Month: November 2022

Healthcare is the last industry that hasn’t yet been truly revolutionized and disrupted by technology

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In this episode, Julia Hu, Founder & CEO of Lark Health, a leading AI virtual healthcare counseling platform, is helping nearly 2 million people manage and prevent chronic conditions, stress, and anxiety. Having invested more than $100 million in R&D, Lark combines cutting-edge AI with remote patient monitoring capabilities to provide 24/7, real-time, text message-based health counseling to patients whenever and wherever they need it.

Julia explains how their text message-based counseling platform is clinically equivalent to live nurse care management services. She also talks about how virtual and at-home care delivery has been impacted by the supply and demand curve, the digital health startup ecosystem, and their new partnership with Salesforce to expand into the “payvider” segment of healthcare. Take a listen.

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Show Notes

01:21Julia, can you talk us through how you got to starting the company and some of your personal journeys that have led you to where you are.
03:40 What kind of conditions do you address using your approach and your platform?
04:53How is your remote and AI enabled care different?
06:42Can you explain the term clinical equivalence?
09:15How has the pandemic impacted your demand environment?
12:20 This year, apart from all the macro factors, inflation, and interest rates, the VC funding environment has contracted a little bit. What does that mean for you and for the digital health startup ecosystem?
15:37You've done some interesting partnerships, especially one with Salesforce. Can you talk about that?
18:03What is your advice for startups founders, those who have either recently come into the market with a product and they're finding themselves facing headwinds because of the macro environment or those who are looking to get into digital health right now.
19:39Julia, you mentioned “payviders” and this is a very interesting segment which is quite different from the normal payer-provider dynamic. Talk to us a little bit about that and why you mentioned that segment as a focus area for your company.
21:58You mentioned early on that you're working mostly with health plans and with employers. Could this potentially be your opportunity to expand into the provider?

About our guest

Julia Hu is an entrepreneur and co-founder and CEO of Lark Health. Founded on the personal experience of living with an undiagnosed chronic condition, Julia is passionate about bringing compassionate care to those preventing or managing chronic disease. Named "10 Most Innovative Apps'' alongside Uber and Airbnb, Lark’s trailblazing A.I. platform allows payers to offer an unlimited, one-on-one chronic disease prevention experience to all patients and is a covered medical benefit offered by many health plans.

Hu was named on the Business Insider’s 30 Under 40 Changing Healthcare list and was awarded as a member of the UCSF Health Awards Hall of Fame in 2021, as well as the EY Entrepreneurial Winning Women™ North America Class of 2021.

Julia Hu is an entrepreneur and co-founder and CEO of Lark Health. Founded on the personal experience of living with an undiagnosed chronic condition, Julia is passionate about bringing compassionate care to those preventing or managing chronic disease. Named "10 Most Innovative Apps'' alongside Uber and Airbnb, Lark’s trailblazing A.I. platform allows payers to offer an unlimited, one-on-one chronic disease prevention experience to all patients and is a covered medical benefit offered by many health plans.

Hu was named on the Business Insider’s 30 Under 40 Changing Healthcare list and was awarded as a member of the UCSF Health Awards Hall of Fame in 2021, as well as the EY Entrepreneurial Winning Women™ North America Class of 2021.

Before founding Lark, Julia ran a global startup incubator, the CleanTech Open, that built a sustainable construction startup, and was an Entrepreneur-in-Residence at Stanford’s StartX incubator. She sits on the board of the Council for Diabetes Prevention and is an active Singularity University faculty member. Hu received her Master’s and Bachelor’s degrees at Stanford University and half of an MBA from MIT Sloan before founding Lark.


Q. Julia, you have a very interesting personal story for how you started Lark Health. Do share that and tell us about your personal journey that led you to where you are.

Julia: It’s certainly been a journey and one that started when I was a child. I’m not a doctor. I have no clinical background, but I am a deep consumer of health care. Ever since I was a little kid, I had many different chronic and autoimmune conditions. They were all undiagnosed but left me pretty sick as a child. My dad had to quit his day job to take care of me. After visiting dozens of doctors, he found this Pediatrician for me and it was like my 24*7 care team — my pediatrician, my dad and I. Over 12 years on this journey where my pediatrician would completely change my diet and help me manage pain, exercise, sleep, medication, and stress, I found that it really changed my life. I got rid of 90% of my attacks, even though I didn’t know what I had as a condition or a series of conditions. That’s what really changed the way that I saw medicine. I felt that if you could treat the whole person and provide 24*7 personal, compassionate care, you could really do a lot to change people’s lives.

Fast forward to me as an adult, I saw that there were not enough doctors and nurses and the ones there were so overworked. How then could you really create this unlimited infinitely scalable care, especially focused on people struggling with chronic conditions or health issues that could lead to chronic conditions or mental health struggles?

As a tech entrepreneur, we decided to tackle this very big problem of using AI and remote patient monitoring, behavioral health, and cognitive behavioral therapy — How do you use these tools and technologies to infinitely scale virtual care? That’s how Lark was born.

Q. What kind of conditions do you address using your approach and your platform?

Julia: Think of our platform as 24*7 text message-based counseling, plus all of the remote patient monitoring. The devices that someone might need, whether they have diabetes, hypertension, pre-diabetes, stress and anxiety, or they just want to sleep better or stop smoking – we cover about ten conditions in preventative, chronic and mental health. We treat about two million patients on our platform and our health plans manage 30 million lives right now for one of these ten conditions.

Q. Are your main customers health plans?

Julia: Yes. We also have about a thousand employers that we work with. We’re also actually just starting to work with pharma companies as well.

Q. Remote care, AI enabled care has been around and there’re a lot of companies that are taking a similar approach to remote care. How is yours specifically different? Is it the cognitive behavioral aspect or the tech?

Julia: Most of population health, today, is what I would call either health care services or tech-enabled health care services, which means you have a care manager, or a nurse and they get on a phone call with you or, they do a webinar with you or, you go in-person to a doctor to get a care plan. That obviously has scale and cost constraints.

What we do is we try to say, “Okay, what if you could automate this first line of defense and turn it essentially into an AI chatbot?” We spent about seven years, $100 million in R&D and trained our AI on about a million patients. It started getting clinical equivalents to live nurses. That’s how we started scaling our services. That’s also why we’re able to manage more than 2 million folks through all this tech and automation.

Now, the tech and automation are not just the devices, the hardware and remote patient monitoring. Also think of us as a friend. We’re there at 1 a.m. If you need to text when you’re feeling stressed, we’ll do a five-minute meditation session with you. When you’re a diabetic and you have some increases in glucose, we will help you understand what you ate that triggered that. So, we’re really all about using the best of cognitive behavioral therapy, the best of the care plans, and providing care in an easy to digest way.

Q. You mentioned the term “clinical equivalence.” What does it mean?

Julia: What we’ve done is, shown that just with our AI text message-based counseling, we can have equivalent outcomes to live nurse care management type services. So, everything from — we’re seeing one-point a1c average drop for diabetics, we’re seeing 13 points drop on hypertensive, and we are, for example, CDC fully recognized as a DPP provider. CDC does a longitudinal look at 2400 providers, and we are in the top 25% of those providers.

We’ve been able to show that our outcomes are just as good. But because we are AI and not taking up and using all these nurses and coaches, we’re able to be much more scalable and deliver care at much lower the cost.

Q. Do you in commercial terms offer these kinds of assurances to your clients — health plans — and really take risk and participate in the rewards and the gains based on this experience?

Julia: Yes, we do. That’s why we do performance-based pricing. We only get paid if we hit certain clinical thresholds and if we engage patients. So, we have that — PMPM and performance guarantees. We really try to ensure that we put our money where our mouth is.

Q. In the last couple of years, we had the pandemic and within that, behavioral health and mental health was a big pandemic. The other big forcing function more recently has been the shortage of labor. How has that impacted your demand environment and your own business in terms of these macro level factors?

Julia: I think that the pandemic has really changed everything. However, specifically the silver lining to the pandemic in my mind, is that healthcare has been the last industry that hasn’t yet been truly revolutionized and disrupted by technology.

I do feel that the pandemic has pushed us probably up a whole generation on unlocking some of that innovation for us. With regard to our managed members, we went from one to 30 million for our health plans. We went from a ragtag team of engineers and tech and data AI folks and raised about $160 million during the pandemic and scaled our team close to 500%.

So, we do feel very excited that we’ve been able to participate because virtual care and getting care delivered through your phone, wherever you are or safe in your own home, are things that really started shifting with supply and demand. It’s been a real learning curve.

Now that the pandemic is in a much better place, people want to stay here. They want to get convenient and cheaper access to care when they want it, when they need it. They want consumer care now rather than health care being very non consumer-centric. In those ways, we’ve been a beneficiary of the acceleration toward digital innovation.

But of course, we have also had to struggle with building a completely remote workforce and creating the culture to align teams. We have not been immune to this recession that’s looming, and I’m just very grateful, though, that we’ve been really pushing forward and had a good growth spurt.

Q. The last couple years were good for fundraising, especially for later stage startups that had demonstrated some degree of traction, stability and growth potential. But things have changed a little in the second half of this year. There’re the macro factors — inflation and interest rates, and the VC funding environment has contracted a little bit. What has that meant for you and the digital health startup ecosystem?

Julia: It’s so interesting. You and I were just talking about the health conference that came out and I was so shocked at how many hundreds of vendors and new digital innovations in the exhibit halls, there were.

I do think that the funding has really pushed forward a ton of innovation. And with the recession coming and the big draw-back of capital funds available now, you have a lot of new companies needing to essentially get toward a go to market strategy, a product market fit, get to more profitability and revenue much more quickly. There is going to be some bumpiness. There is definitely going to be consolidation in the market, a lot of point solutions getting deals here or there that are pretty young and so, the partners on the employer side, on the health system side, on the health plan side might also experience some bumpiness as they work with very innovative but very potentially new and young companies that hopefully, get through the Winter.

However, I think it’s our job — not just of the young companies, in fact all of us growth companies, and the newly public companies — to be good stewards of the capital in our coffers, to really focus on the core business, drop and deprioritize some fun experiments and R&D efforts and really just lean into the focus areas.

Q. One of the things that I’ve learned as an entrepreneur is it’s just as important what you choose not to do as it is to decide what you choose to do. Your comments about the funding environment and what it means for startups that have sort of overextended themselves is true and we’ve seen examples in the behavioral health space with companies indulging in a culling of the herd. Is the recession you mention twice above, a given based on everything that you’re saying or are we probably already in one and we just don’t know it?

Julia: I am not an economist. I don’t know enough about the markets. However, I feel like we need to be very honest with ourselves. We are in the beginnings of winter. I don’t think that winter will be over, immediately. I hope for the best, but I also plan for a more serious winter.

Q. You’ve done some interesting partnerships, especially one with Salesforce. Do tell us about that.

Julia: We were just at Dreamforce with the Chief Customer Officer and the Chief Health Officer launching our products partnership that we created a tech stack with Salesforce. It’s very exciting because here we’ve been able to bring together two parts of the tech stack that serve the marketplace.

Salesforce is very good with being a market leader in CRM and essentially with a data infrastructure and tool kit for everything on the marketing side as well as now for the clinical workforce — the pharmacists, the care managers, the telehealth providers providing data to them through a clinical CRM — so that they can perform at the top of their license. Salesforce came to us and said, “Hey, we’ve got this market leading product. Now, what we do need is a way and a technology to really mass acquire members and patients — to engage them, triage them into virtual care plans, and then, to be the front line of defense for care and at the right time, escalate them to nurses, care managers, providers, ensuring that they get the clinical data so that they can perform at the top of their license.”

That was our exciting partnership — this idea of we being the B2C and they, being the B2B platforms and us cross-selling that into health plans, providers, value based care providers and pharma etc.

Q. It looks like 2023 will be a difficult year. What’s your advice for other founders startups who have either recently come into the market with a product and are now facing headwinds because of the macro environment? Or those who are looking to get into digital health right now and have a nice idea. What’s your advice to them?

Julia: I think you gave great advice — Hold on to that cash.

I think that focus would probably be my advice. Just focus on where your strengths are. Be very honest with yourself, on what your strengths are and where you’re weak. Focus on those strengths and leveraging how do you lean into those strengths to leverage them even more.

For us, I keep telling my team our two strengths are we have a cost advantage and we have a scale advantage. Where do we lean in to, to really where that matters? Where we have a cost sensitive client.

You’d say “Oh! All clients are cost sensitive.” But in fact, we found a lot of interest and scaling in value-based care partners in fully insured. We power many fully insured book of business for health plans. We power Medicare and Medicaid. It’s these types of things, really leaning into your strengths and just being very focused.

Q. So Julia, you mentioned payviders and this is a very, very interesting segment. By the way, my firm does a lot of work with payviders as well. There is a very unique dynamic which is quite different from the normal payer provider dynamic. So, talk to us a little bit about that and why you mentioned that segment as a focus area for your company.

Julia: Absolutely, I’m really excited about the payvider aligned incentive model, right. You’ve got the payer and the provider on one side. They’re all financially aligned to provide value-based care. The plan can provide tools that allow the provider side to really perform at the top of their license. And so, you know, the Salesforce deal that I mentioned that really is a provider type tool. The work that we’re doing is really can we be an effective front line of defense and patient member activation channel for our populations that are at risk because, you know, as a as a product that can scale aggressively, you know, we can engage every single member, you know, in their journey as they become patients, as they need certain things from their chronic condition journey. So, think of us as the, you know, the ongoing engagement and care services in between the doctor visits. So, we’re able to become a front line of defense for providers and, you know, a value-based care service that not only does all the remote monitoring to provide that longitudinal record but pushes people at the right time back to their nurses, doctors and care managers. So, I’m really excited about the transformation and the growth of all of these provider systems.

Q. And for the benefit of listeners who may not be familiar with the term provider, these are integrated health systems that have a large health system, whether kind of a fully owned health plan, which is the payer side of the business. So, these are not the most elegant of terms, but it kind of, you know, conveys the message. And of course, I imagine, Julia, that beginning to work with private providers also now gives you an inroad or a visibility into the provider market segment itself, which is a large, you know, segment on its own. And you mentioned early on that you’re currently working mostly with health plans and with employers, but this could potentially be your opportunity to expand into the provider. So, is that part of your thinking as well?

Julia: I absolutely think that the provider is at the center of care. And as a tech company it’s our job to really be the front line of defense for the provider population, for the PCP population that unfortunately right now is very strained, and a lot of doctors are burning out and we’re not putting enough energy into the PC P ecosystem. So, the short answer is yes. The slightly more nuanced answer is that I think we work best in a value-based care construct because we are, you know, really trying to help the care of the whole person.

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.

It’s a myth that delivering care digitally will result in higher costs

Season 4: Episode #138

Podcast with Michael Hasselberg, Chief Digital Health Officer, University of Rochester Medical Center

"It’s a myth that delivering care digitally will result in higher costs"

paddy Hosted by Paddy Padmanabhan
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In this episode, Michael Hasselberg, Chief Digital Health Officer at the University of Rochester Medical Center (URMC), discusses their digital health priorities and technology solutions to engage the patient population they serve. URMC is a unique organization as it is the only health system still attached to its parent university, and Michael talks about how that differentiates them from others.

URMC, a fully integrated academic medical center, was recently named in our inaugural list of digital health leaders and innovators for our Digital Maturity Awards program.

Michael states that the rural population engages more via digital modalities like telehealth and video visits than in-person visits. He talks about why their digital transformation strategy focuses on data and how the future of healthcare depends on structured and organized data sets. He also talks about how they make their technology choices and digital health priorities for 2023. Take a listen.

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Show Notes

01:44Tell us about the University of Rochester Medical Center and what makes your organization unique?
04:06 Can you talk about your digital health initiatives and the kind of populations you serve?
08:16What are you hearing from your populations in terms of what they want and seek from an organization like yours. Also, talk about the technology enabled solutions that you've developed from a digital health standpoint and the benefits you have delivered?
15:29How have the caregivers and the physicians responded to the digital modalities?
21:08How do you go about making technology choices? Specifically, about the tradeoffs you make when you consider something that is native to your EHR platform, something that may be a standalone tool which is best-in-class but also has its own set of tradeoffs.
25:58 What do you see ahead for health systems? From URMC standpoint, what are you planning for from a digital health priorities/ investment standpoint in 2023?
29:19What do you think of the policy environment? Are you looking at data from the point of view of consumer data strategy that helps you improve your engagement and outreach, or more from the standpoint of improving health care outcomes? Or is it both?

About our guest

Michael Hasselberg, PhD, RN, PMHNP-BC is an Associate Professor of Psychiatry, Clinical Nursing, and Data Science at the University of Rochester (UR). Dr. Hasselberg is the first Chief Digital Health Officer at UR Medical Center and is the co-Director of the UR Health Lab, the health system’s digital health incubator. He was recently named to the “Top 50 in Digital Health” list by Rock Health to recognize his work to improve health equity through technology innovation during the COVID-19 pandemic. Board certified as a Psychiatric Mental Health Nurse Practitioner, Dr. Hasselberg completed his PhD degree in Health Practice Research at the UR and a postdoctoral certificate in Healthcare Leadership at the Johnson School of Management at Cornell University.

Michael Hasselberg, PhD, RN, PMHNP-BC is an Associate Professor of Psychiatry, Clinical Nursing, and Data Science at the University of Rochester (UR). Dr. Hasselberg is the first Chief Digital Health Officer at UR Medicine Center and is the co-Director of the UR Health Lab, the health system’s digital health incubator. He was recently named to the “Top 50 in Digital Health” list by Rock Health to recognize his work to improve health equity through technology innovation during the COVID-19 pandemic. Board certified as a Psychiatric Mental Health Nurse Practitioner, Dr. Hasselberg completed his PhD degree in Health Practice Research at the UR and a postdoctoral certificate in Healthcare Leadership at the Johnson School of Management at Cornell University.

His expertise expands health and technology as a Robert Wood Johnson Foundation Clinical Scholar Fellow and advisor on digital health modalities to the New York State Department of Health, the Department of Health & Human Services, and the National Quality Forum. He also serves as an independent consultant to several digital health.

Q. Michael, can you talk about the URMC and what makes it unique?

Michael: We’re actually even more unique than most academic medical centers left in the country these days in the sense that our health system is still truly fully integrated into our university.

What that means is the budget on the health system side rolls up to the budget of the university. Most academic health systems, today, are no longer fully integrated with their parent university in that they have broken off from the parent university. On the health system side, we tend to make money but on the academic side, it’s much harder to do so. The health system then, ends up subsidizing and sending a lot of their margins over to the college to help support those missions.

A lot of academic medical centers said, “Hey! If we broke away from our parent university, it’s going to be easier for us to obtain our 1-2% annual margins per year that we’re trying to achieve.” At the University of Rochester, we have made the conscious decision that we are not breaking away from our parent university and we actually leverage that as a differentiator for us.

When we think about digital health and digital transformation, I have access to some of the most brilliant engineers, computer scientists, data scientists, business faculty in the country. I have access to even the faculty from our music school. I can apply that expertise and capacity to solving some of the most difficult problems in our health system. I can leverage that expertise to build, create, and deploy new technology solutions into our ecosystem. It’s a unique place and I love it.

Q. Does it also influence your priorities regarding the kind of digital health initiatives you should be in, in addition to serving? Also, tell us about the populations you serve.

Michael: We serve a very diverse patient population. To give you some context around the URMC and Health System, we’re the largest health system outside of New York City. In terms of geography, we have a large geography in the state of New York from central New York all the way out to the Ohio border and all the way down to the Pennsylvania border. This entire region has patients that we serve.

In terms of the kind of diversity of these patients, we have everything from the inner city of Rochester, which looks like the inner city of most moderate sized cities across the country. But if you go 20-25 miles outside of the city, you could be in some of the more rural areas in the States or in the country.

A good portion of our patient population is safety nets and Medicaid. We have a lot of underserved and vulnerable patients that seek care out at our academic medical center. For those reasons and in trying to engage and reach those patient populations, we’ve had to think outside the box and other technology solutions to, not only meet the needs of patients in the inner cities but also meet those for who, there may not be a specific specialist for four counties around them. How do we get care out to them?

With regard to our technology priorities and the influence that the college has on that, actually, there’s not a whole lot of influence from the college in the normal sense. We have a very clear digital transformation strategy that’s set out. When we have gaps in our technology stack, we say, “Hey! We need to solve this problem.” If we don’t have a solution in our technology stack, we may lean on the college. That expertise—if we can’t find a solution or an external vendor that we think is best of breed to fill it in—is what we will leverage and say, “Hey! Can you help us develop the solution in-house?”

It’s not that we don’t develop technologies for the purpose of spinning out companies. We don’t have a true investment arm, so, we’re different from another one of your honorees like Providence Health, which has a $300 million venture arm where they actually incubate a lot of companies in-house. They invest in them and spin them out. We don’t do that.

When we build our technologies, they are truly being built to serve our patient population and community. We build to open source our code and give our technologies away to other health systems in the country. We have a lot of examples of doing that and of other health systems and industry coming in, taking our code, and applying it to their systems.

So, the college, I would say, kind of augments the strategy but doesn’t satay or drive it. They help us fill the gaps.

Q. What are you hearing from these populations in terms of what they want from URMC? Can you talk about the solutions you’ve developed that are technology enabled from a digital health standpoint? What kind of benefits have you delivered?

Michael: Access to health care is something that we hear across the board that these populations are seeking. So, it doesn’t matter if you’re in the inner city or if you’re in rural America. Folks want to have access.

I think one of the myths that jumps out often in the digital health space is this digital divide — that some of these populations don’t have access to the technology needed to receive care or there’s not sufficient broadband in these communities — so they cannot engage.

What we have found in Rochester, for our market and the patients we serve is, that it’s a total myth especially, in some of the more rural areas of the state. What our previous Governor of New York state did was, they invested really heavily in getting broadband access across the state so, there isn’t a problem of Internet not being out in some of these more underserved communities.

The other myth is, a lot of our patients don’t have one of these devices – the smartphone. Pretty much everybody has one of these and you can do a lot with engaging patients on that smartphone. However, as we started deploying things like telemedicine very broadly during the pandemic, what we found was especially in some of these more rural areas and with our safety net patient population, while they engaged quite a bit through the telephonic interactions with our care providers, it wasn’t very significant on the video side. We did a deeper dive in that and found that although there’s Internet access out in these rural communities, the only Internet that’s available to them is through their data plans on their phone. When you’re pushing out a video conferencing feed to somebody’s data plan on their phone, it eats up that data plan quite significantly. So, we’ve thought of and engaged them via more text-based and mobile applications and we’re thinking outside the box around how we can identify other partners and where we can meet these patients in their communities to actually deliver video-based care.

A selfish plug here — just last month we had a publication in the New York-New England Journal of Medicine, Catalyst, which actually talked about our experience delivering telemedicine to the safety net Medicaid population in these rural areas. As they engaged in care, we found out that these populations engaged more via digital modalities than actually in person. On comparing them, we found they engaged more in the digital modalities than even some of our commercial payer patients did. Not only did they engage, they required less in-person care after that engagement in their video consult. They weren’t ending up in the EDs more often than our patients coming in-person. They also required less expensive imaging and lab work than those that were coming in-person.

All these myths then, that delivering care digitally is going to result in higher costs because providers are going to lay hands on them, so, they’re going to need to order more tasks, more imaging to get the data to make those confident care decisions, is not something we saw. The idea that, because the provider’s not going to lay hands on these patients, they’re going to require more in-person follow ups because they’re not going to get their care needs met is not what we saw at all. Again, the patient population that did the best to decrease cancelations, no shows and more follow up was the safety net Patient population engaging in telephonic and video digital modalities who received care.

Q. Does this hold true for all types of care — episodic, preventative, or chronic disease management — or is it more pronounced for one type of care?

Michael: Where I think we had the most success was in primary care because our primary care sees whatever comes through the door.

Another area that we continue to have success in is behavioral health. We’re also having a lot of continued engagements and considerable success in the urgent care and emergency department settings with these modalities.

In terms of the types of digital modalities we have success in some of our subspecialty areas actually may not be telemedicine. And part of that is, digital health in some ways really disrupts their current workflows. Those workflows and more procedural based subspecialty disciplines are set up to be successful with that patient showing up in the office and being seen in-person. If you apply too much digital transformation to those subspecialty areas, it disrupts what’s working for them now.

Being in a health system that’s primarily reimbursed or still in fee for service, we have very little value-based reimbursement contracts. We really don’t want to disrupt a whole lot of our high-cost procedural based subspecialists and what they’re doing. So, in some of those areas, digital engagement has perhaps not been as strong as it’s been in primary care, behavioral health, geriatrics, and urgent care and some of our more non procedural based specialty kind of discipline areas.

Q. How have the caregivers and physicians responded to these digital modalities even if it is for primary care or urgent care or something more specific? What have they had to change or adapt to in terms of their own training, reorientation? Can you talk about their expectations and how you met those?

Michael: I suspect a lot of your listeners — the other health systems — are going to have experienced a lot of what I’m going to say. When we started our digital transformation strategy in our health system, the first two years of the strategy were primarily focused on access and on how we could essentially create a digital front door where our physical front door was located. Our physical front door is primary care. That is where we narrowly focused the beginning of our transformation strategy.

When we started in primary care, we had a significant amount of resistance around, “Right now, my caseload is falling. I don’t have room to take on any more patients. What do you mean you want me to use more technology? This electronic health record that you have for me is the bane of my existence. I am documenting all day long and answering messages from my patients and looking at labs all day. You can’t add another technology on top of this. I can’t do it.” That was a lot of what we heard in the resistance.

We listened to and understood that. We needed to help relieve some of their pain points. We realized the need for a true digital patient portal into our health system. We are an Epic shop and MyChart is the patient portal for Epic. So, we started there in our MyChart penetration. Our digital transformation was not high in primary care — in fact, it was below 30% — and we knew that if we were to engage our patients through digital mechanisms, we had to get that MyChart and that patient portal penetration up. However, the resistance from the primary care site meant they were not championing the patient portal in MyChart because they didn’t want more messages coming in. They equated that patient portal to being their in-baskets, which was overwhelming them.

To get early wins and buy in from our providers, we had to help them out and do a deeper dive into what was clogging up their in-baskets. We found some low hanging fruit here and made system level decisions of getting all that out. We were able to really quickly reduce the in-basket burden on our clinicians by 15% and all this by clicking a button in our system. Getting that win had never happened for these primary care providers in the years that I’ve been in the institution, since we’ve gone live with Epic, and so, that was huge for us.

That gave them more confidence so they said, “Hey! Let’s give this a try.” They started engaging in the digital transformation strategy and started championing MyChart. Now, our patient portal penetration in primary care has gone from less than 30% to up about 90% in a two-year period in the primary care setting. There was resistance at the beginning, but we had to get those early wins.

Along that transformation in primary care, we celebrated those early wins with our providers. We showed the benefits of, “Hey! We’re going to save you more time and free you up to do the things that you really want to do. You can see patients and not be documenting or doing the rest of the stuff.” That’s how we were successful.

We find the same kind of experience in our specialty service lines. We’ve expanded our transformation and one of the things I’m very grateful for is having a great partner in crime. Dr. Gregg Nicandri, our Chief Medical Information Officer and I are attached at the hip. He leads the clinical informatics teams.

We help with the translation, enable getting by at the provider level, and really, leaning on the clinical informatics team. Leaning in on Rosemary Ventura, our Chief Nursing Informatics Officer on the nursing side has also been really helpful to move forward this digital transformation with our providers.

Q. With regard to the technology landscape, how do you make technology choices? What are the tradeoffs you make when you consider something that is native to your EHR platform versus something that may be a standalone tool which is best in class but also has its own set of tradeoffs?

Michael: Folk that have heard me speak in other forums know that I’m, in some ways, a little bullish in my response because we’re an Epic shop. We take an Epic-first mentality. What that means is, if Epic has the functionality and it’s good enough — it does not have to be the best or peripheral but if it has patient experience or patient access functionality that’s a little bit outside of Epic’s bread and butter, then, we’ll go with the Epic solution every single time, even if there is a better solution out there. Part of the reason we’ve just made so much of an investment as a health system into Epic is because we have to maximize that investment is as best as we can.

That being said, if Epic doesn’t have the functionality or it’s on their roadmap but there’s no real clear indication of when it’s actually going to go live, which happens a lot, then, that’s when we make a call about whether this is a high-enough priority. We can’t wait until Epic gets there on the roadmap. We need to find a solution.

The way we evaluate external vendors is not the typical way a vendor may think they would get evaluated. I don’t really care if you’re the best-in-class vendor out there. My first priority is less about your success with regard to your UI, UX and results there. It’s truly about the level of your integration into Epic. If you don’t have a nicely integrated package within Epic already, you’re probably not going to make it on our list of even a vendor to consider. That level of integration is priority number one for us. If we then find a solution that integrates well with Epic’s hyperspace and with the patient MyChart portal in a way that it the patients continue to have that omni channel experience, then, we can onboard that into our health care ecosystem to fill that gap.

One of the things that’s really unique about Rochester and what probably excites me the most is we actually have a true digital innovation incubator. It’s not a research shop. It has faculty from all of our schools — the medical, dental and nursing schools under the same roof — and it uses design thinking methodologies to build solutions in-house to fill those gaps. We build them fully integrated into Epic. That’s the thought process at the URMC as we think about our technology stack and how we take on new solutions.

Q. We are going through a very challenging year in 2022. What do you see ahead for health systems? What are you planning from a digital health priorities/investment standpoint going into 2023?

Michael: Our big investment in priority is actually data. We’re collecting a lot of new data from new technologies that we’ve to had before in our databases within the health system. So, getting our data organized and in good shape is top priority.

As a large academic medical center or health system, we also have a lot of data silos and no source truth of data. It’s important then to build our enterprise data warehouse and break down those silos, bring in all of this new data from these technologies that we’ve rolled out over the last couple of years and make sense of it. That’s actually going to set us up uniquely in two different areas.

One, it’s going to help my health system make more strategic decisions around taking on risk from maybe a payer standpoint in the future. It will also get us set up nicely for moving into more value-based arrangements. That’s priority one.

Priority two is our workforce struggles and shortages. Data will allow us to understand where to start making investments in the workforce. When data is all cleaned and aggregated, we can start taking advantage of some of these Machine Learning products that are popping into the markets. A lot of that machine learning and artificial intelligence technologies that are coming out can potentially significantly impact the workforce shortages, help us start automating things, and supplementing where we have gaps in our workforce.

I have a lot of AI vendors that approach me and want to partner with Rochester. However, my response to them is, we’re not ready yet. The reason is, you may have the best algorithm or model built, but my data isn’t there, yet. If I was to roll out your model now, and I put my data in, then, the results emerging will probably not be the results I was hoping for.

We want to put ourselves in a good place to not just take advantage of machine learning and artificial intelligence in the future to help our workforce but also to help us make better strategic decisions around transformation, in general. That may be on the digital side or even on the payment side.

Q. Are you looking more at data from the point of view of a consumer data strategy that helps you improve your engagement and outreach? Or is it more from the standpoint of improving health care outcomes? Or, both?

Michael: It’s absolutely both. One of the things that excites us is on the outcome standpoint and actually merging that data. We’re very proud of the fact that Rochester’s the home of the bio psychosocial model of medicine and it’s all about focusing on care from these holistic and broad domains.

We made a strategic decision about seven years ago to profile our patients using patient-reported outcomes within those broad domains. It didn’t matter if you came to my health system with a toenail injury but we were going to ask you about your emotional distress, physical functioning, pain interference, and social functioning every single time. We collected this data on iPads and integrated it right into Epic. My health system has, as far as we’re aware, the largest patient reported outcome data set in the entire country. All this is systematically collected in these broad domains. Now we’ve got these outcomes based off the patient’s own perceptions and in their own voice about how they’re doing in health care. We can combine that with some of the more quantitative data from the EHR about lab or mortality outcomes and these newer consumer engagement data that we didn’t otherwise collect using technology. That’s going to be the secret sauce.

When I think about disruptors, in general, in other verticals, Amazon comes to mind. They totally disrupted retail, but Amazon didn’t do it because they were setting up an e-commerce website. It was the data behind that. Amazon knows you as a consumer better than you know yourself. That’s where we want to get to in health care. I want to be able to help predict what you’re going to need as a patient before you know you even need it and get you to the right level of care at the right time. We think that combination of patient reported outcomes collected in these broad domains combined with our EHR data combined with this new consumer data that we’re getting from technology combined with claims data and others will help us at Rochester develop our own Amazon recommendation algorithm that they’ve patented. We’re going to do it for health care. That’s where the future is going and that’s why we’re now heavily invested in getting our data to a point where we can start leveraging our Data Science Institute and the college and some of these AI vendors to help us get there.

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.