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The 229 Podcast: This White House Deal Changed Your Hospital Visits Forever with Aneesh Chopra

Aneesh Chopra: By the end of March you'll see OpenAI, Anthropic, Google, apple, Samsung, all providing abilities for consumers to bring their medical records safely and securely into that environment.

Bill Russell: My name is Bill Russell. I'm a former health system, CIO, and creator of this Week Health, where our mission is to transform healthcare one connection at a time. Welcome to the 2 29 Podcast where we continue the conversations happening at our events with the leaders who are shaping healthcare.

Let's jump into today's conversation.

Aneesh Chopra: Yeah.

Bill Russell: another 2 29 project podcast and today I'm joined with Anise Chopra, chief Strategy Officer at Arcadia, first CTO of the us of the United States.

Period. Like that's the end of the sentence, isn't it?

Bill Russell: Wow. We might as well just kick into it. Anish, well, welcome to the show. I am so thankful for you because we started this podcast a little over it's gonna be nine years in January. And so I think we had all of about three to 400 downloads by the time you came onto the show for the first time.

And you like doubled our downloads with one episode and ended up putting us on the map, all those years ago. So I appreciate you. And I appreciate you continuing the conversation because uh, and because our conversation started before that, when I was CIO at St. Joe's,

Aneesh Chopra: That's right,

Bill Russell: had a shared passion for I, I don't wanna say interoperability 'cause I'm not

Aneesh Chopra: right?

Bill Russell: word.

'cause it was more data liquidity. It's like,

Aneesh Chopra: Yes.

Bill Russell: this into the patient's hands? Can we get it to the right place at the right time? to truly change healthcare. And I think man, we've seen a lot of things change over the years. It's been

Bill Russell: I appreciate it. There, there is an awful lot to talk about. There's a lot of stuff coming out of dc. But I do wanna start on this liquidity conversation. 'cause

Aneesh Chopra: Yes.

Bill Russell: we used to talk a lot about and FHIR and all sorts of other things in the world of ai though experience is that this is sort of changing.

I'm doing a lot of data stuff right now with my company and the AI layer really changes how I'm interacting with data. I'm wondering if that's going to be the case with healthcare data as well.

Without special effort, which means I have the right to communicate with your system. Now the question is who has these rights? Consumers have always had these rights. It's been enshrined since hipaa that I have the right to access my health records. But digitally, we haven't figured out how to exercise those rights, and we're gonna get into that.

And that will allow you Bill to delegate an agent of your choice to interact with your data. And we're gonna get into that on prior auth and a whole range of topics throughout this conversation.

Bill Russell: I'm trying to figure out which direction I want to go in. 21st Century Cures was a pretty transformational. Piece of legislation and really move things forward and had some things in it. But what's, where has that, it was really a launching point.

And where are we at today? What's going on today in DC that's sort of shifting and where we're going

Aneesh Chopra: Yeah.

Bill Russell: of times when I ask these questions, you give me a history lesson,

Which is a demand signal for the data liquidity. But as you could imagine, over the course of the last 15 years, we've ended up a bit more on the supply side. You must open up your data, and then the question is, well, for what and for whom? And well, that's a little bit of like for everyone, for all circumstances.

So a supply side regulation says you've gotta make available U-S-C-D-I and all the rest. And so the meaningful use part ended up becoming a lot more like meaningful use, like a lot more muted on the use cases. So we had a supply side world for the last 15 years and what is happening today?

The health tech ecosystem is a flipping of the weight towards the demand side. And so what CMS has done,

Half a dozen health systems who were kind of the first to kind of have the chance to weigh in before this thing got launched. And four national health plans, basically United, Aetna, Humana, and nts. So Bill, everyone showed up when the president convened and said the following. Number one, we will make it easier for consumers to [00:07:00] access their health information and to address the issue of trust.

We will adopt modern identity standards. So, as you know, Bill usernames and passwords today do not necessarily engender trust. There's so much. Of that which has been, you know, call 'em hacked or stolen. So, moderate identity standards, the NIST i two criteria that allows us to know it's Bill Russell.

And if it's Bill Russell, I should be able to associate Bill's, request for Bill's, health records to be able to pull it out. Trust layer number one, the consumer, everyone agreed to do that on the physician side of trust in the care equality world. We've had a, let's call it liberal data sharing model.

I'm trying to source leads for a malpractice lawsuit. Well, I'm a doctor, so I guess technically a doctor can query the network, but that's not the heart of that trust model. It's are you an active doctor treating this patient? That's what it was supposed to be. So to address that issue of trust, CMS said, okay, we're gonna build this second piece of infrastructure.

We're gonna have a national directory. A doctor's gonna create a profile, tell you what they do, and you should be able to look up that profile. And if that profile is up to date and accurate, then you should honor that. They should be able to pull their records. So we're gonna have a bit more of a qualified trust for physician sharing.

And if I'm measuring quality, I should be able to access the information I need to get measured for quality. So those two use cases introduce this notion of. Many need trust. You're not gonna share everything with the health plan, but you must share this, you know, call it minimum data set. Well, you put those three things together and it sort of looks to me like we've put the demand side at the front of the bus, so to speak.

To move this industry forward. And as a result, ONC is coming in to say, look, you keep pushing the envelope on use cases CMS, I'll make sure that the Cures Act and information blocking rules and certification criteria are there to ensure everyone can kind of catch up. We'll be that caboose, that foundation, but you can reach for the stars.

Bill Russell: There were some commitments made at that meeting. Right?

Aneesh Chopra: Yes,

Aneesh Chopra: Amy Gleason, whom I love first and foremost, she's a mom. She's a nurse. She's an advocate for her child Morgan, who's been suffering from a health condition, a rare condition. And she's a technologist and a leader. And so Amy basically said, we've had plenty of regulations, we've had plenty of investments.

But we haven't had the amount of progress that a mom would want when her child is suffering from a rare disease and has 47 patient portals and she has to memorize them, and we can't get a, you know, full understanding of what's happening and what she could do to get a better care. So Amy said, look, why don't I just get a coalition of the willing if you're willing to come in and engage.

Data sharing across all three use cases. Consumer access, trusted physician access, and minimum payer data sets.

Bill Russell: I want to. At that patient side. I wanna talk about fiduciaries, but I also want to touch on, so, information blocking crackdown. Really, is that the right word? It feels like that's the right word. I mean, it started really feel it took full force in, the latter half of this year. It feels like they're really starting to crack down on non-compliance around this.

The answer to that is no. There's too many barriers. There's a portal password. There's, you know, when you get into the portal, you're only accessing U-S-C-D-I, probably S-C-D-I-V one. U-S-C-D-I-V three comes live in January, 2026, so the information blocking statute. Starts with the premise that you're technically capable of sharing data, but you're choosing not to give it to Bill Russell because he's a famous podcaster and is gonna call you out when it doesn't work.

Like I should be able to face, ID verify my identity, pull my records, and use them without a hell lot, a lot of hassle as that technical approach gets deployed. And organizations adopt the software that facilitates it. If an organization actively chooses to turn that feature off, that's a great candidate for information blocking.

the irony is,

Bill Russell: are,

are doing this for you at this point. I

That is a little bit about why meaningful use was meaningful use. You had to adopt certified Health IT but you had to demonstrate use. You couldn't just like buy it and put it in the shelf. So it may be the case that we have a little bit more work to do on the technical side. On kind of FIHR based network data sharing, which is a new concept.

But when we solve those, the complaints are mostly gonna be probably around the adopters of those technologies, not implementing them in accordance with the no special effort rules.

'cause literally you are at the point of care at every point. And we talked over the years about this whole concept of the healthcare data fiduciary, if you will, somebody maybe Apple or somebody on my behalf. Who's collecting all that information and then I can then utilize it within the within the healthcare ecosystem. It's been fits and starts to be honest with you. And I think the last time we talked about the fact that maybe not enough patients are, we're not pushing it enough from this side of the aisle.

We would actually end up with more or higher quality results. At lower cost. Like in the weird way, like if you asked me could everybody get the best, you know, car? Well unfortunately, you know, the higher quality cars may be more expensive. And so we'd be probably spending more collectively to get more for more.

Healthcare is one of those unique markets where if everybody got more meaning higher quality, we may end up spending less. And it's that philosophy that's been governing healthcare delivery reform for the last 20 years. But we've been putting most of our energy on the physician reform side, get physicians to get a skin in the game to help patients navigate.

Force behind why they want everyone to have an AI super intelligent fiduciary in your pocket when you read all the statistics about how consumers interact with ChatGPT today and all of its, sisters and philanthropic and otherwise we're talking double digit double digit you know, returns.

And that is amazing in my view. When I say returns, I mean, usage, so like market share. So double digit percentage of queries are health related queries. So at the moment we haven't connected the AI chat bot with your HIPAA right of access. What people are doing today, Bill, is they're taking a screenshot of the medical record.

Bill Russell: That is, that's huge. The couple things this year really jumped out at me. If people are wondering why we were talking nostalgic about the year, this is the last episode I'm recording this year. You'll hear it in January, but we're we're literally right up against the holiday break. So, but if I look across this past year, some of the things people were kind of taken aback by open AI's rollout of chat GT five in the middle, they did that healthcare

Aneesh Chopra: Yeah.

Aneesh Chopra: Yeah.

Bill Russell: Like, I mean, I put my blood pressure reading in almost every day into one of the things saying, Hey, what, you know, how is this reading? And

Aneesh Chopra: I'm with you.

Bill Russell: It has memory. So it's looking back and it's going well, Bill, since you started tracking in September, you know, this is good progress and

Aneesh Chopra: yeah, I'm a I'm an Aura Ring customer, and I'm eager to hear when they roll out this feature so I can bring my records in, which is gonna be absolutely game changer. Look, Bill, right now. The idea that the healthy and wealthy that can afford these technologies are gonna be benefiting, doesn't feel great when the majority of concerns for the highest needs, highest risk patients are dual eligible underserved populations.

Bill Russell: I don't worry about such things the language there because, we are seeing the democratization of the AI models.

Aneesh Chopra: Yes,

Bill Russell: can get on them and utilize 'em. All you need is internet connection. And I

Aneesh Chopra: that's right.

Bill Russell: I, yeah. And so that's amazing. If we can get the, and almost, I mean, I understand that, you know, cell phone usage.

I've had this argument with the sisters. I remember when I was trying to roll out technology and they were like, but what about this population? When we were looking at it, a majority of people have mobile phones.

Now we're back to that term fiduciary Bill, which as you know, is my. Favorite because it may be, there'll be a wrapper from an organization I trust that will make it easier for me to make the leap that the AI models are trustworthy to give me advice at every step of the way. And so I think incumbent health systems, health plans, physician groups.

Bill Russell: And a handful of health systems across country are putting out, for lack of a better term, AI personas with their brand to essentially say, Hey,

Aneesh Chopra: yeah.

Bill Russell: Mayo Clinic. Here's the, you know, bring your medical record into

Aneesh Chopra: Yeah.

Bill Russell: And, by the way, you know, we're not saying that hallucinations are zero, but we're. helping to train this model or put a wrapper around it to make it more, more accurate,

Of you know, call it benefits optimization to make sure that you are, you know, maximizing what [00:23:00] you've paid for with the insurance products and that you're getting the best clinical advice so you can make the best decisions about where next to take your family's care.

Bill Russell: So let's talk about this administration. I mean, one of the things I appreciate about you, you served under the Obama administration, but you've been very consistent on what is best for healthcare, what is best for improving outcomes across the board. And I'm not asking you to give like a, an analysis of this administration, but

Aneesh Chopra: Yeah.

Bill Russell: know what's going on.

There's an awful lot of access, I mean, there's a whole bunch of things that just came out recently

Aneesh Chopra: Oh my gosh.

Bill Russell: moving

And the reality is we're a lot closer than people think. And in the area of modernization, the use of technology, data, and innovation to make the country better on health, energy education, you name it, Bill, we're probably within the 48 yard line. Okay. Maybe a little bit more deregulatory in bias and then maybe a little bit more you know, consumer protection on the other side.

But at the end of the day, I can wholeheartedly endorse the technology, data, and innovation roadmap that this administration is pursuing. Let me make a few personal observations. Dr. Oz, I think people had opinions of him going in, like, I don't know. TV celebrity, you know, send a candidate. Maybe that wasn't the place to shine for like being truly policy wonker in his background.

We need the on-ramp for these AI tools to come into healthcare. And most importantly, Bill, we need the productivity engine that takes the scarcity we have in healthcare into one of abundance, so we can make it easier for everybody to get access to primary care, everybody to get access to high quality healthcare.

Where I could chat with it, interact with it, upload my medical records to it, and have it essentially kind of titrate my meds or make other medical decisions, referrals, things that doctors do. The access model, if we look back in history, may be the moment we decoupled labor hours from healthcare delivery outcomes.

RVU physicians have to hit RVU targets. RVU are a function of time. How much time do you spend doing X? Can you document what you did with that time? And if you spend the time and it's documented to be of higher.

AI agents supported physician B, and then if you get to the conclusion that you can have a lot more panel size, do you want that doctor's compensation tied to their time on complexity? Or would you rather say, look, if those 10,000 people are roughly 60% with their blood pressure controlled by the end of the year, and you Dr.

It's not exactly a you know, a really complex phenomenon. You basically have to take your blood, you take your cholesterol fighting meds, and you improve your blood sugar and all that. So anyway, if you if you took that storyline, the access model, which is an extension of health tech ecosystem will be a big driver then.

You could go a step further and say, okay, I wanna move a little bit beyond this. I wanna get to consumerism on a whole range of subjects, including their benefits, their coverage, and everything else. You could take a negative, like the one big, beautiful Bills, you know, work requirements. And I say negative because the assumption is that 11 million people are gonna lose Medicaid because they're not gonna be able to fill out the paperwork.

These questions. They may seem easy at this at some level, but you gotta download PDFs, you gotta upload them to government portals. The usernames and passwords are gonna be forgotten. They're gonna be worries about fraud. So there's a lot of issues around how does one at the consumer level manage all this.

And that we have a more consumer oriented price quality coverage service in addition to the need to get clinical guidance. Okay.

Bill Russell: you just said an awful lot in a short period of time.

Aneesh Chopra: And how partisan is that, just ask yourself the question, Bill, is that a D idea? Is that an R idea? Like, what is that?

Bill Russell: no, I, you know, it, it has been consistent. I mean, we've talked about all the different people who've sat in the chair over the years, HHS. HIT and they have been consistent. I've had 'em on my show and then it's been like consistent. It's like, no we've gotta drive better outcomes.

Aneesh Chopra: in defense of why we haven't made as much progress, if you lined up the cash distribution, High Tech Act, frontloaded a lot of the cash, but the API Cures Act stuff came in on the tail end. So in a weird way, we kind of had a bit of a. Buy the software iterate between CCD exchange, IHE protocols, figuring things out in traditional HIE models to finally settling on API architecture internet.

And it's been very much like whatever the vendor ship is, what you get and you don't get upset. Like that's it. You don't get anything more. If I remember, Bill, you had to build your own external HIE infrastructure. You invested. Data liquidity because you sort of needed it at the St. Joseph's ecosystem.

But that's a rarity, right? Like that, that has really gone away. A lot of those extra investments have kind of consolidated down to whatever the EHR ships out of pocket. We're now entering a new era where we haven't even talked about the Rural Transformation Fund. I'm embarrassed, I forgot that one.

Have basically said, we're gonna drive the adoption and use of the health tech ecosystem. And what that means is they'll have dollars alongside the technical improvements, which is why I think we're gonna make a lot more progress in the relatively short period of time because of the resources that are coming.

Bill Russell: Well, I wanna get the soundbite, you know, just from where I sit, if you were a of a let's just call it a medium sized health system, maybe even a large health system. What's the first, I don't know, two or three moves that you'd make in that role?

Aneesh Chopra: Yeah, I would. I would first start with the strategist role. Who are you? Are you a hospital, CIO, contributing data to the ecosystem, or do you wish to be the trusted health information fiduciary for the community you serve? The answer to this question really shifts what you should spend your time on. If you are the fiduciary, then you wanna have a partnership with AI or whatever, and you wanna be able to say, look if our patients digitally authenticate themselves like the TSA precheck kind of thing, and you get your face id.

And they have access to pull all their records independently of what we can do on the backend with care quality, Commonwealth Legacy Networks, I should be able to pull that and I should invest in that functionality. And you know, think of that like as Baylor Scott and White, where their digital channel is a driver of their economic growth.

I mean, I'm not a hundred percent sure all the engineering details, but you could build on the existing portals, but add a functionality that allows you to sort of serve in that fiduciary role. So that's what I would do, number one, if I was in the offense, if I was playing offense.

Bill Russell: figure out which direction you're gonna go.

Aneesh Chopra: Defense or offense

Bill Russell: right.

Aneesh Chopra: are you gonna respond to people requesting to get the data out safely and securely, or are you gonna be the consumer of that data on the other side? And by the way a big source of the data is gonna include health plan data. So it turns out the health plan data, which is in the population health world, critical to do coordinated care, ends up being almost like an alternative record locator service.

It's free and available for anybody, open source. You could download it, run it on your fire infrastructure and find out. Does my software work, if I were to connect my fire infrastructure to the network or any network, would it allow my information to move safely and securely? A lot of organizations are gonna wake up and realize that their current fire infrastructure doesn't meet basic SLAs, so they're gonna probably have to invest in some kind of improvement to their fire infrastructure.

And that responsibility may feel a bit burdensome because there are a lot more people that want the data than we have the time to manage. But that may be something you're gonna have to figure out as CIO.

Bill Russell: But the federal government is going to establish that trust framework so that when somebody does come in, I can sort of look at it and you're trusted we're good to go..

Aneesh Chopra: Yeah. What's really critical on trust is identity. The two pieces of infrastructure are you Bill Russell, and then the national directory is, do you assert that you're a doctor, treating a patient? I'll trust that you are. But I'm only if you've got an active account on the national directory, you're not a front for some, you know, life insurance company or someone that's not really in a treating world.

Bill Russell: chief Strategy Officer Arcadia,

Aneesh Chopra: Yes, sir.

Bill Russell: What does that role have you doing and what's next for you?

Aneesh Chopra: I as we're recording this podcast I'm transitioning into a role where I'm chairing the Arcadia Institute. Arcadia is, in my view a very important asset in the population health space. You kind of need to organize the data between the payer data, the provider data, and any of this sort of emerging wearables data.

To understand, given all of that information, which patients are getting the best care, which ones are not, and how can I actively engage? Now, the business model for what we do at Arcadia is tied to that value-based care payment model. So a physician network that is trying to get paid in a way for better outcomes, we'll want to invest in organizing that patient's longitudinal record and using it.

We're kind of putting those pieces together. I am also spending a lot of my time Bill helping the rest of the ecosystem better organize their relationship to these public-private partnerships. So I'm encouraging health tech ecosystem participation. I'm encouraging doctors to form access clinics with AI firms.

Bill Russell: Anish, I wanna thank you for your time and it's always great to catch up with you. I can't believe how many how much I've learned from this. We'll have to, we'll have to keep doing it in the new year and thanks for being a part of it.

Aneesh Chopra: Hey Bill, thanks for having me and enjoy the holiday break.

Bill Russell: Thanks for listening to the 2 29 podcast. The best conversations don't end when the event does. They continue here with our community of healthcare leaders. Join us by subscribing at this week health.com/subscribe.

If you have a conversation, that's too good not to share. Reach out. Also, check out our events on the 2 29 project.com website. Share this episode with a peer. It's how we grow our network, increase our collective knowledge and transform healthcare together. Thanks for listening. That's all for now.