TownHall: Have Startups and Systems Overlooked the Patient Experience?
Episode 227th March 2023 • This Week Health: Conference • This Week Health
00:00:00 00:27:37

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Today on This Week Health.

If you think about sort of a pyramid, maybe like a pop health pyramid, where you've got your know your chronic most expensive patients at the top and then your rising risk patients sort of in the middle and then this big block down at the bottom where you've got most of your patients. I see a ton of investment going to serve those patients at the bottom. All kinds of different manifestations to reduce the frictions of people who already have pretty good access to care. We're just trying to accelerate that and make that more convenient and make the process much, much easier.

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hello again. This is Brett Oliver. I'm the Chief Medical Information Officer for Baptist Health in Kentucky and Southern Indiana. And I'm tickled to death today to have John League. John leads the Advisory Board's research on digital health and transformation. We've talked in the past on digital strategy, telehealth gosh, AI, digital equity. You name it. John is an expert. So I am really pleased to have him with us today for the discussion and John thanks for being here.

Thank you so much for inviting me. I'm looking forward to our time together.

Absolutely. Well, let's just jump right in. I know we don't have a lot of time. I'm curious to see from your perspective, where is the momentum right now in the digital space? Where do you see trends emerging?

Sure. I think we are seeing such massive investment from all quarters in pointing digital towards health. And I think when you hear terms like bubble and things like that, I think we're really more of a divergence sort of moment in terms of there is a lot of funding available for a lot of new ideas. And so we're going to see a lot of different stuff. We're going to see a lot of companies. We're going to see a lot of people try things. Eventually we're going to start to see that, that divergence converge again. Through consolidation or business models, not working out or technology not being what we expected.

When I think about where the most interest pops for us though when we look out at the market, I think there are a couple of things that, that really stand out. A couple of big buckets. One is certainly around automation. And that speaks broadly. Especially within the health system. Certainly there's always been automation attention for operational kinds of things, whether that's rev cycle that is only intensifying as health systems get a better sense of how a robust and streamlined rev cycle application really does have benefits to the consumer and the clinician in terms of documentation and experience and things like that. And that technology is only getting better. I see a lot there. There is enormous interest from clinicians in things like Nuance DAX. Anything that can make the documentation process easier.

I think that is incredibly important as we think about things like burnout. I think as we get back to having more inpatient visits, as we look sort of folks start to look away from telehealth as being one of the main ways that we connect to care. Coming out of the pandemic, I think, I think that's terribly important. And then I think generally anything that focuses on scaling a better experience of care. Whether that is using a digital platform to access care more conveniently. Whether that is building out a better digital consumer experience or whether it is some sort of say chronic care management platform.

I think that sort of focus on let's take the digital capabilities and try to get scale out of them and cover as much ground with that as we can. I think those are the places where I see a lot of momentum right now.

Let me go back to something you said, you talked about sort of a bubble emerging and I just recently read a KLAS report that was from a group that got together this past fall. And they were talking about, all over the industry, as healthcare providers, it was patients, it was payers. And one of the main pain points for a patient, at least in an ambulatory experience was communicating pre and post visit with their provider.

Now I forgot something. I'm not sure I understand. And that was way off on the scale that they had. And yet I don't know if every offering that's out there. I see nothing out there in the VC capital space, all these startups and things. And it just made me think, and you and I have talked a little bit offline about this divergence that happens, at least in some respect that you've got 30 billion invested last year. 700 plus deals made. And yet, is there a divergence between the investment and the opportunities that are out there. Do you see that happening?

Absolutely. If you think about sort of a pyramid of maybe like a pop health pyramid, where you've got your know your chronic most expensive patients at the top and then your rising risk patients sort of in the middle, and then this big block down at the bottom where you've got most of your patients. I see a ton of investment going to serve those patients at the bottom. All kinds of different manifestations to reduce the frictions of people who already have pretty good access to care. We're just trying to accelerate that and make that more convenient and make the process for certainly patients who have insurance or have already, already have a relationship with the doctor. Much, much easier. And I think we run the risk of flooding the market with a lot of technology that isn't necessarily solving a problem. When, to your point, we can't even do the simple things yet, like ensuring that we can get the right kind of pre and post visit communication going.

I see things like this all of the time when we really have so much technology available, we have democratized in terms of like everybody has an iPhone and the cost of a lot of the systems that are available now to provider organizations are much lower relative to what it would've cost you to do the same thing in the past.

And certainly compute power is higher and machine learning is better in all of those things. And all of that is very important, but we wind up with the age old problem we've got a solution in search of a problem. And I think we see that a lot. And I look at some of these venture deals that you see coming out and I read the press release and I look at what it is and I can't tell how this is actually any different from a lot of what's already available or what problem this solves in a unique way. And I think it's very important to make sure that that we're focused on the right things, especially when dollars in the health system are generally so limited for investment anyway. It just, it adds pressure to all of those decisions, which I think a lot of times makes it harder to take action. We would much rather wait when we were unsure than really dive in with investment. And I, I worry that what's going to happen is what we'll actually wind up with is potentially disinvestment. We'll look at it and go, you know what? This is, it's just not worth it.

Like let's just not even, let's not even try. And so I think that that sort of focus, that tension is absolutely there Brett and it is an increasing concern as more and more money floods into the market.

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Where does that disconnect originate from? Maybe it's multiple sources, but is it, these guys get a great idea and they don't consult with folks that are actually in the industry. Or they do and they don't think that, cause I don't think it will be hard to find out fairly quickly through a few conversations like, oh my gosh, this space is flooded. Or this is a real opportunity. I'm just curious in that space, cause it's not a space in the venture capitalist, but I don't, I don't live there is it, does it become the sexy investment and like, I've got to get some dollars over into there and you're just looking for that kind of cool idea. I'm just curious. I don't, I don't live in that world.

It's some of all of that, I think from the conversations that I've had, I think there is a lot of, hey, here's this thing in healthcare that we could apply to technology to. So let's do it. And in this day and age, you can do that and make some money. Like build a company on it and get some money to start a product and try to sell it.

And I think certainly that is it. It's sort of the moment that we're in. It hasn't been that way to that extent in the past. If you look at the amount of money that goes into the average deal for say a series B company, as opposed to a series A company. Series A would be a very early stage company. You can get as much now in series a as you were getting in series B five years ago.

Right. So there's a lot more, it's not just that there's more money, it's more money earlier, which I think encourages a lot of folks to just sort of shoot their shot, if you will. Like like let's just, let's just try it. But the other element is I think in a lot of situations, and this is not a unique story just with VC.

Like this has been a problem, this is always a problem in healthcare. But I think part of the challenge is we don't, we're not actually thinking like, like patients in that moment. Or we're not actually thinking like the clinician in that moment. To your point, if you could just ask some questions, you could see a lot of what to someone else might be an obvious problem.

But I think there is not a lot of sympathy at times for how does the patient actually experience the use of this technology as it happens? And I, I think that focusing on that, the technologies, the solutions, the platforms that can actually solve for those problems, those will be the ones that are, that are durable.

And that are sustained and get uptake. Those may not be the things that are getting a lot of attention at the moment, but I do think that that is certainly where the emphasis should be and what the winning strategy will be over time.

Yeah. That makes a lot of sense. Well, so I've been picking on startups and maybe the things that they miss or overlook. What about healthcare systems? Where do you see blind spots there? What opportunities are out there that they're overlooking or miscalculating?

So you and I have talked about this, Brett, and I'll just relay this story very quickly. My dad had a Taver recently. Had a valve replacement in his heart. It went very well. He actually had it at Baptist in Lexington. So this is Brett's hospital. So it's a really good story. One of the things that stood out to me my dad, is that the thing that he leaned on repeatedly during his whole taver journey, cause there are tests and like they gotta make sure he's healthy enough for it.

And had a bunch of COVID tests and all kinds of procedures and all this stuff. The thing he kept going back to was was MyChart. Which shocked me. Just totally shocked me. And that's not a dig at Epic, but I know what patient portals look like, and they're fine for what they do, but I've never been truly impressed by how intuitive they are or anything like that.

And that's okay. But dad went to it all the time and the reason was that it gave him a single consolidated view of everything he needed to know. All of his appointments, all of his tests, all of his doctors. Everything he needed was in there and available to him. Now, the reason I tell that story in answer to your question is I think we have overlooked the value to patients of just giving them a single source of truth for what they need to know in their care journey.

Way too often, we make the patient provide the connective tissue between the different parts of the healthcare system. And usually we feel that tension between, say a provider and a payer. Like I've got to get on the phone to the doctor and then I gotta go over here and call the plan. And then I got to get the doctor to affect something to this specific number at the plan.

But we also do that within the health system. When there's scheduling or there's a question or you try to do the self serve online, but what you really need is to call, to find something out and then you call and the person tells you, well, no, I can't see what you're seeing. Things like that. I think that having that sort of single consolidated view, just to your point earlier about the simple thing about a pre and a post-op communication.

I think those are the kinds of opportunities that we're overlooking. We don't have to give patients the shiniest most intuitive thing that there is, if we're actually solving a problem for them, with the technologies that we can offer.

Yeah you wonder if there's some assumptions out there from the investment community that some of the basic blocking and tackling that we're really good at. And we're not. COVID has exposed a lot of that. And I don't know how for years we've gotten away with such a poor patient experience, but you mentioned something that single source of truth.

One of my concerns is we have spent, and when I say we, our nation has spent the last decade, millions, if not billions of dollars, a lot of time and effort to raise up these EHRs. Right to, to become a digital system. And yet I don't see, I don't see these startup companies and I'm picking on them just outside of the normal healthcare system, I don't see that effort to get that information back to a central source of truth. And so I have concern that we spent all this time breaking down walls of communication, improving interoperability only to start seeing this segmentation and siloing begin again with data. Do you see that? And when I say that I don't see any motivation for these companies to get that information back to me.

I mean, I can, I can tell I have one that we use for our health plan that will remain anonymous that does a good job, has data to improve care of a particular condition, yet as a primary care physician, I wouldn't know if my patient was using that service or not, unless the patient told me about it. Do you see that at all? Is that a concern of yours?

Oh, yeah, absolutely. And I think largely it reflects where the money is flowing from. Right. So. So many of the solutions are oriented to serve whoever is paying for it. So in this case, the employer the employer is the person footing the bill. So we need to be sure that whoever is on that end is connected to the data. That we can prove to them that by investing in this platform we have driven adherence, we have reduced unnecessary visits or whatever the metric is. That's the direction that the data flows, is back towards the money.

Whereas in your case, as the primary care provider for that patient, there's no money flowing from you in there. It's not valuable from the contracted relationship between the platform and the employer for you to have that information. Even though when we think about what digitally enabled care should be, it should absolutely be proactive and holistic.

And that is the element that I feel like we're missing, is that sort of holistic view of health. Just of the individual patient, right? It's not episodic. It's not disease-based but like I had a CMO say this in a meeting once and I say it all the time now. Heart failure patients still get bee stings.

Right. We can have a great platform for adherence and identification of deterioration in a heart failure patient. But any time they do anything that is not directly related to what happens on that platform or the information that is collected there, we bounce them right off of that platform, back into the world of the phone and the fax machine and the experience that they have and the, the digital enablement stops.

Where at the very boundary of that disease or what the platform recognizes as that disease. And that is absolutely not how the patient experiences care or how increasingly we expect the primary care provider to guide that patient's care to quarterback that it's like trying to be the quarterback, but only having the first two pages of the playbook.

Yeah. Or having part of your face mask covered. A hundred percent? Is it impossible these days to be a small private practitioner? I'm part of a relatively large healthcare organization, but I was a solo practitioner for several years in part of a small private practice. I don't know how those folks do that. How they can play the same game. I'm just curious your take. You get to interact with healthcare organizations, practices of different sizes. Is there a difference? Is that a misperception on my part? I'm just curious.

No, I don't think that's a misperception on your part at all. And I think there are two things sort of pushing and pulling on this at the same time. And I honestly don't know what the outcome will be. So from the sort of I guess on the negative side, if you will certainly just all of the, just think of everything you have to do for CMS to get paid, like and how much work that is. CMS changed added, I don't know what it was, a couple of hundred codes a couple of years ago and took off 81, like just figuring that out and having, and knowing that the whatever sort of work platform you're working in is going to be able to do that and relying on that and being responsible for that yourself. Right. To do all of that management that has nothing to do with providing care is an enormous task. And so I think certainly that's where the world of the MSO comes in, where folks are trying to support those docs and things like that. I think all of the things that we know about burnout, certainly weigh heavily in an unusual way on all of those providers.

I think technology can probably help in that regard, but how do you get the scale? How do you afford to invest in a way that that can help that solo practitioner in that same way? The other element though, at the same time is when you look at I'm thinking of and I, I don't want to say platform here because I'm not sure that's the best way to describe it.

And I don't want to say ecosystem because I think that it's overused and we don't even really know what that means. Let's say environment. Let's say an environment like Doximity or something like that, where they provide a lot of the tools for the folks. There's also sort of a community there.

I think the democratization of the technology and the ability to make connections through platforms like that is potentially very interesting. Can that substitute for all of the support that you could get from participating in a bigger partnership? I don't know. It probably depends on the doc.

I think there will always be those fiercely independent providers. But I do think that the deck is stacked against them however much we're able to support them with technology and through sort of the proliferation of social connection that you can get online and things like that.

Yeah. While I love what I do and I love my organization and the way we're set up, it does kind of sadden me that it's becoming harder and harder to just do that. The management portion. I know I went from a half a day, a week, you could handle that. And again, it's been a little while ago, but to nearly every evening and then the weekend. And finally you're throw up your hands. Like, I, I, I'm not good at this either. Right? Am I doing the best for my staff? Am I doing the best with the payers? It's a challenge for sure.

It's not what you were trained to do, right? Like you spend all that time in medical school, it wasn't about running a small business.

Right? I think I got a couple of residency lectures on the basic coding. Some basic blocking and tackling, but it certainly wasn't enough to, to run a small business well. And there's too many lessons learned by my experience in hard knocks for sure. Well, we're just about out of time and I just wanted to give you the floor finally to say, is there anything else?

This is a big, a big space to talk about, and we've just barely scratched the surface on some of these things. But I was just curious if there are any other things you'd like to share with the audience regarding digital health that we haven't talked about.

I think one of the things that we consistently underestimate both as an industry and I think clinicians underestimate this as well, is the influence that they have to help their patients make the most productive use of digital health. Whether that is a chronic care management kind of solution. Whether that is a virtual visit or an asynchronous modality. Most patients view their provider as the person who can make the best recommendations for them about those things.

I think because of the way COVID unfolded and the emphasis that lots of folks have made and myself included. I always try to talk about what consumers want and how their preferences are changing and things like that. I think we have over-indexed to what we think consumers want, and if they really want to use digital tools, they will say so in their visit. If they really want telehealth, they'll schedule it that way. If they really want to use some sort of digital tool, they'll, they'll find it and bring it in and we'll figure out how to, how to deal with that. And I think that's backwards. I think it is up to physicians to help their patients understand what is a good way to use all of these digital tools when could a visit be virtual and when could it not. And what is not appropriate for that? I think managing expectations is incredibly important. I've heard ridiculous stories about folks doing a virtual visit while cycling for exercise. Not just like riding a bike, which is its own thing, but like cycling. I've heard people doing virtual visits and this is a metaphor for our time, probably Brett of folks doing a virtual visit while in the drive-through at McDonald's. I recently talked to an orthopedic surgeon who said that she was encountering patients who were not willing to come back for a postoperative visit, even though they had stitches.

She had patients who had taken stitches out themselves or had just gone to urgent care to have it done and encountered another bill. They just didn't feel like, oh I don't need to go back in. Right. I can just, the doc can just look at it and it'll be fine. And I think that that is that is, we say that and it's kind of funny and we scratch our heads, but I think the, the understanding of how to use these tools is still nascent let's say. And I think that that physicians can play an enormous role, not just in terms of driving utilization. I think we make too much of that. I think what we really need to focus on is not how much of this we want to use, but how can we use it best? And I think the physicians have a lot of influence here that has gone untapped and in many cases ignored by their executives or even patients.

Yeah, I agree with you. I think that's wonderfully said, I think too the average clinician doesn't have the time bandwidth to even think about an alternative way to deliver care. So that's like, at least in my organization, that's where I feel like I've got to come in and at least present those different options because otherwise it's, it's slow to change. Well, John, I really appreciate this was fantastic. I could probably get a cup of coffee and chat with you for another couple hours, but we won't do that to everybody, but I want to thank you again for being here.

Thanks so much Brett. It was 📍 great.

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