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 Welcome to this Week in Health, it influence where we discuss the influence of technology on health with the people who are making it happen today. Sam Banerjee, the VP of Digital Experience for Texas Health Resources, joins us. My name is Bill Russell Healthcare, CIO, coach and creator of this week in Health.

Today's recording is not the best. I was in the process of moving studios and my microphone was already packed, so I did a straight up laptop recording, so I sound a little tinny. The good news is that sand sounds great and his words are the most important on this podcast and on this show. So here's the show, hope you enjoy.

Today. I'm excited to be joined by Sam Banerjee from Texas Health Resources. He's the VP of Digital Experience. Good morning and welcome to the show. Good morning. Glad to be in the show here. So this is, uh, actually the second time we've met you were on a panel discussion that I moderated at the Scottsdale Institute on this very topic, and it was a pretty interesting, a pretty interesting group of people.

We had ACEO, we had, uh, digital officers, we had innovation officers, and we had, uh, you as an experience officer. So it was a pretty interesting cross section. We're gonna dive into, uh, to some of the same topics, but before we get going, give us an idea of what the VP of Digital experience, what does that role do for THR?

So the, in a short summary, I think the role is all about ensuring that we have a connected experience for our consumers across our physical channels, which is our access points and the digital channels that we have. So it's basically creating this seamless experience across all the access points that we have today that is all about, and also driving digital health, which is one of our key focus areas for the So is on the consumer, is it focused internally on the.

On the internal consumer of technologies as well. It is primarily focused on consumers. On the consumers. Yeah. Interesting. This is actually a great time to have this conversation 'cause we had, you know, multiple announcements this week. We had, uh, Amazon care was announced and they're going direct to consumer.

They're a healthcare company and they expect to provide services into the home for 5,000 people to help people age in place. And they're gonna use their expertise in retail in the Geek Squad and actually getting out to the home and technology to set up a, a way for people to actually age in place and connect in with their health system.

And so people are asking this question, Sam, and, and this is probably where we can start, is healthcare gonna be able to play in those same spaces to make it easier? And, and this is what they're doing. They're just making it easier for the consumer. With, let's call 'em intentional experience design around, uh, different healthcare experiences.

I mean, what are your thoughts as you hear those announcements and what can we do as health systems? So I think fundamentally the whole model is shifting, right? If you look at from a consumer perspective, the expectations are changing. They expect the similar kind of experience from healthcare systems, what they have found in retail services and financial services, and.

I think my point of view is that there will be some kind of aggregation that will happen in the industry in saying, well, these are all the services coming up. Whoever can do the best intentional aggregation in service of the consumer, they'll win at end. So it's not about creating point solutions, it's about aggregating inservice of the consumer.

And I think. We have to be very intentional that the models are changing. We have to be smart enough to really figure out who has created the best service in that particular space, bring them along as partners and create a holistic service and experience for our consumers. That's the path in, in my mind, going forward.

Yeah. So is that hard to do? I mean, 'cause one of the things about healthcare is it's so broad that it, it reaches in so many different directions. You have ambulatory and acute and you have, you know, and then you have the different specialties and, and whatnot. Where do you start? Where do you step back and start and try to orchestrate, orchestrated experiences for the consumer?

I think the, the best place in my mind to start is from a consumer needs perspective. Because there are, knowing that the way the healthcare is organized today, there are a lot of gaps from the consumer need perspective. Right. We'll have to start there. Consumer needs will drive a lot of the things that we have to connect.

Right. And to your point, it is hard in all this, all the different services that are coming up the way we have organized ourselves. So what, this last several years, it's difficult to really kind of get out of that and start bringing new partners in there. But I think the easiest way or the most logical place to start is from a consumer need perspective and also looking at what is the provider aspect?

What is the aspect where the people that provide the service can be brought in to understand what the consumer needs looks like. So for a health system, the two places to really start is with consumer leading, with consumer, and also understanding what provider is from a provider perspective, what we.

From a service fulfillment perspective, somebody has to do the hardest of the hardest job, which is providing care. Right? There can be a lot of layers that will be created on top of all that, but providing care is still the most important thing health system really can bring. Okay. There may be a way to connect it better in a different way, but to your question, I think starting from consumer need.

Understanding what the provider capacity is all about and what the provider's trying to do in this space will help connect the dots, um, front and back. So one of the things, so Texas Health Resources has, has done a good job of actually aggregating your consumers and having a conversation with them. And so what are you hearing from the consumers when you sit down with them or when you do focus groups or when you do the other methods that you listen to the consumers, what are you hearing from them that they want from a.

I think there are a couple of things that comes out, right? One is they still think about the way they connect with the health system, right? It is still hard though. We can take talk about, you know, seamless experience, but it is still hard for them, right? So repeatedly we are hearing that the entry barriers of entry is still there.

It is very hard to schedule things, so it may look mundane, but being able to schedule things correctly, being able to.

A need that consumer are talking to us all the time. Second is cost transparency. It is about what is the cost? They're when.

Third is the ability to understand in advance before they come and interact with us what they can expect, right? So there is a huge amount of, uh, question around, well, I'm gonna come for this. What are, what do we expect as a service? Right? So those are some of the top things that we are hearing. We also are hearing about the ability to be in the system and be within the same premises, and being able to do multiple things, right?

It's all going beyond a point. Interaction is a need that the consumers have. And being able to meet their needs in their schedules, able to meet their needs in their timelines is something that we're getting all the time, consumers. So it's interesting, those same things that you're, you're talking about, those are the things that we're hearing.

And when you looked at the Amazon care announcement this week, uh, went out to their website and looked at what the offering is. So they're only offering it in the state of Washington, so you don't have to worry in Texas for competing with this. It's interesting. It's all around that friction. It's, it's reducing the friction so you can get a same day telehealth appointment with a physician and have a conversation.

You can text a clinician of some kind, you know, nurse practitioner, all. Have a conversation. You can have, uh, meds even prescribed over the, uh, telehealth visit. And it's Amazon, so they use pill back and they can actually deliver it. And so when you look at that experience, and what they did is, which is interesting and easier I think than a health system, is they just took one experience.

They packaged it up real nice. And then they took the offering out, and they're just piloting it in the state of Washington, but that's how they're doing it. Are we able to do the same thing in healthcare? Are we able to just take one experience and say, all right, they're asking for this. Let's do this in this one area and get it out there and get feedback.

Well, I think it is possible, and it is something that is not, it's not something that we cannot do, but at the end of the day, if you look at Amazon care model, the one that you explained, it is primarily for the employees, right? And it is a one payer self-funded employee plan where there is no questions of reimbursement and things like that.

I think the biggest thing that we have to figure out in our health system is really creating those experiences where we can, we have a way to do this in Epic and EMR and the way, right, so I think when I look at the whole spectrum here. Experience can be packaged, but experience has to play with our box of whatever old box we have, which is with the EMR, the documentation overload that we have.

The way we are billing and reimbursement is set up the rules and policies that are set up. I think those things have, we figured out to really create those experiences that are meaningful for consumers. And I think we as a system, we have started figuring that out. We have been, we are having conversations with.

So I'm gonna come back and ask you about wins that you guys have had or areas where you've been able to move the needle forward. But let's start with this question. You know, who are the key champions? Within the, the health system that you have to work or not have to work with, but that you choose to work with that see the vision for a consumer experience.

They're excited about a vision for a consumer experience, and they help you. I think people think, Hey, we hired a chief experience officer, we're done here. But really you are a convener. You bring a lot of different people and groups together in order to solve the problem. So who are the, who are the key champions internally?

Great question. I think the way we have done a little bit different, we have for last couple of years, two years, we had been very deliberate in terms of creating the mindshare across the company in terms of why consumer experience is important, right? So that Mindshare was grown over the last two years and then we had to reorganize ourselves in the way the new business is gonna.

So if you, me, today about the key champions, all business leaders. Our leaders who are supporting this initiative to really ensure that we get the right things outta the market. So we do not have a question saying why we have a question, saying what and how the why part has been tackled in a very different way.

So I think that's one of the best practice in my mind, saying you have to stop, spend that time to create that mind share before you start. How the wallet share is going to happen and how do you execute that? And today, I think all the hospital presidents, all the channel leaders, all the business industry leaders, they're pretty much in the same place in terms of why consumer experience is important, how, why should we be driving this, and how they can support.

So we do not have that challenge here. So we, we are in a different place than most of our systems. Yeah, that's fantastic. So let's go to wins. So what, how long have you been there now? Two years. Two years. So we expect huge wins out of you in two years. No, it's healthcare. It doesn't move that fast. Takes a little while to get your feet under you, but what wins have you guys seen over those two years?

What have you been able to, to do around this experience? Uh, yeah, so a couple of wins that we had, number one we had, uh, created some service, which is text-based service SMS based service for. People that come into our eds and then get released out our eds to really get them support so that we can reduce readmissions and know exactly who to bring in for our eds.

So all the ED population that people that come to our doors, we have been able to cover that in service. That has been a great service for us that we have created as a part of this effort. The second is we are tracking pretty good on the virtual care side. We are, we are kind of releasing our virtual care for.

Primary care. Primary care, and our hos in our hospitals. That has all happened in the last two years, and we want to go more deeper into the virtual care within hospitals as well to really create the integrated virtual strategy for us that we wanna connect together. So that has been a big success for us.

The third is really ensuring that we understand what different kind of services we need to tackle chronic conditions. Right. Example, heart and vascular conditions, C-O-P-D-C-H. We are talking and releasing out certain services for them, for those patients by remote patient monitoring and other things to really kind of tackle those kind of chronic conditions.

All happened the last two years. Wow. So you've got a lot going on. It was interesting when you started with ED visits and texting. At the Health 2.0 conference, we heard a lot of people talking about texting as a extremely powerful platform because almost everyone is connected in some way to an SMS platform.

You're able to text, they know how to use it, they do it with their grandkids all the way down to whatever they, they can answer questions that way and, and interact. And it's actually, uh, interesting to hear some of the digital startups talking about how it's really a more powerful platform to connect.

The user C than an app is per se, because it's an app that's already on the phone that they know how to use. And you guys, that's one of the things you tapped into early on was this is a platform that we can help to reduce readmissions and whatnot. How did that come about? Did the idea spring up from the ed or did it, was it a just conversations?

How, how did that idea sort of germinate? Uh. Good question. I think it all came from consumer inputs. So we interviewed a lot of people that were in our EDSS and they went back home. They were part of our forum panels, and some of the people basically said, it'll be good to kind of get help after you are discharged from ed.

We have needs to really talk to somebody on an emergency basis. Do you? You know, some, it came up as a need, right? So what we see is when people with chronic conditions comes to our ED and they get discharged out after a length of stay here, they typically need to talk to somebody to ensure that they're being, they don't have to come to an ED and they can do their self care that is needed at home.

So it basically came back from a focus group, to be honest, and that idea came up. We did the love and care of that idea for some time, and then really took it very seriously saying, we need to do something on this. We gathered a set of emergency physicians on a texting platform in a, in a short way, right?

And then period service. And I'll tell you, this service has been one of the most successful services for us in huge, uh, NPS, right? Net promot, close to about 90%. Because people love the service and our volumes are increasing every week as we speak.

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So, you know, here's what we hear is, is holding digital back, uh, regulatory. We hear payment, you know, how are physicians gonna get paid? Just payment in general. Wallet sharing think is what you refer to, uh, technology, you know, uh, legacy environments and siloed environments. These are some of the things that hold it back.

And culture. Those are probably the four big ones when I do these podcasts and talk to different people that they say, you know, Hey, here are the things that are, are challenging for us. Does that list. Resonate with you in terms of the, the challenges to really push this forward as fast as say you would push forward a, a retail company and you know, which of those do you feel like, you know, we can get our arms around and, and really start to make a difference around?

Yeah, I think the list is a good list. I think the list is universal list across , across the country, to be honest, right? Everybody has the same problems. One thing that I did not see you mention is, is about, uh, people look at virtual and digital to be an OR with whatever we do, it has to be an, and digital is not an or.

It's an, and it's part of the business. It's part of the critical path. So it is very important to think about digital, to be an enabler for the business in the way we do business. Right. And one of the things that people hear me again and again often very is saying digital is not an all it's an hand. I think out of the, all the four things that you talked about, I think the reimbursement and adoption are the two big ones that we face just because the policies are not well in place in few things.

It's not a standard set of rules, so I think the reimbursement is a big one that we are trying to tackle. One of the things that we are doing proactively at this point is to look at our payer contracts and figuring out how can we be intentional about negotiating those things in the, so that it is not left anybody's judgment.

And we are doing that. And also we are keeping a very close eye on CMS because CMS is opening up their doors in terms of virtual and remote patient monitoring. And they're paying for that to be honest today, but it is not an at par reimbursement. There's a difference between reimbursing and there is a difference between reimbursing at par, right?

So there's an at par reimbursement, uh, situation here saying virtual is not getting reimbursed at par. We are talking to the state here. We also have people that talk to CMS all the time, and we are figuring out how do we ensure that the F four reimbursement happens so we can put and shift the kind of people that really need to get into the virtual care as a part of our care.

So we may solve that gap through Medicaid is another way we could, that I, which I assume is why you're talking to the state, but can you help me to understand that a little bit? I mean, if you can go into it a little bit more or we can head in a different direction, but, so there's different levels of reimbursement, is that what I hear you saying?

It's no longer a requirement. Now you can do telemedicine in the city as well. Now the, the second turn of the problem is that it is all about ensuring that the telemedicine visit is as equal to a or in-office visit, right? That's what is called at par. So today, telemedicine visits are not at par with in, in-office visits, right?

So what happens is as long as there are regulations to make that as a five, if it is a five visit, then that will become with CMMS and cms. Already considering this to really make certain visits at five, which is at the level five, from an EM EM code standpoint, that will make things a lot better. On the Medicaid side, on the state side, there are different nuances as well, right?

You need to have a state licenses for anybody practicing, which is typically the case. But they also have regulations which they're lifting up right now because the CMS and other federal agencies are coming pretty heavy and high on virtual medicine. So, I mean, I guess an argument could be made that digital should cost less than it should.

Maybe not be as on par with a, for with an office visit because you don't need an office for starters and rent and all that stuff. But you still need a digital infrastructure, which is expensive and IT, and equipment and all that other stuff to stain that up. So that's, I guess, the argument for why it's at par.

The show is this week in it, so. You know, what kind of IT infrastructure is required to get this right and really support a, a seamless consumer experience across the entire journey. So that's a great question. So we are rebuilding and re-looking at the whole IT stack that we have today. Okay. Because the IT stack that we have today is to service our present or the past data service our past.

So we are looking at a new set of technologies that we can add to our stack or build something new so that we can service the consumer needs that we have. I'll give you some examples. We are looking at a completely brand new CRM, uh, system, which can act across providers, our businesses, as well as our consumers, right?

So we are trying to build a whole CRM stack. We are also looking at the way we collect preferences from the consumers. It has to be in a central place so that we can act on that. We're looking at an open API based structure so that we can connect with any external ecosystem that we need to. These are new muscle, which we never had, and this is, if you have to really think about it, is a parallel stack that is been getting built at this point of time, and at some point we'll fold back, whatever from our past has to come in that stack.

That's the path we on, and you really can't wait for the EHR to say, Hey, we're gonna let you let, let's take something crazy like food, and I'm willing to give you a listing. I'm gonna keep track and give you a listing of all the food I eat. Well, from a health standpoint, that's extremely valuable information.

If we wait for the EHR to bring all that data in, that's not gonna happen. But, and I'm using this as an odd example, but essentially if you have your own stack that sort of sits around the EHR, you can then iterate on that stack and create, uh, a place for that food information or whatever the information.

I, again, interesting and silly example, but if people are willing to give you that kind of information from their, from their digital tools, from their lifestyle, you know, where they're. We know that, that that significantly contributes to health and, and health outcomes, but the technology today, we don't have an easy spot to go.

Well, that's where all that data goes, and that's what you're doing. You're sort of building a, an ecosystem around the existing, uh, environment that you have to support healthcare at THR. That's what it sounds like, right? Yeah. Yes, absolutely. Right. And I think the key question here is where does the golden source of record really lie at?

Existing business model is all about putting our golden source of record in Epic, right? That's where EHR used to play in the, in the, but you have a lot of user defined information today, the way you kind of talked about social determinants of health, that a lot of community partners that can provide us all that.

So we are trying to figure out saying there's a world beyond an ER and how do we bring all this data together so that we can create a single source, golden source of information. Because, and it is, it is about aligning those plans with Epic, which is our partner in this case. And, uh, we have been talking and ensuring that we know exactly what the plans looks like there and aligning our thoughts there as well.

So it's a journey. It absolutely is. And, and actually exciting conversation. I'm looking forward to seeing where you guys go. Do you guys partner with other health systems or do, uh, like health systems partner with you to. Findings, finding the things you're doing. Yeah. We are, we are actually, we do not partner actively today, but we are talking to certain health systems right now.

There are, there's a health system of similar to our size in the same state and there are a couple of other health systems that are not in our state that we are talking to in this point. There are certain things that we can package and it can be meaningful for those health systems and opportunity for to share.

A potential revenue stream. Well, fantastic. Sam, thank you, uh, for coming on the show. I really, really enjoyed our time together. Is there a way for people to follow you or, you know, do, do you post, can you on LinkedIn, what's the best way for people to follow you? So I have a LinkedIn page, which is Sand Banerjee is the LinkedIn page, right, and and anybody can follow me there.

I typically write blogs that comes out once every month and people can follow there as well. Those are the two ways. And I also have a Twitter handle. Sand banerjee people can follow there as well. I really wanna thank San for taking the time to join us this week. I really appreciate his insights and his experience and wisdom in the uh, digital space.

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