"We’re expanding our concept of access beyond just a face-to-face encounter to all the digital encounters that allow us to stay more connected with patients"

Q. Denise, tell us a little about your background. How did you get into this?

Denise: I am a primary care physician by training, but I got involved in a start-up called UpToDate, early in my career. For those who are not aware, think of it as kind of an evidence-based Google for doctors. Then, that startup grew, and we were acquired by a large corporation. I became CEO of that business and continued to build some others around clinical decision support as a general theme within that space. I ran that business for about 13 years and then, just decided to make the move to Ochsner in January this year as the Chief Digital Officer. 

It’s been a journey and I think, it’s a really interesting time to be in healthcare. Healthcare organizations and health systems have a big role to play in what the future of health care looks like, and I wanted to be a part of that. 

Q. What does the role of the Chief Digital Officer entail? 

Denise: We’re still figuring that out. Broadly, I have responsibility for all of our telemedicine, for what we call our digital medicine solutions, which is largely our digital tools around RPM program, remote patient management largely around chronic diseases, and other areas, as well. 

There’s also our innovation team, which we call Innovation Ochsner. So those are the three broad areas. More specifically, I wear a couple of hats, both using digital technologies to improve patient care within Ochsner. It’s all in the family, but entails taking a lot of the tools that we’ve built and looking for opportunities to commercialize them, externally. 

Q. Can you touch on the population you serve and your care mix? How does that inform your larger priorities? 

Denise: It’s huge. Ochsner is in a unique market with just a lot of opportunity. We generally fight it out with Mississippi for being ranked 49th or 50th in most health outcomes, which isn’t a great place to be, and we certainly want to improve that. Some of that is driven by just the prevalence of chronic disease in the state and some of it is driven by the payer mix. We have a lot of patients on Medicaid. I think it’s something like 20% of adults in Louisiana and 50% of children. A pretty high number are on Medicaid. 

We have a lot of patients who are on risk-based contracts so, we do a lot of value-based care. Probably more than 50% of our patients are on risk-based contract, which in many ways allows us to be more innovative. For us to not only survive but thrive as a health system, we have to do a lot of things really well. That’s driven a lot of the innovation that we have a history and are known for. It’s also driven a lot of the tools we’ve built, to be able to take care of that type of patient population and drive both, engagement and outcomes. 

So, that was honestly one of the things that really attracted me to Ochsner because that mix again allows us to potentially be a good or fertile ground for driving change and transformation, because we have to. There’s nothing that drives more innovation than the need to do that. Our location is really key in terms of driving our journey. 

Q. What are the building blocks you work with as you approach your population’s digital needs or preferences?

Denise: You hit the nail on the head, here. We talk all the time about how there’s technology for sure, but it’s the process and people that that really drive the technology to be successful. You really need a combination of all of those things. The technology is almost the easy part. 

Everybody talks about this one example—AI and healthcare and building AI models—but the key to making those successful is how you implement them and what happens to all that data. Where does it go? We can’t push everything back on the physicians like we’ve tended to do over time. So how do you deal with that? 

Even if I think about the remote patient management solutions that we’ve built and I intentionally use the name “management” and not “monitoring”, it’s easy to monitor people remotely. That’s truthfully the easiest part because while you have to do some things right to drive engagement and make sure patients can actually do what they need to do, truthfully, that’s the easy part. 

The hard part is, now that you’ve monitored them, what do you do? That’s where our programs focus. We’re very good technically and we take advantage of that but what do you need to build around that technology to drive outcomes? That is obviously what we all want to do. 

Q. Tell us a little about what kind of programs have made an impact for Ochsner. Can you share some numbers or metrics to help our listeners understand? 

Denise: We are at the highest level so we’ll talk about diabetes and hypertension because those are the programs that have been available the longest and for which we have the most data. With these programs, it’s pretty simple. 

We provide patients with devices to monitor blood pressure, blood glucose, weight, those sorts of things. We have a mechanism for getting all of those readings into MyChart and for that, we use Epic. Then, we surround that with a separate care team. So, it’s a really different model. This doesn’t go back to their primary care physicians, and we communicate with primary care, but we’ve built a separate care team that’s comprised of pharmacists or other APPs, as well as health coaches who absorb all of that data. In addition to health coaching, we also do medication management and that’s the RPM program. 

We have a way of not just monitoring patients at home, but also taking that information and doing something about it at the at the very highest level. And we found a few things. 

First, we’ve done some propensity match studies. For patients who are in our digital medicine programs compared with patients who are not in them for any variety of reasons, but matched them in a lot of ways so that we’re getting good data comparison we found that routinely those patients (in our digital medicine programs) get under control faster, stay under control longer, have reduced utilization of our emergency department, reduced utilization of hospital admissions, and overall save the health system somewhere between $100-200 per month each because of reduced utilization. 

That’s all in, including their medications. That’s why, for a value-based world, that’s really important. I think the interesting things are, one, patients really love it. So, our Net Promoter Scores are in the high 80s. 

Second, it’s worked in every population. We tested it. It works in our fee for service populations, managed care populations and maybe most surprising as it may be, it works in our Medicaid population. We’ve now got around 4000-4400 Medicaid patients in a pilot that we just started 18 months ago that was only supposed to be 1000 patients. And again, all of those outcomes that I just cited are actually greater in our Medicaid population than elsewhere, including Net Promoter Score. So, we’ve been able to digitally engage these patients and drive these sorts of outcomes. 

Q. Are there any learnings there that you’d like to share for the benefit of others who are working with similar populations? How do you get your patients to really embrace the technology? 

Denise: There are a couple of things. 

One, we work hard to make sure that patients can use the technology. So, we have a few different means to onboard patients, make sure they’re comfortable with the devices, and that everything is working well. That’s the technology piece of it. We’ve been doing it long enough that we have that down. Some of it can be done remotely, the rest in person. But there, again, we’ve kind of figured out how to how to do that part of it. 

The other thing, because people have asked me, is the degree of reduction in inpatient admission, as an example, which far exceeds what you would expect from, if we just looked at say, hypertension, and what kinds of inpatient admissions are related to hypertension or what kind of emergency department visits are related to hypertension. You think of coronary heart disease, stroke, those types of things and the reduction that we’re seeing in those high-cost areas of the health system are much greater than you would expect to be driven by, what you think of as complications of hypertension, diabetes. 

We don’t know this for certain, but my hypothesis and this is where it relates to your question, is that when you surround the technology with a care team that’s completely focused on that, and not distracted with trying to do 100 other things, is what really drives the engagement. So, they’re sending these readings in and that’s engagement. They are getting feedback on that. 

We’re experimenting with ways of doing digital coaching and those sorts of things. So, it doesn’t always have to be a person. Sometimes it’s a digital engagement, but they’re getting that feedback routinely. That’s causing a level of engagement that we’ve just not seen before in these populations. So again, it comes back to that—it’s not just the technology, it’s the process and people that surround it. 

Q. How do you go about making your technology selection choices better versus buy? If you have to buy, do you start with the EHR first, for best-in-class? Tell us a little about that process.

Denise: I wish I had a definitive answer for all of that because most of it depends on—as there’s a lot of health systems—do we tend to rely on ourselves, first? Epic is our backbone so; we always want to see what Epic can do. 

But then, we tend to build a lot of things ourselves. We’re starting to recognize that it’s not that we haven’t done partnerships before, but increasingly recognizing that we need to take advantage of more technology that already exists out there. The important thing is that while I don’t have a definitive answer, yet, in making those decisions, you have to have a clear sense of what you want to do and what outcomes you’re trying to drive. 

We get so much outreach from technology vendors these days and the signal to noise ratio is very low, which makes it really difficult. To the point where a lot of times we don’t engage because it just takes so many conversations to have anything that works. So, it’s far better to say, “Here’s a problem we’re trying to solve. Let’s go see if anybody else has solved it.” But again, have very specific outcomes that we have in mind because people have built all sorts of things that solve all sorts of problems but do they solve the problem we want to solve? 

It’s a simple calculus of what does it cost to do that versus building things ourselves in the time that’s required? So, I think increasingly we’re going to find that it’s more effective to partner than we have in the past. But what doesn’t work is to just take in a bunch of cool technology and then figure out what to do with it. 

Q. I imagine that in today’s context, the signals are getting even weaker because of the current funding environment and some of the uncertainties that many of these innovative startups have to live through. Is that a concern to you? 

Denise: That’s always a concern. We all know that the funding that ramped up in 2021 seems like it’s rationalizing a bit this year, which is good, not deep and well decreasing relative to last year, but more on par with the trajectory that happened before the crazy 2021. 

But given everything that’s happened in the last couple of years, there’s the concern of how we find those gems. Once we found them, you almost have to take the approach that if you’re going to start with early-stage companies, we’re going to invest with them to help them be successful. Else, you do run the risk of a bunch of these going under. Or you have to take the perspective that you’re going to work with them but be prepared by whatever means that they may not be successful. Then, what’s plan B? How do you work together to ensure success? And then, always have a plan B. Developing that ecosystem where you can be an innovative partner is going to be really important for health systems moving forward. 

Q. How do you measure the success of their programs? How do you keep score? Do you have a specific set of metrics you’re targeting? Can you talk to us about that? 

Denise: A lot of our internal metrics are around enrollment in the program. So, that’s obviously a big one for us. Then, there are the outcomes that we’re driving. One of the metrics that we use quite a bit for our chronic disease programs are test metrics. Are we continuing to drive those upwards and doing better than our usual care? Some quality metrics, some enrollment types of metrics are being used to the degree that we’re beginning to commercialize these externally. We obviously have financial goals around what all of that looks like. So, it’s a combination of all of those. 

Q. With regard to the investments that you’re making, not a lot of what you just talked about relate to care, especially remote care or chronic care management. These are the high impact, high value use cases and great stories. Can you share anything with regard to access related solutions where you’re driving engagement through digital tools and technologies?

Denise: Access is really critical. Probably one of the top two or three priorities that we have. Ochsner has a whole group that focuses on consumer engagement and then, we collaborate to think about what are our new ways that we can continue to make access easier and easier. 

Some of it is as basic as making sure that our providers have the capability to enable patients to do online scheduling. That sounds so easy, but it turns out that that’s not actually so easy to drive. But we’ve been pretty successful there. We have goals for our providers around access within a certain period of time. 

We are beginning to think about access a little differently. Access doesn’t have to be a face-to-face meeting. It can be a digital encounter. That can be the first access. Then, as we expand how we’re thinking about remote patient management, it doesn’t have to exclusively be around chronic diseases. It can be as simple as monitoring symptoms and a patient with chronic migraines. And then, doing that again digitally, not just in person. 

We’re beginning to expand our concept of access beyond just a face-to-face encounter to what are all the digital encounters that we can have with these patients that allow us to not only stay more connected, but also provide, good access when they need it. We’re also talking about things like e consults and e visits and just all of the asynchronous tools that we have to deliver virtual care. All these are components of the access equation. 

Q. What does Oschner’s governance model and strategy look like? Who’s involved in driving the program besides yourself? 

Denise: Like every health system, there are a lot of top priorities so, that’s always challenging. 

One, we went through a corporate strategy refresh last year, and one of the things that we really drove home is that even with all of our varied strategic priorities, digital transformation isn’t a separate priority. It may be separate but it really becomes a part of every strategic priority within the health system. That may sound like a very simple statement, but it’s an impactful one because it means that it becomes a priority when we’re thinking about solving virtually anything across the health system. I’m fortunate that it’s been set up for success from that perspective because it’s been recognized that it’s an important part of every piece of our strategy. 

This is an executive team level position and since we talk as an executive team about what we need to do, it becomes a part of every conversation. 

We probably spend more just on innovation than a lot of health systems do because it’s just been a commitment there. It doesn’t mean we obviously have endless funding for that but there isn’t a set amount where it’s got to be X percent of our operating income every year. However, that number grows every year. 

From an IS perspective, it’s very embedded in most of our strategic priorities so, it ends up not being quite as challenging as it may sound. What’s potentially more challenging is, for what we call outside the family or for separate businesses that we might want to drive, that’s where the level of investment involves some debates around how to fund all of that compared with how a lot of digital startups are being funded. That becomes a trickier proposition. But it’s been set up from an executive team perspective to drive what we need to drive. 

Q. If you had one best practice or learning from the last six or eight months that you’ve been in this role for your peers in the industry, especially those who are addressing similar populations and maybe in earlier stages of their digital journeys, what would it be?

Denise: It probably goes back to what we already talked about—that it’s not just about the technology. I think that’s my biggest learning. I do think that if you have an organization that either takes a lot of risk or is driving towards that, you can’t move fast enough. So, it has to become a system priority and it has to, again, go beyond what the technology is. Those are probably my key learnings to be able to drive success. 

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