Author: sanjith p

There is a delicate balance between managing costs and being good stewards of investments in new tools and technology innovations

Season 5: Episode #140

Podcast with Tanya Townsend, SVP & CIO, LCMC Health

"There is a delicate balance between managing costs and being good stewards of investments in new tools and technology innovations"

paddy Hosted by Paddy Padmanabhan

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In this episode, Tanya Townsend, CIO of LCMC Health, a New Orleans-based non-profit health system, discusses how they are leveraging their digital capabilities across the continuum of care and improving patient access and clinician experience across their facilities.

Tanya explains how the macroeconomic environment has impacted their investment decisions this year. She states that there is a delicate balance between managing costs and being good stewards of investments in new tools and technology innovations. 

Tanya also talks about how they redesigned their online scheduling tools and patient portal platforms, their journey towards creating an integrated and seamless care experience across service lines, and more. Take a listen.

Show Notes

02:57What does digital health mean for you? Talk to us about the digital health program and LCMC.
07:16 Can you share a couple of examples of how you have improved the patient experience, especially from an access standpoint.
11:42What are your patients telling you? What are the things you're hearing from them that are driving your priorities and your investments?
13:42As the CIO, how do you go about making your technology choices?
15:54How has the macroeconomic environment impacted your investment decisions this year?
18:55 What have been some of the successes that you've had in applying artificial intelligence and advanced analytics to help to drive your outcome?
21:18If a digital health solution founder is listening to this podcast and wants to reach out to you, what's your advice to them before they send you, their pitch?
23:12What does your org model and governance model look like when it comes to digital health investments? How do you how do you make the decisions?

About our guest

Tanya Townsend is the Senior Vice President and Chief Information Officer (CIO) for LCMC Health and its nine-hospital system. An established financial executive who has been working in the healthcare industry for over 20 years, Tanya held a variety of positions from system analyst to CIO in healthcare organizations and hospitals in Wisconsin before she headed south to New Orleans and the LCMC Health system.

Tanya is committed to staying abreast of best practices across the IT industry – in her role as a division CIO in Wisconsin, she was the first to consolidate and integrate Information Technology, HIM, and Clinical Engineering into a more efficient shared services model. Passionate about the topic of information tech, Tanya has spoken at national events in the industry as well as received numerous acknowledgements and awards for her work. She currently sits on Advisory Boards for several technology firms including NetApp, VMWare, Fortified Health Security, and CHIME. She has been named one of the top healthcare IT innovators in the country, and her dedication to establishing and maintaining state-of-the-art information systems for LCMC Health is highly valued.

Tanya was recognized by Becker’s Hospital Review as one of the 2018 Female IT Leaders to Know.

Tanya Townsend is the Senior Vice President and Chief Information Officer (CIO) for LCMC Health and its nine-hospital system. An established financial executive who has been working in the healthcare industry for over 20 years, Tanya held a variety of positions from system analyst to CIO in healthcare organizations and hospitals in Wisconsin before she headed south to New Orleans and the LCMC Health system.

Tanya is committed to staying abreast of best practices across the IT industry – in her role as a division CIO in Wisconsin, she was the first to consolidate and integrate Information Technology, HIM, and Clinical Engineering into a more efficient shared services model. Passionate about the topic of information tech, Tanya has spoken at national events in the industry as well as received numerous acknowledgements and awards for her work. She currently sits on Advisory Boards for several technology firms including NetApp, VMWare, Fortified Health Security, and CHIME. She has been named one of the top healthcare IT innovators in the country, and her dedication to establishing and maintaining state-of-the-art information systems for LCMC Health is highly valued.

Tanya was recognized by Becker’s Hospital Review as one of the 2018 Female IT Leaders to Know.


Q. Tanya, can you tell us a bit about LCMC and the populations you serve?

Tanya: It’s kind of a long journey, but I’ll try to wrap it up there, summarize it. We are originally founded by Louisiana’s only freestanding Children’s Hospital. LCMC originally stood for Louisiana Children’s Medical Center. We just go by LCMC Health now. We have since grown into a healthcare delivery system serving the New Orleans market and the communities in the Gulf South. We kept the legacy of children and pediatrics in our name, which is the LCMC Health piece. We are now in nine hospital locations and Children’s Hospital of New Orleans and several other community hospitals, and we are the area’s only level one trauma center with Tulane Medical Center of New Orleans. We also recently acquired Tulane University Medical Center and its Associated Hospitals. So, we are an academic teaching organization. We train the next generation of health care professionals in partnership with LSU and Tulane Medical Schools, amongst others. For allied health students, where about 3 billion in revenue, 3000 physicians, 14,000 employees, a couple thousand inpatient beds. And we’ve kept the legacy of our founding member, which is Children’s Hospital of New Orleans, in place. But we’ve expanded our services beyond pediatrics. I am the first chief information officer for this organization. It’s formed very rapidly over the years through these mergers. And I have been in my role now for eight years.

Q. In this podcast, we talk a lot about digital health and digital transformation, and I want to focus on that as it relates to LCMC. Can you give us a little bit of an overview of your digital health program? What does Digital health mean for you and talk to us a little bit about the digital health program at LCMC.

Tanya: Sure. We are an organization that did grow through mergers and acquisitions, and so our original goal in our digital health program was to come up with a standardized methodology for systems, for strategies where we could get synergies and really integrate across our continuum of care because we are very locally based here in the New Orleans market. So, all our hospitals geographically wise are very close. And so, it is common for patients to visit any one of our facilities. We really needed to have an integrated digital footprint or electronic health record, which is where we started to make that more of a better patient experience, as well as the opportunity to make that more efficient for our organization and make it a happier or more efficient place to be for our caregivers and our workforce. We were running and somewhere around dozens, if not hundreds of various applications and systems. So, I would like to say you name the electronic health record and platform, and we had it. So that’s what I spent most of the first initial years forming was an electronic health record strategy to again, really integrate care across our continuum and remove some of those redundancies, creative efficiencies, and make that again, a better experience for our workforce as well as our patients. So, step one was to set down that path of creating a centralized shared services model and that common vision. And we did end up selecting Epic as our electronic health record. So, our initial phase of that was in 2017 and we did do Big Bang. So, everything from ancillaries to inpatient to ambulatory to revenue cycle, all of it was big bang and we rolled out. At that time, we were five hospitals and that was all conducted over the course of about a year. So, between the end of 2017 through mid-2018, we were up and running on all of those facilities. And then we acquired another hospital in the middle of the pandemic in 2020. So, we spent the last couple of bringing them into the fold onto the platforms and we are now embarking on that same process for our latest acquisitions with Tulane, which is another three hospitals. And we plan to have them up and running within about a year. So, all of that said, that’s been keeping us very busy and just putting the foundation in place. And now we’re really looking forward to moving past, you know, having the foundation and really leveraging additional digital capabilities for advancing what we can. So right now, we’re really focused on our journey towards systemness. So really developing those standards across service lines, across our continuum of care, because again, our patients in the geography that we serve is very close in proximity. So, we want that to be a seamless and common experience and focus on systemness. We’re also really focused on patient access, and we’re very aware that patients do have a choice and we want to make sure that we make it as easy as possible for patients to access our system. So, we’ve done a lot around that. And then lastly, also not just focus on the patient, but also continue to focus on our clinician experience. So, almost just as much rigor and focus on the clinician experience and happiness and creating user friendly tools that makes it easy to do their job and yet meet all the regulatory requirements and compliance things that are always coming at us for documentation.

Q. Can you give us a couple of examples of what you’ve done to improve the patient experience, especially from an access standpoint.

Tanya: Sure. One of our most recent experiences, which I will tie into even that systemness category that I just mentioned, we just recently did a full redesign of what we call our online scheduling tools and platforms. So, we do have a patient portal there. We were allowing scheduling of it when we went live with Epic a few years ago. But on this journey towards integrating care and making it a common seamless experience across service lines. We revamped, revised all of that and ensured that it was easy to create, to schedule a patient through our platform for, let’s just say, primary care. So, if for some reason my normal physician that I normally see wasn’t available, but I really needed to get in for an appointment, we now make it very easy to search our entire database of availability to get in with the next provider, even if that might not be at the same clinic that that I normally would have seen. So, that has been a huge improvement just in terms of schedule utilization and visit volume increases. So, it’s been a win-win not only for the patients to have easier access, but also, it’s a growth opportunity for the healthcare system. We’re going to start with that and continuing to look at ways for how we improve access. Referrals is another area that we’re going to start looking at again, just making that an easier process to get patients to where they need to be within our system.

Q. What about the clinicians? You mentioned that you’re also trying to provide features and functionalities to help make their jobs and their lives better, right? Can you talk about an example of what you’ve provided for them?

Tanya: Sure. We just recently, it’s still in progress, none of these things are ever done right. As it’s a continuous evolution, continuous improvement. So, one of the projects that we also launched this past year was called Project Joy, and it was a very targeted effort to focus on nursing specifically because I’m sure we are aware of the nursing shortages that many of us are facing. It’s a real challenge to not only retain the nursing staff we have, but also attract and recruit new nurses. How do we make sure that we have an environment that they like? Project Joy, in partnership with our Chief Nursing officers, was an effort to evaluate utilization of our electronic health record. So, now that we have the data in a digital format, it makes it much easier to do some targeted analytics and analysis on where our nurse is spending their time and then really dig into. At a glance we found that some of our nurses were spending an inordinate amount of time in flow sheets and responding to what we called non required best practice alerts. It was almost just kind of an FYI sorts of messages, but not actionable. We spent a lot of time in partnership with our chief nursing officers to identify how can we make these glow sheets a little bit more user friendly and how do we reduce the amount of clicks or interruptions that the nurses face with these alerts that may not really be effective. On our first phase of rolling out the changes to that project, we were able to calculate savings of over 1000 hours per month to give back to our nurses to do other things such as care for our patients at the bedside.

Q. That’s another great example of how you’re really making it work for both the patients and the caregivers. What are your patients telling you at a high level? What are the one or two things you’re hearing from them that are driving your priorities and your investments?

Tanya: We started to get a lot of very positive feedback when we did these revisions around online scheduling and ease of access. And the other thing that was probably another good example, although it’s a little outdated now, but our ability to respond to the pandemic. Obviously, that was a rapid change and we stood up telemedicine overnight. We also did a great deal on what we called mobile testing. So, if patients weren’t in a place that they had easy access, we had busses that were out in our community offering testing and then also did the same thing for vaccinations. When those became available. We really stood up the technology pretty much almost overnight and to be able to have a massive vaccination location that made it easy for patients to get in and out and even looked at some rideshare type of programs for ensuring that transportation wasn’t necessarily an obstacle or barrier in terms of where to get access. So those are just a few of the examples of the great feedback in our community that patients are excited about.

Q. Let’s talk a little bit about the tech. You have got a lot of technology choices. Your major EHR system, which is Epic, is doing a lot in terms of building out their product on their platform with their digital capabilities. You also have a thriving ecosystem of independent software solution providers. This could be everyone from, very well-established firms, but also startups from the digital health ecosystem. As the CIO, how do you go about making your choices and talk to us a little bit about your thought process.

Tanya: That is such a great question, and I don’t think any of us really have the perfect answer. I think we’ve made a lot of strides over the last few years. I think, again, the pandemic really pushed us into this agile, innovative space of not having the ability to wait for perfection and needing to take some chances or risks, hopefully calculated risks. I don’t have a perfect answer, but what we try to do is really align with our overall strategic plan. We do we do have an Epic first mentality, meaning let’s not reinvent the wheel if Epic already can or is doing it, we’ll probably look at that first just because it is already part of the tool that we’ve purchased and invested in. And there is something to be said about complete integration from the start. So, we start there, align with the strategic plan, and then identify where those gaps are. While I think that does an awful lot, they don’t do everything so really targeting and again what are our strategies, where are the gaps and identify where those possible solutions can fit. And even what we call interoperability and integration has really come a long way too. We’re not stuck with just HL7. There are so many more capabilities now in how we can integrate with our core platform. So that’s not so much a barrier as it used to be in years past, but it is something important to ensure that integration is hopefully seamless as can be for both the user experience as well as just continuity of care. If we are talking about patient information.

Q. How has the macroeconomic environment impacted your investment decisions this year? You’ve got a labor shortage; you’ve got an interest rate. There’s a lot of there’s a lot of forces in play in the market.

Tanya: Yeah. Another great question! In the healthcare industry, we are facing issues with reimbursement rules changing and the inflation also continues to rise. So, we really do have to make sure that we’re managing our costs and being good stewards, which is difficult to do when at the same time we just talked about innovation and new tools and investment. It really is a delicate balance. So, while we’re working on enabling new digital technologies that will hopefully drive revenue or improvements, and that’s a key to making sure that we continue to measure that. But also, where can we eliminate costs or really push on opportunities? So, a big opportunity for us because of all the mergers and acquisitions we did was application rationalization. So, as we brought these nine hospitals together, they had a little flavor of just about every application you can think of. That was a huge part of opportunity, is let’s standardize on the application footprint, let’s archive that data as necessary and let’s stop paying maintenance on those systems. So, we’ve done a lot of that over the years. So, some good stories to tell there and making that a priority, but also looking at new cost models. So of course, cloud computing is a whole new method of managing infrastructure compared to the sort of traditional way of buying servers and trying to predict what you were going to need, five years in advance. Now it’s a little bit more consumption based. That’s just a new cost model to evaluate. We already talked a little bit about innovation, but because of the shortage of whether it’s nursing or revenue cycle, where are the opportunities to use some artificial intelligence or maybe what we can call the digital employee experience, where we can get creative on how we can automate certain functions within our organization there where we are having shortages of labor. That’s also not an easy answer, but let’s continue to explore that. And then I already mentioned the project your way around. How do we just keep our clinicians happy and save them some time along the way?

Q. You mentioned artificial intelligence and the use of data analytics. How far are you along in that journey into. Terms of using your data and what have been some of the successes that you’ve had in applying advanced analytics to help to drive your outcomes.

Tanya: I would say that every one of our projects has some sort of metrics or analytics attached to it, and we make that a priority or a requirement before we launch any initiative. How are we going to measure this, what are our goals? Let’s make sure we’ve got a baseline and we’re prepared to measure both during the implementation and then post implementation. It’s something I’m very passionate about. I do have the business intelligence team. It’s good that we can really partner up with our EHR analysts and then our business intelligence data miners to marry that conversation. If I use EPIC for an example upon implementation, for every single module or service line, we did establish goals and we’re prepared to measure those goals during the implementation. I already mentioned the online scheduling. We just completely revised that, and we made sure we were ready to measure. We set our baseline and one month into the implementation we were able to show the metrics like – this is what it looks like last month and this is what it looks like last year and look at the improvement that we saw in just one month. I mentioned – Project Joy, we were able to measure how much time nurses were able to save just by fewer clicks and able to put more documentation at the bedside capabilities through the flow sheet modification. So, we were able to track that to how many minutes we were saving. So those are just a few examples.

Q. There’s a lot of innovation that is taking place in the market right now in terms of digital health solutions. If one of their founder CEO is listening to this podcast and wants to reach out to you, what’s your advice to them before they send you, their pitch?

Tanya: I think we covered a lot of it during this conversation. But if I could summarize maybe the key things to take away. One is really partnering so the CEO and the CIO or operations and IT collaboration to really understand the strategic initiatives or priorities of the organization and prepare to partner on that conversation around measuring accountability and on all parties, whether that’s a vendor solution, internal IT, nursing. Make sure everyone’s on the same page with what we’re measuring and why and the accountability around that. I like to say that even in data conversation, it’s one thing to produce the data. We now have lots of data, but accountability and responding to the data is I think kind of the next step of really making it meaningful. Then the other thing I think is just having conversations like this and staying connected to what the industry is doing, what others are doing, learning from others, just staying connected in the healthcare community. I truly do believe while we can learn from other industries, healthcare is a unique industry when it comes to technology, and it is really a small world at the end of the day for the healthcare IT community at least. So, leverage those conversations and that network to continuously learn from each other.

Q. What does your org model and governance model look like when it comes to digital health investments? How are you organized? How do you make the decisions? Is there a committee?

Tanya: Sure. We have a tiered approach. I call it sort of three layers of the triangle or the pyramid. At the base of the pyramid as your foundational pieces of the structure. So that’s where our subject matter experts get together routinely to talk about what the priorities are, whether they’re changes or optimization or new ideas that start there. And then above that, we call our operational layer. This is where our chief operating officer, our chief nursing officer, our chief medical information officer, sit. Their goal is to oversee trying to ensure that one group doesn’t necessarily make a decision that might negatively impact a different function down the road. They’re looking at that continuum of care for the decisions that we’re making. And then at the top level is the executive team. So, we do have what we call it together, which is our IT steering committee that is comprised of a handful of executives, including myself. Our goal is to really set the strategic priorities for the organization and ensure that there’s alignment within the framework. We also ensure that we’re utilizing resources in a shared fashion across everyone’s needs, which is tricky to do because like I mentioned earlier, we have pediatrics, and we have level one trauma academics. And so, making sure that all needs are met within that shared model can be tricky. Every committee has a chair and a co-chair. The chair is somebody from operations. We like to use the motto operationally led and supported. So, the chair is somebody from nursing or radiology, etc., and the co-chair is somebody from the IT functions or a leader on my team. And they are partners in establishing the teams and the cadence and the conversations. And then every facility is represented through that subject matter experts’ layer. And so, if you have additional questions after that, but that is how we’re structured.

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.

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
To receive regular updates 

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 macro trends driving the growth of digital health funding are still in place

Season 4: Episode #137

Podcast with Jacob Effron, Principal, Redpoint Ventures

"The macro trends driving the growth of digital health funding are still in place"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Jacob Effron, Principal at Redpoint Ventures, discusses the venture capital (VC) environment for digital health. Redpoint Ventures is a venture capital firm focused on investments in seed, early, and growth-stage companies and has been investing in the healthcare tech landscape for the last decade.

Jacob believes that the fundamental trends driving the growth of digital health are in place. However, later-stage companies looking to raise additional capital may experience some uncertainty in the short term. He also talks about the demand environment for Redpoint’s portfolio companies and his advice to founders looking to navigate the health system space. Take a listen.

Our Podcast Partners:

Show Notes

00:32Jacob, tell us about Redpoint Ventures and your role.
02:56 Give us your State of the Union on where we are with digital health, especially the younger companies.
05:24Have you changed focus considering what's happening in the macro environment? Are you investing more in one stage versus another?
06:52What are you hearing from the startup entrepreneurs and the founders about the demand environment, their operations, the talent etc.?
10:10What are you hearing from the market about the demand environment for digital health solutions?
11:43 You mentioned value-based care and how startups now must get creative about demonstrating value, taking on risk, and being able to put more money at risk to earn the right to a seat at the table. Tell us how that's playing out.
16:07What do you think of the policy environment? Are there things that you would like to see in the near term that could make a difference to the picture?
18:34What are some of the core attributes you seek before you begin funding one of these startups?
21:43The competitive landscape for the startups today has big tech---Amazon, Microsoft, Google, Apple---coming into the core healthcare services space. What’s your take on what this means for smaller companies?
24:04What's your take on what to expect for 2023 and what are you advising your followers?

About our guest

Jacob Effron is an investor at Redpoint Ventures specializing in digital heath. He's an operator-turned-investor, having worked as a product leader at Flatiron Health before going into VC in 2019. Jacob’s background as an operator grants him firsthand knowledge of the pain points that health techs go through. He also regularly shares his thoughts on the digital health industry and how he’s approaching his investments on his Substack, Vital Signs with >2K subscribers including many CEOs and industry veterans.

Jacob Effron is an investor at Redpoint Ventures specializing in digital heath. He's an operator-turned-investor, having worked as a product leader at Flatiron Health before going into VC in 2019. Jacob’s background as an operator grants him firsthand knowledge of the pain points that health techs go through. He also regularly shares his thoughts on the digital health industry and how he’s approaching his investments on his Substack, Vital Signs with >2K subscribers including many CEOs and industry veterans.

Q. Jacob, tell us a little about your firm and your role there. 

Jacob: I’ll start with Redpoint and then, give a bit of background on myself. Redpoint is fund, and kind of a classic Silicon Valley venture firm. We’ve been around since the late nineties and the heritage of the fund’s really on the side of enterprise software, data infrastructure, and other categories. So, think companies like Stripe, Snowflake, Twilio and HashiCorp and Ramp. But in the last decade, we’ve gone into health care in a big way so, it’s actually about a quarter of our fund, now. 

The way we think about it is really in bringing the best of enterprise software, data tools, consumer experience, fintech etc. that we’ve come to expect in every other part of our lives into health care. As a firm, we’ve invested in companies like Cityblock Health, Galileo Health, Strive Health, AcuityMD, Garner Health, and hims —a whole host of a really exciting companies. That’s where I spend my time. 

In terms of my background, I joined the health care policy side in college. Then, I started my career at McKinsey working with state Medicaid agencies, payors, providers, and pharma companies. Subsequently, I went over to Flatiron Health, which was doing Big Data for Cancer treatment to help start a new business line there. Eventually, I joined the product team and helped build workflow tools for Cancer centers we worked with. After we got acquired (by Roche), I switched over to the venture side and have been at Redpoint for the last two and a half years. 

Q. With regard to the digital health landscape, we’ve moved from celebrating the blow out funding numbers for startups here to a blowing up of some of these companies. Give us your State of the Union on where we are with digital health. 

Jacob: One of the interesting parts of being at a firm that invests in health care tech is, you get perspective on what’s happening across spaces that venture capital firms invest in. 

There are a series of later stage companies that raised rounds last year when the market was roaring and people thought good times were exclusively ahead. Now that the public markets have really corrected in every space—in software, fintech, and health care—a lot of people don’t know what these later stage health care companies are worth. 

What that means is—and I’ll bifurcate what’s happening in digital health investing right now to early stage and later stage—on the later stage side, there’s just a bit of confusion as to what these companies are worth. People are waiting to see that. With the public markets moving around so much, there aren’t that many health care companies that are public, so, there aren’t that many examples to point to that are analogous to a lot of these startups. In that environment of confusion, folks may be a little bit reticent to invest in some of those later stage health care companies. A lot of the later stage companies are then, facing a period of uncertainty. 

One has to make sure you’ve got runway to see it through to greener times. The overarching theme then, is like all the macros that are driving health care and this is really relevant to the early stage. They’re still there. None of that’s changed because of the current environment. That’s not like last year when the health care cost curve was going up a ton. This year, it’s suddenly flattened. Last year, there was a need for technology and providers, payers, pharma, and that’s suddenly changed. So, all the thematic reasons that make digital health really interesting are still there. 

However, I don’t think the market’s changed dramatically for early-stage companies and really, for strong teams, and going after interesting problems. It’s really these later stage companies where there’s just uncertainty about how they should be priced. 

Q. Have you changed focus in light of what’s happening in the macro environment? Are you investing more in one stage versus another, now? How’s your firm looking at this? 

Jacob: We’ve retained focus on the same stage, throughout. Certainly, there are opportunities across the board and the saying, “No one knows how to price some of these growth rounds” is interesting. They’re actually becoming interesting opportunities. 

There are some great later stage health care companies that are in the private markets that maybe were planning to IPO and now, isn’t really a great time to do that. There continue to be more interesting opportunities across the board but it’s just that maybe last year those deals were priced at a certain price and now they’re not pricing at that level. 

Q. What are you hearing from the entrepreneurs and the founders running these companies about the demand environment, their operations, the talent etc.? 

Jacob: There’s a lot there so maybe I’ll start with the talent side. 

There’s an interesting opportunity on the talent side for digital health where in the past, maybe large tech companies have been able to pay salaries that dwarf what any digital health company can pay. So, anytime you’ve got this inflection in the market as a whole, it’s like an interesting dislocation where it forces people to reconsider, “Oh! I thought I had all these options and I thought they were going to be worth so much money that I had golden handcuffs and I was going to stay at this, at Facebook forever.” Now, people are rethinking that. 

One trend I’ve seen across the board is that folks want to do more mission-driven work that’s meaningful to them. I talk to people all the time and they’re like, “I want to go into health care or climate.” So that’s where they want to spend time and for a while it’s actually a really interesting talent market. 

Across the board, in our portfolio companies, we’re seeing incredible engineers, product people that maybe are using this current environment as a inflection point to think about, “Okay, what do I want to do with this next stage of my career?” On the talent side, I hope to see this continued influx of folks into the digital health space, which is really interesting. 

On the customer side, I guess a classic investor thing that has always made people interested in health care is that it is in many ways countercyclical. There’s this fear in software at large right now that like all these startups sell to other startups. And the second the music stops, there aren’t as many startups out there like all these companies.

Actually, in health care, a lot of our customers and companies sell to large employers, hospital systems, or pharma companies and certainly, there’s a tightening of the belt across the board. But again, back to the original point, the problems haven’t changed. If anything, you have some companies that actually make for really interesting inflection points. For instance, we have one portfolio company, Garner Health, that focuses on helping employers lower the cost of care and improve the member experience. That’s actually even more relevant in this current environment. They have a lot of folks that are seeing the premium costs for next year and saying, “In this economic environment especially, that’s something we really want to tackle.” 

Q. With regard to the enterprises—health plans or health systems—what are you hearing from the market about the demand environment for digital health solutions? 

Jacob: It’s interesting that on the health system side, maybe if you were to bucket different kinds of solutions, there’s stuff that feels like, “Hey! This is a point solution that just does, a very specific thing or, seems cool like a cool algorithm or a cool tool.” But it doesn’t really have an ROI or that’s unclear, still TBD (to be decided). 

We’ve always been reticent to invest in some of that and in this environment, you’re really going to see a bifurcation of tools that are broad in scope, that can really be partners for systems at a much larger level, along with tools that have clinical and financial studies behind them and proof points in case studies with other systems that they work. You do find the best but in this current environment, it’s a really hard time for systems right now. 

When you approach a system to talk about specific clinical applications in one department that maybe has some clinical validity, it’s about how much time you get relative to the person that’s like, “Hey! I understand the staffing challenges you have and here’s something that we’re building around that.” Or “Let’s talk about revenue cycle.” Or “Let’s talk about patient engagement and keeping folks within your system.” Or “Let’s talk about some of these new, value-based models you may be moving into.” 

The current environment forces a prioritization. That’s always been there because it’s always hard to sell to these systems and payers if you’re not one of their top two or three priorities. 

Q. You mentioned value-based care and so let’s talk about how startups now have to get creative about demonstrating value, taking on risk, and being able to put more money at risk in order to earn the right to a seat at the table. Tell us how that’s playing out. 

Jacob: There’s an increasing trend of startups moving from a fee for service world to actually taking on risk for the services they provide. In some ways, it’s the ultimate kind of confidence in your own model to say, “We’re not just showing you a pretty slide that says this thing saves money. We’re so confident it does that we’re willing to go at risk for that.” A few trends that happened have really enabled that. 

The first is, a lot of this stuff follows government policy. There’s been a lot of government policies over the past decade and even more in the last two, three years that have created these interesting models that startups can then, opt into. A lot of times the government creates these models—first, it was ACOs, then, these kidney choice models, and now, direct contracting and easier reaching. They just announced the enhanced Oncology model. So, there’s a whole host of these different models the government introduces, but then private payers also latch on to you. All this it creates an interesting opportunity for startups to provide care in a different way. 

If you think about what a lot of these companies want to do anyway, they want to provide a higher touch, better consumer experience type care, and these payment models enable them to do that. So, there’s a lot of promise in these kinds of businesses. There are early proof points as seen through companies like Validate, Know Street that have demonstrated really interesting outcomes both, clinical and cost related. So, a lot of folks will look at those companies and at their valuations, the way that Oak Street, Agilent, and Validate Health are all valued. They’ll say, “That seems, in a way, like we can do things that are in line with how we want to provide care and also stay financially lucrative.” 

Q. Healthcare is very good at following the money and notwithstanding all the excitement about alternate payment models, value-based care, and risk based, the vast majority of health care payments still go through some model. Do these models work better perhaps for employers but maybe not as much for health systems? Is there a nuance there worth thinking about? 

Jacob: A few thoughts on that. One, as you well know, healthcare is just so massive that all these worlds can coexist and still be really big. You’ve got Oak Street, which, depending on the day is a $5-6 billion company or a ChenMed—All these things that people talk about have done a wonderful job and created a lot of enterprise value but they touch less than one percent of Medicare patients. And there are still massive businesses. 

Then, you have the systems that are more in the fee for service world. I totally agree with the point that almost all payments in the system world are on the fee for service side now. It’s obviously been slower to move to value based than maybe some of the independent physicians and groups, but both worlds can coexist and still be pretty large for the time being. 

I do think it’s a really good point that on the system side, there are a lot of people that come in and they say, “Oh! We’re going to sell value-based care and do something that really works in those models.” However, in these challenging times for systems, you can’t go into a room pitching someone and talking about something that’s not one of the top two or three things they’re thinking about. A lot of times when we talk to early-stage companies, we encourage them that they’re going to do something in the value-based world where a lot of the innovation is really happening. 

Q. What do you think of the policy environment? Are there one or two things that you would like to see or do you anticipate in the near term that could make a difference to the picture? 

Jacob: On the value-based care side, the big policy question is whether any of these models are going to be made mandatory at some point. If I think about how they’ve evolved, basically about how these benchmarks get set up, how much should it cost to take care of a population etc., it’s a median or an average. 

As you can imagine, companies are very good at saying, “Well, you’re in the top quartile of practices. So, if you don’t lift a finger or change anything, you will do better in this model than you were doing in the status quo, because it was set at the median.” So, you have a lot of practices that were in that top quartile saying, “Great, the value-based care sounds awesome.” It’s a real way for health care to move to a different payment model. 

What you’ve seen though, is some of those practices that maybe would or most need to transform. There’s no incentive or even a reason for them to opt in to some of these models. Therefore, the big question is it’s politically difficult. I don’t envy the policymakers that have to do this. But, are these models going to have a little bit of teeth in them where you start pushing people to make the transition? As long as you make it optional there will be some subset of folks that think they’ll be better off in this kind of a future world than they are today. 

Q. What are some of the core attributes you seek before you begin funding one of these startups? 

Jacob: Sometimes a fresh perspective can be helpful but obviously, one needs to have a lot of humility with the U.S. healthcare system. So, we really focus on a combination of things. 

First, if someone’s just like a learning machine—because health care is endlessly nuanced and weird, there are those that love that weirdness or find it interesting—and asks, why something is the case or the way it is. It’s really hard to successfully build in the space and we get really excited by folks that have been inventorying surgery centers for three months for example. But they’ve possibly already uncovered something in that research. They’re just more fluent in that space than just about anyone you talk to. 

Then, there’s a sort of humility like, “Hey! There’s a lot that we don’t know,” which entails bringing the right folks around the table. So, if you’re a technologist, bring in someone that’s an M.D., or someone who has a lot of experience in whatever it is you’re doing. Form that team right on. 

But the one thing that gets me super excited about a lot of the companies we invest in is they’re starting to be like this interesting second generation of founders where essentially, they were tech people, then, they moved into a first wave health care startup like Oscar or Flatiron or HIMMS or any of these companies that were really popular from 2013 to 2019. Then, they went on to form their health care startups. 

That’s just incredibly exciting because those people are great technologists. They have all the stuff you’d want in the traditional software world, but they’re not brand new to healthcare. They ran provider networks at Oscar or they did something that was in the weeds in health care but they know the space really well. That kind of archetype of entrepreneur is really exciting. The more you know and the more folks that come into digital health, the higher the chances of that kind of second wave. 

Q. The competitive landscape for the startups today has big tech—Amazon, Microsoft, Google, Apple—coming into the core healthcare services space. What’s your take on what this means for smaller companies?

Jacob: It’s not something that we spend a lot of time thinking about. The hardest part is that the health systems are hurting. How do you get your solution to matter for that health system and simultaneously, have nothing to do with the competitive landscape? Do you have a product that’s compelling enough to go through all the hurdles that are required to get something adopted? 

As I think about the role of big tech, the Lord knows the pie is big enough in health care and there is a lot of technology that needs to be introduced here so, if we just start moving toward there being more solutions, I think, there’s plenty of pie. 

But if I were to reflect on the role of big tech in health care today, there’s definitely a lot of pieces that are interesting or that folks are trying out. However, I wouldn’t say any of the big tech companies have really figured out how to have an at-scale impact on health care. Amazon One is a great example—they tried to build their own business and they ended up acquiring One Medical that had come from the startup world. In some sense, it’s always good to have more smart technologists working on the problem. 

From a startup perspective, these are potential acquirers. That’s great as they want to do more in health care. But it’s not like we don’t have companies that go head-to-head with pitching against Google, for instance. I think a lot of that problem, for both the big tech companies and the startups, is much more about figuring out. How do you figure out a product that really has resonance for the startups? If we get really good at that, we’ll get to a world in which there’s a lot of direct competition between them. 

Q. One very unique aspect about the competitive landscape is the dominance of electronic health record platforms. 

Jacob: We do think a lot about Epic. Epic is probably the most relevant to the world of selling into health systems than Google, Microsoft, or Amazon. 

Q. How about the macro environment? This year has been an interesting one—interest rates continue to rise, inflation continues to be high, and the demand environment is uncertain. What’s your advice to founders for 2023?

Jacob: I’m certainly not an economist so I will not pretend to have the kind of prescient macro take. But I would say, obviously there’s a range of things that might happen next year. The advice that we always give is, there’s many ways things could go. 

I think next year could have many of the same struggles that this year has. So, we tell our entrepreneurs that they must be ready. If the world starts booming again, great. They can always adjust, accelerate hiring, and change things around. But they may want to plan for what is somewhat a likely case, which is that things don’t get a ton better next year. 

Luckily, we worked with a lot of our companies to make sure they’re well capitalized and can navigate that because I don’t think anybody knows whether things will go down or stay flat, and you just want to be prepared for whatever those circumstances are. 

Q. What’s your firm’s outlook? 

Jacob: We’re very actively investing. We just sent two term sheets in the last few weeks. As a firm, I believe, a lot of the best companies get built in downturns. So, we’re back to where we started. None of the macro trends have changed. Yes, this is like a macro economy change for the time being, but like the things that got us excited about health care a year or three ago, if anything, they’re more exacerbated in this type of environment. The opportunities are very much still there, people just need to figure out on a later stage side, what are things actually worth. 

We hope you enjoyed this podcast. Subscribe to our podcast series at  www.thebigunlock.com and write to us atinfo@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.

Digital health is about applying data in a smart way into interactive user experiences

Season 4: Episode #136

Podcast with Russ Thomas, Chief Executive Officer, Availity

"Digital health is about applying data in a smart way into interactive user experiences"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Russ Thomas, Chief Executive Office of Availity, discusses their core business of clinical and claims data to drive better healthcare outcomes and reduce costs. Availity optimizes information exchange between two of the most critical stakeholders in the healthcare ecosystem – health plans and providers – through a single, secure network.

Russ talks about their recent acquisition of Diameter Health to standardize the unstructured data to automate clinical workflow, make it available to the right people at the right time, create a better healthcare system, and ultimately drive better healthcare outcomes. He also offers thoughts on the digital health landscape. Take a Listen.

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Show Notes

00:13How would you describe the current state of digital health?
03:17 About medical data, is EHR data specifically, also part of the datasets covered?
04:53Is there a HIPAA consideration here? What would be the top considerations when it comes to exchange of data?
11:18You mentioned prior authorization as one of the biggest friction points in healthcare. What is the competitive landscape looks like for you?
12:48Can you share a couple of use cases coming out of the Diameter Health acquisition that enhances the value of your business?
17:02 What about the health outcomes? What is the role of your data set and platform?
20:27Digital transformation of healthcare data and analytics is super important in all of this. Do you work with digital health startups? How do you enable them? What should they know about you?
27:14There’s the emergence of a lot of data consortiums – Truveta, HIEs, etc. What are your thoughts on the market right now?

About our guest

Russ Thomas is the Chief Executive Officer of Availity. His vision helped to diversify Availity’s solutions and grow its customer base, creating the foundation for the expansive Availity network that exists today. Combined, the enterprise now delivers healthcare business solutions to a growing network that connects more than 1,000,000 physicians and allied care providers, 2,700 hospitals, and more than 600 technology partners with health plans nationwide. Under Thomas’s leadership, Availity is leading the charge in provider engagement and empowering health care professionals to improve results.

Russ Thomas is the Chief Executive Officer of Availity. His vision helped to diversify Availity’s solutions and grow its customer base, creating the foundation for the expansive Availity network that exists today. Combined, the enterprise now delivers healthcare business solutions to a growing network that connects more than 1,000,000 physicians and allied care providers, 2,700 hospitals, and more than 600 technology partners with health plans nationwide. Under Thomas’s leadership, Availity is leading the charge in provider engagement and empowering health care professionals to improve results.


Q. Russ, tell us a little about Availity.

Russ: The company’s been around for 21 years now, so, we’re two decades old. We have been in healthcare technology since arguably before it was termed healthcare tech.

At our core, we connect health plans and providers for their business transactions and enable data exchange so they can run their respective businesses more efficiently. What that means in practical terms is that we’ve got two million providers on one side of our two-sided network, and on the other side, we have every health plan. Between them then, we transact roughly 13 billion transactions a year, including claims.

If you look at the aggregate claims and value their network, it’d be claims around USD 2.5 trillion billed through the Availity network on an annual basis. So, there’s a lot of economic and business activity between two of the critical stakeholders in the health care ecosystem. We see a lot of things paying off now.

Q. Availity sits in the middle so neither party really gets to see the other’s data, but eventually has the ability to use the data in ways that create business value for both sides. Is that correct?

Russ: Who owns what is I guess core to that question. So, a provider would say, “When we create a claim, the work that goes into the creation of that claim is our work. So that is our data.”

We send that data through Availity to the health plans. They receive it in the form of a claim. The payer would then say, that at that point the claim becomes theirs and so does the corresponding remittance or response. But then again, when the provider gets that back in their system, now suddenly, that’s their data.

We don’t typically get into the debate around who owns what between health plans, providers. Generally speaking, I think the industry has been fairly practical about these ownership rights when it comes to business workflows. It’s been more focused on getting the workflow automated than haggling over data rights in the context of “Is it claims data? Is it medical data? Who owns it?”

Q. With regard to medical data, is EHR data specifically, also part of the datasets covered?

Russ: Historically, we’ve been moving almost purely administrative data. However, over the last several years, we’ve begun to move more and more medical data which is what we use generically for clinical data in various forms ACT, CCD and variety of formats.

A little over a month ago, we closed on the acquisition of Diameter Health, and we’re very excited about that. If people think that structured X12 data is very standardized — unless you work with it every day wherein you realize that it’s not really as standardized as previously thought – they must see one payer implementation. They’re all different when it comes to clinical data given it’s still very much the Wild West in terms of how data is facilitated, created, transacted, named, or even identified. There’s still a lot of opportunity to provide a structure around clinical data so that it can be used and automated into workflows, which is where we are. We’re very much focused on that.

Q. Is there a HIPAA consideration here? What would be one or two top considerations when it comes to this kind of exchange of data?

Russ: It plays a bit to our strategy. We’ve never sold data and we have a lot of claims data. While remittance data and a lot of very valuable data flows through our networks, we’ve always felt that it’s better to be a trusted data steward than a data broker. So, just like any firm that resembles ours, we take secure information along with security, and privacy, very seriously.

The fact that we have not been in the business of selling data has enabled us to strengthen trust with both sides of the equation — payers and providers — which we think is going to let us create some interesting use cases for data in that business workflow.

But to your specific question, you have just your core underlying concern of “Let’s make sure the data about the right person is going to the right person at the right time.” Our network, like any health care network, is constantly under some form of assault by people trying to breach it or get into it. So, we spend a small fortune on information security and privacy.

Beyond that, it’s about where you’re going. Once you move from those standard business transactions, which everybody opts into to how do you really use that clinical data to create a better health care system, then, you’ve got to be super careful about data rights, both in terms of the payer, provider, and patient who some would say ultimately, owns all the data.

Q. With regard to your recent acquisition, what does Diameter Health bring to the table?

Russ: I’ll use a few analogies to explain this. There’s considerable clinical data being mined out there in the market, many aggregators, and data collection sources as well drilling for oil so to speak, in this case, drilling for data. What we’ve noticed missing is, the ability to take that raw crude and turn it into a usable fuel.

Diameter Health is the data refinery that receives data from a variety of sources. They don’t actually have endpoints into provider systems to gather any data so are wholly dependent upon their customers to create those endpoints. That’s one synergy they have with Availity, which creates endpoints for data all day, every day.

Diameter Health pulls that data in from all these disparate sources and refines it to a particular client’s standard whether that client is a payer, an HIE, works in the government sector, etc. They have a variety of different customers with use cases for clinical data to drive better health outcomes and enable cost reductions, everything we want to see happen.

However, given how fragmented this data is, our ability to automate its flow into a utilization management system or a care management, encounters gaps making it hard to achieve the required scale. Diameter Health applies their tech to raw data and upcycles or standardizes it to create a structure by applying clinical knowledge to the data. Clinicians at Availity — nurse practitioners and Pharm Ds– work on these data structures so that when we flow it back to the end user client, it can be pushed into an automated workflow.

Q. Have you started tapping into individual data?

Russ: We’ve never had a direct-to-consumer strategy because we’re direct-to-provider and the providers ultimately source a lot of the data that the health plans need and vice versa. A direct-to-consumer strategy then, feels like a pretty big lift and one that, frankly, for the use cases that we are bringing to life, includes a lot of patterns. There are many low hanging fruit. To automate workflows like authorization, care management etc., the data required by the plans lies in the provider systems so, that’s where we’re really focused on data capture.

Q. You mention authorization and that’s one of the biggest friction points in healthcare. What is the competitive landscape like for you?

Russ: In that particular one and in others where you have the payer partnering with Epic, we serve as the gateway for the payers that have been identified. We’re big fans of automation, whether it comes in an Epic system or any other application, so we help automate data and workflows.

That said, the biggest pain point between providers and health plans today, is one that frankly has not been solved at scale. I really like what Epic’s doing with the Epic Payer Platform and driving all the automation there. That’s going to be an important source. Frankly, we’ll be a catalyst for a lot of other innovation around over the next few years.

Q. Can you share a couple of use cases coming out of the Diameter acquisition that enhances the value of your business?

Russ: Let’s start with Auth because I really have very personal reasons for wanting to solve the Auth problem. I just think it’s bad not only for business but also, for patient care. Any time a patient’s left standing at a doctor’s front desk waiting for an Auth to be approved, that is not good for patient care. That, to me, is one great example of where even though we’ve got some great tech that’s being applied to the Auth problem itself, you still have to empower data in a consistent, logical way so that it can be transacted into the payer system. One of our helpline partners is Elevance. And to that point, even they’re right. You’ve got to be able to push the data into their systems in a consistent and automated way.

One example of where we will put the Diameter technology to work is upcycling that clinical data that gets used in a Auth UM workflow both, for Auth determination as well as ultimately, the second phase of that process, which is medical necessity determination. If you can get an Auth and still not have medical necessity approved, you have got to have a way to pull that clinical data into the system so that you’re solving both problems at once. So, starting Auth is a great example of that.

I’ll bucket it under the general heading of chart retrieval, for various purposes. Today, the chart retrieval process is still a very manual process with thousands of people sitting in the bowels of health systems looking at paper records all day and scanning them into some OCR system and then, pushing them through. Ultimately, the plan is not to look for that entire medical record. They’re looking for data elements that are in that medical record to approve whatever it may be right for, whether it’s a medical necessity determination, etc. That’s another area where we think there’s just a ton of room with what we’re doing with Diameter Health to bring that data to life.

Everyone knows the data is there but it’s how you bring it to life in an automated way that needs to be seen. One of the comments I was going to make about Elevance is, there’s a lot of really smart people there, but one, in particular, who uses the term “auto adjudication” instead of just “automation.” He talks about auto adjudication in context not just of claims but everything from provider directory data. When a provider updates a piece of demographic data, how do you auto adjudicate that all the way through the planning system to clinical data? It’s a great example as well of getting clinical data and being able to then, auto adjudicate that through whatever multitude of systems the plan may need. That is where we think the real value of Diameter Health is and where you can start to really prove ROI. We know the large costs entailed when a human has to intervene in a chart review. So, that’s a couple of great examples of how we’re going to do it.

Q. What about the other side — health outcomes? What is the role of your data set and platform?

Russ: I love the idea of bringing disparate data sources to life around total care management but the one thing that frustrates me about the U.S. health care system is, it’s by and large, a reactive health care system. We treat symptoms, diseases, and specific diseases. We don’t treat real conditions of human health.

I’m personally very interested and trying to get a lot smarter around things like longevity. What can we do to prolong?

Q. Didn’t that come up with a supplement that does that anyway?

Russ: Yes, but one of the reasons that we aren’t more proactive in managing care and paying for the management of care proactively is, it’s really hard to prove returns on investment. We know all day long that if somebody has high blood pressure, then, treating it with a pharmaceutical product is going to help and if it’s high cholesterol, treat with a statin. But we don’t do anything to get at the underlying conditions which are causing that. So, I’m very excited about the notion of being able to go out and get a lot of differentiated data on people and bring it into this central repository.

We talk at Availity about one patient health record. That is not just what’s happened to you retroactive to becoming sick. For instance, I’m ill and now I’m being treated. But how do we proactively enable providers to know what they need to know about you when you come in instead of just how you may be feeling today? My doctor will be able to look at a chart and say I’ll be ok because he’s been tracking the Hemoglobin A1C, and glucose levels for the last three months so can see where the spikes are. He can then talk about my diet in ways that we can do and test things to reduce those spikes. That to me is the health care system.

The question then, is, where does Availity play? For now, at least, Availity’s play in that is in a retrospective manner, but you ultimately have to have a way to measure what value we’re getting from that and total cost of care. I think that’s the way you look at it over time. So, our ability to look at claims and then, the analytics across claims is critical. I do analytics across claims and know what’s going on with the patient but after the fact is where you get a lot of that.

Q. Let’s talk about digital health. Digital transformation of healthcare data and analytics is super important in all of this. Can you do your work with digital health startups? How do you enable them? What should they know about you?

Russ: While I’m very opinionated on this topic here’s what I think. Digital is another highly overused term, not unlike population health and interoperability and that sort of stuff. To me, digital health is about user experience and it really is that simple.

How do we apply data? How do we make data smarter and apply it into an interactive user experience that drives as a high net promoter score, user satisfaction and gives people the answers to questions they need? That is by proactively anticipating the questions that are going to be asked and answering those questions in a very logical way in workflow.

The example I always use and not a lot people can relate to it is that, I’m a pilot and I’m flying what’s called a glass panel, which means I’m looking at a screen just like I’m looking at two computer screens when I’m in the cockpit. That has evolved over decades from six different devices and instruments to one glass panel that gives you all the information you need, as you need it, even before you need it. It is thinking ahead for you and preparing you for what’s coming next. It’s answering questions intuitively, applying analytics to the data that’s coming in to give you routing information. The truth or the same reason that we did it today in health care is that, I think, we’re still very analog in the way that providers and health plans interact with each other. So, where we’re investing as a company is in two particular areas.

We’re investing in data intelligence and data analytics. We’ve just hired Gigi Yuen-Reed, who was a Principal Data Scientist for IBM Watson, and is now, our VP, Data and Analytics and we’re building a team around her. Their job is going to be to take 13 billion data points and make them smart, more intuitive, more interactive to extract insights and knowledge from all the data flowing through our network.

On the other side, we’re investing in our user experience, not just our screens, but the way that we deliver data to our end users, whether that end user is in an Availity application or in an Epic application. That’s because we sell a ton of provider business through our partnership with Epic or in a nascent digital platform that some brilliant entrepreneur has independently developed.

I’ll give you two examples of where we have a budding partnership with Rhyme, which was brought off and is now run around automating the prior authorization workflow. Leveraging tech that Rhyme has built creates what I call nodal activity – it’s not a very good term. However, the problem with the auth workflow is not a transaction but a conversation between disparate systems and health systems in a payer system. So, Rhyme has really brought intelligence to that conversation so that they can actually speak the same lines. Rhyme is a great example of a partnership where we are bringing value to a young startup digital company to help them get scale.

The other is Vin who’s a very close friend and what Vin is doing with clinical data capture at the point of care is particularly valuable in smaller EMR and EHR systems. We are now leveraging Vin as our own point solution, if you will, which we will bring to scale, to extract and deliver clinical data and insights directly on the provider’s desktop.

Where we are investing is in building an underlying architecture in an API framework so that we can very easily stand up partnerships with some of these brilliant young entrepreneurs who are building applications and sitting there having built something really cool. But question arises, “How do I get scale? Where can I get to a network where I can actually interact with health plans and providers at scale?”

We think Availity should be a logical place for them.

Q. There’s the emergence of a lot of data consortiums – Truveta, HIEs, clearing houses etc. What are your high-level thoughts on the market right now?

Russ: I’ve been involved in HIEs since 2002, so I go back a long way with them and to your point, I think there are HIEs that serve very viable purposes. They’ve figured out a commercial model and are very relevant as data aggregators and local community voices that help create trust around data exchange. We love partnering with them. We’re partnering in Michigan and California. Now with Diameter Health, we’ve got a number of other places where we’re helping bring that data to life.

There’s no lack of data but what do you do with it? We’ll continue to focus on this. We didn’t last for 21 years by not having a good, sustainable business model and I do believe that we knew that some of these disparate, nascent data elements were going to become more and more important to us. Finding ways to consolidate that data into an existing workflow is an area where I think Availity can be very relevant and start creating real value for the end user. What we do today in just transacting claims and eligibility is highly commoditized but if you do it at scale like we do, it creates a phenomenal platform that you can build around.

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.

Healthcare is now about combining the digital pieces with a personal touch

Season 4: Episode #135

Podcast with Zane Burke, Chief Executive Officer, Board Member, Quantum Health

"Healthcare is now about combining the digital pieces with a personal touch"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Zane Burke, CEO of Quantum Health discusses the current state of digital health and how Quantum is working towards creating a different and better healthcare experience with better financial and clinical outcomes.

Zane is a long-time veteran in the healthcare space with successful tenures in Cerner and Livongo. He notes that while there is progress with digital health, data silos and lack of integration are some of the biggest friction points in delivering better healthcare experience and outcomes. He also talks about how healthcare is intensely personal and why the connection of digital pieces and the personal touch pieces will make a huge difference.

Zane discusses a range of other topics, including digital health funding and the M&A environment, the role of big tech in the healthcare ecosystem, and the pace of digital transformation in general. Take a Listen.

Our Podcast Partners:

Show Notes

00:48How would you describe the current state of digital health?
02:20 How did you come to Quantum? What does Quantum Health do?
04:16 Who are your main customers today – employers, plans, or providers? Who would you consider your competition?
08:30In the context of health care, the other big competitor is, “Who pays?” Healthcare is all about following the money. Who pays for the solution as a self-insured employer?
10:42In the context of the markets and data silos, you've been a senior executive at one of the big EHR platform companies and in startups. Give us a State of the Union on interoperability. What's the unfinished business here?
15:27Digital health companies are in their own ecosystem and the consumers are somewhere in the middle with very little control over their data. If companies cannot access the data easily from an EHR system, where do you think that leaves digital health companies today?
18:15 What are your thoughts on the M&A environment of the marketplace today in light of how many digital health companies are actually struggling?
21:27What’s your take on the role of big tech in the healthcare ecosystem going forward?
26:35What is your advice to the health systems and digital health startups trying to play in this environment?

About our guest

Zane Burke is the Chief Executive Officer, Board Member at Quantum Health. An internationally recognized health IT leader, Burke has both a clear, forward-looking vision for digital healthcare and a unique understanding of the challenges in global healthcare delivery.

As healthcare gets continuously harder for people to navigate on their own, Burke’s professional passion is creating great healthcare experiences for all and addressing the imbalances in healthcare delivery. At Quantum Health, he leads the organization's goal to transform the consumer experience, with solutions that uncomplicate and innovate healthcare navigation. By continuing to reach into new end markets, the company will serve more consumers and ultimately improve more lives.

Prior to joining Quantum Health, Burke served as chief executive officer of Silicon Valley-based Livongo Health Inc., a leading software as a service (SaaS) consumer digital health company. Burke spent more than two decades at Cerner Corporation where he concluded his service there as the company’s president. He serves on several industry and not-for-profit boards of directors.

Zane Burke is the Chief Executive Officer, Board Member at Quantum Health. An internationally recognized health IT leader, Burke has both a clear, forward-looking vision for digital healthcare and a unique understanding of the challenges in global healthcare delivery.

As healthcare gets continuously harder for people to navigate on their own, Burke’s professional passion is creating great healthcare experiences for all and addressing the imbalances in healthcare delivery. At Quantum Health, he leads the organization's goal to transform the consumer experience, with solutions that uncomplicate and innovate healthcare navigation. By continuing to reach into new end markets, the company will serve more consumers and ultimately improve more lives.

Prior to joining Quantum Health, Burke served as chief executive officer of Silicon Valley-based Livongo Health Inc., a leading software as a service (SaaS) consumer digital health company. Burke spent more than two decades at Cerner Corporation where he concluded his service there as the company’s president. He serves on several industry and not-for-profit boards of directors.

Q. Zane, you’re a veteran in the healthcare tech space having been part of large enterprise class technology platform providers and startups that have had spectacular success. How would you describe the current state of digital health?

Zane: It’s a fascinating time and digital health has seen a lot of amazing innovation where people are taking on areas that may need better health care experiences and better clinical and financial outcomes. There are a number of places where there’ve been significant movements in a positive light for many disease states. That’s a real big positive.

On the other side, what we’ve seen is almost a bigger silo of data and information that’s really creating too many small pockets of information with not enough views of the larger picture and a lack of integration.

For instance, I know I like to go to concerts and drink wine. That’s what I do for my health care. I don’t do health care to do health care and I don’t think anybody does that, either. I think, they really do it to live their lives. So, it’s a missing component of what’s really occurring. We just see more and more of these little islands of information and more siloed elements and while in those individual spaces, there are better experiences and better outcomes, we’re missing this broader picture for people.

Q. How did you come to Quantum? What does Quantum Health do?

Zane: I came to Quantum Health because it’s really about creating a different and better health care experience with better financial and clinical outcomes and really looking at hard ROI within the boundaries of the medical spends, today. What really attracted me, in addition, to that core piece there, was the people and the business model. That is the only one I’ve seen, particularly in digital health, that’s really around bringing together the plan sponsor, the member, and the provider.

Those three components were what attracted me to Quantum Health because I saw this as a platform by which we could deliver what I call the connective tissue between a clicks and mortar world. It’s increasingly important for people to recognize that it’s not going to just be a digital health or virtual care world, only. It’s a connection back to that physical piece.

How do we create that singular experience for the member and simplify it? That’s what I saw in Quantum Health. That’s the opportunity as we move forward.

Q. Who are your main customers today – employers, plans, or providers? Who or what would you consider competition?

Zane: We are mostly a large self-insured employer. We scale both, up and down. But if you think of a Delta Airlines, a Target, an Allstate, a Honda, then, those are some representative clients. We’re serving over two million members today, in that space and that’s where we got our start.

Increasingly, we’re seeing that the health plans themselves are interested in navigation, although it leads directly to the competitive environment where the biggest competitors are still the health plans themselves. That’s because they think of themselves providing that customer-first experience. Unfortunately, what they’ve done is optimized around business processes.

What we are able to do around navigation is be on the journey with the member by taking all the data sources in whether it’s claims data, PBM data, or that provider information. Every single one of these interactions in health care is a health signal and is calibrated in our Artificial Intelligence to help us create the next best action. It’s really about the next best action for that member and helping them in their journey in the context of their health plan.

What benefits they can be accorded will depend on what’s in-network or out-of-network. So, how do we get them to the right side of care?

When you’re on a real health care journey, you know how difficult it is to actually navigate the health care system. Quantum really guides that person through the journey and it turns out that they’re actually doing the right thing, making the experience better, and helping people navigate to the right places. So, our Net Promoter Scores are in the mid-70s which I just haven’t seen in any other business ever and we’re getting hard ROIs as well. So, doing the right thing turns out to be really, really good for the sponsors and/or for a large self-insured employer. It’s a win, win, win across the board. However, “do nothing” still remains our biggest competitor. Stay with the payer.

Increasingly, there are more people entering into navigation. Unfortunately, it isn’t about just putting a little digital app on the front-end and doing some lightweight pieces. We’re seeing digital applications making a difference. Our front-end, for example, is great and we’ll continue to hone that but it’s really all the data science and ultimately, a personal touch that comes with it, which matters.

I often mention this in my executive meetings. Every single day, I get multiple notes from members that say “thank you for X” — either better clinical outcome, better financial outcome, or better experience — but it’s always tied to a person and what we call our health care lawyers. I’ve never got a response that said, “thank you for writing that software” and that’s what health care is. It’s intensely personal. It’s about how you connect the technical part with the personal part that makes such a huge difference.

Q. In the context of healthcare, the other big competitor is, “Who pays?” because healthcare is all about following the money. Who pays for the solution as a self-insured employer?

Zane: Sometimes, employers hire us and pay us a per member per month fee on behalf of their members so we become the front-end both, for the interactions with their members and our engagements with our providers to get paid. Literally, we created a model for a single flow for that member, the workflow for that physician’s office and that’s how we often garnered a number of those health signals. Then we also delivered value back to either the member or the provider on those signals, along the way.

That this is coming from the sponsors themselves creates great experiences for the employees — better health care experiences, better clinical and financial outcomes — and sponsors, too. We’re seeing significant ROIs then, on the amount of fees that they’re paying. That’s the thing when you talk about what the state of digital health is. If you’re not driving value, there’s just no way you’re going to be in the game in the long run.

Q. In the context of the markets and data silos, you’ve been a senior executive at one of the big EHR platform companies and in startups. Give us a State of the Union on this interoperability. Is it getting better or worse? What’s the unfinished business here?

Zane: It’s getting better but what people have to realize is, it can’t be a one-way street on data. That goes for everyone involved in the conversation. From an EHR perspective, we have to think about what’s in it for those EHR companies and the value they’re going to get back from the connections that they receive. People may look at that and say, that’s a bit of a jaundiced view. They received Dollars as part of the federal programs and incentives to go drive that. So, I do think there’s a responsibility from those EHR companies to be open.

I’ve long been a proponent of health care data. It should be mine as a person, not mine as a EHR company. You ought to own your own electronic health record and I, mine. Whether I choose to share it or turn it off, should be my prerogative and I should have the ability to do so.

EHR companies have come a long way but there’s more to do. The hold-up though is still the notion of what’s in it for them on data-sharing from these other technologies. That’s often lost in the mix. What you have seen in digital health has been more cooperation around democratizing the data and saying, “If I have data to share, I’ll share that with our partners.” If you have data or digital health from our ecosystem, you’re sharing it with us because we can provide better experiences for our members. The digital health community has done a fantastic job in data sharing. I’ve seen it at Livongo, where we’ve shared Apple data, Fitbit data, claims data, and others as part of that conversation. We have an incredibly robust ecosystem and partner program at Quantum Health where we can connect in multitudes of ways and share information which is an important part of that responsibility.

There’s a lot of work to do around the data. Your ability as an individual to be able to turn that on and off and understand where your data goes is critical. Most people don’t appreciate that once they flip the switch for their PHI to be put into an Apple health kit, for instance, then, that data is no longer your PHI anymore. It’s literally part of the Apple ecosystem. Some of those pieces are areas of importance for us to continue to track and follow through on. There’s a lot more to do from the EHR perspective. However, at the digital health level, this notion that your data, should you press a button, will be forever out there, persists.

Q. Digital health companies are in their own ecosystem and the consumers are somewhere in the middle with very little control over their data. If companies cannot access the data easily from an EHR system, what is the true value of a digital health solution?

Zane: It can be much more robust to have the EHR data in those digital health elements. I’d say that there is a ton of information in these digital health organizations that are clinically relevant for those EHR organizations and the providers, and quite frankly, I don’t think digital health has actually stepped up to the plate to embrace the provider meaningfully.

Actually, Quantum is one of the lone exceptions out there in terms of, “Hey! There’s an opportunity to give back here.” There’s a reason why our provider scores are so high and it goes beyond the understanding of the benefits paid. That’s because you actually get some feedback from the first time, from the digital health community so, I do think there’s actually more that digital health community can and should do to close the loop. It’s painful and hard work, but it needs to be done. That’s part of the responsibility of being in health care.

You can get a lot of value in those disease-specific condition states. With those digital health applications, you gain a lot through the claims data and the PBM data, etc. and it would be beneficial to have more access on the EHR side. That’ll come and I really believe that that’s on the right trajectory. Everybody in the ecosystem has to remember you have a responsibility to close the loop on behalf of the member, and that includes leading back to the providers themselves. Doing that in a way that’s useful to the provider, rather than a burden is just one more thing that we put on their plate that they have to sift through.

Q. Livongo’s successful exit may have paved the way somewhat for a few of the large, recent exits — One Medical with Amazon, Signify, CVS, and perhaps Cano Health. Can you share your thoughts on the M&A environment of the marketplace today in light of how many digital health companies are actually struggling?

Zane: The macro financial markets are very tough and challenging for fundraising for digital health solutions and while that may continue for the next 12 to 18 months, it’s going to have implications. There will be people that run out of funding and those whose business models just haven’t shown profitability in those pieces. That will have ramifications on the marketplace. Those with deep balance sheets are going to be in the best position to scoop some of those pieces up. So, you’ve got that dynamic.

You alluded to the amount of M&A activity. You’re going to see more because of the financial challenges that I spoke to start with and the Amazon One Medical and Signify CVS combinations which prove a thesis that I’ve long believed that this ultimately requires personal service. Technology is critically important. You can deliver great experiences through that, help people practice more at the top of their license, whether that’s truly a professional license or just at the top of their game. But at the end of the day, it’s the personal touch that matters. Both those combinations are big signals that it’s the delivery of care integrated into the digital aspects that people are betting on the future and thinking that it’s again back to it’s going to be a digital only world is just not how health care is delivered.

The big value is always in the cases that are the most expensive and in the top 1% driving 50% of costs. But you’ve got to know the whole phone book to be able to dial in and say, “This person is the one that’s going to be on this journey. How do we engage with this person early and often and get them the right kind of information before all the choices have been made?”

That requires the digital pieces, along with the personal touch pieces. So you’re going to see much more M&A activity for those who have deep pockets on a go-forward basis.

Q. There are big tech firms like Amazon actively getting into the core health care services space. What’s your take on the role of big tech in the healthcare ecosystem going forward?

Zane: This might be the part where I’ve been around the block for too many times and so I’m a bit cynical. I’m not a cynic by nature and those that know me well, know I’m an optimist and I’m a half full kind of a person. But I’ve seen IBM and Trident Healthcare trying to get in health care four times. I’ve seen Google try to get in at least twice. I’ve seen Microsoft in it at least three times back in the day, McDonnell Douglas, American Express, and GE.

So, there’s a lot of dead bodies on the side of the road. Health care is a humbling experience for me every day. There’re reasons why your podcast is so wonderful, because what you do is, you turn this gemstone of health care and depending on what lens you look at it through it just gets a different viewpoint every time. That’s one of the fun parts of my own personal career and that is being able to turn the gemstone and see it through a couple of different ways. I’m humbled every day as I get to learn and try to say that I want to make a difference.

There’s a role for big companies and they may be the beneficiaries of a downturn in the financial market side because they have such strong financial statements and they are able to acquire some technologies that they otherwise would not have. So, this is going to be a little different. While I’m, on the one hand, cynical because I’ve seen large companies not be successful, I’m, on the other hand, hopeful that they’ll provide the kind of capital that’s going to be necessary to see some of these technologies reach their full potential. I can be, on the one hand, pessimistic, and on the other hand, optimistic, and say that’ll happen. I look at the company I used to be associated with this arm and Oracle joining that fray and on the one hand, I’m optimistic that contemporizing in the Cerner platform and truly getting to a cloud-based environment and doing some of the things that Oracle is uniquely capable to do would be super beneficial for Cerner. But on the flip side, I’ve seen where large companies think they know it all, and the smart people have come to save the people that are unworthy. I have concerns about those kinds of scenarios.

I’m not being critical of the Oracle or others that have tried and failed. It’s too big a market to ignore 20% of GDP. We’re going to see big-tech players in this space and the ones that will be successful are the ones that say, “I know how to scale. I know how to think about technology. But I’ve got to embrace everything that is health care and understand that there’s different dynamics at play here from the payer models to, you know, the consumer models, the providers and all the elements thereof.” If you think you invented it at your shop, you’re probably wrong. That’s what I would say. Again, I say every single day, I get to learn something.

Q. This year has been a bad one for health systems financially speaking and with labor shortages. Do you think this will slow down the pace of digital transformation? What is your advice to the health systems and digital health startups trying to play in this environment?

Zane: You’re right. I sit on the largest safety net hospital in Missouri, and they’ve prudently managed through what has been a very challenging time. Many of my health system clients have had some significant challenges and a number of health system clients are utilizing Quantum’s services.

They’ve got to be focused on value received and on making their own employee base feel loved and cared for. Often, the health professionals provide the love and care and it’s really important for the health systems to return that because it’s just been an unbelievably taxing time to be a health system provider and any kind of health system worker over the last couple of years.

For me, it’s just thinking about the employee population and then the value, the places they can go to the first dollar value place. How can you, as a health organization, not be subjected to what’s going to be a downward trend around value-based care? As people come after the big spend items, they’re going to have to think about how they’re providing unique value and how they’re going after first dollar. So, it’s a tricky time if you’re in the digital health. If you’re the digital health providers, you better be delivering a heck of a lot of our hard ROI or you’re just going to be out of business.

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.

Technology innovation is about combining unmet medical needs with unmet consumer needs

Season 4: Episode #134

Podcast with David Evendon-Challis, Executive Board Member and Chief Scientific Officer, Bayer Consumer Health

"Technology innovation is about combining unmet medical needs with unmet consumer needs"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, David Evendon-Challis, Executive Board Member and Chief Scientific Officer at Bayer Consumer Health discusses their approach to help consumers adopt digital health tools to manage and improve their healthcare outcomes. David also explores trends driving better self-care among consumers.

Digital health tools are gaining momentum among customers and making better self-care more accessible. However, all these innovative technology solutions must seamlessly integrate into the mainstream healthcare delivery models. David believes that increased interest in health and self-care awareness, affordable healthcare technologies, and people wanting to use more technology to communicate combined will bring the perfect storm for improved health outcomes. He also talks about the current state of digital therapeutics and its relevance in improving consumer health. Take a Listen.

Our Podcast Partners:

Show Notes

00:45About Bayer and the Consumer Health Division.
02:08 Self-care has become a big trend among consumers. What kind of trends are you seeing at Bayer and what is driving all this?
04:07 Can you give us few examples of the digital tools that will gain momentum with consumers, specifically in the U.S.?
07:30How much clinically validated is the self-monitored care? It seems like there's a need to integrate all the technology innovations with mainstream healthcare delivery models. What’s your take on this?
10:20What is the current state of evolution and innovation of digital therapeutics in terms of the consumer-facing devices? How are they fitting into the mainstream healthcare context?
12:46Can you talk about Bayer's approach to the movement around self-care and helping consumers with the tools that they need to manage their care better?
15:43 How is self-care different from people just taking time-off, a vacation, go on a diet, or take some me-time? Is there a connotation that you attach to the term?
19:30Where does old medicine, for instance - Ayurveda, fit in this picture? Do you see that as being a part of the self-care movement?
24:11What’s your advice to our listeners, especially those who are digital health startups looking to get their product out in the market in partnership with a global company such as Bayer?

About our guest

David Evendon-Challis is Head of R&D for Bayer’s Consumer Health Division and is a member of the Consumer Health Executive Committee. He is responsible for worldwide innovation and product development, from scoping and ideation through delivering innovation to the market via internal and external development.

David is a British national, with a first class Master’s degree in Biological Sciences from the University of Oxford, UK. Over the past 17 years he has worked across regulatory, communications & public affairs, sustainability and product development. He joined Bayer in January 2020 from RB where he spent eight years in R&D leadership roles of increasing responsibility - most recently heading innovation across the company’s consumer health business. Prior to this he worked at companies including Kimberly-Clark, Salterbaxter MSL and the Engine Group.

He is passionate about creating and scaling innovations that are purpose-driven, human-centric, scientifically robust, and credible.

David is married with two children. He is based at Consumer Health’s global headquarters in Basel, Switzerland.

David Evendon-Challis is Head of R&D for Bayer’s Consumer Health Division and is a member of the Consumer Health Executive Committee. He is responsible for worldwide innovation and product development, from scoping and ideation through delivering innovation to the market via internal and external development.

David is a British national, with a first class Master’s degree in Biological Sciences from the University of Oxford, UK. Over the past 17 years he has worked across regulatory, communications & public affairs, sustainability and product development. He joined Bayer in January 2020 from RB where he spent eight years in R&D leadership roles of increasing responsibility - most recently heading innovation across the company’s consumer health business. Prior to this he worked at companies including Kimberly-Clark, Salterbaxter MSL and the Engine Group.

He is passionate about creating and scaling innovations that are purpose-driven, human-centric, scientifically robust, and credible.

David is married with two children. He is based at Consumer Health’s global headquarters in Basel, Switzerland.

Q: David, can you talk to us about Bayer and the Consumer Health Division?

David: Bayer has been around for a long time; longer than the Queen and I. I joined the company about three years ago. I work within consumer health, which is one of three divisions—pharmaceuticals, crop science, and consumer health.

We’re a leading player within consumer health with 170 brands of which, 15 are extremely large. We focus our innovation efforts on and work across a lot of different self-care areas—allergy cough, cold, pain, cardio, digestive health, dermatology, and supplements—so we have a broad self-care business.

Self-care has become a big trend among consumers. What are the trends you see as Chief Scientific Officer of the Consumer Health Division of Bayer? What is driving this trend?

David: We’ve been seeing, for some years, an increasing interest in a lot of people to take better care of themselves. You become more aware of the impact of things like smoking, watching your weight, exercise, eating the right fruits and vegetables etc. That has been bubbling along, but there’s not been a huge emphasis on real prevention of disease.

A lot has shifted in the last couple of years, so, we know that people want to take much better care of themselves. That’s totally been accelerated by COVID. I found some of the statistics here, super interesting. In COVID, 44% of people started using new devices to help manage their health proactively. About 90% of them had positive experiences, which I think, is extremely high. Over half of the people want to use more tech to communicate with their health care professionals and manage their health.

This isn’t a new statistic but the one that always gets me and continues to blow my mind is the 200 billion healthcare searches on Google, every year. Combining that increasing interest in health care and our ability to take care of our health and prevent disease with more affordable technologies, particularly, things that are already part of our day-to-day lives may just be the perfect storm for better prevention, better self-care. That’s what we’re seeing across the board.

Q: Can you give us one or two examples of the sort of digital tools that will gain momentum with consumers in the specific context of the United States?

David: There’s all kinds of things. You go from the very simple ones but I would still count digital tools as those that help people make decisions about which products they take.

The online health and wellness questionnaires are very basic but these are on the rise. They help people navigate what is quite a complex shelf to choose what to do, what to buy, when to use it, etc. In the U.S., we have majority stake in companies like Care/of. It’s a personalized VMS company. There has been a big rise in using that from a user’s point of view to actually get better products.

There are increasing sales of specialist devices—the things that people carry with them be it their smartphones, Fitbits, or their Apple watches. These are the things that people are starting to get better insights from, and using to manage their health more and more. I can only see that becoming more important in the future as the devices get more sophisticated and better about giving us actionable insights, if not diagnoses. These are the areas that are going to help make better self-care much, much more accessible for more people.

Take my personal favorite. At the moment, for me, sleep is important but I don’t want to wear a special sleep monitoring device. I’m interested, but not that much, in it. However, I will wear my watch to bed and check it every single morning. I will adjust my behaviors based on that, and it will add that into my daily routine. That’s critical as well, having whatever the solution technology might be, something that can seamlessly integrate into your life, and that will always be as easy to be top of mind and enable us to keep doing it. Those are the things that are going to stay.

We know that complicated, unpleasant experiences—even complying with the medication, for example—may make lots of people drop out. Making things super easy and part of people’s lives is part of this.

Q: While there’s a lot you can now do to monitor yourself and take better care simultaneously, how much of it is clinically validated? It seems like there’s a need to integrate new innovation with mainstream health care delivery models. What’s your take at Bayer?

David: I look at it from two angles one of which is, there’re some really promising technologies for things like digital therapeutics, which we’ll see is in the Rx kind of area. I’m a consumer, but I can see that being absolutely relevant for consumer health, as well. In these areas, we could have a debate, although I’m not an expert about the evidence behind some of these. But there is a lot of evidence being generated on those digital therapeutics. From that angle, there’s a huge relevance for self-care and the digital drug is actually helping people to take care and treat themselves.

When it comes to using digital biomarkers to help identify where your problems are, this isn’t just about being able to run a report and giving that to your doctor. It’s about getting better, actionable insights for you to manage your own health. Those don’t always need to be 100% perfect and accurate in order to get generalized insights that can actually help you shift your behavior in a better direction to become healthier. I think there’s absolutely a role for those kinds of things and the two may ultimately kind of meet in the middle.

In the meantime, there’s a lot of value in the more general health, personal health insights that we can get from these different technologies. They can help individuals determine when they might need to see their healthcare provider and actually dig into an issue in more detail. It’s not always the case for things like, for example, my sleep. This is about me feeling better, waking up lighter, and being able to manage my busy job, two small children etc. The kind of insights that I get from my Apple Watch and the app that I’ve purchased are bang-on for that. So, I think it depends on the need.

Q: Digital therapeutics has become almost a mainstream term, now. What is the current state of their evolution and innovation as it relates to some of these consumer-facing devices? How are they fitting into the mainstream healthcare context?

David: Within self-care, it’s coming from all different angles. There are lots of different roles. If you think about this cycle from within self-care, awareness, education, engagement, assessments, diagnosis, treatments, then, in continuing that cycle, there’s this role for different technologies within that.

I’m really interested in things like the symptoms assessment tool. We’ve been working with Ada Health and piloting with a couple of our brands around the world to see what is the role of powerful symptoms assessment to help guide people when they are in areas that are quite confusing, like irritable bowel syndrome, for example, or identifying the causes of some of your pain. Some of these day-to-day things are real issues to people. There are really important technologies that are helping very much with that part of the self-care continuum we’re seeing.

Whilst there’s absolutely going to be a role for self-selection yet the questionnaire-based approaches, complement some of the digital biomarkers which are getting better, and will continue to do so. At one point, I believe, they will become acceptable to the entire health system. In the meantime, I think they will increasingly provide great information and actionable insights.

I also think that is a role and people are increasingly accepting of drawing blood and providing saliva to actually get more detailed information about themselves. All of these pieces are coming together. Unfortunately, I don’t think we quite have the glue, which is where we, as an industry, need to work together a little bit better, because all of these component pieces are pretty much there but the system isn’t quite working seamlessly yet.

Q: Can you talk about Bayer’s approach to this movement around self-care and helping consumers with the tools that they need to manage their care better?

David: We spend all day doing innovation. When it comes to digital health, versus non digital health and everything that is now in-between, the process is broadly the same. For me, this is within good self-care innovation and it is about taking a broad-scale, medical, unmet need and combining that with a big, consumer, unmet need, adding in the right technology that is going to meet those, layering in your evidence, and giving it a great product experience. That’s my recipe for good innovation. That’s the same for digital health.

So that same process is followed. I do think that technology is making it much quicker for us to get insights to develop the products. Digitalization of labs, prediction of stability, which is one of those pieces within traditional product development, takes quite a long time. We’re using digital almost behind the scenes as well as upfront in the part of the consumer or the user experience to make that whole process better and faster along with how you end up engaging with your consumers. It’s not just about going to CVS and picking up a product and that’s the end of that. We’re now able to unlock better care, better education, better engagement in our communities, all of those so, the same principles apply. But in order to add in the layer of digital, use digital technologies.

One of the things that’s super interesting for me is how all of this is unlocking prevention or the idea of prevention in a much more meaningful way. It’s always been important for people, but many of us included, haven’t acted as much on it. I think it’s human nature we deal with today and we don’t worry too much about tomorrow for a lot of things, particularly, when it comes to our own health. Part of that is because it’s hard to measure.

A lot of these tools that are arriving are actually helping us measure the things that we weren’t able to before—from my sleep score to my biological age and comparing that to my chronological age—all of these things are helping us better our awareness of today and tomorrow, which I think ultimately will help with prevention and unlock a whole new kind of series of innovations that the industry can make.

Q: We’ve used the term self-care quite a bit here. How is it different from people just taking time-off, a vacation, go on a diet, or take some me-time? Is there a connotation that you attach to the term?

David: For me, self-care and consumer health are kind of interchangeable. It’s things like me-time that’s been definitely used as a similar attitude to self-care. Me-time is very important, but for me, it’s not health. Self-care is about evidence-based, credible products and services that are going to improve people’s health. So, there are many different things that play a role.

Alternative medicine can also play a role. However, I believe in evidence-based products and services and that’s really at the core of self-care. It doesn’t mean that these all need to be drugs.

We innovate on herbals and naturals. We have a brand in Europe called Iberogast. It’s had multiple clinicals over many years so, there’s a big body of evidence around treating the symptoms of irritable bowel syndrome, for example. It’s a combination of six herbal extracts so it doesn’t just need to be a drug, but that evidence is really important for me as part of this.

In the last couple of years, I’ve come to the conclusion that there isn’t a great definition of what great self-care looks like. So, along with a couple of colleagues this year, we put down some thoughts on what great actually looks like when it comes to self-care, not in the end product, but how you get there.

That’s really important, particularly when it comes to trust and credibility and ultimately, for us, it’s about combining their real deep medical insights, the science of the human being able to tap into sometimes emerging science and discovering new ways to meet people’s needs with technology, which can be drugs, digital, being able to leverage work within and influence the regulatory environment, which within consumer health is extremely fragmented.

It’s also about things like collaboration and my personal favorite topic, the consumer products experience. This is something which some companies, brands have forgotten a little over the years or maybe never got to. I think sometimes with pharma heritage, there hasn’t been that focus on actually providing a brilliant product experience.

Ultimately, if we want people to take care of their own health, we want them to use something on their own to manage this. It needs to be simple, credible, and work. I need to know and feel that it’s working so that they can continue using that product. I think when you combine all of those different elements, you get really good self-care products. That’s what we’re aiming for.

Q: Where does old medicine for instance, Ayurveda, fit in this picture? Do you see that as being a part of the self-care movement?

David: I think two things—people should do what works for them to manage their health. That’s my general belief. Regardless of what I believe, people need to use their own internal compass, do what’s right for them, feel what works, and go with that.

As much as I might be skeptical about some areas in it, I do think there are lots of areas within alternative medicine and Ayurveda, for instance, has a rich history and lots of evidence. It might not always be packaged in the same way as others but, there are things that are proven to work for many, many people.

That’s incredibly important and needs to play a role within health care, including within self-care. For the areas that have no scientific evidence behind them, it will be much harder for them to enter into that credible health area. There are so many that do.

Q: Health care, at least in the United States, is all about who pays for it. There’s the all-important question of following the money when it comes to health care. How does Bayer approach it when it comes to really driving adoption for some of these health care products that you’re putting out?

David: I think it’s evolving. Over the next couple of years, it will continue to evolve, particularly in the role of those small, premium devices.

In general, there’s a role for expensive, niche diagnostics for those that have the money to use them and are motivated to do so. That can generate evidence that can be relevant for the rest of us who are actually out there self-selecting a product.

So, I think that you can use and it’s not just the halo effect, but it’s the evidence you can generate from an increasingly broad population of people that are buying into the top of your pyramid of world class diagnostics along with say a series of supplements or a different kind of OTC product. You can then use those insights to help everyone else select what would be best for them. I don’t think everyone always needs to buy into all parts of this ecosystem.

There are some real benefits that the more the data we generate about products by the interaction of different products with different behavioral interventions, combining that with different factors—areas where you live, how old you are, etc.—will all give much more targeted advice to the people that don’t want or can’t access that.

But we can give them the great insights to say, actually, for someone like you, this is much more likely to work. That’s a real role. I don’t think there’s the elite versus everyone else but that there’s a huge role in taking the evidence generation that guides everyone. There’s always going to be a role for simple products and good education, with robust evidence behind them that people can opt in at an affordable price to help them manage their pain, their anxiety, whatever that might be.

Q: You mentioned partnerships. What’s your advice to our listeners and especially those who are digital health startups looking to get their product out in the market in partnership with a global company such as Bayer?

David: My advice is, it’s a great time to be working in health care and looking for partnerships because I think everyone has recognized that we need each other. In the many years I’ve been working in health partnerships, I’ve seen lots of great failures as well as some good successes. It’s all about the fit. Finding the like-minded organizations with great people who you can trust is as important as a potential deal or a potential commercial opportunity. It’s something that people like to run into first.

But what I’ve learned is when you take the time to understand where a founder is coming from, where an organization or large corporate priorities are, and you can start to find that common ground, that’s a fantastic place to start.

Then, you start to build a relationship rather than a transaction. This might be a little bit fluffy, but in my experience, that spot works and you get to the deal. You can then be more flexible when you’ve built up the trust.

I think it’s about researching, understanding, connecting, networking, and finding those like-minded companies because there can be a lot of wasted time. We will spend a lot of time researching different technologies, talking to lots of different people, and lots of these things are going to be dead-ends. That’s okay. That’s part of the process. Taking the time to get that fit is right.

And what do you really want? If you’re a small company, are you looking for geographic expansion? Are you looking for fantastic regulatory expertise to scale your proposition? Do you need help with evidence generation that’s going to allow you to skyrocket your growth? Are you looking for brilliant, supply chain expertise to trim out the costs to bring your product to the masses? What are you looking for? What are the skills that your partner or many partners have? That’s the most important thing to me.

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.

Consumers are looking for instant gratification with their digital health experiences

Season 4: Episode #133

Podcast with Reid Stephan, VP and Chief Information Officer, St. Luke’s Health System

"Consumers are looking for instant gratification with their digital health experiences"

paddy Hosted by Paddy Padmanabhan
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In this episode, Reid Stephan, VP and CIO of St. Luke’s Health System, discusses how consumer research drives digital priorities, mobile applications, and other digital features. He also talks about creating a robust technology infrastructure to deliver the superior experiences consumers demand and expect today.

St. Luke’s Health System is a large health system looking to deliver outstanding digital experiences to its patients. Reid discusses three things that significantly impact a frictionless patient experience and talks about how they approach care management, home health, remote monitoring, and more. Take a Listen.

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Show Notes

01:29About St. Luke’s Health System and the populations that you serve.
03:18 What are your thoughts on the digital health program at St Luke's? Tell us about your current priorities as the CIO in supporting digital initiatives for the organization.
07:33 What are your consumers telling you about what they’d like to see and therefore what might go on your roadmap?
11:41What are some of the common metrics that you track when trying to understand whether your investments in the digital programs are meeting expectations?
13:30Are there any macroeconomic factors that are driving some of your priorities today, either at the national or at the regional level?
15:52 How has the payer mix changed for you and how does that drive your investment priorities?
17:12 How are you using data and analytics to drive access-related initiatives?
19:23How are you setting up your whole IT infrastructure and your foundational platforms to successfully drive digital engagement?
22:27Can you talk about the application solutions? You are Epic first, but how do you choose when enabling the digital features and functionalities that your consumers demand?
24:07How are you addressing providers and caregivers’ expectations?
26:10What’s your approach in care management, home health, and remote monitoring?
28:27What are the one or two pieces of advice that you would like to share, either with your peers or with the technology provider community that wants to be a part of your journey?

About our guest

Reid Stephan is the VP, Chief Information Officer at St. Luke’s Health System. St. Luke’s is the only Idaho-based, not-for-profit health system, with 9 hospitals and 200+ clinics serving the needs of communities across Southwest Idaho. He has over 20 years of experience in the technology space, including serving as St. Luke’s Chief Information Security Officer prior to his current role, and 9 years leading HP’s global corporate IT security incident response program.

He has a Bachelor of Management Information Systems from the University of Idaho and an MBA, Technology Management from the University of Phoenix. He is a HealthCare Information Security and Privacy Practitioner (HCISPP) and a College of Healthcare Information Management Executives (CHiME) Certified Healthcare CIO.

Reid Stephan is the VP, Chief Information Officer at St. Luke’s Health System. St. Luke’s is the only Idaho-based, not-for-profit health system, with 9 hospitals and 200+ clinics serving the needs of communities across Southwest Idaho. He has over 20 years of experience in the technology space, including serving as St. Luke’s Chief Information Security Officer prior to his current role, and 9 years leading HP’s global corporate IT security incident response program.

He has a Bachelor of Management Information Systems from the University of Idaho and an MBA, Technology Management from the University of Phoenix. He is a HealthCare Information Security and Privacy Practitioner (HCISPP) and a College of Healthcare Information Management Executives (CHiME) Certified Healthcare CIO.

Q: Reid, tell us a little about St. Luke’s Health System and the populations that you serve.

Reid: St. Luke’s Health System is based out of Boise, Idaho. Our geographic footprint covers southwest Idaho and a little bit of eastern Oregon and serves the populations there.

Our system comprises eight medical centers and a couple of hundred clinics and centers. We see about three million visits a year between those settings and the population is dynamic. It covers a broad cross-section. We’ve had an interesting change in the last couple of years with a huge influx of folks moving into the valley in the Boise area, in particular, which has shifted our population a bit. Given how it covers a city area like Boise, smaller towns, rural hospitals, and rural areas, it then provides challenges in terms of access and equity of access. So, it’s really a unique market where we have a little flavor of everything, which makes it challenging, but also exciting and rewarding.

Q: Do you have a large rural population that’s widely dispersed in some way as well?

Reid: Large in terms of geography, but I wouldn’t say large in terms of population compared to some of the city urban areas. Certainly, large in terms of just the consideration for digital, in particular. You can assume that they’re going to have broadband access or even a device to engage in some of those opportunities.

Q: What are your thoughts on the digital health program at St. Luke’s? Tell us about your current priorities as CIO of the organization in supporting digital initiatives for the organization.

Reid: I have a love-hate relationship with the word “digital.” I understand it, and it’s the context that’s important, but it’s one of those words that get used so ubiquitously that it can start to lose meaning. Then, you have this Tower of Babel experience where people all hear the language differently.

For me, one of the success measures will be when we just start to talk about health generally, and that just naturally encompasses digital. In my mind, I don’t differentiate between my Amazon experience when I’m on my device ordering something versus when someone physically comes to the door to deliver it. It’s just all Amazon experience.

It’s with that backdrop that we set up a Consumer Access and Experience Program (CAE) a year ago. One of my colleagues and great partners is the VP who leads that. That group’s been tasked with not disrupting for the sake of disruption, but really challenging how we think about things and helping us really start with the question because we think that’s the most powerful tool in the toolbox. Don’t go out and ask users what they might want or expect them to design what that digital health experience might be like, but really, bring questions to bear to draw out from what might be best for them.

There are a few things on which that program is focused on that we’ve helped as an IT shop. We launched an app earlier this year and while it’s still nascent in its development, it’s an engagement, an access gateway, and an experience gateway for the future. It gives us a nice cornerstone then, to build on basic things in place there, now. You can access our patient portal, our website to find physicians and locations, and pay your bill too. We’ve put together a few digital assets into one unified experience, and now we need to really gain insights to understand where to add value and components to that. Where can we reduce friction from that experience?

Another thing that the CAE group has championed that we’ve supported is, an on-demand virtual clinic. Like everyone else, we saw a rapid increase in virtual visits with COVID, so, tapering-off of that last year. But it clearly demonstrated to us that there is an appetite in the market for consumers that want to consume their health care through digital for certain business types and needs. Creating a clinic that’s focused just on that and using it to understand preferences and behaviors, has made us look at ways that we can take advantage of existing capacity. Rather than move right to probably bringing it in and looking at how we’re going to augment and outsource the physician or provider need, we’re looking internally at our capacity in other areas where we can have doctors and other providers who can come in to bear on that need and chip in. I’m excited about just some of the early conversations there.

The last thing I’ll touch on is one of the roles of CAE is to just take a hypothesis, experiment quickly, and learn from it. We’re about to launch a medication locker at a local grocery store that doesn’t have a pharmacy. This is just a small test of change to learn and understand consumer appetite, preference, and desire using that omnichannel approach, where we can give consumers a variety of options and then, understand where preferences lie. Subsequently, we hope to guide them to the option that might best be suited for them. I’m really excited about that kind of focus on consumerism.

Q: You’ve mentioned the mobile app and the urgent care initiatives. What are your consumers telling you about what they’d like to see and therefore what might go on your roadmap?

Reid: If I just used one word to describe it, it would be “instant.” They want the same experience they have in just about every other vertical of their life where it’s always on, always available, and there’s that instant gratification or results from what they’re pursuing. Granted, there’s certainly that in health care but, there are situations where that’s just not a logistical possibility. But there are a lot of areas where we can improve that experience, give that access, and that instantaneous result to the consumer.

Some of the things we’ve done to help glean insight from the consumer include focus groups, which are interesting and simple things like going out and visiting with consumers and asking questions. Our CAE group did something fun this year when a group of students from Harvard wanted to do a case study. They came to Boise and we gave them a problem to look at. They spent a couple of days analyzing and undertaking the academic approach and then, generate a report for us.

Interestingly, one of their insights or hypothesis was that one of the challenges you have with something like your patient portal is many of your consumers use it so infrequently. Like I said, it’s based on when they have the need. Compare that to your banking app, the Amazon app, and the social media app that you’re in kind of daily. You develop this dexterity and familiarity with how to navigate there so then, it seems easy. But when you’re just logging on to MyChart once or twice a year to schedule an annual wellness exam or an episodic kind of need, it’s going to feel foreign because you just don’t use it enough.

That’s been a really interesting observation that we’re kind of just churning over and thinking through about how do we ensure we don’t overinvest in building up every single detail of a completely frictionless patient portal experience when the bang might not be worth the buck? Let’s focus in on maybe the one or two things that really, really matter.

Another insight we’ve gleaned is three things that have the biggest impact that we’ve observed on Net Promoter Score. First and foremost is receiving services, which makes sense. Next, our Schedule and Appointments and Finding a provider. And then, way down on the list is Wayfinding. That was interesting because we’ve kicked around Wayfinding for a long time and the thought was how cool this would be. Given we face financial constraints, we had to be really disciplined and ensure that the investments we were making were going to yield the biggest benefit. They were narrowing our focus then, on how to improve that experience for scheduling an appointment to make it as frictionless and as easy as possible? How do we make that experience easy for someone to find a provider? Or even to find out the details they might want to know about that provider?

That consumer insight is really a key for us because that helps us then, to not only meet the consumer need, but be wise stewards of our resources and ensure the work we’re doing is going to have the biggest benefit for that.

Q: Can you share a little bit about what are some of the common metrics that you track when trying to understand whether your investments in those programs are meeting expectations?

Reid: It’s really the pedestrian ones that you would expect. We look at active MyChart users, meaning they’ve logged on some time in the previous 30 days. We do that ratio against our total MyChart user population.

We look at the percentage of patients that use MyChart to schedule an appointment versus those that call our connection, the percentage of folks that use MyChart to refill a prescription request, and that would use MyChart to look at their images or review their after-visit summary in the provider notes. We just really focus on consumption.

One of the things that has been stuck in my mind is, if you accept the fact that the typical consumer then, is just occasionally using your digital health tool and particularly, your patient portal, then, that begs the question that there must be value you’re giving them other than that episodic, specific need they have.

That opens up a whole pantry of opportunities that are really interesting to examine about what we can offer then that would make that app more of a frequent digital stop for that consumer, where they don’t view it as just the transactional experience of St Luke’s, but as holistic within how they’re thinking about their care, whether it’s diet or exercise or preventative kind of regimens. It’s such a great time to be in health care because we own so much of the solution if we can be really thoughtful about leveraging the data we have, gleaning the right insights from it, and then, acting on it.

Q: Are there macroeconomic factors that are driving some of your priorities today, either at the national level or at the regional level?

Reid: Absolutely. I talked to the CIOs on what difference a year makes and that’s the mantra certainly for this last year. Financially, there were two things that really put some headwinds in place for us. We still have a large volume of travelers that are onsite just to fill our critical nursing needs. We have high volumes—the highest that we’ve ever had—but then, we’ve just had this shift in our labor market and there’s this need for nursing but we can’t hire nurses fast enough. To some degree, there is a trickle-down of that.

On the I.T. side, certainly with the labor market and remote work, it’s up-rising but there are challenges that ensure that we’re being competitive, flexible, and agile in order to have a great workforce and keep the culture we want.

There’s also the payer mix which has been an interesting shift for us since we’ve seen that move in a way that’s not favorable. That pressure makes it more imperative for us to realize that in an era of constrained resources—this isn’t something that’s going to go away in a month or a year or two—it’s the new reality we’re going to have to get really adept at living in.

In a way, it’s a gift that’s going to force us to narrow our focus and understand that while there are some things that we are good at and can be better with, we only have capacity to do the very best thing. So, we have to get it right. We don’t have the luxury of an Amazon to put ten pokers in the fire and hope one of them works out. It’s a challenge, but it’s also helping us mature in a way that we otherwise might not be able to do.

Q: How has the payer mix changed for you? How does that drive your investment priorities?

Reid: At a high level, we’ve seen a shift in government payer versus commercial payer, and being a not-for-profit health system, thinking of even a small shift can have an impact. But the conversations we’re having are not about, “How do we shift that back?” Because that’s not the right answer. The answer is, “How do we care for this population?” If this shift is causing this kind of financial strain for us, then, we need to innovate and figure out ways to do it where that government payer isn’t such a drain.

There are opportunities to figure out how reduce waste, focus more on the health care side, and avoid readmissions or avoid a hospitalization, in the first place. That’s again an opportunity to do some cost cutting and wait till things get better. In fact, it’s a chance to reimagine how we’re doing things.

Q: With regard to data analytics, can you share one or two examples of how you’re using data and analytics to drive access-related initiatives?

Reid: We are a developing nation in this state. We are fast followers and love to learn and glean from others. It’s not unique to us but we are data-rich and in many areas, information-poor.

So, with our data and analytics team, one area of focus is trying to be very explicit and disciplined with operational partners and really defining when they come to us and understand the job we’re trying to do. Like – why are you trying to hire this data? Trying to understand the outcomes they’re actually after, trying to offer datasets they’re not aware they have access to where they can do some of this exploratory and inquisitive exercise on their own. And trying to get out of the arena we’re in today where some of the capacity is being consumed by requests for dashboards or like – we have a dashboard, but I don’t want to treat to look like this. We’re trying to get out of that kind of service requests.

We take a first-come-first-served approach by an analytical team to really put together a comprehensive data platform that can then be used to answer a variety of questions, whether it’s on the clinical side or the business operations side or a CRM side from the marketing standpoint. It’s early days in that because right now, often, it’s based on the immediacy of the need in terms of how deeply we dive into a request that comes in. But we’re really trying to create something that’s comprehensive, scalable, and positions us for the future.

Q: How are you setting up your whole IT infrastructure and your foundational platforms to drive digital? You’re an Epic shop, so that’s key but what else drives a successful digital engagement?

Reid: A couple of things come to mind. We have a cloud forward strategy. It’s not cloud-first. It’s not cloud-only. It’s just that we certainly look to the cloud, but we are so focused on wanting to move things to the cloud that we then miss the chance to critically think through opportunities as they arise. For example, we’re an Epic shop. It’s hosted on-premise and we don’t have any plans in the near future to move that to the cloud, although going forward, I would expect that may be an ultimate outcome. But there are areas where it does make sense.

Between our colo data center and our data center at one of our hospitals that’s a couple hours away, we have a completely redundant infrastructure to run Epic for the entire health system—it’s expensive, doesn’t scale well and we have to maintain 100% capacity, 200% total in the event that we may need it. Now, if you think about it from a risk standpoint, those data centers are about two-and-a-half-hours apart, so potentially there could be a geographic event that impacts both data centers. Therefore, we’re moving our Epic VR capability to the cloud over the next year so we have the ability to just have a small presence there that can be scaled up when needed.

It’s the same thing with regard to the other solutions—we have a mix of SaaS, public-private cloud, and on-prem things, so, we’re always looking at what’s the best solution for the current state operational need and what can provide the cleanest path for that future roadmap.

One thing that we’ve learned early on is, it was years ago that we used to lead with the cloud and consider the ROI in terms of spend or savings. It’s just not the case now. It’s your dollars kind of spend elsewhere. However, there’s been a couple of transitions, especially with our finance team, to help them understand that you may not get such cost savings that you’ve heard about at the CFO conference so here’s what you do get what’s beyond the savings. You’re going to get all that the company has to bring to bear in terms of expertise, infrastructure, and cybersecurity, built in and baked in. These are things that we may not be able to ever fully do on our own or fund on our own. That’s our mindset.

Q: Can you talk about the application solutions? You are Epic first but how do you choose when enabling these digital features and functionalities that your consumers demand?

Reid: We have a Strategic Technology Investor Committee and our three pillars of our backbone assets. We have Epic for our EHR. There’s Microsoft, which runs our desktop server infrastructure. Then, there’s Infor, our ERP.

Our guiding principle is, we’ll look to these vendors first—not always, not only. Previously, it used to be, “Hey, I went to a conference, found this great tool, and I want to use it.” Before we knew it, someone acquired it so we’d be trying to figure out how to integrate it into interfaces and then, it’d have duplicative capability we already owned.

We’ve been able to redirect that now to facilitate good conversations. People have varying opinions of Epic based on where they are, what they’ve been listening to, or reading, lately. What we’ve learned through this is, it’s helpful to enable people understand the significance of the investment we’ve made. This is a choice that we made as a system for our EHR, and it is no small investment. If we ever do something outside of Epic, we have to then, do it intentionally. We have to make that decision that we’re going to add incremental costs for whatever reason—either Epic doesn’t have it or it doesn’t meet our needs the way we need it to. But we try and use an 80-20 rule in those conversations. If we can do this at Epic, Microsoft, or Infor and it meets 80% of the need and is not introducing any kind of unacceptable risk or safety issue, then, that’s what we’re going to start.

That’s been very effective and ensured we certainly have avenues for complementary solutions in areas where we really don’t.

Q: What about providers and caregivers? What about their expectations? How are you addressing those?

Reid: Well, they’re fatigued and they’re tired. What I hear most from providers is, “I just want to treat patients. I just want to talk to my patients.” I go see my provider. He knows my role in the organization and he always has a list for me, which is great because he’ll take care of me and then, I try and take care of him. But his number one thing is, “I don’t like that even for a second I have to take my eyes off my patients and be typing on the keyboard, update something.” It doesn’t have to be that way.

We are looking at some ambient listening-type experiences that can augment that. In-basket, the providers view that as a burden. So, we have a project and a way to figure out how we can automate or bring in other resources to offload some of this burden because it’s for our providers and nurses. It’s a risk to their well-being, to the capacity to care for patients, and for their commitment to the profession—for some of them, long-term. That keeps me up at night, just trying to think through all the opportunities in that target-rich environment. How do we really define that? What are the one or two things that we should be all in on that are going to make the biggest impact for this population?

Q: What about digital in the context of care management? What’s your approach in care management, home health, remote monitoring?

Reid: We have what we call a virtual care center as a 24*7*365 digital telehealth hub and a dedicated team of expert physicians, nurses, allied health professionals, and I.T. folks. What it does is offer three key services.

There’re Virtual Care Centers for Clinic Consultations. If a patient at the clinic sees their doctor and then, has some need for a specialty or some kind of advance discussion, we can virtually bring in someone from the virtual care center. That can all happen in that single-visit location with the patient, rather their referral. They then, have to actually sit down after the fact.

We do a Hospital Consultation which is the same kind of concept where the hospitalist then can, through a telehealth video visit, bring in that expert that might be needed.

We also have Telehealth ICU monitoring that really expands the capacity that we have, to monitor patients in an ICU.

With regard to Home Monitoring, we certainly have programs that support patients at their homes. We provide them the devices that collect relevant information, send that back to the virtual care center, where cross-functional teams receive, assess, and intervene as needed before updating appropriately that patient chart.

I’m really proud of that work and excited for this foundation that sets us up for the future. That emerging space is so important and this Hospital and Home is one of our key initiatives to try and really make some headway there. Because our evidence shows that patients are more comfortable in a home, it’s no surprise that a lot of cases heal, recover, when their care is better delivered at home.

Q: What are the one or two pieces of advice or best practices that you would like to share, either with your peers or with the technology provider community that wants to be a part of your journey?

Reid: We could do a whole show just on that but I would say this, and this is not a technical answer at all, that it is really an important grounding principle for me. Don’t ever be embarrassed by where you’re at your journey and don’t be afraid to start because of where you’re at.

There’s so much great content out in the community. There are folks who bring on their thinking, expertise, and where they’re at, that it’s like light years ahead of where we are. It’s easy maybe to start to think, “Oh, I guess we’re just not smart enough” or “Man, we’re never going to be as good as that person or that system.” I think that’s the wrong mindset.

We’re all where we are for a variety of reasons, but we all have the same opportunity, even if it’s just incremental, to improve that experience whether it’s for the patient, a provider, a colleague, or just within the operational work of the hospital or system where you’re at.

I would just say, as you’re empathetic, curious, and as you engage in rapid experimentation, you’ll be surprised at the progress you make. No matter how unsophisticated you might think you are, the work you do, matters. That makes a difference. Don’t ever let that comparison or your own ego get in the way of that.

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.

Technology integration is one of the greatest opportunities that we have in healthcare

Season 4: Episode #132

Podcast with Jared Antczak, Chief Digital Officer, Sanford Health

"Technology integration is one of the greatest opportunities that we have in healthcare"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Jared Antzack, Chief Digital Officer at Sanford Health, discusses the special considerations that go into serving their widely dispersed population and how they design digital solutions for that population. Sanford is a large health system that primarily serves the rural population across the upper Midwest, stretching over 250,000 square miles.

Jared’s role at Sanford ranges from being clinician-facing and consumer-facing to bridging their needs across technology, business needs, and consumer experiences. He states that digital is both about the front-end aspect of technology that users interact with as part of a broader experience and the back end that includes the infrastructure, architecture, databases, interfaces, and networks. Jared points to how the digital divide has become a social determinant of health and how they are removing the friction points to enhance digital patient experience and engagement. Take a listen.

Our Podcast Partners:

Show Notes

06:01Can you talk to us about your priorities and how that is impacted?
08:17 When you talk about the types of care that are important to the populations you serve are we talking about primary care, managing chronic conditions, or acute care procedures? What is the most important gap or need now that someone in your role would be focused on?
10:14 Can you give us an example of a digital enablement that you've launched and implemented that addresses your needs?
15:05How do you go about making your technology choices when it comes to implementing the solutions you referred to?
19:28What is the need you're trying to address? What is your advice for someone who is listening to this podcast, wants to approach you, and offer you a solution?
21:46 Should innovators be considering some very specific attributes of your population as they develop their solution for your population? What is your advice here?

About our guest

Jared Antczak serves as Sanford Health’s chief digital officer, overseeing digital strategy and transformation initiatives to enhance consumer and caregiver engagement, support care delivery, improve business processes and expand health care access through virtual care.

Antczak joined Sanford Health in 2022 after serving in leadership positions at Highmark Health, Intermountain Healthcare and Atrium Health. He holds a bachelor’s degree in biology from Brigham Young University-Idaho and an MBA from Wake Forest University, in addition to a product executive certification (PEC) and an information technology infrastructure library (ITIL) certification. He is also a certified professional in healthcare information and management systems (CPHIMS).

Originally from around Salt Lake City, Utah, Antczak lives in Sioux Falls with his wife, Charlene, and their six children.

Jared Antczak serves as Sanford Health’s chief digital officer, overseeing digital strategy and transformation initiatives to enhance consumer and caregiver engagement, support care delivery, improve business processes and expand health care access through virtual care.

Antczak joined Sanford Health in 2022 after serving in leadership positions at Highmark Health, Intermountain Healthcare and Atrium Health. He holds a bachelor’s degree in biology from Brigham Young University-Idaho and an MBA from Wake Forest University, in addition to a product executive certification (PEC) and an information technology infrastructure library (ITIL) certification. He is also a certified professional in healthcare information and management systems (CPHIMS).

Originally from around Salt Lake City, Utah, Antczak lives in Sioux Falls with his wife, Charlene, and their six children.


Q: Jared, tell us a little about Sanford Health, the populations you serve, the size of the organization, and your role.

Jared: Sanford Health is headquartered in Sioux Falls, South Dakota. We cover a geographic footprint that’s approximately 250,000 square miles—across the upper Midwest— so, you can visualize a geographic footprint approximately the size of Texas.

That’s really the population that we serve in South Dakota, Minnesota, North Dakota, and a little into Iowa, as well. Two-thirds of our population are actually classified as rural population areas and so, it presents a very unique opportunity and set of challenges, especially when you’re presented with a digital strategy in terms of how do you engage that population.

I had the privilege of joining the organization earlier this year as the inaugural Chief Digital Officer. For some of the organization’s history, we’ve had this role but prior to this, I spent about a decade in the health care industry in a variety of different technology and digital strategy-oriented roles with a few different organizations. I worked on the provider side and the payer side. I’ve been in roles that have focused both on the clinician and the consumer experiences and fundamentally, always found myself in a functioning and what I would describe as a bridging role where technology, business needs, and consumer experience really converged.

Early on in my career, I worked with the health system that was implementing an electronic medical record with computerized physician order entry and electronic prescribing for the first time. I observed these providers that were spending all of their time staring at a computer screen rather than making eye contact with their patients. I supported them at 10 p.m. at night when they were trying to finish their documentation for the day because they didn’t have enough time to squeeze it in during their clinic time.

I saw firsthand then, how technology often inhibited that patient provider relationship rather than help facilitate it. That sacred moment between patient and provider was often disrupted by the technology of the day, and consequent to that realization and recognition, I actually turned down an opportunity to go to medical school so that I could focus on that problem. That’s really been the driving force behind my career ever since.

Q: What led Sanford to create this role of a Chief Digital Officer?

Jared: I think Sanford recognized that there was an untapped potential and value in digital to really drive value for the organization and the patients we serve. We’ve done a lot of really great work in the past with IT and now, I actually work closely with our Chief Information Officer, Brad Reimer, in the organization.

But really to unlock value and enable some of our goals around patient and clinician experiences, quality improvement, and cost reduction—that elusive quadruple aim that we talk about in health care–every organization is structured a little bit differently. However, the C.I.O. and I are very much joined at the head and it’s been a very incredibly productive and beneficial dynamic for the organization.

Our roles deeply complement each other, as well. We have very distinct areas of focus, but we also have fundamental areas of opportunity where we converge a lot. It really comes back to how we define digital, though.

As an organization, we’ve defined digital as the frontend aspect of technology that users or human beings interact with as part of a broader experience. That’s the focus area for myself and my team. However, there’s also a backend aspect of technology that includes the infrastructure, the architecture, the databases, the interfaces, and the networks. That’s what the C.I.O. focuses on. All these ultimately come together as part of the technology ecosystem but the focus areas are different to ensure that we’re giving the right attention and resources where it matters.

Q: Let’s talk about your populations. Those fundamental attributes drive your digital priorities in many ways. Can you talk to us about your priorities and how that is impacted?

Jared: As I think about the population that we serve across the upper Midwest, the vast majority of the counties that Sanford Health serves in this area are federally designated provider storage areas as well. So, the opportunity for digital and technology to extend reach to some of these patients who live geographically really far from a venue of care is really one of the compelling things that piqued my interest about this opportunity.

It’s not uncommon for some of our patients to travel 3 to 4 hours, sometimes just to get to the nearest doctor’s office. Unfortunately for many people, that means taking time off of work. Sometimes, for some of our farming communities, it means setting aside really valuable harvest time in order to seek the care that they need, find child care, or even transportation to make that journey.

All of those factors ultimately can become a barrier for many people to get the care that they need in order to make a difference. We know that postponing preventive care can really result in other unintended health complications or poor outcomes. We need to make it easy for our patients to be able to do the right thing and for us to do the right thing for our patients. The ability to leverage virtual care tools and digital experiences to bring care closer to home or even in the home can really become life-changing or life-saving for people who live in these communities.

Q: When you talk about the types of care that are really important to the populations you serve are we talking about primary care, managing chronic conditions, or acute care procedures? What is the most important gap or need now that someone in your role would be focused on?

Jared: To some extent, it’s all of the above. Starting with primary care, the basic preventative care needs and then, moving up the chain from episodic conditions and urgent emerging conditions to potentially elective procedures, it’s really about making sure that we’re delivering the right care in the right place at the right time and doing so in a manner that aligns with our patients and consumers’ needs in terms of when, where, and how they want to receive that care.

Some of the additional considerations we look at especially in the rural communities, is, what does digital equity look like? Digital equity in and of itself is considered a social determinant of health similar to food shortages, housing, transportation, or other determinants of health. It also looks at whether they have Internet access, reliable broadband, device availability—Do they have smartphones or tablets or computers with a camera at their disposal? Are they digitally literate? Are they comfortable downloading, registering, navigating a digital experience? Or is that potentially a barrier to entry for some of these people to be able to engage in a virtual care experience?

We’re looking across the board at all those different elements and really understanding what it is like in our community for these patients and how do we mitigate some of those barriers and points of friction so that we ultimately can deliver the right care at the right time for them.

Q: Can you give us an example of a digital enablement that you’ve launched and implemented that addresses one or more of the needs that you just described?

Jared: We’re very much in the process of evaluating some of our priorities. But as an example, we recently launched a virtual care initiative to really transform how people receive care across the upper Midwest. It was part of a $350 million initiative. Next week, we have a groundbreaking for our virtual care facility that will be our flagship building upon which this initiative will be foundational.

With that initiative, we’re looking at remote patient monitoring for example, and checking how we can ultimately get the right devices in order to be able to care for people in some of these remote communities upstream in a way that’s more proactive and where their care team can be engaged with them from a distance so they don’t have to come in to the doctor’s office in order to have their A1C checked or their blood pressure monitored.

We’re looking at different devices that potentially can connect just based off of a cellular signal without the need for broadband access. We’re looking at how to make the experience as plug-and-play as possible.

One example that we’re exploring is for patients who are in our hospitals who might be eligible for an early discharge with remote patient monitoring as an option for that post-acute care. We’re bringing the devices to the patient while they’re still in our facilities, showing them how to connect and use it. The attempt is to demystify the experience for them so that they feel comfortable and confident about being able to use it at home. Then, when we send them home with the device, we follow-up to make sure that they’re still able to use it. That mitigates the amount of time that they have to spend in our facilities and allows them to return home in the comfort of their own atmosphere and environment to heal.

Q: Can you talk to us about your payer mix? How you develop solutions that address the greatest common denominator across multiple populations with various needs?

Jared: We have a pretty balanced payer mix in terms of commercial, Medicaid, and Medicare across that spectrum. However, Sanford is very much on the journey that a lot of organizations are on in terms of the shift to more of a value-based care model.

With that shift, the value and ability for digital to potentially create value for both our patients and the organization becomes that much more important because we start to get upstream more from the traditional visit and encounter RVU model in terms of caring for patients. We think about patients a little bit more holistically and want to keep them out of the hospitals and away from expensive, costly venues of care. Ultimately, that’s where different digital technologies, potentially remote patient monitoring among other aspects really come into play creating considerable value for the organization and patients.

We’re very much on that journey where we have one foot in and one foot out in a traditional health care landscape. Like a lot of organizations, we’re trying to figure out the best way to accommodate our patients needs and meet the organization’s needs at the same time.

Q: How do you go about making your technology choices when it comes to implementing these solutions that you’re referring to?

Jared: Sanford is actually on a single instance of Epic, and that’s quite an accomplishment for an organization our size. That instance of the EMR was actually implemented in some of our locations over 12 years ago.

If you think about the population that we serve, a considerable part is fairly static. There aren’t many moving in or moving out from some of these areas. We have a really long history of clinical data and longitudinal data sets in terms of some of these patients, which is really, really valuable for us and them in order to help generate the right kinds of insights and help keep them all while managing their conditions.

But, like every organization, I think in order to determine what digital technology is the right fit for us, I always go back to making sure that we have articulated the right problem to solve. In health care, it’s easy to fall into the trap of starting with the solution, and being dazzled by the bells and whistles that you see in a demo and then, moving forward with a particular solution, and then, working backwards to try to figure out, what problem it can solve. That’s a trap I’ve seen a lot of organizations fall into.

One of the things that we’re very deliberate and intentional about is making sure that we understand what problems we’re trying to solve, how those problems align with our strategy and how they meet our patients’ underserved needs or jobs to be done. Ultimately, are they desirable for our patients? Are they viable for the business? Are they feasible from a technology and an operational standpoint? That allows us to ensure that we’re taking the right solution to solve the right problems and that we’re getting the greatest value out of it.

Q: The populations that you serve are fairly stable and don’t move a lot. You’ve gathered longitudinal data to understand this segment. How are you leveraging all of that?

Jared: We do have analytics, machine learning, and artificial intelligence function within our organization. It really is intended to take advantage of that really robust data set that we’ve been able to curate over the years and derive some machine learning in order to generate insights about our population. Ultimately, it’s intended to get the right nudges and next best actions either into the clinician workflow or directly to the patients so they can be proactive. The right actions will help people to stay well, look at different risk factors that ultimately may potentially help predict different conditions, and ensure going upstream from there so we can provide the right treatment proactively to keep people well. It’s a really exciting area and one that we’re in the process of looking to grow and expand at the same time.

Q: What is the need you’re trying to address? What is your advice for someone who is listening to this podcast, wants to approach you, and offer you a solution?

Jared: This is something that we deal with on a daily basis. One of the things that we’re really trying to do as an organization is be very intentional and deliberate about making sure that we’re aligning the right sorts of opportunities with the right challenges, or opportunities that we’re trying to solve for.

We have this concept of the 80-20 rule where 80% of the time we want to define the problem, then, go out and compare different solutions that might be in the marketplace. Then, narrow down the right vendors depending on which ones meet our needs the best and ultimately, go forward in that way. But then, 20% of the time, we want to be able to have that sort of outside-in inspiration. There may be something that a particular vendor has identified in terms of an opportunity or an underserved need that maybe just hasn’t hit our radar for whatever reason. We don’t want to close ourselves off to those opportunities either but we want to make sure that we are also bringing those in through a consistent process.

We have a dedicated team that is on point for managing some of that intake as well as the outreach in terms of our vendor evaluations and selections.

Q: Should innovators be considering some very specific attributes of your population as they develop their solution for your population? What is your advice here?

Jared: I think the challenge is that our population is still relatively diverse though we do have a lot of people in urban settings. We have the farmer that’s out on the field that may or may not have broadband access or may or may not be as digitally savvy. We also have the financial advisor sitting in downtown Sioux Falls that we’re serving as part of our population.

Recognizing not only the population but how a particular solution can meet some of their needs is key. From a technology integration standpoint, it’s really important that we’re removing friction regardless of the type of user or persona that we might be trying to serve.

Integration is one of the greatest opportunities that we have in health care. Everybody wants that sort of Amazon-like experience. When Amazon comes out with a new set of features or functionality or capabilities, they don’t create a new app for that. There’s that old saying back in the early 2000s, “There’s an app for that.” Nowadays, it’s just part of the experience.

What we want to create is the Sanford experience. We don’t want a proliferation of point solutions where we’re asking our patients to go out and download a new app for this and that. We want it to become integrated and seamless. We want that digital front door experience where it’s cohesive, intuitive, and matches the user’s mental model. We have the ability to integrate through APIs or software development kits, the right capabilities from our partners and vendors, as well as any capabilities that we build in-house into that cohesive and seamless experience to remove friction so that our patients can engage in a meaningful way.

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.

One of our goals with digital programs is to eliminate systemic racism in healthcare

Season 4: Episode #131

Podcast with Adam Landman, MD, Chief Information Officer, and Senior VP, Digital, Mass General Brigham

"One of our goals with digital programs is to eliminate systemic racism in healthcare"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Adam Landman, MD, Chief Information Officer of Mass General Brigham (MGB), formerly Partners Healthcare, talks about the four distinct user groups that Mass General’s digital engagement programs have identified and prioritized for improved experiences. In addition to fast and convenient patient experiences, Mass General’s digital programs focus on the needs of diverse population segments to improve access to care and eliminate systemic racism, which they consider a public health issue.

Dr. Landman also talks about their data and analytics capabilities, the need for robust technology infrastructure, and their experience and learnings from evaluating and engaging with young, innovative start-ups. Dr. Landman is also co-author of a paper in Nature Digital Medicine on deploying digital health tools within large, complex health systems. Take a listen.

Our Podcast Partners:

Show Notes

03:18 What are some of the top priorities and digital aspects that you’re currently working on as the CIO?
08:06Can you share the top priorities for improving the patient experience?
09:25 What are you hearing from your patients when it comes to the kind of digital experiences that they're looking for?
13:00 How do you design solutions for a population that is as diverse as yours especially with regard to technology-enabled solutions? How do you ensure maximum coverage?
15:48What kind of technology foundation or enablement do you need to have in place to be able to deliver on all these digital front doors solutions? How have you gone about setting up the foundational infrastructure for such enabling platforms?
18:13You stated that you start with the EHR first; however, do you have a strategy that involves other best in class tools, standalone point solutions, enterprise class platforms, or you build some things yourself? How do you approach these technology choices?
22:05What are the rubrics that you use when you start evaluating the digital health startup companies and how do you make sure all these solutions work well together?
28:45 What kind of data and analytics infrastructure are you building within MGB and what are those competencies focused on?
32:02 What’s your advice for your peers in the industry, and for innovative and young technology solution providers who want to be a part of your journey?

About our guest

Adam Landman, MD, MS, MIS, MHS is Chief Information Officer and Senior Vice President, Digital at Mass General Brigham. He is also Associate Professor of Emergency Medicine at Harvard Medical School, and an attending emergency physician at Brigham and Women’s Hospital. He is an expert in health information technology and digital health design, development, and implementation. In his current role, he is responsible for technology solution delivery and support across all Mass General Brigham hospitals and practices. He works collaboratively to design and implement the future digital strategy such that front-line needs for new digital capabilities are met and emerging technologies are considered while support is delivered highly effectively and efficiently.

Landman received his medical degree from Rutgers-Robert Wood Johnson Medical School and trained in Emergency Medicine at UCLA Medical Center. He was a Robert Wood Johnson Foundation Clinical Scholar at Yale University, where he also received his Master of Health Sciences. He completed graduate degrees in Information Systems and Health Care Policy and Management at Carnegie Mellon University.

Adam Landman, MD, MS, MIS, MHS is Chief Information Officer and Senior Vice President, Digital at Mass General Brigham. He is also Associate Professor of Emergency Medicine at Harvard Medical School, and an attending emergency physician at Brigham and Women’s Hospital. He is an expert in health information technology and digital health design, development, and implementation. In his current role, he is responsible for technology solution delivery and support across all Mass General Brigham hospitals and practices. He works collaboratively to design and implement the future digital strategy such that front-line needs for new digital capabilities are met and emerging technologies are considered while support is delivered highly effectively and efficiently.

Landman received his medical degree from Rutgers-Robert Wood Johnson Medical School and trained in Emergency Medicine at UCLA Medical Center. He was a Robert Wood Johnson Foundation Clinical Scholar at Yale University, where he also received his Master of Health Sciences. He completed graduate degrees in Information Systems and Health Care Policy and Management at Carnegie Mellon University.

Q. Adam, tell us a little about the populations you serve at Mass General Brigham.

Adam: First, I want to address our name. You may know us as Partners Health care but now, we are Mass General Brigham. This new name more closely reflects the world-renowned hospitals that make up our system—Mass General Hospital and Brigham and Women’s Hospital—which are really the foundation and heart of our healthcare system. At a high level, the Mass General Brigham vision is to build the integrated academic health care system of the future in which we have patients at the center transforming care, improving outcomes, and expanding our impact locally, nationally, and globally.

Currently, we see about 1.8 million patients per year. We have 80,000 employees. Our inpatient capacity is >3200 inpatient beds. What is also unique about our system is our research enterprise. We really focus on performing breakthrough innovations and translating those innovations to the world. We have about $2 billion in sponsored research, which includes over 2700 clinical trials across our five academic medical centers—MGB Rigor, McLean Psychiatric Hospital, Mass Pioneer and Spaulding Rehabilitation. All of them encompass our academic mission and focus.

Q. What are some of the top priorities and digital aspects that you’re currently working on as CIO?

Adam: I speak today on behalf of an incredible team of colleagues that really enables us to do what we’re doing not just in digital, but also in health care delivery, overall. I want to acknowledge that we’re led by a new Chief Information and Digital Officer, Jane Moran, my new boss who’s really helped us with our strategic planning and prioritization, some of which I’ll share with you now.

Our priorities now center around experiences of our user groups. While this is something we have not thought about this way, traditionally, and it is a little new for us, I really think it’s the right strategy going forward. The four groups that we’re prioritizing are patients, providers, researchers, and employees. We’re putting together a strategy for each of these groups that focuses on meeting their needs regarding digital technology. I’ll just share two examples of that.

First, for our researchers, like other academic medical centers, we are focused on increasingly enhancing their access to the wealth of clinical data that we have and using modern cloud technologies and platforms so that they can use that data for approved research projects.

For our providers or our care teams, we have a lot of work going on to improve their experiences. One of our key projects is working on the in-basket experiences for our providers and patients. One of the best things about COVID was that we, like other health care organizations, saw a tremendous increase in the use of our patient portal. In fact, during the last two years, we’ve seen a doubling of the number of patients signed up for our portal and more of them actually engage with it. We absolutely want to encourage that, but we recognize that the system, the actual technology, and our workflows were not necessarily designed for the increase in message volume that we’re seeing.

I am working with colleagues across the organization on approaches to improve the in-basket experiences. What’s nice about our chosen approach is that we recognize that we really need a multidisciplinary team—technology experts, members from our digital teams, and colleagues that can focus on policy as well as workflow and care redesign. We’ve brought these worker groups from across these areas to collaborate on how we can change levers and improve the in-basket experience.

At a high level, some of the things we’ve done is worked on removing non-value adds in basket messages. So, we’re turning off all duplicate notifications or acceptance notifications that aren’t needed. We’ve also worked on the policy side to set expectations for how our portal should be used with specific emphasis on results, review, and response by the clinical care teams. Gradually we’re working on making changes which we hope will improve the care team experience.

Q. Can you share one or two top priorities regarding improving the patient experience?

Adam: I want to emphasize that while I gave the example of providers, we are focused on enhancing the experience for the entire care team. Even on the in-basket side, while there is a focus on providers, we’re also thinking about how to improve the front desk workflows and make that as efficient as possible.

With regard to the patient experience, I think of one example which will be similar to many organizations that are working on this—the digital front door. How do we make it easier for patients to interact with us and get access to our services electronically? That’s one of our major priorities and one of my colleagues is leading our efforts in that space.

Q. What are you hearing from your patients when it comes to the kind of digital experiences that they’re looking for?

Adam: Many of our patients have a lot of expectations from us. I can share a couple of the key things they want. First, a fast and convenient experience. They don’t want to have to call us, wait on hold for long periods of time, and then, be transferred to multiple different people to accomplish what they want. They want to be able to interact with us quickly and easily. So, that includes being able to schedule appointments quickly, check their test results, correspond with their care teams, and do virtual visits. Those are all components of functions that we are trying to make as easy as possible as part of our digital front door work.

Second, our patients are appropriately concerned about security and privacy. So, I think it’s essential that for everything we do with our patients, particularly from a technology perspective, we must ensure that it is as secure as possible and that everything possible be done to protect their privacy.

Third, equity. This is something that our system has made a very significant commitment to. We’ve launched a United Against Racism campaign, which really acknowledges and calls out that our system believes that racism is a public health issue. It impacts our patients, our workforce, and the communities we serve. We are acting as a system to dismantle systemic racism, and this has important implications in our digital work.

Just to give you a couple of examples, when we’re talking about digital technologies, particularly for patients, we want to make sure that all patients have access to these services, especially these new digital tools. We’re increasing access to interpreter services through the virtual interpreter services. If patients doing virtual visits don’t speak English, we bring interpreters into that encounter to help with patient communication.

Another example concerns our team of digital access coordinators. These are additional resources to help our patients enroll in our patient portal. They speak multiple languages, take time out to answer patients’ questions and help them not just with enrollment but also how to use the portal’s services. That’s how we’re addressing equity in our patient experience.

Q. How do you design solutions for a population that is as diverse as yours especially with regard to technology-enabled solutions? How do you ensure maximum coverage?

Adam: I’d say that I personally learned a lot about this during COVID because we recognized then that we needed technology to help us solve problems and design solutions around how we could make testing available to all our patients? How could we extend vaccination to them?

We also recognized if we used very sophisticated technologies, that could prevent some of our patients from accessing those services. As we think about our approaches, we bring in our experts from different backgrounds, so our team represents diversity, equity, and inclusion. Those team members are part of our solution and ensure that we consider all our patients’ needs. As we design solutions, the attempt is to enable as many patients as possible to take advantage of those services. For instance, we used quite a bit of text messaging. We found many of our patients, even our most vulnerable patients, had access to and in fact, liked interacting with us over text messaging. So, we use a lot of text messaging and web based tools. We have found them to be very, very successful.

We also found that we had a rather sizable population that didn’t have cell phones and that we only had landline phones for them. So, we used IVR tools with some additional AI capability to enable those patients to interact with an agent and even schedule appointments for vaccination directly over a landline phone.

We’ve baked into our solution process the need to ensure that our base technology solutions reach as many patients as possible. Where there are gaps, we address those with other solutions—sometimes, technology-based, and other times, just additional outreach and greater focus in those areas.

Q. What kind of technology, foundation or enablement do you need to have in place to be able to deliver on all these digital front doors solutions? How have you gone about setting up the foundational infrastructure for such enabling platforms?

Adam: We absolutely think in terms of platforms, and this is something that Jane Moran has helped shape. In an ideal world, we want to leverage our existing platforms as much as possible to meet needs. But we also recognize there are limitations to those platforms which is why we need to consider other solutions.

As we think about patient experience, of course, our electronic health record forms the core there. We absolutely leverage our electronic health record. However, there are limitations to what that platform can do. So, we are also investing in a customer relationship management platform to help supplement our electronic health record.

We’ve also invested in additional tools—chat bots that sit on top of our electronic health record and have added some of these capabilities to help improve interactions with patients. We are in the early stages of using some of these technologies, particularly the chat bots, and so we’re really learning how well they work, for which use cases, and for which patients. We will continue to iterate and improve on those as we go.

Q. You started with the EHR and that’s what other health systems do as well, but they can’t do everything. Do you have a strategy that involves other best in class players, standalone point solutions, enterprise class platforms, or will you build some things yourself? How do you approach these choices?

Adam: Here’s how we are starting to think about this. We’re formalizing a process which we’re calling an Enterprise Architecture Review that we’ll go through when there is a new technology need to really consider and determine which solution, we’ll use to solve that need. First, we’re going to look at our existing enterprise platforms which may include our electronic health record. We’re building out a CRM system as well so that would be considered, too. Our HR and Finance systems are also platforms we’re looking to first, to solve requests that are coming in.

Then, if those major platforms don’t solve the issue, we might look to an existing product that might be in use across our enterprise because if we’re already using it, maybe we can extend that. If it’s already being used for this specific use case in another part of our organization so, we could look to sort of leverage that tool further.

If there really is not a tool that we have or an existing platform that would work, that’s when we’d look to another solution in the market. Ideally, there’s a solution out there that we could just purchase and use.

In some cases, we don’t find a solution that we can purchase and use. That’s where we’d love to find partners who want to co-develop and work with us to shape their tool to meet our needs. If it meets our needs, it probably meets needs from other healthcare systems out there.

Finally, if we cannot find a partner and if there’s nothing out there on the market, that’s when we would consider actually building the software ourselves. We do that from time to time, but we really want to have a rational approach to when we’re using those specialized resources.

I will put a plug in here. We did just write a paper on this, and I can share it with you. But for our listeners, we recently published a paper with a colleague, Jayson Marwaha, who was our first author on this paper. This was published in Nature Digital Medicine, and it really describes how we look at bringing new digital innovations into our organization. It summarizes what I was just talking about, more articulately—our process to look at innovations, where, which platform we’re going to use, and which technology leads.

Q. Adam, there is a lot of digital health innovation out there and billions in venture capital money. It can be quite confusing and can be quite risky to place your bets on one or more of these solutions. How do you go about at a very high level? How do you make sure all of these solutions work well together?

Adam: I feel fortunate that I have the opportunity to do some of this digital innovation. For many years, I oversaw the Brigham Digital Innovation Hub. Now, I oversee a small team across the enterprise. Our Digital Health Innovation team has been making some investments in collaborating with early-stage startups to improve health care delivery.

Perhaps the most important first step is identifying the problems that you want to solve and ensuring that there’s not already a robust solution to it. If there is a robust solution, that will meet the needs, you want to try to make sure you’ve looked at that solution first. Working with an early-stage startup can be really rewarding but has a lot of risks to it as well. So, before you’re looking at the new startups, check for established solutions that may exist.

There are so many new, exciting challenges in healthcare for which we don’t have solutions. There are exciting newer technologies that maybe doing things faster, better, and cheaper that we absolutely want to pay attention to in this space. But to your point, we want to have a rubric and a new way of approaching it.

So, while this may sound like an antithesis for people who like to innovate, we are actually going to add, as some of our strategic work in this space, more process to how we look at our investments in early-stage innovation. That’s because we want to be really systematic about it and increase our chances of success especially as we work with emerging technologies. We are going to try to proactively identify where the problems that we want to try to solve, are.

Second, the next step is to not be as opportunistic but have a process we go through to really look at the landscape of startups, critically, and evaluate them. In essence, what many of us are used to —doing RFPs or RFI—this really goes through that process with rigor. So, we’re looking at the startups, trying to select the best partner, and then, collaborating closely with them.

We want to understand what their experience is like, both on the technology side and in health care. What’s their leadership experience? How well do we work together? When you work in this area, what we’re really trying to do is work together to learn from each other and pivot, to try to find the right solution. So, both organizations need to be aligned on what are the problems that we’re trying to solve and how we are going to adjust over time to do that.

You need to get the right team that’s willing to make those changes, in place. Those are some of the things that I look for as we evaluate early-stage companies to work with and I continue to think that this is a really important area for us.

I will just add that we also have a $30 million AI Digital Innovation Fund, and we are specifically designed to be strategic investor, so this is reserved for early-stage companies that we are working with in some capacity. We will make moderate-sized investments at the series A and B levels in these partners.

Q. What specific capabilities or competencies do you think an organization like MGB needs to keep in-house and build out as you work with this ecosystem of technology partners? How do you bring it all together?

Adam: That’s a question that we’re trying to figure out, and I suspect many across the country are trying to identify as well. One context I’ll share is that the unique components of health care are that we work in a mission-critical organization. That’s 24*7*365. So, the technologies that we’re deploying have to work. We understand there will be some failures—some plans, some players—and when they happen, we have to be able to respond very, very quickly. Our traditional approach has been to in-source all of our expertise—our infrastructure expertise, our service desk, and our platforms really have been in-source.

We are like many organizations right now under significant cost pressures. So, we are starting to think about where we outsource. The questions that we’re trying to address, and I don’t have the answers yet, but I’ll welcome them from there, from you or from others that maybe listening is we can’t compromise on the quality and the service delivery aspect that we’re providing. But we’d love to be able to find ways of being more efficient in how we deliver those services. We’re still trying to identify if there are opportunities to outsource, where they are, or where they might be.

Q. What about the data and analytics infrastructure within Mass General? What kind of infrastructure are you building? What are those competencies focused on?

Adam: Like other organizations, we are also investing in our data infrastructure and more importantly, in moving our data infrastructure to the cloud. We have, for many years, had a very successful data lake and we’re now looking at what would it take to put that data lake into the cloud, to make sure all of our data is available, and ideally increase the amount of real-time data that are available. That’ll make it easier for internal users to access all of that data and use it to improve health care delivery. There’s infrastructure work going on to do that.

What I will share with you is, maybe a successful program that we’re leveraging the data from these environments via our Active Asset Management Program. This started at Brigham and Women’s Hospital a number of years ago. The concept around the program is how do we make efficient? For example, enabling efficient use of very high-cost fixed assets like operating rooms (OR). This program is really driven by operational leaders, but that requires data and data analytics to power it. So, our analytics team at the Brigham, led by Rob Horsford, pulled data from our electronic health record to start to show the utilization and you can imagine they broke that data down by day, time, service, and worked with the managerial leaders, including the provider leaders, to iteratively understand what data they needed to make management decisions. They got feedback on that and eventually created formal dashboards using Tableau and other tools to be able to display this data to the managers and hospital leaders, convene the right leadership stakeholders on a regular basis to review the data and more importantly, make management decisions based on this data so they could change staffing, reassign or blocks etc. timely.

Using the combination of the available data and management intervention, we were able to create more access for patients, which was great because they were waiting to have their procedures done.

There was also a revenue opportunity for the hospital. We’re now replicating this data and management system across Mass General Brigham and looking to use our new cloud-based data infrastructure as we scale this.

Q. What’s your advice or a best practice for your peers in the industry, especially smaller health systems that may not have the scale and the resources to do the kind of things that you’re doing? Likewise, what’s your advice for innovative and young technology solution providers that want to be a part of your journey?

Adam: I think the piece of advice that I will share for health systems and tech vendors is that we need to be agile. I really appreciated this during COVID, and I know there are a lot of definitions of agile out there, including that very specific technology initiative. But I think most health care organizations, including mine, when we approach technology, we want the technology solution to be perfect. So, we’d often spend months, if not years, planning projects, getting ready for the big implementation and then, implementing. Of course, because we’re talking about patient lives and patient safety, we absolutely still need to pay really close attention to the details and need to plan these initiatives carefully.

What I have found and what we proved during COVID is that we can work in a different way where we break projects down into smaller components. We roll these out more quickly, even on the order of days or weeks and follow that very closely. We check how that technology implementation is going and continue to tweak it over time, sometimes making changes every day in order to stabilize the system or correct issues that may have come up.

What I found during COVID is, we built phenomenal relationships with our operational partners. We were talking multiple times a day, working very closely with them, and delivering technology at an extraordinary pace. There were some unique aspects of COVID as well so, we focused all of our digital and operational resources on it and used a very different decision-making governance framework where we had incident command.

What I’m now seeing is that we’re going back to our old ways of working. I hope that I’m trying very hard to find somewhere in the middle, where we can be a little bit more agile and nimble and have these close relationships with our operational and technology colleagues and vendors so that we can move faster.

I think what we’re starting to see is that our health systems have a number of challenges. They are only coming faster. And technology is increasingly part of the solution for these, so we need to find ways of being responsive to all the demands coming toward us and continue to innovate. I think that this is kind of a huge opportunity for us as we think about how we work going forward.

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.

When you develop solutions for the most vulnerable, you make it work for everyone.

Season 4: Episode #130

Podcast with Anika Gardenhire, Chief Digital Officer, Centene Corporation

"When you develop solutions for the most vulnerable, you make it work for everyone."

paddy Hosted by Paddy Padmanabhan
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Anika Gardenhire is the Chief Digital Officer of Centene Corporation – the country’s largest managed Medicaid services organization. In this episode, she talks about why it is important that their most vulnerable populations “show up” in their digital transformation programs. She highlights the importance of innovation for underserved and vulnerable populations and urges the technology vendor community to focus on building solutions for the most vulnerable populations.

Anika discusses Centene’s digital priorities and how they cater to their population’s specific needs by addressing digital literacy, closing the gap of digital divide, and supporting them with digital tools and technologies. Take a listen.

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Show Notes

02:13 How do you drive your digital priorities being a predominantly Medicaid-focused organization?
05:30Give us a couple of examples of programs that you’ve launched for your population.
08:50 You're partnering with healthcare providers to deliver the care that these vulnerable populations need. Can you share some examples of what that collaboration looks like?
11:21 Your populations may be living in areas that are bandwidth deserts or transportation deserts, or food deserts. How do you successfully wrap all of that?
14:18 Can you elaborate on the innovation targeted specifically at your population that you’d like to see from the technology vendor community?
16:30What about data and analytics? How are you deploying these capabilities to serve your populations?
19:11 Do you agree that working under constraints makes you more innovative? What challenges do you face in your role as the CDO when meeting your objectives?
22:18 What’s your one piece of advice for your peers in the industry who are on similar journeys or operating in a resource-constrained environment?

About our guest

Anika Gardenhire, RN, BSN, MMCI serves as Chief Digital Officer for Centene Corporation, a diversified healthcare enterprise providing a portfolio of government-sponsored healthcare programs focusing on under-insured and uninsured individuals to more than 26 million Americans.

In this role, Ms. Gardenhire is responsible for leading the Digital Solutions and Products Organization, where she oversees business capabilities that are enabled by technology. At the same time, she focuses on servicing customers, while driving the highest possible value from the company’s comprehensive portfolio of digital solutions and products. Most recently, Ms. Gardenhire served as Regional Vice President, Digital and Clinical Systems for Centene. She held responsibility for leading teams that partner with clinical and business leaders to streamline how Centene allocates resources, achieves goals, and operates more efficiently.

Ms. Gardenhire initially joined Centene from Intermountain Healthcare, where she served as Assistant Vice President (AVP) of Digital Transformation. She led and served on several governance councils, including intelligent automation and data governance. Ms. Gardenhire also led several impactful initiatives such as unified communication and application rationalization.

A strategic thinker and avid learner, Ms. Gardenhire listens, understands, and communicates the impact of clinical and business workflow on proper use and optimization of technologies to enhance the delivery of patient and member care. Previously, she worked as a Principal with Leidos and Senior Manager with Deloitte, serving as an advisor to executives across many prestigious institutions, including The Mayo Clinic and members of the Ministry of Health in British Columbia, Canada. Ms. Gardenhire’s career has led her to hold various positions as an operations leader and implementer of clinical and IT programs. In addition, she holds significant experience working as a change agent regarding how clinicians, information technology professionals, and interdisciplinary care teams integrate and utilize information systems to augment patient care.

Ms. Gardenhire graduated from the University of South Carolina with a Bachelor of Arts degree in nursing and from Duke University with her Master’s degree in Management and Clinical Informatics. She, her husband, Aaron, and their 100-pound bull mastiff, Titan, reside in Weddington, NC right outside of Charlotte.

Anika Gardenhire, RN, BSN, MMCI serves as Chief Digital Officer for Centene Corporation, a diversified healthcare enterprise providing a portfolio of government-sponsored healthcare programs focusing on under-insured and uninsured individuals to more than 26 million Americans.

In this role, Ms. Gardenhire is responsible for leading the Digital Solutions and Products Organization, where she oversees business capabilities that are enabled by technology. At the same time, she focuses on servicing customers, while driving the highest possible value from the company’s comprehensive portfolio of digital solutions and products.

Most recently, Ms. Gardenhire served as Regional Vice President, Digital and Clinical Systems for Centene. She held responsibility for leading teams that partner with clinical and business leaders to streamline how Centene allocates resources, achieves goals, and operates more efficiently.

Ms. Gardenhire initially joined Centene from Intermountain Healthcare, where she served as Assistant Vice President (AVP) of Digital Transformation. She led and served on several governance councils, including intelligent automation and data governance. Ms. Gardenhire also led several impactful initiatives such as unified communication and application rationalization.

A strategic thinker and avid learner, Ms. Gardenhire listens, understands, and communicates the impact of clinical and business workflow on proper use and optimization of technologies to enhance the delivery of patient and member care. Previously, she worked as a Principal with Leidos and Senior Manager with Deloitte, serving as an advisor to executives across many prestigious institutions, including The Mayo Clinic and members of the Ministry of Health in British Columbia, Canada. Ms. Gardenhire’s career has led her to hold various positions as an operations leader and implementer of clinical and IT programs. In addition, she holds significant experience working as a change agent regarding how clinicians, information technology professionals, and interdisciplinary care teams integrate and utilize information systems to augment patient care.

Ms. Gardenhire graduated from the University of South Carolina with a Bachelor of Arts degree in nursing and from Duke University with her Master’s degree in Management and Clinical Informatics. She, her husband, Aaron, and their 100-pound bull mastiff, Titan, reside in Weddington, NC right outside of Charlotte.

Q. Anika, tell us a bit about your background. What does your role at Centene entail?

Anika: I’m a clinician by training—a registered nurse. I transitioned into Clinical Informatics several years ago and then moved into roles that are progressively more at the intersection of business and technology. I work in that function of being an intermediator, translator, and facilitator, and bring it together. I’ve been really fortunate to join Centene as the Chief Digital Officer responsible for our digital solutions and products, and really driving us toward an even more data-driven organization.

I’ve enjoyed working with the senior leadership team and helped them align around objectives and key results, and how to support the organization holistically by putting our collective efforts toward making the business more efficient and providing ongoing consistent value to our customers. It’s a fun job. It’s different every day and absolutely fulfilling and humbling to serve the membership that we serve.

Q. Centene is the largest managed Medicaid provider in the country. How does being a predominantly Medicaid-focused organization drive digital priorities?

Anika: There are a couple of things. One is really thinking about how we identify our customer segments as a large managed Medicaid organization. Also, we’re thinking about the fact that while we’re so positioned, we better product—a Medicare product—so, how are we supporting our customers?

Holistically, we serve the most vulnerable populations and typically, they have very specific needs from a digital perspective. We think about how to look at digital literacy given the endpoint devices that our applications might be on which might look different. How do we support and close the digital divide? What are the specific ways to support our membership and how can we provide digital tools and technologies from a rural health perspective?

A couple of things for us as we develop our personas to build digital tools which those of you in this space will know, concerns how much time you spend doing that. We think specifically about our Medicaid population and try to ensure that there are situations where they’re represented. Our representation really shows up in the personas that we’re building.

We also think differently about how we undertake customer research. We know that our membership, specifically, isn’t always those that you find responding to surveys. So, how do you build out competency around ethnography among other ways to really understand that membership becomes really important in the work that we’re doing?

One of the things that is really our team’s responsibility, and the responsibility specifically for Centene, is to ensure that our membership including, our very vulnerable populations, show up in digitally transformed health care. Often, we’re developing tools to be very transparent for middle America. It’s not that we shouldn’t necessarily do that, but this ensures that for all of us who really need those tools, we are thinking very specifically about how to also provide access to them in ways that meet people where they are.

Q. Can you give us a couple of examples of programs that you’ve launched based on all the research and the background of your populations?

Anika: A couple of things would be the work that we’ve done to support, for example, digital care management. When we think about digital care management and how we really support our population specifically, question arises of how do we think about what’s the minimum necessary to qualify for digital care management? How do you onboard that membership specifically? How do you, assess the level of digital literacy to ensure that you’re able to provide those services in a way that’s specific and unique to that population? How do you support vendors who might not have really thought about this membership first, and help adapt their products and solutions to provide the best, highest possible value to this membership, uniquely? That’s one of the things that we think about.

Then, you start thinking about – What are some of the things actually regulatory wise that we are doing, in order to really support our membership, that might look different? How does an organization like ours respond to the “no surprises, exit and transparency rules?” When we think about trying to specifically explain benefits or other types of tools and services to a membership that’s not been catered to historically, what does that need to look like?

When I talk about endpoint devices, it comes down to—How do I need to think about how heavy that application is to ensure that it will be valuable across all the endpoint devices that it might show up on for our membership?

These are two of the programs that I think we are laser focused on and that are really helping us ensure that we are accounting for the work we’re doing specifically for our membership. I also want to be honest that it’s part of the reason that I love what I get to do at Centene. Very specifically, the reality is that when you develop for the most vulnerable, you make it work for everyone. You really have the opportunity to devise simplicity and create consistency in the experience that will work for the whole because you’ve actually thought about those who have the most needs. It really creates opportunities for us to make an impact in a truly exponential way because we’ve designed solutions for those who have really specific needs or for the ways that they’re going to use them.

Q. When it comes to care management, you’re partnering with healthcare providers to deliver the care that these vulnerable populations need. What does that collaboration look like? Can you share some examples?

Anika: One of the things that if you’ve heard Sarah London our CEO talk, is that she’s been very specific about how we will partner with provider groups—FQHCs. How do you wrap services and support around the places that our members very specifically are going to receive care? There are a couple of things.

One, we think about those who are providing community services and how we can support them from a data and data integration perspective. How do we support our federal federally qualified health centers from a data perspective? How do we think about the future of risk? How do we support those value-based care models for our most vulnerable provider groups separately from FQs? How do we also support those who are really thinking about how to be comfortable taking risks? How do we support them in understanding contract arrangements?

We know that, when it comes to social determinants and the risks that we see in differences in care around race and ethnicity, if we can keep those providers providing care and support them in the communities that they serve to offer better outcomes for those populations, then, we must think in very specific ways about how to provide such a partnership.

It’s not only about how to provide digital solutions and products to them, but also how to support them in thinking about managing panels and taking on risk. Are we supporting them to supply the right data and digital tools at the point of care to help them continue to really impact outcomes for that membership?

The organization is doing a really good job of that. We are laser focused on continuing to build our capabilities that will explicitly support the very close relationship between the provider and the member/patient/consumer, however you want to title them moving forward.

Q. These populations have a bundle of needs, but they may be living in areas which are bandwidth deserts or transportation deserts or food deserts. How do you successfully wrap all of that?

Anika: We have an incredible number of value-added benefits around transportation and food services. I would call out, for example, programs in our North Carolina Health Plan where we have forums where we encourage members to offer input into what some of the most important things are and how we provide differentiated services to the community.

It’s also crucial that when we think about those types of services, we understand the member’s perspective about what’s really most important to them. This is so that they can really get it and leverage the opportunity to provide that type of input. So, there are a couple of things.

One, it’s really about understanding what’s available from a community services perspective. Is it something that we need to provide directly? Is there an opportunity to support a community-based service that’s already in existence but may actually just need some lift?

When it comes to how we provide some of those additional benefits around transportation, food, and/or partnerships with companies like Lyft, then, that’s a part of our entire benefit model. It may span, for instance, supporting transportation partnerships with being able to provide healthy food services or, being able to send out a food truck to a community event to provide for more gatherings and/or quite frankly, just combat loneliness. That’s really the value that we bring as a managed care organization where the care component is really the most important.

The work that we do and the relationships that we build with our members revolves around really understanding how we engage them and involve them in their care. That is the crux of what we’re trying to do. Our medical director team, our population health and clinical operations teams, and the role that we play from a digital perspective not only support our members and providers but all those that are involved in providing that care.

Our members are really important and that’s why when we think about our customer/consumer/provider, we also think of ensuring that we understand the care manager, the utilization management nurse, the pharmacist, and others that are supporting them. We work at how we are supporting those customers who surround them as well.

Q. The third leg of the stool concerns the technology vendor community that’s coming up with the innovation and the solutions. Can you elaborate on the innovation targeted specifically at your population that you’d like to see from the technology vendor community?

Anika: When we look at how we think about consumer research, innovating, and how we’re developing our tools and services, we try to ensure that we have a representative population. We also try to ensure that you are testing those solutions across the spectrum of healthcare and thinking about it from a wellness and care delivery perspective. It’s equally important that you test it in a rural setting, with an ethnically representative population for understanding youth and language changes among others. That’s incredibly important.

One of the greatest opportunities we have from a digital perspective, is to start to self-govern, for lack of a better term, and really think about the impact that we have on people. This is especially for those of us who are blessed to work in the health care space. When I think about the impact that we have on people, that’s as significant as perhaps big pharma and so, I think about the amount of rigor that it really takes to ensure that we are doing no harm.

We have a very specific responsibility to ensure that we are thinking about digital ethics, research, rigor, and the representative populations in the solutions that we’re developing. This ensures we’re able to provide access to care for digital health and to everyone who needs and should have it.

Q. What about data and analytics? Apixio is one of your portfolio companies now, so, how are you deploying all those capabilities to serve your populations?

Anika: When we think about data, Big Data, contextual data, Artificial Intelligence, and Machine Learning, it’s such an important part of the work that we do, today. It’s an incredible part of what we’ll continue to do. It will help us ensure that we’re doing our best to supply things like a next best action to a care manager and undertake interventions that are most highly aligned with the most important benefits to provide to a particular population. Now, that maybe by geography or perhaps a group which has another type of similarity. That’s where data helps our understanding.

I think there is a “know me” component around data that is so important. But when we think about consistency and how we supply the entirety of the team that is going to surround the individual at the center, we must make sure that they know the things that they need to know at the time that they need to know it. When I think about the data story, it’s really the ability of being able to provide the right data at the right time for the right appropriate action for the individual. The action component for the individual is most important whether we’re asking the consumer or a member to do it themselves or asking a member of their “care team” to provide. It’s understanding that action and the outcome that that action had for the member and then, being able to supply the right next suggestion, that’s really the most critical component of what we have to do.

Q. Do you agree that working under constraints makes you more innovative? What are the challenges you face in your role as CDO when meeting your objectives?

Anika: I am a genuine believer that innovation is born out of friction. So, necessity without question breeds innovation. There is absolute necessity to innovate in the face of scarcity for when you have scarce resources, you are always thinking about how to do more with less. How do you do your best with what you have? That is a constant focus. It creates what is a great responsibility not just around fiscal responsibilities but also in ensuring that we are helping get the right resources to those most in need. That is absolutely one of the wonderful opportunities that we have. To your point, one of the pretty significant challenges is really an opportunity to rise to the occasion. It’s an opportunity again to serve the entirety of our patient populations using those innovative solutions.

When I think about sort of what constraints it might put on me specifically, or the team that I have the great privilege of serving, it’s really about prioritization and focus. When you think about trying to innovate, there is often so much that you want to do and so many things that you could do.

I often say most Chief Digital Officers want to build flying cars. I want to build flying cars too. It’s a natural thing for many of us, but, even more importantly, I want to ensure that we have a tarmac to take-off from. We have solid footing, rules, and an understanding so that when we get to the air, everybody is safe and comfortable. It does the thing that that flying car is supposed to do—get us there faster, safer, and better.

Making sure that those foundational things are in place is important. It gives me an opportunity to really think about what those foundational things are and how important they are to have solidified in concrete. Then, we can think about the additional things we really want to provide and the impact and value they’re going to have on the health care continuum for that membership. Finally, we can create laser focus on executing in the best possible way for those very specific things and deliver that value.

Q. If there’s one thing that you’d like to leave behind for your peers in the industry who are on similar journeys or operating in a resource constrained environment, what’s your advice going to be?

Anika: I think my advice will be—make sure that your digital transformation strategy, your digital strategy, and your technology strategy are centered around people, especially for those of you in healthcare. This is a very, very human industry so, I think of digital transformation very specifically. We are doing something tomorrow that’s different than what we did today because we created a thing. It’s having real, fundamental, important impact and delivering real significant value to people. We are driving through the change that we need humans to make to take best advantage of it. So, again, staying laser focused on ensuring that you are bringing people along your journey is the piece of advice that I will give.

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.

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

Season 4: Episode #129

Podcast with Denise Basow, MD, SVP and Chief Digital Officer, Ochsner Health

"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"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

Dr. Denise Basow, a primary care physician by training, is the Chief Digital Officer of Ochsner Health – a health system that predominantly serves Medicaid populations in a risk-based payment model. She talks about how they’re using digital programs to drive improved healthcare outcomes and reduce care costs.

In this episode, Dr. Basow discusses their telemedicine capabilities, which include digital medicine technologies, remote patient management, digital tools to drive innovation and transformation, and digital coaching programs to drive patient engagement and outcomes. Take a listen.

Our Podcast Partners:

Show Notes

02:50 What kind of population do you serve, and how does that inform your digital priorities?
06:01What building blocks do you work with as you approach your population's digital needs?
08:14 What kind of programs have made an impact for Ochsner?
12:30 Are there any learnings you'd like to share with listeners working with similar populations? How do you get your patients to embrace the technology?
15:36 How do you make your technology selection choices – build versus buy? Do you start with the EHR first or best-in-class?
21:38 Can you share anything about access-related solutions where you're driving engagement through digital tools and technologies?
24:43 What does Ochsner’s governance model and strategy look like?
28:12 Can you share some of the best practices or learnings with your peers in the industry, especially those who are addressing similar populations and maybe in earlier stages of their digital journeys?

About our guest

Dr. Denise Basow joined the Ochsner Health Executive Team in January 2022 as the first Chief Digital Officer, with a mission to scale digital innovations that improve quality, engage patients, and enhance the healthcare provider experience. She is responsible for innovation Ochsner, a leader in digital healthcare solution development, virtual health and telemedicine, and the digital health business unit, which deploys remote patient management solutions focused on chronic diseases. These solutions are deployed within the Ochsner Health System and commercialized nationally.

Prior to joining Ochsner’s team, Dr. Basow had a 25-year career with global information, software and professional services leader Wolters Kluwer and healthcare start-up UpToDate, where she leveraged innovation and technology to improve the quality of healthcare. She joined UpToDate as a start-up in 1996 and served as CEO for 14 years, including the formation of a larger solutions business, Clinical Effectiveness, that expanded the mission beyond clinical decision support to include patient engagement solutions. At the time of her departure, Clinical Effectiveness served more than 2 million physicians globally and tens of millions of patients.

Dr. Basow received her undergraduate degree in Chemistry from Duke University and her medical degree from Baylor College of Medicine. She completed her residency at Johns Hopkins University and practiced internal medicine for several years before joining UpToDate.

Denise-Basow,-MD-profile-dektop

Dr. Denise Basow joined the Ochsner Health Executive Team in January 2022 as the first Chief Digital Officer, with a mission to scale digital innovations that improve quality, engage patients, and enhance the healthcare provider experience. She is responsible for innovation Ochsner, a leader in digital healthcare solution development, virtual health and telemedicine, and the digital health business unit, which deploys remote patient management solutions focused on chronic diseases. These solutions are deployed within the Ochsner Health System and commercialized nationally.

Prior to joining Ochsner’s team, Dr. Basow had a 25-year career with global information, software and professional services leader Wolters Kluwer and healthcare start-up UpToDate, where she leveraged innovation and technology to improve the quality of healthcare. She joined UpToDate as a start-up in 1996 and served as CEO for 14 years, including the formation of a larger solutions business, Clinical Effectiveness, that expanded the mission beyond clinical decision support to include patient engagement solutions. At the time of her departure, Clinical Effectiveness served more than 2 million physicians globally and tens of millions of patients.

Dr. Basow received her undergraduate degree in Chemistry from Duke University and her medical degree from Baylor College of Medicine. She completed her residency at Johns Hopkins University and practiced internal medicine for several years before joining UpToDate.


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. 

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.

We want to build a data set that connects life science and healthcare organizations into one learning community

Season 4: Episode #128

Podcast with Terry Myerson, Chief Executive Officer, Truveta

"We want to build a data set that connects life science and healthcare organizations into one learning community"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

Terry Myerson leads a very interesting organization – Truveta – that’s trying to aggregate healthcare data from health systems across the country in a de-identified form. They then combine this data with other sources to generate insights that drive clinical research and outcomes and develop new therapies and molecules.

In this episode, Terry discusses Truveta’s value proposition for health systems and life sciences organizations, their data sets to generate insights and the technological challenges in bringing the data sets together. We also touch on a variety of other topics, including the digital health startup landscape. Take a listen.

Our Podcast Partners:

Show Notes

00:29 What’s the market need that Truveta is trying to address?
05:48How many health systems are members of Truveta’s consortium? What do they get out of it?
07:10 What kind of data do you gather from the results? Is there any other data that you bring into the Truveta platform as part of your insights and analysis?
08:55 Can you talk about the types of insights you have given back to your members? Tell us about some of the use cases you've been able to generate using this data set.
11:53 How do you protect the privacy of the data? Are there any special precautions that you take to ensure this?
13:14 You're not selling the data, but you are selling insights generated from the analysis of the data --- is that correct?
15:10 What’s been challenging from a technology standpoint in bringing all these datasets together from across the world's healthcare organizations?
20:20 What do you see as the current moment in digital health funding landscape?
21:44 What's your advice to a startup founder who wants to get into digital health today?

About our guest

Terry Myerson is the Chief Executive Officer of Truveta. A leader for teams responsible for some of the world’s most popular technology platforms, Terry Myerson enjoyed a 21-year career at Microsoft. As Executive Vice President, Terry led the development of Windows, Surface, Xbox, and the early days of Office 365. Serving on the Senior Leadership Team, Terry played a pivotal role in developing the strategy for Microsoft alongside CEO Satya Nadella. Terry excelled at managing large teams at scale, tackling complex software challenges, and driving growth in partnership with the technology ecosystem.

After leaving Microsoft in 2018, Terry joined the Madrona Venture Group and the Carlyle Group as an advisor to their investment teams and portfolio companies. He enjoys learning about new technology, particularly at the intersection of data and life sciences, and helping new companies succeed. He continues with both firms today as an advisor.

An entrepreneur at heart, prior to Microsoft Terry cofounded Intersé, one of the earliest internet companies, which Microsoft acquired in 1997.

Terry is a graduate of Duke University and a current member of the Duke Engineering Board of Visitors. He also serves as a member of the Board of Trustees for the Seattle Foundation.

Terry Myerson is the Chief Executive Officer of Truveta. A leader for teams responsible for some of the world’s most popular technology platforms, Terry Myerson enjoyed a 21-year career at Microsoft. As Executive Vice President, Terry led the development of Windows, Surface, Xbox, and the early days of Office 365. Serving on the Senior Leadership Team, Terry played a pivotal role in developing the strategy for Microsoft alongside CEO Satya Nadella. Terry excelled at managing large teams at scale, tackling complex software challenges, and driving growth in partnership with the technology ecosystem.

After leaving Microsoft in 2018, Terry joined the Madrona Venture Group and the Carlyle Group as an advisor to their investment teams and portfolio companies. He enjoys learning about new technology, particularly at the intersection of data and life sciences, and helping new companies succeed. He continues with both firms today as an advisor.

An entrepreneur at heart, prior to Microsoft Terry cofounded Intersé, one of the earliest internet companies, which Microsoft acquired in 1997.

Terry is a graduate of Duke University and a current member of the Duke Engineering Board of Visitors. He also serves as a member of the Board of Trustees for the Seattle Foundation.

Q. Terry, how did Truveta come about? What’s the market need that you are trying to address?

Terry: Truveta is a company with a vision that we can save lives with data. Using data, we can help researchers find cures faster, empower every clinician to be an expert, and help families make the most informed decisions about their care. That’s our vision and mission.

What do we offer? At the end of the day, we’re raising for any medical product, the most complete, timely, and highest quality data to understand the benefits and the risks of how that product should be or how the procedure or device should be used in a health care environment. There’s always an origin story here about how the company came to be and this one, I think, is just so interesting and eventful.

B.J. Moore, who’s been on the podcast, and I were colleagues at Microsoft two years ago. Since then, he’s moved to Providence. I’d left to join a venture capital firm. I had also become fascinated with the intersection of data sciences and life sciences. B.J. and I stayed in touch and when the pandemic started, he introduced me to this project where, there’s this effort inside the health system to try and understand what’s going on with this pandemic. The health system didn’t have the tools in the early stages of the pandemic to ask and answer questions about whether they should treat symptomatic patients with Dexamethasone or Remdesivir. We’re hearing both work well, but which one should be used? Who should be intubated for how long? There were just no tools to ask or answer those questions.

Building on that, Providence, Northwell and Trinity Health Care, three organizations that didn’t know each other so well at that time, tried to collaborate, ask, and answer questions like that. But they had no regulatory or technical framework or legal frameworks to work together, share data, ask, and even answer questions. We could build, learn from each other, and compare results but there was no ability to do that. Then, we had a life science company, a pharmaceutical company, which was selling these drugs and trying to learn they had no ability to learn off of the same data.

So, this idea that we could build this unprecedented data set that would connect life science and health care organizations into one learning community, that would really drive learning, and help us find those cures faster, figure out the safety, and effectiveness of these various medical products or procedures happened to be one of those that felt like just this incredible opportunity for the health care systems to come together and build something new for the world.

Q. Can you tell us a bit about your background? You did spend a long time at Microsoft and B.J. was your friend. So, how did you get here?

Terry: I spent almost 22 years at Microsoft. For the last decade, I was leading Windows Surface and Xbox. B.J. and I left Microsoft in 2018 and it was the pandemic, in 2020, that reconnected us.

When I got connected to this project in Providence later, I realized that Truveta was an idea that actually started in 2018. It revolved around how health care systems could put their data together to create a data set which they could learn from. It was white papers and PowerPoints. It was a great idea but it took a pandemic for us to really galvanize that and turn it into a company. Without the pandemic, it was just my awareness of the issue or the lack of this.

When you first get exposed to Truveta as an idea, you go, “How could this not exist already? How could it be that we don’t have a data set representative the full diversity of our country? How’s it that we can study any drug disease or device? How could this not exist?”

I didn’t know it didn’t exist. When I got exposure to the fact that it didn’t exist and there was a coalition of willing health systems that wanted it to exist, it just felt like the most meaningful thing. I could spend the rest of my career working on it.

Q. With regard to the Truveta System, how many health systems are members of the consortium? What do they get out of it?

Terry: Truveta started with four health systems in September, 2020. We announced 14 in February, 2021, and now, there are more than 20 large, leading health systems across the United States. More will be announced soon.

I think it’s just amazing how they’ve come together. They’re motivated by participating in this learning community for health, so, they can ask and answer questions, get data representative of the United States, and share those studies with each other while building on each other’s work. That access they get is going to help them take better care of patients.

We’re taking their data as normalized, structured, and de-identified data. They get access to all this for use in their health care operations and we pay them. So, they make money when their data is used by others in their research and they are compensated.

Q. What kind of data do you gather from results? Is there any other data that you bring into the Truveta platform as part of your insights and analysis?

Terry: The healthcare organizations send us medical records which are fully de-identified and validated by a third-party. Those de-identified medical records are being made available for research. Today, we have a partnership with LexisNexis, which is giving us three other important data sets to bring into the corpus.

Before that, there was a token which allowed us to link medical records in the de-identified space across health systems. It’s all coming together into one longitudinal medical record.

They’re also giving us the fact of death. Only one-third of people die inside a health system and so, LexisNexis has its Death Registry up-to-date, daily. Through it, we’re actually seeing if people die on the date they die. Being able to assess death as an outcome for research is very important when without the state and health systems, one doesn’t know if you died.

The third thing is, they’re giving us the largest claims data set in the country. We think about it as we get these deep medical records from all of our 20 + health systems and then, we also get to link it with the medical bills or the claims records.

Last but not the least, we get from LexisNexis the socioeconomic data. This is incredibly vast and includes the social determinants of health. All of that’s coming together as are insights about it. You got the 20 + health systems, fact of that token socioeconomic and mortality data. I maybe forgetting something, but it’s also together in the group of longitudinal records they identified for research. It’s a lot of data.

Q. Can you talk about one or two types of insights that you’re getting back to your members? Tell us a bit about some of the use cases you’ve been able to generate using this data set.

Terry: We talked about COVID and in fact, one of the collaborations we’ve announced since then which we’re quite excited about is Pfizer using the Truveta data set to assess their vaccines and therapeutics in the United States. This company has led the innovation response to COVID globally, and no company responded like Pfizer, one might argue. The fact that they would be using our data, is exciting. It’s terrific and I’m honored.

The other research that has been published is on Colonoscopy screenings in response to Chadwick Boseman’s death. Being African-American and he died of Colon cancer so there was some research done on Colon cancer screenings in the African-American community.

Also, there was some work done in response to the baby formula shortage actually going on in the country trying to understand if there were infant hospitalizations or other infant health issues as a result of the baby formula shortage. This idea that we have this dataset representative of our country and the ability to ask and answer questions quickly is new.

We’re having interesting use cases popping up everywhere but at the end of the day, this is our customers’ research. There’s a research project going on in Savannah, but I’m not talking about what they’re using. But Providence is using our data, Pfizer is using our data or even unnamed customers– they’re using our platform for their investigations and we do expect them to publish quite a bit here in the next year. But it’s their research, not our research to talk about.

Q. How do you protect the privacy of the data? Are there any special precautions that you take to ensure this?

Terry: Security and privacy are just critical. They’re foundational to the company. For full details, we actually have white papers—-a white paper on Security and a white paper on Privacy—on our website, which I would encourage anyone who really wants a double click on these to go get them.

We have the HIPAA too, which is our healthcare privacy law in the United States which sets in place two standards for de-identification—one called Safe Harbor, where you lose geography and timestamp information and expert de-identification.

Truveta follows the expert de-identification model so, we have expert determiners that assess all of our systems. The white papers have some great information so, I would encourage anyone who wants to read more to go there.

Q. The monetization model for Truveta is derived from the use of the data, not necessarily the data itself. You’re not selling the data, but you are selling insights generated from the analysis of the data — is that correct?

Terry: I’m not sure. The health systems themselves have access to study the data for their own research. But life science firms that are engaged with it right now are subscribing to study a disease or set of diseases and so on. We tell them to come and analyze the data, look for safety effectiveness or health equity issues in COVID or Multiple Sclerosis or heart disease. You’re subscribing to a disease so, you can ask and answer as many questions as you want during the time of your subscription.

Q. Don’t they get to take a copy of the de-identified data stack into their environment and use it for other purposes such as marketing campaigns etc.? I assume there are permissible uses in there.

Terry: I think there’s two different questions that you might ask there. There’s the data which is to be used for health care research, and not for advertising. Using the data for advertising is explicitly not a permissible use.

But there are circumstances in which they will need to take data out if you’re making a regulatory filing. If you are, there are just some scenarios where we do allow them to extract patient cohorts. Therefore, the concept of the subscription.

Q. Let’s talk about the tech stack for Truveta. It is built on Microsoft Azure as a cloud platform. What are the other big components of the tech stack? What’s been challenging from a technology standpoint in bringing all these datasets together from across the world’s healthcare organizations?

Terry: We’ve talked about two of the biggest challenges—Security and Privacy.

The third biggest challenge is Normalization and it’s not even the fact that it comes from diverse health care systems. Different conditions record outcomes, side effects, recommendations in a different language, often in their vernacular — that’s probably influenced by where they were trained.

So, you have these vast amounts of clinical notes that have so much insight on patient care and that normalization of unstructured data into an ontology of structured terms that can be used for analysis that the AI which drives that process, which actually is another white paper on our website, is a data quality white paper, which goes through that whole process of how we take all that unstructured data and turn it into a high quality data stream for analytics.

So, security, privacy, and normalization are the challenges and then there’s scale. High volumes of data is one thing, and Providence is an incredible system but B.J.’s also got a number of scale challenges.

When you add Providence, Trinity, Northwell, Tenet and Baptiste you know it’s a large lot and that’s the Truveta data challenge— far larger than any one health system anywhere in the world.

Q. To get a sense of the scale and the magnitude of how large the data set is, are we talking about what percentage of the U.S. population it covers among these top 20?

Terry: When you include the LexisNexis claims data, which fills in the gaps and when you’re looking at 100% of adult Americans, then, you know, for Non adults I wouldn’t know the number.

Q. There’s a lot of similar efforts underway now – the Sequoia Project for one to tackle the interoperability issue, and then, you’ve got Graphite, which is kind of a spinoff. There’s also Intermountain and Providence. Are these complementary to each other? Or do you see them as competitive?

Terry: Everyone’s solving a similar but different problem. With Truveta, we’re not solving the exchange of identifiable medical records, we’re not solving being an API layer for applications inside the healthcare system like some of the organizations you just described. But at the core, we’re all looking at security, privacy, and normalization of healthcare data.

As this industry matures, the shape of the boundaries will evolve over time, partners will become competitors and competitors will become partners. But there’s this many different takes on this problem in terms of connecting health care and life sciences to create one shared truth which we can use to really study health.

Thanks for that though. It’s a very unique point of view and I love being part of it.

Q. Truveta’s a unique organization but it’s also a startup and you’ve raised venture capital money. What is going on in the digital health funding landscape? What does the slowing down in funding mean for digital health startups and their customers who make bets on companies that may now be at some kind of financial risk?

Terry: Truveta actually has not taken any venture capital money. Our approach is that the health systems are the biggest stakeholders in Truveta’s success, they contribute their data and so, they should be the owners. I think it’s a very unique approach so no, there’s no venture capital in the company.

I did spend two years in venture capital and it was interesting that the two years I was there, it was easy to invest in everything when the valuations were going up. Somehow high prices made it easier to invest. Now, we have all this uncertainty—war, inflation, layoffs — and somehow the low prices are making it harder for people to invest.

There’s tremendous irony in that. However, for the next decade, I think the companies that make it through the next couple of years will be some of the best investments in the world because it’s an opportunity. We just talked about, the big data on health and I think, those companies are being founded right now.

Q. What’s your advice to a startup founder who wants to get into digital health today?

Terry: My advice would be — Have a great idea. Have a great team. I think that if you have a great team and you’ve got a great idea, you’ll be able to attract capital. You have a bad idea and a bad team, then, that will be harder.

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 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 technology 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 technology 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
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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 technology 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.


Q. Tarun, tell us about your background, how you got into this role, and the populations you serve at Virtua Health. 

Tarun: “Wherever you go, there you are,” I think, sums up my journey which wasn’t ever truly planned. I’m a physician by training — Internal Medicine Hospitalist — and I was actually going to be a Gastroenterologist. I had a Fellowship lined up and then, I came to profound realization that I just didn’t really like abdominal pain. So, I gave up the Fellowship before I started and was gainfully unemployed. I ended up joining a startup at a time when hospital medicine was just emerging. So, I was a Hospitalist. We grew a hospitalist company, a business, and then, I exited successfully. Transition points are recurring themes in my journey but from here, I got the opportunity to get connected with Virtua. 

I’ve been very fortunate at Virtua. I’ve had a number of different roles ranging from informatics, being part of the medical group, and population health. In 2019, I was asked to take on an assignment for digital. Since we had done only five ambulatory video visits in 2019, I set the goal for 500. Then, March 2020 came along. As the saying goes, better lucky than good , we were a little short of 200,000 but we did exceed our goal that year. 

That’s the role we created to hardwire into our organization some of those accelerations from digital transformation being produced by the pandemic. How did we do that so as to not revert to the original way of doing things? We created a digital transformation office. I’m so fortunate to be able to head that team.

Virtua created the integrated delivery network in the southern part of New Jersey, right along that Philadelphia latitude. In terms of a market, New Jersey is pretty dense. From the population density perspective, one of the things that’s really interesting is, there is a tremendous diversity in socioeconomics. 

We have some of the more affluent neighborhoods. One of them actually has two Apple stores within 10 minutes driving distance of each other. Seven miles away is Camden, one of New Jersey’s most disadvantaged communities. It’s just a startling fact that the life expectancy among those seven miles is 16 years. That’s important for us to think about and include in our digital transformation. We’ve got to make sure that what has continued to probably create inequities does not continue to accelerate forward. 

Q. What are your key priorities for the organization? How does the digital transformation function fit into those?

Tarun:  Some of the key priorities I’ll list are probably not that different from many of the other integrated delivery networks. There have been these remarkable swings since 2020, a tough year that saw many business operations shutting down resulting in essentially suppressed demand. 

2021, for us and a number of health systems, saw a dramatic rebound of that demand. It’s likely that that suppressed demand from 2020 was coming into 2021. Then came the Omicron surge which actually hit us—from a volume perspective—harder than the first surges did. What a tough first quarter for that from the perspective of economics and running the business! Now again, it’s rebounding. 

One of the things that is really an important for us here, is understanding market volatility. That is not classically something you would think about in healthcare. That was always the story about healthcare. People are always going to be sick and so, will always need healthcare. It’s a recession-proof business. It’s anything but, and is being impacted more than ever before. 

Going one step further, it’s critical to understand that the demand for healthcare is actually way more elastic than anything we realized or expected. We didn’t understand why it was so during COVID. We literally did not see strokes, for example, at nearly the same volume before. I mean, you have a stroke. You’d think people would come forward with these symptoms. It’s alarming. 

That prompted some deeper questions about what was truly happening with our consumers, our patients. That consumer focus and trying to understand their needs is what’s really and hopefully driving for us what we’re trying to take apart. 

Q. Given those priorities, how are you, as Chief Digital Transformation Officer, directing your investments? How are you factoring in these significant differences in your populations and their expectations from a digital technology enablement standpoint? 

Tarun: One hundred percent. Within the priorities in our Digital Transformation Office, I will quote a formula that we stole from someone who we know stole from somebody else. I’m not exactly sure where the true origins lie but that formula is: NT+OO=COO. Memorize that formula because it continues to keep our standards. 

What does that mean? New Technology + Old Organization = Costly Old Organization. 

We have a budget for digital transformation. If it was as easy as buying a technology, we would have all transformed at this point. But if you simply just buy technology and you wire it in to the existing organization, basically you’ll just be an expensive version of what you were, previously. 

And if we were previously good at what we were doing, then why are we doing the digital transformation? Yeah, we try to spend a lot of our time from our priorities on understanding the operations and where lies that mismatch between what the consumer is truly asking on one end and how we provide it today. Then, we see what are the ways we can transform. 

With regard to my title, Digital Transformation Officer, I would say the T in that title is the capital letter. What is the transformation that has to occur? Where does digital come into it? Where’s the operational change as a company? Sometimes it’s going to be a real problem and at others, the digital is ready while the operations is not, for the transformation. Sometimes the operations may be ready while the digital isn’t. That match is crucial. We spent a lot of time asking, “Is it ready?”, and that’s where we’ve been successful, so far. 

Q. Can you cite examples of how you’ve implemented this thinking in practice at Virtua? Where do you start – with a journey map or company research or something else — before you eventually land the technology? 

Tarun: I don’t think I have one very good answer. In fact, rarely is there a right answer. However, there are usually a few wrong ones to start with. If you must, try to avoid the ones that are pretty clearly wrong. That helps you call the field and then, you just have to pick something and go. 

In some cases, yes, you do your consumer research, get focus groups, and get data back. But don’t get paralyzed by saying, “Okay, I need more data.” Get it, make an educated guess, and get a prototype out there. Then, get feedback and do the five iterations into it. That’s when you actually start to realize that’s what the person’s after.

This concept of agile design in software has been around for 20 years. Agile design doesn’t happen in an integrated delivery network. If we, in health care, can specifically start thinking along these more rapid iterations, it’s very uncomfortable for us because as physicians by training, one part of the Hippocratic Oath in our statement agreement on the theory, says, do no harm. You’d never hear that in a software development company. They’re completely fine with it being, “No, that was a bad idea.” We, however, have to find a balancing act. To me, it was a bad idea. But it was safe. However, that just didn’t make the mark. One example would be online scheduling. 

We’ve had online scheduling technology but what we realized as we started digging deeper is that there was a complete mismatch between what the consumer was seeing and what the doctors and our medical groups had in their schedules. The analogy I’ll give you is if you called the office saying “Let’s use an airline,” and if you called say, American Airlines, the ticket agent would see all the seats on the plane if you were physically at the ticket counter. But if you went to the website, you’d only see rows three and four. 

How is that online scheduling? This could be described as one of those moments when “it was on, but the operational piece had not evolved.” So, what we went from is doing around 13,40,000 online scheduling appointments per year to doing 13,14,000 per month. That’s within about 12 months. Thousands of phone calls and people making their own appointments had a downstream impact both from a revenue and a cost perspective and it’s been enormous. 

Q. Online scheduling is a fantastic use case. What were the challenges you had to overcome? 

Tarun: An analogy I’d like to use is, the fear factor. Do people necessarily resist change because they don’t see the promise? No. Most people will say, “Yeah, I can see the promise.” But the question is, I can also tend to see and specifically, having worked with physicians it comes down to our residency training, it’s gladiatorial training. You do X, Y, Z, QW5. Patient survives. 

Now we’re saying, “Hey! Listen, skip a couple of things. Don’t go through this convoluted path. Just go from here to here. It’ll be fine.” I know if I do this every single time, I’ll get a good outcome. The question then, comes down to trust. 

For us, with our clinicians, we say, “Okay, help us understand what makes you worried about putting your schedule online?” The biggest fear over and over was, “I am worried that the wrong appointment is going to get booked.” What that means is, it’s a brand new patient who’s put into an established slot. With new patients, clinicians need half hour, 45 minutes longer. With established patients, perhaps it’s a 50 tweet I’m behind already. That happens first in morning. I’m catching up all day. 

That was something we could work towards. If you get in with it, you always want to have your early adopter folks. You just let them go. Your late adopters are going to be really hard, but you can get the momentum in between. That’s where it is and that’s just working. We say, “Let’s do a couple. Turn it on for a day. It’s not a big bang approach. Just turn it on for a day.” We ask “How’d it go?” and then, just turn it on for two more days. 

It sounds painful and iterative, but the reality is that’s how change happens. I just sit back now. It’s like an Atul Gawande article — slow ideas — everyone wants everything to go viral, and when they do, it’s wonderful. 

But some things don’t go viral and you’ve just got to work with people and meet them where they are. 

Q. Let’s touch upon the technology enablement aspects. What challenges did you have to deal with when you implemented the tech, the data, or the infrastructure? 

Tarun: I had put this in my LinkedIn profile. I don’t know if I came up with this de novo or sublimely, I stole it from somebody else. But I’d heard the statement “Culture eats strategy for breakfast.” If that’s the case, then, workload eats technology for lunch, dinner, and dessert right here. You ask someone to swivel between screens, and I already know the impact of what I want to get if I swivel to another screen, to another log in, even if it’s single, sign on. I already know the voltage drop is going to be enormous. 

The other question we try to ask is “So what?” Maybe there’s a nicer way to ask it, such as “If I do this technology, what am I going to get for it? What’s the proposed return?” 

One of the things our team uses — whether you use a balanced scorecard or you have smart goals — are OKRs (Objectives and Key Results). We ask, “What are my leading key results? What are my lagging key results?” 

If I put this in, one of these numbers has to move. The other thing we do from a technology perspective if it’s not moving, is, check “Are you prepared to rip it up?”

Yet another thing we also do is for every one thing we bring in is, we rip out at least one or two others because it just cannot be this. I think about this poster from the 1980s — He who has the most toys wins . That’s not a viable solution for us in this space. 

Q. There are literally thousands of solutions to pick from once you’ve designed the experience. Right from the native EHR system and nimble young startups to enterprise class tech firms and everything in between. How do you make that choice?

Tarun: Especially given that the frothiness of the investment market has normalized for now, I can certainly give you a framework. We look at different things that are important for us — not everything can be transformational — and incrementalism is not necessarily a bad thing. 

So, we go, “Hey! Listen, we just need to get a little bit better at this.” We need to constantly iterate and I would think of something like order sets. You have to make orders better. I’ve got to make some of my other functionality within my EMR better. That’s incremental and important. You can’t stop that. That’s not where our sharp focus is. We try to focus on five or six major transformational things and we have to stay so. 

One of the problems we had and one of the mistakes we made early on is we didn’t say “No” enough. I am trying to say “No” a lot. If you really want to do this as an operational owner, you have to prove to me what you’re prepared to do, to do this. I can’t make the change for you btu I will make the change with you. It’s how we think about it. 

When we look at technology, I think we look at it as “Is this a problem that one of our existing solutions can either solve today or in the next 18 months? Somewhere in that window?” It’s a little bit different depending on the problem. 

If it can be solved today with an existing solution, then, to go outside of that world, you really need to have a really good explanation for why someone would want to go with a tool outside of that. 

If it can be solved but not today; and if one of our existing tools has a good road map to get there in the next 18 months, then, it’s a decision around the severity of market need. What’s the market demand on that one? 

Then if you say no, we feel pretty confident it’s not on the roadmap or two years out. Then, we’re open to go looking with a startup or a partner. We’re trying to answer this question that states very transparently that we don’t sign ten-year contracts. 

You have to constantly keep proving yourself because the reality is, one of those native systems that we had on our native platforms eventually is going to catch up. It’s probably been on offer for a fraction of the cost of what the startup is. For example, video visits. We were paying hundreds of thousands of dollars for video visit solutions. Now we’re paying $0.28 for one video visit. Purely click as you go.

So as the commoditization happens, the startups have to continue to say, “What is the problem I am trying to solve?” You may have a good contract right now but you have to work out the assumption in three years. That’s a problem someone else may have solved for cheaper. It’s been commoditized. However, take the learnings you’ve had by partnering with the health system to say, “Okay, what are the problems? I’m going to help you solve that.” That’s an approach that I think of when we look to partner with folks. 

Q. What’s your advice to startups who are listening to this? 

Tarun: What is the reality of the world? I don’t think there’s anything I’m saying on the health care space that’s any different than any other space. Everything in health care is side-aligned — you got the big five in their respective areas. 

When talking to startups, I ask, “What’s your exit strategy? Between being lean and being acquired by Optum.” That is literally when half of the store doctors go, “Yeah, that’s our only choice.” 

With some of the startups that I’ve seen and worked with, once you get acquired by Optum, you get pitched and pulled into that space. It changes the dynamic of the original relationship because in some cases we want to work with people who are independent and outside of the ecosystem. 

In some places, it just makes sense for it to be part of the ecosystem. It’s important to be mindful of and check, “Am I sitting in a space that benefits me being somewhat separate from the big ones or complementary or eventually tied in?” That’s because I think there’s a big misnomer in health care I.T. that the health systems are flush with cash. 

If you think that’s the case, you can look at our P&L record. They’re all wrong and almost all not-for-profit. We’re talking low single digit operating margins. So, it was a bloodbath – though that may be a strong word. It was very difficult and tight. 

Each day you have 10,000 people leading the commercial insurance world where that pays better compared to the Medicare world. So, it comes back to that value proposition of what you’re truly bringing. 

Q. So that obviously begs the ROI question Are you making a lot of digital health investments? 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?

Tarun: I wish I could say, we put data into an Excel spreadsheet and a formula comes out and scores 99. We go with it and it comes out with a six. We don’t. I will tell you though that, there are some gut calls you’ll get at times. We won’t leverage the house on a gut call. But I think one of the things we’ve stated, though, is our investment in digital and our thesis is very clear. Any incremental investment has to help us gain consumers who want to be part of our health system, retain consumers who, if we don’t offer this, are going to find another solution that meets their value proposition. And then, it has to be real, tangible savings. 

You can’t be this soft. Sometimes I look at some of the valuations and the ROI calculations people come up with. It’s like, “We’ll save you half a day in the hospital, which will then, lead to $10,000 of savings.” I think “Yeah, maybe you’re off by like two decimals there.” It has to be hard. Tangible.

Q. You’ve been in this role now for two or three years. If there’s something you’d like to share with your peers listening in, what would those be? 

Tarun: I’ll give two. I think they’re probably the same thing, but maybe slightly different way of saying it. 

I mentioned I was in a startup, and when I first came out of training, one of my mentors gave a statement that one of his mentors gave him, and that is, “no one ever went out of business because they focused too much.” Now, you may not be the biggest business. You may not be getting on the speaking stages, and you may not be on the cover of X, Y, Z magazine, but you’ll still be in business. 

A corollary to that is a term we use in our organization. Specifically, my team is called Coldblooded Execution — There’s a lot of cool, a lot of talk, but at the end, those who execute will win and there will be winners and losers in this space. We’ve seen it over the last couple of years and it will only continue to accelerate. That is relatively new for integrated delivery networks. There are integrated delivery networks who are essentially either are going to get acquired or in some cases shut down because they did not thrive in this business. But cold, hard execution ideas are wonderful. Execution wins. 

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.

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
To receive regular updates 

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.

Our Podcast Partners:

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 patient 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.

We are building a consumer identity and engagement platform as the cornerstone of our digital strategy

Season 4: Episode #124

Podcast with Sara Vaezy, Chief Digital Officer, Providence

"We are building a consumer identity and engagement platform as the cornerstone of our digital strategy"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Sara Vaezy, Chief Digital Officer of Providence talks about her new priorities, the increased focus on patient acquisition through marketing and patient engagement tools, and the role of identity-based marketing programs that get tied with the returns on investment. Sara also discusses the digital health innovation ecosystem, the startup funding environment, and all the tough choices that health systems make in the context of an economic slowdown.

Sara talks about unlocking new business models and operationalizing digital in a multi-modal context to solve both consumer and health system problems that go beyond substituting a physical visit for a virtual visit. She also states that health systems are now going through a much-needed re-evaluation of the value generated by digital business models and partnerships. Take a listen.

Our Podcast Partners:

Show Notes

00:41 About your new role and immediate priorities.
05:18Why do you think health systems today are choosing to define the digital function in product management terms?
07:41Can you describe some of the trends you're seeing in healthcare today?
12:44 Compared to other industries, healthcare is certainly catching up. But historical factors determine how quickly you can transform the siloed nature of data – medical information, demographics, social profiles, and privacy concerns. What makes healthcare a little more challenging?
18:22With the hybrid care delivery model, patients receive some care at home and clinics too. How much of this have you implemented at Providence and how do you ensure a seamless experience?
22:48 There are plenty of digital health startups with thousands of good solutions, smart people, and some VC money. But the change in the funding environment could mean trouble for a few of them. What are your thoughts on this?
28:05 What do you see as a macro-outlook for the next 12 months? What kind of scenarios are you playing out in the context of digital health investments or even your own innovation programs?

About our guest

Sara Vaezy is the Chief Digital Officer for Providence where she is responsible for digital strategy, product innovation, marketing, digital experience, and commercialization for the integrated delivery network (IDN) which includes 52 hospitals and 1,085 clinics and serves over 5 million unique patients.

Sara is the architect of the Providence digital innovation model upon with the Digital Innovation Group (DIG) was founded, resulting in company partnerships and incubation of technologies that deliver value for Providence as well as other health system. The model has resulted in the commercialization of three incubated technologies into independent companies from within DIG— all of which are supporting Providence in delivering on its mission and vision of health for a better world.

Sara_Vaezy_profile-pic-tablet

Sara Vaezy is the Chief Digital Officer for Providence where she is responsible for digital strategy, product innovation, marketing, digital experience, and commercialization for the integrated delivery network (IDN) which includes 52 hospitals and 1,085 clinics and serves over 5 million unique patients.

Sara is the architect of the Providence digital innovation model upon with the Digital Innovation Group (DIG) was founded, resulting in company partnerships and incubation of technologies that deliver value for Providence as well as other health system. The model has resulted in the commercialization of three incubated technologies into independent companies from within DIG— all of which are supporting Providence in delivering on its mission and vision of health for a better world.

Sara is active in the broader healthcare industry serving as an NCQA Board Director, as a member of inaugural class of the Frist Cressey Ventures Collective, a Health Evolution Forum Fellow, World 50 Digital 50 member, and a Forbes Business Council Member. She has won numerous awards and has been recognized as a Business Insider 30 under 40 Transforming the Future of Healthcare (2019), Catholic Health Association Tomorrow’s Leader (2019), a Becker’s Rising Star in Health IT (2020), and a Becker’s Women to Watch in Health IT (2020 & 2022). 

She holds an MHA and an MPH in Health Policy from the University of Washington School of Public Health and BAs in Physics and Philosophy from the University of California, Berkeley.  

Q. Sara, tell us a little about your new role and your immediate priorities.

Sara: My role actually has three parts. The first, that of a Chief Digital Officer, is a bit of a misnomer because the first big part of the organization is the marketing and digital experience. This isn’t just digital marketing or just marketing of digital products but all organizational marketing and really like customer-facing, top-of-the-funnel customer acquisition all the way through in terms of getting our users to convert and acquire services from us. So, the organizational marketing and digital experience spans our marketing platforms, analytics, regional strategy, planning around marketing, website search, performance marketing, and our e-commerce activities both, on our own digital properties as well as on partner properties. Take for instance our payer partners and how we syndicate content and appointments and things like that to them. That constitutes the first big part.

The second part is product development. We have a product development shop with about 80 people that are building enterprise software primarily for health systems. Our core thesis is in terms of where they’re pointed at. We build customer-facing platforms that do not exist in the market today, and we build what we think are essential in terms of health systems having a role in driving the development of those platforms.

The third piece is, once we build, we commercialize. The last part of that is strategy that concerns not just where we build and what goes to our product development team but also spans taking these solutions to market, spinning them out into new companies and then, doing quite a bit of actual market development. In many cases then, we’re building platforms that don’t exist or which are new categories. We just need to educate the broader market out there as to what it is, why it’s important, and what we’re doing among other things.

To your question around priorities, we’ve done all sorts of things in the past — looked at a pretty broad scope of customers, studied consumer-facing solutions, whether they were more growth, mar-tech types of solutions, or even looked at access and convenience things that are behavioral health. We’ve also done work in health equity and in the last six months and in particular, this past quarter, we’ve really doubled down on just focusing all our efforts on driving the growth value proposition and the growth imperative for the organization.

In most industries, and I’m not talking about modernizing infrastructure here, but about digital transformation from a customer-facing perspective. The primary place where digital has a real role is in generating demand, aggregating demand, and capturing demand. That’s what we’re doing. We’re driving growth for the system through customer acquisition, customer retention through engagement, and capturing LTV. We’re changing the LTV equation for our health system and since it’s difficult to do, we’re focusing on that for we want growth, profitable growth all day, every day.

Q. Why do you think health systems are choosing to define the digital function in product management terms, today?

Sara: There are a lot of different answers to this. But here’s one which is that infrastructure and enablement only go so far. You really have to think about the problem that you’re solving for your user all up; in fact, the whole end-to-end experience. That’s what product managers do. They think about the entire problem and start from the customer backwards, hopefully. So, that’s one thing.

The other piece is in healthcare. I’d say that in any other industry, digital unlocks new business models. You must take that product management approach to ensure this else, you’re just enabling the same kind of core business. We have a lot of that, too, in healthcare.

However, unlocking the new business models or operationalizing digital in the context of new forms of access, for instance, is something we’ll get to in a little bit, but multi-modal care is not just about substituting a physical visit for a virtual visit. There’s a lot more to it than that if you really want to solve both, the consumer and the health system’s problems. That’s why it’s becoming increasingly prevalent. You need to think beyond infrastructure and really start thinking about new business models, new customer use cases, and that more transformative aspect of it.

Q. How are your patients and your target audiences driving some of your thinking? Can you describe some of the trends you’re seeing that may be of interest to our listeners?

Sara: There are a lot of different things that have especially happened or accelerated over the course of the last couple of years given both, COVID and greater familiarity with technology, in the context of our healthcare. I’ll just talk about a couple.

The first, is what I just mentioned earlier, multimodal. It’s just the notion of patients and users getting comfortable with both, the physical and the virtual and how these exist in a hybrid environment, together. But there are expectations that go along with this, for instance, the continuity of your data or your authenticated state as a given individual, and an identity that goes along with you as opposed to just these one-off transactional things that may or may not persist across the different mechanisms by which you encounter a system. This concept of “hybrid” is something we’ve seen over the last couple of years and read quite a bit about but, I think, there’s going to be increasingly more of that in different patient segments and use cases. I don’t anticipate that trend to go away.

Another piece of that is that’s tangentially related to the concept of identity. Identity-driven engagement and personalization drives engagement. What I mean by that is if you take the classic example of Pinterest, or any e-commerce platform, say, your home page on Amazon.com. That is going to look very different from my home page there because we are different people with different purchasing patterns, plus we live in different parts of the country. So, based on everything that Amazon knows about us, they are able to drive a completely different personalized experience for you versus for me. That is coming to health care. That’s coming in the context of how specific transactions may or may not be relevant to you. It may be a virtual one or a physical one, but it’ll become relevant to the context of outbound marketing. For instance, we’ve got good at being able to recognize, through some of our marketing platforms’ work, who is in the market for a specific service with us. That helps us undertake targeted outreach. So, we can say to them, “We’ve noticed that you’ve been engaging with us around content for knee pain or you’re being searching for orthopedic surgeons. How can we help you?” That there is personalized targeted marketing, outreach, and outbound marketing.

The third area is just around this as it relates to personalization. It’s just about engagement experiences, in general, that encompass knowing who you are and being persistent. There is a single place for all your information and it’s not just health system-centric, it’s marketplace-centric. We are building, for instance, what we call a consumer identity and engagement platform based on this general trend.

Identity is the cornerstone. It knows that I am who I am. It undertakes identity resolution, management, and identity verification, and then that identity powers a profile of me as an individual and in a single access channel, personalizes my transactions, my billing experiences, my third-party apps, and the services that are relevant to me. This happens on an ongoing basis, not just around an episode of care, but like between episodes of care. We’ve talked about this in healthcare for some time but as we solve the identity and the data problems, it begins to actually become real.

Q. While industries such as, ecommerce, personal banking, securities, travel, and hospitality are further ahead, healthcare is certainly catching up. However, some historical factors determine how quickly you can transform the siloed nature of data – medical information, demographics, social profiles and privacy concerns — related to this. Tell us, what makes healthcare difficult and maybe just a little more challenging?

Sara: Stitching together the data at an individual level and not just clinical data, is one of the key challenges. However, you must solve the problems around data before addressing the fragmentation problem. Stitching that together is difficult because all of the data elements exist in different places.

That example of marketing outreach that I gave earlier, required our team to stitch together Epic and web traffic data. So, it’s not just clinical stuff. It’s all about — how are they performing on our online properties? What are people searching for? How are they navigating their way around financial data? We can purchase data from other sources, integrate them, and then, layer on top of not just the data itself. It’s the models that actually tell you — Is this person in market or out of market for specific services? Stitching together the data or even getting the data out of these different siloes can be very difficult.

Our infrastructure is no secret. Healthcare, for example, is relatively antiquated in terms of the core infrastructure that it has, so, that’s a big problem. You mentioned security so I’ll say, we have an incredible cybersecurity team with folk from across the industry, ecommerce, and other places that have done this kind of work in the past. We’re very fortunate that we’re ahead but in many cases, that is a big barrier especially where security issues can actually hamper the ability to make progress around these kinds of things.

Second, it’s not just the fragmentation on the technology side of things but how it translates into the operationalized channels where care is delivered. That’s still a challenge for us especially nowadays with the worsening workforce crisis and increased burden on caregivers. It’s tough to actually operationalize some of these things in the context of where care is delivered.

However, that is not really a digital problem to solve though some exceptions remain. For instance, we are working on a decision support, similar to a customer service or self-service use case for something that we’re building and calling a conversational and navigation platform which is in one place. It surfaces up as our chat bot. In some places, the chat bot can be focused on all sorts of different problems – something complex as symptom-checking the differential diagnoses or even something very basic like resetting my password and administrative use cases.

What we’re working on is the inbox management problem for our caregivers. Out there, you can tackle it across different pain points. There’s a lot of work being dedicated to this once a message is generated. From triaging it and having different roles on a carrier team tackle different problems or different types of messages, what we’re working on is way upstream of that.

That begs the question, why are those messages being generated in the first place? How can we provide our customers, our users with tools and content to prevent those messages or some proportion of them, from being generated in the first place? There are ways to tackle that sort of in-person experience or even the stuff that gets generated around a specific encounter as well. But there’s a tremendous amount of data that’s required in order to be able to do that. So then, we get to come full-circle to the data problem.

Q. Let’s talk about care delivery. With the hybrid model, patients receive some care at home and then, come into the clinic, too. The communication process then, becomes critical so you don’t need to ask them for the same things, repeatedly. There may be an analogy in Retail – BOPIS (Buy Online Pay In-Store). How much of this was at Providence? How much of this have you implemented? How do you ensure a seamless experience? Have you had any successes that our audience could learn from?

Sara: We’re only at the very beginning stages of this journey but I’ll say that identity is the cornerstone here. You have to have identity that transcends beyond the clinical system of records, because not all of this sits within it. If you’re ceding your identity to just the EMR, then, that’s the first challenge that needs to be overcome. There’s that piece.

We built a simple patient identity platform which has over 4 million accounts now and it resolves all these for us in terms of pulling the identity out and doing everything we talked about. It also undertakes identity federation to third parties and services outside the system of record. That’s one very core element in terms of being able to do this more broadly. I think that’s key. That’s the first key.

The second is, starting to then think about how customers across both, the physical and the virtual actually go through a funnel and convert into buying a service. We, through a combination of our product development as well as our digital experience teams, incubated a technology called DexCare, which we spun out last year. That does three things with identity at its root. They’ve got their own SSL platform, which is around that whole demand aggregation piece. This ensures that your services are discoverable by users. Those services could be physical or virtual but you don’t want to artificially silo them and put people down one specific path without giving them the options that are most relevant to them. Equally important is navigating folk to what is most appropriate based on their intent, motivation, clinical appropriateness, and how the delivery system is structured, operationally.

The third piece matches the supply to the demand. This becomes very interesting in a hybrid environment because there, it’s either available or not. There are different types of services and when you start going into virtual modalities, these could be synchronous or asynchronous videos or chat-based, so, the complexity really increases from there.

So, we work with identity first to understand who the user is, to enable navigation to the options that are relevant to them, and then, to convert them to buy into a service by matching supply to demand. That’s another way by which we’ve actually operationalized it.

I’ve seen really tremendous results. Around 30% of the patients that come through our digitally enabled channel are new to the system, while around 80% of them are commercially insured and stay with us. We have relationships with them and that generates downstream revenue for us as well, so, it’s not just a one-off.

Q. Let’s talk about technology enablement. There are plenty of digital health startups with thousands of good solutions, smart people and some VC money. But, the change in the funding environment could mean trouble for a few of them. You’ve harnessed innovation from the marketplace, so what are your thoughts on what’s going on?

Sara: It’s definitely going to mean trouble for some and potentially, many. We’ve gone through an exciting but relatively undisciplined period and now that the financial tides are turning, we are going to have to become disciplined out of necessity.

The financial state and financial health of buyers and that of the health systems is not good right now. So, as we think about solutions to engage with getting value for those solutions, demonstrated value — demonstrated ROI and not vague, fancy hand-waving and lots of unjustifiable multiples — is going to be absolutely top priority. It’s all going to be about demonstrating value. So, we’re doing quite a bit of work to enhance what we do. We have operational metrics, for instance, that we’re on the hook for, but we’re getting crisper about our returns on digital investment as a system. That will be the number one change — Can you actually return something to the buyers in the form of some sort of demonstrated value?

The other thing is, often, in these types of environments and this happened in multiple cycles — the Great Recession, in 2008-09, or even during the dotcom boom — cash is always king. Hopefully, cash is a proxy for value and it’s presumably if you have cash, that you will probably have something good to sell to the market. I hope that that’s the case and that ultimately with this calling that happens, we’ll end up with solutions that are really meaningfully moving the needle for us.

Q. Cash is king, and it’s even better if the cash is internally accrued through a business as opposed to investor funding. But, how long can you make it stretch? Have you had to make difficult decisions with your portfolio of startups?

Sara: In our system, we are actively going through those discussions right now. I suspect every single health system in the country is going through that, too. Even for our internally-led efforts, we’re actually thinking — Do we really need to do this or not? Is this that important? Is it that foundational? The answer, generally speaking, is yes.

That’s because we’ve done the homework to say that this platform does not exist and so, it’s important enough from a differentiation perspective that we absolutely need to build it. However, we’re going to have to keep coming back to that. It’s like coming back to that and ensuring that our efforts are well-aligned and well-coordinated across the system. We are just in a position where we have to be extremely good stewards of our resources and any “messing around” is just unforgivable at this point.

Q. Does this mean that there’s a “flight towards safety”? Will you approach your EHR areas or your enterprise class technology vendors with deep pockets to ride out any cycle because they’ve got all this cash that they’re sitting on?

Sara: There’s always that. Now it continues to be a theme. That’s why we’re just going back to first principles and really saying it where it’s only absolutely essential. The definition of “absolutely essential” may change. But it’s not a foregone conclusion that these things are absolutely essential at this stage. Depending on how performance improves over the coming quarters, that definition may change and we’re prepared for that.

Q. What do you see as a macro-outlook for the next 12 months? What kind of scenarios are you playing out in the context of digital health investments, continued investment in digital health strategy programs or digital health start-ups, or even your own innovation programs?

Sara: Similar to what we’re seeing in the venture-backed market, it will be all on focus. I suspect that the focus is going to be on a lot of dabbling in digital health and tech-enabled services. There’s a lot of dabbling going on everywhere.

I also think those days are over so, everyone is going to be forced to get more disciplined. The expectations, I think, are going to increase around the value that’s generated by new business models or digital models. So, there will be a lot of innovation efforts going away because they’ll be more “nice to have” than “essential” or maybe because they just aren’t able to articulate their value prop. They may have been extremely valuable but they may not have been able to communicate it or quantify it.

It is not to say I’m pessimistic, but I think, this will be a really tough time. Health systems are going through a turning point and it’s a much needed turning point. In how we do our business, how we serve our customers, and how we’re structured to do so, we’re all going to get leaner and meaner. That’s good; good for affordability and from a macro-perspective. It’s good but it’s just going to be a tough time. We will live to fight another day.

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.