Newsday: The Steps Towards the Whole Care Journey: AI, Start-Ups, and Policy With Brad Bigelow
Episode 137 β€’ 17th July 2023 β€’ This Week Health: Newsroom β€’ This Week Health
00:00:00 00:25:31


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Today on This Week Health.

Who's really our care journey expert, right? It's supposed to be your primary care physician. They're supposed to know everything about you, whether it's, your mental health or your physical health and well being, and they're going to guide you to the right specialist, so they're going to put you on the right programs.

I just personally haven't had that experience with the primary care physician in a long time.

Welcome to Newsday A this week Health Newsroom Show. My name is Bill Russell. I'm a former C I O for a 16 hospital system and creator of this week health, A set of channels dedicated to keeping health IT staff current and engaged. For five years we've been making podcasts that amplify great thinking to propel healthcare forward.

Special thanks to our Newsday show partners and we have a lot of 'em this year, which I am really excited about. Cedar Sinai Accelerator. Clearsense, CrowdStrike,. Digital scientists, Optimum Healthcare IT, Pure Storage, SureTest, Tausight,, Lumeon and VMware. We appreciate them investing in our mission to develop the next generation of health leaders.

Now onto the show.

β€Š (Main) πŸ“ πŸ“ β€Šall right. It's news day. And today we're joined by Brad Bigelow. The chief executive officer and founder of acolyte health. Brad, welcome to the show. Thanks for having me, Bill. Sometimes those titles, you have founder in there.

So you're originally there you're one of those people that has seen something in health care that you want to solve and actually got out of your chair and said, I'm going to go. do this. Tell us a little bit about acolyte health.

Yeah. So acolyte health the thesis starts with my own healthcare journey.

heart attack survivor back in:

12 pages of a lot of information that's not even that important. And then a little section with bullet points on what do I need to do next. And I was just thinking to myself, well, I can get to that point and I can Figure it out on my own, but what about the people, the 25 million limited English proficiency speaking patients out there that English isn't their first language.

So I really wanted to disrupt it and I wanted to turn paper interactions into video interaction because 80% of baby boomers right now are on YouTube. They're consuming digital content. That's where most marketers are putting their money. That's how they're interacting with consumers outside of healthcare.

So let's bring that experience into healthcare. So that's what Acolyte Health is all about. We create interactive video content. Our twist is that we create AI digital twins. We call them digital acolytes of the physician, the nurse, the administrator, so that we can now create an infinite amount of videos from that one digital twin that we've created.

Basically it's their avatar. So now we can create a bunch of videos using the doctor's avatar. We can interact in 25 plus languages. We can switch out avatars on the fly. You can have your primary care physician as one, you can have your specialist as another, and we can do it in multiple languages. And we have buttons on there called actions.

So now you can click on the call to action to sign up for your next appointment to find out where your medication is and get that ordered to take your next step in your patient journey.

I'm just curious is this a space? with a lot of competition because I, man, we leave with a lot of papers in, in most health systems, if I think about it, or is this a space that's really emerging right now?

It's emerging. It's emerging for sure. I think. There's been an evolution, and COVID's really pushed it forward where before it was just papers and phone calls, and COVID, brought up telehealth, brought up text messaging in multiple directions and now the next evolution is unlocking video content, because we've had lots of video education content out there, you can go to any hospital website, you can go to any health plan website, You can click down a couple of places and see an animated video, but what's the new twist or what's the evolution is make it personalized for me, share my physician or my caregiver, give me a button to take the next step.

Nobody's doing that right now. There's a couple of companies that wandered into that space in the past, but the technology just wasn't. Far enough along for it to be effective. So they create a bunch of technical debt and products that probably aren't achieving the highest level of consumer engagement that it needs to, that's where we're coming in.

So we're excited


it for sure. That's cool. So we're solving the paper thing on both ends. We're taking away the clipboard on the on the way in and we're taking away the folder with a lot of extraneous information on the way out. And I assume engaging people with, in ways that they can understand it in ways they can consume it in their language, in video, audio.

Because as we know, not everybody is a from a learning standpoint, there's a lot of different ways to learn. Some people read and. pick things up really well. Some people will listen to things really well, and some people will see things visually really well. So I, yeah, I love the direction that's going.

And we have a bunch of stories that are in line with that. We have Saad Chaudhry's story, is healthcare at the end of its middle age? That's interesting. We have some generative AI work that's going on. We have some health equity stuff that's going on. We can even look at UNC health pilots, generative AI, chatbot.

Let's start with this one, because let's start with is healthcare at the end of its middle age? I like... Saad Chaudhry is more of a philosopher than a than a CIO, but he makes this case in this Forbes article that we had the dark ages and then we had the middle ages before we had the Renaissance.

And he said, some of the things that happened at the end of the. Dark Ages actually made the Middle Ages worse than the Dark Ages were. But what really brought about the Age of Enlightenment was the printing press. The Gutenberg printing press essentially put knowledge in everybody's hands.

I thought one of the more interesting points he makes in this article is generative AI. that printing press for health care. And maybe it's not just generative A. I. Maybe it's this combination of technologies that we're seeing. Are we getting ready for an age of enlightenment in health care?

And that's sort of the question he leaves us with. What are your thoughts as you read that article?

I like the sentiment. I think that we are encroaching or getting into the age of enlightenment. I think big parts that are interoperability. I mean, we have to have the foundational capability to be able to share content securely and effectively, like in almost or near real time in order for a lot of these technologies to be able to work.

And I think that's the foundational work that's been happening for the last 5 to 10 years. that have allowed us to be able to get into the age of enlightenment. I would say also with COVID and, people's expectation to have a virtual exchange with people. I think that has forced the hand of healthcare to realize that not everything needs to be centered around, go in and see your doctor, leave with a stack of papers and call me when you need to get fixed next.

Right. There's now a whole movement towards. Make it centered around my patient experience. Meet me where I live, which is on a phone or virtually on my computer. And help me get better or help me understand how I can get better. So I think that it's those two combinations. And then you start sprinkling in machine learning and large language models.

Connected authentication capabilities through like two way authentication or immediate authentication. You take all of those things. And you can start building technology that actually allows you to streamline and to work within the health care systems. So the H. R. S. And all those things. So I think it's starting to come around.

I think we're right

at the beginning of it. It's interesting. I was talking to some C. I. O. S. Today and we were talking about the care journey and the health journey. And my question to them was. Is healthcare interested in getting in to the health journey? Because we know they're in the care journey, right?

Care journey is I'm sick. I need help, whatever. I entered the bubble. Even if it's a telehealth bubble, I entered the bubble. I come in, they now call me. a patient and they do their things with me and then I end up leaving on the other side. That's my care journey. But my health journey is something where I see it as more of it's not episodic and it's ongoing.

My question to them was, is healthcare now ready? to get into the health journey business or the the health advisor business. The person who's going to come alongside me as I say, I think it's, I'd like to maintain my muscle mass. I'm getting in my fifties. Or I'd like to, lose a few pounds, or I would like to get on a program or fill in the blank.

I'm like, is healthcare ready to get on that journey? I'm curious what your thoughts are on that. I mean, do you feel like healthcare is? Ready to get more touch points along the way and not just care touch points.

I think in phases, I think we're still in the early in that side. I think policy and reimbursement are still driving all those decisions.

A lot of these hospitals are reimbursed for being mechanics. Yeah, the sooner we can get to value based care, the sooner we can get to bundled payments and, really trying to. Encourage hospitals to take on more of the risk of whole health, right? Making sure that their population is cared for before they get into the emergency department or before they're on a chronic illness path.

I also see, which is really interesting is. The health plans are starting to invest in their own clinics, right? And that's been going for a few years now, but I think that's forcing the hand to where now hospitals are going, Oh, wow. Optum, One Medical, CVS, they're going to start eroding our patient base.

And it may be the lower paying patients right now, but as soon as those clinics start opening up surgery centers and the higher reimbursed episodes. It's going to start forcing the hand of hospitals that have to jump on board to be part of a whole health movement. The health plans are incentivized in already health plans.

If they lower the total cost of care is one of the major things that they're all working on. That's going to also push us into health journeys versus care journeys. And so we're seeing that with what we're working on. We're actually getting a lot of health plans. They're really interested in the work that we're doing and how we can be a connective tissue between the health plan and the hospitals within their network.

So it's on its way. Policy and reimbursement stuff would be a big pushing point.

It's interesting when we think about the printing press and its ability to really change. the flow of information during that time period and really take knowledge out to the community. I'm wondering what your thoughts are on generative AI.

So as we look at generative AI, we're seeing it applied in little bits and pieces here and there. It's going to generate some notes to address the inbox challenge that we have. It still requires a physician to read it and hit send, but we have two, if not more health systems that are piloting that kind of thing.

And, you talked about interoperability, the problem with interoperability has never, since I've been in healthcare, has never really been getting information from point A to point B. It's once we get the information, we sort of look at it and go. Well, that doesn't go in here real well, but you know, generative AI has an interesting set of capabilities and granted, we'd have to do a lot of testing and we'd have to, certification and whatnot.

It does have the ability to just. Take mass amounts of information and make sense out of it and spit it back in a summarized format It would be interesting if at some point generative AI Could take in the entire medical record and produce something that was more usable for a physician at the point of care than the entire medical record because We're almost, I mean, not that we can't get to the entire medical record and that's phenomenal, but we're almost I don't know, diluting ourselves to think that the patient who comes in that brings a binder this big.

that the physician read that entire binder more often than not. What they do is they read some summaries, they order some tests and they start over rather than read that entire binder, it would be interesting if there's some aspect of generative AI being applied to that. To the messy data that we have in healthcare and making some sense of it.

I realize there's a lot of risk associated with that. Where do you see generative AI really making a difference in, in the large language models in healthcare today?

Well, I think we're seeing it already. You've mentioned a couple of things in terms of the inbox. You're also seeing it in the denial space where it's helping create denial appeals.

At scale, so they can keep up with the workload and make sure that people are getting covered.

So we have competing AI models. We have denial with AI and that

exactly. So it's a little bit of an armor arms race there. You're seeing that with pre op. You're seeing that in a bunch of other, you're seeing that coding in general.

I think. It helps us unlock the important data that we need and then put context around it. So for example, in our space. You think about, in your after visit summary, in bullet points, lose 20 pounds in the next 30 days, or reduce your milligrams for your pills, or something like that.

What it doesn't do is it doesn't add in some of the narrative, or the ability to associate a narrative around that that protocol for the physician, and then apply it to what is your next step, right? So large language models can do that. It can add narrative capabilities. You can tune it to associate certain protocol that they've seen over and over again with a certain next step or an action.

You can tune it in ways that can add. The context that is required for health literacy. For example, what is myocardial infarction? It's a heart attack. If I read that, I don't know what that means. Just call it a heart attack. So it's going to help us really kind of. Take a lot of that information that is very specific to how doctors speak and turn it into how patients consume the content and communicate.

I think it will help with that bridge. I think that's just one area specific to what we do. It will be very helpful.

β€Š πŸ“ πŸ“

β€Šwe'll get back to our show in just a minute. Our rural healthcare systems face unique challenges in America. Join us for our upcoming free webinar, Rural Healthcare Challenges and Opportunities, on August 3rd at 1 o'clock Eastern Time. We'll unpack these challenges and look for opportunities for smaller health systems to take the lead in the delivery of care to this underserved population.

PM Eastern Time and:


One of the articles it says patients are likely to switch providers if digital tools are hard to use and there's a Becker's article and obviously the title tells you a lot of what the articles about by the way, I think there are some people that have been seeing the same primary care physician since they, like the primary care physician was there when they were born and, they're still seeing that person today kind of thing.

Those people aren't going to leave because. Okay. That providers technology isn't the best. However we're seeing less and less of that connection to a specific provider. Do you think the technology will become a differentiator? Do you think the technology will be part of the reason somebody looks at it and goes?

You know what? I'm going to see this provider over here because the discharge was a video with an avatar. And boy, that was a lot easier to understand than whatever they just handed me here. I'm going to go back over here.

I think people are up for grabs. I would like to say, that I've seen my same primary care physician, but I haven't.

I've had multiple. And a lot of that's because. We're a gig economy. We're transient, much more transient now. Do health insurance plans cover people's original primary care physician or do you have to get a new one or are they in network or out of network? So I think a lot of that, I think people are up for grabs and now the expectation of patients as consumers is driving people to say, make it easier for me, right?

And also I don't know if things have changed with the old school primary care physician relationship where you actually had time to sit down and chat and really get to know each other and exchange, a lot around the mental health aspect of the treatment. But it seems like to me, there's a lot more, it's a lot more transactional now, where it being a transactional relationship again, just makes it so people are up for grabs.

What do you think the expectations are? If you think about consumers, it's interesting because one of the CIOs said to me today, we did a webinar and one of the CIOs said, healthcare systems are no longer just being compared to healthcare systems. Now, we've heard of this before. You're now being compared to other digital experiences that people have.

What do you think their expectations are when you're engaging with the health system? What are the patient expectations now in terms of the experience from one end to the other?

I think that a lot of health systems are really working hard to try and get to more of a amazon type of Experience where I can go and I can search my needs.

I can get all the information on my fingertips. I click on this button and order what I need to do next. I think that they all want to get there, but there's change management, there's investment. And then there's how is that going to work for me in terms of like, what's my ROI on doing something like that?

So I think that they want to get there but I think that they're being pulled more likely. They're being pulled in that direction because they see one medical entering into their space or they see urgent care starting to open up primary. primary care physician opportunities or start, they're starting to care gap closures that urgent cares.

So I think that they're being pulled in. And it's not for lack of desire. It's more of, it's a big shift to turn. So,

Yeah, it's interesting too because some of those services are being commoditized as well. So you see some of the visits, I was reading an article and I saw a list.

And it had the cost of services at a health system At a cvs, at Walgreens, and then at Walmart. And the, the highest cost one was getting it done at a health system and a percent, let's say 80% of that was cvs. The CVS location the Walgreens was competitive, but slightly less than that.

And then Walmart was like a fraction of the cost. It was, wow. I was looking at it going, oh my gosh, that's like 10%. of what I was going to pay if I went to the health care provider. And to me that was sort of startling to say just taking digital out of it. If 90% of Americans live within a couple miles of a Walmart, and you walk in that Walmart and it's pretty easy to sort of set up that appointment, see see the physician and that kind of stuff, and oh by the way, You don't have to worry about any medical debt or costs or surprise bills or anything to that effect.

Now, granted, we're talking about primary care. We're talking about very commoditized services, right? So you're not talking about surgeries and that kind of stuff. But at the end of the day all of that stuff acts as a feeder into the larger healthcare system, and that's going to, that's gonna change how people interact with healthcare.

I'm concerned for healthcare that we are not engaging enough in the health journey. Yeah. And we're not creating enough on ramps. And then once we get them even when they're in the system, Their experiences isn't such that they're saying, yeah, you know what? The next time I'm coming right back here.

I think we still hold on to we gave them great care. They left here healthier, therefore they're going to come back. And I think in some cases that's absolutely true. And in some cases that's not true.

Yeah, I think there's definitely a risk of, everything's being kind of fragmented and compartmentalized and commoditized, as you said, because.

Who's really our care journey expert, right? It's supposed to be your primary care physician. They're supposed to know everything about you, whether it's, your mental health or your physical health and well being, and they're going to guide you to the right specialist, so they're going to put you on the right programs.

I just personally haven't had that experience with the primary care physician in a long time. I've seen a few of them now because of my heart condition. I do see my cardiologist more, but it feels like it's less of a a health journey, more of a, fill out this list, check the box on a couple of things and we'll see you in, six months.

So, like, I agree with you. I think that. Things are going to get more commoditized and more challenging from a whole health journey. But I do think that the companies or the organizations who put an emphasis on that first, Will end up rising to the top and winning in the end.

And I think that technology will play a big part of that because a lot of that's just scale. A lot of it's the ability to serve as many people as they can from a whole health lens. I think that the technology has a big play in that. There are a couple of companies. There's like a company called nudge health, for example, a great startup company.

They basically take the person after discharge and then they give them a care coordination journey with real people and technology. And they work on behalf of the hospital system, so there are companies out there that are trying to extend that, that health journey. It's just a matter of health systems and health plans, investing in those early stage companies to add that extended capability of their clinic.

Well, Brad, I want to thank you for coming on the show. If people want to. Get more information on Acolyte Health. How can they do that?

They can go to and check us out there, or check us out on LinkedIn. We are a Cedar Sinai Accelerator company. We went through that.

They've invested in us and we're looking to go to market this fall and we're very excited about the work that we're doing. So.

Fantastic. Did you say discharge instructions in 26 different languages?

More than, yes. Wow. Yeah, it's pretty cool. We're knocking the door.

Some pretty incredible stuff. They're going to help with underserved populations.

Yeah. And I would imagine that really moves the needle with regard to health equity for a health system. Absolutely. And fantastic, Brad. Thanks again. Really appreciate it.

Take care, Bill.

β€Š πŸ“ And that is the news. If I were a CIO today, I think what I would do is I'd have every team member listening to a show just like this one, and trying to have conversations with them after the show about what they've learned.

and what we can apply to our health system. If you wanna support this week Health, one of the ways you can do that is you can recommend our channels to a peer or to one of your staff members. We have two channels this week, health Newsroom, and this week Health Conference. You can check them out anywhere you listen to podcasts, which is a lot of places apple, Google, , overcast, Spotify, you name it, you could find it there. You could also find us on. And of course you could go to our website this week,, and we want to thank our new state partners again, a lot of 'em, and we appreciate their participation in this show.

Cedar Sinai Accelerator Clearsense, CrowdStrike, digital Scientists, optimum, Pure Storage, Suretest, tausight, Lumeon, and VMware who have πŸ“ invested in our mission to develop the next generation of health leaders. Thanks for listening. That's all for now.



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