Author: sanjith p

Despite initial skepticism around digital health, doctors are driving a lot of digital engagement now

Season 3: Episode #104

Podcast with Dr. Mark Weisman, CIO and CMIO, TidalHealth

“Despite initial skepticism around digital health, doctors are driving a lot of digital engagement now.”

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this podcast, Dr. Mark Weisman, CIO and CMIO of TidalHealth, Maryland, discusses the role of analytics and informatics in identifying bottlenecks and the opportunities where technology may be harnessed to enhance the quality of care. Tidal Health is a two-hospital health system on the eastern shore of Maryland, serving largely the rural population of Delmarva Peninsula.

As a physician who’s well versed with emerging technologies, Dr. Weisman acknowledges the handicaps digital health care must overcome to reach the underserved population in rural America. The foremost focus of their digital journey is to improve patient access to healthcare. He demonstrates how certain digital health tools can bring in cost-effectiveness, reduce the administrative workload on clinical staff, develop effective programs, and provide better healthcare access to everyone.

Dr. Weisman advises digital health start-ups to approach health systems and healthcare as genuine partners in improving patient access and care delivery and not as a salesman merely trying to sell a product or service. Take a listen.

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Show Notes

01:15About Tidal Health, your role, and responsibilities
03:49What are your top priorities right now?
05:44Access and digital health go together. What are you doing in that space?
07:51 How have the physicians responded to digital engagement?
09:24 You largely serve the rural populations. Does that have any kind of a bearing on your adoption rates, for instance, for digital health tools?
11:20 How are you bringing the two words – data and analytics – together to really use data analytics capabilities to drive digital engagement?
13:23 How you go through the thought process of evaluating and picking vendors that you want to talk to?
14:54 Do you go with an EHR-first strategy when it comes to turning-on your capability? How do you see your vendors coming along when it comes to these kinds of newer capabilities?
16:38 What is your advice to startups or healthcare companies who want to contact you?

About our guest

Dr. Mark Weisman is the Chief Information Officer / Chief Medical Information Officer for TidalHealth, Inc. He is a board-certified Internal Medicine and Informatics physician, who has practiced in inpatient and ambulatory care settings in hospitals, high-volume clinics, and retainer-style clinics. As an executive leader CIO and CMIO, he drives technology changes to make the lives of our practicing clinicians better. He is responsible for improving the cybersecurity posture of the organization, creating transparency into IT project activity, and improving IT agility.

Q. Tell us about Tidal Health, your role, and responsibilities.

Mark: Tidal Health is two-hospital health system on the eastern shore of Maryland. We tend to be fairly rural as we’re growing as a health system. Currently, roughly 400 beds at Tidal Health are filled up with COVID patients like everyone else. We continue to acquire practices which are coming to us looking for help because of some of the financial pressures in the market now, so, we’re definitely busy. I became CIO in August. I was the CMIO here for about three years, and it’s been a very interesting couple of months since becoming the CIO. There’s plenty of work to do.

Q: How did being a CMIO prepare you for this role, if at all?

Mark: It did help. My initial focus as a CMIO was on making the lives of the doctors better. That grew into helping the nurse practitioners, the nurses, the physical therapists and really making the EHR easier for a lot of people. It was exciting, fun and people really enjoyed that but there’s a lot left to be done. While we’re not perfect, we’re certainly becoming better.

When the opportunity came up for me to lead the EPIC application team — that was about half of our team and the number of analysts is just unbelievable — we had a good team, and we did some great things. That’s how I got the CIO role. While I still have the CMIO role and I do both, the challenges became clear soon. Already being the CMIO, I realized there was some tech part to becoming the CIO that I had to get up to speed on very quickly. I got the EPIC, the medical part, and the operations part.

Q: You’re a physician and have been involved in tech. What are your top priorities right now?

Mark: The organization is in pretty good shape in terms of infrastructure, so, I get to focus on some of the more fun things though we do have some challenges around access and provisioning — pain points for operations. Every time someone new comes into the organization, we can’t seem to get their access right on their first shift and it’s not good. So, they can’t get in nor see what they have to see. We need to take out the people who have been with our organization for years and not offer them access anymore. I really want to improve that because that goes along with my initial launch of making the EHR better for everyone. While this is just a piece of the entire job, it’s an important one. That’s a focus area plus there are other security issues, though we’re not in bad shape there.

Playing around in the automation space has been the most exciting part that’s energized me. I’m helping others be more efficient. However, it’s in finance that I’ve never had the opportunity to help out. It could be something like scanning of papers for HIM but we’re going to look at automating that with some new technology. What’s cool about being the CIO is that I get to do more.

Q: Access and digital health go hand-in-hand. What are you doing in that space?

Mark: Our digital journey started with EPIC. While we had a portal, there wasn’t anything really exciting there so no one really went to it. In November 2019, after a discussion with our executive leadership, we decided to put all our notes and labs out there to give people a reason to go to the patient portal. And that’s how it started. One of the decisions that was made at that time was around telehealth. That wasn’t on our roadmap then, and we weren’t going to do it. We were going to focus on some other pieces of the digital experience.

But there was a little change in plans. So, eventually we went with telehealth via Zoom and introduced a little more of digital customer engagement. Our weak point was, however, around appointment reminders since it was being undertaken by the front desk — picking up the phone, dialing, getting the next person, leaving a message — and not very modern. I proposed a solution.

We began using Phreesia by which a text message to schedule appointments would be sent out and the frequencies of these messages and their times could be controlled by us. Our aim was to free up the front desk staff so they could be more efficient. We found that previously, our front desk staff were reaching out to over 50% of the patients but their no-show rates were high, and they never took breaks. Now those numbers were far lower, and we could see immediate results.

Our digital journey right now has entailed getting to that point of better access. Though our appointment scheduling is still via the portal, there’s more to the digital experience offered there.

Q: And how have the physicians responded to digital engagement?

Mark: They fought it tooth and nail when it came to certain parts such as, releasing all labs in real-time, releasing pathology though when we did that, I got just one phone call in six months. There are many who must have had questions or concerns, but it became easier when the government enforced it. That did help with some buying acceptance.

The doctors were initially a little skeptical about telehealth. Then, there were the early adopters who jumped on it during the pandemic and did very well. They just went out and got their own tools and started doing telehealth because they wanted to see their patients. I thought it was great. I’m waiting for our tools now. 

However, we’re seeing a lot less — under 10% — maybe 4-6% of our visits now are going by telehealth. The doctors are driving a lot of that; we must not underestimate how resilient healthcare can be to change. The doctors like seeing people in-person, where things are built around them rather than their patients. Healthcare will go back to the way it always was without some other mandate pushing it along.

Q: What about the patients themselves? You mentioned that you were largely rural? Does that have any kind of a bearing on your adoption rates, for instance, for digital health tools?

Mark: It does. When the pandemic began, we suffered with broadband congestion and poor connectivity. The final mile killed us, and we were facing 20% failure rates on video calls. We faced inability to establish the connection, or the patient didn’t know what to do – either way, the technology wasn’t easy, or they just didn’t have the bandwidth, and they became very frustrated.

That has played a big role for all healthcare in America, so we aren’t unique in this regard. We do not have broadband connections across our population neither do we have great cell signal. Some parts of our population are really isolated and that tends to be the segment that needs most care — the underserved with a lot of both, physical and mental health issues.

That segment would really benefit from this. We’ve tried to speak with the carriers — Verizon — and they’re like, we have the best coverage in the country. I get that. But in this little world, we need help. It’s just not realistic until the government coughs up the billions of dollars it’s going to take to get broadband everywhere it needs to be. Till then the rural areas will be struggling.

Q: It looks like the pandemic accelerated the shift towards digital, in a positive way and the early signs are great! It was all about data analytics. How are you bringing these two worlds together to really use data analytics capabilities to drive digital engagement?

Mark: I got into data because I always wanted to win the arguments. The one with the data wins the arguments, so that still applies. When I present to the doctors, I show them the number of patients who are self-scheduling now, and the numbers are going up. The doctors are getting used to that but then, some do say that the patients scheduled in the wrong time slot. This happens all the time.

So, we have to check and see how frequently this happened and once the data is communicated, I don’t hear from them again. So, data will really help drive doctors when they go with the “it always happens or it’s never good” argument. We’re able to show that more patients are checking in online, switching appointments, finding their doctors and that data speaks to me, enough to help convince some of our executives, not just doctors.

Why are we investing in this? Why do we need our website to be something that brings in patients? Well, patients know how to find us for it’s a rural area and where else would they go? They want to connect to us through our website. So, we’re working on it.

Q: You mentioned a couple of partnerships that you have entered into to drive some of your digital initiatives, but the market is flooded with innovative solutions. How do you keep yourself abreast of what’s working and pick vendors you want to talk to?

Mark: It comes a lot from colleagues and via recommendations. I’m still a part of the CMIO forums. So, I’ll ask questions there and get some recommendations, periodically.

I went to CHIME for the first time and had a wonderful experience interacting with other CIOs. I found a whole bunch of other physician-CMIOs, which was very helpful because they’d walked in these shoes, so they knew some of the other technologies that I’d read about and heard of on other podcasts.

There’s no magic answer or one way to stay abreast of this stuff. There are so many vendors, it’s overwhelming and there’s a lot of overlap. Sometimes it’s hard to differentiate one from the other. The price obviously speaks volumes in these kinds of times. And for us, our budget has just been slashed. All the money goes to finding good nurses since they’re what we need right now. So, the vendors that can help us with that problem are very helpful for us.

Q: Do you go with an EHR-first strategy when it comes to turning-on your capability? How do you see them coming along when it comes to these kinds of newer capabilities?

Mark: That’s an interesting question. The EPIC App Orchard is a tool that I would use to locate new vendors because I know certain hurdles have already been covered, so I don’t really have to introduce this vendor to EPIC. In fact, they can start working out that partnership directly. It also means they probably have hit a certain level of maturity because they’re not getting into the EPIC App store without some basic security in place. So, there is some comfort to that. It’s also somewhat limiting. I’m not sure we get all the best vendors that we could ever want by only looking in the App Orchard. Certainly, there’s that bit on interoperability and integration.

I also don’t want people to say that going via a portal implies being out of their workflow. So, if we’re talking about a tool that is for clinicians, yes, I’m going to go EHR-first. If it’s finance there, they don’t really care because they want the best solution.

I’d also like to get some unified solutions for we have a ton of little silos, and it’s very difficult to understand how to run a business without the data even being able to flow back and forth or to see the impact when the census went up. So, how many nurses do we need? How many nurses do we have? How many are on standby? Without all those pieces connecting, it’s very different.

Q: What is your advice to startups or healthcare companies who want to contact you? Do you tell them to get certified on App Orchard first?

Mark: At CHIME, the vendors were certainly there, they were engaging though they were not overly sales-oriented. That’s their business so they’re there. But the ones I liked to connect with, were the ones who came with genuine partnership. They’re not there to sell you. Though I have heard from others, this is a real vendor connection.

There was one vendor who I’m very interested in working with their consulting firm and they have people on their staff who do nothing but work as technology advisors. They’re not selling anything but are around to help. They have a sales arm and other pieces that point to what they do and while I’m intrigued by this, it’s a sign of partnership. And there’s no charge on me calling them up or picking their brain. That’s helpful. Maybe they can guide me through some things or towards solutions that they’ve seen work for others.

Q: I must ask you about your podcast, now. You’ve been one of my favorite podcasters, and I’ve had the honor of being on your podcast as well. So, now that you’re CIO, do you have time for the podcast and will you be doing more? Where’s that headed?

Mark: Doing a podcast is a ton of fun. It was awesome at educating me and I learnt what others were doing. I also made connections — many of those I interviewed, I did run into over the last two or three weeks at Chime. That was fantastic.

Time is a challenge now that I’m both, the CIO and the CMIO, so I have been a delinquent. As my listeners would know, I haven’t put out content in quite some time. But there were some people who I ran into who wanted me to do some things and get back on air. And I would like to do that. So, it’s not dead; just on a little pause till such time as I get the team together and get things how I’d like to have them and convince the leadership that we’re stable and everything’s going to be fine.

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 affordability can be improved by removing financial barriers to care for patients

Season 3: Episode #103

Podcast with Srulik Dvorsky, Co-founder and CEO, TailorMed

"Healthcare affordability can be improved by removing financial barriers to care for patients"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this podcast, Srulik Dvorsky, Co-founder and CEO of TailorMed discusses how healthcare organizations can improve patients’ financial management and enable the chronically ill to reduce their out-of-pocket costs and financial burden, thereby enhancing access to care. TailorMed is a Tel Aviv-based innovative financial management platform.  

Better quality of care translates to higher care costs, resulting in an increased out-of-pocket burden for consumers. This can drill a gaping hole in patients’ pockets if they are uninsured, underinsured, or have little or no access to financial management. Data assumes a critical role in the digital healthcare landscape as it offers a personalized projection of patients’ out-of-pocket costs across their entire medical journey. Leveraging patient-related information and financial data can automatically help detect cost-saving opportunities based on insurance and treatment optimizations and matching financial assistance programs. Take a listen. 

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Show Notes

01:31 Tell us a bit about TailorMed. How did you start the company and what’s the market need you're trying to address?
03:17How does your company address that problem of affording healthcare? Are you focusing more on improving health equity or helping patients and consumers get more out of what they already have?
06:26Are you focusing on any one medical condition, or do you cover a broad range of medical areas? journey?
13:24 Who is your target audience that can benefit the most from your services?
17:48 What are some of the challenges that inevitably startups are going to face?
19:42 In a space with so many startups, how do you stand out? How does a healthcare organization cut through all the noise in the marketplace to understand where the value is?

About our guest

Srulik Dvorsky is the co-founder and CEO of TailorMed, the leading financial navigation technology company that helps patients and healthcare providers remove financial barriers to care

After serving as the primary caretaker for several family members following a cancer diagnosis, he started TailorMed with a personal mission to leverage technology to remove barriers to care. He brings to the company more than a decade of experience in the medical device industry.

Q: Tell us a bit about TailorMed — how did you start the company? What’s the market need you’re trying to address? 

Srulik: TailorMed’s been around for the last four and a half years. I co-founded it with Adam Siton, our CTO, with a mission that intensified over the last few years – that of removing financial barriers to care. Across the United States, it’s clear that over the last few years the cost-sharing dynamics between patients and their payers have been leaning more towards patients, than in the past. There’s a noticeable, dramatic increase in out-of-pocket expenses and premium expenses, basically meaning that a lot of patients requiring either chronic or critical illness treatments are unable to afford it. This is why we started the company. 

We’re working with healthcare organizations – providers, pharmacies, and other strategic partners within that ecosystem — to find those patients as early as possible in their medical journeys and locate opportunities to offset those out-of-pocket expenses by having other financial resources to cover that, whether it’s through different financial assistance programs, governmental subsidies, optimization of their insurance etc. 

That’s happening with very consistent value creation to both patients and our partners who’re large health systems, small clinics and large pharmacy chains so, they just continue to expand with the growing needs in the healthcare industry. 

Q: One-in-five Americans today, has a problem affording health care. How does your company address that? Are you focusing more on improving health equity or helping patients and consumers get more out of what they already have? 

Srulik: From my perspective, one-in-five Americans are facing the issue of affordability. There is also the fact of the dynamics of cost-sharing between patients and their providers. Another area of our focus when it comes to treatment and medication is on the amazing investments in clinical solutions and treatments that provide better clinical outcomes. But those innovative treatments are usually coming to market at steep prices and that’s creating an even bigger gap in access to care. 

Obviously, COVID exacerbated that problem when people lost their jobs and unemployment increased. A lot of people who were maybe under-insured before became uninsured and healthcare costs on the rise for years just continued. The way we are addressing that is first, looking at what patients are covered for and trying to make sure they are maximizing their benefits. Our core focus is on the abundance of different resources out there that can serve different patients depending on where they live, what treatment they are on, what type of insurance coverage they have, and then, offsetting some of that financial burden and having another entity cover that. 

So, for example, there are patients with diabetes who need to have their insulin medication on or may be on a monthly refill cadence, something that isn’t very affordable. They need to leverage opportunities out there ranging from a governmental subsidy if they are low-income earners to a co-pay assistance by the drug manufacturer to a diabetes foundation that can support patients with either direct medical expenses or their living expenses, if they are burdened by that, as well. 

What we are doing is leveraging data from our partners that can beat the diabetes clinic or the IDM that we are serving or a Walgreens Pharmacy that we contract with. We project it as out-of-pocket expenses for that patient throughout the year, while staying proactive about approaching those patients and connecting them with those cost-reducing opportunities, facilitating enrollment and ensuring that they are able to stay on. They require treatment without going bankrupt or seeing substantial financial distress. 

Q: Are you focusing on any one particular medical condition or do you cover a broad range of medical areas? 

Srulik: We do cover a very broad range and till two years ago, focused around specialty areas — Multiple Sclerosis, Oncology and Rheumatoid Arthritis. Unfortunately, the financial barrier to care is not only focused on specific areas, so our solution is completely is disease-state agnostic. When you think about where high prevalence, high-cost conditions lie, I think that Oncology is definitely one, but we are seeing the need and the ability to support across a variety of other conditions. COPD, heart failure is another kind of chronic condition example and others that I mentioned on the specialty care areas. 

Q: So, how many consumers really know about all the options available to make care affordable? This is huge information gap in the market, and you could translate that into literacy along multiple dimensions. What does your company do to bring this information to consumers? 

Srulik: Patients are indeed completely lost in many cases about not only what the treatment will inflict on their lives, but also why they should understand what we have in terms of the insurance benefits. They might have one plan or three, but what is the meaning of a deductible and a co-insurance? 

When we see patients and interact with our partners, first, we find that patients don’t have the ability to forecast or foresee what’s coming up next, whether it’s their next encounter, not to mention a complex drug regimen that can extend through a few months, or sometimes even a few years. 

That’s why, in many cases they abandon, refuse or forgo treatment or if they do get that treatment, a lot of them face a surprise bill at the end of that encounter. So, patients are not aware of the opportunities that are available for them out there, and a lot of times their providers are not aware as well. 

We look at two ways to stop that — One is providing transparency and not only to a specific encounter of what will be their next imaging scan cost, but also, what the next six months will be like. So, it’s like saying they are about to face a high financial event. But there is an out-of-pocket limit to their plan, and three months from now, they’ll probably hear that. So, let’s speak about what happens in these three months. 

If they’re fully covered for that, they can alleviate that by providing clarity to their out-of-pocket state, that’s on the transparency side. But to tell a patient, they’ve just been diagnosed and there is a very substantial out-of-pocket responsibility coming ahead without giving an actionable opportunity to alleviate that, this is where a lot of other solutions fall short. 

For us, it’s always about bringing this as what it is — their expected responsibility — but it’s with what we have found can alleviate that through either supporting their direct medical needs with pharmaceutical company co-pay assistance programs or with a foundation that can also help them alleviate some of the living expenses they have or support their transportation to that facility. It’s making sure that they see the financial impact holistically with what comes up next, but also what can be done. 

Q: Can you give us an example of how your company is actually making this work and talk about some real numbers? 

Srulik: We are working with the very different organizations and organization types. There are >100 facilities — hospitals, 350 pharmacies and 200 clinics working with our system, both on the provider side, which can be a specialty practice or a large health system in multiple regions. We also have independent specialty pharmacies like Alliance, Walgreens that we work with. For example, we are working with Providence in Oregon where they have put together an amazing team of medication assistants that basically get referrals (from across Oregon) from Providence providers — either hospitals or clinics. And their team finds financial resources or leverages replacement drug programs or feedback programs, as they call it, for their patients. 

And since we started there, we were able to increase the level of discovery of patients who may not necessarily be aware of their imminent financial distress, and introduce to them financial opportunities to bridge that gap and then, use substantial automation and predictive analytics to increase the throughput of programs that patients got enrolled into. 

As a result of that there’s a substantial win-win for patients — It removes their financial barriers to care or financial toxicity, enables their organization to collect revenues without relying on patients and decreases the cost of drug spends when it comes to replacement drug programs and leveraging data. 

On average, we see $1500-2500 in increased revenue for patients across our customer base and about $13000 of free drug programs being leveraged. These are big numbers for this system that are seeing such financial returns from our solution while serving their patients in a better way. 

Q: Is there a specific demographic that is your target audience that that can benefit the most from your services? 

Srulik: It’s a great question and one I’m asked frequently. My answer won’t be as intuitive as you think, though. When patients are indigent and might be on Medicaid, for the most part, they would be fully covered unless it’s maybe a carve-out drug. 

Obviously patients that have a very high income might be able to afford whatever is coming their way, although that’s not necessarily the case with the high cost medication, but the vast majority of the population, whether they are middle income families or individuals on Medicare, either on high deductible plans on the marketplace or by their employers or on Medicare, with high out-of-pocket limit or even without a prescription benefit plan — when most of them are required to pay more than 5-10% of their annual income, the families are not able to find those resources. 

From the patient’s perspective, this is our main audience, but this is where most of the healthcare providers in pharmacy will see the biggest financial concern from providing care and being able to fully be reimbursed from those patients. 

Q: Now we’re in open enrollment season. Is this the time of the year when your services become more relevant? How do you approach the market now? 

Srulik: Open enrollment is a unique once -in-a-year opportunity for patients to have the ability to either keep their plan or adjust, because this is where pre-existing conditions would not be an issue for them to enroll on a new plan. 

What we do there is actually take the opportunity to adjust our health plan coverage as kind of addressing the core cause of underinsurance and definitely, people who are uninsured. So, if during the year one has to keep one’s plan and there is a financial obligation that might be mitigated by a co-pay assistance program, which is a great patch, one can do that cost benefit analysis and add a supplemental plan or Part D plan or Medicare, or pay a slightly higher premium and have a higher or a lower deductible plan. This will ensure one’s better covered. End of day, the costs out-of-pocket would be lower. 

What we’re doing is, in addition to just finding financial resources for patients, we’re detecting those within the patient population that either would be considered uninsured or underinsured. And then seeing if there is an opportunity within one of the marketplaces to optimize for that patient. For example, if a patient has a cancer diagnosis, and next year, they’re supposed to have a few chemotherapy cycles and obviously visits and imaging, and they have Medicare. But Medicare A and B only without any supplemental or Medicare Advantage plan. During open enrollment, they can elect to enroll in the Medicare Advantage. That would put a cap on their out-of-pocket limit or if they have a prescription medication that is not covered by Part B, they can include Part D (as in David). This is where it gets complicated. Fortunately, this is what we do for them within the system. We offer an educational tool for their financial counselors to be able to say “this is what you are supposed to pay with your care plan. This is what you can save if you add or switch to another plan,” even without mentioning a specific point. This tells them that it’s a time of year that they can optimize for, like the next insurance period. 

Q: Do you have these educational coaches/counselors on your staff? Or do you provide this information and educate staff in your client organization — How does this work? How does your target audience get to take advantage of your services? 

Srulik: It’s a hybrid model. We see providers and pharmacies that have their own staff but where they leverage our software solution to discover patients in financial need, those with an opportunity for insurance optimization, and then, the staff educates and exposes those patients. 

Where organizations have no staff or insufficient staff, TailorMed’s complete team comes into play. We have some of the experts in financial litigation working with us and training our team to be able to support patients or the financial counselor on the provider side. That can be seen as kind of telehealth to insurance optimization. It’s possible to go on a Zoom call and educate a patient that this is an opportunity to optimize or add an insurance plan or simply give that as a printout through their provider if they are coming into a visit. There’s a little bit of both, and each organization has their own priorities on how they want to engage and accommodate whatever is required. 

Q: I think the name of your company is very clever, TailorMed. In a space with so many startups, how do you stand out? How does a healthcare organization cut through all the noise in the marketplace to understand where the value is? 

Srulik: There are two things that help us stand out. One, the abundance of solutions within revenue cycle that are coming to optimize for either a better collection experience or a more streamlined payment plan solution. These are solutions that come downstream when a patient is faced with a bill that needs to be collected. We are going upstream. We’re trying to avoid the collection attempt by leveraging other financial resources and other pockets of revenues that can help an organization be “patient first” in their mindset and try to remove that financial barrier and increase access plus have robust financial resources to avoid going after patient collections. I think that’s unique. If you think about the holistic patient financial journey, we’re starting at the very beginning, either at the point of care or after the patient gets the cure and is trying to exhaust any other financial resource. Whatever we can find in the residual out-of-pocket, it goes downstream to the very many vendors that are trying to address that. 

Second, in general, there’s an amazing pool of companies, solutions and vendors that are providing digital health solutions. It’s very hard for providers to adopt everything, even if they wanted to. What we are very focused on is how to attribute our intervention to direct financial savings of the healthcare provider or the pharmacy and then make sure that the beneficiary is, always the patient? 

There’s a very clear business case and a very substantial ROI. As one of our latest case studies showed, they are paying for their solution within the first month or two of adopting it. So, the ROI is there and then, they are managing workflows, automatic productivity tools. But there is a very substantial attribution to financial statements. 

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 must embrace the cloud. That is where all the technology innovations are happening

Season 3: Episode #102

Podcast with B.J. Moore, EVP and CIO, Providence Health

"Healthcare must embrace the cloud. That is where all the technology innovations are happening."

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this podcast, B.J. Moore, EVP and CIO of Providence Health discusses the organizational structure at Providence to drive transformation and how he draws on his 27 years of experience at Microsoft to drive change. 

Moore explains his vision to leverage emerging technologies such as cloud and voice recognition to support healthcare delivery, improve patient experiences, and increase caregiver productivity. He maintains that it’s important to partner with leading technology firms to create robust platforms to drive digital health.

Moore discusses Providence’s investments in digital health innovation and advises digital health start-ups to focus on consumer experience. Take a listen.

Our Podcast Partners:    

Show Notes

00:35What are the top two or three things that occupy your mind these days?
01:24Your colleague Aaron Martin was also my guest a while back. How does your role complement his, specifically regarding digital transformation at Providence?
04:22Can you share examples of innovative use of technology that you’re using to drive the organization forward in this transformation journey?
07:19 You've recently come to healthcare. Tell us about your first impression and how that has changed over the past one and a half years.
14:22 What are some of the challenges that inevitably startups are going to face?
16:00 What about the big tech firms?
20:01 What's your advice to the digital health startups?
20:51 Apart from voice and AI, what else are you keeping an eye on as a technology trend to watch?
23:37 What's your advice to other CIOs who are listening to this podcast, who are not from a Providence type organization or from mid-tier healthcare organizations?

About our guest

B.J. Moore is Executive Vice President and Chief Information Officer for Providence. He leads information services to support and enable the way Providence advances its Mission to deliver health for a better world. This includes partnering with other leading organizations in areas such as cloud computing and artificial intelligence (AI).

B.J. has an extensive background in leading initiatives for digital transformation, enterprise cloud services, strategic planning, operational strategy, and analysis, and guiding large-scale projects and teams. He holds multiple CIO and leadership awards.

Previously, B.J. served in multiple executive leadership roles at Microsoft, including Vice President of enterprise commerce and compliance for cloud and AI; Vice President of enterprise commerce for the windows and devices group; Vice President enterprise commerce IT.

B.J. holds a Bachelor of Science with Honors in business administration, finance/marketing, from Colorado State University.

Q: You’re the CIO of one of the largest and most complex health systems in the country. What are the top two or three things that occupy your mind these days?

Moore: One is obviously the pandemic and the things that come with that — how do we keep our communities safe and our caregivers productive? Then, the tools that come with that –remote care delivery, big data, modernizing. We’ve got a lot of technical debt here at Providence and so, we’re unable to be agile and innovate as we’d like. Those are probably the top three things on my mind now.

Q: Your colleague Aaron Martin was also my guest a while back. How does your role complement his, specifically with regard to digital transformation at Providence?

Moore: Aaron and his team create the marketing brand, so, anything that’s kind of external patient community-facing, they own. And they own the front door for that patient experience. So, things like online scheduling, for instance, and anything that has a broad marketing brand front-door as it relates to Providence, is really Aaron’s team.

The handshake that happens when that front door is open is with my team. So, the actual infrastructure and digital assets – EPIC and its scheduling — happens in my space. All the caregiver tools that nurses and doctors use to deliver care is also on my team. All the other stuff, such as network and cyber are on my side along with the administrative tools and systems that support Providence. Once the front door’s cracked open and the handshake happens with my team, it’s a good partnership.

Q: For large organizations — Providence or Mayo Clinic — what I see is that from an old model standpoint, digital is really driven by a handful of senior executives working in collaboration. Is that almost the default model to move a big ship like Providence?

Moore: The strategic intent comes from this handful. But digital transformation includes basically everybody at Providence and within the Digital Innovation Group — everybody along with our caregivers. As far as setting the strategy, tone, direction, phases and approach goes, it’s Aaron and I that define that strategic intent. It is a huge effort.

Q: Can you share examples of innovative use of technology that you’re using in your world to drive the organization forward in this transformation journey?

Moore: There are two partnerships that we have. The technology we’re using entails to deliver better caregiver productivity. We’ve been partnering with Nuance and their DAX tool to work with ambient Artificial Intelligence (AI). It’s common knowledge that the biggest burden for many caregivers is really annotating, adding to the EHR, so, anything we can do to improve that experience for them especially during a pandemic and labor shortage, has been critical. Leveraging very nascent, ambient AI has been crucial. But how do you listen to a conversation and really have AI pluck out the necessary components and add that to the EHR while ignoring the rest of the chitchat in the room? That’s one of the pieces of innovative technology we’re using.

Second, we’re really aggressively moving to the cloud. All of the innovations are happening in the cloud now and our deep partnership with Microsoft enables us to move all of our data centers, assets to Microsoft Azure. That’s where it’s really paid off. During the pandemic, we built our big data model there. Once that’s in the cloud, we’re able to do machine learning and AI to predict the use of ventilators, PPE surges as COVID progresses etc. It’s a strong model which, within two weeks’ advance notice, can help tell us when a community will surge or pull back. These emergent technologies have been invaluable for us to navigate COVID and have helped us really deliver on that vision.

Q: The cloud is right there at the forefront of innovation in healthcare. Nuance is now part of Microsoft, and you too had a partnership with Microsoft. So, did all this make Nuance an easy choice?

Moore: We’ve been a Nuance strategic partner for a decade. Before the acquisition, we were already in a three-way partnership with Microsoft and Nuance to really look at AI. That made it easier as did my 27 years at Microsoft, my last role there was as part of the Azure team. So, my network is strong there and maybe I do have a bit of an advantage over the other CIOs. Many CEOs have been at Microsoft for 27 years and worked on Azure. So, I’d say all of those facets made the partnership easier.

Q: With 27 years at Microsoft, you must have seen a number of different industries. You’ve recently come to healthcare so tell us about your first impression and how that has changed over the past one and a half years you’ve been here.

Moore: I joined Providence about two and a half years ago, and initially, healthcare was really far behind. My observation of healthcare was the industry was 15 to 20 years behind other industries as far as using technology. Providence was further behind or further ahead than everybody else. And my assumption was based on the fact that they were change-averse; maybe just slow to adopt change and that’s been my biggest epiphany through the pandemic.

In the last 18 months, we’ve adopted more change at Providence and accelerated things more than we ever did at Microsoft. We always think of tech companies as agile and quick but we’ve moved quicker than I ever moved at Microsoft. We’ve accepted more change than ever.

Q: I wanted to touch on recent partnerships — Truveta, for instance — where you’ve you talked about AI. This one’s really the big head call for driving those kinds of initiatives. What’s the reason behind it?

Moore: Truveta was really a white paper, an idea that Providence had over three years ago, internally. But we realized the power of something like collecting patient information, voluntarily and being part of this kind of a study and anonymizing that data. But realizing the power of it was really about getting other health systems involved as well. So, we created Truveta. We were the founding members and now there’s over 17 other health systems involved and owing to that, the value is getting large with diverse datasets. We have complete coverage across the United States and having that breadth of data and the diversity of individuals really allows for better insights.

If you know anything about big data, the bigger the data, the better the insights of AI and ML. We’re just at the early stages but we’ve got some really good early insights on things like vaccine efficacy that wouldn’t have been possible before Truvada.

So, we’re really proud of what Providence did to help form that and I’m just amazed to see the progress that Truvada has made. You know, they’ve really hired a great leadership team and a great set of technologists to do some good work.

Q: Truveta also helps drive your own destiny with data and you can get your EHR system to pull it with other data. But when you bring your own data science capabilities and drive your own insights for your own outcomes, was that a move to go in your own direction, at your own pace?

Moore: There are a couple of things — Truveta being owned “by other health systems” being one. So, health systems owning the patient data and being stewards of that data was certainly a big part of it. We took a different approach with Truveta — instead of partnering with a tech company to do this, we basically created Truveta, who hired tech executives to drive it. We got access to that tech talent which was really aligned to the mission work we were doing at Providence and the mission work with other health system. So, it’s been a win-win.

I’ve got great engineers, attracted great talent, but frankly, the talent that Truvada’s been able to attract, you know, is at par with any tech company. We’re stewards of our patient data but we’ve got access to engineers that we would just not be able to touch within healthcare.

Q: Exciting! Providence has also incubated tech companies, partnered, invested in others, been deeply involved in the innovation ecosystem as investors and deployers of technology. How do these innovative new technologies – mature or not as well built-out as you’d like them to be — work? How do you sift through to the ones that have a shot at making an impact on Providence and then, stay for the long haul?

Moore: The first thing is to identify the patient or the caregiver’s experience that we’re trying to fix, where the existing ecosystem isn’t filling that niche. Then, once the area to innovate has been identified, the Digital Innovation Group starts to incubate that work. My team becomes Customer Zero. How do we jointly develop those solutions with Digital Innovation Group to ensure it can meet the needs of a health system? It’s always done in a way knowing that’s going to be spun out and the value would be Providence being just one of 30 or 40 customers. It’s an opportunity to innovate and to fill a niche that isn’t being served by others in the industry. It’s a really unique opportunity to spin these companies out and have them be standalone entities. So, it’s definitely a journey.

Like any incubation process, there’s some things that work amazingly and one hears about them. If they’re disasters, we don’t let anyone know about them. We just quietly — fail fast and move on to the next innovation opportunity.

Q: What are some of the challenges that inevitably startups are going to face? What do you look for them to cross before you can feel reasonably confident? Is it integration, interoperability, workflow?

Moore: My experience, especially coming from tech is that tech individuals seem to feel like they have all the answers. So, it’s one thing to be competent, capable and confident. You know what you want. I guess what I look for early on is a partner that’s willing to listen and learn, know what they don’t know and willing to partner and really use us as a subject matter expert. It’s like we think this is a problem to solve and we think we have a solution, but it’s got to be give and take. It can’t be that they have all the answers and we just accept it.

So frankly, a lot of it has more to do with the partnership aspect versus the tech. Is it really a give and take? Does it have access to our clinicians or expertise? What works or doesn’t work in the real world? Its important to have a partner that’s willing to listen to that and flex; really introduce a design-thinking approach and then, it depends on the solution. Do we integrate three API to something like EPIC? Do we build new interfaces? While those things are more technical in nature, frankly, technical things are pretty easy to solve. It’s more of whether it solves a business problem or not or if it’s a great patient or caregiver experience and whether it meets the needs of Providence or another customer that’s critical. So, I’d say it’s the software things versus the technical things.

Q: What about the other end of the spectrum — the big tech firms?

Moore: I won’t pick on one of them because they’re all partners. I’ll keep it generic. In general, they tend to follow what Matt Campos started with — “We know it all. We’ve solved this problem already. We’re going to come into health care. We’re going to change the world.” Sometimes that kind of fresh thinking is really helpful. That’s how innovation happens. But a lot of times, these problems haven’t been solved. If they were easy, they would have been solved a long time ago. So, it’s maybe a little too much hubris on the part of these companies. Those tech partnerships where they’re more in the listening and learning modes — those tend to be more effective, and some tech companies do it better than others.

Q: With regard to the startups, the digital health ecosystem is awash in new companies and there’s billions pouring into it. What’s your take on this digital landscape? Is it too much fluff or are you seeing some really interesting ones that will transform care as we know it?

Moore: Let me give you a context before I answer that. What I describe when I’m recruiting other tech executives is to imagine it’s 1995. The internet is coming along. We’re talking about how amazing it’s going to be with AOL and MSN, and the browser wars that will get kicked-off. That’s where I feel we are in health tech. It’s a bit crowded right now, it’s not crystal clear who the winners are going to be but when we look back five years from now, it’ll be similar to 2000.

We’re just in the really early phases. There’re a lot of players and frankly, there should be more players in this space. I think the opportunity for innovation and impact are huge and it’s a numbers game. For every hundred people that dabble in the space maybe five succeed and those five to succeed will transform the way we deliver healthcare. I guess that’s a non-answer, but maybe having a context for where we are, gives people an idea of the level of maturity and the opportunity that lies ahead.

Q: That’s a great analogy! With regard to these startups, they all want to work for Providence but Providence can only work with so many. So, when they approach you, what’s your advice to them?

Moore: Healthcare has not undergone their own kind of consumerization of the experience. So, my advice to these startups is, if you are at the forefront of that consumerization, you think about what travel was like before Expedia, or what taxi-ing was before Uber. It’s a similar kind of metaphor for healthcare. If you’re playing in a space that makes patient engagement, access to healthcare easier or smooths navigation of this complex system, enables our health systems to manage patients and ensure better patient outcomes and solve real business problems, that’s fine. But through that lens of consumerization, what we don’t need is more complexity in health care. If you’re adding complexity, even if it’s solving a problem, I’d say that’s not a good match to be in.

Q: What kind of technologies are your betting on except voice and AI. What else are you keeping an eye on as a technology trend to watch?

Moore: AI is still in its formative years. Most people all over use AI, including in this conversation. We’re still at machine learning, not at true artificial intelligence. So, if it’s a 30 year journey, we’re on year two –still early on. And as far as technology trends we’re looking at is concerned, what became evident during COVID is this remote patient delivery tech like telehealth, remote patient care etc. What I see really emerging and transforming is the Internet of Things, especially medical devices.

We served over 20,000 COVID patients from home. If you could send somebody home with a smart pulse oximeter, a smart temperature gauge that was uploading that telemetry real-time to the cloud, really building real-time big data models for each patient, that’s where ML and AI can really shine, real-time monitor patient’s changes in behavior, start comparing large patient populations, start seeing trends that we, as human beings can’t. These are COVID patients that had good outcomes early on and that’s what they look like while patients of bad outcomes look different – such differentiation can be undertaken. These are things that are uncommon.

Those building blocks start with Internet of Things, streaming real-time data to a big data model and then, unleashing the power of ML and AI to change the way we treat both, individuals and communities. To me, that’s really where the innovation needs to happen, in day-to-day care. We’re going to always make innovation-progress there, but we’ve been working on that problem for under 200 years or a millennia depending on when you start counting. They’re really using big data and managing individuals or communities with big data and ML and that’s three years old. So, there’s an opportunity to have an impact — much more opportunity for innovation on that front.

Q: What’s your advice to other CIOs who are listening to this podcast, who are not from a Providence type organization or from mid-tier healthcare organizations?

Moore: My advice is to embrace the cloud. All the innovations for tech companies happen in the cloud. If you’re staying on-prem with on-prem software, you’re stuck. You don’t have the scale, the performance, and you’re not getting any of the innovation that you could get by moving to the cloud. So, embrace it; it’s real. That’s where the power is going to be. That’s where the tech innovation is happening.

I talked to a lot of CIOs that are still debating if the cloud is the right place to be or the right place to put patient data. And unfortunately, every day they pause on that decision, and those are the days they’re not innovating.

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.

Data is the key to simplifying complex operational processes in digital healthcare

Season 3: Episode #101

Podcast with Jason Considine, Chief Business Development Officer, Experian Health

"Data is the key to simplifying complex operational processes in digital healthcare"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this podcast, Jason Considine, Chief Business Development Officer at Experian Health, discusses the critical role of data in digital healthcare systems. He explains why organizations as data collators must first understand data privacy and security, adhere to regulations, and then use that data to better the situation for stakeholders in the healthcare domain. Experian is a data and technology company that transforms data into meaningful analyses to help people across the globe make smarter decisions – for themselves and their businesses.

Consumer-permissioned data offers valuable insights on the social determinants of health, such as access to food, transportation, and the need for financial support, in addition to patients’ physical ailments. Therefore, Jason maintains, it can be a valuable resource in reducing medical bankruptcy, developing financial assistance programs, and ensuring that the patients can focus on getting better rather than being burdened by bills. Take a listen.

Our Podcast Partners:    

Show Notes

00:37About Experian Health.
02:06How is Experian data used in the context of healthcare and how do you ensure privacy when using consumer data?
08:43Can you talk about your recent research on consumer preferences for access to care in the immediate wake of the pandemic last year, its highlights, and what are some of the trends that’ve evolved between last year and now?
17:41 Based on the data you have; do you see any differences between consumer preferences based on their demographic profiles?
23:24 Who are your primary audiences for the data? What are the challenges you encounter when you try to integrate data to target these kinds of interventions?
27:49 What would you say to healthcare executives when it comes to the opportunity to use the data from Experian Health? What should they consider ensuring they're staying within the norms?
30:42 What is your advice to healthcare organizations or policy makers when it comes to using your data for serving public health and social causes?

About our guest

Jason Considine is the Chief Business Development Officer at Experian Health where he is responsible for Corporate Development, Innovation, the Patient Collections product portfolio. Leveraging his diverse background in sales, business development, product management, and operations, Jason is responsible for driving the organic and inorganic growth of Experian Health.

Jason has previously held the following roles at Experian Health: Senior Vice President & General Manager – Patient Access, Collections & Engagement; Senior Vice President – Patient Collections & Engagement; and VP – Sales & Business Development.

Prior to joining Experian, Jason held sales, business development, and sales leadership roles at WebMD Practice Services, Emdeon Practice Services, and Sage Healthcare. 

Jason has a bachelor’s degree in science from Texas Christian University.  

Q: Experian is known globally as one of the big credit bureaus in the world. Tell us a little bit about Experian Health.

Jason: We’re certainly part of that large global organization but our focus at Experian Health is around simplifying the healthcare system for all the stakeholders, patients, providers, and payers. Experian has thousands of healthcare facilities across the United States that help simplify the operational complexities of healthcare.

We look at it from the time the appointment is scheduled by the patient all the way through the claims being filed to the payers and the money being collected from the patient. There are solutions to simplify that process for all stakeholders and some of the things being done with data in this new age of data and understanding patients more precisely is also an exciting opportunity for us in how to simplify healthcare.

Q: With reference to the use cases, you just mentioned in terms of how Experian data is used in the healthcare context, could you explain how you ensure privacy when using consumer data?

Jason: As a data and technology company, Experian Health is no different. The Experian data is core to all its products and services that are delivered to the healthcare industry. This helps make these experiences — for providers and for patients — simpler. So, right from scheduling an appointment all the way through that collections process, Experian data is involved to make it better for all the stakeholders.

From a data and privacy perspective too, it is paramount and core to everything. This just ensures privacy, security and protection of that data. That’s a big part of what we do in the health business, and what Experian does globally to ensure that as a company, it is compliant not only with the regulations that exist and all the different markets that it serves, but that it adheres to a very high standard of ethics and standards as well. And that extends to how this data can be used and leveraged in the healthcare setting.

Q: Your use cases with regard to data, are more to do with the revenue cycle payment integrity type situations. How do you use this in the context of clinical operations? Also, there’s substantial interest today in the social determinants of health so your demographic data is very pertinent here. How is your data used in that context, if at all?

Jason: It is an important part of the clinical setting and becoming increasingly critical. Experian has access to a lot of consumer-permissioned information. That’s one thing that sets Experian apart from its competitors and the industry – not just permission from the consumer but that the data is identifiable to a consumer – and that has a lot more value to a healthcare provider than this de-identified kind of aggregate cohort data.

This is very helpful in making decisions about, for instance, if somebody has access to nutritious food and if they are diabetic patients, then, many providers do help patients get access thus moving them onto a better track. However, if these patients don’t live in a community where they have access to nutritious food, it’s going to be difficult for them to remain compliant with a physician’s directions on how they get better.

Experian has healthcare providers who can see that and by using some of the consumer-permissioned data, are actually prescribing food to patients. If they can’t afford food, then they are given some financial abilities to go procure that food.

Such data helps understand a patient’s propensity to, for instance, adhere to their medication and even access transportation. One of the things that’s very interesting in some of these data studies is that many times, the patient leaves the facility and part of their treatment program is to come back in for rehabilitation. But, if they don’t have access to transportation or can’t afford transportation, then they’re unlikely to return and avail the rehab services they need. This could cause adverse downstream impacts on their condition and prove more expensive to the patient and the healthcare system.

A good solution understanding that is potentially offering a pre-paid rideshare type of a program to patients which can ensure or increase the likelihood that they’re going to return for some of those follow-up visits. There are lots of really interesting ways that some of this social determinant, non-clinical, socio-economic type of data can help providers understand other attributes of how a patient lives and how that might impact their overall wellness.

Q: Great examples! One important point you’ve mentioned is that of consumer-permissioned data and it’s critical because it enables effective targeting of investments. Your firm did some research recently on consumer preferences for access to care in the immediate wake of the pandemic last year. This was updated this summer. Can you talk about the research, its highlights and what are some of the trends that’ve evolved between last year and now?

Jason: The original reason for the research is that consumers have a different level of experience when it’s about non-healthcare work. Everything people do with Amazon, for instance, even a simple thing like going to get a haircut – can be scheduled online. But healthcare is a very different experience. The pandemic forced people to adopt new technology, and there was a big advancement in the adoption of digital solutions – something the research really spelled out.

Even this move to what we call Generation C — we’re all a part of Generation C — but this kind of expectation — as the pandemic’s still on — and going forward, around access to more convenient solutions in the healthcare setting is just a few things that is highlighted by the survey.

It was found that 78% of patients wanted the convenience of 24*7 self-scheduling, but only 40% of providers currently offered that service. There’s a big opportunity for providers to continue to improve in that area, and they agree. We surveyed both patients and providers, and they said that patients are 30% more likely to prefer online registrations. So, they’re seeing some of that in their own feedback they’re giving to us and they’re getting better.

90% of providers reported that improving the patient experience was one of their key top priorities. As the effects of the pandemic on all consumers becomes clearer, it will be noticed that providers will have to continue to improve that patient experience.

We’ve all scheduled online to go get a COVID test. I went to a conference a few weeks ago and digitally uploaded my vaccine card and moved through the process, digitally, to register and check-in for this conference. There are providers doing all this across other aspects of our lives but consumers may not want to go backwards. I think the expectation is that providers are going to continue to offer a way to do business with them in a digital setting that’s more convenient to the patient.

Q: I’ve actually read through the report and there are some fascinating insights in there, but quickly, what is Generation C?

Jason: Generation C was a term coined by a leader of a large financial institution and it’s this generation of consumers and people that are being affected by COVID. We’re all part of Generation C — this younger generation of people engaging in their care that this is kind of the first experience they’ve had.

Q: Your research findings show that consumers want the convenience of online or digital access to care and providers know that they must provide access. But you’ve also found providers cutting back on this. Explain that.

Jason: I think there’s a discomfort still out there with providers. For example, a lot of providers have very customized views of how they schedule appointments into their day and some people are very specialized providers. As they start opening businesses, patients either come in or defer services or only come in for COVID-related treatments or maybe post-operative visits on a certain day but a sub-specialist may want to ensure that patients they shouldn’t be treating aren’t ending up on their schedule.

Those are complicated business problems that digital solutions may find tough to manage and there is a concern with providers that they don’t have everything in place to manage this at scale on a go-forward basis. But there’s some revert. The technologies available have the ability to customize things and provide this experience that consumers want.

It’s important to impress upon providers that they partner with vendors and check the capabilities of the solutions because they can work together to improve the situation for patients and providers. It can actually provide a lot more control and opportunity to make it easier for providers to do business with. But that’s my take.

We were forced into this by the pandemic and now that things are going a bit back to normal in certain parts of the country, some people are reverting to the way things were before. We need to stay the course and continue to evolve as the health care ecosystem while providing patients and consumers what they expect.

Companies like Experian that offer these solutions have a certain responsibility to ensure that they are easy to implement and support the provider communities through that process because change is hard. It’s not just about installing a piece of software but there’s a lot of work and consultation that must be done between the technology provider as well as the provider to make sure that it’s done right.

Q: Based on the data you have; do you see any differences between consumer preferences based on their demographic profiles? About millennials, conventional wisdom holds them to be digital natives as they’re very amenable, but the reality may not be as simple and straightforward. Any comment?

Jason: There are differences and I’ll give a personal example. My mother is 70 years old and she is one of the most digitally-savvy people that I know, and she engages with her provider online. We see different segments of the population and people have different personal preferences. That speaks to the power of that consumer-permissioned data.

One has to be careful when looking at large cohorts of data or cohorts of populations because there are segments and individuals within those cohorts that prefer different things and providers have access to information that can really allow them to engage with people, in a personal way, and provide the right solutions to attract the right kind of market to their unique personal preferences.

Q: Now, about the consumer data industry. One of your competitors, TransUnion Health, was in the news recently on getting acquired by a larger organization on the revenue-side. While you mention a better understanding of consumer profiles to improve payment integrity, what’s driving that interest in consumer data today when you look across your client profile?

Jason: It’s a fascinating time and I think the clinical providing better care is certainly driving a lot of interest in consumer data. I mentioned social determinants, but when I put consumer data with clinical data and derive insights from that, it’s still early innings of understanding what’s going to be possible with the combination of all these data sets. When I add genetic data to that, there will be different types of results that will emerge from this analytical era we’re in and enable understanding of better ways to take care of patients. But it extends way beyond that.

Think back to just a few years ago and even today, largely, patients are treated very uniquely in the clinical setting. Every other thing that they experience from a provider is pretty standard – the same bills and similar marketing techniques and so, the experience doesn’t feel very individual and it doesn’t have to be that way.

Now, data is being leveraged significantly to understand, for instance, that, this patient has a unique financial situation, and perhaps, shouldn’t get billed $5000 because they qualify for our financial assistance program. If the provider knows that up-front, a patient’s outcome may be very different. They don’t get a $5000 bill but are offered financial aid upfront. So, patients can then, focus on getting better and not worrying about how they are going to put food on the table.

That information and being able to provide a personalized financial, administrative experience and even how to market to patients is an interesting learning that emerged through the research at the beginning of the pandemic.

There were huge job losses and people were moving to different parts of the country to find work. After that, and even during that same time, online work boomed. So, if one didn’t need to go into the office, one could also move and work from anywhere. As a result, there was a lot of moving and so, providers found themselves with a bunch of new patients and the communities they served. Understanding who those patients are and how they can reach out to them and get them in for care was important.

Maybe they deferred visits during the pandemic or just came in for four different wellness visits or perhaps even attracted new patients, but the point was to grow as a provider and a business in the community. There are considerable opportunities to leverage data to be very precise about how one can identify those people and then, reach out to them and get those patients into one’s health care system.

Q: Let’s talk about hospitals and health systems. Who are your primary audiences for the data? What are the typical challenges you encounter when you try to integrate data to target these kinds of interventions?

Jason: All stakeholders are often impacted and in a decision around data, there are use cases that are more marketing centric. So, we approach the Chief Marketing Officer. The CEO, CTO, CFO and CIO are also often very important buyers/stakeholders within a health care organization. That’s because one of the things revealed by the research was, improving the patient experience was a key organizational priority.

So, this decision to use data to get smarter about how best to engage patients is something happening all the way up at the highest levels of organizations and there are plenty of challenges and opportunities — around data privacy and understanding how this data is secured and used — encountered along the way.

We’ve talked about data and experience rolling data. Organizations are trying to understand how data is governed in use by companies like Experian. It’s a tough place for hospitals to be in, because this data market – the consumer data — has been around for a long time and is used in a lot of different industries. It’s an incestuous market – there are data brokers that buy data from other data suppliers, who buy data from other data suppliers. But by the time a health care organization gets hold of data like that, who knows what the consumer really gave access to?

That lends a kind of creep factor component to data. The question that must be asked is how is that data something one should be using? How is the vendor treating the data? How is my data going to be treated – will the vendor sell my data?

We work really hard with our health care and hospital customers to ensure everybody’s comfortable with how the data is secured, how it’ll be used and help drive these specific use cases. We reassure them that we’re not just going to go and market their data to a data broker. These then are the challenges we work through from a security and compliance perspective.

Then there’s operationalizing the information – and that can be a challenge to really be impactful. The data needs to get to the right person in the right spot of the patient journey to make an effective decision or if it’s the patient themselves, give them the right solution that they need to engage with it, irrespective of where they are in the health care journey. Ensuring that we have the right integrations and getting access to the right person at the right point in the journey is a really important part of the process as well.

Q: Some very good points there. What would you say to healthcare executives listening to this podcast when it comes to the opportunity to use the data from Experian Health or anyone else in intervening either in a marketing, financial or medical context? What should they consider ensuring they’re staying within the norms?

Jason: Great question! We like to bring privacy and compliance to the start of the conversation because that’s the first thing we discuss, and you have to ask the right questions. If you’re an executive, then, and a health care organization, then you must know where the data comes from. Experian’s data is consumer-permissioned, and that’s important. We spend a lot of time, energy and effort, in not only securing the data and ensuring its privacy is all within our control, but also that we have timely access to it. So, we have a direct relationship with the consumer.

If the consumer decides to stop sharing that data, we maintain that relationship with the consumer and we put that into place efficiently and effectively. We can also maintain and promise freshness of the data while adhering to the governance around that. That’s what we offer as a data supplier. Organizations need to ask those questions and understand where the data organization they’re working with, is getting the data from and how they are procuring it. How’re they maintaining it? How’re they managing consumer positioning?

These are as critical as understanding what data we’re going to be combining with that consumer data to draw new insights and how our partners may be leveraging that information. I would recommend they bring privacy compliance in that discussion earlier in the process because it’s as much or more important than operationalizing and just building the insights on top of the data.

Q: Now, the consumer data from organizations like Experian Health can be a force for good, especially when it comes to improving health equity or healthcare affordability health care outcomes, especially for underserved or vulnerable populations. What is your advice to health care organizations or even policy makers when it comes to using your data for serving public health and social causes?

Jason: Great question! When I think about who we are as a global organization, it’s all about the experience. And how we can use our data to try to make consumers’ lives better. It’s no different in health care and so we access this consumer information and data which when combined with health care information helps us do so many great things.

They can tell us when a patient lives in a community and can’t afford or access nutritious food. That can help us understand when patients are likely to remain non-compliant and take other medicines. It can help us understand when people can’t get access to transportation to even get to the doctor. We’re seeing that drive awesome innovation inside of providers on how they can get people access to food. Maybe they’re going to send nurses out to peoples’ homes for some follow-up work if they cannot afford the trip to the clinic or take a day off to do so.

There are awesome opportunities to use data in that clinical setting. With health equity and consumer data, we know who can afford health care and who can’t before they even come in for their visit. There’ve been a lot of studies on the fear of how you’re going to pay for your bills at the end of a cancer treatment regimen and there are horrible things that people do because they are fearful of how they’re going to put food on the table and how that may impact their families.

Medical bankruptcy is one of the largest causes of bankruptcy in the United States so, we use data as a force for good and get people into financial assistance programs and remove that burden from their head so they can focus on their treatment and getting well. Those are all things that this data can be used for — to make health care better for all stakeholders — patients, providers and payers.

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 is time to focus on a collaborative innovation model in healthcare

Season 3: Episode #100

Podcast with Unity Stoakes, Co-founder and President, StartUp Health

"It is time to focus on a collaborative innovation model in healthcare"

paddy Hosted by Paddy Padmanabhan
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In this 100th episode of the podcast, Unity Stoakes discusses about their life-long mission to improve people’s health and well-being worldwide and how the healthcare landscape has witnessed significant changes over the last ten years.

Unity maintains that by combining the powers of moonshot thinking, a transformer mindset, and collaborative communities, healthcare companies can reinvent the future of health. Health systems should lean towards early-stage innovation, experiment, and then really think about developing an innovation stack in the context of care delivery and better outcomes.

Unity advocates leveraging technology to build a cohesive health care segment where doctorpreneurs and clinicians can together transform organizations using the enormous capital and talent at their disposal. He also advises digital health start-ups to have a persistent and resilient mindset to thrive in the industry. Take a listen.

Note: StartUp Health has recently launched the StartUp Health Moonshots Impact Fund. For more details, visit here.

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Show Notes

01:29About StartUp Health.
03:44Can you talk to us about your new notion of moonshots?
06:54Can you talk to us about the funding environment?
12:44 What's happening to all the startups who are raising all this money?
16:38 Can you talk to us about a couple of your success stories?
20:10 What do you think are the big gravitational forces that are holding back innovation?
24:11 What do your portfolio companies say about their challenges as they build their products?
27:40 What’s the competitive landscape looks like now? Can you comment specifically on big tech and their role in this emerging opportunity landscape?
30:59 If you had something on your wish-list for health care regulators, especially in the digital health context, what would that be?
32:57 If there’s one thing you wanted health systems to do to accelerate innovation?
35:58 What is your advice to the digital health founders?

Q. Tell us about StartUp Health — the story and the one thing you’d consider a proud accomplishment.

Unity: My business partner, Steven Krein, and I co-founded StartUp Health ten years ago. We had a very basic concept that revolved around organizing a global army of what we call Health Transformers. These are the entrepreneurs and innovators reinventing or rebuilding the future of health. We thought, if we got enough of them together, it could transform or achieve some of the biggest health moonshots — big global challenges — of our time.

For the past ten years, we’ve been investing in and mobilizing a global army of entrepreneurs. We now have 400 companies from across six continents and 26 countries — all working on different aspects of health innovation in our portfolio — and we’ve mobilized this ecosystem and community of innovators to work on global challenges like delivering access to care to billions of people, reducing the cost to zero, ending cancer or even, curing diseases like Diabetes and Alzheimer’s.

But as I step back and reflect on what we’re most proud of, it’s just focusing on a vision around collaborative innovation. I think one of the great challenges of healthcare as an industry for the past 50 years or more has been its siloed nature. So, just focusing on a collaborative innovation model is ultimately what I’m most proud of and look forward to.

Q. Tell us about your new notion of Moonshots. What are these?

Unity: They’re connected to the UN’s Sustainable Development Goals around Health and Wellness and we set out to tackle 12 global health moonshots. Each of these can impact at least a billion people by 2040, and we expect to be working around delivering quality care to every human on Earth – note that there are five billion people without basic care right now — and reducing that cost to zero. So, rethink the business models around care the same way we’ve seen the tech world do with things like entertainment or travel or telecommunications.

We have a women’s health moonshot, a children’s health moonshot, a mental health and wellbeing moonshot and two years ago, we launched an addiction moonshot. More recently, a pandemic response moonshot was launched not just for COVID-19, but also to mitigate and manage future pandemics. We believe that all these moonshots are quite interconnected. For example, you can’t achieve longevity without focusing on curing disease or reprioritizing women’s health or children’s health. So, we take a very holistic integrated approach.

But the magic happens when you align a whole ecosystem and a group of innovators around a singular mission and then get them marching collaboratively towards it. Our thesis is that we can speed-up the innovation cycles and learn what’s working or not working. We can share that knowledge and those insights, tap into network effects and ultimately, speed-up progress, manage innovation cycles efficiently and more cost-effectively than ever done before.

Q. What about the funding environment? Twenty billion dollars in the first half alone and all indications are that this is going to be another blow-out year. What do you make of this?

Unity: A decade ago, when we started, there was less than a billion dollars being invested in digital health or early-stage health innovation. We’ve seen over $20 billion for the first half of this year, and after Q3, it’s closer to $30 billion. When you add a lot of the money flowing in globally, we believe that by the end of the year it will be closer to $40 billion. In some ways it’s exciting and surprising.

However, the big question we’ve had up until a pandemic or two years ago is — why isn’t more investment flowing into this sector when it’s a $10-13 trillion global market? In a lot of ways, we believe that there’s still not enough capital flowing in, even though it seems like we’re exponentially scaling.

There’re a lot of smart investors moving into the space in a lot of ways from outside of the healthcare market – SoftBank, Tiger Global, Sovereign Wealth Fund etc., not only healthcare companies but retail, consumer and technology, infrastructure, services, digital health, new diagnostics and med-tech and consumer health companies with direct-to-consumer business models, and everyone’s leveraging technology, data, design innovation, business model innovation. The scope is broad for what we’re seeing now. The past decade has been all about building ecosystems, attracting new streams of capital, bringing new innovators and entrepreneurs into the sector. And now there’s so many new entrants across sectors.

I would argue that Apple or even Dollar General have been doing a lot of interesting things over the years and they’re clearly becoming healthcare companies like some of the retailers — Walmart, Target, and Safeway. It’s just a really exciting time with some trends to watch out for especially with a new generation of innovation happening. I would equate it to being in the second inning of a wide, open market opportunity.

It’s an exciting time to be an entrepreneur and investor in this space as well as a strategic company thinking about their opportunity within the future of healthcare.

Q. There’s a lot of innovation and a Cambrian explosion of digital health startups but the landscape is highly fragmented and clearly not everyone will make it. What’s happening to startups who are raising all this money?

Unity: It’s a great question pointing to exciting trends of some of the newer companies – infrastructure companies –which, over the last 2-3 years, have been trying to be integrators of a very fragmented market. So, if you’re a health system, it can be really confusing when there’s a plethora of solutions trying to do business with you or provide some solution for your system.

But one of our companies, for example, Particle Health, is doing what Plaid did to the financial services market — created an integration layer, so, the financial services companies could plug into that. Particle Health is doing for the data layer something similar to what companies like Komura or Zeus have done — a platform approach that others can try to build-off of.

The tech domain has seen this for decades where Apple would have built a developer’s kit or an app store that others can build on. The same thing is now visible in healthcare. So, the fragmentation of the past decades has been good because there’s been thousands of experiments going on. I would equate this to 1990 for internet and web, when the business models were not clear. They were just figuring out this thing called eCommerce or CPM advertising models. It was very early and there was a lot of different innovation. Now, it’s clear there’s market opportunity, great innovation taking place and accelerating.

By developing new frameworks, things will hopefully speed up so others can start to build on top of these. That’s why the second inning is going to be even more exciting than what we’ve seen over the past 10 years. While there’s been a lot of exciting experimentation going on, what everyone’s looking for now is the impact — where are the results, where are the outcomes, how is this really helping patients or how is this really helping to reduce costs?

What we’re starting to see is like telehealth companies, which are demonstrating to a health system either how they can more efficiently or effectively deliver care during a pandemic or even post-pandemic. So, I believe, the outcomes of the next wave of innovation resulting from all these investments of the past decade, will start to have more quantifiable results.

Q. You’ve had a few significant exits, recently. Do share your success stories for a sense of what’s coming out of Startup Health?

Unity: I’m so proud of our 400 companies — our health moonshot companies. Some are familiar names — Devoted Health, City Block, Vertu Health. Most recently, Conversa was acquired by Amwell. Doctor.com was just acquired by Press Ganey. And then, we have an exciting blood diagnostics company out of Europe called Nightingale Health that went public on Nasdaq in Europe.

Getting back to your first question, I’m proud of the diversity of innovation that we have across our portfolio which spans region, country, business model and subsector. There’s a magic to that because when you cross-pollinate a big company with an innovative emerging company, you speed-up innovation. We saw this with Pfizer and BioNTech. I call it the Peanut-Butter-and-Jelly effect, where one-plus-one-equals-three or refers to creating something better. When we started a decade ago, it was just an idea, thesis, and a belief but now we’re tangibly seeing the fruits of our labor and the impact that these health transformers are making in very tangible ways in the market.

Q. Congratulations, on all those. Conversa CEO and Amwell’s have been guests here, so, it’s like I’m closing the loop with that story. I have two questions here — What about the gravitational forces that hold back innovation in health care? Also, despite some issues in healthcare – siloed data, the interoperability between various systems, the dominance of EHR vendors etc. — it’s interesting that health systems are getting into the act. What do you make of this?

Unity: The biggest challenge remains the siloed nature of healthcare, where everyone’s trying to protect their own sandbox, so to speak. However, as you start to expand beyond with new entrants coming in thinking of retail or tech companies as potential competitors rather than collaborators, structurally, one thinks that for decades there wasn’t enough talent coming into the space. A lot of the entrepreneurial talent was going to build just pure tech companies, photo sharing apps, social networks or going toward management consulting or Wall Street. Now, a lot of the best talent globally is coming into healthcare and that will make a significant impact.

Second, there wasn’t enough capital for early-stage investment and that’s starting to change. Now, there’s talent and capital. If we can break down the innovation and data silos and speed things up, that’ll be the next big thing.

One of the positives we’ve all learned from the global pandemic is really a mindset shift. There was an old framework that certain things around innovation had to take a certain amount of time or be impossible, perhaps. But when you do something like create a vaccine — that everybody thought would take multiple years — in less than a year and bring it to market, it shatters those frameworks and transforms mindsets. It’s really golden age of innovation potential for where we go from here because you’ve got the talent, capital, demand and the mindset shift of “How do we go bigger? How do we transform in a way that’s more significant than previously thought possible?”

The last big hurdle might be how to transform the regulatory frameworks so that it can keep pace with innovation. I am very optimistic about what we’ve seen even in the past 24 months, with how the structural elements that will speed-up innovation in the future have fundamentally changed in a post-pandemic world.

Q. What do your portfolio companies say about their challenges as they build their products, scale and grow sustainable businesses?

Unity: It’s interesting. I think it depends on the stage. I do think there is still a gap at the earliest stages of development. Let’s call it the pre-seed and seed stage where we’re seeing a lot of big $400 million rounds or $100 million rounds, or $67 million rounds. And there’s still a wide gap for the $500,000 rounds or $1 million round.

If you’re talking to the innovators that are just getting started, there still is a capital gap. That’s why, in the past year, we’ve seen multiple large early-stage pre-seed and seed stage funds, including the one just announced today from NFX Ventures, focusing just on early stage. The gap is really around capital.

However, the biggest challenge though, is really around a legacy mindset — around a notion — that the way things work, are the way things are going to be in the future. There’s lots of players within the legacy health care world that still have that framework, so, the opportunity is to demonstrate through real outcomes to basically prove to the market what’s possible.

Some tremendous things have happened over the past 24 months that are starting to bite away at this apple – a major multibillion dollar M&A activity with Teladoc and Livongo. And then, some regulatory, payment and reimbursement shifts have also happened recently, quickly for Telehealth. What these demonstrate to entrepreneurs, innovators and customers of those emerging companies is that the next decade will be different, way bigger and faster than what we may have thought just two years ago.

Q. What’s the competitive landscape like, now? Can you comment specifically on Big Tech and their role in this emerging opportunity landscape?

Unity: In many ways, every great company is trying to figure out how to become a health care company, be it automotive, transport or travel companies. It’s an exciting opportunity because a bunch of new entrants are coming in. The tech world may see this as competitive but really, there’s opportunities for collaboration. See how Amazon has entered this space or Apple versus Google. It’s all very different and they’re each attacking different aspects of health innovation to demonstrate the vastness of the potential and the opportunity. Now, I don’t think technology companies want to suddenly become health systems and health systems’ core focus is not on becoming technologists. So, alignment of their unique abilities will make great potential for collaborations. That’s what we’re starting to see.

One of the misnomers is, there’ve been many failed experiments over the years, from technology companies that were in the third, fourth or fifth iteration of Google Health or Amazon. But if you’re a trillion-dollar market cap company, there’re only a few ways to grow in future and health care is one of them. So, the real opportunity is to really lean-in into collaborative innovation and focus on the core that you may bring and that’s irrespective of whether you’re a startup or emerging innovation health care company or a great health system that has care delivery as your core. What can happen when you start to merge great technology players in with that will be most interesting.

Q. With regard to regulators and the regulatory landscape, if you had something on your wish-list for health care regulators, especially in the digital health context, what would that be?

Unity: If I could wave a magic wand, in terms of regulation, it would be to rethink the future frameworks with the pace of true innovation, in mind. This won’t erode the core of providing safety but will enable a rethink on the guidelines and frameworks in a way that exponential innovation can exist within the framework.

There are ways to do that by developing guiderails or innovation regulatory innovation kits that early-stage companies can build on. This has been seen in cases of drug development, where there are Phases 1, 2, 3 clinical trials and these take you through a process. If we can do the same with health tech innovation or digital health innovation and have frameworks that can move very quickly but give innovators a toolkit to work with at different stages of development, that would also be interesting.

Q. If there’s one thing you wanted health systems to do to accelerate innovation and enable your portfolio companies, what would that be?

Unity: I would study the concepts around the innovator’s dilemma and embrace transformation. There’ve been so many exciting developments around care delivery over the past few years and these new emerging companies — whether One Medical or others, that are working on full-stack innovation, integrating technology and data and thinking about the experience in a new way – are refreshing. The health systems of the future, then, should lean-in to early-stage innovation, experiment in tests and then, really think about how to develop what we in the tech world would call, an innovation stack within the context of care delivery and better outcomes.

I’d also focus on business model and design innovations and other types of frameworks that can be very innovative but may really not have anything to do with pure tech.

Also, I think one of the really exciting assets that so many health systems have, are their clinicians. And one of the great trends we’ve seen over the past few years is what we like to call the rise of the Doctorpreneur. These are clinicians that work with patients, serve patients, but they’re also innovators and they know the problems and they’re becoming entrepreneurs, themselves. So, I think leaning-in to those doctorpreneurs and clinicians within your teams, within your health system can be invaluable for transforming your organization.

Q. Finally, what’s your advice to the Founder who is entering the digital health landscape today?

Unity: It’s a long journey so, resilience and having a long-term mindset towards collaboration while navigating the daily ups and downs and challenges will help you be successful.

We hope you enjoyed this podcast. Subscribe to our podcast series atwww.thebigunlock.comand 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 our guest

Unity Stoakes is on a life-long mission to achieve the impossible: to improve the health and wellbeing of everyone in the world. By combining the power of moonshot thinking, a transformer mindset, and collaborative communities, he believes anything is possible. In 2011, Unity co-founded StartUp Health with Steven Krein, his business partner of more than 20 years, to invest in a global army of entrepreneurs, called Health Transformers, to embark on one extraordinary crusade: to achieve health moonshots, each of which can improve the lives of at least one billion people.

Unity has been a tech entrepreneur since the mid-nineties, previously co-founding OrganizedWisdom and helping build The Privacy Council, Middleberg Interactive, and Webstakes.com/Promotions.com, which he helped take public on NASDAQ with his business partner of 20 years, Steven Krein.

Unity has appeared on Bloomberg TV, CNBC, CNN, NPR, and USA Today, and speaks to entrepreneurs, world leaders, and CEOs around the world about the future of health. He is the publisher of StartUp Health Magazine and co-host of StartUp Health NOW, a weekly web series about Health Transformers.

Unity grew up on a farm in Oxford, Iowa, went to Boston University and currently lives in Berkeley, CA, with his wife and two young kids.

About the host

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

The healthcare delivery model is changing from hospital being within four walls to getting distributed and virtualized

Season 3: Episode #99

Podcast with Amit Phadnis, Chief Digital Officer, GE Healthcare

"The healthcare delivery model is changing from hospital being within four walls to getting distributed and virtualized”

paddy Hosted by Paddy Padmanabhan
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To receive regular updates 

In this podcast, Amit Phadnis, Chief Digital Officer at GE Healthcare reflects on how a geographical transition and a change in domain from IT networking to healthcare has worked out for him and shares his learnings from this shift. GE Healthcare is a leading global medical technology, pharmaceutical, diagnostics, and digital solutions innovator. 

While Phadnis admits that the potent combination of physics, electronics, electromagnetics, and AI will significantly transform care delivery, he discusses how these must be integrated into clinical workflows to change the healthcare delivery model. The majority of digital healthcare technologies provide patient-centric data aggregation, which aids clinicians and speeds up patient diagnosis and treatment. He views healthcare tech also driving beyond the hospital’s four walls to get closer to the patients virtually. The future of healthcare then, does indeed seem to be a robust partnership between the medical practitioners, computing, and analytics.

Amit also advises digital health startups to focus on the last mile of healthcare that is improved patient outcomes, decreased healthcare costs, and early disease detection. Take a listen.  

 

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Show Notes

01:06About your background and how you got to digital healthcare.
04:41What was your first impression when you started here? How has that changed over the past 5 years in GE?
07:01 How are you defining digital at GE healthcare?
15:31 What are the challenges with image data? How have you taken this and converted the aggregated data into advanced analytical insight?
23:38 How do you use data to build the infrastructure internally within GE healthcare?
27:12 How are you demonstrating value? How are your clients seeing the value?
33:08 Can you share one best practice for your peers who are on similar journeys or for startup founders who see an opportunity here in the world of data and advanced analytics to transform healthcare?

Q. Tell us a little about your background and how you got to digital healthcare.

Amit: I grew up in India and did my Master’s in Electronics and Communication from the Indian Institute of Science (IISc). Then, I started working in the fields of embedded systems, communication and networking before moving to GE Healthcare. When I joined GE Healthcare in 2016, I knew nothing about this space. But I was convinced because the whole digital transformation that they wanted to drive and the business was truly exciting. I discussed this with the entire leadership team and decided to take the plunge. Initially I was stumped to get a call for healthcare and then, I learned that the position would be in Milwaukee. Now, I’d been to the US many times before, yet I had no idea where Milwaukee was. When I opened Google Maps, I saw this tiny dot near Chicago and I concluded it was a suburb but, Milwaukee isn’t as near to Chicago.

So, I made two major transitions — one was from networking with Cisco into healthcare – and the second, from Bangalore to Milwaukee. The latter was more challenging but that’s how I ended up with my first role in GE as the CTO for the imaging business.

My focus has always been on digital transformation. And I’ll talk a little later about the Edison Platform, which we conceptualized here. Our CEO, Kieren Murphy at the time, told me that what GE is doing now is really relevant across healthcare. That’s when I picked up the Chief Digital Officer role for the company.

Q. There are CDOs being brought in from outside the industry in healthcare and it’s a good move since it brings a whole different perspective. What was your first impression when you started here? How has that changed over the past 5 years in GE, working with data aggregation, analytics, and advanced analytics?

Amit: Initially, I was taken aback by a couple of things. When you look at technologies like CT or MR or even anesthesia machines, bedside monitors, ICU equipment, there is deep and highly complex tech involved. It’s also a place where there is a fair bit of science – physics, electronics, and electromagnetics — that converges.

With GE Healthcare, I noticed that people who’ve been with GE for a long time really understand the space and the depths very well and that’s very important given how critical the work we do is, from a patient’s perspective.

When I joined GE Healthcare, everything seemed a little slow and there was too much process — a lot of attention towards testing, safety and compliance, privacy etc. When you come from a different world, it’s burdensome. So, it wasn’t a great experience to begin with ­­– the whole regulatory framework – but I started appreciating it over time. I realized why some of these are absolutely crucial. Over the 4-5 years that I’ve been here, I’d say, these are the strong pillars on which the industry stands.

Q. As a CDO, how are you defining digital at GE healthcare? What does that role mean to you?

Amit: If you look at healthcare products, the equipment generally is a combination of hardware and software. When some of this equipment was first made 40-70 years ago, it was always a combination, so software is not new to the healthcare industry.

There’s been a very strong realization that the data this equipment produces or other patient-centric data available within the health system, is a very important asset that can be used to significantly better the healthcare delivery models and outcomes for the patients. Everything revolves around what you do with data. That’s how I look at it from a digital perspective.

So how can we use this data and information produced by the equipment or what we capture for a given patient or cohorts of patients who have undergone similar journeys so that we can gain insights into what’s really going on? How can we learn about the disease status for a patient, a population of patients? How were they diagnosed, what treatment had they undergone and what was the outcome of that?

To learn all that, we need artificial intelligence. But our ability to take this data and information, convert that into insights, use applied techniques like AI to really learn from everything that has happened to better diagnose patients or create better treatments or more targeted treatments – that’s what precision health is all about. That’s how I look at it from a digital perspective.

Q. It’s a very comprehensive vision. Can you tell us a bit about Edison? How is it different from the other GE platforms? Which one’s more exciting?

Amit: I’ll probably answer the second question first. In that context, I’ll also talk about Edison. When you look at the platform, and this is a question that I’ve often got, there are two aspects to it.

One, the basic compute, memory and the rest of the OS, infrastructure etc. All platforms have that but that doesn’t define a platform. Its only what the platform is built on. When you look at the platform, its persona of the platform is defined by the domain it deals with. In this particular case, healthcare predicts that with industrial automation, when you look at that persona, it tends to be very different from industry-to-industry. So, when you look at healthcare, there are standards for data, for storing images, for communicating or connecting to different systems. There’s DICOM and HL7 and now FHIR, the nature of data is different. An image is a pretty big set of data. The way you process that information is different and so are the latency and timing requirements. When you look at all that, you also observe the real persona of this platform. And that’s what differentiates one platform from the other.

With regard to the healthcare platform, there’s a very distinct set of characteristics compared to industrial automation platforms. There may be intersections, for example, even on a healthcare platform you may actually look at the device, represent it and be able to manage it so that goes into the IOT and the industrial automation aspect of the platform. But specifically, when you look at what you’re trying to drive from the platform perspective, I’ll say that the Edison platform is targeted towards clinical workflows and applications.

That persona is very important, and that’s the basic difference between Edison and Predix. When we started that journey, the objectives were simple — GE Healthcare has about four million imaging devices in the field so roughly about and 350,000 or maybe 400,000 imaging devices and the rest are lifecare solutions, ultrasound machines. There are many devices and all produce a tremendous amount of information — we do two billion scans on our devices every year. So, you can imagine the amount of data that we produce.

One of the first things we had to do was, connect all these devices so that all the information could be ingested into a common place. Then, combine that information with the rest of the information available within the health system. I tend to look at it as a vertical axis and a horizontal axis for data. So, there’s the deep data from the device, which is vertical, and it’s combined with for example, horizontal information from within the health system or outside it — now more and more wearable devices, social media information, population health etc. Or there are EHRs and EMRs with patient information, also past imaging information in PACS and that’s horizontal. The Edison platform plays at the intersection of that vertical data and the horizontal information. So, this can all be combined.

One of our first objectives was to start aggregating information so that we could get a comprehensive 360-degree view of everything that’s happening (with a patient) along with all data that is available for them. So, we look at it as a longitudinal patient record. The platform provides supporting tools and services to process that information and create a workflow so that the insights gained either by analyzing the data or running algorithms on it, can be a part of the clinical workflow. It’s a very important aspect that we deal with, as far as healthcare is concerned, because at the end of the day, the solution generated has to fit in the clinician’s workflow, seamlessly. There are things that must be done on the platform and tools that have to be created from that workflow integration perspective. In a nutshell then, the platform is connected to devices and has the ability to ingest information from them, combine that with the horizontal information about the patient, use the processing tools, workflow tools and get insights, which may be converted into clinical workflows and through them to an outcome. That’s what the platform is and that’s how we break it down.

Q. Given GE has a certain heritage in the market with its medical technologies and diagnostic devices, there’s a lot of image data. How have you taken this and converted the aggregated data into advanced analytical insight? What are the challenges here?

Amit: One of the things we realized is when you look at the richness of the data, there is a tremendous amount of information already available, today. But 95% of that information is not used, and that’s a huge opportunity in healthcare because, as you make more use of the information that’s already there, you can get deeper insights and optimize the workflows.

Or you can be very specific and targeted about identification of the disease states. It can also be very targeted about therapies that would be effective for a specific biomarker or a specific disease state. What you start realizing then, is that, you can actually apply some of these insights at various levels across the enterprise, starting with the device.

A couple of examples just to illustrate the point here will be — On the CT and MRI — these are devices which are extremely sophisticated cameras — they’re really taking the picture of the patient and clearly offering insights into the patient, in general. The way the technology works is, when you scan a patient, you get a very weak signal from them. The job is to take that signal and convert it into an image so that the radiologist or physician can then check the image and offer a diagnosis.

In general, to create a better image, you need better hardware, physics, magnetics, more complexity in software etc. In the past, producing a better image would need next-generation hardware, software, all targeted towards processing that signal so that we get a better image because, the better the image, the more insights the clinician can get and the better the diagnosis, However, the image has a lot of noise. What we’ve done in the CT and MR is embed the algorithm to teach the clinicians how to differentiate between the signal and noise at the very raw level of the signal.

Q. What does that mean?

Amit: When you scan a patient, you might actually project “X” ray and then, on the other side, there’s a detector that transforms that projection of the “X” ray. Those transformations are very complex or in an MRI, you’re basically projecting a magnetic field on the patient and the body reacts – that’s to say, the hydrogen atoms react and you get a reflected signal back. It’s a very weak signal, and this is at a crude level.

So, a very weak signal means that there is a lot of noise around it. To convert this into an image requires a lot of transformations and substantially complex image-processing software. With AI, you teach the algorithm to “see” this pattern, which has this signal and this noise and the way to filter the noise. Since the signal is much better, the image will be enhanced quality-wise, too. So now, AI can be used to really create a much better signal before the software undertakes the processing.

We have been able to embed AI into the deepest levels of the product. So, for example, in the MRI machines, when a brain scan/neuro scan is to be done, one of the tricky elements entails the technician having to set the scan plane correctly. It’s a complex procedure that can take a while because it must get a 360-degree view. If it’s not done correctly, the image can be impacted. Using AI algorithms to do automatic scan selection correctly saves time, reduces variability from one technician to another, and lowers errors significantly while improving the quality of the image. So, it results in a significant amount of productivity as well as accuracy. That’s another example.

But then, we’re going all the way. So, we look at workflows and decide how to position the patient on the table. We check for use of the camera feed for analyses and then, do an automatic patient positioning. It’s a very good example of a workflow and we’ve done that, too. Then, the image is taken to the radiology department and interpreted there. When you interpret an image, you have to segment it, quantify or even take the measurements. And subsequently, you get into actual diagnostics.

If you see radiologists and how they work, they spend quite a bit of time segmenting the image, taking the measurements and it’s mostly repetitive, time-consuming and error prone. But you can use the algorithms to actually take a lot of the mundaneness out so this. It improves accuracy, focus, and enables faster diagnosis. So, we have done that. With AI, you can segment the image in 3-D, quantify it, take measurements and for some of the anatomies – the segmentation measurements can take hours depending on the complexity of the anatomies — you can reduce that time to literally 30 seconds. The last step is obviously clinical diagnostic processes and we’ve gone there to help with diagnosis using AI and that’s been the assist tool to the radiologists.

Q. Imaging, the world of radiology is a very high value, high impact-opportunity areas. GE Healthcare has assigned several multi-year contracts with health systems to help them with this. How do these relationships work? Since these are at-risk contracts with some accountability attached, how do you use data to build the infrastructure internally within GE healthcare? How do you demonstrate to your customers that your software delivers?

Amit: When it comes to data and the AI world, there’s no one company that is going to actually do it on all alone. There’s a vast ecosystem out there, a much bigger ecosystem outside of GE Healthcare than what we can do, inside. So, one of the first things we did on the Edison platform is that we opened it up. We publish the APIs, we encourage and run a number of accelerators. We work with start-up companies in India, China, and Europe. We’re working with significant number of companies here in the US too, to actually get their algorithms and their applications integrated on the platform so that we can take them to the providers and integrate them.

In many cases, we do a significant amount of integration work because, the value of the algorithm is enhanced significantly if it’s fitted well within the workflow. If it isn’t within the workflow, it becomes unusable even if it is a great algorithm. So, that’s what we’ve done.

Now through the pandemic, healthcare has witnessed a big change – something that would normally have taken 5-10 years — and that is, the basic delivery model of healthcare has changed from care being limited to inside the four walls of the hospital to it getting distributed and virtualized. And the cloud technologies have enabled this distribution and virtualization of healthcare delivery.

We work with multiple cloud vendors — AWS, Microsoft — and have a multi-cloud strategy. We are open to working with other cloud vendors, too. With AWS we have, a deeper sort of integration currently, and some similar work is being undertaken in some other application domains with Microsoft.

This entails taking some of the clinical workflows and applications that we are building to the cloud so that we can help the providers distribute care across geographies and take it outside of the hospital to the patient. When you do that, you must ensure data privacy, and HIPAA compliance. We encrypt information addressed in motion and are looking at technologies like confidential compute so that even the last mile between the storage and the compute infrastructure, is secure.

Q. How are you demonstrating value? How are your clients seeing the value?

Amit: Essentially, this is an area in which you can’t create a black box solution and deploy it. You need to work hand-in-hand with customers, providers, hospital systems and at times, with payers to really integrate things in a way that is visible to all, and everyone benefits from the accuracy, productivity, positional standpoints. Early engagement in terms of problem-solving is key for us.

Once we get into that dialogue, we need to really set a target. Stroke, for example, is an area where we want to really improve outcomes for patients. The stroke care pathway in general merits is a very detailed conversation about what the workflow is, how the clinicians do their work on a day-to-day basis, what the patient journey really looks like etc. Once you map that and then, get into very specific solutions around the pain points that we are trying to solve, that’s taken care of, on paper.

Post-analysis, you think an element can be reduced by 30% and another, optimized by 40%, reduce patient wait time can be lowered by X%. But you still need to create evidence around it. We’ve done two things — put in sufficient amount of telemetry to everything that we do from a software perspective or from a platform standpoint so that we can capture what’s happening when these applications are deployed. And that goes a long way in creating the evidence about “the before” and “the after.” We’ve also worked hand-in-hand with the health systems to be able to capture that information because a lot of that information gets registered in their systems, and we can work with them to see how we can actually look at the evidence and maximize what we get.

We’ve predicted something in terms of optimizations or operational efficiencies or accuracy or patient outcomes. But the next step is extremely important, and that’s how we work with the customer community.

Q. Increasingly, there will be more data versus more volume and velocity of data. All this can be aggregated, analyzed to drive health care outcomes through advanced analytics and AI. But have we been hobbled by interoperability challenges or self-inflicted problems, such as, algorithmic bias, data insufficiencies, issues related to the acceptance of AI in clinical decision making? Is the vision on the right track or are we further way from the goal?

Amit: I think we’re accelerating. What’s happened through the pandemic is, a lot of things that would have taken many years, actually got implemented very quickly. So, there is in fact, an ever-growing need and a push to deploy more analytics and use data more effectively and faster than before. However, for AI to be effective, the variety of data is very important.

What people have learned is that it is not just the quantity of the information which is important, but the variability of the information across different geographies. Different genetic makeup of the patients is extremely important. And that’s where people struggle, from the AI perspective.

Secondly, a tight integration in existing clinical workflows is noticed because you might have a great algorithm in place, but if it is not integrated in the clinical workflow, it is almost unusable. People underestimate the power that is required to actually do a deeper integration into an existing clinical workflow. That can be a significant barrier if you are not accounting for it right upfront when you actually start designing the full care pathway. Those are the things that need to be taken care of so information is available to us much more effectively through AI and that will change the healthcare delivery model for good, going forward.

Q. The pandemic has forced us to think, in creative ways, about how we can overcome challenges for the immediate future. It’s also laid the foundations for how healthcare might improve with all the virtualization. If there’s one best practice that you would like to share — with your peers or start-up founders, what would that be?

Amit: My learning is that you have to combine the power of computing and analytics with the knowledge of the clinical space. I would very strongly encourage people to form those partnerships with the clinical world. This is a work that needs to happen hand-in-hand with the physicians and the clinicians, and the health systems. So, if you are a startup company working in the AI space, joining hands in a larger ecosystem where you can actually get the domain knowledge, clinical knowledge and then, combine it with all the good things that are happening from connectivity, communications, computing, AI, — you will surely enable the best outcome as far as patients are concerned.

Second, I’d say, we can get very excited about technology, but we always need to focus on the last mile of healthcare, which is — what is the outcome as far as the patient is concerned? It has to improve the patient outcome, decrease the cost of healthcare as delivered to the patient, and help early detection-early treatment while almost going into wellness. But we can lose sight of our goals quickly by becoming very enamored with technology. Focus on the last mile to ensure that every effort put in eventually goes into the patient outcome.

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 our guest

Amit Phadnis is a GE Corporate Officer and holds the position of Chief Digital Officer for GE Healthcare, responsible for leading the company’s digital strategy. Amit oversees GE Healthcare’s complete digital portfolio, including Enterprise Imaging solutions and Clinical Command Centers. With his global digital team, he also works to enable the company’s vision for precision health by creating the industry-leading Edison platform, as well as its cloud, edge, device software infrastructure, data strategy, SaaS enablement, artificial intelligence, and analytics capabilities.

Most recently, Amit was the Vice President and Chief Technology Officer for GE Healthcare Imaging, where he drove digitization, software, digital and cross-modality initiatives across the Imaging business. Amit joined GE Healthcare from Cisco Systems, where he was the India Site Leader and Senior Vice President of Engineering for the Core Software Group, leading product development activities across routing, switching and wireless areas. Amit holds more than 25 U.S. patents in the Networking and Communications space. Prior to working at Cisco Systems, Amit held leadership roles at Motorola, Tata Elxsi and Silcom Automation Systems.

Amit has a master’s degree in electronics and communication from the Indian Institute of Science.

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.

Traditional care relationships cannot be replaced, but virtual care can provide extra support to patients

Season 3: Episode #98

Podcast with Darshak Sanghavi, MD, Global Chief Medical Officer, Babylon Health

"Traditional care relationships cannot be replaced, but virtual care can provide extra support to patients.”

paddy Hosted by Paddy Padmanabhan
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In this podcast, Darshak Sanghavi, MD, Global Chief Medical Officer of Babylon Health talks about how digital healthcare providers can deliver on the sales promise they make about bringing affordable and accessible healthcare to everyone. Babylon Health is the global end-to-end digital healthcare provider serving over a dozen countries and millions of people.

Darshak delves into the challenges around including the demographic segment that has never engaged with healthcare before and is underserved. He discusses how digital primary care is on the verge of possibly replacing about 80 to 90% of in-person visits.

Lastly, Dr. Sanghavi outlines what constitutes a longitudinal care experience. It’s not a ‘one-and-done’ approach but an effective engagement where systems are optimized to do the simple things and consumers find it easy to access them digitally. Take a listen.

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Show Notes

01:10Brief overview of Babylon Health.
02:26Can you share some insights on who you serve – payers, providers, employers, or all of them?
06:23 With regard to the population with low incomes, the underserved population, are they ready for digital engagement?
11:07 When we talk about digital front doors, what are some of the practices you've incorporated into your solution?
16:06 The healthcare system in the United States is still heavily dependent on the fee-for-service model. What's the one thing that will make us part of an accountable care market?
17:06 What are the big trends you're seeing in the market when it comes to digital health?


Q. Can you give us a quick overview of Babylon Health?

Darshak: I’ve been at Babylon Health since earlier this year. It’s a global, digital health company with a philosophy centered around delivering affordable, accessible, and quality care to everyone. This was their sales pitch, but it really got me most excited. It started in the U.K. and then, expanded to Rwanda, the Asia Pacific, Canada and now, the U.S. I’m the Global Chief Medical Officer and my responsibilities include thinking about how we can really deliver on that sales promise. In that context, we have a SPAC event coming up in the next few months and we’re looking forward to it.

Q. The United States obviously presents a big opportunity for Babylon. Can you share some insights on who you serve here — providers, employers, or all of the above?

Darshak: Our tag line is that we want to deliver healthcare to the palm of everyone’s hands, so, ultimately, the people we’re serving are really patients and members, worldwide. Now, the way we reach those members can vary depending on where they happen to live. Most of our members, at least in the U.K. and the U.S., principally, we are customers of their insurers. So, when the insurer says, they need somebody to help these members take care of themselves, in exchange for the premium the latter pay as compensation for service delivered, that’s when Babylon comes into the picture. Although we’re paid by the insurance, the ultimate person we’re serving is really the patient. The same thinking goes for Rwanda and all our other areas of business as well.

Q. So insurers bring you into members’ digital health services and you bring in technology, analytics, and capabilities to efficiently improve health care outcomes. As a consumer, my question is, while the primary care provider helps manage chronic conditions and the insurer also caters to similar issues via a program probably designed by companies like yours, so, who should I speak with? Whose protocol should I follow? Is this a dynamic you see in your work?

Darshak: We never want to get between people who are really satisfied with high quality care and intermediate that in any way. So, I’ll talk about how we’ve operated across areas. This varies from market-to-market. In the U.S., where people choose Medicare Advantage and when they sign up, they know what they’re getting into. Similarly, in the U.K., people elect to have Babylon become their primary care providers. When they choose us, we serve them.

Now, in places like the U.S., for example, we are in Missouri where we serve around 20,000 patients on Medicaid. We give them care but those individuals may not have really engaged with the health care system. These are the hardest to reach patients who are just not engaged in care. Can we go out and actually reach them? We contact them and of them, we actually engage with over 20% or so – a little more than enough to check our numbers — whereas traditionally, only about 5% of the individuals would be engaged.

So, while we really try to offer our services, we never want to supplant traditional care relationships. But we do want to reach people that are not engaged and if they actually do have a doctor, then we add it on as an extra level of care over that and support them in their journey as well. There’s a lot of things that you can’t always go to see your PCP for. When people have needs, we try to fill those.

Q. With regard to the population opting for Medicaid, these are groups with low incomes; in many cases, underserved and geographically spread out. Are such populations really ready for digital engagement? Can we really meet their needs? How do you overcome existing gaps?

Darshak: These are interesting questions or perhaps, the kinds that were raised when we had gone to Rwanda initially, several years ago. We know that these individuals won’t have access to technology and have low bandwidths so, we work around that. Getting back to your question, in the U.S. in particular, I’ll use an analogy. This notion that digital health is too complicated, or people don’t have access was actually tested at the beginning of the COVID pandemic. At that time, I worked for a very large national payer as a Chief Medical Officer overseeing an older population — millions of people. What we saw was, when we suddenly started to actually pay for that kind of care and allowed physicians and clinicians to use that, there was a massive increase from less than 1 in 1% to just over 15 to 20% of our members that were using digital services. These were older people and we’d previously thought they wouldn’t understand that. That’s exactly like it is with social media. But when there’s a value proposition, people will actually use that. I will say it’s not perfect. Some people may not have access to smartphone technology. They may not have access to bandwidth, but at least it’s better than what they have now, which is often no access at all. We started on that base and then, we tried to problem-solve incrementally to get more and more engagement.

Q. You’re operating as a virtual primary care provider on behalf of your insurer health plans. You also recently acquired a primary care physician group. Can you share the rationale for that?

Darshak: What we realize and maybe again, I’ll say one of the great benefits of Babylon, is that we benefit from years of experience, and we can learn from other parts of the world, as well. And one of the learnings we had from our experience in the U.K, was that while digital health care, particularly digital primary care, was incredibly accessible and people liked it, we could replace about 80 to 90% of a lot of in-person visits with digital care.

Now, what that means is we still have 10% that require some people. And we all know that. There are probably some conditions for which there’s no substitute for in-person visits. So, that’s what drove this sort of an acquisition of an IPA in California, which is incredibly high performing. The idea was to now partner with the provider organization and be sure that we now learned how to develop both, digital care in the U.S., and understand how to use that physical presence, as well. That’s going to be a scalable model for us, broadly speaking.

Q. So, acquiring this physician group was really to build the capacity to serve our larger population. Is that the right way to look at it?

Darshak: I’d say a couple of things. The first is that we recognize that we must develop both, the digital and physical presence. If we’re going to offer primary care, we want to do it longitudinally and in high quality. The second piece of it is, we believe that the digital tools we have, are highly scalable. So, we’d like to work with physician groups and then, transfer this technology to them. The point is to see if we can take existing practices and digitally supercharge them in some way. So, it’s not only for them to see patients who are largely virtual, but it’s for the physicians themselves to learn how to work in a digital-first environment, as well. And that’s done with the support of our partners.

Q. When we talk about digital front doors, it’s a hybrid model of care, where for some things one visits a clinic and for others, a physician comes home. These experiences can be very hard to pull together seamlessly from a consumer standpoint despite the vision, gadgets, and the technology. What are some of the practices you’ve incorporated into your solution? How are you approaching this issue of creating seamless experiences from a digital front door standpoint?

Darshak: There are a couple steps to being a seamless experience and to solving — at multiple points along that continuum. It starts as a seamless experience initially, in our view. We have something we call the health loop, where we talk about all the steps of what a seamless rehypothecation experience is. And the first step of that loop is engagement. What that means is how quickly can somebody be onboarding onto the app and getting it installed and actually getting registered?

Now, that seems like a fairly straightforward thing, but the amount of energy we put into that experience is enormous because, we’re checking insurance, birthdate, etc. So, when we talk about a seamless experience, we have a funnel approach. We think about that all along the way. And as I said, it starts with that engagement, that registration.

Then, it moves on to how do we actually acquire data. If we perform a health assessment, can that be done seamlessly? Or, can we try to create a personal connection with a call from one of our navigators? Then, we’ll think about how to initially book an appointment? What we’ve done is, and this is what I’m very proud of, the vast majority of our patients can actually have a virtual visit even the same day if they have a behavioral health concern within that first week. So, we think what’s also technologically important with our scheduling software is we have an enormous amount of quality control over the actual experience. We have over a thousand engineers, for example, all over the world that are helping us develop that plan. And then, we can pull that all the way through all the steps of what that seamless experience means.

Q. How do you keep score of how well you’re doing in a program like this? What are some of your key KPIs?

Darshak: One of our simplest measures probably, and this is the one we’ve started with and actually have a global scorecard on, is simply, patient satisfaction. It’s essentially like a promoter score from our patients. Are they pleased with the experience? And we consistently have, in the U.K., Rwanda and the U.S., for large pressure business, just extremely high satisfaction scores; some sort of a star system. That’s our North Star and it’s on our internal metrics of how we look at quality. As you can imagine, that’s one of the metrics and then, we have an enormous number of operational metrics that that underlines as well.

Q. Let’s talk about the competitive landscape. The digital health landscape has come a long way especially if you use the VC funding numbers as a barometer of growth. While new companies mushroom and it’s great from an innovation standpoint, few will survive this crucible of trial by fire. When you look at the landscape, your clients who are trying to parse through it and pick the platform or the solution provider, best suited to their needs, what are the challenges you see them grappling with when they’re trying to decide if it’ll be Babylon Health or somebody else?

Darshak: I’ll put it simply – in the digital health landscape, it’s so exciting to see all these companies competing. We welcome that competition. We think that’s only great for members who deserve the highest quality services. So, we are one of the only comprehensive digital health care companies that are not only talked about but are willing to essentially take full risk. That’s the mark, in my view, of somebody who truly believes in their company, knows they can scale. We take full financial risk on members. And that’s where we’re going most aggressively. That’s where our contracts are. And that’s why our revenue grows so much. We believe so much in our product that if we’re willing to do that and take that risk, I think that demonstrates to people it’s not just talk, but that we’ll deliver on that. And most importantly, it’s almost no risk for you as a client.

Q. The healthcare system in the United States is still heavily dependent on the fee-for-service model. That there are solution providers who are driving this push towards more of accountable care and at-risk models is welcome news. From your perspective, what will move the needle towards more of this? Will it come from innovative digital health providers like yourself or, from changes to the regulatory environment? What’s the one thing that will make us part of an accountable care market?

Darshak: We all do best when we have to operate within a defined budget and deliver based on metrics. I think that’s at its core. When we talk about value-based care, it’s all about us needing to give good quality, the budget. To me, that move towards full-risk, particularly on digital health, is the key that unlocks growth. Then, we don’t fight over regulatory issues like one’s Medicare, paying for home base, remote monitoring or if they’re doing cross-state license payments. When you offload that risk to companies that actually are digitally enabled and let them pursue what they think is best, I personally believe, that’s what the unlock is.

Q. I think this is the unfinished business and we’re all waiting for to play out over the next few years. What are your final thoughts, on one of the two or three big trends you’re seeing in the market when it comes to digital health — an option that consumers like me should be looking for?

Darshak: From the consumer standpoint, a couple of things. The first is, does your digital health company give you just a one-time experience? Like are they designed just around taking care of your coughs and colds and maybe your reproductive health needs? Or, are they truly giving you a longitudinal care experience where you want to develop a relationship with trust over time and actually take care of you at all of those periods? To me, that’s actually the direction in which we’re going. As a consumer that would be very important. I don’t want it “want it done”, I want to make sure that we push.

The second thing I would say is that how well are they optimized to do the simple things? Because, you know, it’s like the stories about those rock stars who say that in a bowl of M&Ms, they want to make sure that there’s no green M&Ms? That’s the same thing looking at the digital health care pack. How easy do they make it to make an appointment? Do they refill your medications on time? Do they do those simple things? And as a consumer, if they’re doing those things right, then, you can have some confidence you’re going to do the hard things right as well.

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 our guest

Darshak Sanghavi, MD, joined Babylon in 2021 as the Global Chief Medical Officer. He is the former Chief Medical Officer of UnitedHealthcare's Medicare & Retirement, the largest U.S. commercial Medicare program with over $90B in annual revenue, where he oversaw all major national clinical and affordability programs.

Earlier, he was Chief Medical Officer at OptumLabs, running a large portfolio of industry-leading projects with dozens of academic, government, and industry partners. He was also a member of the Obama administration as the Director of Preventive and Population Health at the Center for Medicare and Medicaid Innovation, where he directed the development of large pilot programs aimed at improving the nation’s health care costs and quality. In this capacity, Dr. Sanghavi was the architect of numerous initiatives, including the $157 million Accountable Health Communities model, the 3 million member Million Hearts Cardiovascular Risk Reduction model, and the $1 billion Medicare Diabetes Prevention Program.

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.

Patient home is the new healthcare hub today

Season 3: Episode #97

Podcast with Amber Fencl, VP of Digital Health and Engagement, Novant Health

"Patient home is the new healthcare hub today"

paddy Hosted by Paddy Padmanabhan
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In this podcast, Amber Fencl, VP of Digital Health and Engagement at Novant Health, discusses how innovations in technology are driving healthcare and enabling its seamless, effective delivery into patients’ homes today. They are transforming the home into the new healthcare hub.

From drones that deliver medical supplies and AI-leveraged platforms that detect strokes to harnessing AI voice bots to answering patient questions on COVID vaccine and setting up the remotely monitored COVID-care at home, digital health tools have come a long way. Novant Health is the first healthcare system in the U.S. to get the FAA clearance to use drones for distributing medical supplies during the COVID-19 pandemic. In combination with invaluable consumer insights and when integrated with a robust EHR system, digital health care can only enhance patient-centric care delivery models.

Lastly, but not the least, start with what the consumers need and want to look for, because if you deliver something they’re not interested in, they will not use it. Take a listen.

Our Podcast Partners:    

Show Notes

00:40Brief overview of Novant Health and your role in the organization.
08:18Many health systems have roll-out chatbot program in the context of COVID-19 and looking to go beyond that. What do you think is possible with the chatbots in the next 6-12 months?
13:09 You are combining three different technology tools – chatbots, voice-enabled chatbots, and AI. In terms of the broad functional areas, what are the things that you are planning to roll out in the next year?
16:58 Hospital at home is a theme that we keep hearing a lot. How do you ensure that the experience is in no way degrade in any way by moving services from the hospital to the home? Also, how do you make technology choices in this context? What do you look for in a technology partner on this journey?
23:54 There's a vast amount of VC money being poured into small companies that are very young. If one of them goes under, how do de-risk yourself out of it? Can you share recommendations that you have based on your own experience?
27:48 How do you govern your digital initiatives in your digital health programs at Novant Health?
31:46 What have you learned personally on this journey that you've been on? Can you share that with our listeners and with your peers across the industry?

Q. Amber, can you give us an overview of Novant Health and your role there?

Amber: Novant Health is a not-for-profit, US$ 5.7 billion health system located in North Carolina, South Carolina and Georgia. We have around 15 outpatient and inpatient facilities, about 800 clinic, urgent care locations and over 2300 providers. So, we may be called Super Regional.

Q. We’ve hosted Angela Yochem, Chief Transformation and Digital Health Officer, Novant Health a while ago. Now, you’re handling digital patient engagement. Do share an overview of what’s changed in the last 18 months?

Amber: At Novant, we have been inundated with COVID-19 response to give our patients quick access to the care they want and need. In the last 18 months, that has been a priority for our communities.

However, we have also tried to continue our growth and innovation towards bringing technology into homes in such a way that is meaningful and creates a seamless experience. Before I came into this role, I was working on our consumer-facing product-side. It was a phone call from Angela about “How would you like to lead this team?” that got me thinking. It’s a very natural transition to go beyond just the consumer-facing experience to talk about our digital health experience and initiatives. They span innovations, such as, using drones.

So, we have a partnership with Zipline where we have instituted the delivery of supplies between our facilities. We were the first in the nation to receive FAA clearance to use a drone that is “sight unseen”. So, we lose sight of the drone, and it covers a 30 mile radius to deliver supplies. We are now exploring the next use case with Zipline, and that will be to deliver pharmaceuticals to our patients directly to their homes. So, a drone is going to take their medications and safely and securely, deliver that to their front yard.

We have also partnered with a company called Hyro AI. Hyro is a conversational voice bot technology that will respond to COVID-19 vaccination questions. It’s taken us about four weeks to develop a knowledge base of FAQs related to the vaccine so patients and community members who call-in have the option to speak with this voice Bot to learn more about the vaccine. In a five-month span, we deflected over 13,000 calls from our care connections, our customer service phone team to the bot for people just calling to get more information about the vaccine. So, that was a highly successful initiative with one of our key partners, Hyro.

We have also established what we call COVID-Care at Home, and it’s a great program to assess our inpatient COVID patients. Once they’re in a stable place, and we feel that they have met the selection criteria — an algorithm that confirms that they can recover at home — we will discharge them from our acute facility and send them a care package and remote patient monitoring devices to monitor oxygen levels, etc., so they can comfortably complete recovery at home. Thus, we are also able to alleviate some of the strain that’s on our acute care facilities with that program. And we are doing that across all of our footprints here at Novant Health.

One really cool thing we’ve done is use AI technology for stroke detection. If we have patients that present themselves with stroke symptoms in the ER while they’re in the CT Scanner, the Viz AI and incredible algorithm and technology can assess that patient in real-time, detect and save millions of brain cells per minute and reduce the time spent trying to discern what’s wrong with them. That technology enables us to take swift action within minutes — call in the Neurosurgeon, prepare the OR etc. — at much faster rates.

Q. While emerging technologies and chatbots will play a much bigger role going forward in health care, it looks like every health system has some kind of a program to roll-out now. Do share what you think is possible in the next six to 12 months.

Amber: We are working with our vendor of choice – Hyro — for our web and voice capabilities. I’d say that the chat bot space is becoming very interesting with some out-of-the-box products that you can turn-on and have a chat, instantaneously. What I would offer is if we just turn it on — take the patient, the consumer experience on the other side — just to say that chat and support experience really isn’t worth checking that box because it’s more frustrating. A lot of research here has shown us that about 60% of the digital consumers that we have surveyed, want to self-serve. Chatbots are a great way to self-serve. However, when they want to talk to a person, they still want to be able to get to a person. So, you need to think about that as an organization. What is that ability to still either chat live with the human or transfer them warmly to someone on the phone, if it’s not a webchat? So, yes, people want to self-serve and they want to engage digitally, on their terms, their time and on their mobile device. The majority also are engaging on mobile. So, that capability must be rich and meaningful information. Checking the box and turning it on may not be rewarding to the patient and that’s not going to buy you much either.

As an organization, you need to have robust knowledge. That means looking for technologies like Hyro, for example, that has conversational AI and the robust knowledge graph that is continuously learning, growing its nodes and building relationships with information such that it can constantly ingest and scrape all sorts of different ways to fill the knowledge base and grow it. We want to be able to do that in an effective, efficient, and elegant manner.

Chatbots are more workflow-based. I think they are narrowing and serve the purpose for a very small use case, and can’t grow with you. So, at Novant Health, we have implemented a chatbot with Hyro that serves to search our entire website, if needed. So, you may think you’re about to type in a search term for company information or perhaps you want to find a physician, but what you’re doing is engaging with the chatbot and it will begin a conversation with you, ask questions and narrow down what exactly it is that you’re looking to do. And the chatbot will be used to do that.

I will say that in the space of a chat in AI — here’s the piece that I think folks may not appreciate — we have thankfully begun to scratch the surface here. If you have a conversational AI, some type of natural language processing capability, you are getting consumer insights first-hand. They are typing in, voicing in their questions, so, if you take that that data and analyze it, that is first-hand consumer information for you to make decisions with. It is rich, robust and invaluable. The more we find entities implementing this type of technology and then, using that data to turn it into meaningful information, the more pivotal it will be for that entity to start making very different and customer-focused decisions.

Q. It’s great that you’re leveraging technology like this! In terms of broad functional areas, what are some of the things you’re planning to roll-out in the next year?

Amber: One of our biggest programs that we, along with many other healthcare systems, are exploring is hospital at home. The idea is to take remote patient monitoring — which has become a bit expected – and truly creating an inpatient experience with the same quality and care within the home. This idea is similar to what we did with the TELE-ICU. So, we have the stroke technology with AI. We’ve also created an experience for TELE-ICU where we have a command center of experts in the field to monitor it. And then we have our hospitalists that are there rounding. The hospital at home takes that to a much greater level. This healthcare at home is the new healthcare hub. And we are going to bring an experience into the patient’s home that will enable all their care management, whether it is behavioral health-related, pharmaceutical or some sort of integrative medicine.

It can be something that is more acute for those patients who are better suited to be in the comfort of their home and have the right home environment. It’s going to include labs, imaging, even the ability to do any type of paramedic services.

Let’s say someone’s running low on their oxygen. So, from our command center, we will be able to dispatch that paramedic to them immediately and through the monitoring, technology and the talent that is sitting in that command center offer necessary care. This will be the next great program that we really bring to life.

We began to do it already like in the COVID-Care at-Home program. But what we want to do is to take these individual experiences with a robust set of talent at the command center and stitch it together to take the hospital into the home and provide that level of care just as if they were inside our four walls. And the brick and mortar will have the same quality metrics. We will have the same expectations for our providers, but in a much more accessible and affordable modality to deliver care.

Q. The hospital at home is another theme that we keep hearing a lot — and it’s all work in progress. Question that arises is — how do you make it all seamless as a healthcare service provider? How do you ensure the experience is in no way degrading? How do you make technology choices in this context? What do you look for in a technology partner on this journey?

Amber: The seamless consumer experience is quite the challenge, and we see it on a daily basis. The healthcare technology field has been peppered with point solutions and a lot of good ones, really great ones that came out of COVID, as well. I was reading this weekend there was in the first half of 2021, NRC Health reported, US$ 14.7 billion in venture funding for health technology. That’s huge. It’s booming.

There’s a lot of great technology out there. But the stitching together is where the challenge comes in, and that’s what you alluded to and what I would offer to listeners is when you’re looking to solve a problem, you have to step-up and out to look across, obviously, the whole spectrum of your ecosystem. What we really have become very focused on doing, is looking at it from an ecosystem standpoint rather than a problem-solving standpoint.

So, I think one differentiator of how you first evaluate, then make decisions, think about the perspective in which you’re analyzing it and then, look at the ecosystem. For us, first and foremost to our core is the patient-centric model.

Our digital health is looking at the patient at the very center. I would think of these as concentric ellipses. There’s the patient in the center and then, there’s this provider enablement that has to wrap around that. That is an important point around your providers. You have clinical operations and then, there’s technology that’s wrapping all of that. For you to create a great patient experience and consumer experience, you have to remember that there’s a provider on the other side to deliver that service, whether it’s in a digital or an in-person format and that is a very difficult scale to balance. If it’s great for the patient, it might not always be so great for the provider and what they have to do. So, you really have to look at technology through both of those lenses and figure out what’s a nice compromise to meet in the middle.

Your clinical operations are so burdened right now from the volumes and the strain of COVID for sure. Certainly, people that are trying to get back in for delayed healthcare and then, there’s the potpourri of point solutions that we have brought into our clinical operations to try to solve problems. If we don’t consider how inefficient a new solution may be to the clinic, then, we’re doing those folks a disservice. So, the patients are going to have a bad experience. You really have to think about that piece as well.

As to the technology to wrap, how does Novant approach it? We are looking for a really strong, solid backbone of infrastructure to facilitate this. It has to be a strong foundation that’s going to allow for growth, stability but it must be scalable. So, as we expand that to the hospital at home or into a new digital medicine capability inside the four walls of Novant Health, it must easily integrate. That, too, is another differentiating factor when you’re looking at technology to bring in our eight-point solution. Question that arises then, is, what’s the integration factor here and how easy or hard is it going to be?

There’s also a call to our electronic health record systems to make integration easier. There are great things that better EHRs do and they do it well. But then there are some things that they really don’t. And we need to easily integrate into those spaces and that, today, isn’t so easy. You have to consider that in your evaluation, because the integration to the EHR is what matters for your clinical team.

Q. A few key points here — the integration piece is key. Without a robust integration infrastructure, you are not going to be able to create those seamless experiences. If you’re not able to capture the encounters properly, you won’t be able to bill for it. Plus, patient experience cannot be at the expense of the provider experience.

Now, there’s a vast amount of VC money being poured into very young companies. So, what does it take for them? Who is the risk taker? How do you do skills of tomorrow? If one of them goes under, how do you pull yourself out of it? Do share any one or two recommendations that you have based on your own experience.

Amber: Risk management and mitigation, planning and organizing work really thoughtfully is at the core of how I operate and I’m going to speak from my perspective and not necessarily as an enterprise or as an entity.

When I go to look at a new vendor, there are some challenging questions that I’m going to ask them. A lot of it is to figure out how reality versus the optimistic view that those providers are typically going to offer, the marketing and the sales pitch versus the reality of what it is. So, I will always double whatever they tell me unless it is a very seasoned software provider, service provider with a proven track record.

I’m going to start also managing expectations within my internal partners and my internal stakeholders.

The other thing that I do is bring in a variety of perspectives and talents to credibly challenge the pitch, the solution from a variety of angles. Certainly, there’s a financial conversation on how viable they are financially that we’re going to have to explore.

And then I look for honesty and transparency. The relationship that I start to form with folks that we’re courting, and discernment serves me well to realize where the pitch may be a little more mirrored than an actual reality. I will also have a score card and that is going to be different. We’re familiar with evaluation and score but that allows me to take away any subjectivity based on relationship or conversations, positive or negative. And that of my internal partners as well. So, when we sit down and compare company A with company B, the solutions may be relatively the same. But let’s say, culturally or financially, there’s a risk factors there that don’t align, so we have a more objective way to make that vision absolute.

Q. Coming to governance, how do you govern your digital initiatives in your digital health programs? How do you ensure that cross-functional leadership is involved and you’re prioritizing things the way they are meant to align with organizational needs or goals?

Amber: Its so important to have structure and governance in place. Novant Health has started at the very top with a very innovative, digitally focused CEO. My boss now, Angela Yochem — our Chief Digital and Transformation Officer — reports directly to the CEO. So, there’s a leadership structure in place to support digital growth, advancement and innovation. Having that support is monumental and I think, key to success. If you are an organization that hasn’t quite adopted that model, I would challenge you to think about it. The investment and the level of engagement from across your organization will change positively with that model.

That being said, we also realize that in the digital space, digital health is one thing and it actually used to sit within our medical group. A couple of years ago, it was realized that digital health spans far beyond just our normal clinical practices. So, it was lifted out and put within the digital products and services group which we’d set. That allows us to be surrounded with more technology and innovative tech skill sets, when we’re looking to solve our problems and introduce new things.

But from a governance standpoint, we have a Digital Care Steering Committee that comprises key stakeholders in the organization — financial partners, strategy partners, revenue growth partners, and most importantly, medical practice. That steering committee is where we bring forward new ideas. Certainly, those new ideas may be bumping up against some internal criteria but we also hear from the Committee the things that may be on their minds. We have a very close partnership with our medical group and outside of the Steering Committee, we have regular Cadence Reports out and touch base on key initiatives.

That Steering Committee’s really the glue that brings us all together where we very intentionally talk about what we want to do and where we want to go. Here’s the reality of what’s happening within the medical group from the front lines. Maybe we want to do it, but because of the surge, we have had to make some changes in priorities of the way because our clinical partners need to be serving our patients in the community. That is the forum. And that core group of individuals help us to make those decisions and to talk about it.

Our clinical partners embrace technology and the efficiencies that technology can bring. They also keep us very honest on the point that I’ve talked about before. And what is the lift and the impact to their clinical team members and not just our patients? It’s caring for the patient, giving him the best experience possible while also enabling that provider to do it effectively and efficiently.

Q. What have you learned personally on this journey that you’ve been on? Can you share that with our listeners and with your peers across the industry?

Amber: Yes, I have been impressed, surprised and educated through consumer insights — the level of detail and insights — that I was never privy to before. At Novant Health, we have a consumer patient-focused group called Community Voice. That function is a part of my digital health and engagement team and has about 6,000 volunteer patients, team members and community members that will take surveys that we send out because they are interested in providing us feedback.

And what we may think is a good idea or how we got to do this, may be a game changer and may be great for the patient but it may not be a big deal to the providers. So, we’ll test this concept with our Community Voice members. It’s a very diverse group of individuals. We create these surveys to get their feedback and we’ll find out something that we think may be the next great thing. But it may turn out that it’s really not that important, or what we thought was a great idea is good and the way we wanted to deliver it is not at all how that consumer would want to receive it.

My point is: Finding a way to glean those insights from your demographics in your community is critical and different and very important because it’s a part of your community. You know that it is impactful and it represents those who you are serving. If you are gaining your insights from a different source, that is interesting and absolutely can be a factor.

I have been impressed and find that our community members who participate and give us direct feedback allows us — sometimes it’s directionally the same as perhaps a national survey on a similar topic — but it’s typically different enough to make an impact on how Novant Health wants to choose to deliver that particular concept.

So, that is first and foremost, and what I mentioned earlier, is the insights that you can gain from digital interactions with your patients to predict behaviors, identify trends quick enough that you can react and respond to them so that either the experience is better or perhaps there is a new opportunity in those trends that is good for your system to explore.

For me in this role and the work that I’ve been doing at Novant Health the last couple of years, the access to meaningful insights to make decisions has been delightful and impactful and how we have made decisions that have been a part of that’s wonderful.

Q. So, the cool tech is where you start with really what the consumers need and want to look for. And if there happens to be a cool tech that can deliver what they need, even better.

Amber: Better and better. But if they’re not interested in it, you can have all the cool stuff you want. Nobody’s going to use it.

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 our guest

As the VP of Digital Health & Engagement, Amber is responsible for leading game-changing digital health and digital medicine initiatives through advanced technologies so that Novant Health can deliver the most remarkable patient experience. Amber’s team strives to improve the quality of care for patients and community members; and ensure increased access to care through contemporary methods and technologies. She partners with physician and administrative leaders across the organization to develop and operationalize a robust, omni-channel digital health and innovative engagement product strategy.

Amber is a digital transformation leader with expertise in healthcare technology, software development, portfolio and project management, and risk mitigation. From start-ups to Fortune 500 companies, Amber has held leadership roles across technology, financial services, and healthcare with companies such as Unisys, Oracle, Wells Fargo, and Novant Health.

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.

A lot of digital adoption is driven by demographics

Season 3: Episode #96

Podcast with Tony Ambrozie, SVP and Chief Digital Officer, Baptist Health South Florida

"A lot of digital adoption is driven by demographics"

paddy Hosted by Paddy Padmanabhan
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In this podcast, Tony Ambrozie, Chief Digital Officer of Baptist Health South Florida, shares his journey and learnings embracing digital in healthcare. Transformation in any sector requires sustained effort, a budget, a cohesive team and most importantly, a well-drafted communication plan.

Digital transformation is not easy – setbacks are inevitable. When digital health tools add to the physician’s workload, the rate of adoption slows down. When organizational processes and mindsets don’t adapt, mistakes are unavoidable.

With his deep background in consumer-oriented industry sectors, Tony brings a heightened appreciation of the gaps in digital patient engagement and how to approach the challenges. Take a listen.

Our Podcast Partners:    

Show Notes

01:18About Baptist Health and the current state of your digital health transformation initiatives.
04:55What were your initial impression of healthcare and where we are as a sector in terms of consumer enablement of digital experiences? What are your top priorities?
07:19 What do you see as stark examples of the difference between your previous experiences and healthcare? Are there structural issues with healthcare? If yes, why is it so broken?
10:17 When designing digital experiences, it’s imperative to consider the clinicians’ experiences. The biggest challenges here are increasing adoption and awareness. What can lead to better adoption among the traditional community?
14:58 In the last decade, some physicians have been worn down by the instrumentations and layers of technology sitting atop the charts and trends. Skepticism has increased especially if this adds to workloads because they don’t have enough time. How do you look at the technology solutions landscape when you're trying to address this?
21:48 What does the governance model for driving digital health at Baptist look like?
24:11 How do you make sure all stakeholders are working together in the same sandbox and driving organizational objectives?
25:08 What are the learnings you'd like to share with the audience?

Q. Please tell us about Baptist Health and the current state of your digital health transformation initiatives.

Tony: Baptist Health is a regional system provider in South Florida with about 10 hospitals and approx. 20,000 employees. It’s a really big presence in that community — I have people who work for Baptist and were born in Baptist Hospital!

In terms of going digital, the Baptist executive team and some of the influential members of the Board with experience in commerce and digital platforms, had been discussing digital and the sense of sustained and coherent efforts required for transformation, for some time. I was brought in into Baptist as the Digital Information Officer to ensure a laser focus on driving digital transformation for the entire organization and to work with clinical, operations and all the other constituencies.

About three months into my tenure, I put together a digital strategy and capabilities’ roadmap covering roughly the next 12 to 18 months. It’s important to have an overall strategy. If you don’t know where you’re going, you can’t tell where to turn. But that strategy cannot be all-consuming to the cost of executing. That’s why having a roadmap of capabilities and features, and executing it is very critical.

For us, the focus would be on consumer digital experiences, first, followed by clinical experiences and then, the digital experiences for operations and other groups. We started executing this 3-4 months ago and decided on dedicated funding for the program that was focused on building and rebuilding experiences regarding telehealth. Along the way, we learned and validated from the original assumptions that we didn’t know, and we needed to know in order to change. So, that’s roughly where we are, now. We are building momentum in terms of both, building capabilities and talking about digital transformation inside the organization.

Q. There are three aspects of your mandate — consumer digital experiences, caregiver experiences, and how to enable the organization, digitally. What were your initial impressions of healthcare and where we are as a sector in terms of consumer enablement of digital experiences? What are your top priorities?

Tony: I came into a consumer-focused company from Disney, Disney parks and before that, American Express. While these had very similar focus, clearly, healthcare providers, doctors, physicians, and nurses were more intensely focused on the medical care for patients. The pandemic has shown the relentless and ultimate dedication of medical providers to patients’ lives, well-being and health. However, we must note — compared to other industries — the digital experiences before the encounter, after the encounter, maybe even during the encounter.

Think about the Amazon shopping experience. Ordering a bottle of water on Amazon is nothing compared to healthcare. But still, think about this. If instead of this Amazon experience, you spend time putting down a list, then, get on a call, wait for 30 minutes, talk to somebody, spend another 30 minutes trying to explain on the phone what the problem is, what you want and then, wait another three weeks. All this to discover ultimately that you did not get what you actually wanted but something similar. That’s kind of where we are today because of the more than imperfect digital experiences.

Q. What do you see as stark examples of the difference between your previous experiences and healthcare? Are there structural issues with healthcare? If yes, why’s it so broken?

Tony: Great question and that’s something we’ve been asking ourselves because it’s a combination of factors. So, I’ll put the objective factors aside. You have this interesting dynamic between patients, providers, and payers — a kind of strange arrangement and buying or ordering things is impacted by that. You have to validate the insurance first, and therefore, it’s not as easy as it would’ve been if you’d used your American Express card. So that’s an objective factor. It’s part of the system but needs to be worked on to improve.

There are some things that we can do on the more subjective part — I don’t think this aspect has been focused on for the past few years and frankly, there are still some in the healthcare industry who maintain that patients don’t come here for the mobile app. While that’s absolutely true, it’s equally true that nobody goes to Disney just to use the mobile app. However, without that mobile app, probably they wouldn’t use American Express either. So, how we manage our services, the access to our services with the consumers is important.

At some point, it’s also competitive advantage. All other things considered equal, consumers and patients would choose and use your experience to a more difficult one. The expectations for the consumers have been changing for a while, and some of it is driven by their other experiences and their normal lives. And they want to be part of the focus or the center of the experience, want to have control and information to make decisions about their care. They expect the same type of experiences as elsewhere.

Q. When designing digital experiences, it’s imperative to consider the clinicians’ experiences. The biggest challenges here are increasing adoption and awareness. How can you drive this among the traditional community?

Tony: When I was talking about consumers earlier, to a certain extent I was also thinking about the clinicians having great digital experiences in addition to the normal ones. Do you want to go to the system that has horrible technology and is painful or would you prefer one that’s got all things considered? That’s the second focus aspect for us.

I would say that a lot of digital adoption is driven by demographics. Lifestyle and capabilities are equally crucial drivers. Clearly, the younger generations – those up to and in their 40s have experienced eCommerce – so adoption is basically natural with video calls for everything including a medical encounter subject to other limitations.

Some of the more senior folk whether they have the experience, knowledge or some form factor limitations, they’d also prefer a big screen versus a mobile. So, the life cycle is folk who are very much into the social media of this world. It feels natural; just another interaction and that’s true for both consumers and providers.

For the providers though, there’s a little twist. Digital in healthcare requires process changes to be able to provide benefits. Now, some individual providers probably don’t like these because they may not be convenient and so, they will stay away from the digital. Some provider systems will skew that process. Those process changes may simply be too difficult. There’s inertia and maybe politics. So, when digital is introduced, it’s probably is more work and hassle than it’s worth it. Think about the charts that really are problematic for physicians. When we speak of the third element, which is the quality of the experiences, I think, for both consumers and providers, the quality of the technology and the digital experience have been great but when we speak of the physicians, we all know how painful the charts are for them.

Q. In the last decade, some physicians have been worn down by the instrumentations and layers of technology sitting atop the charts and trends. Skepticism has increased especially if this adds to workloads because they don’t have enough time. As the CDO, how do you look at the technology solutions landscape when you’re trying to address this?

Tony: We don’t want to deal with something that makes more work for us and for physicians. Especially during crises, when things compound in terms of technology landscape, it’s interesting to see how the interactions shape up because you have some of the same type of players — the big tech, the established traditional technology players (distinct from big tech) and then, the older startups. There are some differences in interactions but it’s not very clear what their strategic plan is other than maybe selling more cloud and devices.

Take Google, for instance. They’re possibly reducing their efforts in healthcare or pulling back but while they’ve been in charge, I haven’t seen very much other than very marginal capabilities. If you also look at the Haven — the joint venture between JPMorgan, Amazon, and Berkshire — again, what they’re trying to do isn’t very clear. Apple, in contrast seems very focused on additional health capabilities and their devices, but it’s relatively limited. The Apple Watch is slightly different here. We like some of the health capabilities that provides in terms of established providers.

And in this category, I would say there are the EHR vendors, too. Some of them are very successful, but all of them have somewhat old technology stacks. They’re trying to be all things to all people and this is reminiscent of the ERP and MRP space. They’re slow to market and some of them are still dreaming of closed platforms with customer in. They’ll have to change simply because of the other two categories and the fact that the world is changing and finally talking about startups, lots of money, VC activity etc.

It’s somewhat probably scattered and that’s part of the way it works but I see two different and somewhat opposite categories here. On the one hand, there are some who are certainly trying to emulate OR to build a comprehensive but closed platform. They look at presumably the big vendors and what worked for them. They’ll try it for themselves — either buy the entire platform or their product. Probably in the best case, there’s a doubt about long-term financial viability. On the other hand, there are companies that are very narrowly focused and they don’t integrate very well into the ecosystem. They get the work done and product launched successfully but in an independent fashion.

However, now that we’re bringing in the identity/authentication, how does that work? I’m not going to force the consumers to put their data into a system just because I already have that data. So, it just doesn’t make sense as a realistic approach. I think the startups should focus on very specific capabilities and execute them well, but also have APIs to integrate at all levels in the rest of the ecosystem.

Q. You’ve got multiple stakeholder groups to work with and you have to drive change in the organization. What does the governance model for driving digital health at Baptist look like?

Tony: I structured the digital program as a place for everything to converge in a natural and structured way that has a strategy, scope, priorities and a roadmap for no more than 12 to 18 months. We also got dedicated funding for the program as a concept. In certain places, the digital investments may be very hard to manage but this was one program, so there’s a long-term funding bucket. We got the bucket and the money required, in tranches as we went along. There is a digital council that I chair with very select stakeholders and thought leaders from the organization — the clinical and operational sides etc. A very important and equally critical point is to have a very comprehensive and increasingly well-developed communication plan — whether with artifacts or internal wikis or live presentations and even demos to a variety of different constituents.

Q. How do you make sure all stakeholders are working together in the same sandbox and driving organizational objectives?

Tony: It’s important that digital transformation is not looked at as born-again. We have the digital council, but there’re also a number of other committees and boards that a number of us are on to try to ensure that cohesion. We operate on the premise that everything will be different tomorrow than today. So, as much as possible based on the strategy, some things are done by my team and some by others. As long as it seems coherent and the result is positive, everything is good. There’re a lot of conversations, but I think that’s natural.

Q. It’s been a year since you came into your new role. What are the one or two learnings that you’d like to share?

Tony: First and foremost, don’t debate whether you need to go digital because you do. Then, the final strategy we just described – know why that is important. So, everybody knows how to align, whether in spirit or in details. But don’t overspend on the details. I was never one to spend two years on a strategy and then, have to redo it because the world is different. I’d say, have the right stakeholders and thought leaders with you driving the bus. So, I’m driving the bus with them together. And thought leaders and influencers don’t always have fancy titles, but they’re valuable, nevertheless. This is the team that would do the implementations and drive the change. This is both, from a professional competence perspective, but also, a mindset. Learn from mistakes and know that mistakes will be made. It is important to be ready when these happen and have that team flexibility to turn around and fix them. Digital is not easy. The Amazons and Googles do it very well but it requires a lot of focus and attention to detail. For a successful digital, the organizational processes and the business processes do have to change.

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 our guest

Tony-Ambrozie-profile

Tony Ambrozie is the Senior Vice President and Chief Digital Officer/Chief Information Officer for Baptist Health South Florida, the largest not-for-profit healthcare organization in South Florida. He is responsible for all technologies and customer experience as well as clinical digital and data transformation efforts.

Before joining Baptist Health, Mr. Ambrozie served as the Senior Vice President, Technology and Digital at The Walt Disney Company. In this role, he was responsible for a number of digital and core systems and technologies, engineering, data analytics and machine learning for Disney Parks, Consumer Products, Games and Publishing.

Prior to joining Disney in 2013, Mr. Ambrozie was Vice President for Digital Platform Technologies at American Express, where he was responsible for platform engineering, shared services development and application security, with previous roles focused on application architecture, development, engineering and performance.

He is a proven leader in the technology and digital space with a keen focus on using technology and data to enhance the consumer experience.

Prior to spending the past two decades focused on large business operations, he launched his technology career as the cofounder of a software development startup, specializing in building unique, small business applications.

Mr. Ambrozie holds a dual MBA and master’s degree in Information Management from the W.P. Carey School of Business at Arizona State University.

About the host

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

Competition in the market is forcing more collaboration between healthcare providers and payers

Season 3: Episode #95

Podcast with Jacob Sattelmair, Co-founder and CEO, Wellframe

"Competition in the market is forcing more collaboration between healthcare providers and payers"

paddy Hosted by Paddy Padmanabhan
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In this episode, Jacob Sattelmair, Co-Founder and CEO of Wellframe discusses how technology solution providers can collaborate with health plans to deliver impeccable quality care to people whenever and wherever they need it. With Telemedicine adoption rates gradually on the rise, it’s imperative to enhance investment in a digital concierge type service that puts the patient first, breaks down silos within the health plans, and facilitates improved collaboration between plans and providers vis a vis support.

Sattelmair maintains that leveraging “high-tech for high-touch support” is the way to go in a COVID-ravaged world. This will not only transform patient experiences and care management but will prompt people to better understand their health while smoothing the navigation around the healthcare system. Take a listen.

Our Podcast Partners:    

Show Notes

00:35Could you tell us about who Wellframe is and how you got to funding the company?
03:27What has the pandemic meant for your company and your consumers? How have the past 18 months been for the competitive landscape you operate in?
06:23 Who pays for your technology and services? How do your clients – health plans – justify an investment in a platform like yours?
11:07 Historically, providers and payers have not been great at collaboration. When will that change? Which parts of the market do you see as the opportunity areas to drive these collaborations to create value for the consumers / members / patients?
22:46 In the tech landscape, there are the big tech firms, the larger healthcare focused tech firms, and there's a whole range of digital health startups. What is your advice to the VCs who like to put money in them?
25:22 Recently, couple of the big tech firms have scaled back their investments in the healthcare market. What does it mean for the appetite in the marketplace for disruptive technology-led innovation models?

Q. Tell us about Wellframe and how you got funding for the company?

Jacob: Wellframe is a company that is partnering with healthcare organizations to drive digital transformation of experiences for members and patients. Primarily, we work with health plans and help them modernize the delivery of services and their members’ experiences. We started by digitally modernizing clinical support services for high-risk members and have expanded to help plans drive toward a more integrated and holistic service model. Think: a concierge or advocacy type of service that really transforms members’ experiences and positions plans to help people better understand their health and how best to navigate the healthcare system.

The company was founded in late 2011-early 2012 by a diverse group – an Epidemiologist by training together with a Primary Care Physician, a Computer Scientist, and a Data Scientist. What really drove us was the huge gap between the day-to-day needs of people — especially those living with chronic conditions or multiple chronic conditions — and all that people had to do to manage their health at home. We noted the pressure people were under to make good decisions about the levels of care, their increased stress, isolation and uncertainty and saw a well-endowed health care system struggling to comprehend how to help them — conveniently and on a bigger scale. At that time, some technology enablers – mobile phones and the Machine Learning techniques — were relatively new but they presented huge opportunities to better organize the resources of the health care system around the needs of people outside of the four walls of care delivery, the home and the community.

Motivated to make an impact, we brought our collective skills and expertise together to bridge that gap with technology while focusing on extending relationships and helping people feel supported and cared for during periods of need.

Q. Let’s talk about the macro-environment. What has the pandemic meant for your company and your consumers? How have the past 18 months been for the competitive landscape you operate in?

Jacob: This is a huge topic deserving time but here are a few highlights. Pre-COVID, there were some pretty significant temporal trends governing the market and consumer that were driving demand for what we were doing. Consumers looked to access care and support through digital channels — the mobile — while every other part of life started to take hold for large healthcare organizations. Those who purchased insurance or care, employers or state agencies, expected more from health plans — a more modern service model and experience for their constituents – and that increased the urgency for plans that could enable investments to digitally modernize their services.

Covid had a far-reaching impact — it bared some of the challenges inherent to traditional modes of communication and engagement. One was the absence of ways to communicate policy changes, offer support, guide people or even recommend action to them. These deficiencies became more glaring in light of minimal investment in modern channels to reach a lot of people.

Then, there was the acceleration of Telemedicine. Here, incentives were aligned among consumers or patients, providers, health plans and regulators. That was kind of a perfect storm to massively accelerate its adoption. It challenged a lot of the traditional paradigms that had kept virtual channels as a bit of a sidecar to the health care system. Not a lot of people get care or support through the digital media. And a lot of fairly risk-averse health care organizations had been pretty skeptical about value here. But Telemedicine elevated the stature of some of the things that we were doing. It hit the priority list of more and more health plans, leadership boards and expedited some expansions with our customers. It definitely put us on the radar of more and more plans that recognized that if now wasn’t the time to invest here, then, I don’t know when that could be.

Q. Who pays for your technology and services? Your clients are health plans, so how do they justify an investment in a platform like yours and by extension, any other digital health plan?

Jacob: Our target customer is any organization that’s holding some sort of risk around outcomes and investing resources in supporting and engaging people to improve outcomes to mitigate that risk. Historically, that’s largely been health plans. So, that constitutes the majority of our customers, today.

But the growing prevalence of risk-bearing providers that are hitting scale and investing in these types of services are all relevant for us, as well. So, the kind of business case or value for them is they’re spending money on services, today, that are trying to support and engage their members largely through telephonic interaction and home visits, etc. And the mobile presents a more intimate but scalable channel through which to extend these relationships of therapeutic support, very high touch and convenient manner as to reach more people in need. The aim is to be effective in delivery of services and support to enable people to manage their health at home and be aware of the choices they make about their care. That ultimately leads to higher quality and lower cost and a more competitive plan product. So, our motives are aligned with our health plan customers to deliver a better member experience, a more competitively priced plan product, innovate and differentiate in a market where there’s a growing amount of disruption from startup health plans or a third-party service provider and the expectations around how plans invest to engage and support their members.

We provide the technology and partner-up to catalyze modernization and transformation of these services to help our customers compete and meet their members and stakeholders’ needs.

Q. Messages and outreach campaigns from the provider and health plans both target the same thing — better health behavior and efficient management of chronic conditions. Who do I engage with first? What are you seeing and how does that dynamic play out in the way you position your platform with your services?

Jacob: We see that as an exciting opportunity on the horizon. As we’ve evolved from digitally modernizing care management to helping our customers deliver more holistic support, our first objective was helping break down some of the silos within the health plans to offer more integrated services, holistic support and focus on the needs of the member, first.

From there, we see considerable opportunities to help our customers facilitate greater collaboration between plan and provider as it relates to the provision of support. For the individual patient, remember, it’s not that I’m talking to the plan but I’m talking to the provider and there’s no crosstalk in between. So, digital channels and workflows that can be built around those present an exciting opportunity to facilitate greater collaboration and crosstalk between plan and provider.

That goes along with a growing trend toward vertical integration, value-based care arrangements, more collaboration from a financing and a risk-sharing perspective that creates incentives for this to happen across geographies and markets. We appreciate that.

 There’s no silver bullet and it’s not easy, but we have the building blocks — active strategies with all our plan partners around how to drive more provider collaboration and move more of what we’re doing closer to point of care — to enable this.

Q. Historically, providers and payers haven’t been great at collaboration. When will that change? Where do the opportunity areas to drive these collaborations and create value for the consumer/member/patients?

Jacob: I think that competition in the market will force more collaboration. Large plans that are vertically integrating with providers very aggressively, startup health plans engaging in joint ventures or close collaborations with provider systems are signs that your plan products are getting out there. They will have tight collaboration with providers and there will be benefits to consumers/members, and benefits from an efficiency perspective that can be derived from there. 

That will force everybody to rethink some of the traditional paradigms and relationships that may have been more contentious, historically. Now, we’ll have to figure out how to work collaboratively to deliver the best possible solutions to consumers at the highest value and the best experience. People that aren’t thinking that way will struggle to succeed and compete because the market will pass them by.

Q. Where does a firm like yours play in that equation to bring about this collaboration — Will you straddle both sectors? Will you be working with providers eventually and perhaps integrate both?

Jacob: We also work with providers and have been deployed in the provider context for over 7 years. There are many plans – some provider-owned and some they have partnered or have some sort of value-based care relationship with — that are actively deploying. These offer great learning, proof points and insights into how that model can be scaled across payment arrangements, geographies, lines of business and types of plans.

There are opportunities to work directly with providers that take the risk and hit a scale where they start to invest in their own services. There’re also the regulations around data interoperability and integration that are enabling consumers to share their data seamlessly and creating forcing functions for organizations to open up APIs to allow this data to flow.

So, the idea that we’d help facilitate the exchange of clinical and claims data on behalf of an individual that is both, a patient, and a member, in the coming years seems more possible now than five years ago. The government regulations are encouraging of this type of interoperability, and it plays into the strategy of our customers and what we’re doing, well.

Q. –Let’s talk about the competitive landscape. There are providers who’re doing what you do. Perhaps in very fragmented ways. There are many innovative solution providers, too. But the clients are struggling to make informed choices. On the flip side, the startups, in a bid to stand out are adopting different strategies to stay relevant. What’s your take from the perspective of either increasing surface area or enhancing your impact and going deeper or broader?

Jacob: There’s been a massive influx of investment capital into this space, which is enabling thousands of blossoms to bloom. This is catalyzing innovation in exciting ways to open new care models, solutions and offer a plethora of options to incumbents in terms of either disruptive or enabling forces.

The challenge with that is you run the risk of actually adding to fragmentation as opposed to countering it. There’re lots of point solutions that, for example, offer virtual care for diabetes, behavioral health, maternity and cardiac, which is great! But a lot of the people that have serious need don’t have one condition. They have four, five or six. So, how do you manage that?

We see that health plans are in a pretty unique position where they manage a network of all types of providers. And they capture data that, while not to the clinical depth, looks holistically across the care people are getting, often among multiple providers. And there’s an opportunity for health plans to facilitate integrations that allow people to access the resources they seek and help them navigate to the ones optimal for them.

We’re partnering with plans to help them establish a proactive relationship with their members by identifying their needs and helping them access high-value resources. This could imply finding the right person in customer service or care management on the planet, get them the right provider and network — whether that’s brick and mortar or virtual care – or zero-in on the right solution or third-party benefit that’s offered to them through the plan or employer.

If the plans invest in establishing more modern relationships with members, organize and curate this plethora of solutions, help evaluate the impact of these solutions and then, optimize their routing to connect people with what they seek, then, there’s tremendous opportunity.

What we’re doing can be meaningful in enabling that strategy. And then, as it relates to the provider-side of things, in a world where payments are evolving and risk is shifting, there’s certainly ambiguity in some situations about who’s responsible for what. Whereas historically, the risk was that a lot of people would have fallen between in the cracks, with neither their provider nor the plan paying attention to them, today, there may be situations where they’re being paid too much attention. That’s not ideal but it’s a swing in the right direction. More collaboration between plan and provider can help work that out.

There’s no simple solution – technology isn’t the only one — but there’s an earnest effort among our customers to work collaboratively between plan and provider to sort that out, increase communication and collaboration. That’s not easy nor simple but will pay off over the coming years.

Q. With regard to health care management and chronic conditions, you mention the comorbidities that the most intense cases represent. You’ve also talked about expanding into clinical areas. Are you heading toward becoming a one-stop shop as a company?

Jacob: That’s a critical part of our foundation. For instance, I’ll start with a condition and then, I’ll recognize existence of multiple conditions, and so, I’ll stack these – conditions and specific solutions — and try to cobble them together.

We purpose-built our platform from the start to enable holistic clinical support for people with multimorbidity and clinical complexity across both physical and behavioral health domains, recognizing that it’s the person managing multiple conditions and social drivers of health that tends to be the highest risk and among those, who are targeted for care management programs.

All our programs are modular. So, if there’s an individual with complicated Type 2 Diabetes, stage 2 heart failure and mild depression, they will need help with nutrition and finding a doctor. We can bring those modules together to offer holistic support to that individual in the context of an integrated care team that would include a nurse, a coach, a social worker, an expert peer, and a customer service representative. That’s really been the crux of our strategy from the start. It’s enabled us to help our customers target some of the most complex members that need nurse-led clinical services.

While many of the interventions that are framing themselves as care management are non-clinical coaching services, which can be incredibly valuable, there’s a different scope in terms of what they’re able to tackle and who they’re able to help. For health plans, for instance, while there’s been varying levels of appetite to in-source or out-source some of the less clinically intensive services, most plans have continued to own nurse-led care and case management throughout. 

Q. When it comes to the tech landscape, there are the Big Tech firms — some larger healthcare-focused tech firms and the digital health startups – with more emerging every day. What’s your advice to the newcomers and the VCs who like to invest in them?

Jacob: There’s a lot of money coming into this space. So, the concern or the skepticism is that we’re over-funding ahead of the market. However, there’s also evidence that the market is being disruptive and there are huge pockets of need and opportunity that are conducive to significant change. That change is probably not going to be driven entirely by incumbents. It’s going to be delivered through disruptive forces that push incumbents to change or companies like us that are enabling incumbents to modernize more quickly than they’d be able to do on their own. Given the huge need for improvement in the way care is delivered — the convenience, quality, accessibility, and cost — it’s hard to say that we’re putting too much money into the space.

In fact, even if some of this money is like “wasted,” it helps accelerate the improvements in care and helps expedite better outcomes, and improve quality of lives. There’s a long way to go to make care work for people in the way we all imagine it would.

So, money is coming into the space for a reason and some people will be successful. But that’s the venture model. For entrepreneurs coming in, I’d say, you really need to be passionate about the impact you’re making because nothing happens that quickly in healthcare, it does require significant persistence. But now is a good time to be part of that change. Things possible today wouldn’t have been imaginable 10 years ago.

Q. A couple of the mature big tech firms with deep pockets have recently scaled back their investments in the healthcare market. What does it mean for the appetite in the marketplace for disruptive technology-led innovation models? Is that just a blip or is there a broader message?

Jacob: It’s such a big space and there are so many opportunities that the large tech and retail players will continue to invest here. The idea that their pulling-back signals failure isn’t correct. Large organizations must be encouraged to invest, innovate, and take risks. When one does that, one takes risks to try do something new, and it doesn’t always work exactly the way one thought. So, you must pivot and adjust and its laudable what these players are doing that. I’d be very reticent to criticize such organizations for seeming to pull back or change their strategy. If you’re a startup, you’ll do that 10 times over before you hit your stride. So, I applaud them doing it to make an impact in such an important space.

Between the healthcare incumbents who have the appetite to improve and the commercial pressure that’s pushing the disruptive large tech and retail players and the venture- and private equity-backed startups, hopefully, all of them will meet in the middle and sort themselves out. That’s good for consumers and we’re privileged to be a part of that, but it doesn’t mean you’ll always win. If you can help move the ball forward and make things better for people, then that’s a goal worth working toward.

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 our guest

Jacob-Sattelmair-profile-pic

Jake Sattelmair is the co-founder and CEO of Wellframe. Wellframe fixes the two biggest problems with American health insurance: The patient experience, and the rising cost of care.

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.

In the future, clinicians will have the choice on the blend between physical, virtual, and automated care that they can prescribe.

Season 3: Episode #94

Podcast with Dr. Roy Schoenberg, President and CEO, Amwell

"In the future, clinicians will have the choice on the blend between physical, virtual, and automated care that they can prescribe."

paddy Hosted by Paddy Padmanabhan
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In this episode, Dr. Roy Schoenberg, President and CEO of Amwell, discusses the current state of telehealth in the U.S. and how its adoption is impacting the experience for healthcare stakeholders – consumers, providers, and payers. Amwell is a leading telehealth platform in the United States and globally, connecting and enabling providers, insurers, patients, and innovators to deliver greater access to more affordable and higher quality care. 

The COVID-19 pandemic made people realize that healthcare can be effectively delivered through technology. Telehealth technology has turned the corner and now has a life of its own. Dr. Schoenberg discusses the role of big tech and EHR in the rapidly changing landscape and shares advice for digital health startups. Take a listen.   

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Show Notes

00:56Could you give us a little bit of the State of the Union on telehealth in the United States today?
04:08Have we reached an equilibrium when it comes to in person and virtual visits?
05:21 Who have you primarily served – payers, providers, employers, and how has it changed pre to post pandemic?
08:32 When you talk to your customers, what are the top two or three things that you hear in the context of this coming digital transformation?
12:47 Are consumers willing to go with a virtual first kind of a model? There are challenges when it comes to technology adoption like - provider adoption, systems integration. What are the health systems doing to make this more of a default mode of operation for the most important stakeholders in patient care -- clinician community?
16:09 Where are regulators going with the reimbursement models for telehealth? Are there uncertainties people are overcoming in this context?
18:47 Amwell’s been in the news for the acquisition of SilverCloud and Conversa. What was the rationale? What should your clients and their clients expect next year?
24:25What is your advice for the Chief Digital Officers?
26:42Big tech firms – Google and Apple, for instance – are scaling back some of their programs. What does that say about the nature of the state? Is it too hard for tech?
28:20What’s going on with the information security and ransomware attacks? Is it going to get worse or is it going to get better?

Q. With the pandemic, mental health and social care, have become even more integral to care delivery in the US. Virtual visits initially skyrocketed and then, fell, slightly. In this context, can you share the State of the Union on Telehealth in the US, today?

Roy: The COVID-19 pandemic made a lot of people realize that health care can be delivered safely and effectively over technology. Maybe that’s the highest way of describing it. While that statement is true, it resonated differently with diverse audiences and impacted them differently. We’ve seen many Americans — patients, consumers, members — gravitating towards telehealth because during the pandemic, movement was restricted. So, there was a huge increase in adoption of telehealth by the general population. When the situation improved, the same volume of health care needs started getting balanced by telehealth, retail clinics, ERs and Physicians’ offices. Today, there is a higher volume of telehealth, but it’s definitely come down compared to earlier.

The part that’s less reported but has lasting impact is the adoption of telehealth by the clinicians. Their reasons are very different — Most health systems and offices couldn’t see patient volume, couldn’t submit claims and were experiencing financial upheaval. So, many organizations systematically started shifting a lot of the health care onto telehealth to restore their ability to do business. That created a circumstance where a lot of clinicians were exposed to it for the first time and they liked it. What is really astonishing about the long-lasting effects of the pandemic is that the volume of telehealth on our system being carried out by clinicians with their own patients, continues to grow. So even though, things have hopefully subsided and the critical moment is past, telehealth now has a life of its own – like a viral evolution. I think we’re just at the beginning of understanding how that’s going to affect our experience as patients in the future.

Q. Have we reached an equilibrium or are we still in an exploratory stage? Is this going to play-out over a long time?

Roy: We haven’t even begun to scratch the surface. We may have just passed a point where people are asking — should we be using telehealth? That point is in our rearview mirror. People are starting to wonder how to utilize it effectively. “How can I make life easier for my patients? How can I make it easy for them to be compliant with a medical regimen that they need? How can I move the needle on cost of health care using technology?”

All of these conversations are now being held, but they’re still very nascent. So, I think the world is actually going to change for telehealth much more drastically over the next couple of years, paradoxically, than what it did during the during the pandemic.

Q. Who have you primarily served as payers — providers, employees? How has it changed predisposition to a pandemic?

Roy: That’s a fascinating question. So, we’re a little different at Amwell given we’ve built more of a platform and technology infrastructure. The result was that we could do a lot of business in each of these verticals. We run telehealth for a lot of the payers – regional and national. We run a lot of telehealth for health systems and serve many other institutions, individual clinicians, the government etc. That gave us an interesting lens into how things have changed over the last two years, because the appetite and motivation for telehealth had dramatically changed within those different organizations or verticals. For instance, if historically, the payers and the peers were thinking about telehealth as a way to get people to not use ERs, that was the big-ticket item.

How do you ensure that people have an alternative when there’s something wrong with them so they don’t have to go to very expensive and overutilized ERs? While this still remains a calling for telehealth from the perspective of the payroll, the health plans actually think of it more as an instrument to influence the care being rendered to a patient at the point of care. This is where virtual PCP etc. come into play. But payers are beginning to utilize telehealth and its ability to incorporate data in real-time because it’s a digital platform. This incorporates the best analytics, the best network definitions to ensure that the care being rendered to the patient is much more informed and cost-effective. This has major implications on how much must be spent on insuring those patients. This, then, is a radical transition in the understanding of what these technologies can do. And it’s true for every domain, not only payers.

Q. When you talk to your customers today, it’s a part of the conversation. What are the top two or three things you hear in the context of the imminent digital transformation?

Roy: The conversation is a little different depending on the type of the customer being spoken to – the payer, the health system – it isn’t exactly the same. But, in terms of similarities, the general notion is we need to transition a lot of the care that we’re involved in, to digital platforms. The motivation and the instruments by which this happens are different when you talk to a health system — it’s really more about making this the second language for clinicians because they’re the ones calling the shots and prescribing care. We need to make it very easy for them to take advantage of these technologies. From there, you can peel the onion.

It needs to be integrated into their research, scheduling and their staff needs to be able to help them with patient interactions. They must be able to move seamlessly from the physical to digital to physical between 10 and 11 a.m., for instance. So, there’s a whole list of derivatives that are driven by health systems to make telehealth a channel of health care delivery for themselves.

When you talk to health plans, it’s the same motivation — to move as much of the delivery of care to those digital platforms, as possible. The other questions are – How do we implement access so that it is top of mind of our membership? How do we make it easier to consume given there’s so much variability at the consumer level? How do we make sure that it will operate cleanly in the same way on any platform that they want to utilize? How do we ensure that the employers that essentially govern the communication mention the benefits to the employees and pass this along in their messages?

It’s a very different kind of currency and different instruments, but they all have one endpoint — health care activity needs to transfer over technology. People may attribute different percentages to this –20-25% — and it’s still a nimble kind of aspiration. If you think that more than 50% of retail has already transitioned into technology, that’s it.

Q. There are challenges as well. Provider adoption. Systems integration. And then, are consumers willing to go with a virtual first kind of a model? What are the health systems doing or should be doing to make this more of a default mode of operation for the clinician community who are by far the most important stakeholders in patient care?

Roy: I don’t envy anybody’s job of trying to bring change into the way that clinicians practice. That is a very tough nut to crack. And not because clinicians are bad people but because there’s just so much that they need to do that any learning curve, any variation, is trouble.

While I love technology, and it has a huge role to play, the parameter that makes the most difference is leadership. Technology must be integrated and accessible, predictable and reliable but at the end of the day, people — and clinicians — need to subscribe to why they would make that effort. In our experience, organizations that had exceptional leadership took the time to explain why this was going to be part of the vocabulary and the way to envelop all patients in the future.

The sooner we take advantage of it, we’ll become not only more modern but will be able to really serve our mission of delivering better health care and hope. That is sometimes lost when you talk about system integration and APIs etc. I’d say it has a bigger impact than people usually attribute to it. You are creating a perfect storm because if you do the right thing, you create expectations. Then the expectations are, if one signs up for it, it will work. It won’t be a hindrance to patient care, won’t get one to cancel visits because the patient wasn’t able to sign-in on the other end. So, there’s a lot of technology, work and detail you need to go through to live-up to the promise but it comes down to whether clinicians can absorb the huge impact that this is going to have on patients’ lives and as a result, the way they practice medicine.

Q. Economists mention incentives. With regard to the reimbursement environment for telehealth, where are regulators going with the reimbursement models? How big is this factor? Are there uncertainties people are overcoming in this context? Where are we right now?

Roy: We’ve turned a corner in the sense that nobody paid significant attention to changing reimbursement in a meaningful way prior to COVID. Now again, that question of whether it needs to be changed is behind us.

People understand that the new models of reimbursement have to include enabling clinicians to use technology where they estimate it’s for the good of the patient. It’s tough because it’s a whole new language. When CMS was considering a new zip code or the level of reimbursement for that zip code, it was a ritual that they’d repeated for many years. This one though, is big. You’re talking about how the entire practice of medicine can be rendered in completely different care settings. It really depends on how tech-savvy the patient is, which is really not a parameter in a medical chart. So, it is somewhat of a challenge.

If we’d discussed that question two years ago, I’d have said it’s a strategic challenge for the industry. I think that now, it’s a tactical challenge. There’s little doubt that within the next three to five years, the reimbursement issue is going to be behind us. I think that train has left the station. It’s still annoying and confusing because who knew health care could be so complicated? Where we’re going to end up is — clinicians are going to have the choice on the blend between the physical, the virtual and the automated so they can prescribe to a patient based on who the patient is and what they think is right.

Q. Amwell’s been in the news for the acquisition of SilverCloud and Conversa! What was the rationale? What should your clients and their clients expect next year?

Roy: The biggest impact was a new understanding of where these technologies could help health care. It’s not a question of “if” anymore, it’s “how.” And the understanding that it’s kosher to use technology to surround patients, opened the door to a lot more than just video-visits. People are not even talking about clinicians but have higher receptivity to the fact that some of their health care is going to be done in an office or in a hospital, some through their phone or the television or whichever one they choose. There is a deeper subtlety here — that is critically important, and that ties into the acquisitions — which is, we now have the opportunity to completely rethink how we surround patients. I’m not talking about the transactional people with the flu or a rash but when we think about the patients that really consume the health care dollars — people with chronic conditions, elders, cancer patients etc., it is now a legitimate conversation.

Can we surround them more holistically? Can we be present in a much more effective way than physical health care allowed? Physical health care was present next to a patient when they showed up in the office. When they left the office, they were on their own with a lot of guidance and prescriptions. Technology allows us to rethink the presence of health care around patients. We can be omnipresent. The real question is — how can technologies interact with the patient more automatically? How can we use A.I., NLP and algorithms to be there with the patient when they wake up in the morning? Maybe via a text message that says, “Hey! Did you take your medications this morning? What’s your pain level? Are you out of bed?”

There’s a whole world that opened up with the automated presence of health care around patients and if it is tied correctly to the synchronous clinician-based care for the patient, it can actually be incredibly powerful. Both of the acquisitions that we’ve made are along those lines. SilverCloud offers infrastructure for automated companionship with patients with behavioral health issues, patients who are depressed, anxious, suffer sleeping and eating disorders. There’s a variety of those in Conversa. That’s a very powerful automated infrastructure for companionship with patients along the line of medical conditions — patients who are coming in and out of a hospital, have chronic conditions etc.
We’re now beginning to form a pretty formidable automated encapsulation of patients who have those kinds of conditions. And we’re plugging it together with our fairly significant assets by way of virtual interaction with those patients. Conversa detects that something is going wrong with that patient. It has the ability to summon the truth. It’s connected to the telehealth of our world to bring clinicians in. And we are already connected into the physical world of health care through our integration with all these different health systems and payers.

So, there is the promise of completely reimagining how we approach long-term patient management — the trifecta of physical, virtual and automated care. That was the reason for the acquisition. And that’s the vision.

Q. You’ve described what many Chief Digital Officers (CDOs) are trying to do — surround the patient with technology and a seamless experience. The second part is more challenging – the plethora of technology platforms that can go into a digital roadmap forward. In that context, what is your advice for CDOs?

Roy: We have to acknowledge that we’re not trying to create another health care system. We’re trying to connect the parts and allow different organizations to do the best they can in the context of that kind of holistic, continuous patient experience. Health plans should continue to be health plans and health systems and clinicians will continue to be clinicians. The technologies are just going to give them wings to be available and deliver to a broader population in a more timely and equitable fashion.

While I’m not sure the answer is to have one system, you have to have an EHR and an interactive telehealth system. And they’re both foundational capabilities that must be developed so they speak to each other fluently. One piece of advice I have is — a big part of the way that you care for patients is going to go over technology and that is inevitable. The moment that you take a step back and think of the future, that’s where things will be clear in terms of the infrastructure that you’ll need and how to plug one thing into the other.

Q. Recent newspaper reports speak of big tech firms – Google and Apple, for instance — scaling back some of their programs. What does that say about the nature of the state and the nature of the beast?

Roy: I think it’s different. The biggest challenges in health care are that the consumer doesn’t know what they’re buying and the provider doesn’t know what it costs. The health plan and who pays for it, is nowhere near where care is being rendered. But that doesn’t mean that you can’t be a part of the solution. Sometimes, in large companies, being part of a solution is not necessarily in line with the way you view yourself. While that is humbling, we all have a role to play and eventually we’ll find our places for it’s an ecosystem and not one person’s landgrab.

Q. One last question — you’re very familiar with information security and ransomware attacks so what’s your view of what’s going on? What’s going to get worse before it gets better?

Roy: I don’t want to end with a somber statement. But I shall say that it’s going to get worse simply because so much of health care is transitioning into digital channels and health care is near and dear to people’s livelihoods and pockets, almost like their bank accounts. We already know that medical records are worth more in the cyber black market than a credit card number. So, there will be more attacks, people with interest to disrupt, will steal data. That just means that you need to be very serious about the infrastructure being put in place — Information Security and all of its aspects will need to be from the floor-level of system design and they should not be one-time investments. It’s a long-term battle with the bad guys – they aren’t going away so we can’t, either. We just need to accept this as the way forward and carry on.

About our guest

Roy_Schoenberg_Amwell-profile-pic

Dr. Roy Schoenberg is the President and CEO of Amwell. Since co-founding the company with his brother Ido Schoenberg, Amwell has grown to become one of the largest telehealth eco-systems in the world, digitally connecting healthcare’s key stakeholders - payers, providers, and millions of patients in an efficient, modern healthcare experience.

Prior to Amwell, Roy was the Founder of CareKey and served as the Chief Information Security Officer at TriZetto, following its acquisition of CareKey. In 2013, Roy was appointed to the Federation of State Medical Boards’ Taskforce that issued the landmark guidelines for the “Appropriate Use of Telemedicine in the Practice of Medicine.”

Roy was named one of Modern Healthcare’s 100 Most Influential People in Healthcare in 2020 and is the 2014 recipient of the American Telemedicine Association Industry award for leadership in the field of telemedicine. An inventor at heart, Roy holds over 50 issued US Patents in the area of healthcare technology, speaks frequently in industry and policy forums, serves on the healthcare advisory board of MIT Sloan, holds an MD from the Hebrew University and an MPH from Harvard. He is a sailor, scuba-diver, and, between September and February, a devoted football fan.

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 seeing a lot more proliferation of innovative business models going well beyond just a pure telehealth visit

Season 3: Episode #93

Podcast with Oleg Bestsennyy and Jenny Rost, McKinsey

"We’re seeing a lot more proliferation of innovative business models going well beyond just a pure telehealth visit"

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In this episode, McKinsey partners Oleg Bestsennyy and Jenny Rost discuss the findings of their recently published report – ‘Telehealth: A quarter-trillion-dollar post-Covid-19 Reality?’ The conversation highlights the rapid growth of telehealth since the pandemic and explores several important differences in adoption rates based on types of care, demographic profiles, and other factors.

Telehealth can  be a great enabler for delivering innovations that lead to better quality healthcare, member experience, and lower costs. There is a need for continued innovation to sustain and expand telehealth and investment in building seamless consumer experiences, especially in a hybrid care model.

The report provides several interesting charts that inform readers on the emerging landscape of telehealth and virtual care models. Oleg and Jenny also discuss various headwinds that will impact the growth of telehealth technologies in the future. They also share advice for health systems and health plan executives looking to navigate the transition to virtual care models successfully. Take a listen.

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Show Notes

00:43McKinsey just published a report titled Telehealth: a quarter-trillion-dollar post-covid reality? What are the key findings of the study?
04:48The report mentions that telehealth volumes have dropped off from the pandemic peaks. Have we reached an equilibrium or are we still evolving towards a steady-state hybrid model?
11:42 You mentioned one headwind in telehealth adoption, which is the reimbursement environment. What else could be a significant headwind and what is your study indicates?
13:49 Healthcare is behind other sectors like ecommerce, personal banking and faces real infrastructure as well as design issues. Where do you think health systems and large health plans are today?
17:05 You refer to the VC funding levels for digital health which is driving a lot of innovation in the report. What are you seeing at the other end in terms of acceptance and adoption for these solutions by health systems?
19:40 Can you comment on the competitive landscape: big tech firms, digital health startups, EHR vendors? What is the tech landscape looking like at health systems in a virtual care future?
21:38 Do you think employers are going to become a significant force that's going to chip away at a big part of the overall healthcare services marketplace?
28:18What would you advise health systems and health plan executives who are trying to sort through this changing landscape, the shift towards virtual care, and are faced with big investment decisions as it relates to technology

Q: McKinsey just published a report titled “Telehealth: A quarter-trillion-dollar post-COVID reality?” What are the key findings of the study?

Oleg: It’s worth noting that this article ended with a question mark. Is this quarter-trillion-dollar opportunity going to be a reality? The original article, from over a year ago, tried to outline the potential for telehealth. We arrived at a figure very close to USD 250 billion of care that could potentially be shifted given the underlying fundamentals to telehealth. Recently, we looked at it to ask what had happened since the pandemic started and how this had evolved?

The key findings have been – Telehealth accounts for around 13-17% of all office and outpatient visits in the U.S. That is between 30 to 40 times the pre-pandemic levels. This has been fairly stable since June 2020 has been exciting. It’s continued with variability since June though. I must point out here that despite average telehealth adoption, there’s been a lot of variability in specialties. So, we’re equally excited about how adoption of telehealth has differed by specialties.

Jenny: What I would add is to look at some of the drivers here – initially, we saw huge increases in both consumer demand for telehealth and provider demands due to the realities of being in the midst of the COVID crisis. We saw that perceptions have largely stayed very positive and providers, in particular, many of who did not use a lot of telehealth prior to COVID, have enhanced perceptions of it now, than before. Many do intend to continue using telehealth and similar results are evident on the consumer side. What’s really exciting is that there’s a lot more proliferation of innovative business models going well beyond just pure telehealth business or telehealth visit. However, to really integrate hybrid models of care, telehealth must be integrated with remote monitoring. I’m so excited to see how this continues to evolve going forward in a post-pandemic world.

Q: What do you include in the definition of telehealth and virtual care?

Jenny: For telehealth specifically, and that is what we did our claims analysis on, it would be virtual and telephone-based visits that were coded as such in claims data. Broadly, virtual health would expand to include remote monitoring, digital therapeutics, asynchronous and synchronous visits. So, it’s actually a wider set of ways to receive care, not in-person.

Q: When you published the report last year, telehealth volumes had dropped off a little. Yet they are still higher than pre-pandemic levels. Are we in an equilibrium or are we evolving towards one?

Oleg: When we think about the equilibrium, let’s ask what is the true future potential? The figure that was put out was USD 250 billion. What does it mean? Part of it means that a quarter of all of the visits in the future can, in theory, potentially be done virtually. When you compare it to where it is today — 13-17% of claims — it’s a big positive surprise that it’s risen so high so quickly and close to the outlined potential.

But then, we received feedback a year ago that 25% was on the lower side, that the potential was much greater. So, I hope that we’re not in equilibrium and the situation actually improves. But I’d like to make this provocative statement that, telehealth as a videoconference between a doctor and the patient quickly becomes commoditized. Sure, it improves convenience and access and becomes a great enabler of – innovation, better quality, better member experience and lower potential avoidable costs and better delivery of healthcare but it begs the question — Can you combine telehealth visits with remote patient monitoring applications to deliver better care at home for the elderly? When we look at this, we hope that spurred by investor activity, consumer and provider adoption, there will be more innovation leading to greater adoption of telehealth.

Jenny: I’ll play the devil’s advocate here. There are trends that could evolve and cause it to go down again, so there may not be an equilibrium by any sense. Continued innovation will be needed to sustain and expand the applications as it becomes easier for people to see their doctor in person. It has to be really convenient and offer seamless user experience. So, there’s a noticeable push towards not having telehealth as a siloed experience with the provider you see once, but really having integrated data and care so it’s really used to help you manage your care. On the provider side, will reimbursement stay, is a big question. Can this become a more seamless part of provider workflows too, especially as we think about providers who may be offering a hybrid model, not just a pure virtual health offering? I think there’s still lots of ways this could evolve that could push it in both directions

Oleg: Just one thing and I’ve alluded to it before — when you scrutinize telehealth adoption by specialty, there is a lot of variability. When you see Psychiatry visits or substance use treatment disorder visits, the level of adoption is much higher than average. More than half of all the Psychiatry visits, as we look at claims right now, are conducted using telephonic or telehealth means, which means greater access to a mental healthcare. I think, the innovations that Jenny is talking about, are going to evolve in the microcosm for different kinds of specialties, too. In the future, we’ll see a lot more happening in the space of tele-behavioral health than some other specialties.

Q: There’s plenty of differences between how the adoption rates play out based on the types of care. The rural versus urban setting, within urban areas – the inner city versus the more affluent sections, socioeconomic factors, the demographics, etc. What does your study show when it comes to breaking this down along these multiple dimensions?

Oleg: Even though we did not touch upon figures in the report, our colleagues have analyzed the data, and there seems to be a higher adoption level in the rural setting where the access issues are also much more prominent and pronounced than in the urban settings. There’s also considerable research going on right now in terms of how does telehealth help or maybe set back the question around health equity, access to health and the equal high-quality opportunities among the various strata of the population across socioeconomic backgrounds. The effect is still unclear but I do believe that technology — telehealth and virtual health, in general — espouses great promise to not only innovate around care models and care delivery, but also make a significant step forward to better health equity across the society, irrespective of geography, demographics or socioeconomic backgrounds.

Q: You mentioned one headwind — the reimbursement environment. In healthcare, everything is about following the money. What are the other significant headwinds from your perspective?

Jenny: Great question! There’s probably a few. One would be — just how seamless is the experience? We can do almost everything online today, but some are easier than others. So, is it one click to access all my data and then get a readout? Or is everything really fragmented? I’m probably much more likely to continue using telehealth if it’s all seamless and that’s the management populations with complex conditions need. Data integration is critical too. There are also some questions that are still being worked out around quality — What are the right sets, the conditions or symptoms that really do suit themselves well to a telehealth visit versus an in-person one? As providers work through the clinical models, that will impact what’s done telephonically, by video versus in-person, I think, some of those are the pieces that we’ll see continuing to be worked through.

Q: The fragmented nature of the healthcare experience is not new. There are some real infrastructure issues that make it hard to create that seamless experience – interoperability, design etc. Where are the health systems and large health plans, today? Is there a real difference between the financial performances of those who’re ahead in this game and those a little behind?

Oleg: In general, there is a lot of variability in how much different investors are investing in the underlying capabilities or how seriously they are treating this space. A lot has to go into data enablement, aggregation and interoperability capabilities. But all the capabilities related to working seamlessly with EMR, within the EMR or across care provider boundaries, need strategic investments. These will come with innovations around the way they approach the day-to-day workflows — a virtual only model, a virtual first model or a hybrid model that is seamlessly integrated offline and online experience for members.

Also, like with lots of other spaces, a lot of innovation today, is driven not so much by large systems, large health plans, but actually by smaller startups that are trying to find a niche to innovate around and try to scale it. I’m quite glad to see the high levels of investment and excitement around this space because I do hope that all of these investments ultimately result in better competitiveness and truly disrupting some of the care models to enhance care for everybody.

Jenny: We’re starting to see large players, payors, big health systems and value-based providers signing up for or currently being inundated by a lot of different point solutions and saying, “OK, we signed up for such a condition and such a convenience, for this segment of our members. So, how do we actually create the ecosystem?” That’s a more curated experience.

Q: In your report, you refer to the VC funding levels for digital health as driving a lot of innovation. It’s one thing for startups to get funded and drive innovation and another thing for health plans and systems to adopt solutions and make them work. It’s different altogether for consumers to really use it and make a difference. How much of this is hype? Or are we in some kind of a bubble here?

Jenny: I don’t have a number but if you look at some of the moves that really big players are making, you’ll see large retailers are making lots of acquisitions and big tech companies are expanding and innovating while broadening their portfolio of service offerings in this space. So, it isn’t just a startup game.

Oleg: We’re already starting to see some real innovation in telehealth technology itself. It’s a video conference that is HIPAA-compliant and one can now launch a telehealth visit without even downloading an app, just in one’s browser. When I look at innovation broadly, I see that for some conditions, there are truly remarkable ways in how care has changed compared to even a decade ago where you’re combining AI-driven behavioral nudges that are automated to the member with great member experience, behavioral coaching and remote patient monitoring packed all in one seamless end-to-end offering to really make a dent in the care and the outcomes for a condition.

So, investments lead to innovation. It doesn’t mean that all of these investments will play and pay out. But it does give me hope that some of this leads to true groundbreaking innovation and we’re really on the cusp of it in the next few years.

Q: Let’s talk about the landscape of big tech firms, digital health startups, the private, mature digital health companies. In terms of the opportunity landscape, where do you see the most traction? How are your clients, health systems looking at this technology landscape and making the tradeoffs?

Jenny: There’s an almost bifurcated value proposition that’s emerging. A series of solutions that are forming around convenience. For healthy populations that need convenient access to more routine care, this can be the triage symptom checkers that feed into a telehealth visit that connects to deliver your prescription home or in some cases even accommodates home visits as needed. So, it’s built around convenience. That improved experience often may be more targeted towards large employer health offerings.

Similar levels of innovation may also be seen more around chronic conditions, behavioral health or specific populations that have more complex needs. It’s about how you integrate the technology into those care journeys to improve outcomes, cost and quality of care. So, we’re seeing those two models play out across different types of players, investment areas and health plans and systems as well.

Q: Is there a real possibility that a lot of the business is now going to fall into the hands of the employers who are emerging as a buying force? Are some of the mature companies actually targeting them as a primary market segment — what do you think of that trend?

Oleg: We’re already observing they indeed are becoming a big force. From the purchase of some of these innovative solutions to the point of bifurcation that Jenny has mentioned, there is a lot happening.

How do we increase convenience of access to healthcare for our employee base? How do we look at it not only from the perspective of what leads to reduction in avoidable medical expense, but also how to better members’ experiences? Can this be used as a talent retention and attraction mechanism and what leads to better productivity and happiness?

That is kind of a byproduct of some of the solutions. So, I think we’re already seeing an increase in the levels of purchasing and spending on different kinds of solutions in the space. Some of them are targeting well-being, tackling anxiety and depression, or things related to convenience of routine care and low acuity, access to care by keeping the waiting rooms etc.

Going forward, this will continue to increase and employers will continue to be or become even bigger voices. On the other side of the fork, when you look at the employer base and people who have employer-sponsored insurance, there is great need for solutions that address the chronic care needs of the employee base. Some of the planned procedural base – telehealth, virtual care, and remote patient monitoring can go a long way in making that experience better and hopefully, leading the front line to reduce avoidable medical exacerbations.

Q: You’ve got access to care — a big area of digital health innovation — and on the other side, is the actual care delivery. Where are you seeing more traction?

Oleg: I’m happy to take the time to think about it. It was interesting because when the initial spike in the pandemic hit in late March-early April, telehealth was almost extensively used. One could not visit the doctor who one typically visited regularly, so one needed help to connect to anybody available and talk to them. That led to the growth of the space we call virtual urgent care — connecting to a random doctor on a low acuity, or some level of acuity with urgent issues that one needed to resolve right then and it helped solve the issue of access.

It was not so much about convenience. But what’s been analyzed in the original report, the potential value of that virtual urgent care as a use case is actually a small part of the overall total potential. The bigger part is around what may be described as it’s delivery component — innovation around care models and how that may be done.

Having said that, I think the lines are blurry and gray. So, there’s this category, which we call near virtual visits. For the sake of convenience, while the visit parts here are virtual, yet, some of the services need to be in-person, such as drawing blood or a lab test. Can these be combined to create both, a convenient aspect but still an innovative way to deliver care? Those are some of the interesting use cases that I hope to see grow, scale-up and proliferate going forward as well.

Jenny: There are some interesting questions about how to give access to more and more people. They now want it with their doctor, not just one through a telehealth app. So, how do we use technology to create better access to the care that people want or what they’re familiar with?

Q: What would your advice be to health systems and health plan executives who are trying to shift towards virtual care but are faced with big investment decisions related to technology and transforming organizations?

Jenny: Identify the sources of value from that virtual health that your organization can drive. That’s going to look quite different if you’re a large health system or a payer or a risk bearing provider group. But there’s so many solutions and strategies out there that could be pursued. One must understand what’s being optimized for patients or members — access, improved outcomes and cost or improved convenience and having that North Star to focus on and help cut through the chaff.

Oleg: I agree with Jenny. Viewing virtual health as a tool in the toolbox can break the mold on what and how you deliver care and generate value. It need not shift from one end of the spectrum to the other, but this is one component where it can deliver true innovation to patients and consumers and achieve the triple aim goal.

So, what are the components of the triple aim goal that you’re trying to achieve with virtual care? And how does it fit into your current and existing care delivery strategy? How are the two tied together? This then begs the question around use cases — How do you go about selecting these? Which solutions do you double down on? The one exciting part about the market is that it’s very fragmented. There’s a lot of change happening at breakneck speed with little clarity on how those various parts will emerge. But this is also where health systems and health plans can view themselves as shapers of what the future destiny can become, with some of them setting themselves apart from the competition.

About our guest

Oleg_Bestsennyy_profilepic

Oleg Bestsennyy is Partner at McKinsey & Company and leads McKinsey’s Next Generation Care Models domain.

Oleg has extensively served payers, providers, and private equity firms on a range of topics related to care models, including topics of telehealth, broader virtual care and care management.

Jerry_Rost-profilepic

Jennifer is leader at McKinsey’s healthcare practice and focuses on serving payers, providers, and healthcare technology players to develop innovative models to improve healthcare outcomes, experience and affordability. She co-leads McKinsey’s capability areas in value-based care and virtual health.

Jennifer is passionate about making the healthcare system work better for individuals in need of care. She has spent over a decade leading work with clients to develop and implement value-based care models, including incentive structures, data analytics and technology systems, and support mechanisms to enable providers to succeed in the transition away from fee for service medicine.

She also leads client service and the Firm’s research on virtual health, with a particular focus on bringing advances in digital and analytics to further innovate care delivery and improve healthcare value. She has published and spoken externally on the opportunities for virtual health and the future of care delivery.  She is also an affiliated leader of McKinsey’s Center for Societal Benefit for Healthcare, bringing expertise in virtual health to address under-resourced areas in healthcare, such as mental health and rural health.

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 deep in the throes of implementing several foundational technology platforms

Season 3: Episode #92

Podcast with Matthew Roman, Chief Digital Strategy Officer, Duke University Health System

"We’re deep in the throes of implementing several foundational technology platforms"

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In this episode, Matthew Roman discusses how Duke Health is implementing a number of foundational technology platforms for effective patient engagement and care delivery over the next couple of years. 

A clinician by background, Matthew describes the collaboration model among a diverse group of technology and operational executives to implement digital health programs at Duke Health. He gives us a hint of the one single question he wrestles with every day as the Chief Digital Strategy Officer. He also explains why they choose to “tread lightly” in offering clinical advice through artificial intelligence.

Matthew describes several challenges digital health startups must be prepared to face, even if they have remarkable and game-changing technology solutions. Among his words of advice? Don’t oversell. He also shares a few learnings from his experience for peer group executives in health systems. Take a listen.  

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Show Notes

01:17About Duke Health and the patient populations.
02:34Tell us a bit about the digital programs currently operational at Duke Health, maybe touch on telehealth in particular.
05:07 Talk to us about your top foundational platforms, any ones that you used to execute, and also your whole strategy. Are you using one or you are using multiple platforms for different things? How do they all fit with your other tools, especially the EHR platform? programs?
07:25 Have you been using chatbots more in the context of clinical chats or more in an administrative context for enabling access and providing patients with information on self-service tools?
09:27 Where you are in your CRM journey and what your focus areas are with the CRM platform?
12:09 In the context of a chronic disease, most of the deployments have been from RPM standpoint. How is it worked so far, especially the aspects where you bring back the data from the devices and the sensors and you try to combine that with the patient longitudinal records in the EHR?
16:11 How are you driving data and analytics program at Duke Health and how you are harnessing emerging data sources and tools such as AI?
18:12How are you structured to drive digital strategy? can you share your org model for driving digital transformation?
23:29What is your advice for tech firms, especially startups and innovators who want to be a part of your digital journey?
25:49Can you share a couple of best practices and operating principles for success with digital health programs?

Q: Tell us a bit about the populations you serve at Duke Health and your role in the organization.

Matthew: I’m the Chief Digital Strategy Officer for Duke University Health System. It is a medium-sized yet a very high-quality academic medical center located in the center of North Carolina. We’re pretty proud of the quality of care we offer through our three hospitals — a flagship academic hospital and two community hospitals — along with a large series of clinics, both primary care and a large specialty faculty practice. I report to the CIO and we support the academic mission through the Schools of Medicine and Nursing, as well as the health system functions.

Q: Can you share an overview for some of the digital programs currently in-flight at Duke Health? Telehealth, for instance, has been a big growth area for most organizations. Which one has it been for you?

Matthew: Our Digital Strategy Office was formed about three-and-a-half years ago as envisioned by our CIO, a physician himself. We are responsible for consumer-friendly, patient-facing technologies to help with our patients’ attempts to engage with us as a health system. We’re deep in the throes of implementing a number of, what I would call, foundational technology platforms on which, over the next couple of years, we will build hopefully more effective and broader reaching use cases. So, these platforms include programs, some of which are fully embedded already, some of which are in-flight.

Through our telehealth platform — our patient portal – we are trying to improve patients’ experiences. A CRM strategy around conversational AI and chatbots does exist but it’s important to reach out to the patients to learn from them what they want from us. We’re doing this through a virtual Patient Advisory Council. Some others have done this as well along with remote patient monitoring, both, in support of the telehealth platform and both supporting continuing care via virtual visits. Even if that care is initially delivered in-person, we’re able to — through these remote patient monitoring strategies — capture data points in much greater frequency to support clinical decision-making and predictive modeling.

Q: How have your patients and caregivers responded to Telehealth? What were your platforms and strategy for execution? How do they align with your EHR and other tools involved in delivering a seamless experience to patients?

Matthew: Our experience was like most others. We had a pretty small telehealth footprint. We had some early adopters and really impressive work, pre-pandemic, like our Movement Disorder Clinic. It had a Neurologist who was a very early adopter of telehealth. His patients were A-listers with tremendous movement and mobility disorders, and it took an army to bring them to our clinic. He had a pretty wide capture rate or geography and so, we were able to work with him to enable video visits to these patients. We had the same hockey stick increase in volume as everybody else did in March 2020. We went from 100 visits a month to 2000 visits a day, much like everybody else. The truth is, our highest month volume since the start of the pandemic was March 2021 and then, we’ve started to tail off just a little bit. We continue to have pretty high volume in some specialties or behavioral health and psychiatry clinics have remained very high adopters and high utilizers of our primary care clinics and certainly some of the specialty and surgery clinics as well. We have a primary platform that’s embedded in our EHR. And we have a backup platform, too. This way we’re able to capture patients even if they don’t have an app on their devices or face connectivity issues. Then, we can rescue or salvage that by sending a rescue link. We have two active platforms that we’re working with currently.

Q: You also mentioned the chatbots. Have you used them more in the context of clinical chats or in the administrative context to enable access and provide patients with information on self-service tools? Or are you doing both?

Matthew: This is a great question! We’re in the relatively early stages of implementing our chatbot and we’re cutting our teeth on administrative functions. We will tread lightly in offering clinical advice through AI, more from risk tolerance and quality assurance perspectives than anything else. I think that we’re starting from an administrative place to access some instructions, directions, wayfinding, touchless arrival, etc., and then, we’ll branch from there.

Q: Is your approach to start small, establish adoption levels and make sure that the chat works effectively and people feel comfortable before you get to the more complex, high stakes, high-risk kind of functions?

Matthew: That’s right. We’re also working hard with these platforms but the connection between them is what’s really so intriguing to me. For instance, if the patient had a remote monitoring device at home or when monitoring their BP via home checks, they engage with us via chatbots, our response is informed by the fact that the patient is being monitored. So, we could be smarter in our response and answer the patient differently via AI.

Q: Where are you in your CRM journey? What are your focus areas with the CRM platform?

Matthew: We’ve implemented an enterprise level CRM in our marketing strategy. So, that was our first stretch into CRM many years ago. Since then, at our Duke Clinical Research Organization, a large CRO, we have an installation of the same CRM tool that helps manage multicenter trials, not just site-based research into a bunch of work in the CRM but in the unit, too. Now, we’re in the 11th hour of our implementation of the CRM tool and our Access Services Center with its multiple hubs to serve our primary and specialty care providers.

What we are hoping to do is get a little smarter in our engagement, knowing who the patients are, who’s calling and their call history, which right now we don’t have much insight into but which we’ll be able to add this year. I can, very easily, envision patient acquisition thus.

From the marketing effort within the CRM tool and creating journeys from the time we acquire a patient to when we actually schedule that patient for the needed/requested services to then linking them to the portal and other things that we have downstream to continuously push engagement — clinical and administrative – so as to reduce friction and lower the barrier for entry.

Q: With regard to the last foundational platform — remote monitoring — in the context of a chronic disease, where most of the deployments have been from RPM standpoint, how has it worked thus far? Any learnings you’d like to share?

Matthew: We’re taking an approach that RPM has two really big buckets. The first bucket is to replicate what’s happened over generations. When we walk into our provider’s office, we get weighed, core temperature, height, blood pressure and heart rate measured so we can replicate that when the virtual visit occurs by remote capture, just to continue to be able to capture the same sort of quality data that we have for generations. More importantly, though, this is so that when our providers are being asked to make clinical decisions based on a single data point or very precious few data points over a long longitudinal time point, then we don’t make under-informed decisions.

We’re structuring it so we send patients home with whatever the appropriate biometric kit might be — be it blood pressure, glucose monitoring or pulse oximeter, etc. Bring these data into a lake or a repository short of our EHR where we can analyze the data and apply rules to trigger alerts. These will be alerts to the provider and care teams. If there’s a either a series of or a sequence of progressively out of range numbers or an alert or a value that’s particularly high or low, that’s somewhat dangerous and we may want to intervene or send alerts to patients.

And these might be an alert to patients because we haven’t received a value in a few days or because the values are trending well and we want to send them a nudge that says -“Congratulations! Good job! The work you’re doing is effective and your blood pressure is becoming under control. You’ve lost five pounds or the reverse.”

If the trends are actually going in the wrong direction, we want to send encouraging messages to help them get back on course and nudge the provider to maybe change the course in one way or another. The long game is once we capture enough of these data points across a broad enough segment of our population, it’s representative enough. Then, we’ll get smart about what normal recovery looks like after a procedure and know what normal or well looks like when a variant in the data is actually meaningful or when it’s a predictable variant that’s innocuous.

We’re blessed to have really tremendous data science people around to look at these big data sets and find the pearls. So, we’ll be able to set up predictive models to understand when data are mandating action be taken. This also has, workflow utility, because it can help us give patients a heads-up on events, they can expect to occur somewhere between day 4- 6 after they are back home. So, there’s some workflow utility as well. That’s our journey.

Q: How are you driving data and analytics? How are you set up to serve the multiple needs of the enterprise? What do your structures and successes look like?

Matthew: I’m a consumer of these very brilliant people I work with. One of my peers is the Chief Analytics Officer, whose team’s responsible for all the structure. They’ll explain this better but remember the lake I mentioned earlier? That was built for us to pile-in multiple data-streams. In the near future, we may make informed clinical decisions based on things beyond just the very rich EHR data. That alone is incomplete, of course. So, in this lake or repository we’ll have RPM data, social determinate data, expense/spends as well as location data to facilitate our remote monitoring journey. All of this, of course, with the consent of patients for they will be its greatest beneficiaries.

Q: Your role reports to the CIO. What’s the organization model for driving digital transformation? How did that start?

Matthew: While I report to the CIO, I’m not a deep technician nor an engineer. I come at this from a clinical angle because I’m a clinician, first, and a strategist and digital health person, second. I have a small but diverse team with broad backgrounds — from clinical informatics to physical therapists — including a nurse and a physician, who’s our Medical Director that’s responsible for our portal.

We work very carefully and closely with our colleagues in the health system — clinical and operational leads — to understand the opportunities that our clinicians can have. Our budget is also through our IT shop so we do try to make clever use of technology to ease workflows and enhance abilities of clinicians to engage with patients and empower them with information and tools to supplement their care between clinical encounters.

Our operational colleagues are critical cogs in this wheel that help implement workflows, set appropriate impact metrics, have baseline days against which to compare. I call them impact metrics because it’s not just about numbers of adoption on our portal account; it’s to understand what difference we may have made.

Q: How do you approach technology choices for your transformation especially when it comes to the risks?

Matthew: That’s a question that, candidly, I wrestle with every single day. We have invested significantly in our EHRs – both, dollars and effort. We have a very mature installation of enterprise EHR but it’s our transaction tracking and our medico-legal record keeping system. And that’s important.

We work hard because our clinicians are extremely busy people. In keeping with a concept shared with me by our previous CTO — a classic single pane of glass – I must say we have a fairly high bar in the EHR; high enough for us to tell our staffers, clinicians and administrators to go to another application for a particular purpose. When we want to bring in another application, we try to allow us to be able to launch it from within the primary health record, the place where our staff are working. We insist on single-sign-on, being able to preserve contextual awareness. So, our pendulum swings all the time between high level enterprise solutions and fit for purpose. And it’s an internal struggle. All this is to say that I know I’m not answering your question clearly, but it is maybe the unanswerable one.

Q: When it comes to innovation and innovative technologies, how do you parse through all that’s happening now in the market to find that little nugget that will stand the test of time?

Matthew: With startups, some of this advice is welcome. However, for a complex organization like ours, the sales cycle is longer than you, the startup or I would like it to be, but it’s just the reality. We work very hard to shorten it, but it’s complex. I’m not saying that’s right, but it just takes a long time. So, be patient.

I think that the point that we made a moment ago about respecting the single pane of glass as much as possible is important, even if that widget is just simply remarkable and game-changing. If we can get it in front of the users and the best clinicians, the patients, then it won’t matter.

In other words, there is a tipping point where we can put too many applications on a patient’s device and then it becomes noise rather than signal. For a patient who has comorbid conditions — and we have three or four really magical applications that could change that patient’s course if we could elegantly get that patient to interact with that application — it’s somewhat meaningless.

So, the integration of patience and single pane of glass should be easier over time because of FHIR standards, smart application capabilities in these sorts of things and the underselling and over-delivery. If it’s a niche product, it’s what it is. But the other side of that continuum is the large company or the or the medium-sized company who comes into an organization like this one and says we can solve all your problems. That’s somewhat of an oversell.

Q: That’s good advice. You’ve been in the role for a few years so you’ve had success and times when things didn’t go your way. What’s your advice or best practices that you would like to share with your peers on similar transformations?

Matthew: I love the question and I would answer it by saying — be persistent, tenacious and don’t stop. I won’t tell you that I have better practices because this is a personal semantic question for me. I don’t like that term because it implies that I already have what’s best and it can’t get better. To me, the answer is tenacity.

Try something carefully, monitor the impact, make a change, try something again. That, I happen to think, is the key. Don’t be afraid to try something new, be obviously cautious and judicious in these changes because we’re talking about patient safety. But where possible, the classic fail-fast mentality to me is wise. And then once you’ve failed, you change, learn and reapply,

About our guest

MattRoman-profile-pic

Matt Roman serves as the Chief Digital Strategy Officer for Duke University Health System. He is responsible for developing and deploying consumer-focused digital strategies, implementing innovative technologies to better engage patients and families, and extending our health IT footprint out into the community. Matt is passionate about building an optimal care experience for patients, so they can maximally engage in their health and wellness during and between clinical encounters. As a clinician himself, Matt is empathetic to needs of providers and strives to improve efficiency in care delivery while also improving clinical outcomes and supporting research.

Matt’s teams are responsible for initiatives to include digital health, remote patient monitoring, CRM deployment, patient experience, the patient portal, and utilization of conversational AI in enhancing patient experience, among other strategic initiatives.

Matt has extensive experience in hospital and clinic operations.  He ran the enterprise command centers during the health system’s electronic health record go-live, partnered with clinical and operational leaders to establish enterprise IT governance, and worked closely with community leaders to bring our EHR to non-Duke clinics like our local FQHC, Lincoln Community Health Center.  Matt has partnered with the clinical community to optimize clinical workflows and maximize the utility of our EHR for busy clinicians.  Matt is responsible for designing and deploying technologies to support patients through their health care journey and for working with providers and health system leadership to derive maximal value from our investments in health information technology. 

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 post-COVID normal looks a lot like the pre-COVID normal, plus a plethora of other responsibilities and activities.

Season 3: Episode #91

Podcast with Mike Restuccia, SVP and CIO, Penn Medicine

"The post-COVID normal looks a lot like the pre-COVID normal, plus a plethora of other responsibilities and activities."

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In this episode, Mike Restuccia discusses the state of telehealth in the pre-and post-COVID era and how the overall workload for the technology function has expanded significantly with the onset of virtual care models. He discussed the role of the IT function in the context of the overall mission of Penn Medicine that covers education, research and care delivery.

In this extended interview, Mike discusses a broad range of topics including the role of big tech and EHR companies in the digital transformation journey, his approach to technology vendor relationships, and a governance model for identifying and nurturing innovative startups. He discusses the use of newer data sources such as genomic data in the analytics programs at Penn and the challenges of AI-enabled solutions from the vendor community that overpromise and under-deliver.

Mike also shares how he spends a significant amount of time attracting and nurturing tech talent, and how to support and empower high-performing teams. Take a listen. 

Note: Penn Medicine has published several insightful reports on the IT function’s contributions to the overall mission. These provide valuable insights into the functioning of one of the largest and most prestigious medical institutions in the country. Interested readers can download the reports here.

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Show Notes

00:48What does the post-COVID normal look like at Penn Medicine? What you are working on to prepare for the next phase?
02:52What are the broad trends in the healthcare sector and the changes in the competitive landscape that you are following at the enterprise level to drive technology priorities?
07:41 How have your patients, consumers, and caregiver community responded to the shift towards a digital mode of engagement? programs?
10:33 Have you reached an equilibrium between telehealth and in-person visits? Are you designing the future based on this equilibrium?
12:44 How do you leverage the technology partner ecosystem to drive your enterprise priorities?
15:19 When you realize that your existing partnerships might not have what you need, how do you go about sourcing it from elsewhere or you build it internally? Can you talk about your approach?
18:09 What's your advice for digital health startup founders who want to be a part of your journey and may have something?
22:28What are the challenges that you have had to overcome, especially when harnessing innovation from the marketplace as opposed to innovation from within your existing technology partnerships?
24:21Tell us a little bit about what is the overall mission when it comes to your data and analytics group. How are you supporting - the academic, the research and the health care delivery side of it?
41:10Can you share best practices for the benefit of our industry colleagues on their digital journeys at various stages?

Q: What does your post-COVID, new normal look like at Penn Medicine? What are you preparing for in the next phase, especially from a technology standpoint?

Michael: In many ways, the post-COVID normal looks like a lot like the pre-COVID normal plus a plethora of other responsibilities and activities. So, the post-COVID normal’s more frenetic with things that we’ll see much more of. Pre-COVID we’d been focused on expansion, running, maintaining and growing and all the EHR-type things. Post-COVID, it’s all that plus more engagement, faster expansion, greater monitoring of patients in our remote manor — all big lifts from an IS perspective. We had a pretty substantive role and job as a team pre-pandemic, and post it, it just doubles or triples and there’s no sign that it’s going to slow down.

Q: Interesting observation. Post-COVID, telehealth modalities and virtual care models have gained a lot of ground. What are the top three trends and how do those trends drive your technology priorities?

Michael: I will start with telehealth. Pre-pandemic, we were doing a few hundred tele-visits a month. At its peak, mid-pandemic, over 8000 tele-visits, a day. Now, it’s plateaued to around 3,000 per day, but that’s still significantly higher than our pre-pandemic days. Telehealth is here to stay. It’s an area we need to focus on and from a maturity perspective, we have a pretty good solution in place. But there are other vendors rapidly advancing their telemedicine delivery capabilities into us. Integration with our EHR is critical and getting that done in future will be top priority. Our patients and providers love it.

I had mentioned remote monitoring, a while ago, in the home or in particular within our ICUs across our six-hospitals’ enterprise. We have almost 250 ICU beds, and each is now monitored with a camera connected to a central location. Thus, tele ICU caters to 24*7 monitoring and care. It helps from the delivery of care and responsiveness perspectives and the staffing angle too, because those six hospitals are located in a 150-mile radius which makes staffing, mission-critical.

The third thing I’d speak to is just enhanced patient engagement, which can occur through the patient portal to deliver results, schedule appointments, undertake administrative types of tasks, pay bills, communicate with clinical teams or even, push information and alerts to our patients. That was significant through the pandemic. It was a new opportunity when outpatient clinics were re-opened after having ambulatory clinics, and then again significant with the re-opening of hospitals for non-essential surgeries.

We began an interactive texting campaign that communicated with patients via their phones and asked them a series of YES/NO questions 24-48 hours before they visited us. Based on the responses, the patient would either be cleared, or the employer would be cleared to come back to work. Patients could be cleared to come to the clinic or would be triaged off to a care team. The latter only if patients responded with a list of symptoms, we would not want them coming into the clinic. The care team would reach out to them at that point in time. This is another example of using technology for good engagements with patients.

Q: How have your patients and consumers responded to the shift towards digital modes of engagement? How has the caregiver community responded and what has that experience been like?

Michael: I’ll start with the patients first and this is a bit more anecdotal than scientific. What we consistently heard from the majority of the patients — and there is some differentiation based upon perhaps age or tech-savviness, irrespective — they were thankful. Thankful that we were attentive, concerned for their health and that of their caregivers and other patients in the general vicinity. Overall, it was a big win because of the positive engagement and the way we communicated with our patients.

From the caregivers’ perspectives, it was a big change in the workflow. Now one had to follow multiple steps just to see a patient. So overall, I think the response was mixed or much more positive than negative because interestingly, there was a segmentation of those physicians that were very comfortable using the technology and embraced the concept of using a telemedicine-type approach. This way, they could see more patients, have less downtime, maintain a higher adherence rate to the meeting, resulting in fewer no-shows. On the other hand, there were those that said a tele-visit was OK occasionally, but that patient had to be seen. This meant observing more than just how they were interacting through the screen.

Q: Your telehealth visits went up to about 8,000 a day from a few hundred a month. And then, fell to 3,000 a day today. Is this an equilibrium you have achieved? Are you designing the future based on this?

Michael: I think we’ve reached an equilibrium for now but there is substantial pent-up demand to come back and see in-person, which sort of impacts the decline and that plateauing. I feel there will be another bump in our use of telehealth for several reasons. One is we will have experienced that pent-up demand for in-person visits. Secondly, we’ve learned that not every visit has to be in-person and some balance/ratio of visits per patient can be maintained (one inpatient may have one in-person and two virtual visits, for example or that could be in ratio of 1:3). Thirdly, I think the strength of Penn Medicine lies in the breadth and diversity of care offered and as that expands, it will support more of the telehealth type of engagements.

Q: Penn Medicine, with its historical heritage and as an academic and research institute plus a healthcare delivery organization, is unique as is your mission. From a technology standpoint and your strategic tech partnerships, how does all this drive your mission?

Michael: We believe in few but deep partnerships. We don’t have five different vendors providing 12 different solutions for the same cause because we prefer going with one vendor across the board and implementing common systems that are centrally managed and collaboratively installed. That works very well, across the networking, EHR, telephony sides and other aspects. That’s our approach — standards and systems across the enterprise. We are focused on patient care research and teaching around 121 academic medical centers in the country. It is a unique mission that requires significant integration among those three towers than ever. Our approach towards genomics and leading that into patient care and precision medicine and precision health really makes these times exciting. And that where it gets real exciting with the things that we are doing that is transforming care. But from a partnership perspective, several solutions at most deep relationships that are common across the system is really the attributes that we seek.

Q: While your partners possibly deliver much of what you need, they don’t deliver everything. How do you go about sourcing this from elsewhere or building it internally? What is your approach like in this case?

Michael: Regardless of whether our partners are providing us the proper solution or not, we’re always looking to innovate and that’s within the corporate IS, as well as in partnership with our Center for Health Care Innovation, which is a close ally and very dependent upon corporate assets. So, the Center for Health Care Innovation is a part of Penn Medicine, led by Dr. David Asch and Roy Rosen and their team is focused on what we should be doing next to either improve efficiency, care, accelerate research. They’re quite focused on new technologies, workflows and endeavors and very dependent upon corporate IS for those networks, data, and project leadership in order to advance some of those causes.

How this works is — the Center for Health Care Innovation will identify an opportunity and organize the appropriate constituents because there’s more than IS and big thinkers that need to be in the room. One needs operational assistance, clinical assistance, perhaps research assistance as well. Once that’s organized, a proof of concept is performed to see if the thought really does hold water. If it does, then we try to do a pilot and one that’s completed, we try to determine whether corporate IS should try to scale it across the enterprise. That’s the kind of the approach we’ve taken internally to advance our causes. Often, whether it’s improving access to a particular department, making care more convenient for patients or introducing mechanisms so patients don’t have to come on-site as much and be treated more in the home, are examples of how the Center for Innovation has advanced certain causes.

Q: For digital health startup founders listening-in, how can they reach out to you or someone like you to showcase their solution or capability? Any advice to those who want to be a part of this and may have something?

Michael: People find ways to get to me, Roy Rosen, and Dr. Ashe — no challenge there. We’re pretty public figures. So, we encourage them to reach out and share their ideas and their thoughts. And we look at them all. Whether it’s patient care and engagement or access to care, all of these are things we’re readily looking at on a daily basis to try and improve upon. We’ve made a lot of advances because of the pandemic and there’s more to come. This spirit of being able to introduce things that were once thought to be not possible is amazing — Who would’ve thought you could go from 300 to 8,000 tele-visits? But when you focus on it, you can get it done.

We do have many people that reach out to us and find their way into the Penn Medicine ecosystem. It might be through a friend working here or a Board Member or via some other channel, and it just arrives. The first few times, we took a stab at trying to figure this out on the basis of the recommendations but realized that just because a person says they’re good doesn’t mean they necessarily are. We spent a lot of cycles trying to understand the firm’s stability, their product and their ability to need support, secure any data that we might share with them, their potential for long-term sustainability and had our misses.

So, we introduced a multidisciplinary committee that I Co-chair with Roy Rosen from the Center of Innovation Health Care Innovation, and we call it the New Technology Review. And before we go too far with any new potential partner, we ask them to present to the committee in a one-on-one to better understand their capabilities. This has dramatically lowered our misses, improved efficiency, communication, and efficacy as we move forward with some of these newer technologies and firms. We’ve managed to smooth the waters here and keep people focused on what’s most important.

Q: When you get new solutions, they should be compatible with your overall technology environment which can be quite a challenge. What are the top challenges you’ve overcome when harnessing innovation from the marketplace versus innovation from within your existing technology partnerships?

Michael: It’s the overselling, overpromising and then, under-delivering though some of the firms have been really solid. The sales teams or business development teams have a great vision, but on the flip side, they don’t really have the delivery mechanism tied to it. So, you end up short and that’s where my team ends up having to cover and pick up the slack, because by then, the idea has been sold and budgeted. Leaderships expects some results, after all. That to me is one of the biggest problems we’ve experienced.

Q: You’ve made great strides with your data analytics program and how you’re harnessing genomic. What is the overall mission for your data and analytics group? How are you supporting — the academic, the research and the healthcare delivery sides? What are some of the big successes or learnings you’ve had?

Michael: I’m not the greatest one with vision, but my team is using that construct of a common system — centrally managed and collaboratively installed. If you keep that as the overriding umbrella, then, the spirit around analytics was that we needed a centralized location where we could house patient care data, research data — biobanking, bio tissue, genomic data, and any other types of demographic data. That’s Penn GNP (Penn Genomics and Phenotype). That data is initially loaded in a raw format, so, if someone wants to reach in and grab raw data, they can if they’re savvy enough to do that.

We then move up a tier and we synthesize that raw data and homogenize it into common data definitions – a common data model accessible with common tools and probably a little easier then, for an end-user to reach in and grab what they want at some point. But again, it’s a common location that we’re zeroed-in on.

Finally, what we will do is move that data off into data mart so we might have patient safety and a quality mart. We might have a clinical care art. We might have a research mark that has just that specific domain data associated with it. We do all this now through the Azure Cloud, which we found again makes access to the data even easier through the utilization of standard tools that are accessible to all.

Our goal is to have our end users be less reliant on our data access team and more reliant on themselves through self-service. That may be a big lift for us as it is for many other organizations. How we communicate and educate that end user community and liberate the data for their use so that they’re not as dependent upon us is critical.

Some of the big successes for us are — we were one of the first, if not the first, to begin to take discrete genomic lab results from one of our lab partners and integrate that into our EHR. We put a whole program in place on how to make that work, utilizing our genomics team, genomics counselors, members of our cancer center and then, certainly our end user clinical staff community. We ensured that when these Genomic results showed up in a patient’s chart, the latter was aware of what they had, their result and the implications to the caregiver because many of them could require some level of training and education on how to discern what that variant result might be.

Q: AI means a lot of things to a lot of people. How have you been able to leverage AI, ML, Analytics tools in the context of your data and analytics programs?

Michael: AI falls right under that banner of over-promising and under-delivering and I don’t think I’m the only one to say that. You’re more connected in the industry than I am, Paddy, but I have hope for it because much like innovation was a four-letter word a bunch of years ago, AI is becoming a four letter word since it’s just overpromised at this point with limited, tangible results.

That doesn’t mean that we’re not making strides towards it being more and more beneficial. We are taking a two-pronged approach towards AI. The first is a top-down approach, where we will work with members of the vendor community who claim to have this algorithm whereby if you give it the right data in the right format at the right time and in the right sequence, it’ll tell you something. It might tell you whether — you’re going to have a higher no-show rate, there’s going to be a health deterioration, Sepsis is on the horizon etc. And that’s our top-down approach, where globally we’ll just lay it over the enterprise. We’ve had minimal success with that so far.

We also have a bottom-up approach. I have a team of seven or eight data scientists that work in a more discreet manner with our end user community and some passionate clinicians or researchers who claim they have this great idea. And if only they’ve observed certain things or had data on those things, it could be combined again. In some way, we could develop an in-house algorithm that would bring great benefit to the group. And I think we’ve seen that particularly in at-home care. We see that in palliative care, where we’ve predicted certain occurrences, but that’s in a very narrow tower. It’s not as broad as my top-down approach. So, we will continue on both streams because we think there’s hope. We are big believers, that the answers are in the data or are often in the data and we just have to get better at figuring out how to combine that data in order to generate a proper result.

Q: That’s a very well-balanced articulation of the promise, the potential and the actual performance of AI, today. And like you, I’m optimistic about the future as well. I know you spend a lot of time on your people. How do you ensure that you’re attracting, retaining and nurturing talent within the organization? All this technology is only as good as the people who are committed to making it all work.

Michael: When I joined Penn Medicine 14 years ago, 95% of our IS services were outsourced to third-party vendors. That was done 20 plus years ago for a variety of reasons — cost containment, standardization of delivery capabilities etc. What I was asked to do was help build a team that would in-source the majority of those services, because if you’re going to have world-class clinicians, researchers and educators, you better have world class IS.

In order to enable it — and you’re generally not going to get that passion and commitment from a third party — my job was to rebuild the team, internally. That took about three or four years to in-source, and during that time it gave me and my team, the opportunity to build a culture that was accountable, exceeded expectations, and in which we were viewed as consultative and partners versus just “those folks in IS.”

Building that culture has really put us in a position where we’re attractive to those that we recruit. We want 100% of the people to be doing 200% of the work and be accountable. Our mantra outside of corporate IS is, we always deliver. And it’s not easy to do that and so people do go above and beyond and exceed those expectations. That was a culture we strove to build.

I’ve had the good fortune of working places prior in my career where I saw that culture. I thrived there and wanted to replicate that. Now, we are a USD 280 Mn IS operations business, here. And a big business cannot function properly without really good people. My teammates are great, our leadership’s exceptional.

One of the things that caught me — and I probably haven’t shared this with you before or my team — is despite the fact where you are in Penn Medicine, part of University of Penn trustees, we really didn’t have an internal Managerial Training Program. And if you look at statistics and surveys, one of the top reasons why people come to work every day for that employer is they like working for their manager, they respect their manager, they believe their manager has their best intentions for them with their career and their personal work-life balance.

Well, Penn Medicine has subsequently introduced the Managerial Training Program, but IS did this first, and on our own. We formed a program, educated our managers on how to be not only good technically, but good personally, in their management styles. That to me was one of the best things we’ve done within our organization.

I have over 100 managers and often in a technology world the people that become managers are the best subject matter experts in their technology. Well, I think we all know just because you’re a really good C++ programmer or a really good infrastructure networking person doesn’t mean you’re a good people manager. And we had to bridge that gap and we’ve done that through a series of internal trainings, hosting webinars, team meetings, book readings, book discussions and team discussions, and it’s really elevated our ability to manage. Each of my team has now been through 360 events, twice. So, they’re receiving feedback from all around them — their employees, leaders, colleagues etc. If you invest in people, they’ll respect you, like the culture and in the end, this will account for a really low turnover and really high retention rates.

Q: You also published a biannual and having read the document, I’ve found it to be very informative. For those who are listening to this podcast and watching this, I strongly encourage downloading the documents and learning a little bit about what and how medicine does it.

Michael: I’m happy to share that link with you. Our Benefits Realization is one document that states the financial impact corporate IS has on many of the larger projects. And we do that every two years. In between those two years, we do the State of the Union, which highlights the big projects that we were working on, a little less on benefits, but more on the function of that particular project. And we do that because marketing our services is important so the external community understands our end users, what we’re working on, where that USD 280 million is going to. It’s also really rewarding and refreshing to the employees to see their efforts in print and recognize that. “I worked on that with that department or that center or that entity,” has a ring of a sense of pride, a sense of ownership and a lot of what Penn Medicine is about, is that pride and ownership.

Q: I’d like to conclude this session with one or two best practices or learnings and especially in the context of this transformation that the industry is going through. What would you like our listeners to take away from your experience?

Michael: First, we have to recognize the unique situation we are all in — any individual can make a big impact in some way, shape or form. Within industry or within personal and social lives, anyone can make a big difference. I happen to sit in the seat of the C.I.O. so, I have a bit more influence than most. What I have found is, you need to be bold, selective and pick your shots and go hard at them.

When I joined, one of the goals was to in-source the services, but that wasn’t so bold. It was more something that I needed to do type of thing. I thought some of the boldness way back then was saying we needed to get to an integrated health milestone.

Back then, everybody had their own little pet product or pet solution for filling in. Each ambulatory department had their own car — Orthopaedics or GI — and nothing was connected. The boldness was to get to one and being able to fight off all the reasons that people would give you for not getting to one and continually representing what the benefits could be. Once the approvals were got, then still having energy left and implementing that type of a solution today may not seem like a bold premise. But back then, it certainly was. And it makes a big difference today.

I think when I look at what is there and what’s going to be more of, I come up with more genomics, more data, more engagement – the whole precision medicine. The approach we’re focused on has led us to restructure the corporate team, so we’re focused on maintaining power and doing things on the research side. Now, we have a team focused on bringing those two together, and that’s bold and unique. But as mentioned, Penn Medicine is a pretty unique place.

So, we need to take this to the next level and leverage that position without forgetting all day-to-day activities that have to still take place.

About our guest

Restuccia_2021-profile-pic

Michael Restuccia is the Senior Vice President and Chief Information Officer (CIO) at Penn Medicine. Restuccia has over thirty years of healthcare information technology experience and has worked nearly all his career in the healthcare information technology provider, vendor and consulting services industries.

Prior to joining Penn Medicine as an IS management consultant in 2006, Mr. Restuccia served as President of MedMatica Consulting Associates, a healthcare information technology consulting firm that has been recognized as a four-time recipient of the Inc. Magazine 5,000 Fastest Growing, Privately Held Companies in the US and the Philadelphia region.

While at MedMatica, Restuccia served as the Interim Chief Information Officer for several healthcare organizations, including Phoenixville Hospital, Doylestown Hospital and the University of Pennsylvania Health System. Prior to MedMatica, Restuccia served in leadership roles with several other healthcare information technology firms, including First Consulting Group and Shared Medical Systems (now Cerner Corp.). Restuccia achieved a Bachelor of Science degree from Rider University and earned a MBA from Villanova University.

About the host

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

Our challenge now is using the data correctly to generate actionable evidence and insights

Season 3: Episode #90

Podcast with Dr. David McSwain, Chief Medical Information Officer, The Medical University of South Carolina

"Our challenge now is using the data correctly to generate actionable evidence and insights"

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In this episode, Dr. David McSwain, Chief Medical Information Officer at The Medical University of South Carolina discusses the lessons learned in integrating technology into clinical care and its impact on the workflow of physicians, care team members, and patients. He also shares best practices in telehealth implementation from a clinical and operational standpoint. 

David talks about the disparities in access to care among populations with socioeconomic disadvantages and the challenges in implementing telehealth programs. MUSC’s Sprout program, the nation’s first national collaborative telehealth research program, uses evidence and data to support and provide quality healthcare services and influence the adoption of telehealth technology at the physician level.

While designing and implementing technologies, David advises a consumer-focused approach for an improved experience for both providers and patients. Take a listen.

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Show Notes

01:23Can you tell us about the Medical University of South Carolina and the populations you serve?
02:37Did you manage to codify some of this knowledge, learnings, and best practices so that your peers across the country could utilize it?
05:10 The application of telehealth programs and technologies can vary widely. Can you help us parse through it for someone who is relatively new to implementing telehealth programs?
08:34 Can you talk about one of the challenges that you've faced in rolling out a telehealth program?
10:22 Can you talk to us about pediatric research - the Sprout program?
15:24 Are you seeing telehealth platform providers step up to the challenge and introduce the capability to have a translator in the mix every time there is a video conference call?
17:18 Are you harnessing the data that is coming out of the emerging technology platforms like NLP, conversational AI, voice recognition, etc., to improve outcomes of productivity and improve the quality of the experience?
20:03What are some of the biggest challenges when you're going beyond your core electronic health system and trying to tap into some of the digital health innovation or innovative new technology solutions that are out there?
23:46Can you share your thoughts on how providers can improve the way they deliver care and be more productive and not burnout in the process?

Q: Tell us a bit about the MUSC, the population you serve, and your role and responsibilities there. What kinds of programs do you run?

David: The MUSC is an academic medical center in Charleston, South Carolina. We have five campuses throughout South Carolina and serve the entire state. In addition, there are six different colleges, a diverse student body across health professions and disciplines, as well as great research infrastructure. These have contributed to and driven innovation. As the CMIO at the MUSC, I look at the integration of technology especially in clinical care — and how that impacts the workflow of physicians and other care team members — and patient experience and focus on such integration across different types of technology to streamline the practice of care.

Q: How did you codify some of this knowledge, learning and best practices into something that your peers across the country could utilize?

David: Our Centers for Excellence have produced a number of instructional documents and resources on how to implement telehealth best practices, both, from clinical and operational standpoints. We’ve done a lot of work in the spaces of education and training. In fact, several years ago, we opened a state-of-the-art Center, the Telehealth Learning Commons in our main campus through which we’ve hosted different clinicians, administrators, operational personnel and policy makers from across the country to demonstrate the value of telehealth. That space is also used to conduct classes. But all this was largely pre-pandemic, of course. We have, however, expanded on how we approach interdisciplinary education in terms of developing competencies for telehealth across different disciplines and preparing our workforce of the future to be engaged in telehealth as they go out into their chosen professions.

Q: If one of your peers across the country wants to access some of these materials or programs, where should they go?

David: Our website for the Center for Excellence at MUSC.edu is a good resource and to access profiles, there are Twitter and LinkedIn as well.

Q: The meaning of “telehealth” varies — depending on who one talks to, and may be based on demographic profiles, geographies and the type of care being delivered – as widely as the application of telehealth programs and technologies. Can you help us understand telehealth and how best to implement these programs?

David: Well, the key really is to focus on the problem one’s trying to solve rather than the technology. There’s a variety of technology available and the emerging technologies advance what we’re capable of. So, you don’t want to walk around with your hammer looking for a nail. You want to really focus in on the requirements and the gaps. Once you define what it is that you need to do — how to improve patient care, enhance workflow of your providers, coordinate care across settings or across institutions and across locations – and identify the challenges to be addressed, then, the tools will present themselves. These may span a synchronous video consultation, physician-to-physician, physician-to-patient, an asynchronous encounter, remote patient monitoring — there’re so many different tools that it can be a little overwhelming. But the best way to focus in on that approach is to start with that problem.

Q: With regard to synchronous video conferencing or even a phone call and a number of other things, isn’t telehealth just that?

David: That’s actually a really key point, especially now in the pandemic. As we emerge from it, and it gets to the issue of health — of equity and disparities in access to care — some of the research we’ve been doing actually demonstrates that those at a socioeconomic disadvantage, or with pre-existing disparities in access to care, use telehealth as a broad term at the same rate, or that utilization has increased similarly, across those groups. If we look at the distribution of whether it’s video telehealth or audio telehealth, those who are coming from disadvantaged backgrounds or from other areas that don’t have the same access to technology, seem to be disproportionately using audio telehealth. And that’s really important because as we emerge from the pandemic, looking at the ongoing policy debates and the regulations enacted during the public health emergency as they begin to expire or be rolled back, if the reimbursement for audio-only telehealth is peeled back more so than reimbursement for video telehealth, suddenly we’re only actually exacerbating the disparities. And that’s something that must be maintained and focused on.

Q: What are some of the challenges you’ve faced in rolling out a telehealth program?

David: One of the big challenges is access to broadband and it’s been very apparent during the pandemic. Broadband is something many of us take for granted but in rural areas, people may not have access to it. Another important consideration is when you have access to Broadband, whether you can afford to pay for the data that it takes to do a telemedicine consult. Those may be two completely different things. And so, you need to take that into account as you’re rolling these programs out. The other really important lesson learned is to focus on usability both, for the patients and the providers. The first telemedicine program that I developed was a pediatric critical care telemedicine program that provided emergent consultation to rural community emergency departments for critically ill and injured kids that came into those facilities. In such situations, it’s incredibly important for the system to be as easy to use as possible in that rural or community emergency department, because often they’ll have a very chaotic or very least-very high stress situation, on and logging into your system shouldn’t be worrying. You want to just roll the cart into the room and make that connection. That’s how we develop that program and it was one of the really key aspects of that program’s success.

Q: You’ve been involved in some very interesting work on pediatric research — the SPROUT Program. Please elaborate on this.

David: SPROUT is really the nation’s first national collaborative telehealth research program across both, adult or pediatric services. The SPROUT Network was formed because of the recognition that advancing quality telehealth services really requires having the evidence and data to support what it means to provide quality health services. If you really want to influence adoption of telehealth at the physician level, physicians have always been raised on the concept of evidence-based medicine. If that evidence’s missing, it doesn’t matter that the telehealth program sounds like a terrific idea. They need to know that when they’re going to be taking care of their patient, when it’s a change in practice to the way they interact with their patient, that the evidence is there to support it. SPROUT, stands for Supporting Pediatric Research on Outcomes and Utilization of Telehealth, was formed with several very talented folk from across the country who came together and developed the first National Pediatric Telehealth Infrastructure Survey. We collected data from across the country and developed a collaborative of over 140 institutions across the country and in some other countries that develop frameworks and best practices and provide education around how to study telehealth in your particular institution. We got NIH funding back in 2019 for the program through the National Center for Advancing Translational Science. And we’re just getting into the third year of that funding. Obviously as we went into the pandemic, all of our work became critical to the way that telehealth was being practiced, especially in pediatrics nation-wide.

Q: Given the program is now 2 years old with ample data, could you share one or two findings that may be worthy of consideration?

David: One of the things we did very early on during the pandemic was we brought together national webinars to explore how people were utilizing telehealth in the pediatric setting and studied the challenges they experienced. We identified very early on, the challenge for non-English speaking populations in terms of access to telehealth. Now, the majority of telehealth platforms have been designed with the assumption the patients speak English and that bringing in a translator into a telehealth interaction can be difficult. The platforms themselves often are not available in anything other than English. And that was something, as telehealth programs scaled out across the country very rapidly during the early days of the pandemic, that a lot of institutions were really not prepared to address. Thus, SPROUT served as a convener to bring people together and identify best practices to how to approach that and serve as broad a population as possible. We’ve also done a lot of evaluation around how different institutions and different practices have responded to the pandemic and are working on getting published some data on educational approaches to scaling out telehealth services. We’re also working on publishing a policy evaluation stakeholder table or framework that allows one to evaluate programs based on the different stakeholders that may be engaged in moving a program forward. That may be a hospital system, a patient, a provider or even, a policy maker. We really have a very broad array of tools that we’re developing and they’re really coming out.

Q: Telehealth and the pediatric context is a very interesting space because it’s not just about the minor patient but about the parent, too. Sometimes, both entities may be in different locations and there’s the translator in the middle which can be confusing. But doesn’t this also apply to adult care? Will telehealth platform providers introduce the capability to have a translator in the mix every time there is a video conference call?

David: A lot of people in the industry and vendors have been focusing on this in the last year. Some really creative approaches have now been rolled out. Obviously, multi-party calling is a big part of that — just being able to bring an interpreter into the virtual room when needed, ensuring that the platforms themselves, the education provided there and the instructions are multilingual. Some of the really exciting stuff though involves technologies such as, natural language processing, real-time interpretation and the use of voice recognition — the kind of tools that, when we look back 10 years from now, will reveal how the pandemic really shifted the evolution of telehealth and digitally-enabled health care, in general. The integration of these emerging and promising new technologies into a unified approach addressing those with chronic disease and some of the most challenging patient populations around is possibly where the shift really happened this past year.

Q: Natural language processing, voice recognition, chatbots, Google Glass enabled services – are all based on natural language interfaces. As the CMIO, how do you view the data from these platforms and interactions? How do you harness data streams to generate insights that can improve outcomes of productivity and the quality of the experience?

David: This is one of the key issues that needs focus once we come out of the pandemic especially if we’re to stay focused on the telehealth aspect of things. There’s been such an explosion and adoption of telehealth that our previous challenges around not having enough data is really a thing of the past. Our challenge now is to use the data correctly to generate actionable evidence and insight into what is the best practice. How do you coordinate this across different practices and technologies? How do you develop that hybrid approach to providing either in-person or virtual care by a number of different modalities and do so in a way that is streamlined, that fits into the workflow of clinicians and other providers, and that supports the operations of the hospital in an effective way? Looking at this massive trove of data we have now, one of the things that SPROUT has done is develop a telehealth evaluation and measurement framework that helps folk make sense of all the data coming in. Look at it from the standpoint of a particular program, at a particular stage of maturity, from a particular stakeholder’s viewpoint and the population that’s being served. How do you pull the most meaningful data in the most generalizable information out of the data you’re getting for this service to really advance that safe and effective telehealth service going forward?

Q: What are some of the biggest challenges when you’re going beyond your core electronic health system and trying to tap into innovative new technology solutions? How do you address the integration of different platforms with the main electronic system and more importantly, ensure cybersecurity?

David: People get tired of the term governance, but that’s what’s incredibly important and really generating the alignment. These different technologies often emerge and become central to everything we do in the health care system. Consequently, it’s hard to identify a technology that only impacts one area. There will be overlaps and duplicative capabilities of different platforms. So, there will be platforms that are already in place to do the things for which people are looking at newer platforms. Then it’s important to understand — what your current capabilities are, what is the real gap in what you can do, and how the technology that you have could address those gaps versus what new technology you may need to invest in to be able to effectively address those gaps. That’s a real challenge because, in a health care system — particularly an academic system that has research, education and clinical components — there is a revenue cycle and operational issues and these platforms can be highly integrated. They also cross over into so many different areas that it’s hard to have a good understanding of how your platform and technology decisions impact all the different areas of the institution. Gaining that alignment and that shared decision-making and having that governance in place, is incredibly important.

Coming to the second question, a few months ago, I would have said cybersecurity is an under-recognized risk. But today, I feel like it’s not really recognized anymore. While we have major health care systems now that are being forced back to paper for weeks at a time because of prohibitive ransomware attacks, you have to invest proactively in your cybersecurity. While doing this, you also have to be very proactive in how you engage your cybersecurity team to ensure that they can identify where the risks actually lie. We’re long past the days when a platform could be evaluated based on a clinical need and then handed to the security team to ensure proper fit. The security team must be engaged early on in the process to ensure that you’re not exposing risks that you may not have even recognized were there.

Q: We’re coming to the end of our program now. But there’s one aspect yet to be touched upon. How does one ensure that providers and caregivers can enhance the delivery of care, stay productive and not burnout with the new technologies?

David: I think it’s incredibly important and we all know by now that provider burnout is real. The emergence of technology had and still retains promise, but the ways in which it has, at times, been implemented, has exacerbated challenges and increased workloads on our providers. Organizations like the ONC have taken steps to streamline the electronic health records and there’s some progress there. But increased focus in the health care industry, currently, is on consumerism. There’s certainly a lot of value in that. While there may be some patients that we shouldn’t really think of as consumers because they don’t have those consumer-type choices when they have the significant chronic or complex diseases, still, I see the value in the consumer-focused approach. However, one thing often overlooked when discussing digital health and technology, is that the providers are consumers, too. When it’s a new technology being adopted, especially one that sits in the interface between the doctor and the patient or the nurse and the patient, then there are two sides to that interaction and both are the consumer. When one’s designing, implementing technology or training and supporting it, one must think of the providers, physicians, one’s care team members as one’s customers, because really that’s how they function. If that mindset can be developed around both sides of the equation, then, one can really make a lot of progress in making the experience better for everyone.

About our guest

Dr. Dave McSwain is a Pediatric Intensivist and the Chief Medical Information Officer for MUSC Health in Charleston South Carolina. With over a decade of experience in digital health innovation, clinical informatics, and virtual care, he is an established national leader in telehealth development, research, and policy.

He is the Main Principal Investigator for the NIH/NCATS-funded SPROUT-CTSA National Telehealth Research Collaborative and the Chair of the Section on Telehealth Care at the American Academy of Pediatrics.

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.

In the future, we will see smart adoption of Google Glass technology in clinical use cases.

Season 3: Episode #89

Podcast with Ian Shakil, Co-founder, Augmedix

"In the future, we will see smart adoption of Google Glass technology in clinical use cases."

paddy Hosted by Paddy Padmanabhan
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In this episode, Ian Shakil discusses how Augmedix became the first company to launch a clinical application using Google Glass and a phone to convert the natural clinician-patient conversation into medical documentation.

There has been an increase in adoption for natural language interface technologies for clinical applications in healthcare involving hardware, software, and data analytics. Augmedix works as a tech-enabled remote scribe that processes conversations and distills it real-time into a structured note in the electronic medical record.

Ian also discusses the differences between Google Glass and other conversational interfaces such as voice recognition technology, and how conversational AI tools are evolving in healthcare, specifically in clinical use. Take a listen.

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Show Notes

01:12About Augmedix and the journey about launching the company.
06:08What are the differences between a voice recognition tool like Alexa, Nuance, Siri and what an Augmedix type service does where the hardware is a little different?
11:05 How your technology space is evolving in the context of clinical applications in the healthcare space?
13:49 In the clinical context, what is holding back the growth of these kinds of conversational interfaces?
16:32 How do you see your competitive landscape? Who do you think you're competing against?
18:55 What is the reimbursement environment look like? How do you build a case for a solution like yours?
21:01 What do you see as a big trends emerging as it relates to the moves that big tech firms are making in the market?
26:17What is your advice to digital entrepreneurs and VCs who are getting into this space?

Q: Tell us a bit about Augmedix and your journey.

Ian: I’ve always been excited about healthcare, technology, wearables, and the Internet of Things. So, around 2012, I’d just graduated from Stanford and was meeting some friends from Google. They shared news about some secret hardware they were developing — the Google Glass. In 2012, no one had ever heard of or knew about Google Glass. They let me try this secret hardware but under caution. When asked, “What do you think about this glass prototype hardware?” I said, “Have you thought about doctors? Here’s what you could do in the world of healthcare.” And that was the background.

I got laughed at because they were thinking about consumer applications more like “Dads in the park go pro at selfies” but I stuck to my theory — doctors and enterprise. We agreed to disagree, but I got obsessed enough to find the very first glass company of any sort and create an application for healthcare; for doctors, specifically. With Augmedix, we endeavored to really rehumanize the doctor-patient interaction using technology, such as, Google Glass. Today though, our service has evolved, and we now use many different hardware above and beyond Google Glass.

If you visit a doctor now, it’s a pretty miserable experience as they are typically typing, charting on the computer rather than paying you attention. So, crucial hours of the day are wasted in updating electronic medical record. Fundamentally, we solve that problem. Our doctors put on technology, have phones in the room or use Google Glassand from there on, we are virtually present. Augmedix takes natural doctor-patient conversation and produce EMR notes better and faster than what the doctors would do on their own. In essence, what Augmedix does is, it enables doctors to focus on what matters most — patient care for the patient right in front of them.

Q: Is it that the technology is automatically transcribing the conversation?

Ian: It’s true. But there are a lot of details beyond that. Most of our doctors use smartphone kits, Glass, and the phone. We transmit the visit, the audio and the video to our platform. So, a tech-enabled remote scribe processes the conversation and distills that into a structured note for the EMR. Unfortunately, natural language processing in AI hasn’t reached the stage where an ambient conversation can be processed and results in a perfect note without human involvement. We’re unabashedly human but we skip the chit-chat and focus on what’s medically pertinent and constructive in that conversation to create a note in the EMR — Epic or Cerner – used by the doctor.

This tech-enabled remote scribe at the backend operates within what we call a Scribe Cockpit. It’s a bunch of specialized automation modules that de-burden the Scribe. So, when the note is being constructed, a few clicks and edits happen in our natural language processing Note Builder. This is described as invoking a SR or Speech Recognition modules to create parts of the note in the scrabble and edit those attempts. A marriage of human involvement and technology make a service like Augmedix possible. Yank the humans out of the loop and try to do something with only software, then, it’ll only be something like dictation with the doctor being verbatim throughout the note. That’s been around for a while and isn’t helpful at all.

Q: What’s the difference between what a voice recognition tool like Alexa, Nuance, or Siri and what an Augmedix type service does where the hardware is a little different?

Ian: I’ll segment-out the market and help you understand this. Voice Recognition or Speech Track or Dictation is a whole category that’s been around. A dominant player there, is Dragon. The key marker here is the doctors are basically being verbatim — pressing a button, taking their device and noting their patient presented with this and that.

There’s another category of solutions — in-person, on-site scribes – very like having a third person in the room following you around, computers up, typing, charting, clicking, observing the conversation as it unfolds. There’s no time wasted having to structure, dictate, and review those dictations in this case. The downside is that it’s not scalable – these persons take up physical space, they call in sick and there’s all kinds of quality issues.

We’re in a new category of being remote. We offer all the benefits of that in-person scribing experience but are more cost effective and scalable. We also layer-in technology in ways that were previously impossible. So, like Dragon in-person scribes, and now we’ve got remote scribing or ambient remote documentation.

Q: You were the first company to launch a clinical application for Google Glass and its adoption in the clinical context is still coming along. As a dominant player, what does the rest of the market look like? How far as a technology is this and where is it headed from a broad-based adoption standpoint?

Ian: Google Glass, when it originally launched, was all about consumers. But they ultimately pivoted their glass efforts and refocused them on enterprise applications, of which we are one and certainly the dominant player in healthcare. But within the glass space, there are other very interesting applications and enterprise oil and gas field manufacturing, all kinds of fulfillment, applications of glass and things like glass. It’s a vibrant space but still early. We’re on third-generation hardware now, which is better today than it was 7-8 years ago and the devices last longer, plus Wi-Fi is a lot better. There are more robust enterprise-grade security configurations and settings now so further evolution is expected and smart glass adoption in all of those categories may just be on the rise.

Q: Augmedix went public recently through a somewhat unusual process. Can you brief us on how that looks like?

Ian: Augmedix is now a publicly tradable company under the ticker AUGX. We are listed on the OTC and we are public by way of a reverse merger. It’s a really exciting opportunity for us. For one, we raised additional funding through this process, which fueled our ongoing growth, investment and commercial expansion, investment and technology. We see incredible enthusiasm in the market among all sorts of investors to participate in something like this, which really is a play on burnout, digital health, and telehealth. And so, by being public, we’re able to take in the full spectrum of interested parties and investors that want to participate in Augmedix and prepare for more growth ahead.

Q: While the technology and the clinical applications involve special hardware, software, data analytics, let’s talk about Voice, Chatbots and Glass. How is this space evolving in the context of clinical applications in the healthcare domain?

Ian: Conversational AI is creeping in, in so many interesting ways in healthcare especially with activity such as, patient engagement and interaction. There are many opportunities for patients to be reminded of activities and care goals in remote, asynchronous and conversational ways. Many companies are doing this over text, asynchronous text, SMS platforms. But that’s different from what we’re doing though.

I think our area is white-hot since it’s looking at doctor-patient conversations and deriving structured EMR outputs using technology. We’re the pioneers and the biggest and now, in two key areas. Now, there are other areas where, if you think about it, patients do engage with smart speakers at their bedsides but that’s another aspect of conversational AI and innovation. I’m also seeing applications for communicating with staff, sharing information with family members etc. and there’s a lot of activity there, too.

Q: Patient engagement is critical amidst all the technological advancements. How does your technology handle and manage the patient/consumer side of the conversation in the clinical context? What could be the hurdles here?

Ian: Patient resistance or negative patient reaction was a concern when we first launched Augmedix. But patients are widely accepting the use of Augmedix on phone or on glass in their clinical interactions with their doctors. We always ask the patients if they’re comfortable and ok with the use of Augmedix at the point of care that typically happens on the first visit by the front desk or by the MA. We measure the decline or off rate and 98% of the time, patients are OK and accepting the use of Augmedix in that environment. Patients irrespective of their genders, geographies they come from, age, etc., prefer this new mode of interaction with their doctors.

We also provide the patient with all sorts of assurances around security and privacy. If there is a moment of nudity or anxiety, we go on to incognito mode.

We can juxtapose that with other conversational AI systems, like patients engaging with a chatbot but the difference lies in the marked absence of human insight. Is the human reviewing or involved in high impact decision making? Then there are texts coming from a system that may have a picture of a doctor by that or not. But you’re not verifying with your own two eyes that the humans in the loop qualify. I would expect that the level of skepticism and adoption in that system is higher than the level of skepticism in our system. So, I would advise those companies to do everything they can to indicate and highlight the level of human review early especially for high-impact decisions to kind of tackle that skepticism.

Q: What about your competitive landscape?

Ian: The market is enormous and the vast majority of doctors we encounter are using no solution. They’re toiling away in the EMR looking for a way out. This space is getting a lot more attention with many new entrants. I call them – ‘fast followers.’

A big new entrant here, for example, is Nuance with their DAX product. It’s distinct from their Dictation Dragon product. There are others too, but we are distinct from Nuance. One of the ways is we operate in real-time; we are a live service. Our notes and our interactions are being created literally in real-time as conversations progress, so, that benefits productivity and alleviates memory burdens for doctors.

Another benefit associated with being real time is that we can be interactive and offer you additional services — fire off strategic orders and referrals, remind you regarding HCC and other items etc. All this is possible because of our live and interactive presence.

We also offer a non-real time asynchronous service in that category, with advantages – it’s flexible and affordable.

Q: What is the reimbursement environment look like? How do you build a case for a solution like yours?

Ian: We save doctors a lot of time — two or three hours a day and sometimes more. Doctors can use these savings to see more patients per day. If you’re in primary care, it may take one or two more patients a day to forthrightly pay for the service. If you’re a specialist, the hurdle is even less than that. And if you are being saved two or three hours a day, that’s not so much of a huge ask frequently.

In addition, we see that more revenue per charge is generated when documentation is thorough and accurate, as is the case with us, which is another ROI proposition for us.

Another key thing to mention is we alleviate burnout which is a serious issue. There’s a scarcity of doctors in America right now. Doctors are partially quitting and are leaving health systems. Whenever a doctor leaves the health system or doctor group, it’s very costly, huge productivity loss, plus it’s difficult to find a new doctor and ensure productivity resumption. It could cost nearly a million dollars when a doctor leaves a health system. There’s evidence that Augmedix really rekindles doctors’ love for the practice of medicine, staves off burnout and that’s why a health system would adopt Augmedix.

Q: You mentioned Nuance’s Dragon technology was about to get acquired by Microsoft. What are the big trends emerging related to the moves that big tech firms are making in the market?

Ian: It’s big news that Microsoft and Nuance are now one. As to the thesis behind that marriage, I would argue it’s a little bit of a Rolodex play. We see that Nuance through its legacy products, such as, Dragon is present amongst the majority of health systems and doctor groups. So, one reason for Microsoft’s interest could be so they can upscale into those health systems and doctor groups where there’s just so much market share and access through this acquisition and upscale Azure and Azure-Related Tools and other Microsoft related tools.

Microsoft is also excited about this ambient documentation space and other things that Nuance DAX is doing. Other big tech companies are equally excited and waiting to jump into healthcare because it is such a huge percentage of the U.S. economy. A lot of these tech companies are creating tools and modules that are going to be very useful to Augmedix, such as specialized, medically tuned speech recognition modules, natural language processing modules, cloud hosting and compute capabilities tuned to healthcare needs with the right types of security and compliance aspects. And they’re getting competitive and innovative. But they are stepping back from providing the end-to-end, go-to market and product solutions in those areas. I saw more attempts toward this earlier so that is kind of a trend I’m seeing among these big tech companies.

Q: The one exception to that may possibly be Amazon, which is actually getting into the healthcare services space with AmazonCare. Where do you see yourself in the context of this big tech firm? Do you see partnering with one of these big tech firms in making your technology available?

Ian: Yes. Tech companies are creating more enabling modules versus end-to-end products but this is more around my domain, specifically. In other healthcare domains though, Amazon is jumping into the fray. Over the years, we’ve had significant partnerships with more than one of the big brands, tech companies and we have diverse partnership projects and collaborations with many of them. We use many different enabling tools, cloud systems and hardware — while we don’t make Google Glass, we rely upon Google for their production. So, there will definitely be opportunities for us to get strategically comfortable and focused with just one of those tech companies but presently, that’s not what we’re doing.

Q: You’re one of the first companies launched in the digital health ecosystem. You’ve seen companies come and go, pivot, fail. There’s enough capital floating around and ideas. What is your advice to a digital entrepreneur who is getting into this space now and what is your advice to the VCs?

Ian: Certainly, this space is a lot busier now than it was in 2012. Most of the areas of great pain and need now have a few different venture-backed startups chewing away at the problem, taking different approaches. While that shouldn’t scare anyone away, it creates a situation where most of the digital health innovation is maybe in the mid or later stages and not so much in the very early founding seed stages. There still is an opportunity to found seed-stage digital health companies. The burden of proof is going up now versus previously fair not to get funding and to get initial traction. So, my advice is that the ROI and the validating metrics required for you to get attention and funding and the expectations there, have increased greatly. This isn’t the time to step in with incremental solutions and sort of iterate your way to path forward. It’s time to meet unmet needs with eye-popping ROI benefits that happen pretty quickly. Otherwise, you’ll be passed over in this extremely noisy space.

Entrepreneurs must really focus on clever go to market strategies to scale faster and be data-driven and metrics oriented so that you can prove to all the stakeholders that you’re adding a lot of value. Early-stage entrepreneurs need to invest in the analytics and ROI on day one and overly so to stand out. That’s necessary in today’s environment.

About our guest

IanShakthi-profile-pic

Augmedix Founder, Ian Shakil (pronounced like Shaquille, the basketball player) has an impressive track record of innovation in cutting edge domains such as wearables, smartglasses, global-scale digital health, and IA (intelligence amplification).

In 2012, he founded Augmedix with a mission to harness technology to improve the patient experience and allow doctors to focus on what matters most: patient care.

Shakil holds a BSE in Biomedical Engineering from Duke University and an MBA from Stanford Graduate School of Business.

Before founding Augmedix in 2012, Shakil held a variety of roles at leading healthcare companies such as Edwards Lifesciences (where he still consults), MC10, Intuitive Surgical, and HealthTech Capital. He currently resides in San Francisco.

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 in healthcare needs a purpose-built solution to solve the problems

Season 3: Episode #88

Podcast with Murray Brozinsky, CEO, Conversa Health

"Technology in healthcare needs a purpose-built solution to solve the problems"

paddy Hosted by Paddy Padmanabhan
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In this episode, Murray Brozinsky, CEO of Conversa Health discusses how conversational AI can complement care delivery models and the need for AI and clinicians to work together to apply these tools to clinical use cases. Conversa’s virtual care and triage platform leverages a 360 view of the patient in real-time to predict clinical pathways and make recommendations.

Murray also talks about the virtual care automation programs that are being integrated to manage chronic care, post-acute care, perioperative to women’s health, cancer, pediatrics, and in the ED. AI can be good at computational decision-making, which can give the best solution when combined with human judgment.

Murray also shares practical advice for digital health startups who are looking to raise VC money. Take a listen.

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Show Notes

01:07About Conversa Health and your involvement with the company.
03:35What is the current state of AI in healthcare?
06:11 Conversational AI tools, especially chatbots, are having a moment in light of the pandemic. What COVID has meant for your company?
09:19 Do you think we are further along when it comes to applying conversation AI in the context of administrative use cases like the ones you describe or do think we are further along with clinical use cases?
11:05 Based on what you're seeing and the work your firm is doing, where is the low-hanging fruit today? Is that in certain types of clinical conditions, for instance, behavioral health?
14:25 Who do you mainly serve – payers, providers, employers? What is your ideal client profile?
16:28 What does conversational AI compete with in the context of a healthcare provider?
20:55Where does the voice fit in all of this? Do you compete with voice-based solution providers like Nuance for instance?
22:49When you talk to your clients, what do you ask them to prepare for in terms of the most challenging aspects of rolling out a conversation AI tool?
25:28What do you see the next 12 to 18 months looking like from the point of view of VC money flooding the market? Also, what is your advice to a digital startup that's on the receiving end of this money?

Q. Can you tell us about Conversa Health and your involvement with the company?

Murray: At Conversa, we are pioneering a new care delivery model – automated virtual care. It sits at the intersection of what is happening in automation and what is happening in virtualization. We think about it as a complement to current care delivery models. It complements in-person, digital, telehealth, remote patient monitoring, etc. It adds a piece of the puzzle that we think has been missing and will be standard of care in the future. I have known the founders of the company for years. We have worked together in different healthcare ventures, and this is my fourth digital health venture. I was involved in companies focused on consumers and patients, providers, and the payer market. I was super excited to join the company to help form the strategy and then take over as the CEO about 18 months ago.

Q. You are a private, VC-funded company. Can you tell us who are your major investors and how much money the company raised to date?

Murray: We’ve raised a little over 30 million dollars at C round, A round, and B round. Our investors are a great mix of supportive investors. We have financial investors, builders, VC, and Northwest Ventures, all the big health system in New York. And then we had other folks who were a combination of strategic investors like university hospitals in Cleveland, Allscripts, Pfive, and other healthcare-focused venture firms in Connecticut. We know the space as well as strategic investors with who we have nice operating strategic relationships.

PP: What is the current state of AI in healthcare?

Murray: The way we think about technology in healthcare, especially digital health, you must build a purpose-built solution to solve the problems. Then in that solution set, see if the applications of AI or machine learning or deep learning make sense to improve what you are trying to achieve. Those tend to be the most successful applications. In image recognition, in radiology a lot of good work is being done with AI. But even there, there is a need to recognize where AI needs to complement actual intelligence from people. There are a lot of studies that show this notion of co-bot. For example, the person working with AI in radiology can identify breast cancer tumors and characterize them. But on the corner cases, we need to have an actual trained professional distinguish and then make a judgment call. So, Garry Kasparov, the chess master, distinguishes between what humans are good at and what AI is good at. Humans are good at judgment, and AI is good at decision-making. Decision-making is computational all the way down, and judgment is knowing what matters and why it matters. If you can get those to work together, I think you have the best solutions. There’s a lot of conversational AI being thrown at natural language processing. If you are modeling physician language well, you can get high accuracy because physicians might use big words, but it’s a very prescribed and precise vocabulary. When you start to step into a patient world, they can say anything, and it can mean anything. You must infer if you are trying to rely on that platform for accuracy to determine whether you need to intervene with the patient, probably not the best approach. So, I think there is a lot of technology in search of solutions and the successful ones have understood the problem deeply.

Q. Conversational AI tools, especially chatbots, are having a moment considering the pandemic. What COVID has meant for your company?

Murray: When you think of conversational AI, there are many applications, but they are mainly administrative ones. For instance, I call a call center, and I am trying to make an appointment and understand my explanation of the benefits. There is some good AI because there’s minimal language, a lot of ability to get you to the right place, and its pure cost savings. It is reducing the number of customer service reps on the phone—a lot of proof points outside of healthcare are being brought in healthcare. There is a category that I would call virtual urgent care where an anonymous patient is walking to the door with symptoms. You need a big database of symptoms correlated with outcomes, and you dynamically update that so that you can decide whether I’ve got COVID or I’ve got a rhinovirus or a cold. There is a bunch of companies doing that. Doctors are primarily skeptical, so they are having success selling the payer market to some employers. The category that we live in is more care management, care coordination, transitions of care, pop health. For instance, you are enrolled in a heart failure program, the AI reaches out to you, talks to you, collects information, and checks how you are doing. It is using an evidence-based pathway to determine whether we can automate the next step, where we need to ask you what the right next step for you is, it’s very difficult to do with AI. The state of the technology is still not there, so we have taken a structured approach. Permutations are enormous, and there could be billions of permutations. Our intelligence is how do I stitch together structured conversations so that it’s personalized for you, and you’ll engage. We can collect the information we need and then use the right nudge, escalate you to the right next level of care. We use the AI/ ML in the prediction piece, it’s not just a chatbot, a chatbot is the user experience, but everything we collect from you could be biometrics, could be Piros, could be informal answers to questions, structured information. We then, in real-time assess that and check what we should do next. We use a lot of AI and ML there to predict if you’re going to decompensate because we’ve seen lung function like this with this characterization from your FEV1 scores and you’re likely not to do well in the next month.

Q. Do you think we are further along when it comes to applying conversation AI in the context of administrative use cases like the ones you describe or do think we are further along with clinical use cases?

Murray: Many things moved forward because of COVID. We’ve got about a hundred and fifty automated virtual care programs running at various large health systems around the country. I would say the clinical has caught up, and the stakes are higher. We strive for one hundred percent accuracy in determining whether a patient can be automated or isolated on the next step. You can’t do that with natural language understanding technologies. It must be a very deliberate and structured approach. But then you have the smarts to understand the status of the patient to make the right decision. Conversational AI in the context of administrative use cases was ahead. But clinical is probably a priority right now, and the opportunity for clinical is enormous. They come together in the mid to long-term future because you would want to have the administrative use cases attached to clinical all via one platform.

Q. Based on what you are seeing and the work your firm is doing, where is the low-hanging fruit today? Is that in certain types of clinical conditions, for instance, behavioral health?

Murray: We’ve conceived this to be a platform, meaning that it needs to work across all the meaningful use cases of a large health system or health plans. So, we have decided to build a platform that can accommodate programs or automated virtual care pathways from chronic care management to post-acute care to perioperative to women’s health, cancer, pediatrics, and in the ED. We have programs in those areas, and we are continually building them. Patients do not necessarily fit easily into one use case; you might have diabetes, hypertension, and suddenly you need a hip replacement. We want to accommodate it, be an extension of the health systems care virtually for patients in a seamless way that has a great user experience and leverages the full 360 views of the patient. So, that is where we are heading. We tend to start post-acute, 30 day, 90-day post-acute programs, and monitor people when they leave the hospital, and focusing on helping them recover and reducing unnecessary readmissions. We want to focus on patients who are walking out of the ED, understanding discharge instructions, picking up their prescriptions, going to their follow-up appointments, really focused on lowering recidivism back to the ED, where it’s not necessarily chronic care management.

During COVID, we worked with UCSF Health in San Francisco and shifted our focus to the vulnerable population. We helped reduce the risk of getting infected from COVID and provide a better experience for patients who could calibrate all the parameters remotely. There are many examples where we have identified decompensating patients, whereas otherwise, they would not have to escalate. And then, like ED, we are also now seeing a lot of interest in targeting both pregnancy and early pediatrics. Behavioral health is another area, it was a pandemic before the COVID pandemic. It is amplified because of that and so that’s another area that we’re getting into.

Q. Who do you mainly serve – payers, providers, employers? What is your ideal client profile?

Murray: We primarily work with a lot of midsize and community hospitals. We are also provider-focused because we want to make sure we understand how to extend a trusted relationship. And we have very high enrollment, activation, and the ability to change behaviors and drive measurable outcomes. So, the way that a patient thinks about it as a health companion. It is a twenty-four by seven extension of my doctor and nurse.

From the provider side, they think of it as an automated care team member who is helping to reach out to all these patients on their behalf and can practice at the top of their license. So, within that model, we have expanded to work with health plans. Our focus with health plans is where they are acting as a provider. We work with them to create programs used by patients and health systems and then for employers, schools, and the community and this got accelerated during COVID. We have many employers and universities using our COVID programs to screen for COVID to manage people who are positive, monitor people who have been vaccinated, and now deal with mental health from COVID. All of it is delivered through our healthcare partners. Our focus is that the health system in your community should be responsible for caring for the community. We are giving them a platform to amplify that help that they are already providing.

Q. What does conversational AI compete with in the context of a healthcare provider?

Murray: As a company that is positioned itself as an enterprise-wide platform. So, we want to be your automated virtual care partner if you are a health system. If you are using automation for administrative purposes, that is complementary to what we do. If you are using it for a digital front door, virtual urgent care, it’s complementary to what we do. So, you are now managing your patients; you’re enrolling heart failure and diabetes patients into programs. Our platform will compete with point solutions. If someone says I have an app that can help manage diabetics, I can come in with an entire stack device and coaches. So, somebody might want to choose that to work with their diabetic population. We say, hey, you can use the same platform to treat your diabetes and cancer patients. That is pretty compelling because health systems increasingly want to consolidate. Working with one partner is easier, and you start to understand patient IDs across the continuum. We aspire to manage patients across a lifetime, which does put us in competition with point solutions in certain areas in the future. Our challenge is to figure out if there is a perfect point solution. How do we integrate it into our platform, and how do we start to allow other solutions to plug into our platform?

Q. Does your tool sit on top of an Omada or a Livongo kind of platform? You also mentioned about clients wanting to consolidate into a one-stop-shop. We see this in our work with health systems, where they are trying to reduce the footprint of vendors, they must deal with because of all the complexities involved. How do you fit in that context, and how do you help your clients work through the tradeoffs involved here?

Murray: Companies like Livongo have chronic care management for diabetes, hypertension, weight loss, and behavioral health. They have devices and coaches wherever applicable. Because it is a service-based company, it tends to be with payers and employers very successful. Most companies with full-stack solutions are doing it because payers and employers do not have clinical resources and devices. Health systems already have clinical resources caring for patients; we want them to be more efficient and effective. It is purely a software platform where devices are involved. If they have an RPM partner, we are complimentary. In the health system world, they do not need the provider networks of any of those other companies. They are looking for technology solutions, and we excel there. When we go into the world of payer and employer outside of the health systems, those companies become partners. So, like Livongo, we can say that if you want to add the conversational AI and decision-making we bring, we can help leverage the platforms that they have built in the same way we do for the system. So, if you aggregate what they do, they have clinical resources like the health system does. They have the device as the RPM’s do. We can bring the piece to the puzzle that we get that table in that world.

Q. Where does the voice fit in all of this? Do you compete with voice-based solution providers like Nuance for instance?

Murray: We do not offer voice today. However, I demo our platform using voice a lot, but I am just using the native voice on the phone to do text or voice. We have not gone there yet because we are very driven by where the market need is, and the impact that we are having is enormous. When we see that people interact with voice, we realize it is not a big thing to add. You want to make sure that you are designing the voice interface as per the requirement. You are not translating a text to voice because understanding what someone is saying with 100 per cent accuracy in voice is a different design requirement than doing it through a chatbot.

People like Nuance probably have the best-known value out there. But it is not an accident that they’ve chosen to do transcription for wires because when you’re looking at what a provider says and being able to transcribe accurately, you can do that. You get into the patient world where a patient can say or respond to anything in that world. The way you would measure it is precision and recall precision, where the recall rates will be 80 per cent at best, which means the error rates are 20 per cent plus. No hospital system will use that error rate to decide whether they can automate the next step for a patient.

Q. When you talk to your clients, what do you ask them to prepare for in terms of the most challenging aspects of rolling out a conversation AI tool?

Murray: We have a very rigorous process that has four different swim lanes. There’s integration, configuring the pathway or the program. Everybody delivers their care delivery model for diabetes to slightly different guidelines. So, there is an integration pathway, there are best practices on how you enroll the patients, and then there is how we’re going to measure success.

Some of our clients are very sophisticated and want to collaborate. We have taken off the table things like NLU and liability. So, the real focus is on making a program that we have designed and figuring out how to deliver care that fits in your model, works in your workflow, and integrates into your data flows.

Q. What do you see the next 12 to 18 months looking like from the point of view of VC money flooding the market? Also, what is your advice to a digital startup that is on the receiving end of this money?

Murray: Markets, in my experience, always overshoot. They are trying to get an equilibrium, but there is a massive bait on both sides. There are unprecedented amounts of money in digital health, and it is concentrated in certain areas like behavioral health, which is a big problem. Every time that happens, we are starting to see a massive consolidation. To your point, companies go public and use that capital very quickly to acquire. Teladoc, Livongo kicked off a big part of that, and there are others like Grand Rounds and Doctor On Demand. There are tens of hundreds of these deals happening, and many companies are getting funded. I think what we will see is continued consolidation, and there will be a whole bunch of companies that don’t make it above the threshold to be viable or to be attractive to be purchased, and they’ll go out of business, or will be acquired. It will happen quickly, and that’ll make the companies that are above there much stronger.

So, advice to somebody coming in the space is it is always better to start in a cycle where things look horrible because that is how you develop your product. If you are starting a company now and get funding, spend this time developing your product and getting product-market fit. Pick a problem because I think there is a lot of technologies out there in search of solutions. The market will give you an opportunity if you can solve it better than someone else or if it is an unsolved problem. Once the product is available in 18 to 24 months, that is probably an excellent timeframe to come out with a product. I am in a position right now where I am not worrying about generating revenue but worried about just building the product, and I have the funds to do it.

You must be doing lots of things, but it all comes down to the patient if they feel it is important in their care and have better outcomes. The providers can care for more patients and spend the time doing what humans can do; then, you have a winner. Those are the only two things I look at to see if we are successful. I look at what patients are saying and doing with the products, and I look at whether providers embrace it. If we have those two things in place, everything else will go well and ultimately; it will be successful.

 

About our guest

Murray Brozinsky is CEO of Conversa Health, an Automated Virtual Care Platform designed to expand access to care, enhance the patient experience, and improve health outcomes. Health systems, payers, and pharmaceutical companies use Conversa to keep patients on personalized evidence based pathways to better health.

Conversa was recently honored as the Best Remote Diagnostics company at the 2020 UCSF Digital Health Awards. During COVID-19, Conversa has also been keeping people connected without getting infected.

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.

Everyone believes that digital provisioning of care is here to stay.

Season 3: Episode #87

Podcast with Sean Duffy, Co-founder and CEO, Omada Health

"Everyone believes that digital provisioning of care is here to stay."

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In this episode, Sean Duffy, Co-founder and CEO of Omada Health discusses their journey as a virtual care company, primarily serving self-insured employers with a focus on supporting chronic disease care. Sean also talks about the thought process behind their newly launched offerings and how they stand against their competitors.

According to Sean, to be successful in digital health, it is important to keep up your learning curve, be patient, and operationally innovate within constraints. Payers, providers, and employer customers all have the same need – digital delivery of care. They all believe that digital provisioning of care is here to stay. This belief is bound to yield a remarkable transformation for healthcare. Take a listen.

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Show Notes

00:41About Omada Health and how the company started.
02:39What kind of enterprises do you mainly serve – payers, providers, employers?
03:53 Omada is a privately held company. Who are your major VC’s and how much the company has raised to date?
06:13 Omada is a pioneer in chronic care management using digital tools. Can you speak about your new services and the thought process behind launching these offerings?
20:04 What is your own view of where we ought to be, maybe 18-24 months from now? What does the hybrid world look like for you?
22:55 We are awash in VC funds at the moment, chasing digital health companies at every stage. What do you make of this abundance of capital and what is your advice to startups?
25:44 Big insurers and employers are beginning to acquire telehealth companies, and we’re also seeing a lot of M&A among digital health startups. What is driving this?
27:41What is your view of the big tech firms and the role they're going to play going forward in how care is delivered in future?
30:24What is your view on where the reimbursement environment is headed today in the market? If there is one thing that you would like the regulators to address, what would that be?

Q. Can you tell us about how you got to start the company and when did you launch it?

Sean: Omada Health is a virtual care company. We specialize in longitudinal disease areas with a particular focus on chronic—those disease areas where you need a lot of longitudinal day-by-day support versus visit-by-visit support. We offer an integrated care suite of services in pre-diabetes, diabetes and hypertension, behavioral health, and musculoskeletal. We think that what digital can do best in healthcare is fill in gaps between visits. The company began as an internal project at IDEO. Prior to this, I was in medical school and was in an MD MBA program at Harvard. I had worked at Google before and between my first and second year in medical school, I took an internship at IDEO and thought I would go right back to medical school. But I sat close to this gentleman, Adrian James, who at that point ran medical products for IDEO. We became best friends. We got a little bit of a time and budget to think about transformational opportunities in digital health, and the result was Omada. Omada was founded in 2011. We just crossed our 10-year mark.

Q. What kind of enterprises do you mainly serve – payers, providers, employers?

Sean: Our primary focus is on self-insured employers. That turns into many relationships with payers as well and we do have many partnerships with providers, especially those who have their own health plans, like Intermountain Health, Kaiser Permanente, etc. Our primary operating model is to go to employers, share our vision on what care can be and how a different approach in the disease areas might benefit their employees, both from a clinical outcome, economic, and satisfaction standpoint. Often, they will see if they could find a way for us to work with their health plan to make the implementation easy and simple. In addition to the employers, we serve many health plan partnerships as well.

Q. Omada is a privately held company. Who are your major VCs and how much has the company raised till date?

Sean: We have raised over two hundred and fifty million dollars to date. It does take a lot of capital to start a healthcare company, and you must ensure that you are doing it in a way that earns the right to commercialize and what many times appropriately, very risk-averse by market. Healthcare is one undertaking that requires capital and enough to get started to the investors that we have. We are honored to have great folks from many, many worlds in the earlier stage side, great firms as venture partners like Andreessen Horowitz, Norwest, and Wellington Rock Springs Capital. On the provider side, we’ve had Kaiser Permanente, Intermountain, Providence invests. On the plan side, Cigna, Humana, Blue Cross Blue Shield of Minnesota. Those folks come from so many different worlds on the moment of convergence that we’re having right now in the US health care system between different disciplines.

Q. Omada is a pioneer in chronic care management using digital tools. Can you speak about your new services and the thought process behind launching these offerings?

Sean: It’s been a really neat moment of transformation and the newest areas – musculoskeletal disorders – was through the acquisition of an incredible company called Physera. The primary reason for expanding it has to do with two things. One, clinically Omada is very interested in disease areas where we think our core capabilities can make a difference and that a digital-first approach is a right approach. Not all, but we can really support people effectively from afar. In most cases, clinically it just felt so clear that there is a huge gap in access and quality and outcomes that digital could help bridge.

Second is the voices of our customers. Every year at our customer summits, we ask our customers what they want Omada to do, how we can serve them better, and what needs they have. We got persistent feedback that they wanted to do more and broaden our offerings to other areas in the benefits to simplify implementation and enrollment. But there is also a lot of clinical comorbidities. So, you can create elegant, coordinated care experiences by having an integrated suite in these critical longitudinal areas.

Q. The mental bandwidth that you need, and the resources and the infrastructure can also be a challenge, especially from a leadership standpoint. Does that, in some sense, distract you from the core mission?

Sean: The guidance that I would provide is that you really want to earn the right to enter new areas, but don’t do it too soon and don’t do it too late. Because it requires a lot of organizational transformation to go from one product line to multiple. It is never a simple journey because you have to rethink how you staff the product organization. You must think about how you train and staff your commercial organization; all the subject matter experts from the clinical team need to become fluent in all these conditioned areas.

Second is what I call selective breadth. So, we are the company that is going to focus on the key needs for our buyers and make sure that within those needs, we’re doing a great job in tying the room together and coordinating all the care between them in an elegant way. But it’s a very heavy undertaking. So, focus is so important for companies as they grow.

Q. From the customer standpoint, they see you as something today and then tomorrow you are a little more than that. You are offering new services when maybe to have existing relationships for those new services. How do you help them make the tradeoffs of the choices, especially as a new entrant into the field?

Sean: Firstly, it’s really important to be flexible. We must be able to support an a-la-carte intention. We share a vision on why all the infrastructure ties nicely together and why it may make sense to deploy more than one kind of program area from Omada. But you must be flexible with configurability, especially in markets where employers may have made some great decisions for them. You must approach it with a sense of humility and really listen to customers and fundamentally work not just to show and describe a potential value prop and why the entire suite in some might be better than the individual parts. Show it in the outcome. Show it in the clinical protocols, the rationale. And then, hopefully, you earn the right to support them in new ways. It is never an either-or, and you do need to remain flexible and true to your original product areas as well.

Q. From a competitive standpoint, one of your big competitors last year, Livongo, was acquired by Teladoc, and trying to offer several different things. What does it mean for a company like Omada Health and how do you see them? Also, what are your thoughts on the competitive landscape where you are?

Sean: First and foremost, we’re in early innings. But if you add up the numbers of people we have helped, about four hundred and fifty thousand in counting. I think for us it’s a little bit more in the prediabetes phase and for Livongo it’s more of type two. I think it was about the same when they sold to Teladoc. But look at the overall disease epidemiology of the metabolic disease. We have done nothing relative to improving the overall health curves and epidemiological curves of the country. So that is a statement on how much room there is to have a lot of players here. If we are taking different approaches in the market, I think both organizations will be hugely successful. We do have a common vision that is integrated care suite can make a difference here. We have our unique approaches and styles, and we are honored to compete with them and hopefully, they feel similarly.

Q. Digital health is having a moment with this billion and billions in venture capital money. They are going through a lot of consolidations. When you look at the marketplace out there, what are the things that you try to keep track of so that you can calibrate your progress against whether you are on the right track or not?

Sean: The number one is what our employers and plans are saying and telling us. My most refreshing and insightful moments are talking to our customers, and talking to our sales reps. We have lived in various walks of industry cycles. It is almost too easy sometimes to get caught up in the excitement of a deal or a merger or financing. I always try to remind our employers that let’s stay just true to serving our customers or members and think how you can do that better and all the rest will follow. If you are not in a position where you can ignore the cacophony and a hype cycle, you are not going to be in a position where you can stay true to your roots. Also, you will not be able to power through a cycle where there’s a critique about the digital health space. This is a multi-decade journey, so hang tight and stay measured and focused on serving customers and members. It’s a very dynamic marketplace and it’s an honor to be serving as an innovator in this moment in the U.S. healthcare system’s transformation because it’s really remarkable time.

Q. What is the one common theme that strikes or stands out that you hear from your employer customers versus your health plan customers versus your providers?

Sean: I think in-person care needs to be option B. Why would you drag someone into a waiting room of a clinic unless you could not solve their needs safely and effectively from afar? You can’t do everything from afar. Like, Omada will not be doing hip surgeries, but there is a lot that you can do remotely. What has happened due to COVID, it’s become an obvious that the digital delivery of care is here to stay. And that is something to be embraced as a fundamental part of the U.S. healthcare system. I think tomorrow’s payers will have network teams that set up networks with digital providers just like they do in network teams that set up networks with in-person providers. For all the stakeholders, it’s very hard now to find either an employer or plan or provider that does not have a digital care strategy that does not think that digital care in the digital provisioning of care is here to stay, and it will yield remarkable transformation.

Q. What is your own view of where we ought to be, maybe 18-24 months from now? What does the hybrid world look like for you? 

Sean: I think what COVID did is it exposed huge opportunity, but also exposed some fissures because you cannot trick yourself into thinking that you can do everything digitally. A lot of my friends are not practicing docs, they are doing asynchronous or synchronous digital, like CareFirst. Think of patients that are in the primary care settings and how many you must send to in-person care, it’s actually a fair amount. So, you cannot accomplish everything afar. Omada is focused on disease areas where we think the bulk of the provisioning of care, the tipping point of 80 percent, can be done from afar safely and effectively. We have learned what does work and does not work, and that’s going to help us get into equilibrium, and it’s going to be a hybrid. I think we will end up in a world where every single health system, it does not matter if you’re UCSF or an independent two-person primary care practice, you will be doing some form of telemedicine – video visits or phone visits. And what is going to happen is companies like Omada will become experts in augmenting the in-person care system and filling in all the gaps. As the operational transformation, the pricing model transformation, the care team, and professional and personnel transformation required to orient toward longitudinal is quite heavy. So, I think some things will be adopted universally at the level of the current provider, and some things will stay in the cloud.

Q. The digital health landscape today has somewhere over 5000 digital health startups in the market, and there is a lot of VC money out there. What is your advice to startups and to VC firms who are getting into the digital space today?

Sean: I think I’d like to see the capital and space have a lot of smart minds run at hard problems and innovate and see what happens. The beautiful thing about the world of entrepreneurship and venture is not all going to work, but some are going to work beautifully. In the U.S. healthcare system, you cannot find a shortcut. You will not be able to disrupt from the side and go around the system like that is impossible, nor should that be the objective. You must learn where the value is, how a dollar flows to the system. You must be able to deal with the complex dynamics of navigating different insurance lines. You must plan a go-to-market strategy almost specific to each state because the state-by-state dynamics are entirely different.

The second is, ramp the learning curve, ask a lot of questions, be OK with that and do not try to judge the system; view it as it is and find a way to operationally innovate within the system constraints.

Q. Big insurers and employers are beginning to acquire telehealth companies, and we are also seeing a lot of M&A among digital health startups. Like Walmart, Cigna, etc., are acquiring companies. What is driving this?

Sean: I think they are listening to the same voices that we hear to. However, Walmart is a little bit different here. In the future, if you are a health plan and serve a self-funded employer, your self-funded employers will need to know what you are doing relative to digital care for their employees. You will then think through the pieces that you want to have in-house fundamentally and bring value to my customers and integrate with my additional services. Also, what are the elements that I want to partner with and find great companies to work with? I think it is an exciting time to be in this space and I love the new entrants. It is fun to watch a Walmart come in to care in different ways. I think Walmart will do extraordinary things to care for the country, as there are many of the plans making bets and innovations here.

Q. Amazon is among the big tech firms a little bit different because they are directly getting into the healthcare space instead of the others who are more about offering the technology enablement to deliver care more efficiently. What is your view of the big tech firms and the role they are going to play going forward in how care is delivered in the future?

Sean: I think what naturally tends to happen is companies end up being excellent at the things that are in the back of their core strengths. Look at Google, for instance, they are the sort of computer science miracles. Their approach to developing incredible machine learning and artificial intelligence models to look at radiological data and help augment clinicians’ interpretations of readings is extraordinary. That sort of deep computer science meets biology work will likely be where Google makes its biggest contributions. On the Amazon side, I think it’s complex, the supply chain and operations. And the acquisition of PillPack in the pharmacy is a great example. And then I put AmazonCare in the same category. It is logistically complex to deliver all care digitally. Amazon has a unique, beautiful approach, listening to the pragmatics of care delivery and recognizing that you need in-person care. Amazon approaches the market with a powerful sense of customer-centricity. They are learning the details and specifics that others have maybe tripped on in the past, and they will be very successful in time. It is not going to happen overnight. But that is a patient business, and that is a business that’s willing to put a lot of capital to work to write out whatever period it takes.

Q. In Telehealth, we have seen some of the waivers come in, not permanent yet, but the hope is that they will be there. We are seeing a shift from traditional payment models like PMPM to slightly different alternatives, emerging models. What is your view on where the reimbursement environment is headed today in the market? If there is one thing that you would like the regulators to address, what would that be?

Sean: My biggest worry is relative to the inability or potential for us to seize the opportunity that COVID presented to transform healthcare. Suddenly, we are doing fee-for-service through video, and we call that success at the end of the day. It is great that clinicians can now do video visit or a phone visit, but that is not the end state. Allowing flexibility in service models can accommodate either synchronous interactions or asynchronous interactions. So, people sometimes forget that a lot of care preference at the consumer’s hands might be the kind of text they email to their care professional. So, they ask for Medicare and regulators to open minds to ways to thoughtfully accommodate. Asynchronous building models and there is a way to do it, you can think through like a care episode where once it starts over 15 days, a clinician is allowed to interact in whatever way possible. Think of it as Medicare Advantage and ask that we align with the scope of services we provide. We have a monthly rate that we charge for providing that, and it includes devices, your primary coach or certified diabetes educator, your nurse or all the services we render inside that. But we retain the flexibility to personalize against the need.

About our guest

SeanDuffy-profile

Sean Duffy is the Co-founder and CEO of Omada Health, a digital health program that combines the latest clinical protocols with breakthrough behavior science to make it possible for people with chronic conditions to achieve long term improvements in their health

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.

With innovation, you need to be prepared to recognize that every idea is not a great idea.

Season 3: Episode #86

Podcast with John Donohue, Vice President of Entity Services, Penn Medicine

"With innovation, you need to be prepared to recognize that every idea is not a great idea."

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In this episode, John Donohue, Vice President of Entity Services at Penn Medicine talks about their 6-years long, $1.5 billion investment in a hospital of the future to be launched by the health system in their West Philadelphia campus. The hospital features new interactive technology for improving patient care and Disney-inspired user experience design.

John discusses a range of other topics, from defending against the ever-growing cybersecurity threats to finding success with technology partnerships. Their “3C” mantra for technology enablement in care delivery – common systems, centrally managed, and collaboratively implemented – has been a key to their success over time.

John also provides practical advice for digital health startups looking to partner with Penn Medicine in launching innovative solutions. Take a listen.

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Show Notes

05:50About Penn Medicine’s new hospital facility – The Pavilion.
10:16Brief about the new facility’s design process.
11:10 How long did it take to design the new facility, the patient room of the future?
12:53 How do you ensure that you have adequate security, data, security, and patient privacy? What additional considerations went into this when you were putting the design together?
15:47 How have you laid a data and analytics layer on top of this infrastructure?
17:11 Are you leveraging the cloud to post your applications infrastructure, especially for this new facility and even more specifically for the data?
20:38 Moving things to the cloud may sometimes end up costing you more if you're not careful. Can you comment on that?
21:29Interoperability has been a work in progress for healthcare. How would you describe its State of the Union across all of your applications in your landscape?
24:25Most health systems try to consolidate all the applications into their core platforms. But on the other hand, they also have to be open to bringing on new innovative solutions. How do you manage this?
26:36What advice do you have for startups that have something interesting to say and want an audience?
28:04A best practice you would like to share with your peers in the industry for someone embarking on a journey to make a billion-dollar investment in a new hospital.

Q. John, what does your title mean in terms of the areas of responsibility for your role? Can you describe the applications landscape as well? 

John: I have worn many hats in the 12 years at Penn Medicine for a long time. I was the infrastructure executive responsible for enterprise infrastructure, component data centers, networks, telephony, video services, storage, et cetera. My role there was focused on resiliency and availability, which is critical in any academic health system where I built the information security team. We went from about four employees to about thirty-two dedicated security professionals in less than four years. However, my focus for the last couple of years has been around what we call entity services, and we refer to as entities, hospitals, and other major functions. Today, we have 13 of those today, six inpatient hospitals, several other areas like primary care physicians, specialist providers, home care, school medicine, et cetera. Each of those entities has an Information Officer and Information Entity Officer. So, the entity services team is comprised of about two hundred people across Penn medicine, delivering services like clinical engineering, platform support, network support. They have just been designed to allow the entities to have some autonomy regarding their priorities and resourcing their needs. My role has been for about ten years now and is part of our special sauce, making our information services team successful. It has personally brought me closer to what we do as an organization in providing world-class healthcare. Many of the different hats across the last several years have given me a unique perspective around what it takes to run a large-scale organization in an academic health system.

Our primary application is Epic or what we have started calling PennChart. We started installing Epic probably twenty years ago in the ambulatory setting. About six years ago we migrated to Epic on the inpatient side of things and have since installed many of their specialty modules, like Uptime for the OR, Cupid for cardiology. We also leverage several of their mobile platforms with tools like Haiku and Rover. Epic customers will be familiar with those terms and we use Epic tools that allow us to work with other physician practices in hospitals, things like what they call “healthy planet” care everywhere community connect. We also leverage some of their modules for the data analytics-based tools. Lastly, we use their patient portal for facilitating communications with our patient population for things like appointment scheduling, test results and medications. 

Q. You are about to launch a new hospital which I believe is going to be the hospital of the future. A lot of new technology enablement aspects are going to make for an interesting and improved experience for people. Can you talk about that? 

John: It is an incredibly exciting project and by far the biggest one I’ve ever worked on in my thirty-five-year career. I think it is the biggest capital project in the history of Penn, which goes back about two hundred and fifty-plus years. Our first meeting on this topic was over seven years ago, and we are set up to be patient-ready by the October-November timeframe this year. It is in our West Philadelphia campus, across the street from the hospital of the University of Pennsylvania and the new building. It’s a $1.5 billion investment that includes about 1.5 million square feet, 500 state-of-the-art private patient rooms, 47 state-of-the-art operating rooms in this 17-floor facility. This innovative hospital facility is designed to support our world-class researchers, clinicians, and faculty. It is trying to create a stage for these world-class folks to do what they do best.

From an IT perspective, we view this as an opportunity to significantly improve our patients’ and our providers’ engagement with technology. We have designed the building to support a fully digital experience with Wi-Fi and cellular coverage throughout the facility and have developed what we call the patient footwall, which has really been around designing the integration of several different technologies that will make the patient stay more comfortable. The technology will also enable providers to engage with the patients during their stay. The hospital will be 5G ready, aggregating nurse call and nursing alerts to a mobile app to reduce nursing fatigue. At the center of this will be a seventy-five-inch TV, a centerpiece for education and entertainment for the patient. A tablet in the room will allow patients to manage the room, the temperature, the shades for lighting, noise levels, privacy, potentially ordering dietary requirements, full integration with our electronic health records. As soon as staff enters the room, the patients will know who they are, their role, and potentially why they’re there. All the environmentally friendly components in the facility will help us be responsible from an environmental perspective and reduce some costs. The common theme for us with this Pavilion on the campus is connectivity. The need to have a patient care facility like this with advanced connectivity is fairly evident. When you think about extending this connectivity beyond just IT and creating a seamless patient experience across the campus with transitions of care, you’re talking about some game-changing improvements in patient engagement.

We’re there to take care of the patients and their needs and focus on them. The intent was to have a highly private facility for our patients that would be comfortable for them and their family members and make it a good experience and have the room outfitted so that it does feel like an improved patient experience. We intend to provide a hospitality experience. We talked to Disney and others so that we could work them into our design.

Q. The tech can doeverything but developing this unique and differentiated experience requires a whole different level of understanding of human needs. Can you talk about design process to design the experience carefully? Also, how long did it take you to design this patient room of the future?

John: We brought in subject matter experts from architecture and design from across the globe. And then built out a half a floor in a warehouse out of Styrofoam, brought in time emotion studies, and made some significant changes to our original design based on actual people, wheeling gurneys through these Styrofoam hallways. We looked at access and traffic patterns and did all kinds of timing exercises of how long it would take to get somebody from the ED to an OR. As fun as the technology was, if you design and implement it right, it’s right. Getting it right from a design perspective is a whole other level and I think we knocked it out of the park. 

It almost took three and a half to four years to design the room from start to finish. We found some slick ways of a nurse sitting at a desk outside of the patient room like we mirrored the patient room such that a nurse could monitor two patients at the same time through these windows. We have done some innovative things in the bathroom and the shower design and brought those in these units by leveraging the city’s views. It was an extensive design process. We have also designed flexibilities into the room to be used for many different purposes. In the old days, you had your normal patient care rooms and then you had specialty rooms. These rooms are all designed with booms to move patients and capabilities that can become more specialized on the change of a dime. Over 500 rooms in this net new building are designed and set up in this way.

Q. How do you ensure that you have adequate security, data, security,and patient privacy? What additional considerations went into this when you were putting the design together?

John: If you think about this patient room, many components are of the Internet of things. Whether it’s the lights or the devices in the room that are more typical Internet of Things type devices, everything that sits on the network poses a potential concern. So, we teamed up with several subject matter expert partners. We set up a lab environment and implemented all this technology in the lab. If you walked into this lab, it would almost look like the patient room to you. We rolled in the monitoring equipment and everything else to be really a good mirror of what would be happening in the new Pavilion itself. Then we made sure that we had the security we were looking for in that room. We did some exercises to try to tap into the network through some of these devices and asked our vendors to work in their labs at their own manufacturing plants. The technology that we have integrated and the standard tools we put in place to manage security across the enterprise is in pretty good shape. But in this business, you need to be vigilant. The threat landscape changes dramatically over time. Health care organizations have really become the focus of cyber-attacks over the last several years. It started with medical records being more valuable to criminals than credit cards and has only been exacerbated with organizations like ourselves that are in the center of COVID research and vaccine distribution. Patient privacy and ensuring that we’re a secure organization are really important to us, so we have redoubled our efforts with this new facility to ensure that we’re in good shape. Devices like network segmentation, network access controls, building profiles can change their behavior; we have a chance to isolate them and pull them off the network in case they could have been hacked or breached and could be a vulnerability. We are making sure that new Pavilion and the rest of our enterprise is secure.

Q. You have a ton of data that’s going to be available by observing the way these devices and the software of the services used by patients or caregivers and how the devices interact with one another. Can you talk about how you’ve laid a data and analytics layer on top of this infrastructure? 

John: We started to make investments in our data analytics group from the last three years and have continued to make those investments. With this additional information, we will focus on how we turn that into knowledge, with that data, people can make informed decisions. So, we have matured our efforts on the data analytics side, but we are still trying to identify the best way to use all this data. We are excited by the opportunities and looking at how to make future investments in this informatics to make sure we’re leveraging all this information. Through this data, we make sure our clinicians and executives are aware of what’s available and then optimize it based on that information.

Q. Are you leveraging the cloud in any significant way either for posting your applications infrastructure, especially for this new facility, and for the data?

John: I call our cloud strategy – opportunistic. From a Gartner perspective, what they call a fast follower. Cloud technology is not new by any stretch, but we need to make sure that we have business associate agreements in place with the cloud vendors. We spent a significant amount of time building out our private cloud capabilities using hyper-converged capabilities. We have seen some great efficiencies there and been able to move a significant amount of our workload from different vendors, storage and platforms that are computing. Our focus has been on the HIPAA conversion private cloud. We have also been leveraging SAS applications wherever possible. Many of our applications are cloud based in addition to things like Office 365. We’ve made some investments in the infrastructure applications, but we know that in a long-term perspective, we need to leverage private cloud, public cloud, hybrid clouds so that in any time of the day we can move our enterprise workload to the least cost and in the most secure environment. We continue to work with Azures and the Googles and others out there to make sure that we’ve got the right agreements in place. We have got a rather large high-performance computing that’s used on the Research and School of Medicine side that we’re looking to move to a cloud environment. We don’t drive things to the cloud just to drive things to the cloud. We do when technologies at the end of its life where there is an opportunity to be more efficient. I would say today we probably have close to eighty five percent of our workload in some type of a cloud environment. 

Q. So, over time you have moved a significant amount of enterprise workloads to the cloud. But you look at everything on a case-by-case basis and it’s not a default decision to just drop something into the cloud just because that is where you want it all to be in future. How do you do the tradeoffs?

John: We look at the workload itself and look at what kind of data is on those workloads and then what we’re doing today. If it’s in a hosted environment that we’ve outsourced, we look at what’s the cost of that environment, what are the pros and cons of running it in that environment, speed to market, the way they secure their environment, and so on. We look at it from a cost benefit standpoint and start to check what are the things that would make us more responsive, more agile to get things time to market. We also look at the ways that can take our resources and focus them where we want them to be focused versus running our own data centers and setting up servers and managing the servers and storage. We look really at return on investment and risks.

Q. I have heard often that moving things to the cloud may end upcosting you more if you’re not careful. Can you comment on the ROI part of it? 

John: I think we found the same thing, particularly with our high-performance computing capabilities. It looked attractive on the surface, but the devil is in the details. Once you start to pick up things and move it over, you learn quickly that there’s some hidden costs. There are times where you’ll accept those costs because it reduces investments and resources that you need in other places. But we have learned the hard way that sometimes the cloud is actually more expensive.

Q. How would you describe the State of the Union as it relates to interoperability across all your applications in your landscape?

John: We have taken a three C approach to applications that stands for – common systems, centrally managed, and collaboratively implemented. It is one of the mantras we use in IS, and it’s been key to our success over time. In the last 10 years, we migrated many small applications into these large suites that I talked about earlier, like Epic. It’s allowed us to be efficient in our spending and resources and drive a lot of cost out of the system. As we look at integration or our ability with new applications, we lean on those standard systems first. And then see if they can work for us versus adding in a new best-of-breed type of application. 

Secondly, the legacy there is centrally managed. So, pulling everybody together into a corporate IT organization has allowed us to eliminate most of the shadow IT in some organizations. Shadow IT resources are the ones that in many cases introduce new applications that are hard to integrate or hard to interoperate. Between those two things, we’ve built a pretty effective corporate organization that can deliver the standard solutions fairly quickly and economically. 

The last C, which stands for collaboratively implemented, is our secret sauce. We have business projects that involve technology which means that both IT and the operational folks are at the table with skin in the game. This has really delivered very good results for us, because as things start to go wrong, we lean heavily on each other to make sure that we get good results. This strategy has really helped us eliminate overhead and eliminate the need to integrate and interoperate platforms that may be a challenge. 

Q. Most health systems try to consolidate all the applications into their core platforms. But on the other hand, they also must be open to bringing on new innovative solutions. How do you manage this?

John: On the one hand you must keep your network and clinical systems up and running twenty-four by seven. That requires a certain strategy, mindset, and skill. It’s not an easy job but getting there on time takes some work and focus. At the same time, you must have an innovative mindset to stay ahead and leverage these new capabilities. This requires a whole different strategy, mindset and skillsets. Leading teams that are responsible for both can be a challenge today. With innovation, we feel like you need to be prepared to recognize that every idea is not a great idea and failing fast if you are not going to be a winner. But our environment, where a learning organization, we see many entrepreneurs on campus, comes out of Warton, other schools, and is incredibly bright. We have a place on campus that is called Pennovation – a lab space. Their tagline is ‘where ideas go to work,’ which encourages people to come to Penn to do innovative work and to do emerging technology work. So, we often see people knocking on our door saying, “We work for Penn or we graduated from Penn, and now we’re part of a startup. So, we see a lot of these technologies. And I would say one out of every 10 to 12 has got some real value here. It is addressing a pain point that we have, and it’s something that we can’t go to one of our established partners and ask for the capability. So, we have set up a new technology review board that looks at all these and uses a governance process to ensure that we are fair and consistent. So, not only do you need to keep your legacy applications up and running, but you need to stay focused on innovation where it can be a game-changer for you as an organization.

Q. What is the advice you have for startups across the country that have something interesting to say and want an audience? 

John: I think there are two things. One is timing. You must have robust technology that is ready for prime time. People knock on our door many times, and it’s a concept and we don’t have the cycles with everything else we have going on to work through the concept and spend those kinds of cycles there. Timing is key and it’s got to be close to being ready. Another essential part is finding an internal sponsor, a champion, somebody who is willing to be the representative internally around that technology and speak to its benefits. Look at the cost benefits, ROI, and a partner who will help design functionality and capabilities. Also, find the sponsor, the internal person that can champion that.

Q. Is there a best practice that you would like to share with your peers in the industry? 

John: The best practice is to engage with others. What we learned with the Pavilion was that looking outward was a game-changer for us. This sounds simplistic, but we have brought to the table several technology partners and several integration partners and said – “we want you to partner with us and do development on your dime and later you’re going to be able to talk about how you partnered with us.” Getting the right spirit of partnership and getting the right ability has been a game-changer for us. The best practice for us was as big as we are and as talented as the people we have, both on the IT and clinical sides, partner with folks that has significant resources themselves.

About our guest

John-Donohue-profilepic-may2021

John P. Donohue is the Vice President of Entity Services at Penn Medicine, Information Services. John is responsible for leading the Entity Services group; which includes a number of seasoned technology executives, as well as the onsite teams that support Penn Medicine’s many entities. These entity technology groups are responsible for managing the business and facilitating the technology relationship between Operations and Information Services. Each entity group is comprised of an Entity Information Officer and resources that support clinical engineering, platform, and network technology at the entities. Additionally, John is the IS executive driving technology innovation for the construction of the new patient pavilion project, which is expected to open in late 2021.

Mr. Donohue is a seasoned health care IT Executive with over 30 years of experience which includes: extensive senior executive and customer interaction, understanding complex business requirements, identifying technology solutions, developing and executing IT strategic plans. He is recognized as a proactive leader who builds and develops high performance teams that are committed to excellence in the delivery of IT services and solutions.

Prior to joining Penn Medicine, John held IT vice president roles at both Covance (a $4 billion Clinical Research Organization) and Children’s Hospital of Philadelphia (Number one ranked Pediatric Hospital in the country). John holds a BS in Business Management from University of Phoenix.

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 must utilize AI to change the way healthcare is delivered and how patients can be more engaged in their care

Season 3: Episode #85

Podcast with Sachin Patel, Chief Executive Officer, Apixio

"We must utilize AI to change the way healthcare is delivered and how patients can be more engaged in their care"

paddy Hosted by Paddy Padmanabhan
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In this episode, Sachin Patel, Chief Executive Officer of Apixio, discusses how data science can help solve critical healthcare problems and empower individuals, providers, and health plans with reliable, actionable intelligence. Apixio is a healthcare AI analytics company that was recently acquired by Centene Corporation.

Today, more than 1.2 billion clinical documents are generated each year in the U.S., but there is very little analysis of the unstructured information. The Apixio platform uses advanced analytics to generate insights from unstructured data to deliver significant improvements in financial performance.

Sachin also discusses the big opportunity areas in AI today and the challenges in increasing adoption levels for AI in healthcare. Take a listen.

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Show Notes

04:20Where do you see AI in healthcare today, and what are the big opportunity areas?
07:48Your products are focused mainly on administrative efficiencies, specifically revenue and payment operations. How do these solutions create value?
15:59 Recently, several emerging data partnerships have been announced – Truveta, Mayo Clinic, Highmark-ChristianaCare. What are your thoughts on this trend?
18:40 Does your relationship with Centene preclude you from doing business with their competitors? How do you manage any concerns that may arise from other clients in this regard?
19:44 What are the big challenges for AI that the healthcare industry needs to address before we can realize its full potential?

Q. Can you brief us about Apixio and your interesting journey to how you got here?

Sachin: At Apixio, our mantra has always been to achieve better healthcare through data insights. Apixio has created a proprietary artificial intelligence platform that’s able to render computable data from clinical, administrative and other notes. The text in these documents, the unstructured data, contain 70 to 80 percent of the information about an individual’s healthcare, most of which is not captured in claims or other administrative data. Certainly, you need both pieces, the structured and the unstructured data. We pride ourselves on being able to tackle both of those. What we can do with that data is assemble patient phenotypes from the smart aggregation of various insights that are generated from the two data types. Our artificial intelligence platform can then provide these insights for a variety of different use cases which we can get into.

Prior to Apixio, I was with a healthcare services company and the value-based care space, and prior to that I was in investment banking, a way back when I started my career as an engineer.

Q. Apixio was acquired by Centene late last year. Can you brief us about that?

Sachin: Centene had been a recent customer of ours. They acquired WellCare, who was one of our key customers and they had seen the direction that we were taking our platform and the potential that we had – to use the artificial intelligence capabilities, to improve value-based care, and other activities that are important to a health plan. That was a perfect fit for our next chapter. And importantly, we have had the benefit of having seen 40 plus other customers data inform the quality of our insights that are gathered. Now we have access through Centene to twenty-five million patients’ worth of additional data from which to train our algorithms and develop new capabilities.

Q. Centene is one of the largest health insurance companies in the country with a specific focus on the Medicaid population. Is that right?

Sachin: That’s right. They’re largely focused on Medicaid, but with the acquisition of WellCare they have a pretty significant footprint in terms of number of lives covered in the Medicare space as well.

Q. Where do you see AI in healthcare today and what are the big opportunity areas.

Sachin: In the last handful of months and the last few years, a tremendous amount of buildup in different organizations, plans, providers, analytics firms are utilizing AI to change the way in which healthcare is delivered and how patients can be more engaged in their care. That’s really where the sizzle or the interest lies in any company pursuing their activities within the healthcare realm. So, getting closer to that point of care, getting closer to the patient, that’s where you can really drive some of the changes that are being looked for. But you can’t leave behind the administrative or the plan administration side of it as well that sometimes doesn’t get talked about much. The ability to have a technology platform that works across all those areas and be effective in terms of the access to the data, the analysis that you conduct on it, and mining all of the different pieces of information to form a holistic view of what that care journey looks like for both the payer and the provider. And to the patient as well, as that is how you unlock all of the value. The big opportunity lies is bringing that all together. So, you have got certainly a continuum of folks that operate in different parts, but you want to be able to bring that all together and then have that bear out in the type of care that’s delivered.

Q. The money that’s being made today from applying AI directly seems to be a lot more in the administrative functions where you can see a very direct correlation between what you put in and what you get out of it. Is that right?

Sachin: I think that is spot on. Certainly, with appropriate focus on where we all would like to see healthcare go as it relates to the provider and the patient side of it. No doubt that is where we all want to see improvement. Because if you think about what is caused a lot of the abrasion within healthcare delivery in the US, it’s the burden of those administrative activities that prevent the providers from being able to provide the right type of care. So, we all have an eye towards that. But as it relates to where you also need to have important business focus, it is on that administrative side. And I would say you’re right, certainly in terms of being able to demonstrate a clear ROI and then importantly, as you think about value based care and how those contracts are structured and how you drive the action that is desired from all parties to that set of activities, that’s where you want to make sure that you’ve got the administrative software as well, with the benefit of efficiencies gained from artificial intelligence platforms or other technologies, especially when you look outside of Medicare Advantage and think of the other lines of business that typically don’t have as robust a margin profile.

Q. Tell us how Apixio is bringing about some of these improvements in administrative efficiencies by applying AI in the context of revenue and payment operations.

Sachin: In simple terms, if you’re looking at a series of hundreds of pages of a patient’s chart and you’re a human, let’s make it this area that we’re talking about and particularly our primary use cases within risk adjustment activities. If you’re looking at hundreds of pages of charts for thousands of patients over the course of months, you’re likely to get tired, fatigued, very naturally. It might miss a detail or make a decision that may be as inconsistent with a decision you might have made around two weeks prior with the AI platform. AI type capabilities can allow you to, instead of looking at all 200 pages in this document, see eight pages that matter for what you are trying to do in this activity. It doesn’t have to be a risk assessment, could be anything. It could be a quality initiative and a variety of other activities. And if you’re only looking at those pages and you’re generally guided there and making either a confirmatory decision or you’re saying, ‘hey, actually, I don’t agree, because for our plan X, Y and Z matters a little bit more for whatever that uses.’ You can then make that change and being a lot more efficient with your time. And that’s really where I think you gain those efficiency of scale. Also, if you’re only looking at claims data, you may find 20 to 30 % of the information that’s really rich data. It is the record of truth as it relates to payment. When you think further down into other areas where you would want to expand those capabilities, as we were talking about, point of care, clinical discovery, things of that nature, that’s where you do want to look at the unstructured data. That unstructured data certainly has important details, but also has a richness of data and depth of data from the physician’s notes. So, the physician may code at a certain level and say that I have these two conditions, but they may also add in their notes because they don’t necessarily want a bill for that. But the patient also has these other symptoms that we may want to keep track of. That’s what you also want to know and so that’s where we think the entire profile is important, especially as we talk about things like value-based care.

Q. So, from what you have described, you are primarily talking about natural language processing, is that right?

Sachin: That’s part of it and then there are other techniques as well that can be used to combine for insights.

Q. Did you build the technology on your own? Can you brief us about the evolution of the technology and how you got it to where it is today?

Sachin: Yes, we did build everything. It was purpose-built and was in-house for risk adjustment initially. Certainly, we have used a variety of NLP and machine learning techniques. Think about our platform as it has a core capability of being able to find these insights. You can tune the algorithms to find what it is that you are looking for in a chart. It does not have to be this risk adjustment case. I can then tune those algorithms to find other information, whether it’s a quality initiative. I just want to maybe search in a simple way for all diabetes patients who have had an eye exam or something else. You can do all of those activities by upfront, tuning the platform to run those different use cases. That’s really the way in which we envisioned it. So, think of it as there is this base layer of capability and then on top of that, you build out different applications for different use cases. So, as it relates to risk adjustment, an important area for us to select, certainly because there’s a tangible benefit that folk see right up front in terms of being able to appropriately deliver care for what may be a more higher acuity patient population. It also gave us the richness of data over time. We noticed this after we crossed 10 million patient records from across the U.S. and now we’re worth of 20 million. This diversity of data in the risk adjustment function allows you to have confidence in a narrow confidence interval, in the insights that you’re delivering. That’s really important because you’re going to not only believe in the decision that you’re making as a health plan, but you also want to believe in those decisions being made as a provider to ultimately drive adoption of these technologies.

Q. What you’re really talking about is being compensated for the care that you provide and more specifically making sure you’re not leaving money on the table by missing something in the coding process that could be a legitimate claim for a payment. Is it a fair statement?

Sachin: That’s correct. On the other side of it, one of our important full solution capabilities from a compliance standpoint, you also want to look through and review those same charts and make sure you haven’t previously submitted something that shouldn’t have been. In that case you can proactively flag and note it so that payment is essentially recouped or taken out from what you may be finding for other more higher acuity populations. So, it’s important to do both activities.

Q. So, one of your clients, Centene, puts in a dollar of investment in this technology. What can they expect to get out of it in terms of order of magnitude of returns?

Sachin: So, I think typically from an efficiency of workflow standpoint, customers would typically look for is something in the 4-7 times return in terms of efficiency, of effort, of what’s being done by their folks. And from a dollar perspective, it’s a wide range and it depends on what the initiatives you’re doing. I am not speaking broader to some of the other things that we work on with customers beyond risk adjustment, that can vary a little bit more.

Q. Recently, several emerging data partnerships have been announced – Truveta, Mayo Clinic, Highmark-ChristianaCare. What are your thoughts on this trend?

Sachin: In the last handful of months, I think most of the health systems have come to the realization that the path for them is to have a partner that can help them get there faster rather than perhaps developing the capability in-house. The challenge through all of this is going to be how do you keep that data integrity at a high level? There’s certainly some compliance type of steps that need to be held there, especially as it relates to HIPAA. But if you can clear all of that, then you’ve got high integrity of data and then you need to very specifically define what is the success for this activity that we’re pursuing. I think that is generally alluded to in some of the partnerships that you’re referencing and grow into it over time so that you have confidence that the decisions that you’re making, using those technologies are ones that you can feel really good about. They are not going to either impact you from a financial viability standpoint, but more importantly, that are going to be good decisions for you in delivering care for patients. In one of the organizations that you mentioned, the Mayo Clinic in particular, they referenced that they’re going to be utilizing some of these wearables, technologies and other types of data. I think that’s really exciting and interesting.

Q. One of the things that we see when it comes to applying AI in the context of clinical outcomes, algorithms require a lot of retraining. All the variables need to be adjusted when you are moving from one population to another. So, if you have an NLP algorithm that can scroll through charts and surface opportunity areas, it’ll work just the same in any hospital, any health plan across the country, you don’t really have to do a lot of tweaking to it. Is that a fair statement?

Sachin: It depends. Certainly, there’s different guidelines for each type of organization that you’re working with, plan or provider group that might matter to how you approach each situation. So, there might be custom tuning, but as a general concept, your comment is fair.

Q. You’re a part of Centene now and I guess it is a whole different feel from being a native company. Does your relationship with Centene preclude you from doing any kind of business, especially with their competitors?

Sachin: No, it does not. That is the short answer. So, part of the focus of this transaction, and in particular one of Centene underlying thesis, was that we would continue to sell externally and focus our efforts equally there. The simplest way to do how Optum operates within United in serving both the parent company as well as the broader market. So, we continue to work in that regard to win and have won new contracts with other players in the market.

Q. What are the big challenges for AI that the healthcare industry needs to address before we can realize its full potential?

Sachin: I think there is the widespread adoption or the way in which you drive this fast or appropriately with what are the privacy requirements and what is covered under HIPAA and what other considerations do you need to be aware of? There are other government task forces around this that need to be kept in mind. So, it’s the appropriate attention of how fast technology firms would want to move to say – ‘yeah, give me all the data and I’ll run it through, and we’ll get you that much more high-quality insights and analytics.’ But on the other side, you have to move at the right speed. I would say that the ability to get there should be picking up pace as you start getting folks comfortable that you are able to maintain the integrity and security of the data. That happens with more and more players now. Sometimes a big situation that comes up at some point in the future and there’s a breach. Someone is exposed and that becomes a concern. So, with more firms being focused on that as a table stakes item to be successful in winning new engagements with plans and providers, I think it drives some of the discipline even more so around that. When you think about the different axes of how you propagate or become competitive in healthcare analytics with the use of AI, there are three different vectors: there’s the quality of your data science, which you have general control over; there’s the quality of data volume or the quantity of data volume. This is when you have enough diversity of patient data from which to feel comfortable, or can certainly say – ‘hey, for this case, I don’t want to have too much of a bias in this direction or that direction.’ And then there’s the data liquidity piece and it’s really the data liquidity that’s going to be a rate-limiting factor here when you think about those three vectors, because that is driven by not only decisions by health systems and providers, but also from a regulatory standpoint.

About our guest

Sachin-patel-profilepic1

Sachin brings broad experience across both healthcare and technology, spanning a variety of leadership roles, including operations, finance, and development. Sachin joined Apixio in 2017 as Chief Financial Officer and later served as President and Chief Financial Officer before taking his current role. Sachin has extensive experience working with value-based care provider groups including Vantage Oncology, a national leader in community oncology, where he served as Vice President, Finance, and Chief Financial Officer of Vantage Cancer Care Network, an innovative model for managing cancer populations.

Sachin has also held positions with Citigroup Investment Banking and began his career in engineering roles with Cisco and IBM. Sachin holds a BS in Electrical Engineering from The University of Texas at Austin and an MBA from the UCLA Anderson School of Management.

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.