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Welcome to this week in Health It, where we amplify great thinking to Propel Healthcare forward. My name is Bill Russell, former Healthcare CIO, coach, consultant, and creator of this week Health. It is set of podcast videos and collaboration events dedicated to developing the next generation of health leaders.

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I, you know, do a lot of reading. Uh, I came across these insight papers from the Providence Digital Innovation Group and it was, it's just some great content. So I decided to reach out and I brought in Matt Mia, who was, uh, one of the authors of the papers to discuss it, and I think it's a great episode, and I hope you enjoy.

All right, today we're joined by Matt Comia, the Digital Strategy Executive Director for Providence Digital Innovation Group. Welcome to the show, Matt. Thanks, bill. Great to be here. Well, I'm, I'm excited to have this conversation. You guys have produced some great, uh, content for the industry, but let's start with the basics.

Providence Digital Innovation Group. Uh, what is it that you guys do? . Absolutely. So the Providence Digital Innovation Group, we, we call it dig internally, so I'll probably say, dig throughout this. Our role is really to ensure that the patients of Providence. Have a great digital experience with their care.

Providence is one of the largest health systems in the country. We have 50 some hospitals up and down the west coast and Dig is the sort of enterprise wide consumer digital strategy and deployment group. We have within that a ventures team, a marketing team, and then the sort of core digital team, which is strategy, product, and engineering.

So we actually . In addition to sort of partnering with companies and piloting companies and investing companies, we can build and spin out companies as well. So all of that sort of wrapped into one sort of group helps Providence be best in class with digital experience. So part of that is you generate these, you generated a digital insight series.

What was the genesis for the digital insight series? . Yeah, I mean there's kind of two parts of that. So one is why do we do the work in the first place? And the other is why do we publish it and share it? So for the first part, as I mentioned, our goal is to drive best in class patient digital experience.

And we spend a lot of our time thinking about who the big disruptors are and what the big changes are. And so we're tracking Amazon and Optum and 98.6, and we're tracking how AI or RPM or virtual care are changing in the markets, uh, and trying to stay up to date. And then Covid comes along. And we talk about big disruptors.

Covid is the biggest disruptor healthcare has seen in decades, maybe ever. All these things that we thought might take a really long time, took months, even weeks in some cases, and we said, okay, we need to figure out what's going on here. We need to figure out where the puck is going. And so we're fortunate to have a strategy team, which I and sorry, AZ lead.

And so we immediately set out to. Understand all we could. So we interviewed over a hundred people, both inside Providence and outside, uh, our system, to then put together what our internal strategy was. And about halfway in these conversations, we said, God, this is huge. This is even bigger. Even the folks that we know that are relatively on the conservative side of things are saying This is a profound shift.

And we said, why not show our work and publish these? We as an organization really firmly believe that we've got 20 years of innovation to do in healthcare. And we've only got about five years to do it. And so if we can take part of it and you take part of it and you're another health system, or you're an innovator or whoever it is out there, a startup, we're happy to to sort of all work on this together to solve big problems.

Yeah. So give you, so the, the framework for your presentation, is it primarily around the impact of covid and post covid? And is, is it primarily through a digital lens or is it, does it have a lot of different aspects? Yeah, we are as fundamentally like a digital strategy group, so we're certainly biased in that direction.

And when we looked for what we thought was were going to be big movers, that was where a lot of it came. But certainly not all digital here. And we've got a whole, we've got whole reports on workforce flexibility that have a lot of implications for the way that people do. Their day-to-day work, which may or may not have anything to do with digital.

And we have another couple reports on industry consolidation, which certainly some of those are digital, but a lot of it's just about how we deliver care more broadly. So there's more in the report with certainly, um, a bias towards some digital solutions. Yeah, I love, I love the graphic that you guys put.

Put out, and it's in most of the documents that you have, the, the event, which is covid, then you have the, the mobilization. That's like what we did by instinct, right? We responded as quickly as we could and we stood things up. So there's, there's just that immediate, uh, mobilization, but then there's the, the mitigation recovery evolution, and then you have the second order impacts, and then you lay out all the stuff that's in those.

But you guys, . Man, this is a lot of work and it, and these are great documents. As I was telling you earlier, the only one I haven't read is the behavioral health one. 'cause I think it, we just dropped this week, but it's a good one. Yeah, there's a lot of reports here. So journey towards the next normal recovery, resuming operation and care delivery, mitigation, managing trust and safety evolution, business model movement toward value.

Uh, distributed care and digital health industry consolidation, which is an interesting topic. New workforce and facility models, extended supply chain models, you guys, vulnerable people and under-resourced communities. And then obviously there's gonna be a, a conclusion summary as well. I mean, writing that one now, those are, that's an amazing set of, uh, amazing set of topics.

So when you were out there doing those interviews. Did, I mean, did you have these ideas in mind or did the interview sort of just reveal the, the key topics that you wanted to cover? No, the interviews really revealed the topics. I mean, we, like I said, we started going to try to answer, it wasn't a simple question, but answer a question for ourselves and even for a team that spends a lot of time thinking about disruption, we'd be in a conversation with somebody, we're like, oh my God, I, I didn't even think about that impact, which is core to your world that now we're thinking about around how our facilities need to be different in the future, or things like that.

And we kind of thought of it in a couple different stages. So first it's. What you said, just like what do we have to do? And within that, there's two things. One is obviously just caring for our communities and we've got some work on mobilization and mitigation, but like, it's not just about Covid care and that Covid Care was huge and Providence had one of the first confirmed cases in the country, but we're talking about people who are, who don't feel safe.

People who need access to care and don't know how to get it, when they can't go in person. People who are suddenly isolated, people who may not have the same access to their medications, maybe they've lost their insurance. So all of our populations, and we have a, a report specifically about, uh, vulnerable populations, but really everyone when this time is, is pretty vulnerable.

So how does our system make sure that we can provide care safely and meet patients where they are? But then secondly, and this was obviously a big, you know, topic of conversation with the CARES Act and, and a lot of other policy going on, how do health systems stay viable? We had to recover our business pretty quickly, just like a lot of health systems did.

The long-term impact is, is gonna be pretty significant. But there were a lot of movements that we could take in the short term that we thought could help us stabilize the work and make sure we could deliver at scale safely. And then so, so that was the first part, which is what do we have to do? And then the second part, which is in that sort of second order impacts and outcomes.

Column or segment is where are we going? And the more that we dug the sort of, the more we had to split reports into two. And industry consolidation one you mentioned actually became two separate reports because we just couldn't fit it all into one tidy document. So it grew pretty organically. But I think what we came out with is something that we were really excited about.

I, I think people want me to ask questions on all of these, but I'm, I'm gonna, we're just gonna touch on 'em. And hopefully people will go out and download the reports and, and you can give us the URL towards the end of the show. But, so let's touch on a few of these. What kind of things are we looking at in a recovery phase from Covid?

What, what things were you finding? Yeah, I mean, for most, like most health systems, uh, what Covid revealed was sort of a fundamental disconnect or a fundamental error, even in the way that healthcare is paid for. It revealed that without elective surgeries, we're all dead in the water. Right. And people in healthcare have known this for a long time, right?

That we have the incentives that are aligned around certain kinds of surgical episodes of care, and that can be more aligned around sort of health more broadly. So in the immediate recovery phase, health systems across the country, we're saying, okay, how do we get elective surgeries back and running? How do we make sure that we all get.

People tests. How do we make sure we ship the equipment that we need home to them? We actually like, oh, I've got it here. I know that some people aren't on video, but we have these kits that we're sending to patients before surgery to make sure that they have sanitizer and gloves and masks and those kinds of things.

We stood up over a weekend, a home, uh, monitoring program with a partner that we'd already been working with called tle that we'd actually been using for surgeries. So. We had to automate scheduling for, for pieces of this. So a lot of technology just around how do we get people back in safely had to be deployed like that.

And I think that one of the things that we feel fortunate to have had is a team that was really focused on digital before Covid hit. Because we weren't going around searching for partners to help stand up a home monitoring program. We, we knew some folks in our portfolio that we were ready to work with, that we'd had worked with before.

That we could partner with to move really quickly. So there, there was a lot of tech, a lot of people stood up quickly. I know that we did, we scaled Zoom to tens of thousands of providers or, or was it about 10,000 providers really quickly. So, uh, a lot of that work had to be done just sort of immediately.

I think now we're starting to see in sort of the post emergency law, not that it's still not an emergency in many ways. Some people saying, oh, this workflow isn't great for me. Or, oh, this part of the process is something I hadn't gotten into yet. So we're sort of through some of the emergency response recovery piece, but we're, we've still got a long way to go for the, the real recovery.

It's one of the things you identified in your report was this, and, and when you talked about a little bit here was consumer fear. Right. So there's consumer fear about coming back in to the hospital, consumer fear, and we had to get, we had to get past that. And yes, we can look at remote patient monitoring and those kind of things, but consumer fear is an interesting thing, especially as we get closer and closer.

We don't know what the day is, but we get closer and closer to that vaccine. What are some of the things around patient behavior, consumer behavior that you're, you're noticing and that you've addressed in the reports? . Yeah. One of the things is simply that getting patients and providers to switch to virtual has been largely a success.

I think. I mean, the safest way to deliver, uh, a visit that doesn't need to be in person is to not be in person. Right? And so making sure that patients feel like they have access to their care teams without needing to physically show up is huge. But across the industry, we've also seen things like contactless waiting rooms.

And digital patient registration and all sorts of ways to just remove a little extra touch, uh, and a little extra moment of fear in the process. It's gone a long way, but we still have a long way to go. So as you step back now, how will, so if I were in Seattle and I'm, I'm a Providence patient, how is my experience fundamentally different today?

Let's assume I have a, a surgery coming up. I'm gonna do . I'm gonna do a knee replacement or something to that effect. Mm-Hmm. , how is my experience gonna be fundamentally different than it was pre Covid? Yeah, so, well, one example that's just comes to mind immediately is that for the most part, uh, a lot of our consults and the pre-op visits are now just done virtually.

We have a pre-op video, so you can take the pre-op class without showing up in person. You'll have a consult with your surgeon via video. You'll get shipped. And this isn't in all cases we've, we're sort of a fragmented system, but you'll get shipped a pre-op kit that has some supplies in it so that you can make sure that you feel safe.

And some of those supplies are ones that are for your day of surgery, and some of those are ones that like you would've had to go to the store and buy and now you just don't have to. So adding in another layer of being contactless. We have a patient engagement platform I mentioned earlier called tle that helps engage a patient digitally through their episode of care.

So they get all their pre-op instructions when they need it at the right time and with the right sort of level of engagement, I. Same with post-op, we've seen that, that having that kind of engagement allows us to discharge people from the hospital sooner. So length of stay shorter, reducing infection risk, readmission rates are lower, and so that reduces the risk of folks coming back.

So it's really about creating that sort of surgical, concierge level service from the minute they engage with us all the way through. And the easiest way to do that, whether we're talking about. During Covid or non covid for many patients is gonna be digital to ease their way. Yeah. Well, I noticed you're still working from home, but the mitigation aspect of your reports talks about getting people back to work and keeping them safe in the process.

What are some of the technology opportunities in doing that? It's really interesting. One of the things that mitigation report predicted was that we wouldn't find really good and successful contact tracing. And that we wouldn't kind of see sort of widespread adoption of enough things to make for office workers like us, the ability to go back in to make a ton of sense.

So there's certainly some technology around rapid testing. I know that they've just started with the $5, and I'm not sure how many minute tests it is, but there's certainly some opportunities to do temperature checks and screening and things like that. But I think if anything, what we've seen more is that the technology of

Working from home for those who are able to, has caught up much faster than maybe some people expected. And I think now a lot of offices you see are saying, you know what? Maybe we don't need to go back in the office at all. If I can save myself on the real estate and equip somebody better in their home, maybe that's a better way to do it.

Maybe I get access to a broader talent pool. So. Some of the technology specifically around mitigation hasn't come along as fast as some expected, but I think that some of the other broader thought reconsiderations of what does it mean to be productive, be effective, be a happy and healthy employee, are I think active in most workplaces now.

Yeah. You threw out some. And there's so many directions to go with this. Actually. Let, let's talk a little bit about industry consolidation. Then. I'll, I'll go to the, I'll go to the questions that you threw out. So, industry consolidation in the first half of this year slowed down to a snail space. It's actually been, people are asking, does this represent a trend?

We went through covid. So anyone who was talking about mergers and acquisitions. Mm-Hmm, that balance sheets were pummeled during that time. So even if you were talking about it in the, in the . Process, all the financials got upset during that timeframe. It's almost like people took a breath and said, yeah, not now.

Let's regroup and figure it out. What kind of things did you guys find as you looked at that? Yeah, I think so the, the, a lot of folks paused on their industry consolidation efforts just because it was a crisis and it was an emergency. I don't think that for most of those organizations, the long-term fundamentals changed as.

Much. What changed in the moment was, number one, it's a crisis, so let's make sure that everything is okay first, but number two, all of a sudden we saw a huge shift in cash from . Providers who were really hurting to payers who have never had profits like this. I mean, record profits kind of across the board.

And this goes back to earlier conversation around, uh, how covid exposed some sort of fundamental challenges within the, the business model. We actually, we have a report on business model evolution that covers this more deeply, but, you know, we think that this really puts a, a spotlight on the need to move to value-based care.

So in the interim, I think it changes, uh, from a consolidation standpoint who can be acquired and who does the acquiring a little bit. Certainly more health systems and hospitals and provider assets are gonna be distressed. Certainly more payers are going to have more cash on hand. But a lot of the deals that you're seeing, I mean the biggest one is the, uh, Teladoc and Livongo deal are really about saying, Hey, those who have all of a sudden seen their fortunes as a business become more optimistic, how do we.

Together design what this future might look like. One of the things that we've seen already is that straight telehealth, straight virtual, straight video visit. Technology is gonna quickly become a commodity and then it'll be a matter of who offers the best platform, the best full end-to-end care experience coming out.

The other side of this, which I think you know, speaks to some of the Teladoc work, some of the Amwell work, it's accelerated a lot of those things. Yeah. Do you think, uh, value-based care, so going in the direction of value-based care from a provider standpoint, do you think we'll see, uh, a lot of partnerships there?

Or do you think we'll see, uh, an evolution to or a re evolution going back to health systems trying to become payers? Gi given that, I mean the stark contrast between what happened to payers and what happened to providers during covid Mm-Hmm. . I, I, this is the million dollar question and one that we asked, uh, a hundred people and got a hundred different answers.

I think it'll depend market by market. I think it'll depend. I think some of what it depends on, which I think is new, is we've seen a lot of big tech. I. Getting into the insurance space. Walmart recently getting into the insurance space is really interesting. Google making some moves potentially in the insurance space, so who becomes a payer and who owns that sort of first dollar, I think will be, will evolve really quickly.

I do think that providers will ultimately need to take on. Some risk simply because the care model didn't align with fee for service before, and it definitely doesn't now. So if you, if you think about it this way, and I know there's big questions about whether payers will reimburse for virtual visits, but let's set that aside for a sec.

I'm sure, I'm sure we'll get there. If all you're doing is swap, if you're a provider and all you're doing is swapping one vir, one in-person visit for a virtual visit. You're not gaining the benefits of virtual care, right? What health systems need to be moving towards is a system that, which is, by the way, much better for patients, but instead of having five in-person visits, maybe you have one in-person visit and two virtual visits.

And then 20 tiny little digitally enabled touchpoint to help manage a patient's, uh, you know, care throughout an episode or throughout, throughout their, their sort of chronic care condition or whatever it is. So, um, in order to make that model work. Unless payers are gonna shift pretty dramatically, which they haven't historically shown the eagerness to do.

Providers need to take on risks to be able to enable something like that. So it it, whether it's through a partnership or through becoming payers, it's a direction that we're really gonna have to go to capitalize what, what we're now seeing in virtual. All right, let's put on our prognosticator hats for a minute here.

'cause I wanna, wanna talk through a bunch of little things and just, you know, next five. Gosh, I get in this, I get in trouble here. 'cause I always say, what's gonna happen in the next five years? And it happens in 10 years. 'cause it seems like healthcare moves slow, but maybe Covid has changed that and things will actually happen faster.

Mm-Hmm. . But it seems like we're focused on telehealth right now, and we could talk about what do you think the next movement, let's start there. What do you think the next movement is in telehealth? If, let's, let's assume that the, the state. The states do put up those barriers again, of being able to pr mm-Hmm.

practice across state lines. And that funding comes back in a, in a more targeted way. We have a ton of research that was done during Covid. We're able to see where telehealth has actually benefited the consumer, and we're gonna fund those things and maybe pull back on some others. Where do you think telehealth goes in the next five years?

Yeah, I mean that's a, it's a great question. I think if you, in the reports, I think what we get to, if you combine sort of the distributed care and digital health acceleration sort of thesis, the workforce models and supply chain models, you could paint a pretty amazing picture plus business model evolution.

You can paint a pretty amazing picture about what. A digitally enabled consumer experience might look like. So I'll just, I'll give an example. So let's say someone is, has a couple chronic care conditions, lives at home, is on a Medicare Advantage plan, and we as a health system have incentives aligned and the workforce aligned and supply chain aligned.

Maybe that person gets their visit via a telehealth presenter who comes to their house. Who brings a tablet, who ensures that they are using it correctly? Who helps the provider walk through an exam? Who has all the supplies there that they need, who maybe they can set up while they're there? A smart hub in the home and various remote patient monitoring devices to make sure that we're staying up to date with that patient's care.

We can set up home delivery of prescription for that patient. We can have the provider check in with that patient at a regular cadence via virtual. And one of the things that we hear a lot is that, you know, older patients won't use digital. And I think there are two sort of responses to that. One is they really have, we've seen some pretty incredible utilization during Covid, but number two is they don't have to for, for digital care to.

To make sense. So you can imagine this TelePre presenter who comes to the house to set up an app on their phone that the patients doesn't even have to use, but that coordinates the various, you know, components of their, maybe they've got a blood pressure cuff, maybe they've got a scale, they've got Bluetooth pill cap bottles.

You can have a patient. Just incredibly cared for at home without a ton of human intervention and safer, happier, and healthier than they might have been showing up at their doctor every month for years and years. Yeah. So you can combine these things to get a pretty amazing care model, but we've got a long way to go in some of these areas to enable something that looks like that.

Yeah, and that's the, the picture I'm trying to paint here is telehealth is the start. And the picture you actually painted in your, in your articles, but then there's a whole, there's a whole world that's gonna happen in the home. Mm-Hmm. . And part of that is going to be human assisted because there's the adoption of technology and getting things set up in the home.

There's gonna be active monitors and passive monitors that are going, are, are actually that, that would be the next question I would ask is where do you think that, how far . Along are we in the remote monitoring stages and where do you expect that to be in five years? I hope we're a lot farther along. I mean, we've had remote hait monitoring tools for some time.

Hospital at home has been a thing for decades, but it's never really caught on outside of sort of capitated systems and even within some capitated systems. I think for a few reasons. One is the reimbursement hasn't been there, but two, I think that there's a, a hump to get over. Of if the scale is not large enough, the devices can't be cheap enough and the platforms won't be developed enough and the investment dollars kind of may not follow.

But we've seen plenty of RPM vendors out there. We've seen. Plenty of hospital to home models out there, but with now this like next level of potential adoption, I hope that investors and, and providers and payers will see a lot of opportunity in being able to offer these really effectively at scale. So I'm really excited about the, the potential for that.

There's also back to sort of the, the conversation about virtual an another big space, which is centered around what happens when you unlock. A provider visit to digital. So before the data that came in and out of a provider visit is really the notes, right? The documentation in the EMR when all of a sudden it's on a virtual platform, you can do natural language processing.

To record the conversation in more detail. You can record the visit, you can enable a family member to join in. You can enable, I know we've seen companies out there that are, you know, tracking body language and voice tone and the potential for even real-time clinical decision support popping up right there on the screen is really incredible.

So, to your point, we're now at a sort of telehealth sort of stage of this, but we're seeing the unlocking of so much more than that. Yeah, it's, it the, again, the million dollar question is do you think the, the innovation is gonna come from the payer side or the provider side? And I'm not asking you to answer that question.

I mean, it, it would seem to me that when you talk about value-based care, that there's it, the model that it's going to be incented to build out those tools and deliver those tools is . It's the one who's receiving the first dollar. And it's, it's, it's, I agree that the incentives are there. I think ultimately though health systems, and I say this absolutely for Providence, at every level, feels responsible for our population's health and care very deeply.

And we have a deep connection with our populations, and we want to provide to them the best care. And I think that there's a. Trust between a patient and provider and a patient in their health system that payers are gonna have a hard time replicating. People don't trust as much when it's coming from their payer and, and maybe that shifts and maybe we solve for that, but we really strive every day to be our patient's trusted provider and health.

And I think our ability to. Engage them in their, in their health needs at a really personalized level can allow providers to be the, the sort of source of innovation and improve their value within value-based contracts in partnership with payers taking on risks themselves. I think providers are certainly not setting this one out.

Yep. Absolutely. I, I appreciate you bringing that in that way, Matt. This is great work. How can people find these and download these, these white papers? They're not white papers. Sorry, insight. Yeah. We've been calling them digital insights reports. Yes. So we have a, uh, resource center. And I'll pull up the URL here really quick.

So we have a resource center. It's at providence digital insights.org. It has all of these reports, plus we've got podcasts like this will show up on there. We have some LinkedIn live conversations that are really useful. I really do. I really encourage folks to go read the reports. I'm, I'm proud of the work the team's done and they, they dove

Incredibly deep on some of these topics and, and came out to produce some work that I think is readable, interesting, digestible, and really speaks to where the opportunities we see we see are. So it's, I just said the URL and not the url. I dropped it. Providence dash digital insights.org. Yeah. So what, what can we expect from you going forward?

Obviously we're gonna get a, a capstone to this whole thing, and then where do you guys go from here? Yeah, absolutely. So I'm writing a capstone right now. It's on my other screen, but we're gonna do some follow ups to this, to these reports later on in the year and into next year, providing some updates on what we've seen, some deep dives on topics that have emerged, especially from conversations like this.

So we really want these reports to be a conversation, and so we'd love to hear from folks who read them, who liked them, who hated them, who agree, who disagree, all that's going into sort of how we come back and revisit these topics later. Fantastic. Matt, thanks for your time. I really appreciate it. Bill, this is great.

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