growth for us.

Q: Automation is a hot topic. Can you share your take on where you see automation gaining the most traction? Where’s a health system looking to deploy it the most, today? Can you share your own client examples, to illustrate the point?

Pranay: The insight that we’ve had in working with health systems across the industry is kind of like with AI. Automation is another one of those buzzwords that people want to embrace but have no idea of how to start or from where. We’ve seen health systems that have created Centers of Excellence and people that are trying to figure out what use cases to actually support! But what we found is, it falls into one of three camps.

There’s a camp where it is about – “I want to build it all internally and hope that I can learn from others.” What they tend to actually avoid or ignore is the total cost of ownership. How do you actually maintain that?

There’s a second that is around – “How do I automate the mundane to reduce costs?” It usually turns out to be garbage-in-garbage-out. I’m starting on the backend and it’s low value. Perhaps it’s easy to automate but it probably shouldn’t be needed in the future with where the puck is going.

There’s a third which looks at what the market trends are, strategically, and how automation may be used for growth. Truth be told, most systems aren’t actually thinking about it that way. They’re thinking about it more as a cost-cutting endeavor and less as how to actually tackle a change in how patients are engaging with our health system. Nobody wants to call anymore. We fundamentally believe we want to eliminate the call center from the US healthcare system. That has to happen. It’s inevitable and maybe, it’ll be 1-3% of phone calls, but you don’t need the vast majority that exists today.

The second part of the growth story is, how do you actually start on the access side? So much of healthcare data and workflow starts with — Who is the patient? Why are they coming in? Who’s going to pay for this? With that in mind, we’ve started thinking through that strategy with our partners across different EHRs – Epic, Cerner, Athena etc. But really, we’re looking at what the patient flow looks like. So, how do you engage with the right patient at the right time? How do you collect their insurance information in a delightful way just like we’ve been used to doing in other industries?

What we’ve seen with starting on the frontend and with the access side is, if you do that right, you can engage 80-85-90% of your patients in a digital manner. That is what upstarts around are trying to do. There’s no new health tech startup that provides care that starts with a call center and yet, that’s how healthcare does it.

For us, the places where we can educate our health system partners so as to partner with them truly lies in answering, how do you start on the frontend? We tend to actually partner with operations, red cycle population, and health leaders on — how do you digitize your patient experience to delight them and your staff?

The examples that I share with our partners — be it a large health system in Utah, one in Austin, or here in California — is we’re actually seeing upwards of 80% of patients engaging with health systems digitally. We get feedback from health system staff where their workload is actually reduced by 50% on a Monday, on things that they didn’t have to do — either outbound phone calls to collect registration data, or clinical information from patients, or even have themselves scheduled or rescheduled.

Most importantly, we actually see just elimination of backend workloads — What if you had no follow-up queue? What if you didn’t have a slew of calls that needed to be made to reschedule a patient? All of that starts getting eliminated when you start out on the frontend. We see our role today, in healthcare, as actually helping educate.

One of the things that we’ve done therefore, is codify all of this into something new that we’ve actually rolled out with our partners. We call it the Notable Health Check. I’m really excited about this because what it allows us to do is understand and assess where our partners are on their digitization journey. We understand what their tools and landscape look like and make recommendations of where they would actually get value if they thought about automation and digitizing the patient experience the right way and not just for randomness, like Robotic Process Automation (RPA).

Q: RPA specifically connotes automation of tasks and workflows in ways that essentially replace a human worker with a digital worker. It’s a subcategory within the automation landscape. Are you an RPA company? How do you categorize yourself when you look at automation technologies at large?

Pranay: We actually think RPA is fairly brittle. We don’t consider ourselves an RPA company. We use a lot of different capabilities to integrate. It turns out in certain cases, using APIs are great.

I want to access clinical data using APIs with Fire, App Orchard, or what Cerner has with their code program etc. We want to utilize all of those and we do. We augment that with machine vision capabilities to actually integrate where there aren’t APIs.

We also use a variety of other mechanisms to actually integrate because what we found very early on is, what’s critical in healthcare — the road to purgatory in health tech — is driven by integration. It takes too long to deploy something and then know if it is of value or not. From the time that you actually can get that feedback loop closed, there’s a reorg that’s happened. There’s a change in priority. More importantly, the market has moved on.

What we found is, it’s important to marry — when we talk about automation — a beautiful patient experience that is ADA-compliant in any language that works on any device, for any human on the planet. We spend a significant amount of time on design and how to think about that. To anyone that says the elderly cannot use technology, I like to say they haven’t seen the 60-70-80% conversion rates that we actually see in the 65 + cohort at Notable.

That’s because you sweat the details on who’s engaging, when they engage, and how to engage with them. You marry that with the best workflow integration. It’s not just swivel chair RPA. It’s actually rethinking the workflow in how you collect better data from patients to power clinical and administrative workflows. That’s the industry that we are in. We’re not in just the RPA. If anything, that needs to be commoditized and useless.

Q: What does your competitive landscape look like? There’s the startup ecosystem vs. the traditional EHR companies vs. the enterprise class companies that are non-EHR but have a powerful enterprise class workflow platform.

Pranay: I’d say healthcare is a really noisy landscape of every industry that I’ve been at. There’s a point solution for absolutely everything. The reality is, it turns out nobody wants a solution. They’ve already got so many in their ecosystem that they’re trying to get to work together. The patients and staff see that at the seams they don’t interoperate and they aren’t as seamless as we would want them to be.

For us, there are two parts that I like to think about.

One, how do we set the bar with our partners in digitizing every experience? The way that we actually go about it, on the access side, entails running our health check process to understand how many patients are digital, today. What does your website look like? How are patients calling? What does the call center volume look like? How many payments are being collected? How many denials are occurring on the backend?

By collecting that information, we’re able to share a very strategic solution. That isn’t about how do I bolt on here? How do I bolt on there? It’s really one that’s focused on outcomes for our partners and often, that leads to sunsetting a lot of the points solution. You don’t need an appointment reminder vendor if you also use Notable. You don’t need a denials dashboard because we actually provide that capability. We start with the outcome and then, align strategically with our partners to actually set that up.

Now, there are certain systems of record. It could be the EHR vendor, CRM, or others that you actually want a deep integration with the power workflow or to collect data from because those are the single sources of truth. Those are the ones that we actually embed ourselves in deeply with. So, working with the EHR or the CRM vendors in many different ways resonates because if you approach a health system with this as the only way to deploy, it’s not going to work. Often, they don’t even know how to deploy something to get to success.

I’ll give you one example. We actually studied a part of our health check assessment – scheduling — and looked at this with a partner of ours in Kansas. What we found was, about 12% of their website traffic was coming from Google and then, just bouncing because they couldn’t find how to schedule. Fifty-five percent of their phone call volumes was actually tied to scheduling, of which 35 was inbound and then, 20 or so, was outbound because they had about 10 to 12% of their orders at any given point in time that were unfulfilled. They were trying to follow-up with patients to try to get them back in.

Now, once you have that data, you have strategies on how to deploy software and a platform that can actually tackle those. We gave them personalized links that they could embed onto the website for self-scheduling so that it integrates deeply with Google. We set up ways to actually engage with patients automatically based on their prior visits or when they were actually leaving the clinic. We were monitoring the orders that were placed in, checking to see when and if the patient had scheduled something in the future, texting them, and having them scheduled within a certain window as required.

It’s what the call center agent would do. But all of that is actually built on our no-code platform where you don’t need to write code for any of this. This is all point-and-click to set up that end-vision journey. What we saw, was tens of thousands of phone calls actually being avoided. You don’t actually create a faster call center, if you can read this. You completely avoid the call. We actually saw a patient satisfaction score of 98 and up to 40% of all of these health systems’ appointments actually being scheduled in a digital-first way. That was up from 5%. I share that because they could actually angle in 16 different point solutions.

In trying to pull that all together into EHR and CRM, to us, these are all the tools that bring these solutions to life. But you really have to think about how can you do this end-to-end and then, iterate really quickly. The time to actually deploying that value is key. We deploy that in six weeks. That allows us to learn and iterate. If you don’t have that kind of speed, it’s an 18-months’ journey to get your first piece of data and then, it’s not worth it.

Q: There are a number of new initiatives being launched by the big technology vendors, for instance, Epic’s Cheers CRM platform. You’re a big technology firm, too. How are you seeing your clients? Do the trade-offs matter when they have to choose between a truly innovative solution from you vs. one that may not be best-in-class yet easier to deploy, integrate, work with and have lower overheads?

Pranay: I would challenge that belief. But one fascinating point about healthcare in every sense is, every vertical has its system of record. I think healthcare is the only vertical where the system of record is actually, in certain cases, dictating what you can and can’t do.

That’s flawed in how people actually think about running their health system. I’d challenge the assumption that it might be easier or cheaper to actually deploy because what we’ve seen is, the only path to success is iteration. When we partner a part of that health check process that we go through, we actually assess how well an organization adopts Agile. We ask — Do you know what a product owner is? Are we going to get stuck in committees before we can actually make decisions? If that’s the case, you might have all the willpower in the world but you don’t have the ability yet. We need to actually help you understand what iteration look looks like. What does a two week deploy look like?

There was a CIO recently that asked me, “What does your release cadence look like?” It was 11 a.m. in the morning and I just went on Slack. We have a channel called the Dev Deploys and I was counting quietly. The response was, “Well, it’s 11 a.m. We’ve done 56. It deploys this morning, and that’s just how we work.” And he asked, “Oh, you do? No downtime deploys.” I guess that’s how you build a true technology iterative cycle such that you can actually learn through this.

The reason that I share those stories is, when we sit down with CIOs and technology leaders, we try to decipher, are you a technology leader that wants to play it safe and do the least amount of change possible because that’s actually how you see yourself succeeding? If yes, that’s okay. I would rather know that up-front and not waste each other’s time. Or, are you the technology leader that aligns with the business to drive change? We tend to work best with the latter, not the former.

With the latter, we tend to actually set the bar on — How can you actually reduce the total cost of ownership? How can you actually set up? We always think about it as the EHR should exist; it’s the system of record, so, it will always be there. The system of automation that actually sits on top of that and transforms patient to payer or booking the bill, that’s who we are. That’s the role that we play.

Then, there’s a number of different workflows — everything from outbound scheduling to prior off, checking your prior status and texting the patient on their status or having them reschedule – all of those are intertwined flows. They should not be point solutions across the board. When you start to think about it that way, you get a lower total cost of ownership and higher value much faster than when the legacy systems might actually try to try to mimic what it is that we’re doing.

Fun fact — there may or may not be a legacy system that is a monthly meeting on trying to copy Notable’s features. We love that because we’re actually helping move the industry forward, and that’s the role that we have to play.

Q: There is an emergence of a mindset around treating digital health as a product management function. How do you create value for the end customer? How do you back into what you need to do to build it out?

Pranay: Can I just add to that with an anecdotal example? We’ve actually seen partners start out wanting to build themselves and then, very quickly realize that they’re not an R&D shop and they won’t have the resources. There’s only one master that you can have. Still, we have to share and educate. Sometimes we tend to think that everything is a form and it’s just a text message and a dropdown. Patients can do X, Y, Z, and I have the tools to do that.

But where we actually lack is in that product function of thinking through deeply. How do you productize intelligence at scale? With the world that we’re in, the example that I share is, we started early on with just scanning insurance cards. What we found was, we could actually do it at 95, 97% accuracy versus a human that would transpose zeros and ones.

But the bigger challenge actually came in matching it to a payer plan. It’s that that denial on the backend doesn’t happen. Two years ago, when we first started to look at this, health systems would come to us and say, “Hey, here’s the rule.” We’d look for this PO box number and contort our bodies, do the rain dance, and hopefully, take the right payer plan up.

To productize that in scale, we determined that it was not something that we should just ask every customer. We actually needed to think about how to instrument the platform to learn from what their staff was doing and automatically create a feedback loop that could actually scale such that we could reduce and eliminate their eligibility-based denials on the backend. Those are some of the places where productizing AI and automation is hard. It isn’t just like the swivel chair RPA or, you know, that my portal can do this.

Q: You’re in the middle of the entire startup ecosystem and have raised a lot of funding for your company. But, it’s uncertain times for digital health funding at large. What does that mean for a digital health startup and what’s your advice to them? How are you preparing your own company to work through the next four months or longer?

Pranay: We talk about this as a team. Our focus is on building a company that outlives us. There’s so much to be done in an industry that has been severely underserved and in really building something that we are proud of.

On the external side, the cost of capital is changing and that just pushes for sustainable growth in a reliable fashion. Internally, our focus is always the same. We’re fortunate enough where people ask me about runway and things of that sort. We are not cash strapped in any way in terms of the revenue that we’re making and the growth that we see in the tailwinds that we have with the industry needing what we provide is great.

However, our focus is just maniacally on what that patient feedback looks like. Every patient that actually uses the Notable interface has their feedback streaming into Slack for the entire company to see. That’s what drives us. When you see somebody that gives you positive feedback and says, “I’m a blind man that did this using voiceover”, that’s compelling. That’s reason to exist.

On the flip side, when you actually see our class report with 100% of our customers recommending us, that’s not to say every deploy is swimmingly smooth, but you can go in with your scars and what you’ve learned. Talk to any one of these customers and they would still recommend working with us. At the end of the day, that’s where value is created. For us, that is our focus.

For anyone listening to this and building a business in healthcare, I’ll say, you got to focus on your customers. At the end of the day, I think that drives you. That is our maniacal focus across the board.

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 the host

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

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.