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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 the incomparable Sarah Richardson, and we have a phenomenal conversation.

She started a new role. We start there and how you transition to that role. What are the kind of things you do? And Sarah is my hero at this point. Instead of putting on the C Ovid 15, she'd lost the c Ovid 15. She's an incredible leader and I think you're really gonna enjoy this 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.

If you wanna be a part of our mission, you can become a show sponsor as well. The first step. It's to send an email to partner at this week in health it.com. Common question I get is how do we determine who comes on this week in health it, to be honest, it started organically, it was just me inviting my peer network and after each show I'd ask them, is there anyone else I should talk to?

And then the group, obviously the network group, larger and larger, and it helped us to expand our community. Of thought leaders and practitioners who could just share their, their wisdom and, and expertise with the community. But another way is that we receive emails from you saying, Hey, cover this topic, have this person on the show.

And we really appreciate those submissions as well. You can go ahead and shoot an email to hello at this weekend, health it.com, and we'll go to the entire team. We'll take a look at it, reach out to these people and, uh, see if there's a good fit to, to bring their knowledge and wisdom to the community as well.

Just a quick note before we get to our show. We launched a new podcast today in Health it. We look at one story every weekday morning and we break it down from a health IT perspective. You can subscribe wherever you listen to podcasts at Apple, Google, Spotify, Stitcher, overcast, you name it, we're out there.

You can also go to today in health it.com. And now onto today's show. Alright, today we are joined by Sarah Richardson, CIO for, well, I'm not gonna say who she's with. She's gonna get to do the announcement. Sarah, welcome to the show. Thank you, bill. So this is, thanks me back. This is your first time on the show under a new banner.

So tell us, tell us about the, the new role and the new company you're with. Yeah, absolutely. So I, this is like my third time I believe on your show, and every time I have like a different role or different opportunity, and a lot of times it's in the same company, but this time. It's different. I am, uh, senior vice President, CIO at Titi Health.

Titi is best known for the SilverSneakers brand. Uh, that's our flagship, flagship brand, but we also have Prime Fitness and we have wisely well and full health living. So we have a complete suite of products that, uh, allow us to really be the destination for healthy living. But most people know is for SilverSneakers, which is, uh, fitness programs for, uh, seniors 65 and older, that they primarily get to their Medicare Advantage plans.

Wow. And you know, my parents do silver sneakers. So it is a national program. It is. It's, it's, yes, very much so. It's also a really emotional brand. Like our members love us, we have 17.5 million eligible members and people Absolutely. Love SilverSneakers. The brand itself has been around for almost 30 years.

It's been, you know, it's changed hands in terms of who owns it over a period of time. It's now with Titi where Main, and it's fascinating to see how much our members love us. Like if I'm wearing my gear, even now out in public, people will stop me and talk to me. Well then it, then it's a perfect hire 'cause people love you and they, they love that brand and they love Silver Sneakers.

'cause I, I know my parents talk about it. It's, it's a really fascinating thing and I, I thought it was a, to be honest with you, I thought it was a Geisinger thing 'cause they're through a Geisinger Health plan and, and whatnot, but they, they talk about silver sneakers and being a part of that. That's, that's fascinating.

Tell me about the role. So is, is the role different than other roles you've held in the past? It's really different, and here's why I even took it because I wasn't looking. I think that's such an important thing for people to understand, like how did you choose Tivity? And I said, well, I was with Optum, you know, five years really Exactly, with that five year mark doing a lot of really new and interesting and exciting things.

And then Tivity comes along, you know, recruiters talk to us all the time. And I was like, Hmm, let me look into this a bit more. Well, it's the perfect culmination of. My hospitality background, so I started in the casino hospitality business, seven years in Vegas. Actually worked for an airline for a short period of time as well.

And then healthcare, and I'm big into fitness. I think people that know me know that I'm, I'm a Peloton. I stand, I'm standing on my walking treadmill right now. I sit on an exercise ball, like you can always see me doing something healthy related to fitness as well. And I'm a certified personal trainer.

You don't have the, you don't have the treadmill going right now, do you? I don't have it going right now, but I've actually shared with people, especially this whole covid space, because fitness has been a big piece of, of staying healthy during covid. It's very hard to walk and talk when you need to, either on camera or type or other things.

Like the magic number is one mile an hour, by the way, to actually have a real conversation, potentially even take notes. But you can't facilitate an outcome. You can't, you can't like lead a meeting. And, and be on the treadmill. It's distracting. It's just doesn't really work out. But if I'm in like, you know, a, a monthly performance review where I'm more of an attendee, then I can cruise along at about a mile per hour and get some.

That's awesome. So yeah, so it is different. I mean, what I love about it is I get to be what I would call traditional CIO. Like I have my teams and we have the things we're going after, but I get to work in, in verticals and with, with people I haven't always worked with before, but it's really about transforming the organization from what's, I guess, been a healthcare services provider.

A platform engagement company and a software company because we've always offered fitness as an option for our members and some other add-ons from there. But now we're creating these spaces that's really about how do we engage people at a new level? How do we build in community and volunteerism and tackle loneliness and tackle the things that people want to come to a, a platform to be able to do?

And that's really where we're headed. And so the CEO, Richard Ashworth from Walgreens joined June of last year. He says, you know, I need a couple new roles or new or people in roles to make these things happen. And so one was the CIO with a background like mine and our chief experience and innovation officer, Stacy Santo with a background like hers.

And she comes from Asics and global Omnichannel through law, law, different experiences. And she and I got hired about three weeks apart. What's so cool about Stacy and I joining at the same time, bill, is that we didn't know each other during the recruitment process, but our boss. Richard knew that we would be complimentary for one another.

And so every so often in your career, you meet somebody that you're gonna be working really closely with and you're immediately like able to accomplish things together. So she and I just chat. She's in Boston, I'm in la. So we just chat and text and have a lot of great conversations about what to do, and we're surrounded by amazing humans in the organization.

So it's not like we have to do this by ourselves, by any means. Uh, so we're very grateful that our boss is very selective in choosing who he brought together and how he brought us together. Well, I, I mean, congratulations on the role. I, I wanna go in a couple different directions. One is I've always. On the, your career progression, but before that to, to give a little more background on, on, on, it's not gonna, you're not gonna be a traditional healthcare provider, so you don't have an ER and those kind of things.

You'll have more, more consumer based types of applications. I would, some cloud applications, maybe even some development capabilities. Give us an idea of what the.

Sure. So we're a big dev shop. I would say about 60% of our team is software development. And you think about that being because when SilverSneakers really became mainstream with its digital platforms, you know, well more than a decade ago. Those had to be custom built. Those things didn't exist off the shelf.

And then all the tie-ins that start to go into what it takes to run the organization around that and all these individual offerings and the ability to have customized programs for, for different, uh, products. Those all became homegrown applications and all the different backend that goes along with that.

Technology moves very quickly and the organization has been through pretty significant change over the last decade as well, either mergers, acquisitions, divestitures, so we are. Activity owning the, the Silver Sneakers and the Prime and the whole Health Living and the wisely well brands. We are in the process of truly replatforming that, not just all of our technology on the backend.

Our, you know, going from having a couple of data centers and some cloud activity to guess what, we're gonna have one data center, we're gonna do most of the things that we wanna do in the cloud. We wanna have a hybrid environment that really makes us able to have code-based infrastructure. And then you put all of your development on top of that in, in a place like AWS using Kubernetes for containerization, using low-code environment, because that's where most things are headed.

So they, like we used to talk about, even in the hospitals, you allow people to practice at their highest level of licensure. Create an environment that allows your practitioners in your own environment to practice at their highest level of capability as well. And nobody wants to be running around hard coding things and doing backup and recovery to two data centers anymore.

And so you have to get there. So we are on a fast track to do those things, and when we can partner with a snowflake or a red point, or a stitch or a stream to make these different things happen, we do. And if we have to go and build things still, then we're gonna build them the most optimized and agile environment we possibly can.

So no shortage of just things happening everywhere. And what most people don't realize so important is that our, our entire company has like 350 people in it. That's it. 3, 5, 0. It is about 68 of them with 30 contractors helping us to get us where we need to be. And so you think about the size of a company, it sounds this huge, amazing workforce.

You just have a whole lot of smart people working really hard to do very finite, very specific deliverables in a way that allows us to, to do that, that hasn't been done before. That is, uh, that's pretty cool. Yeah. I, I'm looking forward to, you know, future conversations as, as you start to progress into this, the architecture sounds awesome.

And, you know, our sponsor is VMware, and we didn't talk about this ahead of time, but they're, they're happy that you mentioned Kubernetes. Well, we use VMware, so we're happy with them. It's not a plug for our vendors, it's our partners. It's, we use VMware. We're happy with VMware and we're gonna move it to the next space.

Actually, was joking with VMware, I'm. Should change your name, like you could like everywhere because it's not virtual machines anymore. You do all these other things now. I'm like, I'm not sure that would be a rebranding effort. I'm, I'm not in the marketing department offering suggestions. Frank, on show a little while ago, and

I'm sure you'd appreciate that because it's, it's one of those things that you, you get stuck. And they are, no, I mean, they've changed the data center forever Yes. And how we view it, but they, they're so much more than that these days. Let's talk about your career progression and I, I like the fact that you said, you know, you weren't out there looking for something.

It, it sort of found you. But let's, let's start all the way back, you know, how did you get into your first CIO role and then how did you progress from there? Yeah. So that was, I wanna say, somewhat planned on my part. Like I, my career has not been by accident. There's definitely been things when you say you weren't looking and a new opportunity found you, it still had to be an opportunity you were prepared to take or to handle.

So I was incredibly fortunate that I worked for HCA for to almost 10 years, and I had progressed from the casino business, airline into healthcare. I was working for the hospital in Vegas, and then opportunity. To be a hospital IT director. So I did that. Then I went into security operations for them at the local division, and then I was able to move to Nashville to work at headquarters, which I was like, to me that was like, I'd made it in life, by the way.

I was like 33 years old at headquarters, which is amazing. And I spent three, about three years in a forward facing field operations role, essentially serving the CIOs, helping them stand up their support models, and really getting to know all of them. And then HC is very good about. Training their own leaders and investing in their team to have internal promotions and great succession plans.

So when you've got 14 divisions at the time and ACIO opportunity pops up and you've been the field director supporting those opportunities, then you become a can, a candidate for that. Now, I'll tell you that the reason I was able to become ACIO when I did is I, the first opportunity was in Kansas City, Missouri.

And no shade thrown at Kansas City, Missouri. But it was never a destination on my radar, period. I'd never been to Missouri actually until I moved there. And what I found was you might prepare for the job. You don't always prepare for the geography. And if you're willing to take that, then you get great opportunities.

And so I think a lot of my careers and based on either taking roles. Or geographies that weren't necessarily the first choice of some people. And because I was excited about what, what those things meant and willing to do them, it worked out incredibly well. And I've never, uh, been disappointed in the choices I've made in doing that.

I've moved around a lot, I'll be honest. I mean, I've lived in a lot of states now with, with a few different companies. Um, it's always been for the right reasons and had the right opportunities. Follow Yeahinteresting about that is. One of the things when I was CIO and people would ask me, how'd you get that role?

How'd you and I, and one of the things I say is, you know, if, if, if you really want that role, you don't get to live down the street for your parents. And what I meant by that was I, you know, I, I moved several times and I moved for my career and that was one of the objectives was to get to certain roles.

And I was able to do that. But they, they didn't always pop up, you know, down the street from where we.

They popped up in, they popped up in, in Southern California, and it's hard, it's hard to move depending on your family situation, but you know, it's, it's a decision and hopefully you do it. So you, you get into that HCA role, you get into that, that first CIO role, you know, how does it, how does it progress from there?

I mean, is it a situation where, you know, you outgrew.

You know, it's funny, I look back and people say, I joke about, oh, I took a job where nobody wanted to live. The only thing about KC that wasn't awesome was the geography, like where it physically was in the us but the people, the company. Experiences. I mean, I met my second husband there. Like everything about that entire four and a half years was amazing.

Uh, we still have so many people we're close to, so I love everything but the snow and being three degrees in January kind of deal. I mean, I'm, I'm born and raised in California. I don't do winter, and now I'm back in la. For the last five and a half years and I'm happy, I like the weather kind of thing.

And now randomly, you know, you think about you don't have to necessarily move for your job anymore. You can live anywhere you want. So with that in mind, where do you choose to be? But what was really interesting about that role is that I could have happily stayed there. I mean, HCA is a huge company and they're, again, they're very supportive of moving people around into the right opportunities.

But I was also somewhat, I don't wanna say impatient. That's probably the best way to describe it. I was ready for a bigger role and the next role was gonna have to wait for something to open. And that's okay if, if that's on your radar, but I was like, I don't wanna wait. And so I took an opportunity to be ACIO with a much smaller organization, um, but to be the CIO of, of the, of the hospital system and so on a division ccio of ACIO of a hospital system.

That progressed into them going back into more of like a division type of role with what at the time was healthcare partners out in California and I had personal reasons for needing to move back to California too. I mean, I was found myself in Florida, which was fantastic, but I also had an aging parent who was starting to have some health problems in California.

So I needed not down the street eight hours away, but I still needed to be closer to home. So I took an opportunity and that just progressed into it. Got bought by Davida, got bought by Optum, and it kept going from there. So there are experiences that I believe we curate or want to have in our careers, and sometimes we make them happen and sometimes they happen to us as you.

Well now I'm a big fan of create your own outcomes, create your own destiny, like be prepared for whatever happens. But reinvention is something we are responsible for personally and. Where I am now is part of the things I wanna accomplish in my career. So sometimes you find it, sometimes it finds you, but either way you put it out there in the universe for it to happen.

And you know what I find interesting? I, and, and we talk about this a lot, there's, there's seasons in life where, you know, you made that happen to be close to your parents and that's phenomenal. I, I. Where my daughter came to me and she was in middle school and she said, dad, I don't want you to travel anymore.

Well, prior to that, I was traveling 40 weeks a year and doing consulting all over the place. So I started my own business and for the next three years, essentially hunkered down, uh, you know, right around the location where we lived. And yeah, it's just a season, right. And. On that of, of course, your, uh, healthcare partners job was a pretty good job and you, and you really thrived there.

So you found a pretty good location near your parents. I did. And you know, I, I share this with people because it's important for people to understand and it also says a lot about the, I think the cultures and the structures and the, the key components about being a leader is, and that needed to happen because my mom died of cancer last year.

I mean, and I was able to be with her. On that journey. Journey and spent a lot of time up there. And then of course end of life planning and all the things that that go along with doing that with your parent, which are not pleasant by any stretch of the means, but when you get to actually be there and be part of that conversation and be their advocate and they don't have to be alone, that's a big deal.

So I'm very grateful that I was able to spend the time I was with my mom towards the end. Yeah, absolutely.

And, you know, I, I, I tend to ask this question of anyone who's stepping into a new role, only because it really helps people that from time to time they find themselves, you know, stepping into ACIO role for the first time or stepping into a new company for, for the first time. You know, what do the first days look like for you?

What are you looking for? And, and what do you wanna make sure that you accomplish in those first couple of of weeks while you're there? Or even the weeks proceeding you stepping into the role. It's interesting is that preparedness and or preparation are literally everything. So when you're doing your due diligence and deciding if you're gonna join an organization.

You learn a lot about what you read and what you hear in the interviews. And I'm hopeful that everybody has a list of questions that they're asking that are very specific to what am I stepping into? Like how mature is this organization? How are decisions made? What you know, what am I overcoming when I walk in?

What are the landmines, the sacred cows, all the different pieces, et cetera. And when you ask those in your interview, you also start to get a sense of how transparent the organization is and what you would be. Uh. Finding on day one. When you walk in the door though, you assume you know nothing. really, even after the interview, you just assume that you, you're starting from scratch.

Start from scratch. You know, I have a list of questions. It's not, and it's not science, it is research. I'm not gonna act like I don't do my homework. You know, I joke, I, I spend like four hours before our conversations making sure that I sound relatively, uh, intelligent in, in what we share. It's about, and I'm glad I have a coaching background because you literally have like your five or six questions and you send them to everybody ahead of time because they like to be prepared.

And you ask the open-ended questions, you listen, you're fantastically curious. You take notes, you listen some more. You ask people what do they need most from you? What are those expectations that they're setting? And as you build those relationships, you create a couple of different things. You set and manage expectations and then you create conscious working agreements, like how are you and I bill gonna do business together?

Like what do you need from my team? What does it look like? How do we figure those things out? And then you share that with the team and say, Hey, I just got to meet with Bill Russell and here's what he's saying to me about us. Like, tell me about what that means to you as well. So it's always this partnership and collaboration, but what really I feel like is key is that in the first week.

I did a podcast with our CEOI did an all it meet and greet, and then I committed to meeting with every single member of it, one-on-one for 30 minutes in the first hundred days, and I'll tell you 27 days in on my fifth week, I've met with over 40% of the team one-on-one, and, and it has been phenomenal in terms of being able to learn and grow and understand the organization.

This is in addition to all the standing meetings and all the business partnerships as well, but. People really appreciate when you take the time to get to know them. Yeah. That, that explains what my, my scheduling person was saying. They're like, we, we can have Sarah for this one hour or we can talk to her in three months.

I was like, really? She's that busy? It sounds like you are that busy. I mean, you've made, that's a big commitment. It's talk to everybody for 30 minutes. Yeah. And it's not my favorite mentor. Friends to this day talks to me, Joe Scarlet, do not mistake activity with accomplishment. Because he called me the other day and said, all right, so what are you learning?

What are they telling you? What are you hearing? And notice how he says this. What are you hearing? Because of making sure that I'm listening and like when you have people that keep you humble and honest like that, it's hard to, to make big mistakes. You're gonna make mistakes and, oh, 'em, and I do 'em all the time and I share them.

People laugh like, wow, you do a lot of self-deprecating humor. I'm like, because I do something stupid every day. Like you can't lose a document in teams. But I can. And it was actually agenda for a big meeting that we had, and I totally, I totally like, doesn't even matter how it got lost, but. Team thought it was pretty funny.

That's, that's interesting. You know, one of the things, uh, uh, because I do coaching, you do coaching, we've talked about some of this stuff before. One of the things I do for my clients, especially if they've been in the role for two, you know, a year or two or so, is uh, I'll go in and do the listening tour.

So I have a series of five or six questions. I'll go in, talk to some of the key leaders and some of the, some of the peers within the organization.

I, I just grab a ton of, you know, of quotes, of anecdotes and that kind of stuff, and then we just sit through it and, you know, part of it is telling to say, you know, have you heard this before? Are you aware of this? And, you know, it's sort of, it's sort of eye opening because sometimes they'll tell a third party some things, knowing that it's gonna be anonymous and that that doesn't come out.

It is interesting to continually get that feedback, not only in the first, you know, the first 30 days, but to keep coming back and create new ways to keep engaging and listening to the, to the group. Yeah, it's just an interesting process. I, I wanna shift gears again on you. You know, I love having you on the show.

You're so insightful on so many different areas. And so I'm gonna push you a little bit. The first thing I wanna ask you is what do you think the lasting impact of the pandemic is gonna be on Health it? I love this question because I created like six questions from it, and that's only because not to be annoying and answer a question with a question, but it really got me thinking about some of the things we need to be prepared for because, you know how, how are we actually accelerating?

Digital engagement and digital health, and I'm just talking about telemedicine, like what are the things we're actually doing that we're seeing are stickiness and you know, lifetime value of some of the things we're bringing forward. What's really important is constantly planning for unknowns in that crisis management space and continued disruption.

We weren't very good about. Putting disruption in place because you had to go through like 50 committees to do it. So by the time you actually decided what you were gonna do, it really wasn't disruptive. It was just like a relief to finally get it in place. You must have weren't even excited about some of the things they were putting in place.

So you've gotta create, well, that startup kind of mindset and the ability for people to be like, good enough gives us a minimum viable product to test out and try and either do it or not do it. We would talk about it, but we didn't actually do it. In a lot of organizations, there's always this hesitancy to disrupt things because disruption can actually lead to either it's not gonna be profitable or you're gonna make somebody mad, or whatever reasons.

But I, I feel like we were able to ditch some of the bureaucracy around some of our decision making. But I think really it's, it's how you make investments and changes in your IT workforce. And what does it look like over the next 24 months. I've never met anybody in my company, in person. Anybody. That's amazing.

Hey, I interviewed on Zoom. I work on Zoom. I have literally not met anyone face to face. And so how you can actually curate and build relationships and how do you build trust when you've never met somebody in person? Like you don't get to break bread, you don't get to have a beverage, you don't get to go bowling yet, do those things that you might do for team building.

We're getting there. But I, I believe that, that if nothing else, the, the lasting impact on health, it is our ability to be innovative and try things in a new and different way and not have to let bureaucracy and red tape be one of the dictations about how we are willing to try something. But also, we have a truly distributed workforce, and I worked in that environment for a lot of years, so I was comfortable with it.

But now we really can say. We actually need somebody for three months. Let's contract out this one piece of the puzzle, or let's go pull this over here. Or hey, we can be in 23 different states and be on the same team and get things accomplished and done because you're willing to to go that extra mile sometimes because.

Hey, so and so wants to go to their kids' soccer game and they live in Florida. That's 2:00 PM for me, 5:00 PM for them, but they're going to get back online at seven after the game is over before dinner and it's four. Like you start to like make these trade-offs because you're all trying to achieve the same thing, but you're getting to live your life at the same time.

And that's what I've loved about what's happened is we all get to live our lives and do our jobs. And create new opportunities to make things happen we couldn't do before. You know, Sarah, that is going to be one of the more interesting developments over the next, let's say three to six months, is the work from home.

Whether it was an experiment or whether it is a new way of working. There's, you know, if you are running a hospital system, say in New York, well, LA in la. And a majority of your team is in that location and you require people to be there. There's, uh, there's a lot of interesting policies that need, still need to be worked through.

You know, do you allow people to live in any state when you know full well that you're gonna have to have them on site as are.

Look, it's California, Arizona, Nevada. I mean, that's, that's the geographies that you can live in. We don't want you living in Florida, because quite frankly now we're dealing with three time zones. We're dealing with, you know, a, a travel budget where we're, we're looking at, you know, 600 round trip flights plus hotel stays.

Do you think, uh, I mean, it, it, it is, I mean, the company you're working.

It absolutely does. I mean, I have, I mean, several of my very close friends work in those environments and they're like, Hey, we have a Tri-state region. Which we can recruit because it's hard to do business in California especially. I laugh, I live here. You can make fun of California all day long. There are companies who are like, yeah, we're good.

We're not doing business in California. And I get it. Like California's labor laws are intense and there's a lot of nuances. You may find that there are geographical bubbles or time zone bubbles or different things you need to be able to do. That's also where you've gotta be able to work. You know, with your, your human capital teams and say, yeah, but if I just need this one widget, this one type of work to be done, can that person be anywhere?

And I'm grateful for anybody who has had to go into their hospitals or their offices or provide that frontline care in any given time, uh, throughout the pandemic, and really be working through a lot of those scenarios because that's a very real thing. But I bet you'll start to see. Niche opportunities, especially as we truly modernize our spaces in it, that there will be a large component of the support that is not on site from a technology perspective.

Alright, let me throw out some, some different movements that are going on in healthcare and, and again, I just love your, your perspective con.

Telehealth progresses to a visit at a location of your choosing. So, you know, they'll, they'll come to you at your home, they'll come to you at your, at your place of work, whatever. Uh, great digital interface for the whole experience. And I think I'm oversimplifying a little bit here, but that's the core of it.

What are your thoughts on this? Does this have the potential, if it goes well for Amazon, for, to expand it and then, you know, what's the impact on, on the rest of healthcare? Here's what I find fascinating about what Amazon Care is doing. If you go to their website, which of course you do, if you say, I'm gonna talk about Amazon Care, they literally say, your easy button for healthcare.

And so often we talk about is it easy to do business with our company? All companies have that conversation. How easy. Forbes publishes a list, top a hundred companies, it's easiest to do business with. I talk about that in Chime, CIO bootcamp. I actually teach it. Companies are easy to do business with, and guess what?

None of them are healthcare companies. , but one of them is Amazon. And so you think about the ability to create an experience with your employees first, that gives you realtime feedback. The ability to to pivot changes, the things you need to be able to do. Test out your go-to-market strategy. Understand what needs to be addressed in the moment.

Is it sticky? Does it create lifetime value? But I think about it this way too, bill. How many times in the last five to 10 years when describing what you would want an experience to be? Have you literally said it's like having an Amazon experience? Right? And now they're just doing it in healthcare. And in order for someone to want to do business with a company, it comes down to the brand loyalty around trust.

Why do you go to a certain company? Why do you use their services? Because you trust it and because you have some kind of emotional attachment to it. Amazon shows up at my house every single day, every day. Why not bring a doctor next time? Yeah. Yeah. We, I think Drex and I talked about if, if Amazon were given the opportunity to do the mass vaccination of.

How would it have been handled differently? And it was an interesting sort of thought exercise of what it might have looked like. But I, I'll tell you this, if they had been given that it would've been very efficient, whatever it was, whatever they did would've been very efficient. I know that. But the pandemic changed behaviors a lot of ways our, our personal behaviors.

But, but specifically.

You know, post pandemic, how much of that is gonna swing back to previous behaviors. You know, clinicians got used to using telehealth. Patients got used to using telehealth. Clinicians got used to just a, a lot of different ways of interacting. A lot of clinicians were remote. I heard of a clinician that spent, you know, three months literally in, in another country seeing patients back here in the states via telehealth.

So behaviors changed significantly. When we see, you know, any of what happened during the pandemic stick, and I'm sure we'll see some of it, but how much of it's gonna swing back to previous behaviors? So here's where you, when you talk about behaviors, makes you a little nervous. But I'll say like, telemedicine was already readily available form of care.

And I had to use Doctor on Demand because at the time my provider didn't have telemedicine. And so. I think that convenience factor is a component. It's like the hybrid work environment. Do you wanna go to the office a couple days? Do you wanna, you know, stay home a couple days? Do you wanna go the doctor or not go to the doctor?

But if you didn't wanna go, you could go via telemedicine visit, especially in places that are harder to reach or some of the access issues we have. I'm hopeful that that continues to be a space that that proliferates. But I think about, talk about behavior, so. New York Times published an article that said the average American gained two pounds per month during the pandemic.

Well, last time I took, the pandemic wasn't over, so people were still gaining an average of two pounds per month. And so if you think about. The highest risk factor for getting Covid was obesity. And even before the pandemic, over 66% of Americans were had ABMI of over 25, which is overweight. Over 30 is considered obese.

So if you have two thirds of Americans already a high risk factor, and now people have packed on an an average of two pounds per month during the pandemic. What I'm worried about is that how do you motivate people to want to go ? And get in shape or lose the weight that they gained or not develop new conditions and new comorbidities simply because they were either homebound because they couldn't, you know, leave.

We were in locked down different situations. But then you think about the people who did have to go out and work or do two or three jobs to, to maintain a certain level of, of status in the economy. And they don't get to do the things that the rest of us did during a pandemic. So I bought a Peloton. I lost 30 pounds during the pandemic.

Wow. Literally. But it's weight I'd gained from being on the road. So when you think about the, like, how some of these dynamics have shifted is people. Will only change if the, the pain of having to make the change greater than actually doing it has to be a reason to want to be able to change something.

And you think even about like having choice, and it was, who was it? It was William Glasser suggested we behave and choose things that are central to our existence. It was choice theory, and it's driven by survival, love, belonging, freedom, fun and power. When you think about healthcare, survival, freedom and power.

Our big of choice in how we seek services every day. So I believe that it's gonna change behaviors, but I'm not so certain that we are gonna be, we're gonna come out of this healthier. We're not gonna come out of this with less of an opportunity to not have it be a risk factor for something else that may be coming down the pike.

There's too much we don't know about pandemics today, but I'll tell you that if obesity is a key factor, we are not addressing that issue very well in this country. How do we address that issue? I mean, so you know, silver sneakers for 50 year olds. Do you have silver sneakers for 50 year olds? Well, so we do, we have Prime Fitness, prime Fitness also available through your insurance.

So if your employer chooses to provide fitness as one of your options, then they would contract with us to provide Prime Fitness for you to stay healthy and motivated and make it part of your benefit plan. Absolutely interesting. I wanna keep marching through this because we do have a hard stop with you , because you're, because you're busy right now, money flowing into health tech current numbers.

Healthcare, government, and life science got the most funding 23 billion last year. So it can accelerate drug discovery and it boost client engagement. So I looked up a company, I was curious about them, called . They provide AI tools for medical and industrial fields out of Japan. They extract features of small data for ai and they use what they call the sparse modeling technology.

So it's not just the data. They also pull in research. About opinions and social habits and create these algorithms to make better decisions. So they are considered a data intelligence organization. They did series B last year and pulled in 12.4 million just for that. So now you don't need these massive data lakes to start to nuance some of these decisions.

You pull in all these factors from all kinds of different activities and behaviors, and now you have a niche product that can help you. Use insights in a new and different way. Fantastic. Data intelligence. Yeah. I, I feel like, you know, I, I, I joke about the fact that this, this show is, is sometimes the education of Bill Russell, and so I appreciate you continuing that tradition of educating Bill Russell on, on this stuff.

This is great. This one I'm gonna focus you in a little bit more area of most change in the next three years. Cybersecurity, AI or automation within healthcare. So I'm a big fan of automation, so I want that to be my answer except for the fact that I can't get away from being drawn to cybersecurity because I'm intrigued in what we're seeing in both data discovery and classification.

So if you think about what you can do to scan your environment. To look for structured unstructured data to make sure it's safe. 'cause data is our biggest monetizable asset as we continue to move forward. But then database activity monitoring doesn't sound like it's very sexy, but you can find fraudulent, illegal, undesirable behavior inside your databases.

Because if something can get inside your information and mine it and you don't even know it, that's insane. Think of the dollars that are there, because if we're using data. To make and drive new and different decisions all the time, way beyond what our own computing capabilities are. Personally. If someone's in there taking that information and the aggregation of data is, is where some of these biggest fines are gonna be, then you've got to make sure that you can protect your data.

So I'm gonna say cyber security, because if you don't have that, then you're not gonna have damage. Then the rest blows up and does the rest of it doesn't matter. But if to say like, I was excited about, I'd say automation, but. I can't automate it if someone just stole it or locked me out of it. Yeah. The best advice on cybersecurity I ever got was assume they are already in your network.

So now that you know that they're already in and amongst your, they're on your wire, they're, they're on your network. Now, how do you protect it? And that.

How do I make sure that they can't get to the things that they wanna get to? And once they get there and start tooling around, how do I make sure they don't get out with it And mm-hmm. . And so we an awful exfil. On identifying their, uh, anomalous activity on the wire and, and what they were doing and those kind of things, and putting the right tools in place.

So that I can really double down on what it means for us to be a, a high performing software development shop and being able to do that in, in the most nuanced ways that are, that are new and exciting and allow people to keep growing and building and learning. What's really cool is that I don't have to displace a bunch of people to do it.

It's about re-skilling, retooling, and creating new opportunities for the team. So any place where we can automate things and really take technology to. Tier one support or tier one activities on all fronts. Like no one should be, no one should be answering the phone to handle a help desk password reset anymore, and yet that's pretty common.

So how do you move all of the tier one activities to automation so that people can perform at tier two and tier three? Huge job satisfaction there, but that doesn't take just one product. It takes a philosophy across an organization and it's hard. Change is hard for people. You gotta get people to want to go with you because it can't happen to them to be successful in that endeavor.

You and I have spoken about the patient experience. It's a passion of yours and you know, how, how do you feel about our progress as industry far and what, what do.

Pleasantly surprised that the, the patient experience has improves in, in, in a certain way over the next year. What way would the patient experience improve over the next year that they would be really happy with that you think is possible? What I find fascinating about the question is it's not even different about how we lead teams or have conversations with anybody.

And I think about what does that mean for us as. Living longer, healthier, happier lives. People want to age in place, they wanna be able to stay home, 'cause less expensive and it's healthier and it's safer and they have better routines. So sticking to medication adherence or following the protocols you need to to have.

'cause as you age, things just happen to your body. We just start to wear out. But I think about this. What options do you have if you can't afford a caregiver? Yeah, that's a good question. I'm not sure. And that's not even just for the elderly populations, what happens if you can't afford healthcare? And so I'm hopeful that that patient experience and something we're taking to heart based on what we've learned.

Because if a pandemic did nothing else, it really uncovered the need for true empathy to be present, to, to listen, to communicate. To understand what people's individual circumstances are, that we put a greater focus on the advocacy of wellness and the advocacy of helping people truly be healthy. Because when you're sick, it's scary, and if you're alone, forget it.

And I don't want anybody to ever feel like they can't get great care and feel like they matter individually because they're either. Alone and they don't have help or they can't afford it. Yeah. And I gotta believe that we still are taking strides towards what that can mean for us both as a country, but as we lead our own organizations.

Well said. I, I have started to close the interviews with a goofy question, but it's to some pretty interesting back and forth, so. What, what's the question or topic that I haven't asked you that you think would be interesting for the community, for, for us to discuss or for you to, uh, share with us? It parlays on our last topic, health advocacy.

So health advocacy with the augmentation of technology because. We've got a real problem to solve coming up. Yep, absolutely. Sarah, always, always great to catch up with you and we will have to do this again, I don't know, in the fall. Hopefully you'll, you know, free up an hour or so in, in the fall and, and you and I can, uh, catch up again.

We'll be great. Yes, we'll be at Chime, fall forum in person in San Diego as well. Wow. So those hallway conversations and all that fun stuff you set up for. For listeners and for people, I'm pretty sure you're, you're gonna have a line out the door, um, because we can . I'm looking forward to. It should be a great event down there.

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