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 Thanks for joining us on this week in Health IT Influence. My name is Bill Russell, former Healthcare CIO for 16 hospital system and creator of this week in Health. IT a channel dedicated to keeping health IT staff current and engaged. Today we're joined by Dr. Karen Murphy. She's a registered nurse, but she's also the EVP and Chief Innovation Officer for Geisinger Health, and she recently spoke at the HIMSS Accelerate Health Series Conference.

She was a keynote speaker and she discussed the lessons learned. As we move through the pandemic, and we're gonna cover those four lessons that she, uh, shared at that panel discussion, and we're gonna break 'em down in more detail. A great conversation. Special thanks to our influence show sponsors Sirius Healthcare and Health lyrics for choosing to invest in our mission to develop the next generation of health IT leaders.

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All right. Today we are gonna take a look at how the pandemic has and will influence digital strategy post pandemic. And, uh, we have as our guest today, Dr. Karen Murphy, who is the EVP Chief Innovation Officer for Geisinger. Welcome to the show, Karen. Good morning, bill, and thank you very much for having me.

Yeah. I'm looking forward to this conversation, although we are, we're recording on a day where there's probably a fair amount of snow outside, although that picture behind you doesn't reflect it. Is Did were, did you guys get dumped on, uh, yesterday? I live in the northeast part of Pennsylvania and I have two feet.

Two feet. Mm-Hmm. Wow. Yeah, I, I, I talked to my parents there in Bethlehem, Pennsylvania, and they were, they were saying that . You know, it would normally feel like a snow day, but since Covid, it's like every day. We're she That's right. They're sort of stuck inside. Well, well, thanks for doing this. I, let's just start off, you're, you're new to the show.

Tell us a little bit about Geisinger and your role at Geisinger. Sure. Well, thanks, bill. So Geisinger is an integrated delivery network. That means we have a health plan, clinical enterprise. Also a medical college. We're located in several counties throughout Pennsylvania. The building you see behind me is our major center, major academic medical center.

And then we have several smaller rural hospitals scattered in our rural communities. And then finally we have two fairly large platforms in a more. Urban, Northeastern, Pennsylvania. Yeah. So tell us a little bit about the chief innovation officer role at AT at Geisinger. So the Chief Innovation Officer role is to lead the Steel Institute for Health Innovation, and we define innovation as a fundamentally different approach to solving a problem that has quantifiable outcomes.

So if it's not a problem, we don't work on it because. We all know that we have plenty of problems in healthcare, right? So we concentrate our efforts on solving really big problems. And I always say it's the hardest job I ever had. Um, because what we're trying to do is make a meaningful difference in cost or quality.

And as you well know, that is very challenging. So we have in the Steel Institute. We house the data informatics shop or for the entire enterprise. We also have a unit that addresses innovative approaches to population health and social determinants. We have a care delivery team that is looking at new care models, and we also have artificial intelligence.

We have a digital strategy . Transformation office where we're leveraging digital strategy to accelerate transformation. And we also have an intelligent automation hub where we're building chat bots that has become increasingly important during covid. And then finally we have a unit called the Nudge Unit.

We have a scientist, behavioral scientist that really study how we could nudge. Better decision making. Yeah, I've, we've, we've had that conversation on the show before. Just the, until you can get me to stop going to McDonald's. It, it's hard to really influence my care and as a health system, it's that, it's that behavioral science and the, the nudges integrated into digital tools that's gonna make that difference, isn't it?

We hope. We hope. Absolutely. Uh, so you gave a talk recently at at, at the HIMS Accelerate Health Series. Uh, it was virtual and online. So, but you discussed the, the lessons healthcare systems learned going through the pandemic. Give us, give us a little, uh, glimpse into what some of those lessons were that you discussed in the, in the talk.

So, from the very beginning, bill, we have tried to look at the silver lining of this very challenging, both professionally and. I think everyone has really had a very obviously difficult time since last March, but we've tried to study from the very beginning what are the lessons that are coming out and how do we carry forward and not go back to where we were before?

So if you think about last March, we. Like on March 1st, if you ever said to me We can transform the healthcare delivery system in a matter of hours and days, I would've said That's impossible. But we did, and we really demonstrated that we're a lot more flexible than we thought we were, and quite frankly, a lot more resilient.

So that's one lesson. I think. Another lesson is we used to talk about innovation. In periods of months, years, we have been innovating since last March and hours and days. That's our time, that's our timeframe. I think the other, the other lesson that, that we've learned is the important of data to drive decision making and the advantages that predictive analytics and also other types of digital strategies.

Have really enhanced our response and our ability to respond. And then finally, I think it's crystal clear that the fee for service system that we're all living under is abysmal. So if you think back, what we did in March, we did all the right things to protect our patients, our communities, and our workers.

We stopped our elective procedures, we amped up our care in the home. We encourage commu, we provided public health services for our communities and really it was financially devastating. That should not be the case. It should be that we're always incentivized to do the right thing, and that doing the right thing does not, does not result in financial payroll.

So we're. Really always have been, but have really increased our advocacy to say we've gotta move this payment system to value and be compensated on cost and quality and not on the number of types of services that we render. Wow. So those are four great, four great. Uh, lessons, or as you said earlier, silver linings to the.

The pandemic. And, and so those four things, flexibility, really the innovation around digital tools and the use of, of innovative tools, using the data much more effectively and healthcare payment models. I, I wanna break those four down a little bit and go through each one, you know, in, in, in the opening.

Absolutely moved at a speed. I've never seen healthcare move before and we moved. We moved in that way, almost adopting agile methods, agile methodologies in terms of, you know, just, just move, move fast and adjust and people were meeting on a daily basis, even an hourly basis in some cases, and adjusting what they were doing.

What, what strategies do you think healthcare leaders will take? To make that a part of the cultural DNA of the organization moving forward. So I think it, it is been very clear to us that a part of our success was the focus. So everyone was aligned, everyone knew our goal was to protect our patients, our communities, our employees.

And I think strategically as we move forward, we have to take those lessons of focus. And be very clear in our communication that this is what we're trying to achieve. Because I, I think the clarity of the message and the focus of the organization really allowed us to, to improve and to continue to serve the needs that of our patients and, and our providers.

Safety of safety our employees and of our communities was, was paramount. And, and that drove everything. Work from home telehealth, that's, uh, remote, remote patient strategy. It was, it was really fascinating to watch. I I, I'm wondering though, if the expectations of change, the expectations of leaders and the expectations of board members.

That healthcare should be able, we've, we've demonstrated it. Uh, you know, do you think they're gonna expect us to move at this pace Post pandemic? I, you know, I, I think we're all gonna have to temper and really evaluate. Are there, are there moves that we can make, that we can make quicker? Can we lighten up the decision making process?

I don't think the expectations. This pace that we're at now 24 7, and now we're into the vaccine program? Yeah. You know, I don't think it, it's sustainable, but I do think the expectations should be really evaluated. If we were talking about an innovation, for example, there's no reason to do a one year, a one year timeline, right?

We were always going for perfection in design. I think we have learned to iterate and it is okay for it not to be perfect to start, and I think we'll have to compress to compress where we're able to do so. The danger of adopting that universally, of course, is that you create a chaos because the reason we were able to move so quickly this time is because, again, very clear focus, very clear mission.

And really put all the parts together to achieve what we did. But I, I, I definitely think that there is going to be, not only from boards, but I, I think the public will become, uh, demand from us, which they should, uh, much faster response rate and a much tighter communication, a much tighter communication rate.

So look, look, you know, it's a little off, off topic, but not too much off topic. The burden that the pandemic has put on our staff, we're talking about moving faster and you know, it's kind of neat on the technology side to say, oh look, we're gonna act like Silicon Valley and we're gonna do these things.

But I mean, since March of last year, there's been a significant burden on the clinical staff. To expect them to just, you know, move out pandemic and continue to move at, you know, the pace we're talking about is, is probably gonna take its toll. Is that something that you guys are, are, are keeping an eye on it and what are thinking about with regard to, you know, just, uh, the long term wellness of your staff?

So we're really focused on that, focused on burnout because I think it's only natural. Given the intensity, the sheer intensity that people have been working. I mean, even the frontline workers, even my team who has been building a lot of these digital tools have been working for months and months, seven days a week, and really trying to respond to the needs of the system.

So we, I think there's gonna be, you know, there are some things that are gonna come out post pandemic. That we're gonna have to really work on. And, and I really think there will be, I hate to say the word PTSD so strongly, but I, I think there is gonna be an adjustment that we're gonna have to make and, and really a focus on wellness, mental, mental health, particularly for our frontline workers and for all that have been working so hard in this pandemic.

I, I agree. It's, uh, no human can work at this pace. And there's even some aspects of working at home and being isolated that I think we're gonna, we're gonna look at in retrospect and maybe change the way we're, we're doing things, but this is, this is, you know, what safety has driven us to, of, you know, we're gonna do the right thing and we'll figure some of this stuff out as we go, I guess.

I, you know, the, the second thing you talked about was digital tools and innovation around.

The use of digital tools, but more specifically how they extend care outside the four walls of the health system and, and really give choice back to the patient. In, in what specific areas do you think, you know, telehealth and, and other tools, uh, are, are going to be used outside the, the, the health system following the pandemic?

So, that's a great question. So if we look at the lessons of the pandemic and what digital did for us. Part of the transformation that we were able to make, such as keeping in contact with our patients, particularly those with chronic diseases, we were able to do that through virtual health and remote monitoring.

I think after the pandemic, we are gonna have to really think about where's the value and identify where the value is. I, I think my past experience as a policymaker. You just can't go to policymakers and say, we just wanna be paid on parity fee for service for everything. I think we really have to demonstrate in the post pandemic world, what, where does virtual health sit?

Where does it produce the greatest outcomes? Where does it lower the total cost of care? And I think we have to study that because it's not based on a percentage to say, oh, you know, overall 20% of our visits are, um, virtual. I think we have to say instead, we have found in these use cases that we can really impact outcome and, and cost going forward.

So I think remote patient monitoring, we don't, we can't monitor every patient because we, we shouldn't monitor every patient just because we can, we have to figure out what kind, what type of remote monitoring transforms care and delivers higher. Higher outcomes. So I think that will be, I know it's something we're already working on.

It's a post pandemic exercise. I think the other thing that we have figured out is the importance of connecting and knowing our patients very well. So if you, you know, I always joke and say retailers were reaching out to me during the pandemic asking me how I was. More than healthcare because they know their customers and they're in constant contact with their pa, with their customers.

We have to transform that consumer experience to the patient experience. We have to be available to them. We have to know what their needs are, and we have to provide them with a much simpler way than picking up the phone and get bounced about around to 20 phone lines before they actually get their answer.

So we're working on digital strategy in three ways or three focus areas. The first is in the care delivery model. We're creating a new model of chronic disease management, leveraging our case managers with remote monitoring, patient reported outcomes, and artificial intelligence. We are working in the consumer area of making the journey easier, easier to create better health.

Then we're also leveraging digital. How do we bring down the total cost of care? What digital tools are, they are there both in business processes and clinical. The clinical area to say if we can replace Digi, if we can replace some, uh, roles within the healthcare system, using digital technology, then we will be able to, uh, able to achieve a lower cost of care.

Is your, is your lens maybe a little different because you're, you're looking at, because Geiser has a, a health plan as well, is your lens a little different because you have a health plan or are you predominantly looking at it through the provider lens? So I would say we look through both because all of our payment is not from the Geiser Health Plan.

So I, you know, I think if you take it from a provider perspective, all providers. Want to be in as great a contact with their patients as, as they possibly can. I think the I, the areas of moving care to home, we certainly can do in a much more advantageous way because we have the health plan, so we pay ourselves based on a value-based payment.

So it's easier for us to do that. But I think when you're talking about digital, I think it's . Excuse me. I think it's industry wide. I don't think it's a provider or health plan. I think all parts of the system have to really look at leveraging digital technology. So let's, let's talk te, let's talk telehealth a little bit.

So telehealth, you know, obviously in the behavioral health and, and mental health space has really demonstrated a significant amount of value during the pandemic and, and I think there's low hanging fruit that we've known for years.

And some of those things are, are obvious. Are there other areas in Telehealth that we really saw in Excel during the pandemic? You know, it's really been across the board. I was talking to a neurosurgeon last week now you would think a surgical specialist has to have all visits in person. And he was describing how he was able to enhance access and see more patients by leveraging virtual care.

So I think, and I go back to my earlier comments of really identifying the value proposition. You mentioned behavioral health. We had the lowest cancellation rates that we've ever seen in behavioral health. Now, that could be because of the behavioral needs brought on by the pandemic, but it's also, it's easier for patients, more convenient.

So they tend to keep their appointments. I think that, I think there is use cases in almost every specialty that will be able to render us a higher yield to greater value that will improve access, and that's one of the things that we're really focusing on also, is how do we leverage virtual technology that will allow us to actually see more patients and serve more patients.

In a timely manner. So remote patient monitoring is another thing that you mentioned. How far do you think we're gonna be able to take that? I mean, what, what, what level of acuity are we gonna do in the home and what kind of things do you think will be, I don't know, maybe common in five years that, that we don't see today?

Assuming we're gonna move to value-based payment. Right. So we have to have value-based payment to move to the home. I think we have discovered, and we have our Geisinger Home program that's around for about three years, and we have discovered that a very high intensity of services can be rendered in the home.

So I think if we move to value, we will move. We will move more patients home and prevent those hospitalizations. You know, we're administering IV fluid at home. We're monitoring congestive heart failure at home that five years ago would've had a five day stay in the hospital with, with very good outcomes.

I, I think, again, always in mind, always keeping in mind the total cost of care. I think we have to identify what the value proposition is for remote patient monitoring. Just because we can do something doesn't mean we should. I. Again. So I think we have to figure out where does it produce the greatest value?

And I think the other piece that we can't lose sight of is patient engagement. And that is, you know, a 49 year old hypertensive doesn't really want to call every day to tell them they have high blood pressure. You know, they, they may want to know once a week to send in a. Blood pressure reading, whereas the 70 year old with uncontrolled hypertension understands that the consequences could be very grave and they may need a heavier touch with monitoring.

So I think we have to figure out the right way to engage patients in this valuable tool, and we have to figure out and design programs according. To what the patients are telling us. Like, you know, a lot of times in healthcare we make the mistake of we're all knowing, and in our innovation lab we insist that we have patients engaged as we design, so that we don't believe our own stuff.

Yeah. So the, uh, the third area, which is always an interesting area to talk about is the use of data. In healthcare and healthcare delivery. And, you know, the, you noted that the use of data expanded during the pandemic. You know, what, what have you seen and how has that played out? So, it's been tremendously valuable to us internally with operations.

So during the first wave, you know, we started out by just reporting the number of positive cases that we, that we were saying. Then we pivoted to, we realized . That we saw a pattern and were able to predict of the cases that we saw, what is that gonna do to hospital capacity? And of course, in the spring it was easier because we had all of our clinic shut down.

We had redeployed population, we canceled elective surgery. But that has a cost also. And, uh, I mean, a human toll in that. If patients need open heart surgery, they need open heart surgery. If they need their knee done because they can't walk, they need their knee done. So we approached the second wave a little bit differently, and that was to rely on the data to predict what we were going to see over the next couple of weeks and really dial down and dial up our elective procedures without canceling them completely based on bed capacity.

That has been, uh, tremendously important. The other piece of, um, studying the data that has been really important is in the area of employee infections. So we were able to hone in by monitoring employee covid infections, we were able to do contact tracing and really identify behaviors that we wouldn't have thought of had we not been monitoring the data behaviors that we needed to

Really adjust so that we lowered that degree of communication while people were communicating the virus while people were at work. So the data shop was tremendously beneficial for us to learn, trending, to be able to adjust to capacity, to be able to monitor PPE and really be able to share with the community.

What we were seeing and really be able to effectively, based on data, get that public service messaging out. Were were, were there any external data sources that you guys were taking a look at that were maybe informing some of the models you were developing? Sure. So we stayed heavily in line with the Pennsylvania Department of Health, which had very good data analytics.

On infection rates, because in some of our communities in Danville, the hospital that I'm sitting behind we're the sole provider. But in many other communities there were different testing sites, there were other hospitals. So to really understand community spread, it was necessary to combine those data sources to understand what potentially was coming down the road.

Interesting. So. You know the last thing is payment models. Payment models is huge, and you, you have served in . You know, policy rules within the state of Pennsylvania and whatnot. So it is interesting topic to discuss with you at the JP Morgan conference. Listened to CFOs and CEOs get up there and they laid out their financials and it didn't take like an MBA to look at these financials and go, what happened between March, you know, and, and May.

And the answer to that was, you know, the elective procedures went away and in some cases, you know, New York and, and other markets. You know, the, the beds were filled with covid patients, but in a majority of the markets, they were not filled with covid patient patients. And, uh, there was a significant sort of body blow to the, to the financials for a lot of health systems.

You know, how, how do you think that's gonna shape strategies going into next year for health systems and, and maybe even the, the debate that is, uh, gonna go on around. Fee for service value-based care and, and I don't know, maybe changes to the, uh, affordable Care Act and, and, and just providing more coverage.

And the reason that is, is because they're not dependent on what they do. They're dependent on the value that they create. In Pennsylvania when I was Secretary of Health, we worked with CMS on developing the first national payment model for new payment model for rural hospitals, which was a global budget, a multi-payer, global budget, and actually based off of the Maryland model.

And I was at a call a couple weeks ago with a hospital. It was a rural hospital. Had they not had the global budget during the pandemic is they most likely would've been closed because to your point, they didn't have a hospital full of Covid patients, but they had an empty hospital. But they receive a global payment, a fixed payment, sustainable payment that's predictable throughout the whole year that allows them to transform into something that's meaningful and sustainable.

So I. If, if policymakers wanna lower the total cost of care and really take care out of the higher payment areas and wanna encourage virtual, uh, virtual care, a higher level of acuity outside of walls of the hospital, we're gonna have to accelerate to value much faster by all payers, not just by public payers.

So I'm hoping it accelerates the conversation. Do you think the leadership for this is gonna come from the state level or the federal level? I mean, during the Obama administration we had, uh, bundled payments, and I would assume that that's gonna come back again under the Biden administration. But what you just described is what Maryland did and what Pennsylvania did.

Do you think we'll see it from the, the state level? Yeah. It really has to come from both, and it really has to be principles that are bought in by all payers. . So we live in that world now, right? Every hospital lives in a piece of value and a piece of fee for service, and we've gotta get those reconciled.

And I think, you know, Medicare is a leader in our markets and the state has control over Medicaid and they also have, uh, some regulatory authority over insurance companies through their insurance commissions. So I, I think for policymakers it's a federal and state. It's not one or the other. I, I think it's both.

Yeah. And this example, you know, it's, it's interesting because, you know, we talk about the, the financial chassis and the, the models and that kind of stuff, but really it boils down to one is being paid to take care of the sick and the other is to keep people. Well, I mean, at the end of the day. That's right.

And to keep people, even though they are sick, not to have them in the highest level of service just because they're sick. There are, there are, we can treat illness outside of the four hospital walls. Yeah, absolutely. Well, I, this is, you know, I, I appreciate your, your insights and your experience going through the, the pandemic.

And I, I really wanna thank you for taking the time to come on here and share it with us. , thank you. It's been my pleasure, bill. What a great discussion. If you know of someone that might benefit from our channel, from these kinds of discussions, please forward them a note. Perhaps your team, your staff. I know if I were ACIO today, I would have every one of my team members listening to this show.

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