Digital health technology is helping people to engage in a healthier lifestyle

Posted on December 17, 2021December 30, 2023 by sanjith p

Season 3: Episode #105

Podcast with Richard Ashworth, President and CEO, Tivity Health

"Digital health technology is helping people to engage in a healthier lifestyle"

Hosted by Paddy Padmanabhan

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In this podcast, Richard Ashworth, President and CEO of Tivity Health, discusses why senior fitness is an important space and brimming with opportunities waiting to be capitalized. Tivity Health leverages core healthcare capabilities to deliver market-leading fitness, nutrition, and social engagement programs that improve health and lower healthcare costs.

In the episode, Ashworth talks about two significant macro trends in healthcare: the shift to digital health solutions and growth in Medicare Advantage. He further acknowledges how seniors have enthusiastically adopted technology but maintains that the future of healthcare is hybrid, i.e., a combination of digital and in-person care.

Healthcare is mission-driven and offers ample innovation opportunities in digital health, data, mental health, senior living, and home-based care. He advises youngsters to pick a job to make a difference, leverage opportunities, and continue to innovate and learn. Take a listen.

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Show Notes

00:38		About Tivity health and how you came into the role?

03:42		What are the macro trends you see playing out in healthcare as we head into 2022? How will they impact or influence your business?

07:49		Who are your consumers and who is paying for the services -- the health plans, the employers, the individual subscribers, all of them?

12:10		After the pandemic, telehealth kind of took off like a rocket. Wasn’t the case pre-Pandemic. Do you also see an analogous trend in your business?

15:47		Peloton and Apple Fitness come to mind first but where does your company fit in that milieu of online fitness?

20:59		Health systems are in a fee-for-service model and health insurance companies are trying to get everybody into more of an accountable care kind of a model. Do you see a tug of war between these two instincts?

29:47		What is your advice to the younger generation that is coming into the workplace today and is looking at healthcare as a career?

About our guest

Richard Ashworth is the President and CEO of Tivity Health. He has spent his career focused on improving the health and well-being of others, with a passion for making a difference in the lives of customers and members. As a pharmacist, Ashworth has a keen understanding of the factors that influence health, including social determinants, adherence to treatment and a healthy lifestyle.

As President and CEO of Tivity Health since June 2020, Ashworth has brought financial stability and strategic focus to the business, prioritizing growth in the company’s core SilverSneakers offering and creating a digital-first strategy to drive further expansion. Previously, Ashworth facilitated the growth of Walgreens for nearly 30 years, transforming the company into a global leader in pharmacy and health and wellness. He most recently served as President, responsible for the leadership, development and management of all Walgreens operations.

Ashworth is an influential voice in public health policy and the future of healthcare and has shared his views at the White House and on Capitol Hill. He earned a Doctor of Pharmacy degree (PharmD) and a master’s degree in business administration (MBA).

Q. Tell us about Tivity Health and how you came into the role.

Richard: Tivity Health’s number one focus is on empowering people, communities, and partners and supporting them on their lives’ journeys. Our vision is healthier, happier, and more connected lives so we’re trying to help an aging population manage this in a couple of ways. One is through physical and virtual activities. So, we help people by giving them a gym membership and having them engage in physical, healthy behavior. We enable engagement and help people have social connectedness as well as mental enrichment. At Tivity Health, we also have a couple of other businesses like an integrated health service that has Chiropractic Care, Physical Therapy, Occupational Therapy, Acupuncture, Acute Therapeutic Massage etc. Our premier brand, Silver Sneakers, is the nation’s leading fitness program for older adults. Then, there’s also prime fitness, which is a discounted access to thousands of fitness locations. This is undertaken in partnership with commercial plans and employers. There’s also Whole Health Living, which is an integrative kind of health management business.

I started working as a stock boy at Walgreens when I was in high school, and really fell in love with pharmacy. So, I became a pharmacist. I just loved the way pharmacists worked within the community. You could walk up to any drug store and talk to a pharmacist any time, and they’d always be there to help you. So, it wasn’t just about the medicine; it was more about the community, the relationships, the life, and I was drawn to that aspect. I was at Walgreens for 30 years and by the time I left there as President, I’d held a lot of roles — commercial, operational, Strategic, International etc. Then, I came to Tivity and I’ve been here for 18 months.

I’ve spent my whole career on the treatment side of healthcare so, by the time I got to the people, they were taking medicine, were overweight, and struggling with health. I really do have a personal passion for fitness and nutrition and actually for the elderly, so I was keen to reach a spot that helped me do that well. There’s no better place in all of healthcare to do that than here at Tivity Health.

Q. What a fascinating story! So, Richard, what are the macro trends you see playing out in healthcare? How will they impact or influence your business?

Richard: I think there are two significant trends. One is more toward digital health solutions which have obviously been accelerated through the pandemic but were growing before. Then the pandemic hit, and digital health just took off at a stratospheric growth rate. The second is the growth in Medicare Advantage.

On the digital front, the seniors have adopted virtual solutions more readily than what everyone expected. That’s enabled us at Tivity Health to drive our SilverSneakers platform to deliver services differently than before. In fact, a recently published HHS study showed a 63-fold increase in the use of telehealth under Medicare during the pandemic. If you think about seniors using telehealth for their regular healthcare, while it’s hard for them to get around and go into offices, into facilities, then, that is a massive increase in the adoption.

When during the lockdown, many of our fitness locations closed, we quickly pivoted to offer virtual lives with instructor classes. Today, we’ve had more than three and a half million visits to those classes. So, the enthusiasm and the appetite are clear. We also have a pretty robust research engineer and so end up having lots of conversations with our members. These indicate that 85% will continue to use digital offerings in addition to visiting physical locations or fitness centers. Over 60% will use technology for video calls and live streaming with their friends and families. Over half will use it for medical appointments and fitness classes.

This tells me there’s a coalescing of adoption of digital health. Our members can choose from thousands of virtual activities, each week.

We’ve logged more than 3.4 million of that but many of those members are first-time users of SilverSneakers — almost half – that implies that the barrier to entry into maybe working out or engaging in a healthier lifestyle – technology, virtual or digital – whatever the term — is really helping people get into it for the first time.

On the Medicare side, 10,000 people age every day. It’s a fantastic entitlement program to take care of our older population. By 2030, the number of beneficiaries enrolled in the program is supposed to hit 80 million people. So just the sheer numbers require us to think very differently about this population and their expectations will also shift. The Baby Boomers coming in today versus those coming in 10 years from now will need very different technical capabilities and they’ll likely live longer. Those that get older later, will probably want to age in place with their own community, friends, family activities, while maintaining an active lifestyle. All this will influence the kinds of programs and services that get offered to seniors in the health and wellness space.

Q. The pandemic has accelerated the shift towards digital health. So, who are your consumers? You mentioned Medicare beneficiaries for your SilverSneakers program but who’s paying for the services — the health plans, the employers, the individual subscribers, all of them? Do explain.

Richard: The number one way we deliver SilverSneakers is through a partnership with the nation’s leading Medicare Advantage plans. So, the funder of the program makes this available to the beneficiaries. There’s no out-of-pocket cost for the members, themselves, since they sign up for their chosen Medicare Advantage plan. If Silver Sneakers is part of that then, they access this at no cost to them. Membership into our virtual experiences include social engagement, mental enrichment, and virtual fitness programs. In that context, members also avail of a robust gym network of up to 20-23,000 gyms across the United States. So, we share a goal with the health plan and that’s why it works so well. Not only us, but many times, the members themselves and the plan, really care about providing physical fitness options for older adults.

What we also care about is the community that’s built around that. So, the result of engaging with SilverSneakers is better health outcomes, lower healthcare costs. A study with Avalere Health showed savings in total annual average health expenses, including lowered medical and pharmacy costs. So, if you’re a SilverSneakers member, that’s a nod to $4463 in healthcare costs, versus an average of $5303 if you’re not. It is a significant reduction. It’s how a healthier lifestyle positively impacts your overall costs – for instance, somebody who works out is probably healthier than somebody who doesn’t; somebody who eats poorly probably isn’t as healthy as someone who eats well. What we do at SilverSneakers is help people engage in that healthier behavior. Sometimes it’s about food, other times about physical health or even mental and social aspects. What we see in our population on a like-for-like basis is 40% fewer hospital stays, 18% fewer visits to the emergency room and when they do go to the hospital, they stay 1.4 days less than those that are not SilverSneakers members. Being able to demonstrate this connection is important.

One of the other value propositions of SilverSneakers on the health side is that we’re really good and our brand is well-loved and understood, which enables the acquisition and retention of members within the plan. We get leveraged in the communications coming from the plans, which members like and so, they engage with that plan more often and stay longer.

On the service side, we help raise the overall customer service scores that health plans get just by having the SilverSneakers experience in close proximity. In fact, our NPS score is 83 and our customer satisfaction score is 96. We work alongside the health plans to promote healthier activity and drive this fantastic service experience.

Q. The pandemic obviously has changed the way a lot of services are delivered — Take telehealth as example. That wasn’t being used widely pre-pandemic but during the pandemic, online engagements shot up. Was that something you were already beginning to do or something that you built and rolled-out as a consequence of the pandemic? Now, telehealth engagements are reducing a little. Do you also see an analogous trend in your business?

Richard: I wish I could say that we were really planning for this, had a robust strategy before, and we knew that digital was the new frontier for senior fitness! It wouldn’t be true. We were really focused on getting people out and about and when the pandemic hit, we had to quickly pivot to the digital. We weren’t sure if that would work. There were so many misnomers all over — seniors can’t engage in technology as well as younger folk etc. It just turned out to be untrue. They are a lot more savvy than one gives them credit for. They’re on Facebook streaming live with families all the time so they are getting comfortable on the technology side.

Now, I come from retail. We’d been building “buy online, pickup in-store” for 10 years and had that capability at Walgreens for a long time, but nobody used it. Now, it’s become “let’s buy online, get delivered at home.” Taco Bell does it, too. And the pandemic has just cemented that into the fabric of how consumers operate. So, are we seeing that in our business? Yes. Do I see this as the future? I think it’s typical consumer behavior – there’ll be high demand and then a retraction and then, it’ll repeat quite like the rubber band. Peloton is seeing this, and others are seeing us.

For us, the future for SilverSneakers or for physical fitness is not 100% digital, and not physical or vice versa. It’ll be a hybrid world. I come from a consumer world, my mind is always consumer-oriented, so you just have to give consumers the choice and the experiences that they desire. Those desires will wax and wane so, today will not be important in three- or four-years’ time. As businesses, we must expand and retract alongside. The future then, is physical and digital.

I’ll share a quick example. In a letter from one of our members, she said she liked being at the YMCA though she also visited a 24-hour gym — that’s possible under our program so it’s a cool value proposition. Given how it rained one of those days, she as 73 years old didn’t want to drive but was keen on getting her workout. So, she attended our Zumba class with Sherilyn, one of our popular national trainers. We gave her an offering that she incorporated into the fabric of her life in a way that worked for her. And yet, we still had this other experience, if she wanted that. That’s a perfect instance of what we built here and why it’s applicable for her.

Q. The hybrid model is on everyone’s plans going forward. Peloton and Apple Fitness come to mind first but where does your company fit in that milieu of online fitness?

Richard: I love Apple Fitness and use it all the time at home. We’re all in the living room doing it together. So that’s a cool experience. I don’t view that as competitive but as additive.

If some of our members want to do that, that’s fantastic though it’s important that we adopt scientific ways in having the elderly work out. The reason I don’t really see Peloton as a competitor is for most of our members, I don’t want them up on a bike off the ground. There’s more of a risk for fall and if we have hip fractures then, that is detrimental to their health outcomes, in totality. So, we are very proprietary and clinical about how we do workouts.

We know what orthostatic hypotension is or how many times you should be getting on the floor and back up in a 10-15 minute period. We understand flexibility and mobility changes over time and the rigidity of tendons or how to exercise them. The audiences for those other companies are very different than what we’re talking about. What we try and do is deliver a best-in-class experience that has measurable value for the health plan. Fitness is so competitive when you go to YouTube and watch anything you want. But it may not be safe for some or for their condition or for where they’re at.

The other thing for us is we are live now and we have a full on-demand library to send everybody else. Some people like that and with our live sessions we highlight the community aspect and value that social connection. In Julia Hunt’s aging study, she found that if you wanted to live long, you needed to see the factors determining this – they could be your DNA, where you lived or even how many friends you had. When all the data and samples were considered, the number one conclusion was — people that had many friends lived longer. So, there is an inherent social community — evidence for us — that we must participate in.

On the competition front, our number one competitor are our members. You may like Apple Fitness, but there are days you’re in bed and you know you need to go workout but the biggest enemy preventing that is you. It’s not the access to the computer or to Apple. That’s who I see as the real competitor. We have 8-9-10% of our people work out regularly and I’d want that to be 80% but how do I get the remaining 70% to come? It’s not about giving them more gyms or a better virtual-online experience. It’s the intrinsic motivation. We do have traditional competitors, though and it’s worrying what everybody can do with our members because I’d like to ensure we’re here for them. That’s the way I see it.

Q. In the world of technology, the biggest competitor is usually a “do nothing.” Healthcare is driven by reimbursements or a fee-for-service model. The health insurance companies try to ensure an accountable-for-care model. Those in wellness and preventive care, your space, are into keeping people out of hospitals. Do you see a tug of war between these two instincts? How does the twain meet?

Richard: Great question. In the time I’ve spent in other countries with different healthcare models, I find they all have their intrinsic flaws. What you brought up is very basic and one-way, but cuts through all the other commentary about healthcare. It really gets down to a symptom-based healthcare system where providers make money on activity. If it’s that versus making money on hold, the whole outcome will always be the tension you just described.

The optimist in me is really encouraged by all the new value-based primary care provider organization like — Oak Street, etc. The leadership in those organizations is fantastic and trying to create the right kind of healthcare system for members — a 360 view. That will enable us to move forward in taking care of patients. Being a pharmacist, I saw there were many times I went back to your “do nothing” comment which has a lot of value and I agree with.

But we are making a choice for instance, on which five meds we can buy this week since we can’t afford all five. One’s for water intake so that can’t be dropped, the next is for pressure, else that’ll spike, the third is for diabetes and if sugar isn’t controlled, that’ll put you in the hospital and affect your feet, your eyes. All the drugs are important and having to choose is awful. If we’re just focused on that front then, we’ll have less people with diabetes and high blood pressure, people will make better food choices and start moving more. The entire healthcare system should be incentivized to drive that, not just the periphery organizations. It’s easy for me to say since that’s how I get paid but that tension will always be true.

The other thing that encourages me is that health systems also get this. Premier health systems are pivoting from big buildings with high towers and blinking lights and moving into more community settings and value-based arrangements or total cap risk. These types of things as CMS continues to incentivize that will make it possible for us to get there over time. But, will it be a 15 or 20 year vision versus a 5? I don’t know but it’s a real tension point.

Q. You’ve had a distinguished career in Walgreens and now you’re in a related business but what prepared you for your current role?

Richard: It’s my first time being a CEO, so till recently, I’ve felt that sometimes you just go by the seat of your pants. Walgreens is a really refined institution with smart people and world-class processes so my 28 years there gave me some unique capabilities to excel in my current role.

When I was working in stores as stock boy, cashier, photo clerk, pharmacy technician, assistant manager, pharmacist and then a store manager, I got the chance to help people, deliver a service to them and see the pain they underwent. What hit me hard was an episode in Minnesota where I was a district manager. I’d been waiting to shut the store, but the Front Cashier still had a few people in line. One of the ladies wasn’t buying anything but had been there for a couple of minutes and was explaining to the Cashier about her cat. I listened in and when I checked with the Cashier, I realised that the lady was here every day. She was lonely so the impact of that front cashier on this lady’s life was profound. Because of that I understood the humanity of living next to other humans who have different things.

On one of the panels, I was on, I heard someone say “we’re all in this together” — in this pandemic — but we all have different boats, yachts, families, wealth, a good home and there are those who are just trying to survive. I learned that being in retail, on the ground with patients pays me huge dividends today, because every time I make an executive decision, I put myself in that member’s shoes and check if this decision makes it better for that person. If the answer’s no, then, we’re not spending money on that. It’s hard to stay principled that way because you have shareholders and other competing priorities. But if you do that, it works out well for everybody.

Q. I can relate to that anecdote. I’ve realized through the pandemic; how every little thing makes a profound impact on somebody’s life when you don’t even know about it. There’s a great deal of resignation but also great opportunity, especially in healthcare. What is your advice to the younger generation that is coming into the workplace today and is looking at healthcare as a career?

Richard: I have three very simple things to say. One, pick a job where it makes a difference. Work in something that you have a passion for. Healthcare is mission-driven, our colleagues are so proud to work here and I’m impressed every day by the passion and commitment they have in the roles they play and in the difference they make. If you are passionate about helping people, addressing inequity, and improving the health of those around you, this is a great profession for you.

Second, the opportunities are limitless. We have a shortage of clinical people to deliver care in the future for this population. That means, there’s money and jobs available. I moderated a discussion about healthcare, workforce, and the need for clinical workers at all levels, recently, especially as we get out into rural America. But there are also these very innovative opportunities in digital health, data, health related services, mental health, senior living, home-based care etc. There’s a lot of M&A, money, finance, and banking. So, it makes a difference.

Third, learn about the aging space. This is a high need-high spend space. And all of us had a mom and dad and grandparents at some point. So, there’s so much innovation, need and jobs in the aging space. Nothing feels better than serving this population.

I got lucky because I discovered pharmacy. I got a job at a drugstore because I needed a pull-out CD player that my dad wouldn’t buy for me. When I fell upon pharmacy, it felt like I was giving back. Many young kids don’t always have the right opportunities because all that depends on your ecosystem — where you live and what you know of the world, which isn’t much when you’re young, even though a lot of time I thought, I knew everything. I learned over time that there’s so much you don’t know. So, I think it’s about the mission and the opportunity. The age-related space is cool for youngsters to get into.

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 

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

Posted on November 28, 2021December 5, 2022 by sanjith p

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.”

Hosted by Paddy Padmanabhan

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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

01:15		About Tidal Health, your role, and responsibilities

03:49		What are your top priorities right now?

05:44		Access 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 health patient 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 health patient 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 health patient 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

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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

Posted on November 18, 2021December 30, 2023 by sanjith p

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"

Hosted by Paddy Padmanabhan

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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.

Our Podcast Partners:

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?

03:17		How 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?

06:26		Are 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

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

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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

Posted on November 14, 2021December 30, 2023 by sanjith p

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."

Hosted by Paddy Padmanabhan

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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

00:35		What are the top two or three things that occupy your mind these days?

01:24		Your colleague Aaron Martin was also my guest a while back. How does your role complement his, specifically regarding digital transformation at Providence?

04:22		Can 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 technology 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 technology 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 technology 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 technology 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 technology 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

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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

Posted on November 8, 2021December 5, 2022 by sanjith p

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"

Hosted by Paddy Padmanabhan

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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.

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Show Notes

00:37		About Experian Health.

02:06		How is Experian data used in the context of healthcare and how do you ensure privacy when using consumer data?

08:43		Can 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

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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

Posted on October 14, 2021December 5, 2022 by sanjith p

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"

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.

Our Podcast Partners:

Show Notes

01:29		About StartUp Health.

03:44		Can you talk to us about your new notion of moonshots?

06:54		Can 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 healthcare 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 Healthcare 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 Healthcare innovation? 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 Healthcare 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 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

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.

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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.

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

Posted on October 11, 2021December 5, 2022 by sanjith p

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”

Hosted by Paddy Padmanabhan

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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

01:06		About your background and how you got to digital healthcare.

04:41		What 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.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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

Posted on October 1, 2021December 30, 2023 by sanjith p

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.”

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.

Our Podcast Partners:

Show Notes

01:10		Brief overview of Babylon Health.

02:26		Can 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 virtual 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 under virtual care, 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 care 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.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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Patient home is the new healthcare hub today

Posted on September 24, 2021December 5, 2022 by sanjith p

Season 3: Episode #97

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

"Patient home is the new healthcare hub today"

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

00:40		Brief overview of Novant Health and your role in the organization.

08:18		Many 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.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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A lot of digital adoption is driven by demographics

Posted on September 13, 2021December 5, 2022 by sanjith p

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"

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

01:18		About Baptist Health and the current state of your digital health transformation initiatives.

04:55		What 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 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.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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

Posted on September 6, 2021December 30, 2023 by sanjith p

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"

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

00:35		Could you tell us about who Wellframe is and how you got to funding the company?

03:27		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?

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

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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.

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

Posted on August 30, 2021December 30, 2023 by sanjith p

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."

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

00:56		Could you give us a little bit of the State of the Union on telehealth in the United States today?

04:08		Have 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?

24:25		What is your advice for the Chief Digital Officers?

26:42		Big 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?

28:20		What’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

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.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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

Posted on July 26, 2021December 30, 2023 by sanjith p

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"

Hosted by Paddy Padmanabhan

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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.

Our Podcast Partners:

Show Notes

00:43		McKinsey just published a report titled Telehealth: a quarter-trillion-dollar post-covid reality? What are the key findings of the study?

04:48		The 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?

28:18		What 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

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.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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

Posted on July 9, 2021December 30, 2023 by sanjith p

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"

Hosted by Paddy Padmanabhan

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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.

Our Podcast Partners:

Show Notes

01:17		About Duke Health and the patient populations.

02:34		Tell 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?

18:12		How do you approach technology choices for your transformation especially when it comes to the risks?

23:29		What is your advice for tech firms, especially startups and innovators who want to be a part of your digital journey?

25:49		Can 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

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.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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

Posted on June 28, 2021December 30, 2023 by sanjith p

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."

Hosted by Paddy Padmanabhan

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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

00:48		What does the post-COVID normal look like at Penn Medicine? What you are working on to prepare for the next phase?

02:52		What 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?

22:28		What 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?

24:21		Tell 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?

41:10		Can 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

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.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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

Posted on June 11, 2021December 30, 2023 by sanjith p

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"

Hosted by Paddy Padmanabhan

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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.

Our Podcast Partners:

Show Notes

01:23		Can you tell us about the Medical University of South Carolina and the populations you serve?

02:37		Did 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?

20:03		What 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?

23:46		Can 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.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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

Posted on June 7, 2021December 30, 2023 by sanjith p

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."

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.

Our Podcast Partners:

Show Notes

01:12		About Augmedix and the journey about launching the company.

06:08		What 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?

26:17		What 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

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.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

Connect

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

Posted on June 1, 2021December 30, 2023 by sanjith p

Season 3: Episode #88

Podcast with Murray Brozinsky, CEO, Conversa Health

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

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.

Our Podcast Partners:

Show Notes

01:07		About Conversa Health and your involvement with the company.

03:35		What 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?

20:55		Where does the voice fit in all of this? Do you compete with voice-based solution providers like Nuance for instance?

22:49		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?

25:28		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'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.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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Everyone believes that digital provisioning of care is here to stay.

Posted on May 21, 2021December 30, 2023 by sanjith p

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."

Hosted by Paddy Padmanabhan

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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.

Our Podcast Partners:

Show Notes

00:41		About Omada Health and how the company started.

02:39		What 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?

27:41		What 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?

30:24		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?

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

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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With innovation, you need to be prepared to recognize that every idea is not a great idea.

Posted on May 17, 2021December 30, 2023 by sanjith p

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."

Hosted by Paddy Padmanabhan

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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

05:50		About Penn Medicine’s new hospital facility – The Pavilion.

10:16		Brief 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?

21:29		Interoperability 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?

24:25		Most 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?

26:36		What advice do you have for startups that have something interesting to say and want an audience?

28:04		A 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 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.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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We must utilize AI to change the way healthcare is delivered and how patients can be more engaged in their care

Posted on May 10, 2021December 30, 2023 by sanjith p

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"

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

04:20		Where do you see AI in healthcare today, and what are the big opportunity areas?

07:48		Your 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 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.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

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

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

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Medical records must become a living record that pulls in data real-time, follows your health, and displays it back to a physician in a useful form

Posted on May 3, 2021December 30, 2023 by sanjith p

Season 3: Episode #84

Podcast with Grace Kitzmiller, AWS and
Dr. Michael Snyder, Stanford University’s School of Medicine

"Medical records must become a living record that pulls in data real-time, follows your health, and displays it back to a physician in a useful form."

Hosted by Paddy Padmanabhan

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In this episode, Grace Kitzmiller of AWS and Dr. Michael Snyder of Stanford University’s School of Medicine discuss AWS’ Diagnostic Development Initiative (DDI), a two-year, $20 million commitment that uses cloud computing to scale up diagnostic innovations.

In the wake of the pandemic, Stanford University School of Medicine’s Healthcare Innovation Lab developed a smartwatch-enabled alarm system powered by AWS cloud, designed for early detection of COVID-19 by identifying increased heart rates prior to the infection. Dr. Snyder explains how the application works by pulling heart rate information from the smartwatch, applying an early detection algorithm, and pushes back the signal to a smartphone to set off alerts for possible infections.

Grace shares three gaps that AWS strives to address through the Diagnostic Development Initiative: accurate detection, reprioritization of diagnostic research, and scaling up computing power for machine learning and analytics. Take a listen.

Note: Those interested in participating in the Stanford COVID-19 wearables study can sign up here.

Developers interested in the AWS Diagnostic Development Initiative program can apply here.

Our Podcast Partners:

Show Notes

02:42		What are the gaps AWS is looking to address with the Diagnostic Development Initiative?

04:49		About Stanford’s smartwatch-based diagnostic app for COVID-19 detection alerts.

08:16		What has been the predictive power of these smartwatch-based diagnostic algorithms and how they hold up across populations or regions?

12:27		How do the wearable device integrate with Epic or Cerner and make it a part of the longitudinal patient record for diagnostic and treatment on an ongoing basis?

14:58		What about patient privacy? Even in the research phases you're putting some guardrails on what happens to the data. How is Stanford protecting patient’s data?

17:33		What has been the response so far for AWS’ Diagnostic Development Initiative? What kind of research projects are we likely to see, with a focus on healthcare?

Q. Dr. Snyder, can you tell us about your role at Stanford?

Dr. Snyder: I am Professor and Chair of Genetics at Stanford University’s School of Medicine. I also run the Center for Genomics and Personalized Medicine, the innovation lab there, and we do a lot with big data in health.

Q. Grace, can you brief us on your role?

Grace: Paddy, I lead Solutions Development for the AWS Disaster Response Program, which focuses on how technology and the cloud can assist organizations that are active across crisis such as the COVID-19 pandemic or across the lifecycle of natural disasters.

Q. Amazon has recently been in the news for several healthcare-related initiatives, and one of them was the Diagnostic Development Initiative. It was targeting COVID-19. Grace, what was the gap or need that AWS was looking to address with this initiative?

Grace: AWS Diagnostic Development Initiative is a 20-million-dollar commitment that we made last year to support customers and accelerate their diagnostic innovations. We provided this support in the form of both cloud computing credits and technical support from AWS experts like our solution architects and our AWS professional services team. These AWS experts helped those organizations that were part of the Diagnostic Development Initiative to use AWS services to either stand up or scale their COVID-19 diagnostics projects. As COVID began rapidly spreading around the world, there were a few reasons diagnostics really bubbled up to the top. First, accurate detection is the tip of the spear for any effective pandemic response strategy. Secondly, diagnostics research has historically been underfunded and largely de-prioritized when compared to vaccine or treatment development. But realistically and thirdly, organizations working on diagnostics also need access to reliable and scalable compute power, which AWS could deliver along with things like analytics and machine learning to help researchers process and analyze some of those large datasets that were being generated and iterate more quickly. So, in the first year of the program, we have been excited and seen some inspirational results from customers like the wearables work that Dr. Synder’s research team is doing at Stanford. It’s really been great to see how these projects are pushing the boundaries of diagnostic innovation.

Q. Dr. Snyder, Stanford has been one of the early participants in the program. And you have launched a smartwatch-based diagnostic app for the COVID alerts. Can you tell us about the app and some of the results that you have seen so far?

Dr. Snyder: Several years before we found that you could tell when people are getting ill from Lyme disease, as well as respiratory viral infections using a smartwatch. When the pandemic came along a little over a year ago, with Amazon’s help we have really been able to scale this thing up. So, we first showed that we could detect COVID with a smartwatch. It turns out, on average, four days before symptoms and for some people, as much as 10 days before symptoms, we can see when they are getting ill because their heart rate jumps up on a smartwatch. So, we first showed you could do that and recently, we have rolled out this app that alerts people when their heart rate jumps up, which does happen before you get ill with COVID or other things. It can happen with other lifestyle events as well, for example, you drink way too much. But it certainly seems to work for infectious disease about 73% of the time, according to our latest work. It is a simple app that you download on your smartphone that integrates with the smartwatch. It works for Fitbit; Apple Watch and we are trying to work it for other watches as well. Basically, they are following your heart rate, will transfer the information over to the phone. We use the cloud to pull any information, and then we compute using our algorithm. When we see a jump up in heart rate or other abnormalities, it will send off a signal which pushes back to your smartphone and it’ll set these alerts. Right now, we have just launched the second phase of the study where we are sending the alerts. As I said, it sometimes picks infections, and it does pick up COVID infections as well as asymptomatic cases. We think this is going to be very powerful. It absolutely requires the cloud for this to work because you need to be able to access people all around the world. The study is global, and you can compute everywhere. You keep the costs down actually by running some of the computing areas that are less busy and then distribute the load, so to speak, in the more cost-effective fashion. That’s probably the only way you could do a project like this that uses the cloud and it’s totally scalable. 50 million people in the U.S. wear a smartwatch and right now they could all have an alerting function for COVID-19 if they tuned in to this program.

Q. This is a global program. So, I imagine that your application has been downloaded globally by people onto the smartwatches – Apple or Fitbit. You mentioned that the elevated heart rate could be a result of various potential activities and not necessarily just COVID. I imagine that the algorithm in some way adjusts for different likely causes and then combines it with other kinds of wearables and so on. What has been the predictive power of these algorithms and how do they hold up across populations or across regions?

Dr. Snyder: We’re going to need more data to answer the last question because the numbers are so small. That’s why we want to have more people join the study. We’ve had several thousand people signed up. We’ve had something like 70 positive cases so far. So, we’ve picked up seventy-three percent of them from different parts of the country, and we’re still improving the algorithms. We want to get that Seventy-three percent up to ninety-five percent or better. We can do that as we pull in more different data types focused on resting heart rate steps and sleep. We pull in different kinds of data; we can improve the algorithms, so we are trying to get as many people signed up as possible. We can detect COVID from different ethnic groups. I’m optimistic it should work for everyone because when people get sick, their heart rate jumps up.

Q. If you do get a million people signed up, what’s the end goal here?

Dr. Snyder: My end goal is to put a smartwatch on everyone on the planet, seven billion people, so they have a health monitor for every single person. That cannot happen today, but that is the long run. The only way to do it is to be following your health in real time, not doing PCR two days later when they get symptoms. You want to be following people while they are healthy in real time, seeing when you see and detect an abnormality and catch and push it back to them as quickly as possible so they can act on it. In the case of a pandemic, if they get one of these alerts, we want it to be as sensitive as possible and as specific as possible, we want them to ultimately self-isolate or get checked right away, before they spread it around to one hundred other people.

Q. Grace, one of the outcomes of these programs is that you are going to get a lot of data about patients, about consumers and so on. Do you have any plans to harness insights from this data in any way, let’s say, for public health in this case?

Grace: No, that is not the programs intent. AWS is vigilant about our customer’s privacy and data security. Our technology and program policies are really designed with that security and privacy in mind. So, for customers like Dr. Snyder at Stanford and others retain ownership and control of any data and content that they store on AWS, along with the ability to encrypt it, protect it, move it or delete it in alignment with their security policies.

Q. Dr. Snyder, how do the wearable device integrate with Epic or Cerner and make it a part of the longitudinal patient record for diagnostic and treatment on an ongoing basis?

Dr. Snyder: Right now, we’re in the research phase and testing these algorithms, seeing how well it works, and optimizing them. You would have to have a follow up test for that to go into in the record. That’s where we stand now, but in the future, these things will get better validated and they’ll have to get FDA approved, which is not hard to do for simple devices like thermometers. And that will be the case for smartwatches. I think they will be able to get validated and you’ll be able to pull information from them and aspects of that will be in the medical record. Now, my own view is the whole medical record needs to change. Right now, it is not useful to most doctors. It’s hard for them to access information from the record. I’d like to see the record become a living record, meaning it pulls in your data in real time, follows your health, and then can displays it back to a physician in a very useful form in which they can see how is your cardiovascular health, how is your metabolic health, how is your other forms of health? So, I think we should transform the whole medical records system to make it in a useful fashion. An example of this is when they measure your heart rate in a doctor’s office, it’s all over the map and it depends on whether you drove by bike there, what stress is going on, all sorts of things. But you can pull a pretty accurate heart rate right first thing in the morning from someone and get a much better picture of their health. Imagine incorporating that kind of information into a health record for a physician to be able to see what is called a longitudinal record so they can really follow what is going on.

Q. Dr. Snyder, what about patient privacy? In the research phases I guess you are putting some guardrails on what happens to the data, how are you protecting patient data and so on. Can you talk about that?

Dr. Snyder: That is a big concern. So as Grace said, we encrypt everything as it comes. It gets encrypted as we compute it, and we compute encrypted data. As these alerts go out, they get pushed back so that everything is stored. One thing that is important is we do try and pull the data and share it in an anonymized fashion and Amazon has been fantastic for helping. People use the term data lake, but I want to make it a data ocean where we have all these data for people to be able to access again in an anonymous fashion so that we can improve our algorithms and be able to detect disease much better. I think this kind of platform is going to be powerful well beyond the pandemic, meaning you can pull other kinds of information from your smartwatch. You can pull other kinds of health measurements from a smartwatch like dehydration. So, by having data that is accessible, researchers can improve this health monitoring system, I think we can really transform the way people’s health is followed. So, I like to think healthcare instead of sick care, so we can then follow people and better manage their health.

Q. AWS is offering millions in credits to developers worldwide as a part of this program. What has been the response so far? What kind of research projects are we likely to see with a focus on healthcare?

Grace: In the first year of the Diagnostic Development Initiative, we supported around eighty-seven organizations in 70 countries. The organizations included customers that are startups, non-profits, research organizations and businesses. We provided cloud computing credits and technical support to really work backwards from the needs of these researchers to understand how technology could help accelerate or scale their work. In addition to the work that Dr. Snyder’s team has been doing around wearables at Stanford, we’ve also seen organizations focusing on looking at uncovering clues about how COVID-19 presents in individuals and what are some of the impacts or what are some of the outcomes that they’re seeing based on characteristics of their immune response networks been done by the Institute for Systems Biology. Our biology team uses machine learning to try to quantify the silent spread of COVID-19 for those with symptoms. Organizations look at using smartphone cameras to provide accurate and reliable diagnostics within 30 minutes of doing a test. One of the things we are doing this year is broadening the scope of the Diagnostic Development Initiative to cover not just diagnostics but also three new areas. First, early disease detection to help identify outbreaks and trends at both the individual and the community level. Also, prognosis to better understand disease trajectory. And then last for public health genomics to bolster genome sequencing worldwide, which is becoming more important as different variants of COVID-19 emerge.

About our guests

Grace Kitzmiller is a Principal and Senior Product Manager for AWS Disaster Response Program, Grace leads strategy and execution for product development by working backwards from the needs of organizations active across the disaster and crisis lifecycle to learn about the biggest technology challenges they encounter, while preparing for, responding to, or recovering from disasters and crises.

Grace works across AWS people, services, information, and technology, and AWS Partners to build or extend solutions and proofs of concept that can solve those challenges. Grace has been with AWS for over five years and was previously Senior Product Lead for AWS Educate, Amazon’s global initiative to accelerate cloud learning to better prepare students for the cloud workforce. Prior to joining AWS, Grace held leadership positions at a graph database start-up and at a consulting firm focused on using technology to develop solutions for state and federal environmental protection agencies.

Dr. Michael Snyder, Stanford W. Ascherman Professor and Chair, Department of Genetics and Director of the Center for Genomics and Personalized Medicine in the Stanford School of Medicine, is a world-leading expert in genomics, personalized molecular profiling, and precision medicine. Dr. Snyder's Lab has been a pioneering force in the field of precision medicine, including establishing many foundational methods in the field of genomics. He was recruited by Stanford in 2009 to chair the Genetics Department and direct the Center for Genomics and Personalized Medicine. Under his leadership, U.S. News & World Report has ranked Stanford University first or tied for first in Genetics, Genomics, and Bioinformatics every year for the last decade. Dr. Snyder was the first to apply personalized health tracking using multiomics in coordination with wearable devices to predict and prevent disease.

Dr. Snyder also established the first longitudinal integrated multiomic (genomics, proteomics, metabolomics, lipidomics, transcriptomics, microbiomics, and wearables) profiling of humans for personalized health and medicine. This project has produced the most deeply profiled cohort in human history. Most recently, Dr. Snyder has launched Stanford’s Personal Health Dashboard, a novel research app using wearables, currently in exploration for the very early, real-time detection of COVID-19. Additionally, Dr. Snyder has co-founded 13 biotechnology companies including Personalis, Qbio, January AI, Mirvie, & SensOmics.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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We are seeing virtual care and telehealth as an important tool in the toolbox for ambulatory care practices

Posted on April 26, 2021December 5, 2022 by sanjith p

Season 3: Episode #83

Podcast with David Cohen, Chief Product and Technology Officer, Greenway Health

"We are seeing virtual care and telehealth as an important tool in the toolbox for ambulatory care practices"

Hosted by Paddy Padmanabhan

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In this episode, David Cohen, Chief Product and Technology Officer of Greenway Health, highlights the need for RCM service providers to scale up to meet the revenue cycle needs of the larger healthcare practices. Greenway Health is an electronic health records (EHR), practice management, and revenue cycle management solutions company serving more than 50,000 ambulatory practices.

The RCM services is witnessing M&A and consolidation to find the efficiencies of scale. David points out that sophisticated RCM software must develop automation capabilities, robust analytics, and machine learning models to help reduce the overall cost of these practices to collect and improve financial outcomes for practices.

David advises medical practices to stay on top of regulatory changes and be aware of the changing payment roles and cycles. Take a listen.

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Show Notes

02:50		The current state of the RCM services provider sector and drivers of M&A and consolidation in the sector.

04:48		The impact of pandemic on Greenway Health’s clients.

06:42		What has the shift to virtual care meant for Greenway Health’s clients in terms of reimbursements and cash flow, specifically telehealth visits?

12:32		There is a highly fragmented market of digital health and telehealth technology providers. What does it mean for practices that are running stand-alone platforms and how should they address it?

15:47		What kind of performance indicators should practices examine in the current context?

17:51		What role do the front-office, clinical, and back-office staff have in RCM, and how can these groups work together efficiently to enable patient care and improve the quality of care? What are the best practices for providers to improve their practice’s RCM?

Q. David, can you tell us a little bit about Greenway Health and your role?

David: I am the chief product and technology officer at Greenway Health, and Greenway is a leading provider of health care technology, solutions, and services. Our clients represent about 50 thousand ambulatory health care providers across multiple specialties, and that equates to about several million patient lives cared for using Greenway solutions. I’ve worked in this intersection of health care and technology for over 15 years, and it’s been a very exciting and dynamic space to be focused on, particularly seeing the level of impact that we’re able to have in helping practices better care for and manage patients and also improving the health of the communities that they serve.

Q. What is the current state of the RCM service provider sector and what is driving M&A and consolidation in the sector?

David: Greenway provides EHR, practice management technology solutions to our clients, and we are a leader in the RCM services space. I agree that there is a lot of M&A activity happening in the market and the major driver for that is really efficiency of scale. So, being part of a larger organization has several advantages. One is sophisticated RCM service providers, like Greenway, develop automation capabilities, robust analytics and machine learning models that can help to reduce the overall cost of practices to collect and improve financial outcomes for practices. And these are capabilities that smaller companies would struggle to develop on their own. It’s also the reason why we’re seeing more and more ambulatory practices turning to revenue cycle services providers to help them with their RCM operations. We also see larger RCM service providers getting better financial outcomes and results for clients, and that can result in better contract negotiations. And the third thing is around scalability.

Q. How has the pandemic impacted your clients, the ambulatory practices?

David: It has been an interesting up and down year and a half for our clients. So COVID, at the early onset had a significant impact on ambulatory practices throughout 2020. We saw spikes in COVID cases and hospitalizations putting immense pressure on healthcare staff and resources, which resulted in steep declines in non-COVID volume and sharply reduced revenues. So, at a macro level, reports show that visits to ambulatory care practices declined by almost 60% last year, with primary care practices experiencing significant revenue losses across the board. In 2021, we are starting to see things stabilized quite a bit, but practices still need to consider adding new revenue cycle resources and added support to improve their financial stability.

Q. There had been a shift to virtual care across the sector, both in the ambulatory and inpatient space and remote patient monitoring, telehealth, telemedicine. All of that has sort of accelerated by an order of magnitude from everything that we see now for your clients, specifically in the ambulatory space. What has this shift meant for your clients in terms of reimbursements and cash flow, specifically telehealth visits?

David: Before COVID, virtual care and telehealth was the most talked-about least adopted technology in the industry. Obviously, there were reimbursement rules that were driving that quite a bit. But COVID was just a tremendous catalyst in the industry that saw significant adoption uptake in telehealth. What we are seeing now is that having virtual care as an additional tool in the toolbox for patient care, it really has a double benefit of keeping patients healthier, as well as helping practices to stabilize financially by giving them an additional source of revenue. The 2021 CMS fee schedule that extended reimbursement guidelines for telehealth visit, it made many of those changes permanent, is exciting for the industry.

A lot of our practices are having glad to see that happen. We believe that telehealth is here to stay. Where it stabilizes is kind of the question now, but it is absolutely important. We are advising practices to start to define and understand how virtual care fits into the services portfolio that they offer, including which visit types will be eligible to schedule virtual care visits as part of that practice strategy. Virtual care is a great way for practices to reach out to underserved areas of their population and they should be thinking about how they can extend the reach of their practice into the communities. Beyond telehealth, we also are seeing increases in opportunities to support remote patient monitoring as part of that overarching virtual care strategy. And it is important for practices in terms of managing patient chronic conditions, particularly when patients are not physically making it into the clinic as frequently with telehealth becoming so accessible and available. So, we are seeing those great improvements to patient outcomes and seeing virtual care telehealth as an important tool in the toolbox for ambulatory care practices, but then also using virtual care telehealth as an important catalyst and additional revenue opportunity for practices.

Q. From your comments, it’s very clear that the providers have to invest in the technology in order to handle virtual visits or provide remote patient monitoring, chronic care management. So, there is a technology enablement aspect to it and a cost related to that as well. How are they dealing with it right now? And does that mean that you are also changing your business model to become something different, something more to your clients than you were earlier?

David: At Greenway, our clients absolutely look for us to stay ahead of the curve in the market. And that is something we really view our role as trusted advisers to our clients and understanding where the industry is going, as well as obviously keeping abreast of the regulatory changes and dynamic regulatory landscape. Last year we saw things start to emerge, Greenway responded by bringing to market a proprietary or home-grown telehealth product. We also extended some of our existing services to offer our clients virtual care and remote patient monitoring capabilities, so certainly I think this industry shift towards virtual care has put Greenway in a position to pivot on behalf of our client, to be able to offer them the services and technologies that our clients need for them to be successful.

Q. We find that there is a highly fragmented market of digital health and telehealth technology providers, and many of these solutions are not well integrated. What does it mean for your clients, the ambulatory practices, that are running stand-alone platforms and how should they address it?

David: At Greenway, one of the things that we will always do is give our clients choice. And our marketplace has several telehealth partners that our clients can leverage. And certainly, we are seeing in the industry a lot of new virtual care players emerging. Greenway went down the path of developing our own telehealth product, because what we saw was that a lot of products on the market were missing the mark with our clients in terms of what they are looking for and the level of integration with their core EHR practice management systems. That lack of integration created a lot of inefficiency in practice workflow. So, we focused on, as we were building a product, things that are important for practices to consider. Number one obviously is being HIPAA compliant and security conscious first and foremost. As many practices were taking a shotgun approach to telehealth adoption, we saw practices out of the gate adopting nonstandard telehealth products. And I would really encourage practices to consider the security aspects of the products that they are leveraging. Number two is the level of integration that practices are expecting from a core product with their existing EHR practice management solutions. And that can come into play in terms of how a telehealth and virtual care product integrates with their scheduling systems, their registration systems, as well as their billing systems, all things that are important in terms of having a seamless practice experience. For example, with our product we have the ability to see virtual waiting room directly within the practice management system. So, it’s one stop shopping for practices and provider. Another integration capability is a real patient flow tracking within the EHR practice management solution. So being able to see when a patient is virtually checked into that waiting room and ready to be seen by a clinician is important. And then when that virtual visit ends up being able to automatically check patients out of the encounter as well, so we know that encounter is closed. There are several areas and points of integration that I think is important for practices to consider as they are adopting different telehealth technologies.

Q. From an ambulatory practice standpoint, what are the new performance indicators that practices examine in the current context? Can you also maybe talk about how you might be enabling them with analytics capabilities in better managing their cash flows and the revenue cycle operations?

David: So, like everything in business if you can’t measure it, you can’t improve it. And that is one of the top mistakes that I think practices make, is trying to run their business blind. So measuring and baselining medical practice financial performance is absolutely the best first step that practices should take in managing their financial health. It also helps to be able to benchmark performance against known best practices. That is something a revenue cycle partner can help with. So, some of the more important revenue cycle, key performance indicators that we focus on with our clients in our Greenway Revenue Services business are things like clean claims rate, days in A/R, percentage of claims over 90 days, collections per visit. We have a series of financial metrics that we track with our clients. It is also important for practice to establish tangible goals for improvement, and that includes setting monthly annual targets. Oftentimes, just by measuring and observing trends of these key metrics, practices can quickly see what’s working and what’s not. So, for example, when we trim days in A/R by aging bucket, it can help to tell a practice how long they’re waiting to collect on balances, and we’ll tell them that their collection strategies are working or not. So, we work directly with our clients to measure those different key performance indicators, baseline them against best practices, establish tangible targets, and then work on improvement plans and strategies against them.

Q. What role do the front-office, clinical, and back-office staff have in RCM, and how can these groups work together efficiently to enable patient care and improve the quality of care? What are the best practices for providers to improve their practice’s RCM?

David: Revenue cycle management absolutely requires shared responsibility among the office staff and team members. They must work together to ensure patient information is complete and accurate from the initial scheduling of an appointment and all the way through clinical documentation. It’s important in any practice that everyone understands the overarching financial objectives of the practice and how their unique function contributes to achieving those goals. So, each function must understand what part they play and how crucial their function is to the overall success of the practice. Once they know that, in identifying the obstacles or blockers to inefficiency becomes much clearer. Having well-defined documentation of these policies and procedures are extremely important for each functional area, as it is defining how the handoffs are going to work across those teams. So, for the front office, for example, over half of claimed denials can be attributed to front-end issues, but most of these denials can be avoided. It is extremely important that the front desk staff is reviewing captured patient information, for example, for accuracy during the patient take process. And that they’re verifying health insurance coverage in any authorizations that may be required prior to service. For clinicians, it’s extremely important that visit documentation is adequately meeting payer documentation requirements. Having clearly defined EHR documentation workflows can help to streamline that process and ensure clinicians are efficient with their time and maximizing the time spent with their patients. In the back-office, staff remains the central point for billing and collections, as well as interfacing with payers to ensure claims are accepted and paid. So, staff should focus on validating accuracy of build procedure and diagnosis codes and ensuring that those codes are correct and valid for data service. Staff should also ensure the effectiveness of their implemented claims scrubber and ensuring high quality play metrics. All the different parts of the practice play an important role in revenue cycle operations and collections and ensuring everyone understands what their role is and what those handoffs need to look like is extremely important for practices.

My top piece of advice for practices to really stay on top of the regulatory changes, stay on top of the changes to payment roles and payment cycles. If there’s one constant in healthcare, it’s changes in practices need to continually stay on top of those changes in the industry, whether that’s things like billing codes or documentation requirement changes, such as the recent easement of documentation that’s necessary for E/M billing coding. That is one of the reasons that Greenway recently launched a new service offering that we’re calling JIRA select, which is a highly customizable revenue cycle offering that’s designed to meet the unique, individualized needs of healthcare practices. And that is something I would encourage practices that are looking for a revenue cycle management partners to really look for that can complement the things they’re already doing and doing well and really identify where they need help and make sure that they’re selecting a partner that can offer them help in the right areas.

About our guest

David is passionate about technology solutions that allow practices to thrive. As Greenway’s Chief Product and Technology Officer, he brings more than 20 years of enterprise information technology leadership experience to the role, with the most recent 15 years focused on healthcare

Prior to joining Greenway, David was responsible for artificial intelligence and machine learning initiatives at Cerner. Before that, he developed custom software solutions and contributed to Agile software development methodologies as a Senior Consultant at ThoughtWorks. Service is core to David’s philosophy. He is committed to serving as a trusted partner to clients and helping them address the healthcare needs of their patients and communities.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

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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.

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One of the lessons learned as a result of COVID is we have to create a more resilient supply chain

Posted on April 19, 2021December 30, 2023 by sanjith p

Season 3: Episode #82

Podcast with Mike Alkire, President & Incoming CEO, Premier Inc.

"One of the lessons learned as a result of COVID is we have to create a more resilient supply chain"

Hosted by Paddy Padmanabhan

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In this episode, Mike Alkire, President & Incoming CEO of Premier Inc., discusses the ongoing vaccine roll-out and the lack of resiliency in the medical supply chain for U.S. healthcare.

He discusses how Premier is expanding their data analytics capabilities, such as AI and machine learning to make the supply chain infrastructure more resilient and support better clinical decisions. Mike believes that the changing competitive landscape of healthcare and the entrance of non-traditional players is unleashing innovation in the industry. He also shares three leadership lessons from his long and successful career. Take a listen.

Our Podcast Partners:

Show Notes

02:49		Some significant lessons learned as a result to the COVID virus is we have to create a more resilient supply chain.

05:16		We need technology to really support the federal government and public health officials around syndromic surveillance.

16:28		Approximately 30% of our healthcare systems cost is wasted and we want to help them with evidence based, AI-enabled guidelines embedded in their workflow to drive that waste out.

Q. What are you seeing as a big trend driving the healthcare industry in the wake of the pandemic? What are you hearing from your major customers?

Mike: I think along with the public, our healthcare systems are really focused on getting as many shots and arms as possible. Our first focus area is to bring in efficiency to the supply chain of the vaccine. Second focus is getting back to normalcy. Healthcare systems obviously have been really caring for the COVID patients and our focus over the last few months is really helping our healthcare systems think about what does the new normal look like and leveraging some of the silver linings in the cloud that was covered.

We had some significant lessons learned as a result related to the COVID virus. One is we must create a more resilient supply chain. What happened was there was this huge demand-supply balance and Premier had to go out and stand-up additional capabilities to secure additional masks, isolation gowns, gloves, and drugs. We found that this supply chain that was being utilized by U.S. healthcare was not resilient enough. And so, we got a big focus on trying to diversify that. We partnered with several our healthcare systems to create domestic production of N95 masks. We have also partnered with them down the lines for manufacturing isolation gowns domestically. We are going to continue down that path from a supply chain standpoint. From a technology standpoint, there were a few lessons learned as well. One was that we did not have the technology to ascertain what the inventory levels look like across the healthcare system. And we’re right now working with a few agencies or organizations within the federal government to leverage some of our technology that would potentially help them in the future pandemic to dynamically allocate product. Because what has happened in the last few months or the last number of months is that everybody is trying to create stockpiles and it’s creating an incredible inefficiency in the market. We believe that if we could leverage technology, we could understand inventory levels and we could dynamically allocate product where it was needed so that not everybody was going out and trying to create these stockpiles. With the technology, we created a science of predictive capabilities on the onset of the virus, where we use both public and our data. And as the virus progressed, we built out some models based upon utilization of PPE and generic drugs to forecast where those products were going to be needed, depending on where the virus spreads. The knowledge about the onset of virus in demographic areas and the utilization or resources accordingly are, I think, very critical. We also need technology to really support the federal government and public health officials around syndrome surveillance.

Q. I understand that you’re talking about supply chain lacking resiliency because we are over dependent on certain types of sources. What are you referring to there?

Mike: I think we had way too much dependency on China in Southeast Asia for these critical products. What happened is that when the pandemic hit, there were all sorts of instances of constriction of supply products from where we historically gotten products and a lot of cases like this was China, but we contract manufacturer for PPE, we probably do six billion or so gloves a year. We set up production in Taiwan for N95 facemasks as well. When we needed it the most domestically, we were unable to get it out of the factory that we had contract manufactured those products for. And all that product was for the most part, shipped to mainland China. That’s just one example. Another example is during the peak of the virus, filtration media is critical to N95, it’s primarily produced in China and India, China embargo the shipment of all that filtration media. So, all the production of N95s were happening in China and nowhere else in the world. And that created a big issue. There are other instances where I am not saying it was right or wrong, but I am just saying we had an overdependence on one country. And the other area that I have been talking about this since basically 2011, if not earlier, is we have way too much over dependence on China and other Southeast Asian places for generic drugs, especially those that are chronically in short supply, as well as those active pharmaceutical ingredients that go into those drugs.

Q. Can you talk about using data analytics technology to bring out additional efficiencies and get better with the distribution processes. How have you driven that kind of transformation for yourself as well as for your clients?

Mike: Over the years, the clients, the customers, and our members really asked us to continue to invest in technology enabling the supply chain. That really was the notion of bringing AI, machine learning, predictive technology into the supply chain setting. So, think about as you are making a decision, a clinical decision from a supply perspective, they want the ability to look at clinical outcomes as it relates to the utilization of specific products. So, they want that kind of data. They want the data on appropriate utilization. Should they use one or two per procedure and what is showing the best outcome in those kinds of things? So that tie between the clinical and the supply chain data is critical as our healthcare systems are continuing to figure out ways to transform their supply chain. We also made some significant investments just prior to the pandemic. But then during the pandemic, I’m really building out an e-commerce platform to help the non-acute side of our customer base get access to product. During the pandemic, New York City and Seattle were hit hardest first. Seattle sort of exhibited itself in nursing homes and long-term care facilities. Historically, those kinds of organizations did not have a great deal of access to PPEs. So, our platform called stockd^TMis a platform that has reliably sourced products. Organizations in our acute setting buy products on that platform. But we open it to provide access to non-acute folks that were affiliated with Premier to allow them to get access to these products. We have reliably sourced and had a strong chain of custody, which is obviously really, important to protect the caregivers who are caring for those patients. So that’s number one. Number two, we recently made an investment in a company called IDS. And what IDS does is it is all about e-invoicing and e-pays. And we believe, along with our ERP and our front end stockd^TM program, that we now have an end to end procure to pay technology ability truly all the way from the purchase point on the e-commerce platform all the way through e-invoicing and then through e-payment plan, we believe by leveraging the IDS technology, our healthcare systems can centralize the whole invoicing function across their health system and the accounts’ payable function. So, we are incredibly excited about integrating all those data assets and bringing all the efficiency to our health system.

Q. We talked a great deal about the syndromic surveillance, last time when you were on my podcast, tools and the algorithms that you were using to get early indications of who is likely to be contracting COVID. We are now at a moment to roll out vaccination across the country. Have you been able to use some of the same tools to repurpose them towards the vaccine distribution effort?

Mike: We took a technology that we were utilizing to help our healthcare systems manage for PAMA, which were the CMS Medicare guidelines for high-cost imaging utilization. We were looking at the unstructured notes of the electronic medical record using natural language technology, natural language processing, to obviously create the mechanism for using appropriate utilization of images and we pivoted that very quickly. And because we could get that the unstructured notes, the unstructured data, we could actually look at symptoms of the disease and we could identify where there were surges or where there was a significant part of the disease. That is something we do think that various health officials should really begin to think about. As what it allows is, because the data is at a zip code level, for public health officials to create different models to protect populations depending on where the submerges are where you did not have to shut the whole state down. You can look at various zip codes and determine where are the resurges and those kinds of things. For the same kind of technology, we have been having dialog with different parts of the federal government about looking at the success rates of the vaccines and looking at the clinical efficacy of the vaccine and those kinds of things. So, we are primarily just in conversations because it was so quick upon us if we weren’t able to get the product out. We are certainly in the discussions to save for future events. Not just Premier, but there are a number of organizations that the technology is underpinning and could truly support them as they’re either developing a new vaccine or as launching one.

Q. You have been a part of this journey for the past 18 years at Premier and have seen it all unfold in front of your eyes as you take on the role of CEO. Can you share with us what new areas do you anticipate are going to take up your time and attention?

Mike: Yeah, I think they fall under two broad buckets. One is I think we have got to leverage all the technology and capabilities that I’ve been talking about to really accelerate value to our members, our partners, that also then obviously accelerate value to our investors and shareholders. I think accelerating the utilization of that technology, getting it implemented, helping our healthcare systems get back to normal and truly delineating that value, is going to be critical. The second area falls under three principles. One, we need to help our healthcare systems reduce the waste in healthcare. Approximately 30 percent of the cost is waste, and we want to help them with evidence based, AI-enabled guidelines embedded in the workflow to drive that waste out. Number two, we want to modernize, and tech enable the supply chain. We think that there is a ton of manual tasks. There is a ton of data that is not being utilized at the point of decisions. And we want to make sure that we are bringing that information transparently to the decision makers. We have got to continue to build out more resiliency in that supply chain, look for more opportunities to domestically manufacture products, especially those that are highly automated and generic drugs, as well as some of the APIs. We need to be thinking about how to do that more domestically as well as nearshore. And then finally, we need to continue to evolve our technologies to help our healthcare systems truly thrive in a value-based care economy. So, those kinds of capabilities include clinical decision support, which obviously we believe is going to be important. As you know, healthcare systems are going to be on the hook to deliver high levels of care, high quality care by both employers as well as payers, and then obviously at a patient level as well.

Q. The shift towards value-based care is perhaps not as fast and not as rapid, not as deep as we might have expected, and we are still in a predominantly fee-for-service environment. However, the marketplace has its own way of recalibrating the market for products and services. We are at a moment when we have big technology players like Amazon, for instance, getting into core care delivery. We have got digital first companies that are delivering healthcare in a more digitally enabled, digital first kind of way. And we have got all the non-traditional players like CVS and Walgreens and Walmart looking at the healthcare space. What does it all mean for your clients and consequently for Premier?

Mike: There’s always going to be new competitors, given that healthcare is such a significant part of the gross national product of this country. So, we happen to believe that competition is good as it unleashes innovation. And ultimately, at the end of the day, it provides better levels of patient satisfaction and obviously more innovation becomes online. It provides more choices and obviously a better overall system. Our health systems, specifically the ones that are tied with Premier are embracing the challenges and the demands of all this innovation, and we see it every day as they are building out new capabilities around telehealth and virtual health. And our clinical decision support capabilities are an important underpinning of that so that you can drive a level of consistency. As you think about all these virtual visits, you think about our health systems as they are building out more models around hospitals at home and mobile clinics and the need for all that clinical decision support, patient engagement tools are going to be critical. We believe that vertical and horizontal integration is going to continue. So horizontally, healthcare systems coming together to create more scale. Vertically, you are going to see them get into other areas of service that is outside of the four walls of the hospital to include areas like post-acute pharmacy and integrated primary care.

Q. All this potentially expands your own addressable market and opens brand new market opportunities for Premier. Is that a fair statement?

Mike: It’s very fair and that’s the reason we’re so focused on the technology enablement of both sides of our business, both the clinical as well as the supply chain, because as they vertically integrate, it’s going to be extremely important to ensure that information flow is seamless and accurate as we’re caring for patients across the continuum. So that you have the right clinical data, the right safety data, and the right supply chain data so folks can make decisions along that entire vertical integration. So that it just goes back to our primary premise, which is why this technology enablement is so critical, especially using advanced technologies like a machine learning, natural language processing and technology.

Q. Are there any potential other implications? For instance, you talked about the horizontal integration of health systems looking for economies of scale and what that potentially means is that service providers or suppliers such as Premier, for instance, might feel a little bit of price pressure. So, you have to stay one step ahead by making your own operations a little bit more efficient so that you can protect your margins while continuing to be of value in the emerging landscape? Is that a valid assessment?

Mike: Well, that is a very fair statement. But I think we are so fortunate in that as we have this incredibly strong network of innovative healthcare systems that I think constantly push us to innovate and bring us ideas around how to create more efficiency for them. So, they as opposed to each of them building out the clinical decision support and the technology for global payment, they’re coming to us and saying, can you build those kinds of things as opposed to each of them blockchain enabling those sophisticated invoicing and payment systems are saying, can you build that out for us? So, we look at it as an opportunity as all this technology continues to advance and the shifting landscape continues to evolve, because of that tight connectivity we have with our health systems, we’re going to be able to innovate right along with them and create technology and services to help them become more efficient.

Q. Mike, you’ve had a long and successful career and many of my listeners would want to know a few lessons from you. Maybe talk about one thing that you wish someone had told you when you were younger?

Mike: Firstly, the notion of diversity and the exposure to diversity. When I talk about diversity, I’m thinking of every sense of the word. I think it is important for folks to have that sort of thinking because it provides you insights and perspectives that you might never have seen before. So, diversity in terms of people that come from different walks of life that are trained differently. On the other side of that equation, it also gives you a bit of compassion and empathy and understanding of what others are going through. Right on my podcast, I talked quite a bit about the word humanity. And what I mean by humanity is getting to know everybody as an individual as opposed to a label or something else. That exposure to diversity is important. I think number two is just understand and appreciate. You are going to make bad choices and bad decisions. And to me, the most important thing throughout your career is how do you recover from decisions that did not go the way you want it. And so, I’ve always sort of built a process or an internal process, if you will, of how to sort of recover very quickly from decisions that you have made that have not gone the way that you want. And it is really important to have that perseverance to bounce back and come right back at it with some great learning because of a decision that didn’t go the way you wanted. I also think that one of my strengths was the ability to get onto the next thing faster. Whatever that issue was or whatever the strategy was, it was critical in my development that I did not just harp on a bad decision or a bad strategy. I fixed it and moved on and got into the next thing. And then the last thing is this notion of an inverted leadership structure. Sometimes people call it the inverted pyramid of leadership. I think that is critical. All that means is that I’m here to support my next layer of leadership and to take out the roadblocks that are inhibiting them from growing and accomplishing their jobs. And their job is to do the same thing for their people. I think we have got incredibly talented group of people at Premier. And one of the things I asked my leadership team to do is make sure that you’re helping your leaders manage folks and provide leadership to people in the most effective way possible and to just unleash their brilliance. So, I think that notion of the inverted leadership structure is real as well.

About our guest

Michael J. Alkire is the President of Premier. As President, Alkire leads the continued integration of Premier’s clinical, financial, supply chain and operational performance improvement offerings helping member hospitals and health systems provide higher quality care at a better cost. He oversees Premier’s quality, safety, labor and supply chain technology apps and data-driven collaboratives allowing alliance members to make decisions based on a combination of healthcare information. These performance improvement offerings access Premier’s comparative database, one of the nation’s largest outcomes databases.

Alkire also led Premier’s efforts to address public health and safety issues from the nationwide drug shortage problem, testifying before the U.S. House of Representatives regarding Premier research on shortages and gray market price gouging. This work contributed to the president and Congress taking action to investigate and correct the problem, resulting in two pieces of bipartisan legislation.

Prior to serving as President, Alkire was president of Premier Purchasing Partners, which offers group purchasing, supply chain and resource utilization services to hospitals and health systems. Premier remains among the top group purchasing organizations in the industry as the value of supplies purchased through its contracts has increased to more than $56 billion. Upon joining Premier in late 2003, Alkire worked closely with the Purchasing Partners team to develop and implement a three-year transformation plan designed to dramatically increase returns to the alliance’s shareholders while building stronger relationships with members and suppliers.

Alkire is a past board member of GHX and the Healthcare Supply Chain Association. He recently was named one of the Top 25 COOs in Healthcare for 2018 by Modern Healthcare. In 2015, Alkire won the Gold Stevie Award for Executive of the Year and in 2014 he was recognized as a Gold Award Winner for COO of the Year by the Golden Bridge Awards. He has more than 20 years of experience in running business operations and business development organizations at Deloitte & Touche and Cap Gemini Ernst & Young. Before joining Premier, he served in a number of leadership roles at Cap Gemini, including North American responsibilities for supply chain and high-tech manufacturing.

Alkire graduated magna cum laude with a Bachelor of Science from Indiana State University and a MBA from Indiana University.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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Inserting data back into the workflow to make it useful is the number one challenge

Posted on April 12, 2021December 30, 2023 by sanjith p

Season 3: Episode #81

Podcast with Jim Beinlich, VP and Chief Data Information Officer, Penn Medicine

"Inserting data back into the workflow to make it useful is the number one challenge"

Hosted by Paddy Padmanabhan

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In this episode, Jim Beinlich discusses the current state and maturity level of data and analytics in healthcare.

Healthcare lags other industries when it comes to using new technologies. The industry still needs to apply standardization, governance, and ensure data quality to get the right data at the right time to the right person. Jim states that one of the challenges with data is inserting it back into the workflow to make it useful. One of the important use cases of Penn Medicine’s data and analytics program has been the transition from traditional analytics to cloud-based tools and leveraging data lakes to unlock self-service data models.

Penn Medicine is one of the very few healthcare organizations to integrate genomic testing results into the EMR. Jim shares their extensive protocols for integrating genomic data into patient records for diagnosis and treatment. Take a listen.

Our Podcast Partners:

Show Notes

05:00		Being able to share data more easily can always be good. I think the challenge is going to how do you balance that against privacy and security.

14:21		Data quality is the foundation for any of the programs. If people do not trust the data, they don't trust the results out of any of the systems or technologies.

25:54		We're able to take data and stratify patients and take our low-risk population and say that those people can get a remote follow up.

34:15		My advice would be talk to your EMR vendors, cloud vendors, understand what tools are available to you so that you don't have to hire highly technical staff to build it.

About our guest

Jim Beinlich is the Vice-President and Chief Data Information Officer of Information Services at Penn Medicine. He has responsibility for the Data Analytics Center and the Project Management Office within Corporate Information Services..

He has over 30 years of experience in healthcare operations and management (hospital and physician practice), research computing, information management and technology. He is a certified Project Management Professional and holds an MBA in Health Care Management from Widener University.

Jim has significant experience with large, complex health systems in the areas of strategic planning, process redesign, project management, IoT, and operations improvement. He has consulted for large organizations such as the US Department of Defense, the National Institutes of Health, and Catholic Health Initiatives. He holds adjunct faculty appointments at Temple University Graduate School of Health Information Management and Widener University Graduate School of Business

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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The hard part isn’t the technology piece but making sure the experience is right enough for patient engagement

Posted on March 30, 2021December 30, 2023 by sanjith p

Season 3: Episode #80

Podcast with Kash Patel, VP and Chief Digital Technology Officer, Penn Medicine

"The hard part isn’t the technology piece but making sure the experience is right enough for patient engagement"

Hosted by Paddy Padmanabhan

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In this episode, Kash Patel discusses his role as the Chief Digital Technology Officer at Penn Medicine and provides an overview of their digital transformation initiatives covering all aspects of the institution, including research, academic programs, and patient engagement.

According to Kash, the hard part with digital transformation is not necessarily implementing technology but ensuring the patient experience is seamless with the technology and they feel positive about it.

While making technology choices, Penn Medicine’s first and foremost preference is to make the maximum use of their existing EHR infrastructure. Kash also describes the governance process that includes their leadership and subject matter experts to make technology decisions about newer digital tools and platforms. Take a listen.

Our Podcast Partners:

Show Notes

05:04		We are creating a roadmap for the journey to digitize our research platform that allows us to do all the prejudgments of the clinical trials, human subject trials, and ultimately manufacturing.

10:40		The hard part wasn't the technology piece, but making sure that experience was correct and right enough for engagement.

11:03		We bring a lot of technology to the table and figure out what is the level of detail that a patient will tolerate, adhere to, engage with and feel positive about the experience.

About our guest

Kash Patel is the Vice President and Chief Digital Technology Officer at Penn Medicine. Kash has over 20 years’ experience in technology leadership ranging from startups to multi-national corporations and is a seasoned leader in healthcare with a strong focus on innovation and building great teams.

At Penn Medicine, Kash is leading the world class Pearlman School of Medicine Information Technology team. He supports the areas of research, clinical trials, manufacturing high performance computing, informatics, genomic science and many others. In addition, Kash is responsible for all of bespoke software development.

The team has been credited with several innovations that are streaming the complex business of healthcare. In 2020 there is a large focus on COVID-19 activities, working with Microsoft, Google and Apple to develop novel solutions that reflect Penn Medicine’s outstanding reputation.

After graduating in engineering from Sheffield in the UK, Kash gained valuable experience in building business driven software solutions in various industries. His earlier career started in consulting in the UK. He has managed global delivery teams for fortune 100 companies and started a new venture that created leading edge communications technologies.

In healthcare, Kash was the vice president for population health and analytics at Mount Sinai Health System where he led the technology strategy to support the institutions business shift from fee for service to assuming more risk. In addition, Kash was the IT lead for Mount Sinai’s New York DSRIP Program, involving over 250 partners led by Mount Sinai with over a $100M technology investment plan. He also managed health systems analytics and data engineering functions where he developed analytics as a service using advanced technologies.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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Our role is to support community health centers and getting members educated about the vaccine

Posted on March 22, 2021December 30, 2023 by sanjith p

Season 3: Episode #79

Podcast with Dr. Rich Parker, Chief Medical Officer, Arcadia and Jennifer Polello, Senior Director of Quality and Population Health at Community Health Plan of Washington

"Our role is to support community health centers and getting members educated about the vaccine"

Hosted by Paddy Padmanabhan

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In this episode, Dr. Rich Parker and Jennifer Polello discuss their vaccination distribution program, challenges around vaccine hesitancy, and how they have overcome this.

Community Health Plan of Washington is a not-for-profit health plan that caters to the underserved and non-English speaking communities. Their role has been to support the community health centers and getting members educated about the vaccine. One of the most successful vaccination outreach programs has been their text messaging campaign, with a nearly 80% success rate.

Arcadia works specifically with data aggregated from disparate data sources like claims, EHR, lab, state health information exchange, social determinants of health, and others. This longitudinal record of each member helps them risk stratify and identify gaps in care, thereby helping them with their vaccination outreach and distribution priorities. Take a listen.

Our Podcast Partners:

Show Notes

04:36		In terms of getting ready for vaccine distribution, our role really has been to support our community health centers around getting members aware and educated around the vaccine.

09:25		Having access to data, the demographic and EHRs combined with all of that other data, gave us actionable longitudinal picture of the member and enabled us to assist our community health centers for needs they might have.

16:41		We had nearly 80% success rate from our text campaign.

20:09		I am very enthusiastic about using data to help push the vaccination rates up as high as possible.

Q. Jennifer, can you tell us a little bit about the Community Health Plan in Washington and the populations that you serve.

Jennifer: Community Health Plan of Washington is a not-for-profit health plan. We were founded by 20 federally qualified health centers almost 30 years ago. Now we’ve got approximately two hundred fifty thousand members through our Medicaid, Medicare, which also includes special needs population, and then Cascade Care, which is a new line of business for us that we started this year. Our network consists of one hundred hospitals across the state and one hundred and seventy-four clinics. We have more than twenty-seven hundred primary care providers and over fourteen thousand specialists. The thing that really makes our organization unique is that we believe in the power of community and our mission is to serve our members and our communities across the state of Washington.

Q. Can you start by telling us how long ago you had to start planning for the vaccine. Tell us about the program itself and what have been some of your challenges in rolling out the vaccine to populations?

Jennifer: The planning around vaccine distribution started well before we had an approved vaccine, in terms of looking at eligibility, what would be available and how we were going to roll this out. Our main emphasis was providing support to our community health centers across our network and trying to help them with any logistic challenges or education and awareness need. That’s where our partnership with Arcadia really took off. In 2020 we had great success using the Arcadia outreach module when the pandemic started for things like what exactly is coronavirus, where to go for testing, which evolved to benefit reminders and connections to our community program teams for referrals to social service needs for things like food security. So, we kind of laid the groundwork for all of this in 2020 when the pandemic started and using all of these resources and distributing that information via the outreach functionality within Arcadia. In terms of getting ready for vaccine distribution, our role really has been to support our community health centers around getting members aware and educated around the vaccine.

Q. Rich, tell us about your analytics and about your involvement in the vaccine outreach effort with Community Health Plan.

Rich: Arcadia is a company dedicated to assisting healthcare networks and to some extent, payers, mostly commercial payers, deal with all the disparate data that is out there. So, getting all the data together from different sources, whether it is claims data, electronic health record data, lab data, state health information exchange data, social determinants data, and aggregating it, cleaning it up, making it useful. And then we have a set of analytics that sits on top of that data for each of our customers, allowing them to succeed in what we call value-based care, basically improving the health of the community.

As for vaccines, I have always been interested in vaccines since I started medical school and fortunately, we have these fantastic vaccines available so quickly to help deal with this epidemic. Arcadia has worked with many customers in helping risk-stratify patients. That is figuring out who is at risk for COVID, educating patients as to when they should ask for care or when vaccines are available, where can they get them? And then also looking at gaps in care. So, if people who should have had a vaccine didn’t get it, we can identify those gaps and help our customers fill them.

Q. Where are you getting all this data from? Can you share a couple of insights that you were able to get from the data that helped you to enable Community Health Plan and Jennifer’s team to drive better outcomes or outreach?

Rich: Our main sources of data are from the electronic health record. We get a download of data that’s extremely up to date and we get it usually on a monthly basis and the claims data. Which means that every time a patient is seen either in a doctor’s office or in a hospital setting a claim is generated. That information comes back to us and we can use that to figure out what’s going on with the population. And so that information, for example, at CHPW where Jen works, it would allow us to understand, which zip codes are doing better with vaccination, which are doing worse, and where do we have to focus our efforts more accurately and intensively.

Jennifer: We relied heavily on our Arcadia Analytics platform during this time. We have 20 cases connected to the Arcadia platform. We have got our data from all those organizations. We have also added ADT data, which is admin discharge transfer data. So, we get information from the hospitals and we also have a separate lab feed. So, all that data really allows us that longitudinal picture of what is going on with the member. This really allowed us to help the community health centers know, who has got care gaps, who hasn’t been seen, who’s at risk for COVID.

We got almost an 80 percent success rate with our outreach efforts, which is high considering we’re dealing with Medicare and Medicaid members that typically are a little bit harder to reach. And so, having access to that data, the demographic and contact information in the EHRs combined with all of the other data, really gave us that actionable longitudinal picture of the member and enabled us to assist our community health centers in reaching those numbers for whatever needs they might have.

Q. Can you tell us about the insights that you got from the platform and the added tools that Arcadia may have deployed? Anything that came out that surprised you or was in some way unanticipated and helped to really improve the outcomes that you were going after?

Jennifer: We’ve got lots of different registries available to us in the platform. And one of the most utilized is our patient registry and being able to sort that registry by members that are at most risk. So, we can sort by the highest risk members, we can sort by members that have a lot of care gaps or chronic conditions. All that flexibility within the platform allows us to tailor different outreach methods within the CHPW language preferences. That was one thing that came in handy over 2020 because we relied on Arcadia for outreach and translated into lots of different languages, which was helpful and used the accurate contact information and targeted those messages by zip code. So, there was not any one thing that stood out. It was kind of a combination of all the different functionalities within the platform that we were able to tailor to each of our centers’ needs at the time.

Q. Can you tell us about some of the challenges that you have to deal with when you’re pulling all these data sources together and what you’ve had to overcome to make your algorithms and your risk stratification models meaningful?

Rich: There are some countries that have a single health record for everyone in the country. And that, in retrospect, seems like a really good idea. But it’s not what we have in the United States. We have many EHRs and still have some people on paper, but most people are on some computer system now. And since it’s healthcare data, it has to be very accurate. Now, sometimes we have challenges with getting corrupted data or incorrect data that could come in the form of a claims file from a payer that has a problem in it. We have very sophisticated tools where we’re usually able to identify the issue with the data and quickly fix it. Healthcare data is complicated, but we have years of experience doing this and the analytics are only as good as the data source that sits underneath it. We spend a lot of time and effort to make sure the data is correct for each customer.

Jennifer: We have a team that works directly with the Arcadia team to ensure that data quality is up to speed and the integrity of the data is there. We have got lots of different connectors just in the EHRs alone. There’s 20 different data points and data connectors there which are with 20 different organizations and each time they make a change to their workflow, it could impact how the data gets back to Arcadia. So, it’s a constant management of the data with our centers to make sure that data quality and data integrity is first and foremost.

Q. You’re addressing a population that may not be as technologically enabled, especially if you are talking about lower income populations. So, what kind of modalities do you use in your outreach as far as the vaccination program goes?

Rich: One of the big learnings for us is that text outreach is the best way to go. In the old days, we were sending letters, then we were making phone calls, and then a lot of people switched from landlines to cell phones and then a lot of people got a lot of junk calls and stopped answering their phones. But we have learned through experience that most people look at texts on their cell phone. We have now sent over three million text messages out to patients on behalf of our customers, all healthcare related, a lot of it around vaccine education, gaps in care for text messages. The messages are short. And the other thing we have learned about text messages is we can embed a URL. So, for example, if there’s a longer message that wants to get out to its patients, they can put a URL in there and the patient or the customer can click on that and get the website that CHPW wants them to see.

Q. How does that work for you, Jennifer?

Jennifer: It worked exceptionally well. As I mentioned, we had that nearly 80 percent success rate and that was from our text campaign. So, I completely agree with Dr. Rich that text is the way to go. We had very good success rates in reaching our members, and the ability to embed additional information was helpful, because you can send a real short message and then have links for additional information. In terms of vaccine, education, and awareness, we were able to a link to our state’s Phase Finder to help folks understand when it was their turn to get the vaccine. And then over the last year, it was great for driving folks to testing locations and benefit reminders. It was invaluable in terms of directing members exactly where we wanted them to go.

Q. We very often hear about vaccine hesitancy and a significant percentage of the American population do not want to be vaccinated or have concerns. Is that a problem at your institution?

Rich: Absolutely. Vaccine hesitancy is a big problem. Probably right now, about a third of people in the United States are reluctant to get the COVID vaccine. We know that people that are over the age of fifty-five are more likely to accept the vaccine. Younger people are less likely to accept the vaccine. And we can use our data to figure out where the gaps in care are.

Jennifer: I think we we are pretty much in alignment with that as well. We serve the underserved and a lot of those communities are non-English speaking and have different cultural beliefs. So, there’s a lot of education and general awareness that needs to take place. Our strategy has been to reach out to those community leaders as potential models or potential leaders that can help distribute vaccine education and awareness information.

Q. Can you share one best practice for your peers in the industry? One each based on your experience, especially around vaccines.

Rich: I am very optimistic, very enthusiastic about using data to help push the vaccination rates up as high as possible. I would say that without data, you are just operating in the dark. You have no idea what is going on with data. With data, we are not going to get perfect compliance, but we will find out who has been vaccinated, who still needs vaccines, and then we can target our outreach to the people that are still outstanding so we can do the best possible effort to get as many people vaccinated as possible.

Jennifer: Dr. Rich, I completely agree with that. Arcadia platform and access to this integrated data and access to this longitudinal record of our members, the ability to sort by risk and look at care gaps to find out who had the first vaccine, who needs the second one, all those different functionalities really allow us to be in the forefront and at the top end of the curve on reaching our members. I think the key is that we got timely data and data that really connects us back to the needs of our members and our communities.

About our guest

Dr. Parker serves as Chief Medical Officer for Arcadia with overall responsibility for the design and implementation of clinical strategies, input into the roadmap and development of Arcadia’s technology and service programs, thought leadership in support of providers transitioning to value-based care, and strategic advisory work for physician leaders at Arcadia’s clients.

Previously, Dr. Parker was an internist with a 30-year history at Beth Israel Deaconess Medical Center. From 2001 until 2015, Dr. Parker served as the medical director and chief medical officer for the 2,200 doctor Beth Israel Deaconess Care Organization. He oversaw the physician network evolve from a fee-for-service payment system to a nationally recognized global payment pioneer Accountable Care Organization.

Dr. Parker’s other areas of expertise include end of life care, medical malpractice, care of the mentally ill, electronic medical records, and population health management. Dr. Parker served as assistant professor of medicine at Harvard Medical School. Dr. Parker graduated from Harvard College in 1978, and the Dartmouth-Brown Program in Medicine in 1985 Dr. Parker is an in-demand speaker to associations, companies, and academic institutions on the topics of population health management, electronic health records, value-based care, and evolutionary, medical and business impacts of stress.

Jennifer serves as the Senior Director of Quality and Population Health at Community Health Plan of Washington. She has over 20 years of extensive experience across the healthcare continuum in the areas of public health, chronic disease management, quality improvement, health policy, population health management and clinical informatics. She has exercised this experience from several points of view across the health care environment and has demonstrated expert facilitation skills in leading teams of clinicians, nurses and physicians through the transformation process of patient care in the ambulatory setting.

Jennifer has worked on regional health information exchange projects and assisted in the design of a clinical decision support tool for patients with type 2 diabetes. She has also served as an Adjunct Clinical Assistant Professor mentoring PharmD candidates at Washington State University.

Jennifer is currently leveraging her knowledge and expertise as the Senior Director of Quality and Population Health at Community Health Plan of Washington where she leads the company’s quality improvement strategies, population health and clinical data integration programs across the Network of 20 community health centers that operate more than 130 clinics across the state.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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Tech firms must build software that aligns with patient demographics, is usable for them, and delivers outcomes.

Posted on March 15, 2021December 30, 2023 by sanjith p

Season 3: Episode #78

Podcast with Josh Goode, Chief Information Officer, SCAN Health Plan

"Tech firms must build software that aligns with patient demographics, is usable for them, and delivers outcomes."

Hosted by Paddy Padmanabhan

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In this episode, Josh Goode, CIO of SCAN Health Plan, discusses their digital programs, the patient population they serve, and how they evaluate digital technologies and deploy it at every stage of the care journey for improved outcomes.

Being a Medicare Advantage plan, SCAN Health deals with the senior population. They strive to address the digital divide in the elderly by implementing software that aligns with their requirements, is easy to use, and delivers improved outcomes while taking care of patient privacy and data security. The technology considers the social determinants of health by implementing a robust data and analytics program that has helped develop AI models to predict chronic conditions.

Josh also talks about person-centered design processes and how it helps deploy the right digital technology by looking at the patient’s journey touchpoints. Take a listen.

Our Podcast Partners:

Show Notes

06:39		There's a lot of technology and capabilities out there that we can be deploying. But how do you know you're deploying the right one?

07:25		We are very focused on person-centered design.

10:33		When you're dealing with Medicare, the senior population, you got to design the experience with that population in mind.

17:29		I think it's our imperative to use data to help influence care, and help improve the service experience as well.

Q. Can you tell us about SCAN Health Plan and the populations that you serve?

Josh: SCAN Health Plan is a Southern California based Medicare Advantage plan and we have been in this business for about 40 years. SCAN Health started out as a social HMO and now we are the third largest Medicare Advantage plan in California. Although our firm is a regional plan, but we do have a strong national presence. We are a leader in a lot of the Medicare Advantage metrics. Our scores are usually near the top of the industry. As per customer satisfaction, we have a strong performance in the star rating and are pretty active from a policy standpoint. We recently got a new CEO Sachin Jain and he came on board about seven months ago. And when you look at such incoming on-board SCAN Health Plan, we’ve had a good foundation, really stable, solid company to the metrics. And now we’re really looking at how do we capitalize on that? How do we build up on that and expand upon all the good work we’ve been doing for seniors across California?

Q. How many lives you cover today approximately and what kind of digital programs have you rolled out in the last couple of years at SCAN Health?

Josh: We’ve got about two hundred and twenty-five thousand listed.

In the last couple of years, we have been focussing on consumer-facing technologies and how do we improve that consumer experience. When I joined SCAN Health, we were more focused on a technology modernization program, a lot of our core admin systems were outdated. They were no longer supported by vendors. Also, our primary core admin systems that does a lot of our administration was written in a programming language RPG. We were hundred percent on premise. So, I put in place a technology modernization program, replacing all those core systems and moved to a SaaS-based model. As all the systems are now moving into a cloud environment, we pivoted our focus more on the consumer facing technology.

We have also built our self-service capabilities, to try to minimize the amount of phone calls we get. To enable our members and our seniors, we have provided online channel options to use. Also, we’ve been doing a lot around data and analytics, advanced analytics. Interoperability has been something we have been doing a lot around last year. And with the new CMS interoperability rule, we are excited. We are really trying to unlock data sharing and trying to focus on our contact centre, our touch points with our members in driving innovation and using technology and data to support those areas of our company.

Q. On the provider side, as well as on the payer side of the business, for instance digital front doors, can you talk about what kind of specific high impact features or functionalities or solutions you’ve launched? How is it making a difference, how do you pick what to deploy, and how do you track whether it’s working?

Josh: There’s a lot of technology and a lot of capabilities out there that we can be deploying. So how do you know you’re deploying the right one? The answer is we like to do journey mapping. Looking at what is that member experience, that constituent experience and looking at what are those touch points that we have, what are the areas that have pain points. We call them – the moments that matter and we look at how we can apply the technology to help solve the issue.

Also, we are very focused on a person-centred design. We use our member advisory committees to give us guidance on things that we need to be working on and have our members, our seniors inform us on the things that we think we need to be working on and focusing on. Then we always have a heavy focus on caregivers and really increasing their abilities has been an area of focus for us.

The other thing that had come up around our members was multifactor authentication on our member portal that is protecting their data. To look after this concern, for us, it starts with that journey mapping of looking at what is the experience and what are those pain points that we can solve with technology.

We have a fully integrated broker portal and we look at their experience of interacting with SCAN Health Plan. By streamlining that, we are making it easier to do business with us from a broker perspective. With our providers we are trying to provide them with better experience as well. So, to sum up, our providers, and our brokers, both can provide our members with a better experience.

Q. You are serving multiple constituencies and your population might not be ready for some of the digital technologies and tools. Can you tell us about one or two unique things about your population that you had to take into consideration while designing these solutions and experiences?

Josh: It’s really not a one-size-fits-all. When you’re dealing with the Medicare and the senior population, you got to design the experience with that population in mind. How do you make it simple? How do you make it easy to utilize those technologies? And that’s something we strive to do with our website and any of our touch points with our members, whether it be telehealth, whether it be doing a virtual visit and even getting that virtual visit invite over to our members.

One of the things we’ve seen in particular with COVID-19 is digital adoption skyrocketed even among the senior population. We saw our member portal registrations go up over 30 percent and these are not one-time registrations. We have also seen our virtual visits, our video conference visit dramatically increased. When the pandemic hit, me and my team brainstormed for solutions and tools to help solve the digital divide with seniors and quickly rolled out a member technology support line. We were able to get it up and running for about three weeks but then after the pandemic really kind of took hold as everybody started going into our virtual environment. And the success out of that is when you look at what happened with the pandemic, you and your members were really thrust to get into a digital environment and some of them were ready for it. You can’t generalize the senior population, some are very digitally savvy and some were not ready for it.

I will never forget our first call which was a forty-five-minute call and was very impactful. It was with a 92-year-old member who was calling. His provider health system had sent him a text to do a virtual visit and you need an email address to register to do it. He never used email and we helped him set up an email account and walk him through how to do that virtual visit. We’ve had a number of stories since then, but it’s something that we’ve been proud of to help solve that digital divide.

Q. In the immediate wake of COVID-19, everybody saw a spike in virtual visits. But now all the data points to the fact that virtual visits are flattening out as patients start going back to clinics and hospitals and there’s a slight of pent-up demand. What are you seeing?

Josh: Something as an industry we have been able to demonstrate through the pandemic is that we can operate in a virtual fashion, but obviously not all care can be delivered virtually. But we have built that trust with our members and our patients, that there are effective ways to service those individuals virtually. And so, we are seeing that it is still running at high levels, but not as high as the peaks that we’ve had in pre-pandemic. So, as we start to open more, those numbers will continue to drop. But what we’re seeing and hearing from our member patient population is that they will continue to use virtual services for select interactions.

Q. Can you talk about your data and analytics program and how you’ve harnessed some of the social determinants of health?

Josh: Data and analytics is something that has always been one of the strengths for us. Under my purview, we manage the architecture, the data infrastructure, the tools and the healthcare informatics department. When you look at our role as a payer, we’re really a data aggregator where we’re getting all the data and we’re using that data to help influence care and help improve the service experience as well.

Also, we’ve got a centre of excellence that we run and enable all of our different business departments around the company and give them the tools to develop their own analytics. So, they can have data at their fingertips to make decisions and serve it up to the leaders in their departments. Also, more recently, we’ve moved into advanced analytics, leveraging AI, machine learning, where we’ve been selective on the use cases we target with AI. It takes more care and feeding as compared to traditional analytics. To make sure you’re focusing on the right use cases for AI and having the right processes in place, we need to be very focussed on our use cases to really improve our ability to leverage data and gain insights on data.

Social determinants of health have always been a priority focus of ours. So, starting out as a social HMO, we were really focused on SDOH. We use a bit of the external sources but have always maintained a good history of information and had the ability to collect that information directly from our members through a variety of means. We’ve been able to develop a pretty rich repository of SDOH data that we’ll leverage across the board. Those clinical models are very effective in looking at predicting some chronic conditions and potential clinical outcomes. We’ll be able to improve the care we deliver by using that data and then coupling it with the robust analytics program.

The last thing I would say on analytics is something we’re really focused on is real time analytics. But with the advancements of technologies, the replication technologies and with the CMS interoperability rule, we need to more tightly integrate with our provider network. This is because we are getting real time data straight from our health systems provider network. And we’re able to take that data and feed it across a rich and robust analytics program to really drive more outcomes as well.

Q. What is your advice to the tech firms and start-ups who are looking to be a part of your journey?

Josh: My advice to those start-ups and tech firms around is, make sure you’re building software that is aligned to your demographic population. As a Medicare Advantage CIO, I see it all the time that we present the software that is not geared towards the senior population. So, make sure you’re engaging that demographic using person-centred design, organising workshops with them, getting their feedback etc. Also, make sure you are building the software that’s going to be usable for them and is going to deliver outcomes.

The last thing I would say is, as a healthcare CIO, we’re all under attack from a cybersecurity standpoint. And even today, you still see a lack of adoption around information security. In the near future, if you’re not a high trust certified vendor, you’re going to have a tough time operating in the market. So, make sure you have a security focus as well.

Q. How did your consulting background prepare you for the CIO role? And what advice do you have for others in the consulting world who want to make a transition?

Josh: So, my background before becoming a CIO was exclusively working in the consulting industry. What really made me a well-rounded individual in my career is learning strategy work, which helped me understand how I need to develop strategies for organizations. Also, I learnt a sizable amount of system implementation work, leading a large system implementation and designing the operating model.

The thing that the consulting background really prepares you for is having that mindset of being able to design an operating model where you can put people in place to be successful and allow them to be able to execute on the strategies that you developed.

About our guest

Josh Goode is Chief Information Officer at SCAN. He provides leadership, direction and support to the company’s information technology (IT) areas including Digital Strategy, Business Intelligence, IT Infrastructure, Project Management, Electronic Data Interchange (EDI) and Application Development. Under Josh’s guidance, SCAN is leveraging its technology investments to meet the individual needs of seniors now and in the future.

Prior to joining SCAN in 2013, Josh worked for Accenture, a multinational technology and management consulting firm. During his 15 years at Accenture, he worked with several health plans throughout the United States, including PacifiCare, CIGNA, Express Scripts and UnitedHealth Group.

His experience includes analyzing, planning and implementing a variety of technological improvements and leading large technology programs, such as systems implementations and IT transformations.

Josh holds a Bachelor of Science in Business Management from the University of Tennessee.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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The best way for patients to interact with us will be through voice technology opposed to any other UI

Posted on March 8, 2021December 5, 2022 by sanjith p

Season 3: Episode #77

Podcast with Dr. Stephanie Lahr, CIO of Monument Health and Peter Durlach, Chief Strategy Officer of Nuance Communications

"The best way for patients to interact with us will be through voice technology opposed to any other UI"

Hosted by Paddy Padmanabhan

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In this episode, Dr. Stephanie Lahr, CIO of Monument Health, and Peter Durlach, Chief Strategy Officer of Nuance Communications, discuss voice recognition technology, its demand and adoption level in the marketplace, emerging use cases, and the next stage of improvements in the technology.

Dr. Lahr believes that voice recognition technology is the best way for patients to interact with their providers as opposed to any other user interface in the future.

Nuance is eliminating the burden on clinicians by powering virtual consults with voice-enabled clinical documentation. According to Peter, other aspects such as scheduling appointments, preparing for a doctor’s visit, medication adherence, and other clinical and non-clinical use cases can improve patient experience through personalized voice-based interactions. Take a listen.

Our Podcast Partners:

PP: Tell us about the voice recognition technology marketplace and the environment for adoption of the technology. What have been the broader learnings so far and what are the next round of improvements likely to be in voice recognition?

Peter: The move from directed voice where you say exactly what you want of a more intelligent listening system, that we call ambient, is really the next generation of technology. In healthcare, long before we had the COVID pandemic, we have had the pandemic of administrative burden, overwhelming clinicians, as you probably know, they spend roughly twice as much time taking care of administrative requirements as seeing patients. This has resulted clinicians feeling burnt out, depression going up, and people retiring. It has really been a crisis for healthcare. What they all want as part of the solution is why cannot they just focus on the patient, have a conversation with the patient and use that conversation in the encounter, whether it’s in a physical setting or a virtual setting, and then have the technology to create the documentation for them and do other things like coding and things that they see as taking away from taking care of patients. We have a solution called the Dragon Ambient Experience that we launched right before COVID that does exactly that. We are still early in the journey around ambient, but it’s a very exciting area. In terms of the learning so far, I would say that different physicians have different requirements. So, we roll this out by specialties because you must build these ambient models by specialty. And we have learned that for some clinicians the technology fits in extremely well. For others, they may be looking for the technology to morph in a little way based on the workflow that they have. So as time goes on and as the technology matures, I think you are going to see more and more physicians across a wide degree of specialties really adopt. The results so far in general have been quite good. We are generally, on average, seeing a reduction in clinician burnout for those who are using it. Dropping from about 72% to 17% and freeing up about six minutes per encounter for an average panel size of twenty to thirty a day. That’s a couple hours a day. So, as the technology gets better and better, faster and faster, and needs less and less human involvement in reviewing the note, I think you’re going to see higher adoption and also the development of more automated things coming out of the note like coding and quality abstraction.

Stephanie: I will just add a couple of comments. This is one of those fun times when as a CIO and CMIO, I get to deliver a tool to my clinical colleagues that they are excited about and really makes their lives and their interaction with the patients better. I mean, it’s unfortunate, but true. A lot of the things that we have done and had to do over the last decade or so add to that burden that Peter referred to. And again, this is one of those times where I have a waiting list of people who are excited to try this. I do think that there are certain specialties where this is going to lend itself more to, at least early on, because there are some workflow elements of this. We see our colleagues really being able to take this and fly. And that is great for them, because to Peter’s point, if at the reduced time and documentation and some of those other things, gives them more time to do procedures and be in the operating room and do those things that really impact the improvement of the lives of the patients. The other thing I would say is we are still helping our patients get used to this construct. Most patients are very accepting of this idea of the conversation happening and then the note being created. They are accepting it because they’re anxious and excited to get the intimacy of their relationship with their provider back. But it is still an education point that we must help our patients understand kind of what this is about and what it means and what it does not mean.

Q. So, for the non-native English-speaking populations, there could be an issue with the technology. That is certainly the case with a lot of personal tech. Is that something the technology is beginning to overcome and what are the pros and cons?

Peter: Yeah, that is great. So, the core product in this space for the non-radiology clinician is a product called Dragon Medical One, which is a cloud-based dictation system which approximately 60 percent of all physicians in the U.S. use. The product already supports over twenty-five languages with incredibly high fidelity. It’s sold worldwide today on that front. In terms of the ambient part, as we do these more colloquial conversational stuff that’s earlier in the journey. So, we’re in the process now of morphing that into support. Multiple languages today that is focused on English. But we have a lot of demand, as you would expect, to start penetrating other languages like Spanish, et cetera. So that’s on the roadmap today. So, depending on which product you’re talking about, we either have wide coverage of that or we’re on the early stages for the newest ambient piece.

Q. What are some of the high impact, high value non-clinical use cases for voice recognition technology in healthcare?

Peter: One of the hot areas which crosses both clinical and non-clinical is in the patient engagement space. As you know, like many industries, healthcare is now taking this idea of using digital technologies to redefine what is often called – the digital front door. So, how do you access care and how do you follow up on care using technology? From Nuance perspective, we are a leader in what’s called omni-channel virtual assistant technology. We power these sophisticated applications for companies like FedEx, Disney, American Airlines, when their consumers interact over our telephone line for an interactive voice response system or a chatbot or on a social system like Facebook Messenger. So, we have started to bring all that into the healthcare arena for healthcare providers as they look to do things like manage booking your appointment. Did you prep for your clinical visit? Are you taking your meds? All of these are both clinical and non-clinical use cases.

We are the leading provider of voice biometrics technology for user identification and prevent fraud. This has generally been used in the banking financial services industry for obvious reasons, and we’re bringing that into healthcare now. So that’s a non-clinical thing that we’re seeing. And the last case, which is clinical but is exciting, is there is a whole set of companies that are building technology to use voice to help with diagnosis of clinical conditions. There are companies that are using voice for clinical depression screening, for example. You may have seen recently some COVID screening. So, this idea of using the acoustic signal to predict or screening is at the early stages but is something super exciting for us. We are looking at expanding the capabilities of what voice can do beyond the core use today, which is really for documentation of the clinical encounter.

Stephanie: Authentication passwords and the security of our systems is one of those things that a CIO does keep you up at night. There are just too many systems we all have to be in and out of and so we take shortcuts on the utilization and how we reuse and those kinds of things with passwords. So, I love the idea of voice for authentication on the clinical delivery side. On the patient side, for example, in their homes, as we are looking at that, breaking down of the boundaries of where care occurs and trying to identify that best location to help some of our patients in their home. The best way for them to be able to interact with us will be through voice technology as opposed to any other user interface that may just not be conducive based on some of their limitations. We’re already seeing things where people can set up medication, reminders and things like that, but taking it to the next step of really almost having an attendant at home, a healthcare attendant at home and leveraging voice in that interaction. I think these are some of the exciting pieces in addition. We are starting to utilize the elements of IVR and texting to help improve some of the patient experience elements that are high volume and allow us to be more efficient within the utilization of our in-person resources. And we really see it as a blend. Again, to maintain that intimacy of the relationship. We could start off with some of these automated tools. If they are voice driven, that is then more personal than something else. And then we can hand off to a real person when we get to some of the more complex related things. So, lots and lots of exciting opportunities, I think, with voice.

Q. Peter, you’ve been on an acquisition spree, and most recently you acquired this company, Saykara. Tell us a little bit about where that fits into your overall product roadmap, generally in your acquisition strategy?

Peter: Recently, we had a new CEO come in about three years ago. Historically, we had done a lot of acquisitions and we slowed that down a little bit. But we did acquire Saykara and its really interesting. So, Saykara was founded by a guy named Harjinder Sandhu, who is a close friend of mine. He used to be the healthcare CTO at Nuance about a decade ago, a very sharp guy. And after he left Nuance he went off and started a patient engagement company with a partner of his and then kind of came back to his roots, which is really around the clinical documentation space. They started a company called Saykara to really try to do things like what we were doing with our Dragon Ambient Experience. So, we have been keeping in touch with our agenda over the last couple of years. And recently as they were about to go for their next round of financing, we discussed with them together what happens if we try to combine forces because we really all have a passion for solving this really big problem to help our clinician friends and clients, which is this idea of taking a colloquial conversation and turning that into a highly accurate, structured summarize note with a set of extracted data using a language that often wasn’t even discussed in the conversation explicitly, is a really hard technical task. There are very few people in this world that actually have experience trying to solve this problem. Harjinder’s team had relevant experience. So, for us, it was really an attempt to take our incredible team that we have with DAX and supplement it with the great team that Harjinder had put together and combine that into one journey together with a common mission. That’s how we came together to do this. And so, all the Saykara team are going to be working on our combined DAX effort and we’ll look to integrate components of their technology where appropriate and really try to attack this really important moonshot that we’re all after this in this ambient world. So that’s really what the purpose was of that acquisition.

Q. How has COVID-19 impacted the demand or the adoption for voice-based solutions?

Stephanie: It’s been a really interesting journey over this last year. I think from a technology perspective, one of the silver linings of this pandemic has been the rapid deployment and adoption of a variety of different technologies, some of which was telehealth. We all saw this massive uptick in telemedicine. And we did it in a constructive way. Most of our organizations, for a variety of reasons, didn’t have a ton of experience or a deeply embedded telemedicine infrastructure before that. It really is a different way of delivering care to a patient. It takes practice and experience and a little bit of a different format in order to have a high-quality telemedicine experience with a patient. So, one of the things that we saw was that we had a provider who was sitting in front of a computer, sometimes in front of two computers or multiple screens. Depending on whether the video was integrated, they still needed access to the EHR. They wanted to look at the patient. They needed to create their documentation. And the patient was sometimes looking for additional assistance and kind of how to maneuver through this. It was overwhelming at times to be able to figure out how and what to concentrate on. So, for example, with DAX, it was a great use case. We already knew that it was going to be amazing to take this ambient technology and have a conversation in the background in an in-person interaction, because we want to solve the problem of the documentation burden. But the documentation burden was compounded in this telemedicine environment where we did not have a good way to be able to look at the document, talk to the patient and use the technology at the same time. If the documentation was writing itself while we were having the conversation and I was managing the technology with the patient, what a huge win that was. So, definitely we saw that in telemedicine. And then the other piece, I think was huge was we saw really rapid and sometimes very difficult to predict changes in demand. For example, our nurse call center would at times get a hundred calls in a day and then the next day, with the same staffing plan in place, would receive seven hundred calls in the day. We don’t know exactly which day is it going to happen. One hundred or the seven hundred. It was variable depending on everything else that was happening in the environment, what was coming out in the news, all of those kinds of things. So we began to see that maybe automation with voice was a tool set that we could use to help us get through these high-demand periods. Again, allowing the people who needed to do the in-person work to be able to focus on the highest and most complex elements of DAX and let the voice and other elements maybe be able to help patients who didn’t need that higher level support. And so lots and lots of use cases started to come out around where we could leverage voice to get through this high demand situation where none of us had enough resources.

Q. What have you been seeing in the rest of the healthcare ecosystem?

Peter: On the voice side, specifically, the two big things that have exploded are exactly aligned with what Stephanie did. One is that the clinicians, docs, nurses, et cetera, are not in great shape from a burnout perspective before COVID. And obviously it has been absolutely overwhelming for them. So the demand for anything that could help them get through the day has really exploded, whether it was DAX, our dragon ambient product, or even with our dragon cloud moving more expansively of that. I mean, we had things where a lot of these field hospitals, we work with Epic and others to stand up a whole voice enabled system for field hospitals and a few days in multiple cities. So, there was that whole sort of tools for clinicians to try to reduce as much of this other stuff as possible while they were trying to take care of patients. Stephanie also said the inbound flux of patient requests around prepping for a telehealth visit, trying to log into their portal now about getting a vaccine, have just overwhelmed the [health systems. Most health systems don’t have the infrastructure to deal with it. And as Stephanie said, they certainly don’t have the dollars to fund people to do that. So, our digital patient engagement technology that allows you, just like the website or text channels provide these automated systems to do a lot of the basic lifting for them, both on inbound interactions and outbound. We just also signed deals with several large, major pharmacy chains in the country that are rolling out the covid vaccines now and doing centralized virtual assistant front ends to their scheduling system so people can call up, find out what vaccine are they eligible that actually book an appointment. So, all of that sort of exploded both on the provider side, but also on the health plan and retail pharmacy side as a result of COVID.

Q. What is holding us back from a faster adoption of voice recognition technology in healthcare? What do you think are the big challenges that we need to overcome?

Stephanie: I think the documentation is amazing. We want to do that and help improve that area of the satisfaction of our providers. But now we got to go further than that. One of the challenges that we still need to overcome is the amount of medical information to understand, digest and then utilize in the care of patients is increasing exponentially. We need tool sets that can help us access the relevant information or even provide reminders. So, I really want to see us go beyond documentation and doing things. For example, the relationship between our EHR vendors and the voice recognition side of things so that we can completely eliminate any kind of user interface with our providers that requires a keyboard that is the ultimate goal. Get rid of the keyboard altogether and let me have an interaction, a voice based interaction with the patient and a voice based interaction with the technology. If I need to know when the last CT scan was, let me ask it instead of typing and looking it up. If the system is listening and thinks there’s a piece of relevant information that I should know about as I look into placing an order or creating a plan, tell me about it proactively or alert me that there is potentially a clinical decision, support information that I need in order to make those things happen. The integration between the EHR which now sits at the center of these tool sets and the voice recognition side is an absolute requirement.

Peter: I think Stephanie really hit it on the mark. She really touched on two critical points. So, in terms of driving adoption, obviously the core technology from folks like us has to be good enough to be use number one. I think we have done a good job of that. There’s obviously room for improvement. And certainly, we’re still early on the journey of ambient world. But the early indications are positive. As Stephanie mentioned, there’s two other key points. One is we integrate into other systems. So, the more integrated and more natural the integration is, the better the adoption will be. We’re working with folks like Epic, Cerner, Meditech and others. All these virtual assistant technologies they’ve launched under the names like Hey Epic, Hey Cerner, Hey Meditech are all powered by Nuance technology. So, we’re working with the major EHR vendors to integrate that. So we can do exactly what Stephanie said, which is to basically have a virtual assistant. Every physician and all of us would love to have an intelligent virtual assistant or a physical assistant that works with us. What we’re trying to do is we’re not going to mimic everything a human can do, obviously. But there are a lot of tasks that if you had an assistant, you would really be much more productive. So, this idea of being able to ask what’s the latest CT scan or queue up in order or send a follow up note to the primary care physician, they should be able to do that very seamlessly by voice, as if they were telling their assistant to go do that. Number two, this idea of turning the system into an intelligent system. And for clinicians, generally, what intelligence means is you don’t have to ask it for something. It’s going to recognize something and tell you. So, Stephanie’s example of clinical decision support is a clear one if we’re listening to the conversation of the patient and we know their clinical history, we know what their primary diagnoses are and we hear something, why shouldn’t the system be able to say, oh, it looks like they may be discussing “X’ based on the clinical indicators. This might be a good thing for you to talk to the patient about. That is what’s going to come here as more AI gets deployed to predictive analytics and predictive to clinical decision making. That is really the holy grail here, which is you’ve got a virtual system that can do tasks for you, but it also provides you clinical advice as if they were like a resident or a fellow working next to you.

Q. If there is a best practice that you’d like to share with you as an industry, we’re listening to this podcast. What would that be?

Stephanie: I think the key here is think about the challenges that you are facing organizationally on the front end and the back end. There are so many use cases for this and ask yourself if voice could be a solution for that to help in the efficiency cetera of solving the problem. There are a lot of places that we could leverage voice driven technology that is going to be different than our typical construct. I think it will be effective if we’re willing to be open minded and ask ourselves that question, could voice be part of the solution? And I say part of the solution as my second best practice, which is if voice can lend to the improvement of a situation, it does not mean it has to be the complete answer. So I think the example that I gave earlier about an IVR, having an initial interaction, authenticating a patient, confirming what it is that they’re asking for, and then potentially handing that off to a live person for the more complex parts of what might need to be done is a way to be able to move forward in increments and really start to see progress, knowing that we don’t have to solve the entirety of the problem with one solution, but it might be one of the building blocks. So, think about voice, but don’t expect that to have to be all end all of everything. It may be a component.

Peter: Pick problems that are important to solve and then really get clinician owners and champions inside the organization. In healthcare, there’s a lot of technology promises. And often if you don’t set yourself up for success, no matter how good the tech, it’s not going to be successful. So, I think best practices is having alignment internally, goals we are trying to achieve, metrics we’re trying to drive. Some of this stuff also involves some business process changes and integration with the how to optimize these things. I think having both the supplier of the technology and the internal stakeholders aligned on the objectives, the internal alignment of what we’re trying to drive through and then sort of end-to-end view of how we’re going to solve this, including things that may not be voiced, is really critical so that when you do that, we can absolutely drive meaningful outcomes. We have thousands of examples and material improvements in physician and nursing, satisfaction reduction of administrative time, better financial outcomes, better patient experience. So, if you do it right and you focus on a problem that we can solve with the tech, we can make a difference.

Show Notes

02:36		The move from voice to a more intelligent listening system that we call ambient is really the next generation of technology.

08:30		Healthcare is really now taking this idea of using digital technologies to redefine what's often called in healthcare, the digital front door.

11:47		We're already seeing things where people can set up medication, reminders and things like that on voice technology. The next step is having a healthcare attendant at home and leveraging voice in that interaction.

16:19		I think from a technology perspective, one of the silver linings of this pandemic has been the rapid deployment and adoption of a variety of different technologies, some of which was telehealth.

28:59		In healthcare, there's a lot of technology promises. Often if you don't set yourself up for success, no matter how good the tech is, it's not going to be successful.

About our guest

Stephanie Lahr, MD is the CIO and CMIO at Monument Health, a South Dakota healthcare provider operating clinics, regional hospitals, senior care, surgical units, institutes, and acute care. Stephanie works on the strategy, implementation and management of technologies within the health care system.

Stephanie graduated from The University of Texas Medical Branch at Galveston, completed an Internal Medicine residency, and is board certified in Internal Medicine and Clinical Informatics with an additional certification through CHIME as a Certified Healthcare CIO.

Peter Durlach is the Chief Strategy Officer at Nuance Communications. Peter holds a pivotal role in advancing the portfolio of healthcare solutions to align with industry pressures and shifting needs of healthcare clients. He helped create the Healthcare division and drive significant growth between 2006 and 2011 and then briefly left the company to act as the Entrepreneur in Residence at the University of Pittsburgh Medical Center.

Prior to Nuance, Peter worked as a consultant, president of Unveil Technologies, Inc. and vice president of marketing and business development at Lernout and Hauspie. He graduated from the University of Vermont with Summa Cum Laude honors where he received his B.S. in Business Administration.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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The pace of innovation and development of AI tools is outrunning the FDA and other regulators’ ability to stay on top of AI innovations

Posted on March 3, 2021December 30, 2023 by sanjith p

Season 3: Episode #76

Podcast with Casey Ross, National Technology Correspondent, STAT News

"The pace of innovation and development of AI tools is outrunning the FDA and other regulators’ ability to stay on top of AI innovations"

Hosted by Paddy Padmanabhan

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In this episode, Casey Ross, National Technology Correspondent at Stat News, discusses his recently published report on FDA-approved AI-enabled tools. These are Software as a Medical Device (SaMD) tools that work as decision support tools to supply patients’ data to physicians and help them diagnose and treat the patients. Data is the core ingredient that AI tools use. As per Casey, one of the major issues prevailing in the industry today is that there are inadequate disclosures on data sets used by many medical devices and algorithms approved by the FDA. To improve healthcare outcomes, transparency and disclosure in date sets must be the central agenda in future. He further states that the pace of innovation, development, and building process of AI tools is outrunning the FDA and other regulators’ ability to stay on top of the AI innovations. Take a listen.

Our Podcast Partners:

Q: Can you talk about the report you recently published highlighting the possibility of racial bias in some of the FDA approved AI enabled products and devices?

Casey: I built a database of all the FDA cleared AI algorithms to date. As a reporter, I’m always getting press releases from companies talking about the clearances that they’ve gained from the FDA. But there is no real systematic way to look at those products. There is no database that identifies them to look in totality about what has been approved. So, I took a step further after identifying the products and looking at the level of validation that was done on them, like what was the size of the validation sets? What were the methods used? What is in those data sets? How diverse are they by race, by gender? Where were the data sets gained to get a sense of what level of information was disclosed? What is publicly available? And what I found was that it’s really all over the map in terms of the sample sizes that are used to validate these algorithms. And there’s also really very little information about the demographics of the data sets in a way that raises questions about the ability of these products to generalize across populations. And I found that variation happening even within products that are designed to do the same thing, like assess patients for intracranial hemorrhage or stroke or even things like breast cancer.

Q: What kind of products we talking about here? Are these medical devices, software products, and how many of them did you really scrutinize?

Casey: The category is sort of software as a medical device. These are used as decision support tools that supply data to physicians on patients, that helps them make decisions and helps them diagnose and treat those patients. There were 161 products that I identified within specific product codes. You can search the FDA’s databases to try find these and figure out what validation was done on them. I have read medical studies that suggest there is up to 220 of these products and these are all deep learning AI products. So, it is machine learning technology which have all been approved. We see a vast amount of innovation going on in that area over the past six years.

Q: On your reports you focus on the breast cancer related products. Can you talk about that?

Casey: Yeah, that was an area where I’m especially interested in looking at because diversity really matters, and breast cancer varies so widely among patients. And it’s particularly important to have diversity in those data sets so that any AI system that might be advising a doctor or a physician on how to care for these patients sees enough patients and can give good advice so that its conclusions can be generalized to broader populations of patients. What we’ve seen over time with a lot of medical products and algorithms that have made their way into the market is that they’re not tested on diverse groups of people. And instead, their recommendations, their reliability mainly exists within European Caucasian populations, which shouldn’t be acceptable to patients or medical providers.

Q: So there is reason to be concerned about the lack of a standardized validation process and a lack of disclosure specifically around the data that is being used to develop these algorithms and there is a real potential for racial discrimination. Is it correct?

Casey: I think that’s right. It’s the lack of standards there and in particular, disclosure of the contents of the data sets that is troubling from that point of view.

Q: Based on all your reporting, do you think the challenge lies in the quality of the data or maybe even the sufficiency of the data? Or is it more to do with the deficiencies in the algorithms or is it both?

Casey: I think the biggest issue is the quality of the data and the access to the data such that you can have really, truly representative data across populations and have enough of it to be able to train an algorithm to adequately perform the task you’re asking it to perform. There have been some studies done that suggest that the vast majority of data supplied for AI research comes from institutions in three states in California, New York, and Massachusetts. That’s missing a huge part of the places that we sit in now. So many people in so many communities end up getting excluded from that. This is the major hole right now that this ecosystem needs to figure out how to remedy.

Q: You make a very provocative statement at the beginning of one of your reports – ‘AI is now a lawless frontier in medicine.’ Some people might say maybe it’s just a little bit harsh, perhaps because it has had some success in other areas in healthcare, like administrative functions, revenue cycle operations, claim management, fraud and abuse, or even in chronic disease management. What would you say to those who feel that?

Casey: I’m making a comparison to sort of frontier development, like the development of the American West. I’m sort of making that comparison because I’m trying to crystallize the notion that the sheriff isn’t in town yet, that the pace of innovation, the pace of development, the pace of that building process is outrunning the ability of the FDA and other regulators to stay on top of the questions that innovation is raising. That is a big concern right now. I think the FDA is trying very hard, but I think it’s under-resourced and it can’t keep up with the very important questions that this is raising. The other part of that metaphor that is worth diving into is, does that mean that there are a bunch of bandits out there that are a bunch of evildoers who are trying to gather data and do bad things with it? By and large, from the companies and the people that I’ve talked to, I would say no. I would say that most of them are very well-meaning and altruistic. But there is still the issue of unintended consequences that may arise from the use of products that are not fully and carefully vetted. I think once that process begins to fully mature and catch up with the innovation, everyone will be better for it.

Q: You made a comment a little bit earlier about not been enough data available to do a rigorous training of the algorithms. There is a vast amount of data available in the form of images, more so than other forms of healthcare data. What can we do with the large amount of data available, especially the data sitting in our systems, for instance, in hospitals?

Casey: It’s very hard for researchers to come by to aggregate that data to do anything meaningful with it. EHR data is notoriously siloed and kept in environments where it’s just very difficult to access the data and make use of it for meaningful research and purposes that could really benefit people. I think it’s very difficult to harness that data, even though there is so much of it. And about the imaging data, I think a big question for the industry and a big problem right now, is the issue of transparency. Where are those data sets from? What is in them? We need to know the ingredients of these algorithms. We need to know who these people are, where they come from. We don’t need to know their identities. I don’t mean to suggest that, but we need to know how these algorithms are being built on what data so that there can be some confidence in these products, that they can generalize and do what the developers intend.

Q: What are you hearing from policymakers and industry executives, especially tech firms, on how they’re wrestling with the ethical use of data and how they’re moving forward with this?

Casey: Over the past six months a lot of companies are realizing that this is an issue and they’re bringing it out into the light and wanting to talk about it at industry conferences and on virtual gatherings and so forth, to be able to set forth, OK, well, you know what? This is an issue for us in terms of optics. We want to be inclusive companies. We want to emphasize that. And you’re seeing a lot of those companies’ fund research and hold events to talk about it. But there isn’t yet sort of a consensus that emerged on the best way to accomplish this. What are the set of practices that ought to be used to ensure that these products are inclusive and don’t unintentionally discriminate against certain groups? So, I think there’s kind of a recognition that these issues need to be addressed. But how to do that really has not been agreed upon, there really aren’t any clear best practice standards that have been identified. There is just a process that’s beginning to confront those issues.

Q: Is this a question for the FDA or is this more for the industry to self-regulate and self-governance and come up with the best practices and hope that the outcomes are good? What is your thought?

Casey: That is really the big question right now. Whose responsibility is that? Where should that vetting process take place? Should it take place at the FDA before these products get onto the market? That is not happening right now. Some of the people I have talked to, executives of companies say, the FDA clearance, the 510 K clearance that’s granted to most of these products has never really filled that role for any kind of product. So, usually what happens is there are follow up studies done at conferences and by clients of these products to bear out their efficacy. And there is a process that takes place normally in the private market to verify that these products are the best things for patients. The responsibility lies on the health systems to adopt products that are really going to benefit the people. Data is the main thing that these products use in order to deliver services, to help inform physicians to provide care to patients. You wouldn’t say to somebody – ‘you should just take this drug. Don’t worry about it. We don’t need to talk about the ingredients or where it came from or what’s in it. Just take it, OK? It’s fine.’ You would tell them the ingredients. It would be studied rigorously. You would know who is in those validation data sets, you would be able to analyse it in all the different cohorts and how it affects different racial subgroups. That’s done now in public at the FDA for drugs. Now, drugs have a different risk profile. Hence, the data analysis should be rigorously done and must have transparency.

Q: We’ve recently seen some initiatives, especially the one where several health systems come together and formed Truveta, that is going to pool patient data from several leading health systems and use it to analyze it for insights and help improve healthcare outcomes. There are also some other initiatives like the synthetic data challenge that the ONC has come up with. All are looking to address the same problem that there isn’t enough data for us to really analyze or train the algorithms and come up with some kind of heuristics or benchmarks for us to drive the outcomes. Would you care to comment on these initiatives? And is that an alternative? Is this a viable alternative that is taking shape?

Casey: It’s a timely question. I’ve been talking to the executives and stakeholders that founded Truveta over the past week or so to talk to them about that initiative. I think it is interesting in something that the industry, by and large, has just failed to do to date, and that is aggregate a large amount of data that comes from health systems all over the country and not just health systems that are on the coast. Those 14 health systems that are gathered in Truveta represent patients who are spread throughout 40 states all over the country. So, I think that’s really exciting and potentially provides a really great resource that researchers can tap to be able to gain access to large amounts of representative patient data. There still are a lot of questions though with that because we all know about controversies that have arisen from, say, given the hospital system, working with a tech company and sharing their data with that tech company because of all the privacy questions and questions of economic exploitation that might arise from that. It is like you’re using data from the patients that got care at your institution. Then you are selling that data to another entity to do research on it to build a product that that entity will profit from and not necessarily the patient. So, there are issues of consent that get raised in that. There are questions that should be raised and talked about so that there can be a consensus or at least an open public discussion about how to get access to that data, who does it benefit, how to do this in a way that respects the patients and all of the stakeholders?

Q: What are the top two or three items of the unfinished agenda in harnessing data for us to really make a difference in healthcare outcomes? One is interoperability. Can you share your thoughts on this?

Casey: I think interoperability is a key issue and that issue is part of developing data sets at scale, large enough data sets that can be used by researchers and companies to be able to build meaningful and generalizable AI products that will benefit everybody. I think the biggest issues in my mind about that are really transparency, disclosure and some of those regulatory questions. I think it’s really important to think about the nature of these products, which are machine learning. It’s a computer that is able to comb the contours of a data set to form conclusions on its own without being explicitly sort of programed. I think when you have a system like that where it might be somewhat of a black box about how it is reaching the conclusions that it’s especially important for people to know what is going into those training sets. How is it being tested on what data is it being validated? Are these things at the end of the day going to improve care or are they just going to layer on top of care an additional level of cost without providing the benefit that they advertise? And I think that process just must unfold in a meaningful way so that, before we start paying for these things, before they get into the market and start providing care for people, we know that they are fair. We need to know that they are safe. We need to know that they stand some chance of improving care to people. So, I think those are the things that sort of need to be front and center questions that are addressed over the next few years.

Q: To sum it up in one word, would that be transparency?

Casey: I would say that would be the word I would choose as the one word that the industry needs to sort of focus on in the next couple of years.

Show Notes

04:52		It's important to have diversity in data sets so that any AI system advising a doctor / physician on how to care for these patients can give good advice and conclusions that are generalizable to broader populations of patients.

09:07		The pace of innovation, the pace of development, the pace of that building process is outrunning the ability of the FDA and other regulators to stay on top of the questions that innovation is raising.

12:07		A big question for the industry and a big problem right now is the issue of transparency in data sources.

21:42		The biggest issues while harnessing data are transparency, disclosure, and interoperability.

About our guest

Casey Ross is a National Technology Correspondent at STAT and co-writer of STAT Health Tech, our weekly newsletter on the growing digital health industry. His reporting examines the use of artificial intelligence in medicine and its underlying questions of safety, fairness, and privacy..

Before joining STAT in 2016, he wrote for the Cleveland Plain Dealer and the Boston Globe, where he worked on the Spotlight Team in 2014 and was a finalist for the Pulitzer Prize. A Vermont native, he now lives in Ohio with his wife and three children. When he's not with them, he's in his cornfield, cultivating some of the sweetest bicolor in the Midwest.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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The biggest challenge in digital engagement and its adoption is shifting to a consumer mindset

Posted on February 28, 2021December 30, 2023 by sanjith p

Season 3: Episode #75

Podcast with Mona Baset, VP of Digital Services, SCL Health

"The biggest challenge in digital engagement and its adoption is shifting to a consumer mindset"

Hosted by Paddy Padmanabhan

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In this episode, Mona Baset discusses how SCL is transforming its digital capabilities to provide a seamless digital patient experience just like other industries – retail, travel, and financial services.

According to Mona, one of the biggest challenges in adopting digital engagement is shifting to a consumer mindset. Health systems are now increasingly focusing on their digital front door initiatives. However, one of the biggest challenges in building a robust consumer app is incorporating both outside and native foundational capabilities, and bringing together a single native app.

SCL is a non-profit healthcare system and focuses on patient engagement and technologies to enable better patient experience. Take a listen.

Our Podcast Partners:

Q: Tell us about SCL health, your role as the VP of Digital engagement, your responsibilities, and who the role reports to.

Mona: SCL health is a faith based non-profit healthcare system. We’re based in the Denver metro area, and primarily serve Colorado and Montana. SCL Health provides care across eight hospitals, more than one hundred clinics, and areas such as home health and hospice, mental health, and safety net services. My role as the Vice President of Digital Services was a newly formed position when I joined and it is part of the information technology and digital services organization here. I report to our Chief Information Digital Officer, but I really find that my role straddles a few different worlds – technology, marketing, consumer experience, engagement, associate engagement, and innovation. I get to work with a lot of incredibly talented people across all those areas. My team primarily focuses on engagement and the technologies that help enable those experiences. They are responsible for everything from our external website to our internet site, digital marketing and automation platforms, application development, and user experience. There are some new areas as well where we’ve begun to explore and implement like arts and robotic process automation. We find that when people have different ideas or things that they want to do or explore, oftentimes those ideas start with my team and then we can sort of assess them and figure out how to move forward.

Q: Can you walk us through some of the initiatives that you’ve rolled out in the last year and a half, especially in the areas of digital front door marketing and digital patient engagement?

Mona: When I arrived at SCL Health, we had a basic level of digital capabilities in place. We had MyChart, external website intranet, an older CRM instance, and virtual care capabilities. There was a lot of room for improvement to create that wonderful experience for patients, consumers, and even our own associates. We did a quick assessment of the current tools and some basic customer journey mapping. Once that information was laid out, it was easy to see where the gaps were and what we needed to put in place to fill those gaps. We did some prioritization exercises and some mapping exercises after generating some interesting ideas. What we really wanted to do was to deliver an experience that was similar to what consumers are expecting in other industries like retail, travel, and financial services.

We organized the efforts into four streams. One of those work streams is customer relationship management. In that area, we rolled out a new implementation of Salesforce Health Cloud and Marketing Cloud. We finished that up very recently. We are also looking at call center tools and consumer contact center transformation. Underneath that workstream, we are rolling out some different capabilities around automated communications to patients and consumers through text and email and phone.

The second workstream is what we’re calling digital workforce. If you think about that area, it’s really some of the automated tools and processes that we can put in place. For example, chatbots would fall in that area. So, we’ve rolled out a few different types of chatbots focused on different capabilities so consumers and patients can get the answers they need right away without having to wait to talk to someone. We’re also exploring some robotic process automation to help us become more efficient on the backend.

The third workstream is about associate tools. Currently, we have a very large-scale project underway to completely redesign re-platform our internet site for our associates and our providers. That will be rolled out mid-year. We are also looking at different ways to communicate among our associates, some HR focused tools and technologies.

The final workstream we are focused on is consumer and patient experience. This is where you find things like our external website, which we’re constantly improving and updating. That’s where you find MyChart optimization. We rolled out a brand-new provider directory to help people search for providers and schedule really easily. And this is also where we’ve been partnering with our innovation team to roll out a new consumer app that is actually rolling out next week. We’re super excited about that. It’s going to give our patients and consumers a really nice, streamlined way to access our services and information.

Q: With regards to consumer engagement and your role, what do you see as the big challenges in digital engagement and adoption?

MB: Healthcare no longer gets a pass on consumer experience. People are comparing their experiences with healthcare to their best experiences in other industries, and they’re expecting more now. I think the biggest challenge in our industry is really shifting to a consumer mindset. This is something that I think was slowly happening. COVID really accelerated that journey.

For example, prior to COVID, virtual care was available here, but it was slow to be adopted by our providers and our patients alike. When there was really no other option for care at certain points in this pandemic journey, we went from under one hundred video visits a month to thousands and thousands of video visits immediately. Now both providers and patients have experienced sort of the new way of doing things. They can see the ease and convenience and the effectiveness, and they see that they can get things done in the healthcare space, in a virtual way.

While we may not see the huge numbers that we saw at the very beginning, when there was really no other options for care, we will see this virtual care continue. Even after COVID isn’t part of our every thought and conversation, challenges of getting things rolled out while keeping that consumer mindset as a technology organization for healthcare system remains. Our job is really to support that acceleration toward consumerism and put on the table everything we know and everything we can learn to make that happen. We have to take that knowledge and not only be technologists, but we also have to be salespeople and we have to be marketers to be able to show our internal stakeholders and our patients how much better it could be for them.

Q: What are some of the biggest challenges that you faced when it comes to preparing yourself for this emerging virtual care era and digital engagement you just described?

MB: From a career perspective, I essentially grew up in marketing and many years in consumer financial services. When I made that transition to technology a few years ago, the consumer was always the starting point and the end point for me. We’re really taking that approach and are focused on how we can deliver care safely and effectively. We’re offering more types of virtual care than ever before and we’re listening to consumers. We have a patient family advisory council approach that we take and we connect with these patients and their families regularly to understand what they’re going through, what their journey is, how can we adapt to meet those needs? What additional engagement channels can we offer to really empower them to take control of their health journey? And I think so many things are involved in building that strong brand and that high level of consumer engagement is certainly key. The word, or the phrase digital front door is an interesting one, because it almost suggests that there’s just one door, but there are many doors. Our website is one of the digital front doors, our consumer app is another. So, we’re really trying to provide options and as we look at how our website functions, we’re looking at how are consumers expecting to engage with us? What do they expect to find there? And we’re trying to make improvements across the board so they can find information quickly. They can self-service, they can reach out to us if they need more help and just really giving them that full experience.

Q: From a technology choice standpoint, do you start with a bit of capabilities that are available in your system or do you start with a blank sheet of paper and look at what the best-in-class tools are out there and recommend and implement the ones that make the most sense from an impact standpoint?

Mona: I think a little bit of both. We have as an organization, five strategic platforms that we focus on and they really serve as solid foundation for our work. We have Epic for our EHR, Google for communications within our organization, Salesforce, Oracle ERP that’s going to be launching in April, and ServiceNow for internal types of requests. We try to start there and in many cases we have to consider additional capabilities. Obviously, these are very foundational and only do certain things. So we look at both. We are looking at some guiding principles that we use when we’re making technology choices. We want to be sure that we make experiences easy and low effort and want to focus on the user and their needs, not our processes. We want to leverage the small number of connected platforms that are needed, because it’s just much easier to manage. We also want to personalize experiences based on deep knowledge of our users, and we want to provide options to engage with us. We start with our foundational platforms and then when we decide to bring in other tools. Sometimes we do bring in sort of those proven best-in-class big tech solutions.

We’ve brought in a lot of others that are more in startup mode and they may ultimately become best-in-class. I think about some of the recent work we did to completely rebuild our provider directory on our website and all of the chatbot technologies we’re introducing. So, for those we partnered with what I consider to be smaller, really innovative companies that are nimble and creative and just offer solutions that are very unique and partner with us really well. We can almost co-develop solutions with them and it’s worked out great.

Q: When you talk about startups, there could also be risky bets. For instance, what if they run out of money from the venture capitalists or they lose their key individuals because they’re a small team. Have you ever had to plan for that kind of a situation, or have you had to actually live through one of those?

Mona: Thankfully, we have not. We know that is certainly a risk. These organizations are much more willing to partner with us to give us exactly what we need and really fitting into our budgets. As a not-for-profit, we don’t have huge budgets. So, it is a tradeoff and we have not experienced anything yet. We have taken those risks and have been able to deliver some interesting capabilities. I’m pretty happy about that and proud that we have really been able to partner with some great organizations to do so.

Q: How are you leveraging your internal datasets, patient histories and how are you combining that with externally available data sets? What is the framework you’re applying and the infrastructure you’re investing in order to harness the data, and improve and deliver the kind of experiences that the marketplace is looking for?

Mona: Data analytics is such an interesting topic these days. We have so much data out there. I would say it is truly at the heart of the work we do in digital engagement. Epic is our source of record for patient information. We don’t try to recreate that. I know other organizations have sort of challenges with some of that, but we really leverage that data as much as possible so that we truly know our patients. We can customize communications and touch points to them. I will say that in any digital project we have launched, data piece takes the longest. It’s the most complex and requires a lot of thought about data models and how integrations are going to work for our CRM implementation. We spent a lot of time building the right data model and integrations just to ensure that we have the most accurate and recent data available to help engage with our patients. If that information is not correct, then you are not engaging in a way that patients find useful. We are working on a similar project around expanding some automated communications to patients like those who are discharged from hospital. We’re spending a lot of time to make sure data is perfect so that the messages we’re sending makes sense and are relevant.

Q: When you talk to your peers across other health systems, what are some of the best practices? Can you share one that you’ve either adopted from one of your peers or one that one of your peers may adopt from your own experience?

Mona: As I look at what some of my most innovative peers are doing at other health systems, I’ve seen some really interesting implications and tools. I think COVID is top of mind. Some of those COVID related innovations have been pretty incredible, everything from vaccines management to screenings. One of the things I’ve seen more and more health systems working on is delivering on that consumer app approach, what might be called the digital front doors. They’re doing a great job at that. The best ones are addressing one of the biggest challenges in building a robust consumer app, that is, to have a plan for how any new capabilities, including those that might be offered by many different vendors, are brought together seamlessly for the consumer in a single native app. Sometimes your foundational platform just can’t deliver everything and you’re going to have to go outside of that and bring in other capabilities. But how do you make that invisible to the consumer so that they feel that they are just dealing with one organization, one tool, and they’re able to see everything?

I think as far as other best practices go and something we’re exploring and hope to make a best practice is really the use of artificial intelligence, patient engagement. When a consumer or patient doesn’t need to talk to a person and in many cases they don’t want to, they just want to be able to get things done themselves using chatbots and other artificial intelligence, and that’s a good thing for them. We try to leverage some of that and roll things out quickly, especially early on in COVID. So, we rolled out a chat that would allow people to learn more about COVID, take a risk assessment. It really reduced the anxiety that consumers had about COVID and reduce the number of anxious phone calls that came into our care sites, in our clinics. We’ve used similar technology to screen associates before work for COVID symptoms to keep them safe and our patients safer. Recently, we launched some additional chat technology on our website to answer key questions and information that consumers and patients have. We can change that on a daily basis. If we find that people are asking a lot about vaccines, for example, we can do that. So, we hope that will become a best practice going forward.

Q: Do you primarily rely on externally developed solutions for assembling this whole consumer experience? Are there pieces that you take complete ownership of, for instance, the mobile piece, if you do that internally and then have all of the embedded components behind the scenes come from different sources, or are you really looking at buying it all off the shelf where in that continuum are you?

Mona: I think it’s a little bit of both and sort of a hybrid. For example, with our CRM implementation, we purchased a solution for that and implemented it. Our internal team takes that over and maintains it and enhances it, similar to what we’ll be doing with our new consumer mobile app. We partnered with an organization to help us build that from scratch. Then we will be taking on the maintenance, the enhancements going forward. So, I think it’s a little bit of both. In some cases it makes sense for us to be able to have the autonomy to build on a platform and be able to be very flexible with improvements, enhancements in many cases.

Show Notes

09:35		Biggest challenge in digital engagement and its adoption is shifting to a consumer mindset.

11:03		Technology organizations for healthcare systems must support virtual care acceleration toward consumerism

13:34		The phrase digital front door is an interesting one; it almost suggests that there's just one door. But of course, there are many doors.

22:11		Sometimes your foundational platform just can't deliver everything and you're going to have to go outside of that and bring in other capabilities.

About our guest

As Vice President of Digital Services at SCL Health, Mona Baset leads digital strategy and transformation, including development and implementation of the digital technology road map. Prior to joining SCL Health, Mona was Assistant Vice President in the technology organization at Atrium Health, leading consumer engagement strategies.

Previously, Mona spent almost 10 years at Bank of America, where she led various marketing and communications teams. Mona holds a bachelor’s degree in English from the University of California at Irvine, a master’s degree in Communications from Cal State Fullerton, and a master’s degree in Business Administration from Wake Forest University.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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Our focus for virtual health is making sure encounters are documented in such a way that it is not burdensome

Posted on February 22, 2021December 30, 2023 by sanjith p

Season 3: Episode #74

Podcast with Katherine Lusk, President / Board Chair, AHIMA

"Our focus for virtual health is making sure encounters are documented in such a way that it is not burdensome"

Hosted by Paddy Padmanabhan

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In this episode, Katherine Lusk discusses how AHIMA works at the intersection of healthcare and technology to empower patients with their health information, and ensures to keep the data accurate, accessible, and safe.

Health systems are working towards mapping patient data to the EHR systems so that the frontline care providers have the information readily available to improve healthcare delivery and outcomes. The next step is to standardize the data normalization process and make it interoperable while taking care of patient data privacy, confidentiality, and security.

Katherine says that the industry must now focus on implementing initiatives to reduce social issues such as the digital divide and health inequalities . She further states that AHIMA’s focus is to make sure that patient’s virtual health information is documented in a safe, secure, and convenient way. Take a listen.

Our Podcast Partners:

Q. What has been your professional journey and how did it lead you to your current role at AHIMA?

Katherine: I think it’s inspiring because if I can do it, anyone can do it. I’m from Gainesville, Texas, which is a small town in North Texas, and I went to work in 18 years of age at Gainesville Memorial Hospital. I worked my way up from a clerk to become the director of Health Information Management. From there, I went to Fort Worth and worked in the Osteopathic Medical Center of Texas, which was an academic medical center focused on the geriatric population, where our average age was eighty-three. Then, I went to Children’s Health System of Texas, which is a pediatric healthcare system with the average age being four. So, I’ve worked at two very different spectrums of healthcare delivery. The documentation and the rules and the governance and the empathy that needs to happen to support patients and families is the same regardless of the setting. Recently, I’ve gone to work for the Texas Health Services Authority with a focus on health information exchange within Texas that includes public health. I’m taking what I learned from the frontline at a local hospital to a geriatric healthcare system to a pediatric healthcare system and applying it at a state level on how we can exchange information in an accurate and complete manner, across the state of Texas to improve healthcare delivery.

Q. We are still in very early stages of harnessing data in a comprehensive way, especially relative to other sectors. Would you agree with that? And what are you seeing across health systems in this regard?

Katherine: I would have to agree and disagree a little bit. I think healthcare is beginning to harness data and efforts to improve patient safety. With clinical decision support to identify duplicate tests and take advantage of tests completed, they’re beginning to map data so that it appears within the electronic health record and allows the frontline care providers to have that information front and center. They are also beginning to look for different ways to streamline the administrative processes. What is curtailing us from doing that is normalizing the data across platforms and organizations. Most organizations in electronic health records have the normalizing data process down using SNOMED and then using intelligent medical objects to translate the very diverse, nuanced clinical data into clinical languages and classification systems to normalize within themselves. So, the EMR vendors have taken advantage of that and they normalize data within their own EMR vendors. But with the care quality and with e-health exchange, that data normalization has occurred on a much broader spectrum. Things are much better than they were even in twenty seventeen. The pandemic forced things to move along at a much more efficient manner and a much faster pace. Before the pandemic there was lots of discussion about mapping laboratory test results across different EMR platforms so that they wouldn’t have to be repeated and using LOINC codes. And it was lots of discussion and hashing with pathologists and with other clinical care providers on how you actually go about normalizing this data. But with the pandemic and COVID-19 people came together and figured it out. I think things are much better than they used to be.

Q. What are your key themes that you’re focusing on, your advocacy efforts this year at AHIMA?

Katherine: We have a big year planned at AHIMA and our 2021 advocacy agenda seeks to transform healthcare by connecting people, systems, and ideas. We’ve embraced three principles that directly align this vision and underpin our work, outlook, and our advocacy efforts – access, integrity, and connection. We’re advocating for the use of accurate and timely data for public health responses and initiatives while protecting confidentiality, privacy, and security of individuals health information. With the pandemic, we feel that public health was not supported sufficiently in the past, and we’d like to focus our attention on making sure that sector of the ecosystem has the information they need. We are firm advocates for the individual’s right to have timely and seamless access to their health information. We had a consumer advocacy pledge campaign earlier this year where we had our members reaffirm our pledge to consumer advocacy on having access to their records. We have been advocating for accurate patient identification to improve patient safety, interoperability, and the appropriate use of workforce resources.

We also understand that with the pandemic and with all of the social issues that we’re currently experiencing, social determinants of health must be the focus to enrich clinical decision making and improve health outcomes. We believe that public health is supported, and health inequities are diminished. We must can gather this information and culturally respect and manner and portray it accurately. We really believe in advancing a complete, accurate and timeliness of data by influencing the development and maintenance of national and international coding standards. Where policy goes, so does the public. We started the Patient Identity Now Coalition, where we worked with six of our partners, the American College of Surgeons, CHIME, HIMSS, Intermountain Healthcare and Premier. There is a coalition of healthcare organizations that are really advocating discussion around a unique patient identifier. So, if you haven’t looked at that, I want to encourage everyone to look at the Patient Identity Now initiative.

Q. Can you touch upon one or two things in the context of telehealth, which obviously in the wake of the pandemic has been on a tear? Can you talk to us a little bit about how this growth in telehealth needs to be viewed in the context of AHIMA’s mission and your priorities?

Katherine: The convenience of telehealth has changed delivery models. Telehealth was being embraced prior to the pandemic, but with the pandemic, it was a wholesale embrace. It moved healthcare delivery from solely brick and mortar into the virtual arena much faster. With AHIMA and our work, we focus on what are the documentation requirements for telehealth, how do we classify the diagnoses that are captured in that arena, how do we make sure that patients have consented to their information being shared in that manner, and how do we keep it safe and secure. Our focus for virtual health is making sure that the patient’s information is safe and secure, making sure that the encounter is documented in such a way that it completely explains the encounter but not be over burdensome.

Q. Where is the challenge in harnessing all the data we receive from different sources? Is it a technology challenge, a better-quality challenge, policies challenge?

Katherine: I believe it’s probably a data quality challenge, because just like all other clinical data, when we began the journey, we had to figure out how to normalize the data. We had to translate the clinical language into SNOMED and accurately capturing that in the electronic health record and then transferring that to clinical language or the classification system. So I believe social determinants of health is our next step on that clinical journey. While they’re not widely used now, we do capture some with ICD 10. Now, are there more that is needed? Absolutely. I believe that as we go through this journey and begin to utilize information and embrace these concepts, data normalization process will only get better and better.

Q. What is the State of the Union today as it relates to a patient privacy? Are there adequate privacy safeguards, especially when we see data being moved to the cloud, or now that we’ve got the final interoperability ruling that’s coming up. And patients are now going to have access to their own data and can share it with anyone they like. What should we be careful about?

Katherine: At AHIMA, we worry the most about is apps, and patients and families using these apps and not really understanding that how their information might be shared. How they have really given away the most personal thing they have, which is their clinical information to an app without completely understanding that information might be sold to someone else, used for marketing, used for a vendor’s personal financial benefit, and it might not be protected. I think that’s one of our biggest concerns now. I personally love an app and I love the convenience. And I’m like everyone else. I have a Garmin and my husband has a Fitbit that we track our health. We take advantage of all those things. We also do 23andme. From a human standpoint, we want to make sure that patients and families and individuals like you and I understand that we are giving away pieces of our very personal information and we want that information to be kept secure and private. The healthcare organizations are ruled by HIPAA and so patients and families and you and I believe that our healthcare information is protected. We’re forced to sign HIPAA requirements when we go to the physician’s office or to an ED or anything like that. So, we’re lulled into this feeling that healthcare information is so sacred and that is so protected. Then when we give that information to an app or a personal health record and a portal, that information is not held to the same standards. We want to make sure that everyone understands that they’re not following the same rules of engagement and to be very considerate of that.

Q. What is your advice for startups and digital health companies that want to go deep into the data and take the data and combine it and use it and analyze it and create new offerings out of it? What is your advice to them to safeguard the data, but also to be successful with it?

Katherine: My advice to them is, be the crane that rises to the top. People will choose to use their apps if they are convenient, useful, safe, and secure. When you develop these healthcare apps, you want to be able to normalize that data and integrate it into the longitudinal record of care. You don’t want to be standalone. These apps need to understand the clinical languages and the classification systems that the big vendors understand. They need to have a depth of knowledge with them. I would also advise that they use standards and look at what those standards are and not be frightened of them, but to embrace them so that they can leverage those standards and integrate with the EHR. They must understand that they are a cog in the healthcare wheel, that we’re all cogs in the healthcare wheel. And we’ve got to figure out how to integrate the data into the entire ecosystem so that it can be shared with everyone. What I would suggest that they do is engage the health information management professionals to help them understand the clinical language or classification system for data mapping and to serve as a guiding hand with patient privacy. This discipline serves in that middle space, and I think it could be very, very helpful to them.

Q. If I were to summarize you here – adopt standards, be interoperable with the EHR systems, but also with other similar applications, take care of patient privacy and protect their privacy with all their applications. And finally, you referred to us being cogs in the wheel. I like to say that healthcare is a team sport, and we are all part of the same team. Do you agree with that?

Katherine: Absolutely. Healthcare is a team sport, and the patient is the captain of the team.

About our guest

Katherine Lusk, MHSM, RHIA, FAHIMA is AHIMA’s 2021 President / Chair. As an active AHIMA member her attention is focused on championing the profession, patient identity, health information exchange, standard development, and information governance.

Her previous leadership roles include serving on Epic’s Care Everywhere Governing Council as Co-Lead, eHealth Exchange Workgroup Member, ONC Patient Identity Workgroup, TxHIMA President, and the Texas Interoperability Collaborative. She is a sought-after national speaker on information governance, standards, interoperability, clinical documentation improvement, patient identity, leveraging technology and promoting the HIM profession.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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A lot of point solutions are emerging, but if they’re not integrated into the EMRs, they’re likely to fail.

Posted on February 18, 2021December 30, 2023 by sanjith p

Season 3: Episode #73

Podcast with Harry Fox, Board Chair, Whitman-Walker Health

"A lot of point solutions are emerging, but if they’re not integrated into the EMRs, they’re likely to fail."

Hosted by Paddy Padmanabhan

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In this episode, Harry Fox discusses his role at Whitman-Walker Health (WWH) and how as a community-based health center they are serving a diverse patient population with technology disparity and making healthcare inclusive for everyone.

WWH is a federally qualified health center. A significant part of their patient population is the low-income group and LGBTQ community. Harry shares that half of their patient population is below 100% of the federal poverty level, and around 40% are below 50% of the federal poverty level. This automatically creates an issue of digital divide among them where they struggle with technology. Technology providers are addressing these disparities, and several standalone point solutions are emerging. However, the two major issues – interoperability and integration – still exist in the healthcare space. Take a listen.

Our Podcast Partners:

Q: Can you talk about Whitman-Walker, your role there, and about your prior experiences?

Harry: Whitman-Walker is a federally qualified health center. It was started back in 1979 to serve the needs of the gay and lesbian community of Washington. Since then, it has evolved with all kinds of services for the growing demand in Washington. About 10 years ago, it became a federally qualified health center. Today, it offers medical, dental, mental health, specialty care, specific youth service, and pharmacy services in multiple locations. Whitman Walker has a division that does clinical research in HIV and hepatitis. It’s got a policy and advocacy arm, and an education arm.

I joined the board back in 2014 when I was still the CIO of CareFirst. Today, I sit on two boards – Whitman Walker Health, which is the federally qualified health center where all the clinical services are, and also chair the board of Whitman Walker Health System, which houses the Whitman Walker Foundation and the Whitman Walker Institute for Research Policy and Education. It has been a fascinating ride. I’ve been in healthcare forever but began around 1999 in what was then called e-commerce, which we now call digital health. I started in the space with PricewaterhouseCoopers, then through Coventry Health Care as their vice president of eCommerce, and then at Kaiser Permanente as the regional CIO. Lastly, at CareFirst, and then, in more recent years, as an independent consultant. All of my work has its anchor in core digital health. I had the opportunity at the beginning at Kaiser Permanente to implement the mid-Atlantic region’s first telemedicine for primary care in certain specialties like dermatology, and then at CareFirst, worked extensively with third party telemedicine vendors to implement that service for our members.

Q: How has the pandemic impacted care for Whitman Walker’s patient population?

Harry: It’s been dramatic. When Washington DC issued their stay-at-home order, we shut down for two days. Over those two days plus a weekend, we pivoted completely to virtual services.

Whitman Walker uses eClinicalWorks as their EMR. In a three-day period, they had to bring up the module, test it, develop patient education documents, and develop staff training documents. They implemented DocuSign, because all the forms that you would fill out in the office, now had to be done virtually. Luckily, CMS around that same time made some changes in both repayments. So, if we couldn’t do telemedicine, we could do an audio encounter with a patient who might not have been able to do video services and we can still get reimbursed for it. CMS also lifted some of their licensure restrictions. Earlier, patients came to us in one of our locations in Washington, DC. Now that we serve the tri state area, we have patients in Maryland and Virginia and then a small population of patients from across the country, who come for our specialty LGBT care. Before the pandemic, if you weren’t licensed in a state, you couldn’t virtually see someone in the state. That’s been lifted now, at least temporarily. So, we pivoted over a very short time and opened on Monday morning. Everything went virtual, except for a small number of patients who were still coming in for more serious issues – COVID related and breathing kind of issues.

All the rest went virtual and it’s continuing to evolve. We had started out with everything on the eClinicalWorks. We found that for patients with behavioral health, some in individual and some in group sessions, eClinicalWorks couldn’t handle groups. It handled patient to doctor. So, we pivoted to zoom for behavioral health. Also, the bandwidth demand was better in Zoom with lower bandwidth could still get high quality video. ECW had a little bit higher requirement for that. So, we now operate with eClinicalWorks for all of our medical and dental patients and then we use zoom for behavioral health and substance abuse treatment for individuals and groups.

Q. Were there any unique needs for the LGBTQ populations that you had to take care of while standing up these capabilities?

Harry: As a federally qualified health center, we serve the entire community, and a portion of our patients are in the LGBT community. Because it’s a federally qualified health center, it’s often lower income. So, we have issues of technology disparity where people may have a cell phone but may not have an email. We find our younger clients usually have a phone but often don’t have a PC or a tablet. Our older patients may or may not have a phone, or another device, but often struggle with the technology. I have a 92-year-old mother that I do tech support all the time and I know how hard it can be when you’re trying to get someone to hold the camera a certain way and point the camera here. A lot of people have these challenges. About half of our patient population is below one 100 percent of the federal poverty level and thirty nine percent are below 50 percent of the federal poverty level. We have folks at the other end of the spectrum, too. When you have this tremendous diversity of background, it makes rolling out telehealth ubiquitously difficult. We have patients, living at the lower end of the poverty level, who may not want us to see where they live. They may have access to technology, but they’re uncomfortable having their homes seen. There are these very interesting, unique situations that are not LGBT specific, but are more issues of equity and what people have in terms of education and access to high-speed internet and technology.

Q. What are you seeing in terms of efforts by the technology community to address these technology disparities and making healthcare more inclusive for everyone?

Harry: It’s an interesting question. We got two small grants and we’ve been able to purchase three Wi-Fi only phones. That’s helpful up to a point because the individuals in the community may or may not even have access to Wi-Fi. There is no Wi-Fi in some areas of Washington, D.C. So, it’s useful if someone doesn’t have a phone, but they still have to access Wi-Fi for a virtual visit. There is a lot of point solutions I see emerging, but if they’re not integrated into the electronic medical record, they’re likely to fail. Every time you’ve got a standalone point solution, it is more work. When we’re using Zoom, we have to schedule the patient in the EMR and then schedule zoom separately. We’re using the eClinicalWorks for a virtual visit only and then we’re using them for the digital part as well. It’s all set up within the system. We create the scheduled event, we say that it’s digital. Automatically, the patient gets an email with the link and then later a text with a link. So, there’s some really fast emerging useful technologies in this space. The issue all along has been interoperability and integration.

Q. If you just expand the Zoom versus the eClinicalWorks situation you went through, how you kind of roll it out across a broader ecosystem?

Harry: The larger, well-funded delivery systems have the luxury of having enough cash and can choose best-in-class solutions and integrate themselves or work with the vendor to integrate them. If you’re a CIO of a small clinic, you don’t have that luxury. In Washington, in Whitman Walker’s case, eClinicalWorks is funded by the DC Primary Care Association for all seven FQHC’s in the District of Columbia. So, it’s not a technology choice Whitman Walker made. They wouldn’t have been able to afford that kind of platform without the DC Primary Care Association. So, your ability to pick best-in-class really depends on who you are and what kind of assets you have to invest in technology. The bigger systems just have the luxury of doing a lot better job of picking best-in-class solutions. Although I will say that there’s a thorn there too, because if you let best in class run wild, you have a situation soon enough where vendors get acquired. What was best-in-class this year is not best-in-class next year. And so, you’re pulling things in and out of connectivity around your electronic medical record, which is kind of the heartbeat of it all. So, you’ve got to choose very carefully when you think about going best-in-class. Make sure it’s not going to get acquired by a bigger player because they’re so small right now, because that can also cause a lot of rework and a lot of spending down the road.

Q. Tell us a little bit about how your experience with CareFirst as a CIO of a health plan. How is that different from your similar role at a leading provider was is Kaiser. What are the big points of difference between payers and providers at a broader level when it comes to approaching digital patient engagement today?

Harry: Kaiser has two arms of its company. It has the insurance company, and it has the whole care delivery operations. And because of their scale, Kaiser has the luxury of truly picking best-in-class. And they have been an early investor in EHRs. They really put the Epic chart on the map, and they’ve been a big investor in digital solutions for their patients. When you get to the payer side, it’s a very different world because there’s a lot of intent to help on the clinical side. But it’s really around the edges as far as I see it, because at the heart, you’re an insurance company. So, when you look at the member portals of an insurance company, they are your claims, your explanation of benefits, your annual deductibles, and co-pays. They may have other services like telemedicine, but they are really rolling out telemedicine in support of the clinical community outside their four walls. It’s a different perspective. My observation is that the payers often have more money to invest in technology. The very large clinical delivery systems have money, but the smaller hospitals can really struggle to stay abreast of the technology. Implementing a hospital EMR, like Epic or Cerner, is millions and millions of dollars and a multi-year process. They often make or break projects for the organization. So, it takes a lot to bring up these massive EMR solutions.

Q. How does all the regulatory environments affect the pace of acceleration or pace of adoption of digital health and telehealth?

Harry: United States unlike a lot of countries has healthcare at the local level, rules at the state and often county level. With the pandemic, public health has been in a mess of a rollout because everything is at the local level. In Maryland, for example, we have state rules following CMS rules. Then we have county versions that are different. So, by county in Maryland, when you get your inoculation, it will vary because the rules are different. I say that as a backdrop because reimbursement and regulatory landscape is a little bit like this. When you think of the fact that providers during COVID almost universally are getting reimbursed for telemedicine, whether it’s a private payer or Medicare or Medicaid. Before COVID, they didn’t get reimbursed for a phone call. They are temporarily getting reimbursed for a phone call. If that goes away, it will hurt the lower income portion of the patient population. Same thing with provider credentialing. Whitman Walker Health, for example, wants to serve their communities in Maryland and Virginia with telemedicine services. If the rule switches back to what it was before COVID, that’s going to be a barrier for us. So, the more that CMS, HHS and the states can break down these healthcare islands and barriers through rule making or credentialing. I think it’s going to be critical. When CareFirst was looking to do telemedicine, we were looking to hire a third-party company to be our telemedicine provider. One of the big challenges was finding a company that had providers credentialed in every state and not all the companies did. So being able to learn the lessons of what worked and what didn’t work during this pandemic and be able to carry some of those temporary regulations and make them permanent, I think would be really valuable as we go forward.

Q. Can you talk a little bit about the startup ecosystem in the context of Whitman Walker? What are they getting right today and what are they missing?

Harry: Whitman Walker for the most part is using more established vendors. First, looking at emerging technology in the digital space, the biggest challenge I see is multiple vendors telling how incredible their new thing is. Most don’t understand the complexity of medicine. They don’t understand the complexity of health insurance. So, when you look at the life cycle of a claim insurance you look at the workflow in the clinical delivery side. These are incredibly complex today. Any vendor that wants to make it, must bring in enough clinical expertise that they understand and they’re not naive about how complex the health care world is.

Secondly, I would say going back to what I said earlier, they must be integrated with the major players. So, for example, Whitman Walker is implementing a texting solution called Well. And if you look on the Well website, they integrate with all the major EMR. So, we’re looking to do bidirectional text messaging with our patients. We’ve got to be wary of HIPAA rules, about privacy as we do that. And so, going with a major player, is important, but also going with a major player that fully integrates that into EMR is absolutely critical of the box. So, we’re not creating an island somewhere of information separate from the EMR. So those are two key areas I think are critical success factors.

Q. Big tech companies like Amazon, Microsoft, Google all have their sights set on healthcare. Companies like Microsoft have been in the enterprise workplace collaboration software space for a long. What can we expect from them going forward?

Harry: It’s a great question. On the truly clinical side, I personally don’t think a lot. Microsoft touted its own health record years ago, which is now shut down heavily. I think they’ve all struggled with solutions that rely on deep domain knowledge of healthcare. But if you take a broader view, AWS has done well. It’s not HIPAA certified, but it’s something like that. It’s an area that’s more secure to meet HIPAA regulations. Microsoft and Google have similar parts of their domain. That’s a big area because there’s a lot of fear in the clinical space of what do you put in the cloud. If I put it in the cloud, what happens if it’s breached and what are my liabilities from the perspective? I would say to payers and hospitals and clinics, delivery systems, to look closely at what these three companies call their HIPAA space in the cloud because they take no liability. They offer you increased protection, maybe from their regular everyday part of the AWS or cloud environment, but they’ll indemnify you for very little. But nonetheless, it’s where the world’s going. We are going to see more and more movement to the cloud, but I would also tell the healthcare domain spaces to move very carefully and thoughtfully because there is significant risk at the same time.

About our guest

Harry Fox is currently a Principal at Oak Advisor’s Group, a strategic advisory firm focusing on the intersection of information technology and healthcare.

Harry has broad experience with information systems and over thirty years working in IT leadership roles. He has a strong background and a focus on cybersecurity, healthcare systems, and strategic architecture. He has extensive experience in eCommerce, large scale systems development, data warehousing and business analytics. He has experience developing strategies for cloud, blockchain and big data.

Harry was the Executive Vice President, Chief Information Officer and Shared Services Executive at CareFirst Blue Cross Blue Shield from 2011 to mid-2018. CareFirst is a $9.0 billion not-for-profit health care company offering a comprehensive portfolio of health insurance products and administrative services to 3.2 million individuals and groups in Maryland, the District of Columbia, and Northern Virginia. Harry was the most senior out executive at CareFirst and was the Executive Sponsor for ProPride, CareFirst’s LGBTQ Associate Resource Group.

Harry has also held senior-level positions at Kaiser Permanente, Coventry Health Care (now Aetna), and PricewaterhouseCoopers. He currently serves on multiple boards. He is on two private equity-backed healthtech company boards, Medliminal and Trusty.care. Harry also serves on the boards of two not-for-profit organizations, Whitman-Walker Health System, where he is the Board Chair, and Whitman-Walker Health a Federally Qualified Health Center (FQHC), serving greater Washington’s diverse urban community.

Harry is a graduate of the Wharton School, where he received an M.B.A. in finance.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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Roughly, 30% of total healthcare spend for provider organizations falls into the shoppable category.

Posted on February 12, 2021December 30, 2023 by sanjith p

Season 3: Episode #72

Podcast with Bill Krause, VP and GM, Experience and Consumer Engagement, Change Healthcare

"Roughly, 30% of total healthcare spend for provider organizations falls into the shoppable category."

Hosted by Paddy Padmanabhan

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In this episode, Bill Krause, VP and GM, Experience and Consumer Engagement at Change Healthcare discusses how the CMS’s price transparency rule will affect consumer’s shoppable behavior, the providers, the traditional payers, and the new emerging payers – the employers.

A better functioning healthcare marketplace requires transparency in access to information provided to consumers during their healthcare decision-making time. With COVID accelerating digital health, organizations supporting digital transformation can now drive the digital first approach and provide a seamless digital experience to consumers. Consumers’ journey to care begins with the awareness of their need, understanding the options of where they should go, and knowing their financial responsibility. This is the core of any digital transformation agenda. Access to information regarding price will drive consumer shoppable behavior beyond just going to a provider’s digital front door.

Bill states that, because of the new emerging payer in the marketplace, i.e., the employers, roughly 30 percent of total healthcare spend for providers fall into shoppable tests and procedures. He further projects that this is poised to grow in the future. Take a listen.

Our Podcast Partners:

Q: Change Healthcare will be now a part of Optum from what we see in the news. Is that right?

Bill Krause: We expect the transaction to close in the second half of 2021, subject to regulatory approvals and other customary closing conditions. Until that time, we will continue to operate in the market as separate entities. That means, for now, it is business as usual from both the Change Healthcare and Optum sides.

Q: Since we spoke on this podcast, you have continued to focus on payment, transparency, and solutions for healthcare consumers. What is driving that focus from a marketplace standpoint, and what is the emerging need you are trying to serve?

Bill: Several factors are going into this, and the government has also provided a fair amount of commentary around their rationale for putting forward the regulatory changes. From a customer standpoint, the provider and payer experience underneath it needs more information to be available at decision making time to inform consumers on their healthcare journey. There is tremendous friction today with consumers in understanding their financial responsibility at points in time when they can manage and make decisions to address whatever those needs are. This friction in understanding has a ripple effect for provider organizations because it’s challenging for the revenue cycle departments to function at a high performance given the challenges. From a more macro standpoint, better-functioning markets require transparent access. This plays into the government’s objectives to create a more functioning health care marketplace.

Q: The CMS had announced the hospital price transparency rule in May 2019. The deadline for compliance is already up. Can you tell us more about that?

Bill: The CMS price transparency rule became effective on . The rule requires providers to post on their websites all prices in a machine-readable format and prices for a select group of shoppable services in a consumer-friendly format. That has changed the dynamic as it relates to making information available. The rule went much further than previous iterations of transparency rules requiring publishing providers’ chargemasters. Now, providers must put forward the negotiated rates for services that they have established with all the payer organizations that work with the providers.

Q: As a consumer, I should see some degree of price transparency, which allows me to exercise some choice. With digital transformation, I should see all this information online, make choices, and make payments before taking the service. How does this fit into the notion of a seamless digital patient experience?

Bill: It fits in a very critical way through a lot of the research that we have done with consumers around their top needs and friction points in healthcare. Among the very top is understanding consumer benefits and their financial responsibilities. When provider organizations are laying out their strategic priorities to transform digitally, financial management and financial information are among the top areas providers are looking to address first. For a consumer, the beginning of that care journey begins with awareness of what they need and then considering in more detail where they should go, their care options, and financial responsibility.

Q: Change Healthcare recently launched a solution to meet this need. Can you talk a little bit about that?

Bill: We had previously rolled out Shop Book and Pay™, which is the solution to create digital storefronts for provider organizations. You can brand and put forward into the public square shoppable tests and procedures. Last year, we decided to enhance the solution further by meeting regulatory requirements for price transparency. Many hospitals have adopted the solution to comply with transparency, host, create and host the machine-readable files, and meet other requirements around both tests and procedures in a consumer-friendly, self-service searchable format. So that’s part of our connected consumer health and patient engagement portfolio. It is an area that, as a company, we have been making a lot of investments and innovation.

Q: How are hospital administrators responding to the Shop Book and Pay™ solution? As consumers, are we going to see the level of transparency that is intended through this ruling?

Bill: As of December, the estimates were that about 60 percent of providers were still not compliant with the rule. The smaller providers are more likely to be compliant, probably because they cannot afford the three hundred dollars per facility per day penalty. For large hospital organizations, achieving that transparency is on the agenda, but they have not yet gotten into compliance with the rule. Across the US, there is varied adoption of the rule while many are still working towards it. The work itself requires a fair amount of detailed analysis of their contracts with payers and efforts to bring that data into a format to comply with the rule.

Q: What impact does it have on the business of the health systems?

Bill: According to the initial assessment, there has been tremendous interest from all parties in accessing this information to incorporate it into decision making, beyond just informing consumers. Many providers are just beginning to integrate ways to communicate the availability of the tool in a language that a consumer can understand. When you compared this to the situation prior to the CMS rule on transparency, there have been select examples in different markets throughout the country where transparency information was made available through a few contracting cycles.

Right now, among the top issues are the providers and payers thinking through what this means for pricing strategy for shoppable tests and procedures, which then will come back to consumers. It, however, will be driven more from provider and payer strategies than it might be from direct consumer shopping in the immediate term.

Q: Consumers who are covered by employer-based health insurance do not care who pays and how much. What would be driving this interest in increased transparency among consumers? Are there specific types of procedures that are now transparent to consumers, and is it making an impact in the way they make their choices? Is there a certain type of demography among consumers taking advantage of this more than the others?

Bill: The government has specified the everyday services and tests to be included in the consumer-friendly requirements of the rule. Things like physical therapy visits, office visits, and simple lab tests are the highest volume areas and have the largest everyday care needs across the broader population. In the case where a patient has purchased care prior to a service, the demography is typically a female in her early forties managing a household, and thus taking care of healthcare needs of the household and demonstrating a real tendency towards shoppable behavior. This demography is going to pursue shopping more frequently. The other thing is, there are many organizations that are growing quite rapidly in the arena of care navigation and support. When you think about the consumer holistically, the influences, and their healthcare experience, they will have other resources such as navigation services that an employer or organization may license for the consumer to use. There are other ways that steering and price shopping can show up and drive consumer behavior beyond just a consumer going to the front door.

Q: How did the pandemic impact consumer attitudes for healthcare services in general and price shopping? Has it accelerated the price shopping behavior?

Bill: It is accelerated the movement to digital healthcare journeys. There is a dramatic shift toward telemedicine behavior. The general behavior of interacting with a digital-first channel of care is the primary driver. This also supports the digital transformation initiatives of companies putting information transparency directly in front of the consumer. With the most recent rollout of price transparency, it is really in the first innings. It has not yet shown up from a shopping standpoint so much as just the general shift in the use of the digital-first approach to care, which is a precursor to shopping for care services and using transparency and further.

Q: We see more employers contracting directly with providers, taking control of healthcare costs, and funding something themselves. What do you make of this trend, and what kind of impact does it have on consumer behavior and price transparency and choice? Is there a correlation between this trend and what you see as the demand for your offerings in particular?

Bill: I see a correlation between those trends. Employers are taking an active role and driving our health care industry to be a more value-based care system. [9.9s] Direct contracting is an example of things that provider organizations, associations, and others representing the self-insured employer segment are helping to facilitate. There have been many examples of centers of excellence, strategies of large employers contracting with health systems for certain services, and more. Direct contracting strategy for price transparency and a focus on shoppable testing procedures is probably poised to grow even faster. For example, according to data shared by a payer customer, there’s a vested interest on both the provider and the employer organization to find new ways to direct contract to include shoppable tests and procedures. Previously, this interest might have been focused more on certain surgeries, service lines, and centers of excellence.

About our guest

Bill Krause is the Vice President and General Manager, Experience and Consumer Engagement at Change Healthcare. Serving the healthcare industry for over 12 years, Bill Krause leads innovation and solution development for patient experience management at Change Healthcare. In this role, Mr. Krause is responsible for the development and execution of strategies that enable healthcare organizations to realize value through leading-edge consumer engagement capabilities

Previously, Mr. Krause provided insight and direction into new product and service strategies for McKesson and Change Healthcare. He also managed business development planning, partnerships and corporate development across a variety of healthcare service and technology lines of business for those companies.

Prior to McKesson, Mr. Krause worked at McKinsey & Company as a strategy consultant, serving a variety of clients in healthcare and other industries. He received his MBA from Harvard Business School and his undergraduate degree from University of Virginia. He also served as a lieutenant in the United States Navy.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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Solutions that meet patients, where they are and where they want to be, has tremendous legs in 2021 and going forward.

Posted on February 10, 2021December 30, 2023 by sanjith p

Season 3: Episode #71

Podcast with Colin Banas, MD, Chief Medical Officer, DrFirst

"Solutions that meet patients, where they are and where they want to be, has tremendous legs in 2021 and going forward."

Hosted by Paddy Padmanabhan

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In this episode, Dr. Colin Banas discusses how they are uniting different stakeholders in the healthcare space through their concept – Healthiverse^TM – and providing actionable solutions for a better healthcare experience and outcome to all.

According to Dr. Banas, the overall spend in the U.S. healthcare market in medication management and adherence space rose from 10 percent to 20 percent over the last few decades. In future, the opportunity lies in the solutions that meet patients’ needs wherever they are and where they want to be.

DrFirst serves hospitals and health systems, individual clinics, offer e-prescribing platforms, provide patient-focused price transparency solutions, and much more. Take a listen.

Our Podcast Partner:

Click to See Transcript

PP: [00:01:02] Hello again, everyone. Welcome back to the podcast. This is Paddy, and it is my great privilege and honor to introduce my special guest today, Dr. Colin Banas, Chief Medical Officer of Dr. First Colin. Thank you so much for setting aside the time. And welcome to the show.

CB: [00:01:20] Thank you for having me. I’m honored to be here.

PP: [00:01:23] You’re most welcome. Thank you so much for that. So, let’s get started.

PP: [00:01:26] Tell us a little bit about Dr. First and the market need that the company is trying to address.

CB: [00:01:33] Yeah. So, Dr. First is a pioneering health technology company that’s been around for over two decades. In fact, we just hit our twenty first birthday on January 1st. And what started as an e-prescribing company, a medication management company, has morphed and evolved over these decades to include more and more solutions. And what we’re trying to do is unite all the different players in the health care space and break down the silos. So, we have this concept of the healthy verse. This is because there are so many different players in the health care universe that we’ve coined the term, the healthy verse. And we like to put the information in an actionable way in front of the key players at the moment of care so that we can provide better outcomes and better experiences for all of them.

PP: [00:02:27] So would you then call yourself a more of a data management and a data services company? Or are you offering solutions that use the data? Which side of the aisle would you see yourself more in?

CB: [00:02:45] Yeah, I love the word solutions and we are a solutions company, so putting actionable solutions in front of those key players is really where we sit.

PP: [00:02:54] You mentioned that the company’s origins are a prescription medication management that I imagine continues to be at the core of what you do.

PP: [00:03:04] So let’s talk a little bit about what are the biggest gaps that you see in this market today as you try to unite the data sources using the Healthworks concept that you talked about? And what really is the size of this opportunity? What are we talking about here?

CB: [00:03:20] Yeah, so I’ll start with the size question. I think it’s an interesting question, depending on how you define the medication management space and all of the various pieces and parts.

CB: [00:03:31] But what I’m reminded of is, if you look at the overall spend in health care in the United States a few decades ago, the medication management in its totality was probably 10 percent of the spend. And of course, the rest of it was 90. And over the course of these decades, it has inched up to the point where medication spend and all things related to it is closer to 20 percent now.

CB: [00:04:01] And so depending on how you want to visualize the pie of opportunity, it could be quite sizable. And when I think of medication management, I think of the lifecycle of the prescription from soup to nuts. The decision to initiate therapy and write the prescription all the way to getting it filled at the pharmacy to adjudicating the potential claim all the way to medication history services. So, when you’re seeing the patient back in the clinic or back in the ER or for an admission and trying to figure out patient adherence at that time. So, here’s really a whole lot of those places where our solutions intersect and can provide value.

PP: [00:04:45] Yeah, I’m familiar with the medication management and the medication adherence problems, and it’s a multibillion-dollar opportunity or a problem depending on how you want to define it.

PP: [00:04:56] And I imagine that, among other things, the life sciences companies, the pharma companies in particular are very interested in how to address those gaps because there’s some real revenue implications for them. So, who are your primary target markets for this? Are you serving life sciences companies? You’re selling providers. Who are your target clients?

CB: [00:05:19] Yes, to all of the above but really, I think the biggest opportunity and our biggest success stories are in the clinical space, health systems, hospitals, individual clinics and the solutions that again, surface robust medication histories. Price transparency could talk on about that and solutions that are patient focused and centered around patient activation. And so those are the things that really get me excited about the work that Dr. First is doing. We do have relationships with the payer community as well and trying to bring meaningful data from them into the workflow for our clinicians.

PP: [00:06:00] So, let’s pick any one of these constitutionalists, say health systems, for instance, how are they using your solutions? And then you walk us through maybe an example of how they use it and how the values created and abstracted. In other words, you’ve got a solution that helps them address their medication and hear those gaps. How are they using it? Are they using it for population health management as an example? How do they justify the investment in the solution? Is that a reimbursement component or Is the whole economics involved? Could you walk us through maybe an example using one of your prime journeys?

CB: [00:06:39] Sure. One of the ones with the most legs would be in that medication history, medication reconciliation space. So, we actually have a solution. And then layered on top of that is a patented AI and LP engine that we affectionately call smart. And I’ll tell you how this works. And so, we’re able to provide our clients with a robust medication history.

CB: [00:07:03] We give them a feed of the medications that were prescribed in the medications that are filled. And we actually fill in the gaps, perhaps, of what you may be lacking from our traditional medication history feed. Because we’ve been able to create relationships with independent pharmacies and payers and pharmacy vendor software systems. And so, we were able to augment the existing feed that you may have. And then we take it a step further and we use this AI engine smart to clean up that data, to duplicate it, to prioritize it etc. And then we can actually bring it into the electronic medical record structured. And then we can land it in the appropriate fields without having the clinician, whether it be the farmer or the nurse or the physician who is doing this interview to gather the medication history. We can land it in the appropriate fields so that you don’t have to re-input things. Believe it or not, even though we have all of these mandates for structure and for codify data when we’re transmitting prescriptions. A lot of times when we bring it back into systems, it comes in as free text. So, we’re actually able to solve the data cleanliness problem in a variety of venues. And what we’ve seen is by doing that, you can make the clinicians a whole lot more efficient. And so, we’ve seen client examples gaining efficiency from fifteen to twenty five percent in terms of the number of medication histories and medication reconciliation’s they’re able to get in a particular shift. And more importantly, the data they’re bringing in is accurate and actionable. And so, you can imagine that not only efficiency is important to whomever you’re talking to, but me wearing my safety hat, I actually like to think that the safety side of the equation is even more important. The fact that you’re not having to re-enter data that should flow seamlessly and potentially fact fingering some of those values can really help improve the safety side of the equation. One of our success stories and Covenant Health were in that 15 percent improvement in terms of efficiency. They saw a massive increase in the accuracy of the medication lists on the order of like thirty five percent improved accuracy. And by their own math, maybe we were able to claim a savings ROI of six hundred and fifty thousand dollars in a year. And that’s just one success story from one small piece of our solution set. So, you can imagine as I get the opportunity to describe other solutions and layer them all together, you can get this synergistic effect of improvements in the health care outcomes and the return on investment.

PP: [00:09:50] So that’s helpful to know if you put a number on the benefits system.

PP: [00:09:54] Twenty thousand dollars a year is a sizable number, I imagine, for how sustainable the other side is that you’re talking about.

PP: [00:10:05] When they approach this kind of situation, do you provide any commitments or assurances to them that they are going to achieve a certain threshold level of returns? Or how do you help them really make the decision? What conceptually it’s very straightforward that, yes, if we can improve medication, adherence and manage accuracy and medication and saw the benefits are obvious, it’s fairly straightforward.

PP: [00:10:29] But putting that into action and really helping your clients, specifically clinicians, pharmacists, to sell the idea internally and to gain approvals for budgets and so on and so forth is important. So, hoes it work today?

PP: [00:10:46] And what is one of the top things that they look for in order to feel reassured that this is actually going to deliver?

CB: [00:10:54] Yeah, it’s a great question and it’s become even more relevant in the current era that a return on investment wasn’t always top of mind when trying to pitch these solutions. But even more so now, things like automation and ease of implementation as well as return on investment have become increasingly important. So, one of the things we’re able to do with the solution I just outlined is we have a pretty robust return on investment calculator. And that calculator is based not only on industry standards, industry publications, but also success stories that we’ve been able to see with existing clients. And so, it’s an ever-evolving calculator that we’re able to provide and walk our health care partners through as these are the things you can expect to see. We also have a pretty robust applied clinical research arm at Dr. First. I’m happy to have that up with one of my colleagues. And, we’re constantly looking for partners who are wanting to study those things, just like you said, in order to as twofold. One, we want to give back to the research domain. We want to be able to show positive impact with the things that we’re providing. And then two, we would like to be able to tell those success stories to other partners and other potential partners out there. So, we do have a sort of a one to approach being able to help clients and potential clients with that return on investment.

CB: [00:12:21] So there’s other solutions in the medication management space, things like price transparency tools. So, showing the doctor what the co-pay will be for the patient at the time of writing the prescription so that you can make a more informed decision. Also, maybe, you can even select an alternative. Yet another one being able to provide patients after the moment of prescribing actionable text messages that can show them coupon cards or the prices that they can expect to pay again, as well as education. And so those things were also able to show our clients just through raw data. You know, this is the utilization that you’re getting from these particular solutions. And in the example of that patient facing solution, we’re also able to study adherence rates. And so, we know that when you get an engaged patient who is able to get those secure texts, we know that there are twenty five percent more likely to go pick up that prescription. And so that’s the kind of data that we can feedback. And ultimately, as you pointed out, these are the things that help build the case so that you can continue to layer on solutions with your partners or go extend solutions to new partners.

PP: [00:13:38] You mentioned depending on the focus on the ROI has become even more intense than it was before. Has the pandemic impacted the demand environment in any way, positively or negatively? Can you talk to what has changed for your company as a result of the pandemic?

CB: [00:14:03] Yeah, a couple of things. So, one, our own internal data shows us on the medication management space that adherence took a dip during the pandemic. Possibly due to cost concerns or patients losing their employment and thus their insurance status, perhaps.

CB: [00:14:21] And so back to those solutions that can help point out prescription benefits or help to activate patients so that they can see education, coupon cards, costs out of pocket. Those things actually have had a bit of an uptick in terms of interest in adoption. And a couple of things come to mind in terms of the impact on our company and our solutions. One, I even made mention to this a second ago, the ease of the implementation or the size of the lift seems to matter a great deal during the pandemic. And what I mean by that is there isn’t a lot of appetite nor time for multi month implementations that perhaps we had the luxury of before. But a lot of the solutions that we are able to offer up, especially in the medication management space, are very light lift. In fact, they’re often sort of unplug one and plug this one in and you’re good to go. And I think that has benefited us greatly in terms of being able to keep the momentum on a lot of our solution sets. So, we’ve actually some increases in our medication history space, our price transparency. This is again, unplug or perhaps an addition of our service to one you may already have. Go ahead and plug that in. And we’re talking light lifts for these things or under 20 hours for some of them. And that actually seems to be an appetite for that. So, you couple the ROI with the fact that you are not going to engage a whole lot of your internal IT talent. In fact, a lot of the lift is being done by us as the company. This seems to be a winning combination during the pandemic and even more than it was pre pandemic.

PP: [00:16:07] Medication management has been a target for quite a while by a number of different players in the industry.

PP: [00:16:14] And I imagine that the pharma companies obviously are tracking it from the point of view of their own products.

PP: [00:16:21] And I imagine that PBM would be another category that are really looking at the medication out in space and building solutions to create incremental value for their clients.

PP: [00:16:33] You talked a little bit about the competitive landscape. Do you compete with PBM’s, for instance, are you competing with an entirely new class of solution providers?

PP: [00:16:43] You talk a little bit about the competitive landscape.

CB: [00:16:45] I wouldn’t say that we compete with PBM. If anything, I’d rather use the word complement. And so, if you think about the traditional PBM relationships, they function in claims management for the most part. So, they have these relationships with pharmacies, with payers, with health plans. But again, traditionally they’ve had trouble getting upstream in the medication lifecycle to where the actual decision to prescribe something is being made. And that’s where we come in. We are leveraging relationships that we have at the point of care relationships with providers through our e-prescribing platforms, with our price transparency tools. And then also with the patients, again the solution I keep referencing about patient activation and patient engagement is called our e-inform. And it’s pretty revolutionary stuff in terms of being able to activate our patient base. And so again, I like that word complement the PBM’s. In terms of the competitive landscape, I would say there are other players in these spaces who are trying to skate to the same place. Or I can say independent solutions in terms of the ability to show price transparency or other prescription platforms and prescribing platforms, for example. And so I think that’s the competitive space that we’re playing.

PP: [00:18:05] And what do you see as the outlook for 2021? I know you said big technology firms getting into this in a big way. Amazon comes to mind. Obviously, their ambitions in the pharma space are fairly out in the open now.

PP: [00:18:20] What do you see as the demand environment going into 2021?

CB: [00:18:24] Yeah, you know, it’s always been interesting to keep an eye on quote unquote, the big guys for the past few years. In terms of their ambitions, I’m still not sure what to make of the Amazon play. But I do know, and I do think that there’s enough room for all of us. I guess, this is a good way to say it right now. And I do think that the outlook, at least in terms of things that are meeting the patient where they are in the name of consumerism. And I’m not a big fan of the term consumerism when it comes to patients, but I do think it fits. And so, the space to the extent of a solution that meets the patient, where they are, where they want to be, has tremendous legs in 2021 and going forward. And I think that’s the space that we’re filling nicely.

PP: [00:19:12] That’s fantastic. So, I guess we we’ll leave it there.

PP: [00:19:17] That’s a great positive note to end the podcast conversation on that column. Once again, it has been a pleasure having you on the podcast.

PP: [00:19:26] I wish you and Dr. First all the very best going into 2021.

CB: [00:19:30] Oh, again, thank you for having me so much. It really has been an honor.

[00:20:00] We hope you enjoyed this podcast. You can reach us at info@bigunlock.com with your feedback and questions.

[00:19:44] This podcast is brought to you with the support of our partner mailbox and secure email for modern health care right out of the box.

About our guest

Colin Banas is an Internal Medicine Hospitalist and the former Chief Medical Information Officer for VCU Health System in Richmond, VA prior to stepping down after 15 fulfilling years to pursue consulting. He is proud to have testified before the U.S. Senate and the Office of the National Coordinator (ONC) on the topic of Health IT and the Meaningful Use Program and is a former Health IT Fellow for the ONC.

His interests center the role of big-data and analytics on patient outcomes and on novel forms of Clinical Decision Support, those that are outside of the realm of traditional rules and alerts, and include real-time dashboarding and intuitive usability designs.

He also helped spearhead the VCU effort to participate in the Open Notes initiative, where patients have access to their clinical documentation in real time. In 2017, Dr. Banas was humbled to receive the HIMSS-AMDIS award for Physician Executive of the Year from his peers.

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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Financially, you can’t just buy the best-in-class, so we look at our legacy systems and tools first

Posted on February 8, 2021December 30, 2023 by sanjith p

Season 3: Episode #70

Podcast with Pamela Landis, VP of Digital Patient Engagement, Hackensack Meridian Health

"Financially, you can't just buy the best-in-class, so we look at our legacy systems and tools first."

Hosted by Paddy Padmanabhan

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In this episode, Pamela Landis discusses how they brought together a ‘digital ecosystem,’ a.k.a. a digital front door strategy. She also talks about how they engage patients at every major touchpoint of their journey by providing a seamless digital experience that is intuitive, consumer-friendly, and easy to use.

Healthcare is changing fast and patient needs must be addressed in a more front-facing way. While it is easy to look at best-in-class tools, financially they may not always make sense. At Hackensack Meridian, they first look at their legacy systems and tools to check for available core solutions to handle the digital patient engagement journey from a technology standpoint.

Hackensack Meridian plans to invest more in transforming themselves into a digitally-enabled organization and serve the patients in a digitally-enabled way that is consumer-friendly, like Amazon. Take a listen.

Our Podcast Partner:

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Pamela Landis, VP of Digital Patient Engagement, Hackensack Meridian Health in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Financially, you can’t just buy the best-in-class, so we look at our legacy systems and tools first.”

PP: [00:01:02] Hello, everyone, and welcome back to my podcast. This is Paddy, and it is my great privilege and honor to introduce my special guest today, Pamela Landis, Vice President of Digital Patient Engagement at Hackensack Meridian Health. Pamela, thank you so much for setting aside the time and welcome to the show.

PL: [00:01:22] Thank you so much for having me here.

PP: [00:01:38] So, maybe you could start by telling us a little bit about Hackensack Meridian Health and the populations you serve.

PL: [00:01:50] Hackensack Meridian Health is a relatively new company. It’s the result of a merger of two mid-sized health systems in New Jersey. We are now the largest health care provider in the state of New Jersey. It’s a really traditional looking health system where you have hospitals and physicians and other care entities all under one umbrella. We basically serve people from northern New Jersey all the way down the beautiful coastline in South Jersey. So, from here, you’ll probably find a Hackensack Meridian Health property. There are 17 hospitals in our network right now, and we actually have a mix of private and employed physicians and we have nine thousand physicians who are on our staffs.

PP: [00:02:43] That’s quite a large health system. It’s obviously a very well-known and prominent name in New Jersey. But thank you for that background and context. So as the VP of digital patient engagement, how do you define your responsibilities and who does it all report to?

PL: [00:03:02] I report to our Chief Strategy Officer and our CIO here, so it’s a dual report. And when Hackensack Meridian Health created this role about a year and a half ago, I’ve only been here a year and a half and came from Atrium Health and Prior to that Henry Ford Health System, where I worked on digital engagement tools and services to find health institutions. When I came here, Hackensack really wanted to say that we’ve got a lot of work that we need to do and we need to bring together a digital ecosystem.

So, it’s not just about websites, it’s not just about mobile applications. It’s not just about a patient portal, but it’s all of those things. And it also includes what I call our contact management. And our contact management is more than just taking phone calls. Our contact management is how we engage with our patients, our consumers and our teammates in all forms of online and offline tools and how do we build this ecosystem underneath. So that when you contact us, whether it’s through a website or through social media or through a forum somewhere or even through a phone call, we know who you are. We know what your needs may be, we understand how you want to be communicated with, and what answers that we can provide you. And so that’s basically what we’ve been building for the last year and a half. Some things around COVID have accelerated that process and something have actually decelerated that process. Because you’re so busy caring for a surge of COVID patients. Some things like you have to put on hold, but other things that you’ve been waiting to do, get unleashed very quickly.

PP: [00:04:58] And it’s often been told over the last several months that what was expected to take five years has now been accomplished in something like five months. This is because of the kind of urgency that COVID-19 created for us. You described at a high level what we would typically refer to as a digital front door strategy. So, it’s all of the above right patient portals, it’s about patient contact centers, and about digital patient engagement, which is why you define your role.

PL: [00:05:31] It’s how we do customer relationship management using modern tools and leading edge tools. And that’s where the crux of matter lies. So, there are some foundational pieces that is your EMR, you might have a CRM solution, some business intelligence tools, a patient portal or call center technology. And what my job is to nip those pieces together. Also, to make sure that the consumer experience is seamless, so it doesn’t matter what doorway they come in, they understand it. It’s intuitive and easy to use. It doesn’t take us to do all kinds of education up front. It’s just as consumer friendly as using Amazon and nobody’s there yet in health.

PP: [00:06:29] Healthcare, as you alluded to, has traditionally been behind other sectors with regards to consumer engagement, digital consumer engagement in particular. The Amazon experience is not there yet in healthcare. And one might see this as the opportunity really to up the game in many ways. And you talked about all of the foundational pieces, CRM platform, the EMR platform, the call center technology and others. And then, of course, there’s a lot of new solutions that are available to really create the best-in-class experiences that would create the sort of seamless consumer experience that you referred to. So how do you approach this and the creation of this experience? How do you approach it from a technology standpoint? I know it’s a two-part question, but can you walk us through one program where you’ve really transformed the experience.

PL: [00:07:28] I have been doing some of this work since 1995. And when we would say, we need to build a website to do X, Y and Z and it’s going to cost X amount of dollars. My leadership and I, working with over the years at all the institutions would say to me, that’s a lot of money. And so, I go back to like what healthcare did in the late 90s and early aughts. They were really investing their capital in foundational solutions, revenue cycle, EMR and also in clinical tools. Proton beam therapy is expensive, robots are expensive. And so, when we would come and say we need to do a digital patient solution and it’s going to cost five hundred thousand dollars. So, an executive might look at that and say, I could get some new 128-bit imaging slicers into my hospitals for that amount of money or I can hire four more nurses. Those were hard decisions to make. And so, a lot of times what healthcare was doing was investing in some of that foundational infrastructure. So, yes we’re behind. We in terms of a digital solution for patients have made very strategic decisions that we were going to invest in people and cutting-edge technology to deliver world-class care. Those are hard discussions to have and so you have to really make your case. I think, in the last 10 years what we have seen is an embrace at the executive level that is the model of healthcare is changing in a way that we have to now start addressing patient needs in a more front facing way than we have previously. So, what we’re starting to see, is the understanding among executives who said, I get it because I’m using these tools because my health system isn’t as easy to use as an Amazon or another tool. They now get a look at the financial services industry who have made a really successful pivot into digital tools. The health care leaders across the country are saying we need to do the same thing. So now, the work and the emphasis is going into that transformation. But it’s going to take a while because we still have a really important legacy tools that we need to optimize to be able to handle the digital patient engagement journey.

PP: [00:10:22] In that context, you have to your point, the legacy investments in some of the core platforms like your EHR systems, for instance. Now you are transforming the enterprise into more of a digitally enabled organization that can serve patients in a very digitally enabled way. And so, it requires a whole different set of perspectives on technology choices. So, when you look at transforming the patient experience, do you start with your legacy platforms from a technology standpoint, and do you look at what’s available? And then roll it out and make the most of it, or do you say, I’m going to look at what’s best in class out there and then I’ll be back into what I think is the right solution for our enterprise. How do you approach this?

PL: [00:11:12] How we do it here is we look first at our legacy systems and our tools. What we have here in our core solutions, you have to rule those out first. I mean, financially, you just can’t, like, buy a best in class. You just can’t do everything at once and then hope everything integrates that creates a long-term maintenance and support challenge that you want to try to avoid. So, the first thing you got to do is, for instance, here at Hackensack, can Epic do this? Can Oracle or Google do this? And if they can’t, then it’s time to say, there are wrap around services and tools that can integrate easily. And have API services available to integrate to an Epic or Oracle or a Google cloud platform. So, I look at those things first. And so, I try to look at our core solutions. Then we say, if they can’t meet it, are there companies that have relationships with those core solutions that have done the integrations? And if not that, then I go to the best in class.

PP: [00:12:29] Let’s say you’ve got some native features in Epic and they will do the job for you. But at the same time, you know that there are other tools out in the market for those same features that we plug and play easily with Epic and have a superior interface or a superior set of features. What do you do then?

PL: [00:12:57] Yeah, and that actually happens a lot more often that people probably understand. Sometimes you see much more elegant solutions in that third party market, and you have to prioritize which one is going to give you the biggest bang for your buck. Can you live with the way Epic open scheduling works today? Or do you need a layer on top of it from a company like Kyruus? And I think that those are individual business decisions that have to be made, understanding what you’re trying to achieve, what your goal is. Can you live with the 80-20 rule or do you have to say no? What is so important that we actually have to go outside.

PP: [00:13:41] That is a great example actually, that you just mentioned. And I’m sure that when you look at all the digital engagement touchpoints that are available to you, you could probably come across several in the category where you have an elegant solution that performs better than a native feature in your platform. Now, let me switch to the back end of the technology infrastructure. All the front end experiences that you describe can work seamlessly only if you have a robust backend. And that means that you’ve got to have your data centers or your cloud policies like the orders and infrastructure, your wireless infrastructure, all of the above. And you mentioned that your role has to do a report into the CIO as well as a chief strategy officer. So, I imagine you get very involved in a lot of these back and transformational initiatives that are going to help you deliver the kind of experiences that you seek to deliver. Can you talk a little bit about what are the top two or three things that you think are absolutely critical table stakes for you to be able to deliver the experience you seek to deliver?

PL: [00:14:51] Yeah, so as we’re recording this, we’re doing our vaccination rollout and we’re doing online vaccination scheduling. And so, we knew that we were going to get hit hard on our Web sites. And so, we at the front end engaged our partners in this. In this case, it was eight of US and in Epic our data center folks say, we’re going to get some traffic that we’ve never seen before. And all through COVID, we’ve seen traffic to our external websites at a rate that is unparalleled. So, let me give you one example. This time last year, we were getting about three hundred and fifty thousand visitors a month to our website, and now I’m doing about three million consistently. And so we started scaling up and we made sure that our backend was able to handle the load. On this vaccination scheduling, we actually understood that with Epic we had as much horsepower to handle all of that as possible. And there are moments during the day when you’re trying to schedule an appointment, you get the busy signal on the server, you don’t get it often, but you do get it. For example: A week ago on Friday, we opened up scheduling at our mega site at the Meadowlands and we opened up slots for people to make appointments. And we’re working with the state of New Jersey in the New Jersey State Police and the National Guard who are helping our staff at that site. But we’re managing and operating that site and using our scheduling tools. So, we had thirty-five thousand people scheduled within four hours. That’s a lot of traffic to our servers in that time and it went fast. And so the site performed and we were ready for it. We were monitoring it during the whole time, but every single slot was taken within four hours. And so, it’s always about planning and thinking that I’ll just double it. Well, you probably need to triple or quadruple it when you think that you’ve got enough and you probably don’t. And you’re going to need more in these particular use cases. I think that they’re extraordinary and off the charts for a while. But that’s what we’ve learned over the last year.

PP: [00:17:21] That is such an interesting anecdote here, Pamela. Eight months ago, everyone was talking about having to deal with a 10X and 15X increases in telehealth visits and what kind of challenges they represented for IT executives. How they are trying to scale up the infrastructure to make sure that the line doesn’t drop? You’re able to log in, you have high quality video and so on. And now we are talking about vaccines. So, it’s a very interesting change in tone, if you are talking about dealing with COVID-19 related virtual visits and not talking about vaccines. And I imagine that through these experiences, the ability to scale and also the potential for emerging technologies, specifically cloud, since you mentioned AWS will do it in a way that you’re able to meet the expectations of your constituents.

So, switching back to the digital front doors and switching back to digital patient engagement, you’ve been here for about a year and a half, but you’ve been doing this longer. So just looking at your Hackensack experience, what does your data tell you about the adoption levels for digital engagement tools among your patient population? And what is sense of the change in consumer preferences today?

PL: [00:18:47] Yeah, so here’s one piece of data. We saw MyChart usage in terms of activation. You always want to have people use MyChart as much as possible. But we were not, unlike many health systems across the country where adoption wasn’t as high as we want it to be. In the year of COVID, we increased MyChart activation to 68% and that was without doing one IOTA of marketing.

PP: [00:19:18] How does the benchmark with best in class, in your view?

PL: [00:19:22] So I would say that we are probably under best in class. We were probably in the bottom quartile of health systems around the country. When I look at some of the best ones around the country, like a Kyruus or somebody that has very high adoption rates or a Providence, Saint Joseph’s out there in Seattle. I would say we’re in the top quartile now. We’re not just in class, but we’re getting there.

PP: [00:19:47] Well, that’s significant improvement.

PL: [00:19:49] And if you think about it, Paddy, we didn’t tell anybody about it. It was just consumer demand that drove it. And that’s where I think we have a lot of learnings that have come out of this. People are now ready. Another anecdote was, there are still important tools like your phone lines. During this vaccine, when we started doing vaccinations, one of our phone lines, for example, would normally get about one hundred and fifty calls a day. It’s now running fourteen thousand calls a day. And it was like, to find a doctor and to hook people up to the right doctor in their area. The demand around health care services is exploding and it’s basically about the vaccine. Our challenge will be, how do we keep and capture those people after people are vaccinated? How do we make sure that they stay with us in care, that we start not only just vaccinating but caring for them through their life.

PP: [00:20:59] How does the profile of the population that you serve play in the adoption rates? Within New Jersey, do you see differences between one part of your area versus another?

PL: [00:21:15] Yeah. So, where I’m seeing the difference is if we’re thinking about the digital divide, here are two areas that I worry about in the digital divide. And I don’t have great answers and I would love for someone to give me the great answer. How do we help people where English is a second language and where they’re not native English speakers as much of our work is still in English only. And that worries us in some ways. And the other one is for those that are seventy-five and older, where digital adoption is lower than in other age groups. It’s still pretty decent, but it’s not where it needs to be. And when I think about the people who are most at risk having serious complications from COVID, those people who are 75 and older, and people from minority communities or people of color, I need to make sure that when we build these systems, we address those needs too.

PP: [00:22:18] It’s interesting you bring that up. One of my recent guests on this podcast is the CIO of Health System in Southern California that serves Medicaid populations, mostly Latin communities. They’re one of the things that you mentioned was very relevant in their context, which is the bilingual capability to whenever you turn on a digital solution. And, of course, the one thing that in their case, they had to deal with was serving low-income population. They had to really make some of their digital solutions backward, compatible with earlier generations of devices. And this was something that was counterintuitive to me. Maybe we’re on the latest version of iPhone. But their population are two or three or even earlier generations. To make healthcare inclusive for them, one of the big things about the digital divide is to make sure that the solutions reach everyone, not just certain parts of the public. That’s what I’ve heard from that vision. Sounds like that’s what you’re saying too.

PL: [00:23:26] Yeah, I am seeing the same thing. And a lot of folks say to us and when I look at the data in the state of New Jersey, they assume that those people of color or other groups don’t have access. They might not have broadband laptop access in their homes, but they certainly have phones. And here’s the other sensitivity. We need to be sensitive about how much we’re using in terms of their data plans. And I need to make sure that whatever we deliver is as efficient as possible so that we’re not sucking down a lot out of their data plans.

PP: [00:24:00] That’s another very important consideration as well. You worked in Atrium, you mentioned and prior to that Henry Ford Health System. And so, my guess is you’ve seen a lot of best practices from your peer group, health systems, both by virtue of your own experience, but also through your network in your community. So, can you talk about what you’re seeing as some of the best practices? Maybe one or two best practices that you would like to share with my listeners and maybe one from your own experience?

PL: [00:24:33] I think that a lot of groups are doing some things really well. So, when I go back to my former coworkers, the Atrium Health, I think some of the work that they’re doing there around the vaccine is just like a huge event at Charlotte Motor Speedway where they inoculated sixteen thousand people. We were really surprised by seeing the work that they were doing there and how they had really figured out the efficient way to manage those folks through such a large operational endeavor. Kudos to them for doing that work. I think that there are some folks across the country who have taken different approaches to it. Some of my colleagues around the country, their health systems are inoculating only. For instance, their own health care workers and a small cohort of patients. We at Hackensack Meridian Health are not only going to do our own health care workers, but we’re going to start servicing the public, too. It is hard work to take on that piece too, but we would be able to do all of this getting as many shots and arms as possible, not just for ourselves and not just for our own patients, but also for the communities we serve at large.

PP: [00:26:08] That’s so wonderful and thank you for sharing that. We are at the end of a time here, and I guess we’ll have to leave it at that for today. But I’m fascinated by all of the anecdotes that you’ve shared. And thank you so much for setting aside the time. I look forward to staying in touch with you.

PL: [00:26:25] Thank you, Paddy. I’ve enjoyed this. Have a great day.

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

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

About our guest

Pamela DeSalvo Landis is vice president of digital engagement at Hackensack Meridian Health Network, a $7 billion integrated network in New Jersey. She is responsible for the strategy and implementation of all voice, AI/ML, mobile, web, unified communication, engagement and collaborative technologies for patients, consumers, physicians and employees. Her team leads technology and development efforts around making it easier for patients and consumers to get access to healthcare services, particularly online and on the phone. Her team is building a 24-7 digital network operations center where all consumer traffic will flow.

Prior to joining Hackensack Meridian, she led digital efforts at Atrium Health in Charlotte, N.C. and Henry Ford Health System in Detroit, MI.

She is a graduate of Ohio University in Athens, OH and earned a master’s degree in health informatics from the University of Illinois-Chicago.

Recent Episodes

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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.

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In any healthcare organization, integration of third-party apps with your digital solutions can either make you or break you

Posted on February 1, 2021December 30, 2023 by sanjith p

Season 3: Episode #69

Podcast with Ray Lowe, SVP and Chief Information Officer, AltaMed Health Services

"In any healthcare organization, integration of third-party apps with your digital solutions can either make or break you."

Hosted by Paddy Padmanabhan

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In this episode, Ray Lowe discusses the multi-year digital “overhaul” at AltaMed and the challenges they faced while driving adoption of digital solutions in the organization.

AltaMed predominantly serves a low-income population and underserved communities. There is a digital divide that exists out there. AltaMed strives to address those challenges while connecting with their patient populations electronically.

Ray also discusses the drivers of technology selection at AltaMed for building digital front door tools and mobile apps, and engaging with their patient populations. Take a listen.

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Ray Lowe, Senior Vice President and Chief Information Officer, AltaMed Health Services in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “In any healthcare organization, integration of third-party apps with your digital solutions can either make or break you.”

PP: [00:01:08] Hello, everyone, and welcome back to my podcast. It is my great privilege and honor to introduce my special guest today, Ray Lowe, SVP and CIO of AltaMed Health Services in California. Ray, thank you so much for setting aside the time, welcome to the show.

RL: [00:01:26] Thank you for including me today.

PP: [00:01:29] Thank you. Can you tell us a little bit about AltaMed Health and the patient populations you serve?

RL: [00:01:40] Sure, I’d be delighted to. So, I’m Ray Lowe, CIO and Senior Vice President for all of the health services. I’ve been with the organization for three years and in this time period, we actually have completed a ‘digital overhaul’ of the enterprise, including technology applications, patient engagements. AltaMed serves over three thousand patients at over 50 locations and the greater Los Angeles and Orange County areas with over one million visits per year. We provide services to the Medicaid, underserved populations that are primarily Latin, multi-ethnic, and many of those are 200 percent below the poverty level and 40 percent are pediatrics. Some of our services include primary care services, women’s services, pediatrics, HIV AIDS outreach. We also have programs for all-inclusive care for the elderly. We also have two other companies. One is the ALtaMed Health network, which is a strategic ______

again, focusing on Medicaid internal product, as well as a managed care organization known as Alterra.

PP: [00:02:48] Thank you for that background. I am obviously interested in learning about the complete digital overhaul that you referred to, and that will be the focus of our conversation. But before we jump into the digital transformation journey and AltaMed, I understand that it is also a pioneer in the use of the patient centered medical home concept, the PCMH concept. Could you talk a little bit about that experience and how that has worked for your population?

RL: [00:03:22] Sure. So, I just started PCMH or patient centered medical home until it actually started this in 2011. So, you have a bit of time working on this. We started with our pediatric populations in joint co-operation with Children’s Hospital, Los Angeles, and we also utilize the PCMH approach on our senior services. At its core, what PCMH is, it’s a way of coordinating care for our patients. It also means adjusting our processes and care to treat the whole person. Within our PACE program, we have nurses that manage patients ensuring they receive regular treatments, required medical equipment, special referrals and other type of clinically related activities. We also provide PT/OT, dental, and socializations to help them vibrant. We expanded this even further, including interdisciplinary care, which is our social aspects and social determinants of health. So, for our PACE seniors, our teams work to address both the clinical, the social interdisciplinary and any type of SDOH things that can impact them and their overall well-being.

PP: [00:04:35] You’ve been practicing this since 2011, so you would have been one of the pioneers in this concept. I imagine that you have a wealth of data and you’re utilizing that to drive improved outcomes for your population. So, you mentioned about coming out of a three-year digital transformation, digital overhaul. Can you tell us a little bit about that? What were the top priority areas for that program and what kind of programs are currently operational at AltaMed?

RL: [00:05:10] Yeah. Our priority is really providing quality care without exception. And from a digital health perspective, that really means patient centric care where, when and how they want it. AltaMed provides care for essential workers. Many of them are low income and underserved communities, this is a patient population that has been inadvertently left behind. I would say due to the digital divide that does exist out there. As we plan our strategy, first and foremost, we want to have a global strategy that provides care with flexible walls both inside and outside of our brick-and-mortar facilities. The second thing that we do with our digital health strategy is that we leverage our Epic MyChart. We call it MyAltamed portal for patient interaction and messaging. We went live with Epic in October of 2019 in a 10-month implementation cycle. And the interesting thing is we’re barely five months ago from a pandemic yet. And the digital solutions that we built – telehealth, remote patient monitoring, patient engagement strategies – are all centered around MyAltaMed in MyChart of Epic. So that we can have the rich clinical information and stay in good contact with our patients around them. In March of last year, if you draw that as a starting date, we had on our roadmap the virtual health, the tele visits and RPM and my diet partner and we were evaluating who would be possible candidates that we should be looking at. And for instance, on the RPM side Vivify, Livongo, VitalTech, McKesson and other ones that we were having conversations with, we had not selected one. And then even in terms of the televideo, we’re having conversations with American Well, Vidyo, Cisco extended care. In other words, what would be the right solution for the organization?

In our digital journey, we learned quickly through the pandemic that we had to be able to deliver a televisual platform around that. The third area we’re looking at is transitions of care and managing our patients in the hospitals and beyond our hospitals as a case management. This is all about data interchange and being able to mine the data so that we can have timely data and we can do the proper kind of interventions. A fourth area we’re looking at would be in our women’s services and their pregnancy journeys. What is the type of handheld app that can help on the mother baby journey. Be Babyscripts, be it mommy or others that help our pregnant moms as they’re going through their different trimesters and their wellness checks and then again, continuing expanding our care on the walls for our PACE participants. The pandemic has really reduced the amount of participants that can actually come to our centers. And so, we’re looking at how do we continue to have the seniors be vibrant, receive the same amount of care in a technology supported method. And often you’re dealing now with a population that may not be the most technically savvy, but we want to make sure that they are not afraid of the technology, how to use it. And lastly, again, looking at the wage aspects on the care and helping our patients access to services.

PP: [00:08:45] Well, that sounds like a really comprehensive digital transformation program.

You cover pretty much everything that would be considered a high impact area. So, you talked about telehealth, remote patient monitoring and mobile applications for the populations. The question that comes to my mind is you mentioned that you serve predominantly low-income populations, and you also mentioned the digital divide that is out there. So, in that context, what kind of unique capabilities or unique enablement do you have to plan for and put in place for your populations to get the same access to the same quality of care as anyone else?

RL: [00:09:28] You really hit the nail on the head. That’s one of our most significant challenges, an area that AltaMed strives, which is to be culturally sensitive. Rather, the majority of our patients are Spanish speaking. They may only have a third or fourth grade education. So how do you communicate with them when you start even at the top with Epic systems in Verona, Wisconsin, as we launched our Epic MyChart, our cultural and linguistic folks know the Spanish translation. And so, we work jointly with Epic to really enrich a Spanish translation so that users can understand it more easily. Again, we are working here in East Los Angeles, a very heavy Latino area versus folks in Madison that may have more a Google translation of Spanish, but that’s a big key area around there. The other thing that we’re seeing is there are a lot of folks building apps that may work on an iPhone 10 or something new or maybe an iPhone 8. But when you’re dealing with the underserved and low income, oftentimes they may not have that latest iOS system. They may not have an iPhone 6 or 4 because they can’t afford to get a new iPhone. With this patient population, they’re making decisions on whether they pay their cellular bill or whether they’re putting food on the table or the real decisions they have to make every day in terms of how they spend their valuable dollars. So, when we look at the technology solutions, we require the language diversity, backward compatibility on different types of iOS systems and ease of use. And you would really be amazed to hear that many folks don’t think about it as they’re delivering and bringing things to market.

PP: [00:11:22] Wow. That is something really counter intuitive. Having to plan for backward compatibility. And a lot of us are looking at the next version of the iPhone as opposed to an iPhone that is three or four generations ago. But it’s a very real problem that you’ve described. I think this is what healthcare is all about, making sure that it’s inclusive and it serves the needs of all populations. You talked about a lot of technology choices here and all the different platforms that you would consider Livongo and so on. When you assess technology partnerships in your technology choices for implementing digital programs for the population, what are you looking for? What are the top two or three things that drive your decisions, especially as it relates to digital front door tools and mobile apps and engaging with your populations?

RL: [00:12:18] So we rely heavily upon Epic through either the user groups, what we’re seeing in the App Orchard, because it’s really so strong and sharing the best practices we’re able to learn from UPMC, from Cleveland Clinic, Kaiser Stanford in terms of their journeys. And they make it available so your learning can be faster because they’ve proven what technologies can work. Speaking more about the App Orchard, in any type of healthcare organization, the integration of third-party apps can make you or break you. And further it will tell how well that digital solution will integrate. Granted with enough time and money, you can make many things work, but when you’re doing a digital transformation in a matter of months. And which is really the pace which most of us are going now versus years of kind of playing with ROI and fed and interfaces etc. You really need to be pretty clear that it’s going to integrate very easily, stacking them together just like Legos so that you can turn something on in a couple of months versus looking at maybe six months or eight months later. And part of innovation is failing quickly. So, you can learn around that. And by taking that approach, you can easily see the results before you’re so committed to a program or to an approach. The other things we’re evaluating is now e-console platforms are really becoming very interesting right now in terms of how we help our providers. And we’re looking also ambient voice for provider productivity and ease of use. And then on the patient side, kind of looking at our elders and some of the other areas is can we extend tablets out to them that they’ll find easy to use? And again, kind of addressing that inherent digital divide so that they can be connected electronically to AltaMed.

PP: [00:14:27] One question that comes to mind when you talk about a range of digital solutions that you’re trying to implement is how do they pay for themselves? There is a reimbursement component to it, a ROI component to it, and obviously there’s a cost component to it for the patients as well in terms of the devices or bandwidth access and a range of other things. How do you go about looking at this from a business standpoint?

RL: [00:14:56] That’s a great question because you need to look at why are we innovating? What is the business outcome? There may not always be a financial reason, a financial payback. And when you look at the quality and doing what’s right for the patient and so that by extending solutions to them is the right thing to do. Honestly, I would say, again, we went live in October of 2019. And before that, if you wanted to come to AltaMed as an essential worker, you’d have to take a day off. You may have to take multiple buses to come in. You could not auto-register etc. And when you look now in 2021 in January, we offer both telephonic or tele video visits. We provide this with the ability to bring in language translation services to the mom with that kid that could be sick or somebody with the URI, which is very prevalent. People are very concerned and able to address those needs. So that’s really about doing the right thing for the patient, because nobody wants to go into a hospital and nobody really wants to go to a clinic, but you still can provide that care for the patient at the right time.

So, I look at a lot of that. ROI is what’s the right thing we need to do for the patient. How do we need to do about quality as well? You mentioned reimbursement. That’s always a tricky topic because now we’re talking about the feds and how the CMS guidelines are reimbursing or not reimbursing. And that could be complex sometimes. It does affect timing sometimes in terms of what you introduce for your digital solutions. But I think ultimately keeping what’s at the best interest of the patient is where we need to be. And I think the other part of it is when you’re implementing, you need to understand what is the provider workflow change will look like and what will the patient look like? You can put in some very cool digital tools, but if it’s not adopted, you won’t be successful with the outcomes you need.

PP: [00:17:08] That leads us to obviously the big question, how do you get people to adopt to it? And at this point, we are not just talking about patients, but we’re also talking about caregivers. What kind of training, what kind of enablement do they need? How do you make them change their workflow or their daily problems? So, this is not new to you. This is a universal challenge across all of healthcare. Can you talk about one or two things that you consider a success in this regard in driving adoption?

RL: [00:17:39] I can use a language and I can use a tele-video as both example, because they’re all very new. Again, if we go back, it was April 8th of 2020, the CEO came to me and he said, give me a video solution. And I’m like we didn’t even have anything instantiated. And then CMS was dropping their HIPAA requirements. It was making it much more open. You could do some video, other areas to address it. But we want to make sure that what we talk is still a HIPAA compliant approach. So, we didn’t expose anything accidentally or put anybody in a breach type of position. So, we actually selected two, which was Doxy and Doximity, which is widely used in healthcare with an eye towards a long-term solution which should be integrated with Epic, launching out of Epic etc. It’s a change moment, right. We got it to work. We try to be the correct flows and templates inside of Epic. We trained the providers and yet there was a lot of confusion because they really didn’t know and patients didn’t understand on personal care going into a black room. It was really very challenging in terms of driving the adoption.

So, what we did is we reset, and we created a digital center of excellence within two of our clinics where they would primarily focus around the televisual experience. This includes language and other requirements that we would have so that we got really good at it. And then we’re able to share those best practices across the other two hundred plus providers in all time so that it’s much more standardized. The other thing I did, as well is that from a training perspective, my training team was certainly conducting a lot of distance training, web training as a norm and we weren’t getting the results. So I said, you need to meet the providers where they are. And we could do Zoom training, Webex training all day, but they’re not quite getting it. So, we really doubled down, tripled down on the hand training with the folks and they had hours working with them. The clinics up there, again, able to be much more comfortable with the usage of the tool.

PP: [00:20:00] Yeah, those are very interesting examples. You talk about innovation; you talk about it few times that you’ve accomplished quite a bit within a very short time given the pandemic and everything. And possibly because of the pandemic in the sense of urgency that created around the implementation of some of these programs. Does the other side of driving innovation rapidly? You refer to it in passing when you talked about failing fast and learning quickly and moving on? So, how do you manage the risks of innovation, especially the innovation that comes to it in the form of a solution that’s been developed by digital health startup? And what is your advice to startups who are looking to engage with you and be part of your innovation journey?

RL: [00:20:50] That’s a multipart question. So, I think it’s actually cited in your book. From an infrastructure perspective, have a sound foundation in terms that you can go ahead and sprint and look to leverage your technology backbone to deliver these resources. There are so many different workshops or data center processing activities hosted solutions that can cause many problems to fail, technical debt etc. And there was quite a bit of technical debt here. I remember I heard there’s a great quote from Warren Buffett that when the tide goes out, you discover who’s been swimming naked.

PP: [00:21:40] Yeah, I’ve heard that one too.

RL: [00:21:44] Yeah, I love that quote. And a lot of folks, that have been ignoring their technology infrastructure, just putting it off, extending the life they were caught when the tide went out. So, the investment of understanding the life cycle and the technology that you’re building. Again, we kind of did almost a wholesale upgrade from our data center to our networks that are happening out there. And part of that is building really strong partner relationships. I selected, of course, AT&T and heavily with Cisco, NetApp and partnerships with Presidio networked connection. And I had to leverage those technology partners. And the thought leadership where I had gaps in my own team’s ability to deliver. But the net sum of the parts just delivered superb results. I like having executive briefing sessions. And again, at Cisco, there’s a girl, Catherine Howe, who’s the director of their healthcare, and we had an EBC with her. And I was putting all of the Cisco products and we went through an exercise that was actually able to determine for what we wanted to deliver, that I have actually made all the right technology choices. And so, I was like, OK, turn the afterburners on, we can go even faster. And that occurred about at the end of 2019. So that was a good way to start from a technology perspective. But then you ask me, what do you share to startups, what would you tell them? You know, there’s so many great ideas and companies that are out there. I manage the risk by having a joint review of my diet partner, Dr. Eric Lee. He’ll look at the clinical expertise and how the workflow is and the experience and what is seen.

So, we’re able to assess it from a clinical perspective. And I look at it from overall systems perspective, interoperability, security, how it works in the overall ecosystem, whether it’s a sound business decision, etc. And ideating between the two of us, we really kind of come up with a very solid solution that we’re very confident as we move ahead. But other startups, I think they have a very clear vision of what problem they are trying to solve. I know some folks say that they will do RPM primarily for diabetes management and they will be moving to a CHF type platform or COPD or other type of chronic disease states. I appreciate that honesty. They tell me what they’re really good at and where they’re going to go. I know where the baseline is from or I get a little more perplexed when people tell you they can do it all that is also known as advertising, but not in line, I think what they say is very disappointing.

And then people also underestimate the integration activities, or they don’t have good technical resources to make it easy for the health system to ingest the product and to start getting results, ultimately you want us to be your evangelists of why this product is the best thing, sliced bread. And this is the outcome of what we’ve been able to achieve by them.

PP: [00:25:01] I think that’s great advice to start ups. You mentioned that you have a clinician, a partner with whom you work very closely in determining how to roll out these programs, what programs to learn, how to roll them out and what kind of technology foundation you need to have in place and so on. Can you talk a little bit more about your governance model? What is the governance structure for driving these initiatives? Do you have a board level, C- level approval?

How do you prioritize? Can you talk a little bit about how do you fund, how do you prioritize it and implement?

RL: [00:25:46] Sure. The term digital is a very broad term. Who you talk to, it means different things. In AltaMed we do have a structured governance process that is overseen by our Executive Governance Leaders Committee of which I’m a member of. It is basically the C-suite where key decisions are made. But then when I look at, there’s really four areas that you drill down into. One part of it is the digital engagement or the patient front door, which is your website, social media and CRM patient engagement activities. Another key is going to be your clinical digital, which is tied to your EMR and the related applications and how that’s working. We try to leverage as much as we can out of Epic and the MyChart as versus looking at third party apps to have to be built on because Epic is very rich. The technical digitalization, which are many of the hardware vendors, also want to talk to you about that data center or ______

. And those are managed primarily under my direct purview. And then as we look at innovation and destructive areas, there is business strategic oversight with as I spoke earlier on, women’s health RPM and how we can leverage other types of services. So, each of these four contribute to digital. I may have left out a few other areas that are out there. But it’s a top 10 list that I review with a CEO so that I stay aligned with the CEO’s plans and what we’re supposed to be executing. The budgeting and prioritization is an art. There are lots of apps that come up and there are lots of shiny coins that are thrown out there. But again, through maintaining focus on one of those top trends and other things come up, perhaps we can put them under a sub project of one of those ______

. But as you look at something with a significant investment, we look at what is the total cost of ownership, what’s the ROI and what are the KPIs that we will be achieving. And are we going to be achieving those for a very large investment, say, over 10 million? We may bring in an outside consultant to help us get through it. So, we really understand how we’re going to be achieving those type of KPIs. But it ultimately has to make good business sense, good financial sense. And we really should not be doing it just for technology purposes. We need to have a direct business outcome to it.

PP: [00:28:25] That’s very comprehensive. We’re almost out of time here. I want to ask you just one final question here. If there’s one best practice from your experience with digital transformation and augment that you would like to share with your peers, what would that be?

RL: [00:28:42] Yeah, I would say this. I mean, I met late on my journey on this. And as I’ve been able to review your guys book, it’s really good. I mean, thank you. It lays out the steps, the technology, the approach. So, I think if you’re trying to figure out where and how to go your digital journey, if you use your book as a reference, it will be very helpful.

And the second part of that is, again, you need to have a solid understanding once the solution is implemented that you keep both a provider and a patient centric view. You cannot keep an eye view because that would ease the adoption and accelerate the overall benefits. Yeah, don’t make it an IT project, right?

PP: [00:29:27] That’s correct. All right. Thank you so much for those kind comments about the book. And I will be sure to pass this on through ahead as well.

PP: [00:29:38] Well, I guess we’re going to have to leave it there for today. It’s been such a fascinating conversation. Thank you so much for taking the time to share your experience, your insights, best practices.

PP: [00:29:50] And I look forward to following all your successes going forward.

RL: [00:29:54] Thank you. Thanks for inviting me today. I really enjoyed our time.

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

season3-ep69-podcast-with-raymondlowe-profilepic

Raymond Lowe joined AltaMed Health Services in January 2018 as Senior Vice President and Chief Information Officer. He is an accomplished healthcare Information Systems (IS) & Information Technology (IT) executive with extensive experience in complex system delivery and operations. At AltaMed, he is responsible for all aspects of IS and IT for the organization, including strategy, innovation, delivery, operations, cybersecurity, data reporting, health plan and clinical applications, and merger and acquisition activities.

Among his many accomplishments at AltaMed, Mr. Lowe has been integral in the organization’s clinical systems transformation from the legacy system to EPIC, implementing the new Electronic Medical Record (EMR) platform system-wide, while meeting strict timeline and budgetary parameters.

He also spearheaded the establishment of foundational infrastructure, cybersecurity enhancements, and application stabilization required to support the enterprise organization. Prior to joining AltaMed, Mr. Lowe spent several years with Dignity Health as their Senior Director of Technology and Infrastructure. There he was responsible for the strategic design and delivery of IT transformation and optimization, including their Data Center, Network Consolidation, Unified Communication, and application rationalization. He also served as the Senior Director of Clinical Applications and Implementations for the Cerner EMR at seven Dignity Health hospitals.

Mr. Lowe has more than 20 years of knowledge and experience in healthcare IS/IT leadership including roles with Providence Health Services’ California Region and as Chief Information Officer for Kaiser Permanente Information Technology – Los Angeles Metro Area. Throughout his career, Mr. Lowe has been recognized with such distinguished honors as Becker’s 100 Top CIOs to Watch in 2019 and 2020, and BT150’s Most Transformational Leaders in 2019 among other noted recognitions.

Education:

M.S. Engineering Management, University of Southern California
B.S. Electrical Engineering, University of Southern California

Recent Episodes

AI Revolution Will Come Down To Who Has The Most Differentiating Data And The Highest Quality Of Data

Self-Assessment of Your Digital Transformation Efforts is Important

Clinical, Ethical, and Legal Considerations of AI in Healthcare Innovation

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

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

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It’s vital for tech firms to earn and maintain the trust of people we care for

Posted on January 22, 2021December 30, 2023 by sanjith p

Season 3: Episode #68

Podcast with Dr. Vivian S. Lee, President of Health Platforms, Verily Life Sciences

"It’s vital for tech firms to earn and maintain the trust of people we care for"

Hosted by Paddy Padmanabhan

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In this episode, Dr. Lee shares some examples of how the intersection between traditional healthcare and technology can be beneficial to improve healthcare outcomes and reduce costs of care.

The relationship between a healthcare provider and a tech provider is more about co-producing, co-designing, and working together for better health outcomes. To accelerate the pace of change in healthcare, technology firms must earn and maintain the trust of people. At the same time, digital health innovators must transform care and the way we pay for it. Dr. Lee also discusses her book , and how employers, who cover healthcare for half of the population in the U.S., will play a significant role in transforming the healthcare system. Take a listen.

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Dr. Vivian Lee, President of Health Platforms, Verily Life Sciences in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “It’s vital for tech firms to earn and maintain the trust of people we care for”

PP: [0:01:03] Hello again everyone, and welcome back to my podcast. It’s my great privilege and honor to introduce my special guest today, Dr. Vivian Lee, President of Health Platforms at Verily Life Sciences. Vivian, thank you so much for setting aside the time and welcome to the show.

VL: [0:01:11] Thanks so much, Paddy, it’s wonderful to be with you.

PP: [0:01:25] You’re most welcome. Can you tell us for the benefit of our listeners a little bit about Verily and its mission?

VL: [00:01:33] I joined Verily about two and a half years ago, not really knowing much about the technology sector. For those of your listeners who may not know much about Verily, let me give you a little bit of background. Verily originally started as a part of Google X. We were originally called Google Life Sciences, and then we were spun out and became one of the best of the Alphabet family when Google became Alphabet. From the beginning, we were purpose-built to develop life sciences and healthcare products. When I joined about two and a half years ago, I was to lead health platforms. Our mission really has been to think about how we can leverage some of the really remarkable capabilities in Verily, whether it’s new sensors and devices like continuous glucose monitors for people with diabetes or big data analytics, machine learning capabilities. And how do we leverage all of those in order to really improve our healthcare system and help reduce the cost of care. We are very mission driven organization and we’ve been very fortunate to attract some really wonderful talent. I feel very, very privileged to be in this role.

PP: [00:03:03] Thank you. That’s a great background. Vivian, you’ve had a very distinguished career, you’ve been a healthcare leader for a long time, you’re a clinician by background, and you’ve spent a long time with some leading providers across the country and now for the last couple of years you have been on a technology firm. What is the change been like? Can you maybe touch on a couple of your observations or learnings from your experience in the last couple of years at Verily?

VL: [00:03:38] Yeah, I’ve learned so much and thanks for this question, because it’s really interesting for me to reflect on just how much I have learned. There is so much complementarity between the healthcare environment and the technology environment and culture. I feel like the intersection of the two is exactly where there’s a sort of a sweet spot in terms of what I think we need in the industry in order to improve health outcomes and reduce the cost of care. And I’ll give you a couple of examples. When I went through medical school and residency and training and then worked in a number of different healthcare environments, I was always taught that we as physicians are really providing healthcare to patients. It was sort of more or less a unilateral kind of relationship. We understood about biology and physiology, and we had medications and tests that we could perform or operations that we could do. It was really our job to deliver health to people. When I joined the technology side, I came to realize that there’s a very different way of thinking about the relationship between the provider or the business and the customer or the patient. It is really the one that is much more about co-producing, co-designing, and really working together. And that plays out in the way in which we think about, for example, digital health, digital technologies or virtual care. So, when we have our company called Onduo, which is a digital health company, really help people with chronic diseases like diabetes, cardiovascular disease, like hypertension or mental wellbeing. We actually don’t think about ourselves as being the provider of health. We think about how do we work with people to co-produce their own health. We can provide information, for example, from a continuous glucose monitor about their blood sugars. We can help them take pictures of their meals and snacks from their camera on the app on their cell phone. And then they actually make the visual association between what they’re eating and how they’re sleeping, how they’re exercising, and then what their blood sugars are doing. We might make some recommendations using our algorithms and say, Paddy, for you soya milk seems to be better than skim milk in your coffee. But Vivian, for you maybe the skim milk is better. That can be helpful, are we’re really helping the individual produce their health. So that’s one example of how the intersection between traditional healthcare and technology can be really beneficial to improve health outcomes.

Another example is, in healthcare we have traditionally kind of used a one size fits all approach to caring for people. When I was in medical school, every patient was a 70 kilogram white male. The medications were dosed as if the individual was a 70-kilogram white male. And someone just corrected me yesterday and said, on these days, it’s like the 90-kilogram white male, which is not a good direction to be going with. On the technology side, of course, we all carry around very similar phones, but our interaction with those phones, the way we use the phones, the experience we have, and the benefit that we derive from them is extremely personalized. That’s another example of where I think technology can help us in healthcare. Think about how do we create healthcare solutions that are really personalized and sensitive to cultural differences, the language differences to differences in perceptions about our own health. And making it engaging so that people can again, co-produce and co-design their own health.

PP: [00:07:43] Those are great examples of the intersection of healthcare and technology. Now, the third element of that, which I know Google is really strong at, is the data side of it. Google is known for its ability to aggregate very large data sets, make sense of them, apply advanced analytics algorithms to them and identify insights that can drive action. And I can’t think of a sector which can benefit from this kind of capability more than healthcare as we know it today. So, my understanding is that Verily is focused more on the clinical research side of it, although you did mention the partnerships with Onduo and I’m aware of the partnership with Dexcom. And more recently Fitbit is going to be part of the family as well. Can you talk a little bit about how the data element plays into your overall mission for driving improved healthcare outcomes?

VL: [00:08:52] Verily is actually a sister company to Google, we are both part of the Alphabet family. Of course, Google is a much bigger sister than we are, but we’re actually a completely separate company in many regards. So just to clarify that, we all are definitely part of the Alphabet family, though. Your question about data is a really good one. Our roots are in research and in clinical research, that’s definitely how Verily got started. So, that’s why when I joined about two and a half years ago, getting close to three years now, actually, my charge was to think about the delivery side of healthcare. And your question about data element is really a spot on. So, we think about it in terms of are there new data sources we should be introducing that can actually help engage people and drive better outcomes? One example of that is our work in the continuous glucose monitor technology, which we have done in partnership with Dexcom. So, there it’s really a matter of saying that people with diabetes in the past, the information that they had about their own blood sugars was really based on either of these hemoglobin A1c blood tests that you might take every six months or even a year. Or maybe if you’re daily doing the finger pricks to check your blood sugars and saying, well, maybe that’s not enough information for individuals to really manage their blood sugars successfully. And so, the idea of having a continuous glucose monitor, is maybe the size of a key fob that you might put on your arm or your abdomen. They can measure your blood sugars 24/7 for a couple of weeks. At a time, it can provide whole new levels of insights for individuals and whole new data sources for people in order to manage their health better. And so, that’s one example of data, thinking about data to provide not only insights, but personalized insights, because my blood sugar reaction to what I eat is going to be very different from yours. We see that consistently across thousands of people that are part of our programs, that we all are very different. Our physiology is very different, our microbe biome is actually very different. And that is the way our blood sugars react to our meals and exercise is actually very different. Another example of data is in a different area that we’ve been working. We actually started a new company, which is a stop-loss health insurance company. We announced that last year in partnership with Swiss Re and there we have a whole different kind of approach to data and analytics to create what we call a precision risk analysis. So, this is for employers who are self-insured and are, of course, managing the health of their employees and covering the insurance. And enabling them to have a more precise understanding of the risk of their employee population. The purpose is to enable us working with them and to think about how they can reduce the risk if they can see some of their populations of patients are at higher risk. For example, developing kidney problems or developing cardiovascular problems, how can we intervene and lower that risk? So that’s, again, very data driven, data science, and analytics driven. So those are a couple of examples.

PP: [00:12:53] I will come back to the point you made about helping employers manage their employee population and manage their health, especially for chronic conditions such as diabetes. But thank you for clarifying the organizational structure. Many of us, me included, may not have been entirely familiar with how Alphabet and Google and different companies within Google are organized. So, thank you for clarifying that. I am aware that it is really a separate company and you have investors besides Alphabet as well. Let me switch to the topic you just mentioned, the employers and their desire to control the costs of healthcare for their employees. And everybody knows that one of the biggest components of any employer cost base is healthcare and is certainly one of the fastest growing in terms of the inflation year upon years. And in your book, The Long Fix, you addressed and you talk about why we should be concerned not just about the cost, but also about what we’re spending on. Can you elaborate on that a little bit for the benefit of our listeners? What led you write the book and what was the central theme or message that you were trying to communicate through the book?

VL: [00:14:31] I wrote the book – The Long Fix – during a sabbatical after serving as the CEO of a healthcare system for about six years and the dean of the medical school actually. And the audience for The Long Fix was really the general public, people who wanted to understand why is it that our healthcare system seems so dysfunctional? Why is it in the news all the time? And why there is fundamental paradox of healthcare in the U.S. that is we spend so much money on healthcare in this country. We spend about two to three times as much per person on healthcare than any other high income country in the world. Yet when you look at our health outcomes, we’re really at the bottom of that list of those high-income nations for the most part. And so how we are overspending and yet underperforming? And one statistic, for example, when people say, I can’t believe our health outcomes are really that much worse than Germany or Australia. And actually if you look at longevity, that’s one of the measurements. I mean, how long on average are the babies born today going to live right now? The current projections are for five or six years, not months, but years, less than the average baby born in Italy, Japan, Israel, and Australia. It’s really stunning. And so, I really wanted to understand this question and I wanted to offer some thoughts about how we could actually get to a much better place. And those thoughts were not my own thoughts, or they were just a figment of my imagination. They were really a lesson from across the country where there are fantastic examples of much better performing health systems, much better ways of thinking about improving health and I wanted to share those success. And so, that really was my overarching goal in that book. And one of the targets was employers. So, I have a chapter just dedicated to employers with this. I think there is a 10-point action plan at the end. Employers, as you know, cover healthcare for half of all Americans. So, they are very important group of individuals who really need to understand how to bend the cost curve for their employees and keep them healthier. Also, it is important to understand that they’re financially and operationally motivated to do that. And yet they really haven’t had the tools. And so, I wanted to lay out and I wanted to provide in that chapter some really fantastic examples of how employers have worked together with healthcare systems. They worked not only to get better health outcomes for their employees, but actually lower their costs of care and get those costs down. From interviewing people and from talking to people, I put together basically an action plan. So those are some of my motivations and some of the areas that I talk about in the book.

PP: [00:17:56] There have been several examples of employers finding success, with addressing maybe, specific conditions such as diabetes, for instance, and partnering with companies such as the ones that you’re associated with. This is also a good time for us to talk about at least one experiment that didn’t turn out as expected and I’m talking about Haven. What are your thoughts on that? Because the whole model was essentially what you just described, which is to take control of the costs and try to influence it as employers by looking at it holistically. And also, trying to find ways to bend the cost curve and to improve the outcomes. I’m just curious to know your thoughts on that. What we may have learned from that?

VL: [00:18:53] I think that we’re starting to see analysis of that, and I’m sure there will be many case studies written across business schools all over the country about lessons learned there. When I was really studying this space from the perspective of having been an employer. And when I was at the University of Utah, we had about fifteen thousand employees plus their dependents. We actually had a health plan, initially that was just for our own employees and for some Medicaid members that we were responsible for. And then we took a commercial license and became a commercial health plan. Because so many of the employers in our community were really interested in how we had been able to reduce the cost of care. And then interviewing around the country, I thought people became very clear that as employers, we actually really have levers for driving change in this country that we’re just not tapping into.

One of the stories that I talk about in The Long Fix, is about what happened in Seattle at Virginia Mason Medical Center. One day, the chairman of medicine was informed that four of the big employers in Seattle who had been sending their employees to Virginia Mason Medical Center for their care said that we’re going to stop doing it. This is because they were too expensive. And those employers were people that we all know about, like Starbucks, Costco, Nordstrom, for example. And when he sat down and started looking at this, he realized that these employers were the ones who are actually paying his salary and his team’s salary. They were actually his payers. And secondly, he realized that the relationship between them and the employers really need to change. And the employers realized that healthcare was like a supply chain issue for them, if they couldn’t get good healthcare from Virginia Mason, their employees couldn’t work. It was just like if you couldn’t get a chip into the Intel factory, your business would just stop if their employees couldn’t work. So, they started declaring specific performance specifications specs just like they would for any other supplier. They would expect that Virginia Mason would deliver on those.

Once they started to have that kind of a conversation and they actually got more engaged in helping Virginia Mason perform better. It actually completely transformed the way in which Virginia Mason practiced to actually become a much better health system. And that’s why they became a center of excellence in Walmart and Lowe’s and G.E. started flying their employees all the way over there just to get care. So, I think there are lot of lessons from those experiences that still make me feel very optimistic that employers have a really big role to play in transforming our healthcare system.

PP: [00:22:10] That’s a great example, and I’m sure that this whole space is going to be carefully analyzed and I definitely see a trend towards employers taking more and more control over their costs. I wanted to go back to this idea of one concept that you mentioned in one of your earlier comments and for the benefit of our listeners. You mentioned the stop-loss insurance company that you’ve started in partnership with Swiss Re. Could you just explain briefly for our listeners, what a stop-loss insurance mean?

VL: [00:22:48] About half of all Americans receive their healthcare through their employers. And if they’re large enough, they can decide that instead of doing this through an insurance company, they can in fact be the insurance company. They can take the financial risk an insurance company would take because they’re big enough. And so, they just set aside a pool of money every year to pay for the healthcare costs of their employees. And then usually they engage in insurance company to be the administrator, to send the bills, to pay the hospitals to deal with prescriptions and so on, so forth. When they do that, they’re usually referred to as being self-insured. And when they are self-insured employer, they still may want to have some insurance just in case there are exceptional things that happen. For example, say an employee has a diagnosis that requires a very expensive treatment or gets into a really bad accident, heaven forbid. That’s called stop-loss insurance. Also, they’ll take out an insurance plan just to cover really high costs of care for individual employees. Typically, when we do that as an employer or if we buy stop-loss insurance, it’s usually just a set cutoff. So, we’ll say, we just want to insure against any claim that’s over, say, one hundred and fifty thousand dollars of anything above that. The insurance company will cover it. And it’s kind of a one size fits all. And what we’ve been doing is really thinking about it in a more precise way, saying, well, you know, some people in your population may be at higher risk for having a really expensive condition. For example, they might look like they need a transplant in the next year or two. Whereas others statisticians and the actuaries would tell us is a very low risk. And so, we’re starting to basically look at this space and refine it and make it a lot more precise. That enables us to identify those people who are at high risk. So that we could potentially lower that risk and maybe provide them a transplant if we can actually intervene early enough. Now, that’s really our goal.

PP: [00:25:19] Another great example of applying data and advanced analytics to try and influence the costs. Switching back to digital health and technology. One thing that I find is that healthcare traditionally is better than anyone else. It is cautious and slow for very good reason or patient safety and a host of other issues. Technology, on the other hand, and especially, Silicon Valley based technology firms, they move very fast, they break things and fail fast. These are the kind of buzzwords that drive the way they do business. How do you reconcile these two instincts in your role and given your background when you’re trying to really accelerate the pace of change, but at the same time do it in a risky containment manner?

VL: [00:26:20] That’s a really interesting question. And in fact, we’ve seen it in the last nine months in response to COVID. Back in March, when it was really clear that we needed a lot more lab testing. And if you remember when all of us started to get shelter at home and there was such a shortage of testing and we just could see the numbers taking off. But we just didn’t have enough information about what was going in the country because we didn’t have enough testing. Our company was drawn into that. And Verily began to build these community-based COVID testing centers starting in California and then all over the country, often in partnership, for example, with Rite Aid. We actually turned over almost overnight into a company that had full of these data scientists and we have laboratory scientists, some clinicians. And all of a sudden we were becoming PPE experts and printing out bar codes for lab testing, it is really remarkable.

And the pace of that change, Paddy, was just fantastic. Our team in the health platform side were reached out by a number of employers. Because obviously we work with so many different businesses and said – “how can you help us now during COVID?” So, very quickly we were able to stand up a whole new business. It’s called Healthy at Work. It helps employers keep their employees safely in the workplace or bring them back to work safely. It includes everything from the app that it helps to check their symptoms, helps them order their lab tests. We’ll send people to do the testing or you can do it yourself. We have kits and hundreds of thousands of employees that built this entire business and now, using our program.

And it was done in such a record speed. I find it really remarkable. Our engineers work 24/7 to write the code, our quality people, our FDA approval regulatory team just work non-stop. That pace, I think we saw a lot across the whole country, the private sector really stepping up. Look at how quickly vaccines have been developed. At the same time, I think what you’re asking is sort of the balance, the yin and yang of that. And I think that it is really important that in companies like Verily, we do have seasoned healthcare executives. And so, I feel very fortunate to be a part of a Verily. My Chief Clinical Officer is a long-time physician, Vindell Washington. He was the National Coordinator for Health IT under President Obama. We were very fortunate to work with Robert Califf, who was the former FDA Commissioner under President Obama, who now works with us and with Google Health. I think we also have that element of a deep understanding of healthcare and recognizing that healthcare is different from many other industries. It’s really vital for us as a health technology company to protect the people that we care for and to maintain that trust. And then we need to earn that trust. And that’s something we all learned in healthcare as clinicians and people caring for people and making very important decisions with them. But it’s especially important in the technology sector, especially these days, we have to balance each other. The speed is absolutely essential, but the care that we take and that maintenance of trust is absolutely vital as well.

PP: [00:30:37] That’s so well said. I can certainly appreciate when the challenge is thrown at us, how we can turn around and do things that we didn’t think we could do. So, I heard someone made a comment the other day, and apparently this taught us that we’re limited not by what we can do, but what we think we can do. So, to your point, coming up with a vaccine in nine months I don’t think this would have been possible a couple of years back. It’s similar to the alacrity with which we’ve turned it on and responded to the crises in PPE production and the testing. And all of these are fantastic stories that we can learn from. If you look deeper and find out how as a community we all got together and really overcame this challenge.

I want to touch upon the outlook for digital health startups now. Digital health startups have been raising a lot of money and many of them have gone IPO. All of that continues to look very strong. The outlook seems very strong. Is this directly a function of health systems transforming themselves and really picking up the pace of change? Or is this more of a longer-term outlook with the sort of thinking that this is going to happen sooner or later? So, we’re going to make our next now and wait for it to happen. Is it already happening and what is driving this activity? Or all this activity is in anticipation of something that we all expect is going to happen?

VL: [00:32:35] Well, COVID is definitely accelerating everything. It’s almost unprecedented to have hospitals and clinics essentially shuttered except for their COVID wings for such a period of time. And for people who are most vulnerable, also being the ones that really need that care, people who have chronic conditions. The folks and people in nursing homes, the frail and elderly who actually need access to healthcare are the ones that are most afraid. This is because they are most susceptible to COVID. So, in that kind of environment, it became obvious to everyone. Obviously, you can see from the telehealth numbers that overnight every healthcare system developed a telehealth offering. And then, we recognized that in telehealth, while it’s very helpful to be able to text or video conference with a clinician, that doesn’t supplant in-person visits there. You need to make measurements, or you may need to listen to somebody’s heart and lungs. There are a lot of things that you need to do when you have an in-person visit. So, again, there’s more interest in expanding beyond telehealth to other digital health offerings. And I think everyone could see even before COVID that this is a direction that was really exciting. As we have gone with continuous glucose monitors and people with diabetes, the new sensors, the new attachments can go on to different phones. It’s been a really interesting area, a very innovative area. A lot of things coming out. I think most of us think that it’s relatively early. I think what will be developed in digital health is just going to be pretty phenomenal over the next few years. I can’t wait. I’m actually really excited to see what happens. And so, I think this is an enormous excitement and some of the barriers to digital health in terms of reimbursement and some of the regulatory issues also fell down overnight with COVID. Now, it’s not clear that those are going to stay down forever. But I think that also freed up the market probably a little bit more. One thing that’s important that I do want to mention, Paddy. It’s very important that innovators in digital health think just as hard about innovating in terms of the way in which they’re paid as they do about the products. And I’ll give you an example of that in our own work. So, in Onduo our disease management platform in healthcare is a very much fee-for-service model right now. That is one of the themes in my book, The Long Fix. We need to move from this model of paying for people to do things to us in a fee-for-service mode like more procedures, more operations, more imaging studies and so on. And instead, I think are we really getting better health or are we actually getting healthier with all this treatment? I think the same thing is true on the digital side. That is instead of recapitulating some of those weaknesses of our current healthcare system, say – “pay me every time I click or text or for video conference.” Instead we should get paid for showing that we’re actually improving health outcomes. And that’s what we’ve done actually in Onduo. We’ve had a few several contracts with payers. And we only want to get paid if we are actually showing people with diabetes have better blood sugar control, people with high blood pressure have lower blood pressure. People who need their eyes checked, get their kidneys check because they have diabetes, have had those things done. And kind of putting our money where our mouth is in terms of really moving from fee-for-service to a more value-based model. So, I’d like to see digital not only transform care, but also transform the way in which we pay for care, the business model of healthcare, because I think that’s really where there’s a huge opportunity.

PP: [00:36:56] I couldn’t agree more with you in that. That really is the opportunity ahead of us. I have just one last question at a personal level. What are you currently reading?

VL: [00:37:11] I just finished the book Team of Rivals, which is the book about Abraham Lincoln. And that was partly motivated by what happened in the summer, in the fall Black Lives matters and just really wanted to think back. About that, I am actually reading something called Seven Brief Lessons on Physics, my daughter suggested this by Carlo Rovelli. I’m reading that on my phone. It’s beautiful little vignettes about physics. And I’m also reading Bill Bryson’s, who’s one of my favorite writers, just to distract myself – Made in America.

PP: [00:38:07] Fantastic. It’s such a coincidence that I am reading a book titled Forged in Crisis. It profiles six different leaders and Abraham Lincoln is one of them. And I’m actually in the middle of that chapter right now. There is something common there. Vivian it’s such a pleasure speaking with you and having you on the podcast. And I look forward to following all of your work at Verily and all your other initiatives. Thank you once again for being on the podcast.

VL: [00:39:14] Thank you so much, Paddy. Really enjoyed 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

Vivian S. Lee, M.D., Ph.D., M.B.A., is the author of The Long Fix: Solving America's Health Care Crisis with Strategies that Work for Everyone (Norton). She is the President of Health Platforms at Verily Life Sciences. A physician and healthcare executive, Lee also serves as a senior lecturer at Harvard Medical School.

Prior to joining Verily, Lee served as the Dean of the Medical School and CEO of the University of Utah Health Care, an integrated health system with a budget of $3.6 billion, including a 1400 member physician group and health insurance plan. During her tenure, she led University of Utah Health to recognition for its health care delivery system innovations that enable higher quality at lower costs and with higher patient satisfaction, and superior financial performance.

In 2016, University of Utah was ranked first among all university hospitals in quality and safety (Vizient). Dr. Lee previously was the inaugural Chief Scientific Officer of New York University’s Langone Medical Center.

Elected to the National Academy of Medicine with over 200 peer-reviewed publications, Lee serves on the Board of Directors of the Commonwealth Fund, and is also a director on the board of Zions Bancorporation, a publicly traded company.

Dr. Lee is a magna cum laude graduate of Harvard, received a D.Phil in medical engineering from Oxford University as a Rhodes Scholar, earned her M.D. with honors from Harvard Medical School, and her MBA from NYU. She was named by Modern Healthcare as one of the 50 Most Influential Clinical Executives in 2020.

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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.

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