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Today on This Week Health.

We want to do population health. We want to do immunizations and we want to do quality and what we ended up with was a set of requirements that required every physician at every encounter to record 141 pieces of information while seeing the patient making eye contact and being empathetic. And we got burnout. Oh, that's a shock.

today on this week health, we are at the mid-year point. And we're gonna take a look back over the next couple weeks with highlight shows, which look at the great guests that we've had in the first half of the year. We really have had some fantastic guests. And as I was making this just looking back, I was reminded of the great wisdom that we've been able to capture and share with the community. 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. A set of channels dedicated to keeping health it staff current and engaged special. Thanks to our keynote show sponsors, serious healthcare, VMware transparent press Ganey, Seus, and Veritas for choosing to invest in our mission to develop the next generation of health leaders.

All right, let's get to the show. Probably one of the most notable guests we've had on the show this year is mark Cuban. It's great story. I shot him a note and said, Hey, you're starting this mark Cuban cost plus drug company. Love to interview you for the show. And he got back to me within like 15 minutes and I was kind of shocked that he did and said love to do it.

I just sent it to his personal email address, which he shares with everybody M Cuban gmail.com. And he got back to me and gave me 30 minutes to talk to him about his new cost plus drug company in this clip. I actually crowdsourced some questions and this is one of the crowdsourced questions that was given to me that I threw at mark Cuban. Here 📍 you go.

He's up against giant companies with lots of money and influence and complicated relationships with tentacles wrapped around through government manufacturers, insurance companies, drug stores, pharmacists, retailers, and more. There's all kinds of super complicated contract arrangements that include rebates and hardwired incentives that keep this giant self-licking ice cream cone stuck together. The participants in this cartel, mostly like the deals they have and they make good money on it. And the system is built to keep others out. How is Mark going to break in or break out?

So first, this didn't just happen overnight. Our pharmacy launched on January 19th and we've got hundreds of thousands of customers already. But we've been doing this and working on this for more than three and a half years. And so it took a lot of time to build trust. So when we went to manufacturers, it wasn't like, oh, okay let's ignore our biggest customers. Our biggest distributors. Our biggest insurance companies that we work with.

It took time for us to explain the model, show them, demonstrate to them how we were going to do it. Let them see it when we started to put together and let them see the initial response once we launched on January 19th. It was a culmination of all those things to build trust. And then the second part, all those incestuous relationships, we just avoided We didn't deal. If you don't want to deal with us, great. Don't deal with us. That's why we started with generics because there's typically more than one manufacturer or we have the opportunity to manufacture ourselves. And so that created an 📍 opportunity there.

So year in and year out, one of our most listened to guests is Dr. John Halamka, who is the head of the Mayo clinic platform. And John has a way of my team says he has a way of talking in soundbites. So you ask him a question and it's really succinct. Answers and really crystal clear, they really love having him on the show cuz they learn so much.

And I think many of you learn a lot from him as well. So we had to throw in a clip again. One of the most listened to shows every year is the shows we do with John Halaka. So in this clip, we talk about the future of the EHR. So here you go, Dr. John Halamka on the future 📍 of the, EHR Getting back to the EHR. What do you think the future of the EHR is? I mean, do you think it just sort of goes into the background, acts as a repository, does its transactional work great within the health system itself. It is opened up via FHIR. Or do you think there's going to be a new like ground up something that we're going to see in maybe the next five years or so?

Have you spent time with Don Berwick?

I have not.

So he was our CMS administrator, but he founded something called the Institute for Healthcare Improvement. The IHI. And Don would use the term sometimes you engineer a system to achieve exactly the result you got. Now, let's think about what we did during the meaningful use era.

I mean, I was part of that, right? We said, oh, well, we want to do population health. We want to do immunizations and we want to do quality and what we ended up with was a set of requirements that required every physician at every encounter to record 141 pieces of information while seeing the patient making eye contact and being empathetic.

And we got burnout. Oh, that's a shock. We got exactly the results we engineered. Now. The dream is not just lipstick on a pig, so to speak. Remember I run a farm so I can say that but to say that we're just doing the EHR as it is today. And we're putting some FHIR interfaces and maybe a little bit more decision support, not good enough. What I think we need exactly as you described it as a complete paradigm shift in the way that medical records are recorded. How about this? A doctor and a patient have a conversation. The computer, of course, with everyone's consent, whether it's audio video, or both is recording that conversation. And the end result is through NLP and ML.

What you're doing is taking the unstructured conversation, figuring out who said what, putting it into some structured, coded form, and then using it for various purposes, whether that's clinical care, research, billing, whatever. Because this idea that the human is transcribing a deep conversation into a set of discrete data elements is not going to get any better. We have to 📍 change the paradigm.

So we finally got Angela Yoko, who is the chief transformation and digital officer at Novan health to come on the show.

we had crossed paths a lot of times in this industry, but I've never been able to get her on the show. And we had a phenomenal conversation. Love talk nerve about data science about innovation. You name it. We touched on it. It was a really great convers. in this one, I just opened it up and say, talk to me about the potential within healthcare and the future of healthcare given the things that we are working on. So Angela shares some great thoughts here. 📍 Here you go.

What excites you about the potential future of healthcare, what can you imagine healthcare could look like that would really benefit the communities that you serve?

We need every member of our community to be as healthy as they possibly can. So traditionally, when we think about what healthcare, the role that healthcare providers play in that, in that mission, it is expanded access to care and it's improved quality of care.

Okay. Those are still our top two focus areas. So expanded access to care. This is how we think about providing care through digital channels. Being able to provide on demand care either through physical digital, or some hybrid channel. And then of course, expand in increased quality of care is in as far as my teams are concerned, it has a lot to do with advanced analytics, our ability to apply AI based solutions to get to faster diagnosis, to get to more personalized treatment plans, to predict major health events before they happen. This is all, this is all sort of bread and butter in the modern healthcare provider space. And I think we do that very well and we tend to do it first.

So I'm really, really happy about the team's work there. However, this is not enough. Healthcare should not be, when we think about like take, for example, a virtual visit, even with advanced sensors that allow you to take vitals remotely and all the rest of it, that is still just a digitized version of a traditional healthcare engagement.

Right. That's still the patient making an appointment with a provider, through whatever channel and all well and good and that should continue. The future of healthcare is going to be about empowering each individual, each family, each member of the community to manage their own health and wellness in a way that is more of a continuum and less 📍 about individual visits.

The next two clips are two gentlemen that are joined at the hip. We have leash Shapiro managing partner, seven wire ventures, and then we have Glen Toman, CEO, transparent they serve together at Allscripts and they still serve together with seven wire ventures.

So I think that there's a lot of learnings that are coming about how best to engage people. Even in, in group sessions using mental health tools. One of the companies that we've worked with that has done a terrific job, helping people with severe anxiety and depression, obsessive compulsive disorder is No CD and they're in network with many plans that they're helping people with obsessive compulsive disorder become diagnosed more quickly. As well as delivering them services that they can access on their own terms. Self-help tools, some ability to speak with care coaches as well as to get online appointments, if they need stepped up care or live appointments, if we need to schedule them.

So it provides that wraparound set of tools to help those individuals keep their condition in control and in check, which is really beneficial for them, as well as those who are 📍 sponsoring your care.

Fantastic. So the next conversation I've already teed up, it was with Glen Toman, CEO of transparent, transparent doing some phenomenal work to address the cost of care to address some of the inefficiencies within care that exists and really knitting together a really excellent solution.

This earlier this year, they raised another $200 million. In a funding round. And I just ask Glen, what's the urgency? Why are we moving so fast to raise so much money? And here 📍 was his answer.

What's the urgency to the work that Transcarent, that you guys are doing in the industry?

Well, I think there's two ways to answer that. One is about the funding and the other one is about the urgency of the work itself. And the reason that I started Transcarent was because we have an urgent problem in healthcare today. And that problem is that every day people aren't getting the care they need.

They're paying too much for the care. We're denying care. We have a broken healthcare system. And as we've discussed before, if you ask people about their experience, they'll tell you that today healthcare is more confusing, more complex, more costly than ever before and getting worse. We know factually that the single largest cause of bankruptcy in the United States, personal bankruptcy is healthcare costs. And you can specifically trace that to co-insurance. That is people are getting surgeries and treatments don't understand their personal obligation. So all of this is going on. Meanwhile, we have some of the largest payers in the country making record profits and denying a record number of claims. So this is an urgent situation and the backdrop is we've got a pandemic going on. So every 📍 day matters.

Fantastic. I love the work that Glen Toman and the team at trans Karen is doing. One of the people I was so excited to get on the show this year is Missy Krasner.

Missy Krasner is someone I met very early on in my healthcare career. And she has introduced me to just a world of people. She is a phenomenal networker and the reason I struggled to get her on the show is she's worked for some great companies, but they wouldn't let her come on the show. She worked for Google.

She worked for Amazon and, tech startups to that. And really wasn't able to come on the show. So I was really excited. She is now the venture chair at redesign. And since she had such great experience with the tech startups, I posed this, this challenge to her, which is the experience that a lot of people have when they when they interact with big tech and healthcare for the first time.

And a lot of them come out, just sort of scratching their heads going. That didn't go how I. Thought it would go. And so I asked Missy, it's like, what's the disconnect? What's going on? That we don't have this experience of, oh, this is going to solve some of the problems we have in healthcare. And we, we get excited, which is probably what we should get when we go to visit Coopertino or go up to Seattle and visit Amazon.

But it doesn't happen all the time. and I ask her, why is that? And she gives us some great insights 📍 here. You.

I will say this, the number of CIOs I know who've gone up to Cupertino and you talked to them before they go up and they're like, oh, I'm so excited. This is great. And even one of them was like, Hey, Epic's going to be in the room and Apple's gonna be in the room. This is going to be amazing, every one of them when they come out, I said, how did they go? They scratching their head going. I, I'm not really sure. . And that gets to your point of their DNA is really towards the consumer. They don't know how to work with a health system and the EHR provider to do too much beyond what they, this is what we do. You guys figure out how to use us as the approach.

Yeah. One of the, one of the three lines that I saw at both Google and Amazon is that the way in which teams are set up and Apple's like this as well just mostly from most of my friends and working with apple is that teams are set up individually. So there's not one central healthcare leader. You're on a need to know basis with some projects, some projects are super confidential and there's not like a a holistic experience. So if I'm ethic or I'm Ascension and I'm like, Hey I'm, I'm using AWS at Amazon. So I have I'm Cerner, I have a big footprint there. And I hear that there's some kind of wearable coming out of Amazon devices, which is another division. So can I get the update over there? What's happening over there, right. And, oh, by the way, I got wind that there was something called Amazon care and that's happening.

So why am I not talking to that team? Right. And so that's a great example of this whole concept of technology companies are de-centralized in their innovation efforts. And so if I'm innovating something at Google that has to do with health search, I'm not reporting up to Dave Feinberg, right? Who might be doing something in health search might be doing something with Fitbit, might be doing something with streams in the NHS, and maybe he's talking to the cloud people, maybe he's not right.

So there's this fragmentation inside the company, which makes it really difficult to manage the enterprise client on the outside that you're partnering. Right, because they're holistically looking at all of the things that the technology company could do. And there's pros and cons, right?

I get kind of being on both companies, I get the management reasons for both of 📍 those sides.

All right. One of my favorite recurring guests is Rob D mache, retired CFO for U P M C and now board member and board advisor for several great companies. And every year I get together with 'em at least once, if not twice a year. And we take a look at the financial outlook for healthcare in that year, following the JP Morgan conference.

So we get to sit in on 24 or so presentations from health systems, they share their financials, they share their strategies. And we just talk about the themes. And so here's. Just a small excerpt, but if you like this, you're gonna wanna go listen to the entire episode. Cuz we break down the JP Morgan conference, individual presentations and you name it. But this is high level themes. What did you hear from the conference with Rob D former C F O 📍 for U P M C.

What were some of the themes? Let's start with strategy. I mean, the financial performance, I think, is going to be an interesting conversation as well, but let's start with just high-level themes. What we heard from some of these CEOs.

From a strategy perspective and I think we come from this, you and I from sort of a provider angle, given that was both of our backgrounds, but this industry is becoming as much about the for-profits and the IPO's and the private equity investors as it is the non-profits. These worlds are really converging.

So in terms of strategy, it was interesting. What I saw from the providers Bill is in the past, we've talked a lot about insurers acquiring provider assets and kind of moving into that space and becoming payviders. And one of the macro themes that I saw really emphasized with all the nonprofit presentations was a convergence of the strategy.

The providers are now kind of realizing where the competition's going to be, and they're expanding, they're acquiring assets away from just the kind of acute area thinking about being upfront with the patient, the consumer. They're thinking about the whole continuum of care, whether that's home care, whether that's ancillary types of services, whether that's value based care.

So I think what I saw was a real emphasis this year was a realization on the providers part that they can't survive just being fee for service, acute care kind of hub business, they need to actually expand their offerings and get ready for the future. So I think that's the, the battlefield has been set and it's across all these 📍 areas of care.

I love my conversations with Rob and that reminds me, I probably need to have 'em on again to have our mid-year catch up on what's going on with the financials in healthcare. Our final guest for this episode is Lee Milligan, former CIO for Asante health and a very good friend of mine. And in this episode we had a webinar and in the webinar, it was essentially walking through.

An actual ransomware attack. So Asante didn't fall prey to the ransomware attack, but one of their community connect partners, sky Lake's medical did fall prey to it. And after doing the webinar, which was incredibly well attended, I think 98% of the people stayed for the entire 60 minutes of the webinar, which is really unheard of because it was a great story.

I mean, they were just as vulnerable as they could be. They shared a lot of great insights, but I wanted to get, I wanted to get the real story. So I pushed Lee a little bit and I said, Hey, what, what didn't you tell me on the webinar that. That people should hear. So here's here's me pushing Lee a little bit to get some feedback on what what's really going on at a ransomware event. So here's 📍 Lee Milligan You participated in our webinar on ransomware, a community connect partner of yours Sky Lakes Medical Center was ransomed. And we had four people on that webinar. So a lot of times when that happens, you only get about 10 minutes to talk.

And I'd like to expound on that experience a little bit more with you. We'll start with the, the phone call, which I guess is where this starts for Asante. Talk about that night, getting that phone call and what your response is immediately following?

Oh so you want to hear the real story?

No, that was, that was a great webinar. That was the real story. But the Sky Lake story was really the focus of that. So that was about 25 minutes of the total webinar.

So, okay. Yeah. The phone call was scary. Right. You get this phone call from the CIO of the other system. You've got your Citrix and VPN connection and FTP all connecting to to that system.

And they call and say, Hey, we've been hacked. We don't know exactly what's going on. All we know it's this thing called Ryuk. And I hadn't heard of Ryuk before. So I'm like everybody else Googling this as I'm talking to the CIO, trying to figure this out. And that my biggest concern was the time delay.

So there was, between infection and expansion of the infection and our phone call was somewhere around six hours. And so I was very concerned about that. So I pulled my team together. We immediately cut ties and then began an introspection. Essentially they're looking to see if we had gotten infected by this. While at the same time, my team is looking at Ryuk really trying to understand the nature of Ryuk, trying to gather more information. So we're gathering information while at the same time, we're looking at our internals to see whether we have any infection. On top of all of that, this is our community connect partner, and we certainly want to be mindful of the catastrophe they were experiencing and doing our best to help support them in that process. But those were kind of the initial thoughts that 📍 that happened

so that's it for part one. And the reason there's a part two is cuz the team couldn't decide on which clips to use. Cuz there were so many great clips and in the next one we're gonna talk with Phoebe yang, Daniel Barchi, Aaron, Mary. Nadine Hasha Haram doctor Nadine haha. Haram an Denise Chopra, Mickey Tripathi David Feinberg, Steven Klasko.

And now you understand why it was so hard to narrow it down. So we have eight more clips for you. We're gonna do another week of this and I appreciate you being part and should be a note. Let me know. What you think of our guests in the first half? And if you can think of any guests, you would love to have me interview shoot that note over as well.

It's bill at this week, health.com. If you know someone that might benefit from a channel like this, from these kinds of discussions, go ahead and forward them a note. I know if I were a CIO today, I would have every one of my team members listening to a show like this one. It's conference level value every week. They can subscribe on our website thisweekhealth.com or wherever you listen to podcasts. Apple, Google, Overcast, everywhere. Go ahead. Subscribe today. Send a note to someone and have them subscribe as well. We want to thank our Keynote sponsors who are investing in our mission to develop the next generation of health leaders. Those are Sirius Healthcare. VMware, 📍 Transcarent, Press Ganey, Semperis and Veritas. Thanks for listening. That's all for now.