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Today on This Week Health.

The metaverse. I still don't quite understand how big it's gonna be or how fast or how much we need to play in it. But if you think about the technology behind that, taking that concept out of it, this idea that we're combining the ability for us to just consume other services, to kind of move into a world where we really are in control of our digital life a little bit more. I do think that solves a number of the challenges that we have in healthcare around portability of information, around the security challenges, around how we actually can be immersed in different things and travel and get different experiences that aren't necessarily requiring us to be in a really expensive building for long.

Thanks for joining us on This Week Health Keynote. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to our Keynote show sponsors Sirius Healthcare, VMware, Transcarent, Press Ganey, Semperis and Veritas for choosing to invest in our mission to develop the next generation of health leaders.

All right. Today we're joined by Jason Joseph, the chief digital and information officer for BHSH. Jason. Welcome back to the show.

Thanks bill. Great to be here again.

A lot going on with you, with your organization. I heard your CEO talk at the Scottsdale Institute about all the cultural work that's that's going on there, and that's gonna be one of the topics for today. We're gonna talk about bringing two organizations together.

We're gonna talk about priorities. We're gonna talk about technologies. Cause I love the conversations we have around technologies. To start off. My listeners want me to start with this question? Tell us about B H S H and your scope, who you're, you're serving and all those things.

Well BHS H which is such a fabulous name is really a temporary name. And it's the combination of Beaumont health spectrum health in Michigan. And the combination of our organizations really have created the largest health system in the state. We have about 64,000 dedicated team members.

That includes three care delivery divisions spectrum health, Lakeland, or BHS H. Lakeland west, Michigan, and then the former Beaumont. And then we also have priority health, which is our health plan in the state of Michigan, which is about 1.2, just over million members. So pretty large integrated care delivery payer provider system covering the state of Michigan.

Wow. That's a lot of people I didn't, I didn't recognize that.

Yeah, revenue wise, I think we're somewhere between 13 and 14 billion. and you asked my scope. So the combination, obviously when you put large organizations together my role is really responsible for all of technology, digital information services, data analytics. So my formal title being chief digital and information officer kind of fits.

And, and we could obviously go down the, bringing two organizations together from technology standpoint, but I think where I wanna start is the culture work walk us through the integration of the two health systems, current work environment how you bring two organizations together from a culture standpoint. And then we'll talk a little bit about system and processes.

the good news is we're bringing two organizations together in the state of Michigan. And there's definitely distinct kind of regional cultures. If you look at Michigan people use the hand, right? So the Detroit area, Metro Detroit, Southeast Michigan is really the legacy Beaumont organization and west Michigan over here. Is the legacy spectrum health organization and our health plan priority health really covers the state. And from a culture perspective, we have a lot of people who are really wired. Very, very similarly, the organizations coming. Together had similar pedigrees, really great high end services, really nationally renowned specialty care breadth of coverage, really kind of the, the flagships in their areas by many respects.

So you've got a foundation of people who really. There's mutual respect. And I think that's a good thing, right? It's not like you're coming in in one organization is really has a dominant feature over another. So bringing those two together really has been an interesting activity. And within is in particular, we made the decision very, very early on.

We've only been at this about six months now. And sometimes when you're doing M and a, you get a, a really long runway anyway, six or 12 months to really start working on planning. We had. We didn't have quite as much runway. We had a lot of things we had to do to kind of get through the FTC process and everything.

So we really remained kind of operating independently until we were able to come together, which started on in February. And so as we've done that very early on, we decided it's very hard if you're gonna. Integrate services to have two teams even well intended. There's always an awesome of them.

And so we really started from day one planning, how we could just create one team out of all of our, is it data and analytics teams and started bringing those together and, and the storming. Or what is it forming, storming, norming performing, right. I would say we're definitely through the forming.

Maybe we're in some areas into, or through storming, but in some areas we're just getting into it because we're starting to dive into the work and my experience, the culture really comes from a couple of things, right? How you treat people. How respected they feel and how they show up to work and bringing themselves kind of their behaviors and attitudes every day and how you work together, like how you actually get work done.

And we have some similarities, but we have some differences, right? Different styles. I think we, we've got a whole document that we had a consultant create. We did a lot of surveys to understand our starting points as an organization and where we had differences and where we've had similar similarities.

In that culture. And so part of that work is doing the work together and putting our teams together and doing it. And part of that work is recognizing and putting a name on the things that are different and purposefully saying, look, this isn't a good and a bad, these are just differences. And so these differences are areas where we know that we have some work to come together.

And those vary from things like how. How we approve. Thanks. It varies with things like, what is our philosophy on investments for certain technologies? It varies on how rigorous do we put people through different processes does it very minimalistic process to very process driven organizations?

So those are the types of things that we're wrestling through right now. I think you have to do this again in six months, and I'll give you an update on this, but I would say so far. Our is, and it teams have been fantastic in being able to really come together. I've just seen amazing collaboration from everybody on all sides and it's it's really encouraging to see.

So the other thing that happens when you bring two organizations together is you're bringing systems together and processes together and you have to get those, right, like from the first day, right? So you have to get change control, right? You have to get governance, right? Security processes, right. You have to get all those things. Right. So talk a little bit about bringing systems and putting the process in place for the new organization.

I'm gonna even back up before the it and say the, the most important thing actually we did was have a discussion with our executive leadership team, our board, really making sure that we had an alignment on what we expect, this new combined entity to be.

How do, what is this? Is this. This is a holding company, right. Are we gonna put a new umbrella over the former Beaumont, the former spectrum, the former priority? Or are we expecting to create something new? That's more integrated. We walk through a lot of discussions on this, right? Where do we want be?

And when you get to a few different points of the discussion where you say, well, we want kind of one, one brand, we want to be an integr. System that operates in an integrated way, not just perfume, Monte pig as I like to call it, but we actually wanna have consistent care pathways. We want to be able to provide virtual and digital care at scale and not just do it in pocket.

So we wanna be able to innovate and not just have it be a pilot that you have to then retrofit three or four or five times down the road, but actually have those types of things scale you write, you start to dial in. A certain operating model. And then that operating model starts to inform and illuminate what the it infrastructure needs to look like to support the operating model.

And so we went through that exercise before we ever had a conversation about what we should do with systems, but you know, the short story of it is our future really is going to be. Aligning for value. We have that integration of payer provider. We have the breadth and the scale, and we believe that to drive value in the future, you need to be able to really drive the value.

That means really tightly control that experience and have it be. System, have it be affordable. And when you stack all that stuff up, what it looks like is a lot of really best in class platforms that we use to bring together kind of that platform for value based care. And that starts with our cybersecurity infrastructure day.

One was. Kind of got out of the gates actually before day one, making sure that we're working on that stuff. We know that we need to tie things together with a common identity fabric. So that's probably the biggest core dependency for everything else, but then you build on it with things like our E R P and corporate systems, knowing that we need to align those getting onto a common Microsoft 365 stack, and then ultimately ING with really an integrated epic platform that we then from there can build on top of and what we.

Essentially have done is created a strategies or six different integration work streams around that, on those different areas. That's gonna take us the better part of two and a half, three years to get through, but that really focuses on us. We're calling it integrate to transform, right? It's not just doing what we're doing today and pulling it together.

It's actually a. Accelerating us forward getting to do some of those things that we know we need to do over that period of time, but we're gonna do them as within the scope of integrating our services. So that kind of rising tide lifts all boats, if you will.

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So that, that really gets to that digital officer title as well, keeping a, keeping an eye on the, on where you want to go to.

I mean, that's the forward leaning aspect of that role and I. A lot of times when mergers happen, it slows a bunch of that work down, but you're really seeing this as almost a catalyst for. I don't wanna use the transformation word. I get, it gets used way too much, but you almost, it almost is a callous for transformation. Cuz you have to look at multiple builds of the EHR. Do you integrate those? what is your consumer facing strategy? What is your clinician enablement and efficiency platform gonna look like? You really get to rethink all those things. When you're coming together as two organizations.

Yeah, you do. And I think the way we think about this is it's very hard to separate the consumer experience of the engagement. If you will, from the way you operate your business, right. That that is your business. And what I think is changing in the transformation here is we're bringing the the patient, the consumer into the business in a way that they never were. And so if you think about it from that perspective care at home, isn't something different, it's care at home, and it needs a different set of technologies and connectivity and tools, but the operating model to support that still needs to be supported and sustained.

It moves. you Into a very different way of thinking about your health system is people aren't necessarily coming to us. It's about putting a virtual or a digital framework on all of the services that you provide and figuring out how to connect those things. And so if you don't have an integrated way of operating and getting the information and providing.

The real time analytics and seeing a population on your screen with advanced analytics or AI popping the most critical things to the top, whether that's home based stuff or virtual ICU or somewhere in between that spectrum, all of those things really are a platform play with different degrees of connectivity on them.

And so, as we're thinking about this, we're looking at. Building, not just for the way that we've been built for the last 5, 10, 15 years, but actually creating those programs and taking parts of those programs that are already in place and put spreading them essentially across all of our service areas.

And that's, what's really great about bringing these organizations together is we have pockets of this excellence that we can just basically translate to the remainder of the organization. Once we're on that common set of platforms.

so platforms. I wanna talk about platforms a little bit because when people hear platforms in healthcare, they think, oh, I've, I've got epic, I've got an EHR platform, I've got whatever.

And a lot of organizations really struggle with this concept of platform. I've heard Mayo talk about the platform. Like it's the system like the whole health system is, is the platform. There, there is there is a sort of acknowledgement. There, there isn't a single platform for healthcare. How do we take platform thinking, which is what you're describing here and make that operational. So turn that into a reality. If you will.

It's a great question. And I probably have more conversations about this with my CIO colleagues across the country, cuz as systems grow and scale, this is the fundamental question is can we do this by keeping maybe micro platforms around? And I think that becomes increasingly difficult as you scale.

If you don't have something common underneath that you can kind of build to and different organizations will solve this in different ways. Right we're. Thankfully all epic organization within our walls, including our payer now priority health is on the. Payer platform. So we'll have essentially an epic ecosystem that will kind of underpin the core.

And our strategy really is to use that platform. For example, to its fullest, Epic's driving innovation. They're gonna continue to develop out feature and where it's there. Boy, that is the fastest, easiest way for us to adopt that. We also recognize that there's times where that isn't where we want to go, or they're not going to be in a certain part of the.

And so we've got the ability to connect in and extend that platform for clinical care delivery, whether that be remote monitoring technologies the devices themselves, some of the AI algorithms, which aren't always embedded that will need to be developed. We're still gonna try to use the tool set in the data and the connectivity of our platform, but we're going to recognize sometimes things are embedded and kind of. Packaged with it. And sometimes we're gonna have to extend it, but our goal really is not to fragment the experience. We don't wanna fragment it between the providers and each other. We don't want to fragment it between the provider and the patient or the consumer. And we're trying to even less and less.

Fragment between the payer and the provider, because there's so many of those workflows that share the same need, but we just do a lot of data passing back and forth. So when we think of platforms, I don't think of one platform per se. I think of a set of platforms. We have a platform for our, what we're calling kind of our enterprise planning and E R P that's for us, it's around Workday, but it's other things that really manages all.

Corporate functions, supply chain. And there's a series of things that are tightly coupled and create a platform for us to do that work around epic. It's an ecosystem of epic, but plus hundreds, literally of other connected things from monitoring to credentialing to other things, but to have those in a way that they're really predefined and you're looking at it and saying, this is the way we do these things.

They're optimized. They're efficient, they're connected. It allows you to scale. It allows you to be more efficient. It allows you to change more quickly and you don't have that variability under the hood that winds up gumming up the works. I mean, ask anybody who's in here. It's like, it's not. The technology usually isn't that hard.

The connectivity usually isn't that hard. The variability in all of it is what you have to plan for. And that's just an exponential drag on the system. So the way we think about it is the platform's job is to create as much simplicity and elegance at the. Core so that when you need to use it, you can, and when you need to extend it, you can do it quickly and you can scale it without having to take you a decade and millions and millions of dollars to do it.

Yep. I, I remember trying to explain this to somebody they're like, why can't you get the data from here to here? It's like, well, we can get the data from here to here. We just can't get it into the system once it gets there. Right. Because the, the, the data structure. Doesn't work in both. So we've gotta either clean it up on this side or we've gotta change it on this side.

The translation is a very underrated feature of all of this stuff. Data can move from a to B making sense of it is a totally different animal.

absolutely. So here's what I think I'd, I'd love. I'd love to hear you talk a little bit about the. landscape of challenges that are facing health systems today.

So I'll throw out a couple here. We've got staffing, we've got inflation. In some cases the payer mix is changing, in some areas. Regulatory is always there as, as something how are you, or I assume all of those things are at play in Michigan. How are you looking at those things? How are you guys responding to those challenges?

I wish I could tell you, Michigan was in, we have no inflation staffing is plentiful. Financial situation is fantastic. People are throwing more money our way than we know what to do with. But of course, none of that is true and we're in the same boat as everybody. It, it is really. Is really rough. I was hoping you're gonna ask me like a happy question bill but sure. This is, it is a challenge. And especially when you're facing what worth facing, which is trying to balance like two seemingly opposed things.

We're gonna put a whole bunch of energy and effort and investment into things right now and integrate while we're dealing with these headwinds.

So let's just take one. Let's, let's narrow it down to one. And it's the one that I find is being talked about the most. We just had. 2 29 event. And it is the topic that gets talked about the most.

And it is clinical staffing shortages and addressing is, is there, is there something in the digital world, is there something in the technology world that we're starting to apply to that challenge? Not to eliminate, obviously, but to alleviate it in some way.

If there was a silver bullet, I think we'd all have found it. I think it's gonna be a combination of, of things and the clinical staffing that I wish this were temporary some type of transitory if you will issue, but. When you look at the projections, there's just nothing telling us that it's gonna go away anytime soon. So short of pipeline, increasing activities, which we have as a system made investments in partnering with local universities to increase the nursing output, those kind of things, which are really great.

But those aren't gonna kick in immediately, as we think about these, it's our job. really To reduce the burden that can add what I call productivity to the mix. Right? You may not be able to find more people, but you can make fewer people go further and without giving them things that drag them down.

And I put that in two categories. One is like automation and those things become a little bit obvious. We've done things like robotics for taking away the manual steps of delivering trays and finding supplies and those kind of things. And I think you'll see that increase. We're looking at different areas to apply automation, just for simple things like charting and documentation, where we can put Some ambient technologies in rooms. We've got pilots underway there, not only on the physician side, but also looking at areas of simple things like how much charting a nurse has to do for certain things that could be automated, that could be captured in a different way. I think the flip side of that is the burden that we place.

On different parts of our health system because of the regulatory or our compliance, or however you wanna look at it just trying to get paid for stuff. We have a lot of, if you really trace down the steps and the work of a clinician on any given day, there's a lot that just goes into creating documentation to justify.

Why we're getting paid for something or making sure that we've covered our bases from a compliance perspective. And those are some areas where I think we need to be more aggressive and challenging ourselves say, is that value add, is that step really helpful? Does documenting that 57 times a day for a nurse?

Does it make it safer? Does it make it better? Does it really matter? Or are these some things that we could start to reduce the burden by rethinking ways of accomplishing what those things were intended to do? And there's. a Pretty gnarly, knot of stuff under that surface, that we're gonna have to start unpacking as a system.

Some of it, the technology can help with some of it's actually removing technology and saying, Hey, we're not gonna show you this. We're not gonna make you click through all those alerts. We're not gonna force you into this documentation conversation. We're gonna find another way to do that. That's gonna save you some time.

That's probably thousands of little things that are gonna add up to something big not one big thing that we could find or somebody really, really smart. Would've found it.

Yeah, cuz there's an awful lot of smart people who are looking at this problem right now. One of the first times we talked, I think was at the Becker's conference in Chicago. It might have even been like your first week or something on the job.

Yeah, it was, yeah. I think I was like three days into the job or something like that. But what did all days bill?

The good old one of the things I loved is we, we had a really robust technology conversation. So I, I want to take you down that path again. Hopefully you haven't been CIO long enough and you still have the CDO title. So you have to stay current on the technology. I wanna throw certain technologies at you and I'd love to hear how you're thinking about 'em or how they are progressing at, your health system. So, let's start with telehealth strategies have you been able to move the needle in that, in that space?

Yeah, we have actually, and I think we all took a lot of credit for what COVID did, which is forced people into it. And we've been able to maintain we, some systems have really, they shot up and they plateaued. We definitely have come back down a little bit, but we've still maintained a much higher level and. It's due to several factors, but we've really optimized the workflow for the providers and for the patients so that these visits go quickly. They're simple. They don't require a lot of extra steps. We recently were the first in the country to launch a partnership with a company called key care, which really provides 50 state virtual coverage on an epic platform.

So it's, it's really seamless to our patients. They can kind of engage us in a virtual visit, but if they're in Idaho, They can still connect through a provider and have that experience with the documentation connected. It doesn't feel like we're sending them to a different company to do something. And I think that's a, a really key part of any health system is making it connected for the people that you're caring for.

We have done quite a bit with just remote connected. Diagnostics. So we have a partnership with a company called Tito care, which has these kits that you can look in your ears and your nose and your mouth and temperature. And those are really, really great for keeping people at home, especially for chronic disease.

It's great for kids and for well, child visits, those kind of things. So you don't need to come in just to have those things happen and guides you through it, using AI. And some of those things, we've done things with school. Virtual health clinics, where we've applied the technology in innovative ways.

We've certainly expanded our what I call monitoring program all the way from the in-home stuff that I mentioned earlier for different types of patients, whether we're sending 'em home with CHF or something, but also our virtualized. ICU program really by necessity. When you have a COVID situation, you have to make scarce resources go even further.

So we really expanded that to cover the breadth of our service areas. And those are, that's a great example of something in the future where you say, okay, if we can do that, instead of this big of a. Pie. What if it was across this much service and you can just imagine that the quality improves, the scalability improves, removing those things I could go on.

We've got telestroke and we've got things we're doing in rehab, but our digital footprint of what we're doing has really been driven quite heavily over the past several years, in terms of just our ability to innovate.

We could dive in there, but I wanna hit on some different areas as well. Let me throw this one at you. I'm not even sure what the category's called, but the let's call it clinical documentation. So we've we have all these new technologies sort of floating around out there. Some have been around for a while. What are we doing to in the area of clinical documentation with regard to technology?

I think probably the most exciting thing that people are probably buzzing about is. The ambient stuff where you can really just listen to a conversation with smart speakers and have the AI in the back end, really parse out things like what's part of a note, what's a diagnosis, what's an allergy, what's an order.

And having all that stuff go forward. And I think the data is really starting to approve that for not for every place, but in, in certain specialties for certain types of providers. This is a huge. Improvement over their current documentation load. I mentioned even on the nursing side of things, just really going back through and looking at all of the different areas where we're capturing data that could be automated through device capture and gateways of smart devices in a room. I think those are the types of things that we're gonna continue to see investments and innovations in in the years to come

Let's talk consumer. So right now, as we speak, the apple event is going on. That always, always change. I mean, the phone has changed how we interact with the consumer.

But I assume you have a multi-channel approach to interact with consumer increasing the number of touchpoint, all those things. But I'd love to hear you tell me about how you're thinking about the consumer and what's happening with the consumer experience at your health.

it's hard when you put that consumer hat on to put it into buckets, but I'll tell you the way we think about this our number one priority right now is what we'd call the ease bucket. Right? And every touch point that you have with the consumer ought to have a digital channel.

Self-services the win-win win all the way around. Right. It saves us time and resources. It typically makes the consumer happier and it connects the process. So we're putting. First and, and main priority on creating almost every schedule, a full appointment to be online. And you would think that would be relatively easy, right? We have the technology, but this is, this is actually more about going through massive complexities and scheduling for specialists.

It's an operational project,

operational problem. So we have a huge program underway with a goal. To take basically everything that can possibly be given to a consumer and do that. We've done a combination of just open scheduling, renovating those templates, and then what we call ticket scheduling. Whereas, Hey, it's too complex. So we gotta create something, but we can at least do all the hard work and then send somebody a. Token, if you will. So they can schedule in the block they want.

So we're doing a lot of things around that. Self-service but it's from check-in to geofencing, we've got bidirectional text messaging where you can, you know, not only text message to say you're here, but you can kind of take that minimal. Touchpoint because believe it or not we learned this through, COVID downloading an app and logging in.

Isn't always that intuitive to people. So we're trying to focus more on any of those things that could be as simple as a text message response back and forth and looking at those. So if you think about the ease side of it, if you think about the digital health and therapeutic side, which to, to us is replacing conventional therapies or treatments with things you can do digitally, and that can be anything.

Smoking cessation programs to chronic disease management programs, where you can prescribe this. And we have an ability for a physician to prescribe that, send a link, download the app, get a closed loop that they're actually doing it and get the data fed back right into our EMR. So the physicians can still monitor these people doing it, but that's a huge time saver.

It's a satisfier, it's a cost reducer. Overall, and then really that third category for us is, is really around what I call communications and just making sure that all the handoffs that happen in a health system really can be connected seamlessly, like within any given care experience. Usually people will say, Hey, that worked great.

I checked in, I did all this stuff. The problem is I went from this specialty lane. To that specialty lane. And so we're starting to actually connect across those things now as well. And you'll see more and more people driving that it's just kind of the frontier for us in healthcare right now is to be it's pretty pretty odd that we compare ourselves to the airlines, but there's a lot of comparability in terms of the complexity you need to navigate.

But also what. The airlines have been able to do by just pushing a lot of those features into people's pockets.

I just finished interviewing Tony Ambros down at Baptist health, south Florida, who came from Disney, who came from Amex. And we were talking about the Disney magic band. I don't know if you've. Yeah. And, he was, he was just talking about the operational lift behind putting the magic band in place was greater than the magic, the magic band's. All that impressive technology. It's essentially an identity token, right? As you walk around the park, but then you have to retrain the photographers in their process.

You gotta retrain the, everybody. You have to retrain everybody on, Hey, this is what we're doing, but then you're able to create this seamless experience across the board.

And the unique thing about that is what happens is you do that is you realize the things that don't get included in that retraining are actually now outliers and are really worse.

So it, it just exposes them even more as you start down that path of don't say the word transformation, but that's really what it is. It's the operational transformation of the system to use the digital technologies that are.

All right, I'm gonna give you a big, broad category. It could be analytics could be sure AI could be whatever, if it's the category is data. And what, how are you guys thinking about data and how are you applying data to healthcare and health outcomes?

It is a big, broad category. Cuz when you say that word, everybody thinks of something different. I think that the I could probably go down into improving our intelligence and business intelligence and reporting and we're, we're doing a lot of those things, but I, I think the biggest thing is data needs to be organized made sense of pulled together in a way that we can actually apply intelligence to it with predictive analytics. I mean, that, that really is a future. When people think about data, it's being able to look at data and have the ability to model it out and to provide real time. This is what's going on.

And whether that's a predictive score to say this patient is 89% likelihood to have this outcome, whether it's this person just left the emergency room and they shouldn't be leaving the emergency room, cuz they're 102 likely to come back. Whatever those things are, those predictive analytics need to be harnessed and turned into things that actually nudge our system.

And right now we have a lot of rules based things in healthcare. Everything's a rule. If this, then that then this, and alert, fatigue is an example of this because we've got a bazillion alerts for things. I think the promise of data of bringing relevant information and making it organized in a way, if it's scattered all through a bazillion different systems, this becomes exponentially harder, which is a big part of our strategy of bringing it together.

Bringing it together, making sense of it. And then applying that intelligence on top, I think in the future, the, the health systems that are gonna win are more and more gonna remove the rules or at a minimum, use the data with some predictive analytics to supplement the rules, to guide care, to better outcomes at a lower cost.

And that could be everything from earlier diagnosis. To physician assisted diagnosis or treatments or providing likelihood of these are the four most likely scenarios for a given patient. And this is the one with the highest likelihood of success. I mean, the possibilities down that road really become quite limitless.

If you can get a hold of your data enough and then have the expertise to actually start either applying or building those algorithms.

Yeah, you and I could probably do a whole thing on data and what we have to do to take that data turn in, in a lot of cases, turn into discreet data, even if it is unstructured data to begin with, we still, in order to function against that, you still turn into discreet data at some point. And there's so many things you can do. You just have to get it into a form. It can be used

just editorial comment here, I've been in this business longer than I probably care to mention, but that has always been in the conversation. And the one thing that I've learned is make progress.

With value, because there's always a way to think about this that feels like boiling the ocean. If we just had all the data everywhere, perfectly organized, like people are on that quest and God bless 'em for doing it. They're never gonna get there. Right. And so if you, if you are waiting for it to be a certain state before you start doing that, you're probably gonna be waiting a long time.

The incremental. Kind of a strategy to know where you're going, but the incremental approach of adding the value I think is who's gonna win in this market. If you can find those steps along the way. That's, that's what we all need to be focused on.

All right. I'm gonna have two two exit questions here.

First one and they're both forward leaning type questions. First one is is there a technology or an area in technology that you're looking at that has a lot of promise right now that you're just keeping an eye.

Yeah. I think If I were really thinking about this it's funny, I'm not using this as an example, but the metaverse because I still don't quite understand how big it's gonna be or how fast or how much we need to play in it. But if you think about the technology behind that, taking that concept out of it, this idea that we're combining the ability for us to just consume other services, to kind of move into a world where. We really are in control of our digital life a little bit more. I do think that solves a number of the challenges that we have in healthcare around portability of information around the security challenges around how we actually can be immersed in different things and travel and get different experiences that aren't necessarily requiring us to be in a really expensive building for long.

And so if you think. That set of capabilities. I do think that there's a lot there. And then we already talked about the AI and, and what I would call more predictive analytics. I think that the sky is the limit there for people that really can develop the competency around leveraging that combined data to really make nudges and incrementally improve things to the point where care will get more and more.

Higher and higher quality and more and more affordable that will in a number of years become something you just buy in an appliance and you can use it versus having a lot of the systems that we have today to deal with.

I just interviewed a guy on the, they created meta universities, right? So meta universities. Yep. And he said they, for the testing of it, they did a class in person. Then they did a class via zoom. And interestingly enough, the two came across almost at the same level of retention and testing and all that other stuff. And then the meta university, because you're actually dissecting something and you're and all that stuff, the retention and everything else was.

It is significantly higher. I forget the percent I'm gonna go back and listen to it. But the number was significantly higher from a learning experience, cuz they were immersed in the whole thing. I, I don't know what the application is to healthcare yet, but it was just fascinating to think about.

I don't either. I mean, it's it, you can see the technology getting so real that the photorealism in people's avatars. I mean, it's gonna get to a point where it's gonna be hard to distinguish reality from fiction. And if it could either be really weird, like ready player one where weird, or it could be really, really powerful if we use it the right.

Yeah. Last question and this is, this is gonna tax your business person. As CIOs, we have to have this acumen across the board operational technology and from a business standpoint we saw just today the CVS signify health deal going through, we see Amazon care going away, but then Amazon with one medical, you see obviously United healthcare is making significant digital improvements and investments.

And then all Walmart's always there in the background, lurking from a healthcare perspective. When, when you guys look at that, is it, is it more of a, Hey, we just need to focus on ourselves. Or is there something about that that you're looking at going, Hey, this, this is probably signaling a direction, a future direction of where healthcare's going.

In a way I feel like this is the evolution of the same strategy that's played out in healthcare systems for 20 years. And what it is is it's a play to control the direction of care. the funnel, if you will, the decision making process. So the primary care, lower cost venues of care, whether it be home health and those kind of things.

And I think people are gonna try and stumble and realize. Business is crazy. It doesn't work and Amazon's a good example of that, right? Trying something going a different direction. But I think health systems for a number of years were buying up primary care. Not because primary care ever made the money, it was a different strategy to really create an entire network so that they could balance this out.

I actually, I'm gonna be a little bit controversial here. I think actually at the fundamental core of this is. Healthcare systems aren't necessarily as broken as the disruptors think they are. They're actually perfectly adapted to a completely insane business model, which doesn't pay certain things to even do them at cost.

So they have to be subsidized with charity type care organizations and other parts of the business that make a good margin that we use. Offset it, and that's differences by payer. Who's paying for it. It's differences by market it's differences by service line. And so what's happened is this crazy set of things is all come, how do you get paid?

How do you code for it? How do you balance the services so that your losses, your less than your gains and you run at these incredibly small margins. I think what's gonna ultimately happen. And this is the process of shaking it up is the systems, the health systems, the disruptors, the Amazons, the Walmarts.

Everybody's gonna figure. Markets are pretty good at shaking out things at work and things that don't, they're all gonna figure out some way to either innovate the business model, right? Capture some revenue, and then provide the service in a way that actually provides you some level of positive margin, or they're gonna go away and re reinvent themselves until they can find that and this gonna happen over.

So we might have some creative destruction happening, and I think we're seeing it already, but I think the business model here is actually the part of this that everybody's looking at. We're thinking of it as technology challenges maybe, but it really is a business model challenge. And we're going through that process.

I think the winners are the ones who are gonna figure out how to take the technology. And take part of the business model and change it fundamentally enough that it can actually work for them. And then unfortunately, I think somebody will be left holding the bill on the parts of it that won't be working as well. And nobody wants to be in that situation.

It it's hard for me not to comment on that, cuz it's so rich but you know, it's the interesting classification of each of those. They're all. Payer providers. They're all trying to figure out how to be payer providers, which is why your system, which I hope you renamed soon.

Because I don't wanna say we all do we all? No, but I, hope you guys have that entire continuum, so you're paid to keep people healthy and that's what we want as consumers. We want a partner in our health and obviously we need the health system when we get sick, but we want that partner in health from one end to the other and the payer provider model. It seems to be the only one that, that really works across the entire board.

Well, it's set, it's got the potential to work and I will say healthcare, nobody wants to put more money into healthcare. So anybody who's trying to take some money out of healthcare and glean part of the pie isn't helping to solve the problem.

The only thing that can help solve the problem is to actually make the. Pie smaller. And in order to do that, we can't have a winner and a loser or you can, but then you're gonna have a lot of you're gonna have losers. Right. And everybody's gonna be fighting the idea that really around that of payer providers say, look, if you can figure out ways to provide better.

Care, or at least the same care for less money, then you can take money out of the system and you can divide up the share of that and still remain whole. And that's gotta be at some level, we're gonna wrestle through what the business model is for this, but that fundamentally has gotta be what we focus on for this all to work.

Cuz any piece of this that just adds cost or does something or shifts dollars from one part to the other isn't necessarily gonna solve the big problem or it's still gonna have this still gonna have this tension for a while.

Jason, you never disappoint. I appreciate the conversation. Thanks again for your time.

Bill. Always a pleasure. Thanks for 📍 having me.

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