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 Welcome to this week in Health IT News, where we look at as many stories as we can in 20 minutes or less that are going to impact health it. It's Tuesday Newsday, and here's what we have on tap. Amazon joins the trend of sending workers away for healthcare. We have a Wall Street Journal article and a, uh, modern healthcare article.

Uh, we're gonna talk about why this is happening and how health health systems should think about this trend. Uh, we're also gonna take a look at, uh, what happens to customer satisfaction following a a health IT merger and acquisition. . We're going to, uh, I again, 12 some odd stories here. No way we're gonna get to all of them.

I'm actually wearing my glasses today because I've done so much reading this morning. A lot of really interesting things going on. Um. Yeah, looking forward to getting to it. My name is Bill Russell, recovering healthcare, CIO, and creator of this week in Health. it a set of podcasts and videos dedicated to developing the next generation of health IT leaders.

This podcast is sponsored by health lyrics. Professional athletes have coaches for every aspect of their life to improve performance. Yet many CIOs and health executives choose to go it alone. Technology has taken center stage for healthcare. Get a coach in your corner. Visit health lyrics.com to schedule your free consultation.

Let's, you know what, let's just jump straight to the news. Uh, we have, uh, a lot of stuff going on on the website. Want you to check it out. Uh, insights staff meeting. If you haven't signed up for that already, join the, uh, over a hundred people who have, uh, already signed up for those. . Uh, pretty exciting response to it.

I love making them and, uh, love your feedback on them. Uh, so let's get to the news. Amazon joins the trend for sending workers away for healthcare. Uh, wall Street Journal article behind a paywall, uh, one that, uh, was not behind a paywall. Amazon, uh, city of Hope partnership gives workers access to cancer support.

I have 'em both linked in the, uh, . Um, in the, uh, section that will be on the website, so you can click on either of those stories. Uh, let's see, what does it say? You know, this partnership allows Amazon employees to request a review of their diagnosis and treatment plan from City of Hope specialists who may recommend improvements to the plan if appropriate.

Amazon employees may also travel to City of Hope for an in-person evaluation. According to the Cancer Center's announcement on Tuesday, workers can call the cancer center support line staffed by oncology nurses who will answer questions about treatment or provide emotional support. Though it's a through its accountable precision oncology program, city of Hope said it will also support the care of patients with complex cancers by engaging their local oncologists to offer recommendations for genetic testing and targeted therapies and accurately in to accurately interpret test results.

Uh, cancer, uh, here's a quote. Cancer could affect anyone no matter where they live, but not everyone lives geographically close to comprehensive cancer center. That can give them the best chance for survival. Dr. Harlan Levine. City of Hope's President of Strategy and Business Ventures said in a statement, we are always thinking about practical ways to provide best in class care.

And we are excited to partner with Amazon on this important initiative designed to provide expertise to cancer patients and their, uh, treating physicians so that the right care is delivered at the right time. In the patient's own communities. Important point, Amazon, which declined to comment beyond the press release employees about 275,000 people in the us, which is a fair amount.

Uh, we believe that it's critical to provide our employees with comprehensive cancer care program from real time support to second opinions and treatment planning. Dane Spar, Amazon's director of Global Benefits, said in an announcement. So why are they doing this? Well, you know, first of all, it's a really good benefit.

That's one of the reasons they're doing it. I, if, you know, if my employer takes the time to negotiate this kind of a agreement, and, uh, again, I mean think not a lot of these. Uh, 275,000 employees, is that what we said? 270,000? Our employees are gonna use this benefit, but if you're one of the ones that are gonna use this benefit, it's a phenomenal benefit, uh, for you.

So it's, first of all, it's just a really good benefit. Um. But you know, the reason they're doing this and the reason that others have done it, uh, I'm just gonna take you back two weeks to talking about this. Uh, no, actually about a month talking about this. There was an article about, uh, Mayo and Walmart's, uh, collaboration.

And here's just a paragraph from the article that I shared. Uh, almost a month ago. So I consider associates who received a diagnosis of cancer from their local medical providers, of those who were approved by the Mayo Clinic, which is Walmart, centers of Excellence for Cancer, to travel to Rochester, Minnesota for an evaluation.

More than 10% learn that they, in fact, do not have cancer. . That's staggering in and of itself, but it goes on from there. They receive a different diagnosis entirely while 55% receive a different treatment plan. Some Walmart associates have learned that their cancer diagnosis was based on biopsies that were never completed at their local hospitals or medical groups.

Said Ms. Woods, who's in charge of their program, uh, at Walmart? . And so one of the reasons that this is important is these centers of excellence, uh, are where the knowledge and the research are, are coalescing around. And because they're coalescing around there, uh, you just have, you know, just access to, to better resources.

People who, uh, their, their sole focus is on cancer and, uh, they have access to, to just . Uh, you know, funding, federal funding funding for research. And they're just doing some exciting things. And so by having this specialist specialization, uh, the theory is that you'll get better care at those locations and, uh, in some ways the Walmart numbers would, uh, back that up.

Um, you know, so, so what's I, I, I've gotten away from this a little bit. I'll get back to it. So what's the So up for health? It, uh, you know, remote health strategies to centers of excellence is really picking up steam for employer, employer programs. I don't think this is an isolated incident. This is gonna continue to pick up steam, and you're gonna see this happen more and more, not just around cancer.

You're gonna see it happen, uh, in other areas as well. And the question I would ask from a strategy standpoint is, do you have programs within your health system that, uh, you think employers would find valuable? That you could be a center of excellence for a geography, a regional geography, or even a national geography?

Um, if you, if you do, have you designed the technology foundation to, to deliver those services in a frictionless process, uh, to those remote patients? And, you know, there's a lot of different things. Obviously the, uh, remote consults via video visits, uh, is important. The ability to do, uh, chat, uh, do, do your, uh, call centers, uh, provide the ability to, uh, you know, to route calls to, uh, match that.

Uh, with incoming, with the, uh, patient medical record. Do you have the ability to share that medical record and the information back? Uh, if you're gonna be a destination place back with the, uh, . Uh, the originating health system. Uh, these are just some of the technology foundations and platforms that need to be in place.

Uh, and then finally, maybe not an IT thing, but from a health system standpoint, do you have the sales and marketing teams to position your programs effectively to those employers? Uh, one of the things I've found. It is that most, most health systems have never had to sell before and have never had to market before.

And because of that, they, they don't have the muscle. They, they have not worked that muscle too much in their organization and because they haven't worked that that muscle, they . They have to stand it up from scratch. They just don't know it. They just don't understand it. You know? How do you sell to an employer program?

How do you position yourself, uh, how do you present, uh, to, you know, and how do you partner correctly in those spaces? So there's a lot of things to, uh, consider, but this is a growing trend. Uh, keep an eye on it. Uh, next story. So what happens to customer satisfaction following a health it m and a Rajiv Leventhal Healthcare Innovation Group?

Um, you know, and this is just to be clear, this is not healthcare m and a. This is health IT vendors merging and acquiring. So here's the, here's the gist of this. So, a class report examines best practices on how vendors can avoid unhappy customers after mergers, uh, after merging and acquiring. UH, has taken place.

How do mergers and acquisitions in the health IT vendor space impact these companies customers going forward post sale? So here's some of the key points. Uh, there's about six of 'em. They're, uh, some of 'em are a little long. So first point, the research revealed that almost all m and a result in notable, uh, change in customer satisfaction.

So the next point, vendors see a significant increase, or I'm sorry, vendors who see a significant decrease. Decrease in customer satisfaction in their first year. Typically take three to five years to recover if they recover at all the research noted. So that's important. If you're gonna do an m and a, it's important to get the communication and those things right up front, or you're just wasting your money.

Uh, poor customer satisfaction in the wake of the merger and acquisition has a significant impact on customer retention. According to class. On average, the number of customers looking to leave their vendor doubles one year after a poor merger or acquisition. The top sided reasons are frequent nickel and dimming, not a surprise, uh, declining the quality of phone and web support and a stagnant product development cycle, which can happen.

You bring two organizations together, they have to figure out how to come together. They have to figure out. You know, what standards they're gonna use, what their, uh, principles around, uh, development are gonna be. And so they, m and a slows things down within an organization. 'cause there's a lot of things to do.

Uh, next point. Conversely, a strong merger and acquisition strengthens both customer loyalty and evangelism. This is, this is because customers feel their vendor is aligned with their goals, cares about their success, and provides a sense of stability. The research revealed. So, um, so if you do it right, there's a, there's a significant upside.

So these are two key points. So the three key best practices help drive m and a success are consistent pricing during the time of change. Proactive communication to alleviate decision maker concerns and prioritizing delivering value over . Uh, value over delivering new functionality. So when you bring two organizations together, you're not all of a sudden starting a new development cycle and bringing out new products.

Um, that's just gonna, uh, confuse things. You want to communicate very clearly with your clients. And, uh, one of the things I find interesting is that starts with your employees. Most times when these m and a, uh, this activity happens, you talk to the employees and they don't understand it, and that just somehow falls through the, the gaps.

And I have no idea how that happens, but that is critical. Um, . Alright, let's go onto the next one. So, when m and i, when m and a go poorly, the three common themes that emerge are according to the research, poor executive involvement, uh, leading to poor problem resolution, overselling and overpromising, leading to unrealistic expectations.

Also, of note, the research found that the companies with healthcare specific focus are more, more likely to, to see increases in customer sat after the merger and acquisition. Since the companies often are aware of the level of communication, training, and handholding required within healthcare customers.

Okay, so what, so why is this important? Uh, you know, I think this is gonna happen more often and I think it's a good thing. I really do think it's a good thing. Health IT vendors, um, are really, we're exiting the heyday of health. It spending mu really drove a ton of health IT spending and um, and we have just thrown a lot of money in this direction.

Um, the numbers for health system profitability is gonna continue to be squeezed no matter who wins the election. Uh, it seems to be heading in that direction where everyone agrees that the cost of healthcare needs to come down, and so there's gonna be, uh, public pressure to come down. There's going to be, uh,

Pressure from the payers. Uh, not only that, uh, once that pressure starts to happening, health systems start to spend less money, become more discerning buyers, and they are becoming more discerning buyers. I'm finding that more and more as I talk to people. Um, the other thing that's gonna happen is you're gonna have private equity, which has backed a lot of these health IT vendors.

Um, as they try to scale up, they're not gonna be happy with the returns, and they're gonna look for exits and exits. Leads to m and a activity. Uh, and again, this is a good thing. Uh, we have a lot of poorly run companies and bad solutions within healthcare. It, uh, we could actually use a purge right now, to be honest with you.

Uh, second thing I'll say is 1, 1, 1 plus one rarely equals two and almost never equals three. I hear people say all the, you know, this is a one plus one is going to equal three kind of situation. Um, you know, consolidation of vendors. Uh, let's just take one simple thing. It it, it never leads to lower prices.

I know sometimes you'll hear somebody say, yeah, we're gonna be able to, you know, these two, we're gonna bring these two contracts together and you're gonna spend less. Almost never the case. If they came together on the financials of them charging you for both solutions, they're gonna figure out a way to get the same amount of money, if not more from you.

Um. You know, I have my economics degree, and there's almost no graph that shows fewer suppliers of goods leads to lower prices. It always leads to higher prices, less competition leads to higher prices. Uh, so when they say that your costs are going to go down, they're, uh, they're likely lying at worst and misinformed at best.

Um, you know, I, I'll skip the, skip the last thing, but at, at the end of the day. , what can you do? You know? So, so, so what's the so what, and I'm not gonna give you my, so what I'm gonna give you s shade. So what Sos s Shade. And this hit another article. 12 Tips for Effective, effective Vendor Management. And, uh, and I'm gonna force you to read the blog post and not give you a ton of detail on it.

I'm just gonna give you the 12 things. Um, . It's a, uh, really solid article from someone who has managed a lot of vendor contracts. And, uh, you should take a look at it. So when these two things come together or any vendor contract, these are the things you should be looking for. You should be looking at the product roadmap.

They should be able to articulate. We brought these two organizations together. We believe we're going to bring out these products or bring these products together in this way. Sh they should have a good vendor roadmap. Uh, they should be more service oriented and sales oriented. How are they helping you to do your job and helping you to be more effective?

Uh, they should be able to talk about TCO. How are they helping you to hit your goals? How are they helping you to reduce the cost of healthcare to, uh, remove friction, to make it a better experience all around. Uh, for your providers and uh, your patients. Um, fourth thing, reputation. Check the references. If they did m and a and you're not familiar with the other company, see if you can get references for that other company before you start bringing their product in.

I'm sure you already do that. Good. Solid advice. Uh, solid contracts are your friend. Um, spend the time there, know your contracts, know what they say, and uh, you know, I had a, in our health system and now we did about, uh, $200 million a year. Uh, I had a person dedicated to contracts both on the financial side and on the legal side, and um, and I had a person dedicated within it to just managing those contracts.

When you're spending around $200 million a year, that's a lot of money. And you wanna make sure that your contracts say what you need them to say. And they're not cookie cutter. Um, I, you know, I just, I, we've read enough of them. They're, they're just, uh, you're gonna be able to get different things from different people.

Uh, the sixth thing, are they focused on implementation? Have they been successful in implementing within healthcare? Seventh, uh, thing, escalation. Can you get to the right people when you need to? And that is critical. I talked to ACIO. Uh, who is working through that right now with one of their, uh, one of, uh, his vendors.

Um, getting the escalation right within those, uh, companies is important. Uh, excellent customer service, effective account management, ex executive level relationship. Make sure you can talk to that executive when you need to. Uh, long-term value, uh, our long-term, uh, value for the investment. . And, uh, support for your mergers and acquisitions.

So, uh, this is the thing I'm telling people now to make sure is in their contracts. Uh, try to spell it out today. What does m and I look like? If you are the acquiring company, you should be able to dictate based on your current contract, uh, how much more you're gonna spend as you add to, uh, your contract.

So, um, . , you know, this is, uh, this, this, this is great. Uh, suss Shades, uh, articles on suss shade.com. Check it out and, uh, let her know that I referenced it. In fact, I just, uh, recorded a, uh, podcast with her and David Mutts on the same show, talking through some things, uh, phenomenal episode. I'll air that in a, in a couple weeks and, uh, share that with you on one of the Friday.

Episodes. Uh, let's see. I want to get to two more stories, so I'm gonna move through this pretty quick. So, the future of healthcare at Walmart includes root canals next to the garden rakes, med City News, Sheila Mulrooney, Eldrid. . Um, and this is a follow-up from two weeks ago. So when a man in his forties went to get a toothache checked out, recently the dentist immediately realized his pain wasn't due to to his teeth.

The dentist put the patient in a three D CAT scan and showed a horrific sinus infection. So the dentist called over to the primary care doctor while the pair discussed the patient. The man mentioned his vision was also a little off. Could this be due to the sinus infection as well? Probably not. But the dentist and doctor agreed and walked the man over to the op, uh, optician who pre prescribed bifocals the bill for the man with the toothache dentist primary care optician visit a third of the traditional costs.

Uh, Vinky. Uh, uh, Sean Vinky, president of Health and Wellness for Walmart said every patient has the option to pay through insurance or cash on the spot. An appointment that may cost a total of 60 to $70 through insurance would cost $20 in cash. Uh, and this is just a follow up from a couple weeks ago, what is Walmart's, uh, strategy gonna look like?

Um, and Sean Vinky says, we hope that this integration would occur. And it's, and it is. I. Uh, so far it hasn't been hard. Uh, he goes on to say, so far it hasn't been hard to recruit medical professionals to rural locations. Dallas is about 45 minutes outside of Atlanta. We've had hundreds of people applying.

He said they're hungry for something different. Many got into the business to provide care and the fact that they got to come and practice in a holistic way, it's like a field day for them. Since it opened next to the Walmart Garden Center, the health center has averaged over a hundred visits a day about triple the expectations.

Vinky said, in addition to full dental care, primary care, and optical care, each health center will have full LA laboratory imaging services, pharmacy, and audiology and behavioral health counseling. Next piece Lavinsky said, will be to take advantage of the company's trucking system, the largest in the country to offer mobile services.

Trucks will travel from store to store to offer specialty services that can be targeted to the needs of the individual communities, such as dialysis and mammography. Wow. That's what Walmart's doing, and uh, . Uh, it, I, the only reason I came back to this story is to say it looks like it's coming together.

They have some initial, uh, feedback. I think it's worth keeping an eye on . It's definitely worth keeping an eye on. Um, but if this doesn't sound like a national healthcare company, I. I don't know what does. And yes, it's, it's only one location, but, uh, this is exactly how Walmart made their name. They started rural and they gobbled up everything rural.

And then they moved into the city and they said, well, it'll never work in the city. And it, it appears to have worked in the city. So, uh, keep an eye on this. This is, uh, this is exciting if you are in a health system. Um. Ask yourself, how do we compete with this and when are we gonna have to compete with this?

These are good questions. Um, I am past 20 minutes, so let's just say news stories in 25 minutes or less. So here we go. Our last story, how blockchain can help improve patient identity, matching and consent. Healthcare IT news, Mike Millard dur during, uh, converged to accelerate, hosted by blockchain in healthcare today, in telehealth, uh, in telehealth and medicine today.

At the HIMMS Connected Health Conference, a discussion went on with direct Trusts, CEO, Scott Stewy, S-T-U-E-W-E, Ewey, uh, and Haven Health, CEO, Vincent Albanese, and I'm sharing this story first of all 'cause I like to talk about this. I think it's one of the core issues when we talk about interoperability is this patient ID thing.

And as you know, this is something I'm pretty passionate about and I think this national patient ID is a red herring. I think it's . Uh, just the, the, the a, a bad direction. And so I wanted to lay this out. Um, because I think it's interesting 'cause I think he captures, uh, I, I think he captures the, the challenge pretty succinctly.

So let me go into this. So patient matching is a problem of trying to get artifacts, uh, I'm sorry, still laid out. The four big problems that we have yet to solve. Fundamentally, patient matching identity. Consent and tension between what is called mass centralization and mass synchronization. And by the way, I think that's brilliant, uh, to capture that all in one sentence.

Uh, patient mastering is a problem of trying to get artifacts in care to match up, ensuring that data produced in two different settings are in sync. Additionally, you have this problem of, uh, duplication. Where at an individual institution, frequently up to 20% of the records are duplicates. That's a high number.

But anyway, uh, he said, but I think, um, I think of that as an identity problem. The question of identity is still fundamental issue. I'm not saying it's not, uh, high, but it's 20% would be a, a really poorly run HIM department. It should, um, I mean it should be in the single digits. Uh, sometimes it ticks up if you do m and a, you have some challenges and those things, but 20% is extremely high.

Uh, as for consent, that's an even thornier issue. It's straightforward for treatment between the providers. As long as the data is not sensitive in any way, Sue, we explained. But if the, uh, substance abuse treatment or behavioral health, all that data actually needs to have different consents in different states, which is a complex problem.

And I agree, and it is, and with the fourth challenge, the friction between centralization and synchronization, if I'm going to centralize everything, . Um, if I've got one system and everybody is on that one platform, I only have to get that system to work. He said, actually, that didn't make sense. And with the fourth challenge, the friction between centralization and synchronization, if I'm going to centralize everything, if I've got one system and everybody is on one platform, I only have to get that system to work.

He said, ah, if on the other hand, I've got lots and lots of systems probing, uh, I'm going to have to get all those systems to synchronized. And the more, uh, of those systems there are, the harder, the synchronization problem is. The tension remains in our world and is actually codified in Tef fca, which is basically set up, which is basically set up the tension by saying that there will be a relatively small number of highly centralized organizations that will nonetheless synchronize between each other for the purpose of patient identification.

To get past this, he said the fundamental issue is to grapple with the solution. That might actually start with the identity problem. So if we actually build a system that was built on the notion that identity was at the source, that could go a long way towards solving the patient matching issue. Let's get, uh, let's get it right in the start.

That do we, let's identify the proof of people when they show up wherever they show up, but then also issue the, issue them a credential that can be utilized in various settings. So he goes on to talk about the thing. So what, uh, this captures the crux of the issue really well, mass centralization versus mass synchronization.

Um, and, you know, it's, it's interesting, uh, to me the solution is obvious. I believe it is a, a mass synchronization with, uh, . Uh, with data standards being pushed out federally and then mass synchronize synchronization with the patient, uh, being the, uh, locus of the, uh, identity and of the medical record, to be honest with you.

So, I. . Um, you know, and if you look at how we design systems within the, within health systems, we have, you know, 400 distinct applications in just about, uh, the average health system and 75% of those applications have something that refers to the patient. But we don't like create one single database and look at all the vendors and say, Hey, look, y'all have to use this one database.

That would be, that would be crazy. We would never do that. It would never work. What we do is we create, uh, points of integration and we figure out . How to synchronize those things across those 400 applications and attribute the right data to the right patient. And we do that all the time within our four walls.

And when we go outside the four walls, we think all of a sudden we're gonna get to a, a mass, um, not mass synchronization, what do you call it? Uh, a, a mass centralization solution. And, uh, I, it just, it doesn't make any sense. It's, it's easier to think about, it's easier to get your arms around, and it might be easier to, uh, solve if, if it was easy to solve.

But it's a, it's a easy, complex, nuanced problem, and I think it requires mass synchronization. I think, uh, blockchain and, and Ledger, uh, is an interesting platform with which to address this. So why did I cover it? I think it's an interesting use of blockchain. National patient ID remains . To, to me, seeing almost fire of healthcare.

Uh, and this one sentence really did capture it pretty well, four big problems. Um, patient matching identity, consent, and tension between what is called mass centralization and mass synchronization. Well, that's all for this week. Uh, don't forget every Friday to check out our interviews with industry influencers.

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