* Krista’s huge ‘ah-ha’ moment in regards to change management

* The explosion of technology for virtually every use case

* How healthcare is person-centric, but the EHR is not

* And much more.

—- 

Krista Hoglund, Chief Executive Officer of Security Health Plan of Wisconsin, Inc., is a healthcare executive with a track record of building high-functioning leadership teams, developing corporate strategies that work, achieving strong growth and positive financial results. She makes change happen by listening, analyzing and being willing to take risks.

Krista is a key proponent of Security Health Plan’s strategic imperative calling for stewardship of financial and human resources. She is highly focused on reducing the total cost of care for Security Health Plan customers, and across the health insurance and health care industry. As Chief Actuary and Financial Officer, Krista was a key leader in cost reduction efforts at Marshfield Clinic Health System through which Security Health Plan achieved more than $80 million in year-over-year savings. She has shaped policy, planning and analysis guiding the Health Plan’s decisions that affect its financial performance. She has worked especially closely with the financial leadership team at Marshfield Clinic Health System to ensure financial vitality for Security Health Plan and the Health System overall. 

Prior to being named CEO in 2021, Krista built her career through progressively advancing roles within Security Health Plan’s executive leadership, actuarial and business intelligence areas, most recently serving as Chief Actuary & Financial Officer. 

Krista is a graduate of the University of Wisconsin-Stout with a bachelor’s degree in applied mathematics, and is working toward her master’s degree in business administration. In addition, she completed the Carol Emmott Foundation Fellowship Program, along with a number of additional executive leadership training programs that have created the foundation of her leadership philosophy. She is an Associate of the Society of Actuaries, and a Member of the American Academy of Actuaries.

—- 

Outline

Here are the timestamps for this episode.

(00:00) - Intro

(01:35) - The changing payer-provider dynamic

(03:40) - The power of data in breaking down provider resistance

(06:05) - When driving alignment between payers and providers, the messenger matters

(09:00) - The unique challenges faced by plans when driving toward value-based care

(11:07) - Deploying technology into the provider space to help make value-based care a reality

(14:25) - What it takes to earn the trust of the provider community

(18:55) - The technology strategies that are being used at Security Health Plan

(22:30) - What fundamentals make the move to value-based care significantly more difficult than it should be?

(27:05) - What does personalized member or patient engagement look like?

(28:00) - Shifting from reactive to proactive patient engagement and care delivery

(29:30) - Healthcare’s opportunity for personalization and automation through technology

(30:34) - What will technology unlock for payers and providers over the next few years?

(32:49) - The optimization of healthcare’s administrative tasks with technology

(34:56) - The role of technology in creating synergies between payers and providers

(36:02) - Advice for those looking to bring plans and providers closer together

(40:14) - End

Relevant links

* Krista Hoglund on LinkedIn

* Dr. Neinstein on LinkedIn and Twitter

* Notable on LinkedIn

* Notable Perspectives

* The impact of automation on patient registration and clinical intake

* The role of AI in helping address challenges in nursing

* How the next generation of nurses view the profession

* And much more.

—- 

Erica DeBoer, RN, MA, CCRN, CNL, serves as Sanford Health’s chief nursing officer. A member of the organization’s executive leadership team, DeBoer provides clinical expertise for Sanford Health’s work in quality, safety, research and care management. She also oversees the integration of clinical initiatives.

DeBoer has more than 20 years of experience as a front-line registered nurse, including roles in critical care, clinical leadership and education. She most recently served as Sanford Health’s senior executive director of nursing and clinical services and clinical informatics. DeBoer has also served as adjunct faculty for nursing programs at South Dakota State University and the University of Sioux Falls.

The Sanford Health nursing practice DeBoer oversees is the largest division of the enterprise workforce supporting patient and resident care, including nearly 9,000 nurses across the post-acute, ambulatory and inpatient settings. She believes nurses are a critical part of the fabric binding the many facets of health care work together to achieve safe, high-quality care that exceeds patient expectations.

DeBoer is particularly interested in the link between patient experience and employee experience, knowing that changes in one sphere often directly drive improvements in the other. She sponsors a variety of initiatives in both areas at Sanford, including the use of predictive analytics to inform care and plan workforce needs; leveraging technology to automate non-value-added work so teams can focus on patient care; reducing clinical variations in care; and improving health equity and reducing the barriers patients face in accessing care. DeBoer says nurses are an incredibly flexible, innovative resource in these efforts and are essential to meeting the needs of our patients and communities.

Active in several professional associations, DeBoer holds a bachelor’s degree in nursing from South Dakota State University and a master’s degree in nursing from Augustana University.

DeBoer resides in Lennox, South Dakota, with her husband, Shane, and their two children.

—- 

Outline

Here are the timestamps for this episode.

(00:00) - Intro

(01:25) - Why is the nursing workforce shortage coming?

(02:22) - What are we doing about the nursing shortage?

(03:25) - How nursing will change in 2024 and beyond

(04:42) - Why technology is important but only when properly focused

(06:09) - Examples of ‘unlocks’ that have made nurses lives better

(07:45) - The impact of automating patient registration and clinical intake

(09:34) - As administrative burden is removed for frontline staff, where do they focus?

(10:49) - Sanford Health is the largest rural healthcare system in the United States

(12:16) - The role of AI in addressing challenges in nursing

(14:10) - How Sanford is addressing governance when it comes to AI

(15:20) - How do nurses view AI? Helpful or hurtful?

(20:41) - The critical importance of change management 

(23:10) - Sanford’s job architecture project and defining career pathways

(25:00) - Reimagining nursing and the role of regulation

(26:55) - What do the next generation of nurses want from the profession?

(29:01) - Nearly every nurse wants help removing or reducing this aspect of their job

(34:56) - End

Relevant links

* Erica DeBoer on LinkedIn

* Dr. Neinstein on LinkedIn and Twitter

* Notable on LinkedIn

* Notable Perspectives

* How IT has become a strategic priority in healthcare

* What ROI means in today’s business environment

* What comes next for generative AI in healthcare

* And much more.

—- 

Eric Berger is a member of Bain’s Healthcare & Life Sciences and Private Equity practices with more than 10 years of consulting experience.

Eric advises clients across a range of industries, with a focus in private equity funds as well as healthcare payers and services and biotech / pharma. He has additional experience in industrial goods and services and consumer packaged goods.

He holds expertise in topics related to commercial due diligence, business unit strategy, operating model, organization design, pricing, brand strategy and mergers & acquisitions.

Prior to joining Bain in 2011, Eric worked for a small consulting firm in Boston focused on the pharmaceutical, biotech and medical device industries. Previously, he was a researcher in organic chemistry at Harvard University. Eric has published in Science and the Journal of the American Chemical Society and was awarded a grant from the Howard Hughes Medical Institute and the Jean Dreyfus Boissevain scholarship.

Eric earned an MBA from MIT Sloan School of Management. He holds a BA cum laude and MA in chemistry from Harvard University.

—- 

Outline

Here are the timestamps for this episode.

(00:00) - Intro

(00:15) - The state of healthcare IT

(01:25) - Healthcare executives’ mindset today

(02:55) - Healthcare’s ‘new normal’ is here

(05:30) - IT is a strategic priority in healthcare

(07:40) - Competing priorities and feelings among the healthcare C-suite

(09:40) - The rapidly evolving role of the healthcare CIO

(10:50) - What ROI means in today’s environment

(12:35) - Healthcare executives are making technology investments in these key areas

(13:44) - Why patient experience and quality are significant priorities

(16:19) - Generative AI in healthcare - where are we now?

(18:43) - The leading vanguard of health systems using AI

(19:30) - Using Generative AI for healthcare’s unstructured data

(21:41) - From thinking about AI use cases to a focus on how AI impacts business strategy

(26:52) - What comes next for AI in healthcare?

(29:52) - End

Relevant links

* Eric Berger on LinkedIn

* Dr. Neinstein on LinkedIn and Twitter

* Notable on LinkedIn

* Notable Perspectives

* Why the latest AI innovations are a true game-changer for healthcare

* What most healthcare organizations can learn from the Atlanta Braves

* How to balance safety and benefits when it comes to AI

* And much more.

—- 

Dr. Robert M. Wachter is chair of the UCSF Department of Medicine, which leads the nation in grants from the National Institutes of Health and is consistently ranked as one of the nation’s best. His primary interests are health care quality, safety and policy. He coined the term hospitalist in 1996 and is widely credited as the founder and academic leader of the hospitalist specialty in medicine, the fastest-growing specialty in U.S. medical history.

Wachter is an international leader in health care safety and quality. He has published more than 250 articles and six books on health care topics, including Understanding Patient Safety, the world’s top-selling safety primer, now in its third edition. He is a frequent contributor to the New York Times and Wall Street Journal.

Wachter received his medical degree at the Perelman School of Medicine at the University of Pennsylvania. He completed a residency in internal medicine, serving as chief resident, at UCSF. He was a Robert Wood Johnson Foundation Clinical Scholar at Stanford University, and he studied patient safety in England in 2011 as a Fulbright Scholar.

—- 

Outline

Here are the timestamps for this episode.

(00:00) - Intro

(01:24) - Your book Digital Doctor from 10 years ago - what did you get right and wrong?

(03:33) - Avoiding unintended consequences with digital in healthcare

(04:33) - How the industry is cautiously approaching GPT-4 and new AI innovations

(05:00) - The biggest opportunity in healthcare? Focusing on this area

(05:40) - How the Atlanta Braves compare to the average healthcare organization

(06:29) - Have GPT-4 and LLMs helped us move beyond the ‘AI winter?’

(10:19) - Why the latest AI innovations represent a step-change for healthcare

(11:43) - What problems in healthcare are most ripe for solving with AI?

(14:54) - Balancing safety and benefit as we think about AI in healthcare

(19:11) - What is top of mind as we head into 2024?

(22:24) - The future risk of AI complacency

(25:27) - End

Relevant links

* Bob Wachter on LinkedIn

* Bob Wachter on Twitter

* Dr. Neinstein on LinkedIn and Twitter

* Notable on LinkedIn

* Notable Perspectives

* The role of data and analytics in moving a value-based model forward

* The criticality of aligned incentives in transitioning to a value-based care model

* How AI can impact future care models

* And much more.

—- 

Mike Hancock serves as Executive Director of Operations Transformation for Castell. In this role, Mike leads the Operations Transformation and Care Traffic Control teams that support Intermountain Medical Group and Affiliate Partner Clinics. Mike has worked for Intermountain Healthcare for eight years in service line, geographic operations, and practice management roles leading a variety of outpatient clinic and hospital outpatient services.

Before working for Intermountain, Mike worked for three years in the ambulatory setting with HCA/Mountainstar. Mike earned both a Master of Health Administration and undergraduate Health Administration degrees from Weber State University.

—- 

OUTLINE

Here are the timestamps for this episode.

(00:00) - Intro

(01:11) - What inspired Hancock to get into healthcare?

(01:56) - What is operations transformation and what is the role?

(03:52) - Operations transformation started in primary care, where does it go from there?

(05:17) - Top lessons learned from transitioning primary care to a value-based model

(07:42) - The role of data and analytics in moving a value-based model forward

(11:37) - Exploring financial models for ‘care traffic controllers’ and care managers

(15:00) - How the make-up of the practice staff has evolved

(19:22) - Success metrics of a value-based care model

(21:26) - The criticality of aligned incentives in transitioning to a value-based care model

(22:00) - What is the sweet spot for provider incentives?

(22:43) - How AI can impact the future of these care models

(26:33) - Staying current with trends in care delivery and operational transformation

(27:53) - Do not be afraid to take action, test, and iterate to get to a value-based model

(30:18) - End

Relevant links

* Michael Hancock on LinkedIn

* Dr. Neinstein on LinkedIn and Twitter

* Notable on LinkedIn

* Notable Perspectives

* Why transformation requires courage and how to be a courageous leader

* The need to think about ROI in terms that go beyond just financials

* The promise of Generative AI for healthcare

* And much more.

—- 

Patrick McGill, MD, is an executive vice president and Community Health Network's chief transformation officer, a role he assumed in November 2021.

Dr. McGill is responsible for population health management, value-based care, envisioning data-enabled strategies, overseeing information technology and digital transformation, and leading Community’s effort to use analytics to drive transformation.

Since joining Community in 2010 as a family medicine physician, Dr. McGill has advanced through a variety of roles. After working in informatics, he was named medical director for physician informatics. In 2017, Dr. McGill was named vice president, clinical transformation, and shortly thereafter became senior vice president, clinical strategies.

Dr. McGill holds a bachelor of science degree from the University of Georgia and received his medical degree at the Medical College of Georgia School of Medicine in Augusta, GA. He completed his family medicine residency at Ball Memorial Hospital in Muncie, IN. He is board-certified by the American Board of Family Medicine.

—- 

OUTLINE

Here are the timestamps for this episode.

(00:00) - Intro

(01:57) - Why having courage is critical in bringing transformation to healthcare

(03:37) - Any transformation project must start by clearly defining the problem to be solved

(04:30) - Breaking down healthcare’s traditional mindset of siloed thinking

(07:51) - Why healthcare organizations need to think about ROI differently

(10:29) - The healthcare workforce now and in the future

(13:15) - Healthcare problems that were once intractable can now be solved with AI

(14:34) - Using AI for segmentation and personalization in healthcare

(15:33) - Examples of failed programs and the leadership lessons learned

(17:34) - The critical importance of alignment in driving change and transformation

(19:14) - Why right now is one of the most exciting times for the healthcare industry

(21:21) - End

—- 

Relevant links

* Dr. Patrick McGill on LinkedIn

* Dr. Neinstein on LinkedIn and Twitter

* Notable on LinkedIn

* Notable Perspectives

* How AI can make healthcare human again

* Patient autonomy and access to care

* The medical community’s resistance to change

* And much more.

—- 

Eric Topol is the Founder and Director of the Scripps Research Translational Institute, Professor of Molecular Medicine, and Executive Vice-President of Scripps Research.

He has published over 1,200 peer-reviewed articles, with more than 320,000 citations, was elected to the National Academy of Medicine, and is one of the top 10 most cited researchers in medicine. His principal scientific focus has been on individualized medicine using genomic, digital, and A.I. tools.

He authored three bestseller books on the future of medicine: The Creative Destruction of Medicine, The Patient Will See You Now, and Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again. Topol is the principal investigator to two large NIH grants, the All of Us Research Program that supports precision medicine and a Clinical and Translational Science (CTSA) Award that promotes innovation in medicine. He was the founder of a new medical school at Cleveland Clinic (Lerner College of Medicine), was commissioned by the UK to lead a review of their National Health Service, and is active clinically as a cardiologist. 

—- 

OUTLINE

Here are the timestamps for this episode.

(00:00) - Intro

(01:26) - How AI can impact the doctor-patient relationship

(05:00) - What is the next book Dr. Topol will write that correctly predicts a future trend?

(06:07) - Why it took a pandemic to get telemedicine off the ground

(06:32) - Resistance to change in the medical community

(07:00) - How LLMs and advanced AI can change the mindset

(10:23) - Why the industry needs to seize the moment we are in

(12:01) - Exploring how to build trust in AI among the medical community

(14:30) - Which areas are seeing the most uptake in terms of AI in healthcare?

(16:28) - Keeping the doctor-patient relationship at the core as AI becomes more widely deployed

(18:45) - Tips for staying current on the latest trends and news

(21:43) - End

Relevant links

* Eric Topol, MD on LinkedIn and Twitter

* Dr. Neinstein on LinkedIn and Twitter

* Notable on LinkedIn

* Notable Perspectives

* The power of advanced AI and LLMs to dramatically reduce development time

* How pre-trained models are being used to power automated form fillers

* The drivers and motivations of being an early adopter

* And much more.

—- 

Dr. Michael Hasselberg is the first Chief Digital Health Officer at University of Rochester (UR) Medicine and is the co-Director of the UR Health Lab, the health system’s digital health incubator. He is also an Associate Professor of Psychiatry, Clinical Nursing, and Data Science at the University of Rochester. 

Board certified as a Psychiatric Mental Health Nurse Practitioner, Dr. Hasselberg completed his Ph.D. degree in Health Practice Research at the UR and a postdoctoral certificate in Healthcare Leadership at the Johnson School of Management at Cornell University.

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

—- 

Outline

Here are the timestamps for this episode.

(00:00) - Intro

(02:02) - Trying to solve complex healthcare problems before GPT-4

(03:41) - Solving the patient messaging problem with GPT-4 in just two days

(08:03) - Non-patient facing use cases for LLMs and generative AI

(09:22) - Building automated form fillers (workers comp)

(10:54) - Using LLMs to build tools for the IT Help Desk at a health system

(12:45) - Generative AI for ambient documentation

(14:45) - What’s the motivation to be an early adopter of technology?

(18:40) - Why banning the use of generative AI is not a winning strategy

(19:28) - Exploring the incentives for continued innovation

(23:22) - What guardrails does an innovation incubator operate within?

(27:45) - End

Relevant links

* Dr. Michael Hasselberg on LinkedIn

* Dr. Neinstein on LinkedIn and Twitter

* Notable on LinkedIn

* Notable Perspectives

* What organizations look and function like when they are taking the right approach to responsible AI

* How responsible AI is similar to the ‘rules of the road’ that keep us organized, safe, and able to get to where we want to go quickly when driving

* Where healthcare organizations typically start with responsible AI

* And much more.

—- 

Ilana is Director and Responsible AI Lead at PwC US, where she serves as one of the leads for Artificial Intelligence. Ilana specializes in applying machine learning and simulation modeling to address client needs across sectors regarding strategic deployment of new services, operational efficiencies, geospatial analytics, explainability and bias. 

Ilana is a Certified Ethical Emerging Technologist, is listed as one of 100 “Brilliant Women in AI Ethics” in 2020, and was recently recognized in Forbes as one of 15 leaders advancing Ethical AI. Since 2018, she has led PwC’s efforts globally in the development of cutting-edge approaches to build and deploy Responsible AI.

—- 

Outline

Here are the timestamps for this episode.

(00:00) - Intro

(02:00) - Defining Responsible AI

(05:25) - Who typically ‘owns’ responsible AI within an organization?

(08:10) - Why responsible AI should fit within existing governance capabilities

(10:42) - The differences in responsible AI for builders vs. implementers

(13:33) - Who is doing responsible AI the right way? What are examples?

(16:30) - How a good governance program is like the rules of the road for driving

(19:10) - Where organizations have ‘gone wrong’ with responsible AI - common themes

(24:13) - Where healthcare executives should start with responsible AI

(29:04) - Exploring the common objections to advanced AI technologies 

(30:26) - Recommended resources for learning more about responsible AI

(34:47) - End

Relevant links

* Ilana Golbin on LinkedIn

* Dr. Neinstein on LinkedIn and Twitter

* NIST AI Risk Management Framework

* Notable on LinkedIn

* Notable Perspectives

* How Intermountain Health thinks about and sets out to build consumer-grade experiences for its patients

* How advanced technology is augmenting human healthcare workers

* Why it is important to incorporate empathy into any ROI calculation

* And much more.

—- 

As Vice President of Digital Services at Intermountain Health, Mona Baset leads digital strategy and transformation, including the development and implementation of the digital technology roadmap. She was also appointed by the Governor of Colorado to serve on the state’s eHealth Commission.

Prior to that, Mona was a leader 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.

—- 

Outline

Here are the timestamps for this episode.

(00:00) - Intro

(00:52) - The motivation to work in healthcare

(01:48) - Does healthcare lag in consumer technology adoption?

(03:24) - Best-in-class consumer technology from a health system POV

(04:47) - Amazon’s consumer experience vs. the healthcare experience

(07:34) - Building the consumer experience at Intermountain Health 

(10:04) - Prioritizing the work

(11:09) - Factors that influence the build vs. partner decision

(13:07) - How Design Thinking applies in healthcare

(20:32) - Quantifying the ROI of empathy

(25:01) - How Intermountain Health thinks about time horizons for digital projects

(26:59) - Intermountain’s best partners have these common characteristics

(28:34) - The impact of ChatGPT and large language models in healthcare

(33:31) - Does technology augment human workers or eliminate the need?

(40:54) - End

Relevant links

* Mona Baset on LinkedIn

* Dr. Alagappan on LinkedIn and Twitter

* Notable on LinkedIn

* Notable Perspectives

—- 

Kevin Huang serves as Head of Data and Machine Learning for Notable, where he leads the development of the company’s intelligence platform, starting in the early days of natural language processing to work on incorporating large language models. Prior to Notable, Kevin was a data science technical lead at Change Healthcare. He holds a Ph.D. in electrical engineering from Stanford University, where he built computer simulations and new algorithms to study nanoscale LED devices.

—- 

OUTLINE

Here are the timestamps for this episode.

(00:00) - Intro

(00:46) - What is artificial intelligence?

(03:00) - The differences between artificial intelligence and machine learning

(07:03) - Deep learning and natural language processing (NLP)

(11:53) - Limitations of NLP in healthcare

(14:49) - How do transformers connect NLP to large language models (LLMs)?

(18:43) - Defining large language models

(22:31) - Key AI terms summarized and defined

(23:51) - How do you create an LLM?

(25:44) - Limits to the power of LLMs

(29:55) - How to differentiate when everyone is using the same LLM

(33:33) - LLM use cases in healthcare

(39:18) - Safety, security, and LLMs

(44:18) - End

Relevant links

• Kevin Huang on LinkedIn
• Dr. Alagappan on LinkedIn and Twitter
• Notable on LinkedIn
• Notable Perspectives

—- 

Bri Buch leads solutions development and product strategy in patient access and digital engagement at Notable. Previously she served as a consultant and strategic advisor to over 20 leading healthcare organizations on digital health transformation and digital front-door strategy. Prior to this, Bri worked at Epic Systems, leading EHR installations around the globe. She was integral to the debut of Epic’s predictive analytics suite, launching the first five AI analytics models for Epic customers and training internal teams on commercialization and deployment. Bri holds degrees in Public Health and Economics from the College of William and Mary, a Master's degree from the London School of Economics, and a certificate in Managing Innovative Technology from the University of Oxford.

—- 

0:03:16.8: Dr. Alagappan asks what do you think some of the biggest challenges in healthcare are today?

0:03:56.7: Bri Buch: “I'm really laser-focused on two issues right now. And they are, how do patients access care and then how do providers get paid for that care? And even within both of those, we could talk about equity of care access across different patient populations, and right patient to right doctor, right provider matching, and even the amount of kind of manual work or humans required to get a bill out the door and make sure that bill is accurate.”

0:05:09.0: Bri Buch: “But even beyond that, something that I spend a lot of time thinking about is, why are we not getting better, right? Even in my training in economics and policy, we spend a lot of times looking at these questions and they haven't gone away.”

0:05:53.0: Dr. Alagappan asks “Why do you think digital technology has failed to meet its expectation in the last 20, 25 years?”

0:07:29.7: Bri Buch: “...we have this idea that healthcare and specifically healthcare access is inherently something worth investing in that we don't necessarily hold it to a high standard of outcomes, right? We don't necessarily measure on the backend, are we getting patients in at the rate we need to? Are we keeping patients in the system? And the dollars that are funneled in are not necessarily held to the same standard of are they achieving the outcomes we want to see? I think the second case is oftentimes, something I think of maybe the DMV effect, right? We have a consumer population that need this service. And sometimes, there's competition for those patients, but oftentimes there's kind of one group that can take care of their needs or see them in a geographic location.”

0:08:29.6: Bri Buch: “...we need to switch from saying, ‘okay, this technology is going to replace a workflow’ to, ‘how is it going to enhance, augment or improve a workflow alongside the humans that are currently doing these tasks?’” 

0:09:39.4: Dr. Alagappan: I haven't heard that before, and I think it's very true. And so you're describing the DMV effect as not having to improve your process because you sort of own that geography. 

0:14:25.9: Dr. Alagappan talks about Bri’s work to help healthcare organizations big and small implement automation technology, asking, “What advice would you give to those organizations or other organizations looking at automation as a potential solution?” 

0:15:02.8: Bri Buch: “I think there are three things that come top of mind and really are general trends I see across organizations regardless of size, shape, geography that they serve. And I think the first is, getting really clear on what problem the automation is intended to solve.” 

0:16:04.7: Bri Buch: “I think the second I'd say is, understanding that as organizations are evaluating, thinking about going into the space or maybe advancing into this space, that not all automation is created equal. I think there was a kind of V1 version of automation in healthcare, which was almost looking for different pixels on the screen as part of scripts, oftentimes robotic process automation.”

0:16:55.0: Bri Buch: “And these types of workflows are maybe just as brittle as some of the old technologies that we're looking to replace. And then there's a lot of different types of automation now, some that are backed by machine vision, computer vision, that are able to be flexible as screens change, as EHRs change, as technology changes. And it's important to know how to ask about and get into the differences between those different types of automation.”

0:17:33.0: Bri Buch: “...the third I would say that comes up a lot in the patient access realm is standardization as part of the process of implementing automation. And oftentimes we hear organizations, they'll say, ‘I would love to implement this, I would love to work with you in this area, but I don't feel that I can until we've done some internal rework or centralization of our processes.’ And I would actually challenge that and say, oftentimes automation can be a great forcing function and source of maybe a catalyst for a system to actually undergo some of that work to bring disparate groups back together.”

0:18:37.0: Dr. Alagappan asks: “And so as someone who works with hundreds of health systems to implement automation, what use cases do you see as the best place to start for automation? Where do you recommend people look first?”

0:19:20.0: Bri Buch says, “I think there are a few key areas that I'd call out that are helpful when you're looking for what to automate. And the first would be kind of two core buckets, one being unseen manual work, so places that you just...You have open job recs constantly, you're often hiring for those roles, you're training, maybe there's high attrition there. And then the second would be places that there would be manual work occurring, but there's not even enough staff to work that workflow.”

0:20:40.9: Bri Buch: “And then maybe the last one I'll add in is, anywhere you have multiple systems that don't talk to each other, because in healthcare, we often take a human band-aid and put them between two different disparate systems, and that's another great use case for automation where it can ease the flow of information without needing to take another FTE or staff member.”

0:22:29.7: Dr. Alagappan asks: “Where do you see common pitfalls or mistakes that organizations make when it comes to implementing automation?”

0:24:13.8: Bri Buch: “One of the common pitfalls of not seeing the benefits of automation is teaching staff what not to do. Or maybe put another way, teaching staff how to interact with automation and see themselves as the gut check, the kind of human analysis to make sure that what is there is correct, but to not go ahead and do the same work.”

0:25:33.5: Dr. Alagappan asks “If you put yourself in the shoes of a health system executive, how do you justify paying for new technology or investing in automation when you're already operating perhaps at a loss and are under significant financial pressure? How do you justify that or make that case to yourself?”

0:26:48.0: Bri Buch: “...it reminds me a little bit of a saying in tech, I think this came out of IBM in the computer age, that you don't get fired for buying IBM. And the idea here was, if a CIO is implementing IBM as a technology, regardless of the outcomes, it's a safe bet. And I think in healthcare, we sort of attribute that mentality to EHR first. I have these technologies, I have these tools, and if I go with that as my strategy, I can't lose. Even with everything going on around me, that is kind of the safe path as we try to navigate these waters. But I think there's a hidden cost that comes with this mentality, and oftentimes it's hidden costs of needing a staff of an organization's own IT teams, needing additional hardware, long times for rollouts.”

0:32:00.8: Dr. Alagappan asks what do you think of health systems depending on an EHR to be a one-stop shop for all technology solution needs?

0:33:22.4: Bri Buch: “I have to go deep and think through the core competency of a tool. What is it designed to solve, what is it trying to solve for? And for the EHR, that primarily has been three things. It's a system of record, it's a practice management software, and it's a billing suite. And more and more today, the organizations I talk to have those three in one. But at the end of the day, that has primarily been the core competency for a system of record, and that's been true for the past 10 years and throughout my experience. But, what a system of record is not, is a system of action, and a system to actually act on information within that system of record.”

0:36:18.1: Bri Buch: “And what we're actually doing when we try to use the EHR as our system of action, is we're introducing friction into the patient experience. We're taking a tool with one core competency and trying to use it to accomplish a different goal.”

0:37:28.1: Dr. Alagappan asks what patient access should look like in healthcare versus what it does look like at present.

0:38:32.8: Bri Buch says, “I think the current default is if you need patient access, it's very reactive, as opposed to proactive. We just expect the patient will come to us and they will call in. And typically the call-in is between the hours of 9:00 and 5:00, and maybe there are 10 minutes of hold time. There's kind of all these barriers and this friction. And I think what we need to do is invert this paradigm to say, ‘A patient only calls the health system for support when the system breaks. So how can we provide other tools so that the patient... They're only calling us as a last resort?’”

0:41:15.3: Dr. Alagappan asks where artificial intelligence and machine learning stand to make a difference in healthcare moving forward.

0:42:06.8: Bri Buch: “I see a lot of promise in the AI/ML world to really help us move the needle on more sophisticated patient and provider matching, symptom-to-visit type matching, allocation of visit types on templates.”

0:43:11.0: Bri Buch: “I think AI and ML have a lot of abilities, but again, we need to look beyond maybe V1, which is things like static decision trees or basic chatbots and really say, ‘How can we use machine learning systems that take knowledge from a patient's workflow or interaction seeking care? From what they put in as the symptom, to what the provider writes in the note, to what the outcome of the visit is, and then have a feedback loop pulling that back into the next patient who comes in and looks for care and how we direct them to care.’”

0:45:29.7: END

Relevant links

• Bri Buch on LinkedIn
• Dr. Alagappan on LinkedIn and Twitter
• Notable on LinkedIn
• Notable Perspectives

—- 

Manish M. Naik, MD, joined ARC in 1996. He has served as Associate Chief of ARC Internal Medicine since 2011 and Chief Medical Information Officer since 2014. He was named Chief Medical Officer in June, 2021, providing leadership to ARC physicians and clinicians. Under his leadership, ARC continues to explore new technologies that allow physicians to optimize clinical and administrative work flows for better physician wellness and patient care. He serves as Chairman of the ARC Executive Board and is a member of the ARC Clinical Quality Committee.

—- 

0:04:03.9: Dr. Naik: “Right now, in many cases, the technology is a hindrance, it's interfering with the patient-physician interaction because it's now in the room with you and you're interacting with it and you may be losing eye contact with the patient. And one of the great promises of these electronic systems was if we spent all day entering data into them, there would be some return on that investment. These systems would help us do tasks in an easier way, they would help us with clinical guidance. And I think that is still, in my mind, in many ways, an unfulfilled promise. So I think there's a lot of opportunity still there.”

0:06:01.4: Dr. Naik: “So again, we have better access to information but my own assessment is that in the current state of things, in no way shape or form has the electronic health record made us more efficient. And that's the challenge that we deal with today.”

0:09:21.8: Dr. Naik on what the impact of the EHR is on both older and younger physicians. “I think they recognize the value of digitalization, but both the younger and the more senior physician are being impacted by the electronic health record in a negative way, because the screens are very busy. There's a lot of clicking, there's a lot of scrolling. It has added a significant cognitive load to the brain in getting through the day, and that's on top of all of the cognition that happens evaluating patients and deciding on what is the differential diagnosis, what is the treatment plan.”

0:13:46.1 Dr. Naik: “So I definitely think there are components of the workflow that can be automated. And actually some of these components like the medication reconciliation, for example, can be automated with the help of the patient. In other words, the patient can do some of that work for you, and ideally some of that work can be done even before the patient shows up in your office.”

0:15:28.8 Dr. Naik: “Healthcare has always been behind in terms of leveraging technology in a way that actually improves efficiency, improves quality of care, and reduces the staffing need.”

0:16:45.1 Dr. Naik: “The other challenge in our healthcare system is the payment model. We live in a healthcare system in this country where you're reimbursed for everything that you do, if you do something, you get paid for it. And I think, increasingly, we're recognizing that we need to move to a model where we're rewarded for keeping patients healthy.”

0:17:26.3 Dr. Naik: “...I do think the future of healthcare is bright. We have to better leverage technology to accomplish the goals that we have set for ourselves, not that somebody else has set for us.”

0:18:24.0 Dr. Alagappan asks about the staffing shortage and whether or not we’ve seen the worst of it.

0:18:58.6 Dr. Naik, “So I think there's a long and a short-term problem there, but I think it's solvable. I think that we're also recognizing, and in any healthcare organization this is true, that the staffing and the people are the most expensive resource. And I think as there continues to be downward pressure on reimbursement, it's going to make sense to think about where are the places where actually you know what, I don't need a staff member here, what I need is a technology so that I can have that staff member do some higher level tasks and as we grow as an organization. We don't need to add as many staff and that will be part of the staffing solution as well. So we at ARC, we are turning to technology to try to bridge that gap.”

0:22:24.2 Dr. Naik on transitioning into the chief medical officer role: “As you know, the electronic health record touches every part of the organization. And as a result, I quickly found myself spreading from something that was purely electronic health records into other operational and clinical issues across the organization. And to be honest, it was a perfect match because you really have to look at things through both lenses to really get a holistic view of what's happening in the organization.”

0:23:26.2 Dr. Muthu Alagappan asks about the role of a CMIO.

0:23:44.5 Dr. Naik: “So really and truly, it boils down to one primary concept. And that is, I'm somewhat of a translator between the technical teams who do the build in the electronic health record system and the clinical folks who want to take care of patients, and I do the translating.”

0:25:09.0 Dr. Naik on taking a multidisciplinary approach to technology: “So before we actually put something into production, depending on what pieces it touches, we get input from our operations teams, from our nursing teams, from our business office teams. It really is important to have a multidisciplinary approach and not exclude anybody that might be impacted. And it's a much smoother process if you approach it that way.”

0:29:13.8 Dr. Alagappan asks about how CMIOs interact with one another.

0:29:37.4 Dr. Naik: “But I also have developed a network of CMIO contacts through those engagements and will not infrequently reach out to them when we have new ideas, new thoughts, questions, ‘How are you dealing with this challenge?’ And those conversations have been very productive. So we do have a network of sorts that each of us have developed over time.”

0:31:08.4 Dr. Naik on the notion that people don’t want to see their PCP anymore. It’s not true, it’s that it’s too hard and cumbersome in many cases: “So as healthcare organizations, we need to understand that it's not just the relationship we have with our patients, but patients care about access. Patients care about convenience. And we need to continue to move the ball forward and not get behind on our technology capabilities or our access.”

0:33:41.4 Dr. Alagappan asks if there is a concern with non-traditional entrants coming into healthcare like Amazon. 

0:34:00.4 Dr. Naik, “In order to really deliver high-quality care, it needs to be what I would call connected care. So when a patient gets seen for an urgent care visit, they should then follow up with their primary care doctor, and I need to be able to see what that visit was all about. I need to be able to see the results of that visit. I need to be able to then refer that patient to somebody who can also see all of that stuff and whoever that specialist is that patient needs to see next. So it all needs to be done in a very coordinated fashion to deliver high-quality care.”

0:35:17.3 Dr. Alagappan asks what Dr. Naik is most optimistic about.

0:35:32.1 Dr. Naik says one is a shift in payment models to focus on rewarding those who keep patients healthy. The second, “My other hope is that we can really start to better leverage a lot of this digital technology to improve efficiency and take some of the load off of physicians and their clinical staff. Right now, it's a bit of a challenge.”

0:36:54.4 Dr. Alagappan asks about the best piece of advice that Dr. Naik has ever received.

0:37:06.7 Dr. Naik says, “One of the best pieces of advice I've gotten is, ‘Don't spend too much time worrying about an outcome of something you're working on. Spend more of your time focusing on what it is that you can do and what it is that you can control. So, give it your personal best and the outcome will take care of itself.’ I think people sometimes get so caught up in focusing on what will the outcome be that they lose sight of the path to get there. And so just give it your best.”

0:38:04.7: END

Relevant links

• Dr. Naik on LinkedIn
• Austin Regional Clinic on LinkedIn and Twitter
• Dr. Alagappan on LinkedIn and Twitter
• Notable on LinkedIn

--

Robert M. Wachter, MD is Professor and Chair of the Department of Medicine at the University of California, San Francisco (UCSF). In 2021-22, the Department was ranked the best internal medicine department in the nation by U.S. News & World Report. Wachter is the author of 300 articles and 6 books. He coined the term “hospitalist” in 1996 and is often considered the “father” of the hospitalist field, the fastest-growing medical specialty in the U.S. history. He is past president of the Society of Hospital Medicine and past chair of the American Board of Internal Medicine. He has written two books on safety and quality, including Understanding Patient Safety, the world’s top-selling safety primer (now in its 3rd edition). His 2015 book, The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age, was a New York Times science bestseller. In 2020-22, his tweets on Covid-19 were viewed over 400 million times by 250,000 followers and served as a trusted source of information on the clinical, public health, and policy issues surrounding the pandemic.

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0:02:55: During his residency at UCSF, Dr. Wachter found physicians who weren’t studying genes/molecules but rather the system and how to make it work better.

0:03:29: Dr. Muthu Alagappan asks what sparked Dr. Wachter’s interest in digital transformation.

0:04:24: Dr. Wachter: “You can think of every walk of life, and digital arrived, and it transformed the way we did it, and created new expectations, and generally more satisfied consumers, although often a lot of unanticipated consequences. And I was kind of waiting for decades for our moment to arrive in healthcare. If you think about it, almost every other industry, maybe with the exception of education, went digital and was transformed, and I'd say mostly for the better.”

0:05:04: Dr. Wachter: “If you analyze medical mistakes you come to realize very quickly that many of them relate to information systems and structures that don’t work very well.”

0:05:53: Dr. Wachter: “In 2008, fewer than one in 10 American hospitals had an electronic health record. By 2017, fewer than one in 10 did not. So it was really over the past 10 to 15 years that medicine went from fundamentally an analog industry, to mostly a digital industry…”

0:07:21: Dr. Wachter talks about a 40-fold overdose of an antibiotic that was given at UCSF and the reason was that the digital systems recommended the dosage (because of human input errors), and the staff followed the recommendation vs. questioning it. 

0:07:41: Key quote from Dr. Wachter: “The fundamental flaw here was digital systems that, through a series of human glitches meeting the digital system, came up with an absurd dose. A 40-fold overdose would be like being on the highway and seeing a sign that said speed limit is 2,500 miles per hour, it's absurd. And yet everybody just turned their brains off and did it because the computer was telling them to do that, and they trusted the computer, and they've lost trust in their own instincts.”

0:09:15: Dr. Wachter’s conclusion from talking to dozens of people in the industry (and beyond) for his book? He’s optimistic about the future of healthcare.

0:09:45: Dr. Wachter says “It's going to take some time, and part of what it's going to take is to move from the monolithic system of your main digital thing is this big enterprise system called the Electronic Health Record that controls everything, to a much more nuanced, and a much more diverse set of digital tools…”

0:11:44: The four stages of digital transformation in healthcare, according to Dr. Wachter are 1) digitizing the data (that’s what the EHR did), 2) connecting different digital pieces (aka interoperability), 3) analyzing the data, making sense of it, and coming up with new insights/predictions around how to do things better, 4) take the insights and build new systems and new workflows and structures to make things better.

0:16:09: Dr. Muthu Alagappan asks why the healthcare trends from COVID (telehealth, virtual care, etc.) don’t seem to have ‘stuck’ now that we’ve come out the other side.

0:18:42: Dr. Wachter says we don’t know the answer. Key quote: “I think there is something about the doctor-patient relationship, that some combination of doctors and patients value as an in-person enterprise in a way that they don't seem to value in terms of a relationship with a travel agent, a bank teller…”

0:19:33: Dr. Wachter continues: “So there are a lot of subtle forces, some of which are cultural and historical, some of which relate or are in some way sociological that you and I were trained to lay our hands on and feel that that relationship is very meaningful.”

0:21:09: Dr. Muthu Alagappan asks about the productivity paradox and how Dr. Wachter defines it in healthcare.

0:23:50: Dr. Wachter explains the paradox, saying “The paradox being you do not see productivity gains [from new technology] the way you expected and the way you hyped. The wonderful news about the productivity paradox and the one that makes me a digital optimist is in essentially every case that I can think of, the paradox ultimately resolves itself.”

0:24:09: Dr. Wachter: “It resolves itself, and sometimes it takes five years, sometimes 10 years. And I expect in healthcare it'll be more in the 10-20 year timeframe. Because the regulatory environment is harder. The stakes are higher. You know, I live in Silicon Valley, fail fast sounds good if you're building a restaurant app, pretty bad if you kill somebody. And so there are a lot of reasons why healthcare will be slower.”

0:26:01: The key to unlocking the productivity advantage of technology? It’s reimagining the work. Dr. Wachter says, “But no one seems to be creative enough to understand what their world with technology will look like until they actually are living with the technology. So they typically do not re-think the way they do the work or the workflow, or the way they staff themselves in advance. They have to live with the technology for a few years…”

0:28:32: Dr. Wachter on why the change is so slow in healthcare: “This takes 10 or 20 years, because you've got to then build the culture, the people, the structures, the incentives to truly re-imagine the work and an industry like healthcare that generally is relatively fat and happy, there are very few unemployed doctors and nurses.” 

0:29:35: Dr. Wachter discusses that historically healthcare’s solution to any problem has been to hire people to handle it. Billing, scheduling, call centers, etc. Now, for the first time in his 40-year history in healthcare, that’s just not possible. 

0:30:33: Dr. Wachter: “...now there's actually a limit on the number of people you can find, so that's a forcing function that may create a meaningful difference that even if you have enough money, you may not be able to find the bodies, which really is a very powerful argument for automation.”

0:30:48: Dr. Muthu Alagappan asks about reimagining the workforce.

0:34:14: Dr. Wachter: “I think the competitive forces are going to make us ask some very hard questions about the way we're organizing work…”

0:35:52: Dr. Wachter on the future of work in healthcare. “We've gotta think in a very new way about who's doing the work and how they could do their work better and safer and less expensively if they had technology in a form that was really useful and usable. And that to me is one of the most exciting phases that we're at in healthcare.”

0:37:24: Dr. Wachter on what ails healthcare today. “You look at the amount of time that people are spending trying to figure out what your insurance will or won't pay for, so that they can send the appropriate build to the appropriate person. Or you look at the struggle that someone has to try to get an appointment to figure out who the right doctor is and get an appointment in my system or yours. It's just terrible, it's wasteful, and in almost every other industry, people wouldn't tolerate it.”

0:37:55: Comparing healthcare to other industries. Dr. Wachter says, “We deliver the appropriate highest quality care, maybe 50 or 60% of the time. Think about how long FedEx would be in business if they got you your package 50 or 60% of the time, and on the time that they promised. They'd be out of business by next Monday.”

0:39:53: Muthu asks about technological innovation and the balance that will come from the legacy EHR vendors vs. newer companies that sit around the EHR.

0:43:40: Dr. Wachter: “I would bet on the third-party vendors, obviously not all of them, a lot of them won't do well, and a lot of them will go out of business. But the ones that do well, I think have an advantage in solving some of these complex, specific use case problems.”

0:44:13: Dr. Muthu Alagappan asks 'what is the big technology trend on the horizon for healthcare?'

0:46:17: Dr. Wachter says, “It's no longer, going to be elective, you're going need to use AI and AI-based tools to take the data, get smarter about it, and to some extent replace human FTEs with systems that can automate certain processes. I think that feels to me like the megatrend...”

0:48:19: END

Relevant links

Dr. Wachter on Twitter

Dr. Alagappan on LinkedIn and Twitter

Notable on LinkedIn

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Dr. Patrick J. Cawley is the Chief Executive Officer of MUSC Health and Executive Vice President for Health Affairs of the Medical University of South Carolina. In this role, he oversees all clinical matters as they relate to MUSC. During his leadership, MUSC has significantly expanded its clinical enterprise with a new Children's Hospital, a regional health network, multiple ambulatory sites, development of additional clinical affiliates, and numerous novel joint ventures. Additionally, MUSC has become a national leader in telehealth and has continued as South Carolina's #1 hospital/health system per US News and World Report.

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0:09:12: The role of technology in improving patient safety and quality.

0:09:53: How do you use technology to change the business?

0:10:10: Digital transformation.

0:11:04: Dr. Cawley: “There have been phenomenal technology advances in the past 10 years in healthcare, we use a lot of them, but I still have this feeling we're not using enough of them, mainly because we're trying to fix problems in the same old way through the same old checklist rather than using AI or some advanced sensor that we might be able to put somewhere in order to answer some of these really basic but recurring problems.”

0:19:04: Labor shortages on the clinician and administrative staff side of things.

0:19:51: Burnout is a real issue and it was an issue pre-pandemic. When the pandemic hit, the industry doubled down on doing things the way they had always been done. That compounded the issue and now we’re seeing the result. 

0:20:22: Dr. Cawley: “We must change the way we deliver care.”

0:22:24: Dr. Cawley: “...we have to figure out how we optimize the things that only our physicians, nurses, and other providers can do and take the other stuff away from them, use technology to replace a lot of it, but we have got to be purposeful about it.”

0:22:41: Burnout and the labor shortages are the challenge of the next 10 years. 

0:22:50: Dr. Cawley: “What we see today is just going to be nothing compared to what happens in 10 years as the population ages, as there are more people needing healthcare, and burnout has continued, people leave early, and now, you got a severe problem. It’s a real problem today. This could get worse if we don’t approach it right.”

0:23:13: Dr. Muthu Alagappan asks ‘Is automation inevitable in that case?’ He says, “Is that how you see this playing out in the next five or 10 years, that a lot of the work at health systems that is currently manual becomes automated?”

0:23:43: Dr. Cawley: “Absolutely, we have to keep people working at the very, very top of their license.”

0:24:06: Dr. Cawley: “I think there’s a lot of technology out there today, we just don't use enough of it, and we don't use enough of it because leaders get caught in this paradigm of delivering care the way they see it today…”

0:24:35 Dr. Cawley: “When you begin to really, really understand that [the technology] and seek to change the way you do things today, that's when the magic happens. And you can bring technology experts to the physician, but until the physician, the physician leader, the clinical leader begins to say, ‘Hey, wecan do this differently’, that's when it's going to change faster.”

0:28:05: Dr. Muthu Alagappan asks how you sift through the noise and determine when to partner and with whom from a technology POV.

0:28:45: Dr. Cawley: “Every leader should be involved in their own search for that digital transformation.”

0:30:10: The key to finding the right partners, per Dr. Cawley, is finding those who are aligned, even somewhat broadly, around mission, vision and values.

0:31:49: Lessons learned for other health systems as they may be about to embark on a partnership journey around technology.

0:32:04: Dr. Cawley: “Very, very, very first tip I would give is, get over yourself. Partnership is better than doing it by yourself.”

0:34:55: END

Relevant Links

• How MUSC and Notable are partnering to drive better patient retention and empower staff to use their higher purpose.

0:02:04 Dr. Muthu Alagappan: How would you describe how you kind of transitioned from practicing medicine into administrative and leadership positions and eventually becoming the CEO of the health system you work at today?

0:03:23 Dr. Muthu Alagappan: I've always been really interested in whether there are certain skills you learn from practicing medicine that then translate into leading health systems or leadership positions in general. Are there certain skills or experiences from your sort of practicing days that you've then drawn on a lot in your leadership positions?

0:04:48 Dr. Muthu Alagappan: When it comes to technology and digital transformation, some point out that rural communities are less likely to engage with technology and digital approaches to care than individuals in non-rural communities. Have you found that to be true in your health system?

0:06:50 Dr. Muthu Alagappan: Are there specific techniques you've used to engage the population digitally. Marketing strategies, patient education? How have you been successful in getting this population to adopt technology as a medium of care navigation?

0:09:19 Dr. Muthu Alagappan: When people talk about digital technology, digital transformation, there's often a split view on whether it's helpful or harmful to rural communities. So some people say that it actually further entrenches and reinforces some of the digital divide and can actually make health disparities even more pronounced. Whereas other people say technology can actually be a great equalizer and provide multilingual support and access to care for folks that are otherwise marginalized. I have a guess, but where on that spectrum of helpful versus harmful do you tend to stand?

0:11:56 Dr. Muthu Alagappan: That's fantastic. And thank you for sharing that. I like to think about technology as a mechanism, as sort of an agent of change. And so when you think about the problems that are facing your patient population, your community now, if you had a magic wand to sort of create a technology that could solve those problems, which problem do you think needs the most attention? Or what is the problem you'd want that sort of magic wand focused on?

0:13:40 Dr. Muthu Alagappan: You mentioned one piece there around technology to improve communication for patients and their families. One thing as a potential downside of technology we've seen is in cases with bi-directional chat or messaging where patients can message back and forth with providers, it's often very convenient for patients and families, but leads to a huge number of messages and increased responsibility on the care team, which may or may not be contributing to higher levels of work stress and burnout. Have you seen that play out at Marshfield? And is that a concern of yours at all, that technology could maybe make the patient experience better, but at the detriment of the amount of work that staff now have to do?

0:16:10 Dr. Muthu Alagappan: We talked a bit about health care disparities. And I want to touch on health care equity as well. So you are a founding member of the Carol Emmett Foundations Equity Collaborative. Would love if you could tell us more about that and what inspired you to be a founding member of that organization.

0:18:12 Dr. Muthu Alagappan: Are there lessons you've learned from your own journey into leadership or advice you'd have to women who are hoping to take on those types of positions in terms of how to navigate their careers

0:19:48 Dr. Muthu Alagappan: On the topic of health care equity as it relates to leadership and management, would love to talk a little bit about the future of work and how the workplace will perhaps transform as a result of the pandemic and what we've seen over the last few years. One trend that has become very pronounced are the labor shortages across different service lines and roles. Are you seeing that at Marshfield? And in what specific roles or areas are you feeling the labor shortage to be most pressing? And how has that sort of presented itself over the last few months?

0:23:42 Dr. Muthu Alagappan: How much of the labor shortage is pressure from outside industries raising wages, taking employees that used to work in health care in administrative roles, support roles, and now are moving into food service, Amazon? Are you seeing that shift out of health care just given the wage pressure?

0:25:52 Dr. Muthu Alagappan: What is the time frame in which you'd expect a health system like yours to adopt automation in a way that really makes a dent into this problem?

0:28:36 Dr. Muthu Alagappan: You mentioned a point there at the end of choosing or deciding is it something that we can do on our own or do we need to partner with an organization on this capability. How do you make those determinations of when you want to solve a problem with technology, how do you decide if it's a problem you're going to try to tackle on your own versus look to the market at vendors or partners that can help you solve it?

0:30:49 Dr. Muthu Alagappan: There are certainly local dips and inflections as you're adopting technology, but the long-term trend hopefully is very, very positive. When you're thinking about the partners that you like to work with, what are some of the characteristics of those partners that make them good partners to you? What are the intangible qualities of the team or of the partnership that make an organization feel like a good partner to Marshfield?

0:32:13 Dr. Muthu Alagappan: I'd like to leave by asking you, what do you think the rural health system of the future will look like or should look like? What's your grand vision for where we should try to get to?

0:34:31 END

0:00:51 Muthu Alagappan: I always like to start from the beginning. So the beginning of your career, what first got you into healthcare and helped you decide to become a physician?

0:01:55 Muthu Alagappan:  You're now in a leadership position. What was that transition like? Was it conscious, deliberate decision to leave the practice of medicine and move into this type of a role or did it just happen organically?

0:04:07 Muthu Alagappan: Do you miss practicing medicine in your day-to-day job? And if so, how have you dealt with that transition out of that?

0:05:31 Muthu Alagappan: Great. And so you were named president of Corewell Health East in June of this year. Most people are familiar with what it's like to transition jobs, but transitioning health systems, especially at this level, is a very different experience. What was that transition like, leaving Northwell and joining Corewell?

0:09:31 Muthu Alagappan: And so you get into this new system. You're the president now. What are your five-year goals for the system? Where do you want to see Corewell Health East get to in 3-5 years that you're sort of energizing the base around?

0:13:07 Muthu Alagappan: I'm so glad you mentioned making it a terrific place to work. So often when I ask that question, we hear all about the great ways we're going to improve the patient experience and often neglect the staff experience. So I'm really kind of glad you mentioned that. And I'd love to ask you more about creating a culture in a provider organization that's conducive to that. We had Dr. Toby Cosgrove of the Cleveland Clinic on, and he mentioned how at the Cleveland Clinic, where I know you spent some years training, everyone is called a caregiver, whether you're driving a transportation shuttle or cleaning up the operating room or doing the surgery. Are there examples of that type of culture building at Corewell that inspire you or that you're hoping to bring to the system to improve the culture?

0:17:16 Muthu Alagappan: I remember hearing once that I believe UT Southwestern, instead of just phones in the provider workrooms, they actually have video screens attached to the phones because they found that people are nicer to each other when they're on video than when they're just talking to each other on the phone. And as you know, providers, consultants, etcetera, conversations can get heated sometimes. And it was just a striking example of how environment can affect how we behave and how designing environments in a thoughtful way can really improve culture and make people feel respected and things like that.

0:19:25 Muthu Alagappan: Yeah, that's terrific. And I think we continue to be very optimistic about technology's ability to bring people together, to improve culture, to improve the experience, and so exciting to hear that. I'd love to shift gears a little bit and talk more about the recent merger that you alluded to in February of this year with Beaumont Health and Spectrum Health joining together. Mergers and consolidation are happening across the country. From the patient perspective, is this something patients should welcome? And does this ultimately affect patients either positively or negatively when large health systems come together, in your opinion?

0:22:28 Muthu Alagappan: In the case of this merger, I believe both Beaumont and Spectrum were on Epic before the merger. And so I imagine integrating those is a little easier than if you came from two different EMRs. How much of a consideration is that, do you think, during a big consolidation or merger in making sure that the EMRs are the same? Because I imagine that facilitates the record sharing and everything else that's going on.

25:15 Muthu Alagappan: Are there areas that you, in your role right now, would want to look outside of the EMR when it comes to filling a need, solving a problem, developing an innovative strategy? Where do you choose to look to the EMR and where do you choose to look outside?

0:29:00 Muthu Alagappan: We were talking about mergers and the system getting bigger and the advantages that has. One of the disadvantages is likely that it becomes harder to make decisions the bigger you are, of course. And it's also hard to make decisions because there's too many options, like you mentioned, so many different companies and ideas that are vying for your attention. I would love to hear how either at Northwell or now at Corewell, you think about the process of bringing teams together to make a decision on whether to work with a vendor or not. How do you mobilize an organization that big to make a decision and to move through the process of implementing a new technology?

0:33:46 Muthu Alagappan: Yeah, I love the idea of an almost uncoupled or disconnected sandbox where you can try and prove value. Do you think that sandbox can be shared amongst many health systems instead of having each health system have their own version of that? Could there be almost a shared demonstration environment that a company shows value in that many health systems look at to get signal on, does this work or not? Or do you think each health system is unique enough where that needs to exist in collaboration with the health system?

0:35:46 Muthu Alagappan: I'm curious, how do large health systems educate themselves on the merits of a particular vendor today? If I'm buying shoes, for example, I can try it on, I can read reviews. I've got a process for knowing how to vet one shoe versus the other. How do you do that at a health system? Are you talking to peer health systems? Are you looking at industry organizations like Class? How does it work?

0:38:35 Muthu Alagappan: So I think we've got time for one more question. And I want to ask you about automation, which we think a lot about at Notable. You mentioned at Corewell you've got 60,000 employees at Northwell, close to 90,000. I'm sure if you had the option, you'd love 10,000 more to be doing all types of value-based care and other work to make the patient experience better. But that's hard for health systems these days, finding staff and being able to hire them. What are your thoughts on automation and automation's role in the future of health care? At Notable, of course, we have a lot of excitement about automation and digital workforces helping to offset some of the administrative burden that we've found ourselves in. Do you share that same level of enthusiasm? And do you think automation is going to become more mainstream in health care in the next 5-10 years?

0:42:13 END

0:01:17 How did you get into healthcare? When did you first get interested in the industry? '

0:04:56 I'm fast forwarding a bit, but you later went on to be the first and serve as the first CTO under President Barack Obama. What was it like defining that role as the first person to serve in that capacity? How did you go about defining what you would work on and what did you ultimately spend time on during those four years?

0:10:26  I believe in that role, you spent time in areas outside of healthcare as well, or at least, the broader sectors you mentioned. When you were looking at healthcare versus education or climate or infrastructure, did healthcare as an industry lag behind those in terms of technology adoption at that time? We love to say that healthcare lags other industries. Is that what you noticed in that role? 

0:14:30 You mentioned in the earlier part of your career being interested in the application of the internet to health care. And we look today in 2022, and it's just amazing how much progress technology has made as a whole. And if you were to sort of grade health care in terms of the pace of innovation over the last 20, 30 years, the early part of your career to where we are now, how well do you think health care has done in terms of the pace of technology innovation and adoption in the industry at large? 

0:18:19  It's been $40 billion in the last year alone invested in this space by capital allocators. Thousands of new companies literally have entered the space. What about the last few years have made digital health such a popular space for folks to be in compared to the decade before that? 

0:21:16 When we think of the next wave of digital transformation in healthcare, do you think it's going to be led by the large population of startups and new entrants into the space or will innovation continue to be led by the large EMRs, Optum, Change, Amazon, sort of the incumbents and big corporations? Where do you see that power balance actually ending up?

0:25:02 One of the advantages of competitive advantages of smaller companies has always been the agility and the ability to partner where they have their own internal gaps. What are your thoughts on the value of new entrants partnering with one another sharing services, combining to reach more collective, whether it's reach or audience or impact? 

0:29:00 I want to transition a bit to talk a little bit about interoperability of which you're one of the foremost experts. To begin with, just break it down for me very simply. What do we mean by healthcare interoperability and what are the challenges so far and what's the goal? Where are we heading toward? 

0:35:25 I understand the optimism and I feel bullish. But as a provider, as a patient, as a member of a software company in the space, it still feels like there are... It is not easy to access information, develop applications to get to that application substitutability vision you outlined. Am I off or are we still a far away, away from getting there? 

0:38:57 I believe part of the Cures Act is also about information blocking. And so I'd love to hear in your mind, what are some of the examples where information blocking is still taking place to a great extent? Where, if anywhere, does that still happen? 

0:42:18 I'd love to hear what is the best case scenario that you see for interoperability and the health care digital landscape in, let's call it three years or five years. If all of this works as intended and goes really well past this 12/31 day, what is the world going to look like? What can we be excited about?

0:44:53 End

Puneet Singh serves as the CEO of Quartet Health. Prior to Quartet, Puneet was the Chief Growth Officer of the Diversified Business Group at Anthem, and prior to that was the Chief Development Officer of Aspire Health. Quartet focuses on matching patients to mental healthcare professionals based on their preferences, needs, and insurance. 

00:37 How did you get into healthcare, and what has led you to stay in it for this many years?

02:21 Why do you think there is that sort of dichotomy where on one side, people are drawn to it for the mission, and yet at the same time, many of them are also experiencing higher levels of burnout than other industries are?

05:24 Any thoughts on how that sort of marriage of different industries coming into healthcare has worked so far, and how do you think about it at Quartet when you're sort of building the team and the company?

07:24 Do you mind just giving everyone a brief introduction into what Quarter does and where the company's headed? 

09:38 There's a certain avenue of sort of business building which argues you should maybe pick a few core competencies that you want to really specialize in and then partner with organizations in other areas. Did you subscribe to that type of philosophy? And if so, what are the one, two, or a few things that you think Quartet is really... That's the core competency that you're kind of dialing in on? 

11:56 There's this new breed of company that is tech-enabled, service providers, and you're sort of in that middle ground as both a technology company and also sort of a care provider. How do you think... You could go and try to rebuild many sort of core technologies yourself, the EMR, the patient intake platform, much more. How do you think about where you'd like to partner on technology initiatives versus what technology pieces you wanna own in-house? 

15:00 Quartet and Notable kicked off a partnership a few months ago and so we are honored to be part of assisting in such a great mission like you all have. When you think about partnership more broadly, whether it's on, kind of the piece of the puzzle that we work on or anything else, what have you learned in terms of picking a technology partner? What are the characteristics you look for? How do you vet technology partners and any advice for healthcare providers and systems out there that are going through this type of partner evaluation process? 

17:48 Two of the big trends that I think a lot of people are quite worried about are the growing administrative burden and sort of the corresponding labor shortages or increases in labor cost. As a CEO of a company that opt in and delivers care, are these two of the bigger challenges you see in the industry or are there others that are out there that you find more pressing? 

21:21 Another "lever" you mentioned is augmenting licensed staff with a team of folks around them that can allow them to operate at the top of their license. And then a third one was the use of technology. And so where can you kind of bring in technology to lever up existing workforces? We think about that a lot at Notable. We'd love if you have any other anecdotes or observations you've had on where technology can be a form of leverage for sort of the, not shrinking, but smaller workforce that we often have in there to deal with.

25:22 You mentioned also expecting to double the size of your care delivery organization in the next year. How do you think about technology in terms of growing the number of patients you can serve, maybe without proportionally growing the number of support staff and administrative work that you have to perform? Is automation on the roadmap for you all in that sense, the way many health systems are thinking about it? 

29:07 Should traditional health systems be concerned that now it's not enough just to exist? You actually have to delight patients or they will go somewhere else. They will go to tech-enabled players. They will go to Amazon One Medical. How real is that threat that patient experience now actually does matter? 

32:58 Where broadly do you think we are under-investing in technology or where would you like to see us? Where would you like to see technology kind of go over the next few years in healthcare? Where should we put more chips that we aren't putting them today?

36:35Through technology, you can enable a vast array of multilingual service offerings in a way that you can't replicate with people. Are there other examples at Quartet or just in general where you see technology is actually helping bridge the gap as opposed to widen it like many fear technology will do? 

38:34 What gives you the most optimism for the next 10 years in healthcare in this country or worldwide? What are you most optimistic about? 

0:40:31. END

2:00 What drew you into healthcare?

5:36 If you had to do it over, would you become a physician?

7:05 Tell us about your career progression to CEO.

11:55 Was your training and experience as a surgeon helpful as CEO?

14:10 What achievements are you most proud of?

15:55 What had you hoped you would have achieved as CEO but did not?

17:39 What lessons can America learn from healthcare overseas?

19:31 Thoughts on the increased venture capital investment in healthcare technology?

22:30 Should health systems look for technical expertise outside the organization?

24:44 What are the most significant challenges health systems face today?

26:38 Do you think the problem of caregiver burnout is overstated?

29:19 What makes an AMC unique?

32:50 Do AMCs lag non-AMCs when it comes to digital transformation?

34:03 When EMRs were introduced, did anyone foresee how much time the staff would spend on a screen?

35:26 Will automation will reduce the administrative work EMRs have introduced?

37:01 What gives you optimism about the future of healthcare?

Our guest:

Dr. Toby Cosgrove is the former President and Chief Executive Officer of Cleveland Clinic. Currently, he serves as an Executive Advisor to a select group of companies in the healthcare industry, including Notable. Toby is an acclaimed cardiothoracic surgeon by training. He started at the Cleveland Clinic in the mid-70s. He served as the President and Chief Executive of the Cleveland Clinic from 2004 to 2017. During his tenure, the Cleveland Clinic’s more than doubled its revenue and expanded locally, nationally, and internationally, becoming Ohio’s largest employer.

Highlights:

1:30 What does healthcare get wrong about digital transformation?

8:00 How to get the correct balance between automation and manual work?

11:07 Why does healthcare innovation lag behind other industries?

15:18 What are some examples from other industries that could serve as role models for healthcare?

17:43 Should hospitals be thinking about the staff experience just as much as the patient experience?

21:00 Should digital transformation only be in the hands of the Chief Digital Officer?

23:06 What does an effective Chief Digital Officer look like?

27:54 What is the biggest misunderstanding healthcare executives have about automation?

Our guest:

Carle Falk is currently the Head of Research for Notable and a 20-year veteran of The Advisory Board Company, where she led client services for Crimson, a physician-driven software platform used by over 200 health systems to compare clinician cost and quality performance. She is the author of over a dozen best-practice studies on care variation reduction, clinical operations improvement, population health, and physician-hospital engagement strategy.