Jeff Johnson discusses Digital Business at Banner Health
Episode 9621st June 2019 • This Week Health: Conference • This Week Health
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 Welcome to this Week in Health, IT influence where we discuss the influence of technology on health with people who are making it happen. We are the fastest growing podcast in the health IT space. My name is Bill Russell. We're covering healthcare, c i o, and creator of this week in Health. It a set of podcasts and videos dedicated to developing the next generation of health IT leaders.

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Very helpful. And you can subscribe to the newsletter on the website. So, let's get to the show. Uh, today we're joined by Jeff Johnson, VP of Innovation and Digital Business at Banner Health. Uh, good morning Jeff. And, and thanks for, uh, joining us on the show. Good morning, bill. Thanks for having me. Great to be here, man.

So that's that. As you know, as I've said before, that's a, that's a great title. Sounds like you get to work with, uh, you know, really cool stuff, really cool people. Uh, but not too long ago you were the VP of Digital Health, so there's, there's a lot of, I. A lot of change, including a new office for you, uh, there in the background.

So give us an idea on the role and, uh, and and, and what, what it entails to be the VP of Innovation and Digital business. Yeah, well, thanks for noticing the NICE office I've got here with absolutely no atmosphere whatsoever. Um, that, but it's, you know, that's actually part of, of the change here, the growth.

I've, uh, I'm on my third job title in two years at Banner. Um, this is my third location as well. So we continue to grow this innovation and, and bus, uh, digital segment. But, um, yeah, you're correct. I started, uh, with Banner with this notion of a digital garage where we thought, you know, we need to start really making some headway into a digital strategy.

And we realized really quickly, well that's, you know, we can't toy around in this stuff. This has gotta be a core competency and, and really have leadership at a higher level in the organization. So we, it's evolved into this role of digital business and innovation. Um, our approach to this is that it's not traditional.

It, it's not traditional marketing. It's, uh, it's a new competency. It's a new area of focus with dedicated leadership and accountability. I. And, uh, I'm in the middle of, of all of those other areas, but, uh, it's the way we've, we've set ourselves up. Yeah. So that's, uh, so, uh, this whole episode's gonna be about, uh, about digital health and, and digital consumer and all those things.

Um, I. And so we have some history. I, uh, I at the Scottsdale Institute, you were on a panel discussion with four similar types of roles. But I think one of the things that was interesting from that, uh, you know, from that, uh, panel discussion was I. It very similar, but every health system seems to be doing something a little different.

Was that, was that your feeling as well? It is, and I, I, I get that sense with every health system I talk to that everybody's kind of cracking this nut a little bit differently. I. I'm careful not to say that the way we're doing it is the right way. I think each organization, uh, needs to figure out the way, uh, to approach it for themselves, uh, and, you know, based on their legacy and their skills and their leaders and who they have.

But, uh, so far this is an approach that's working for us. So, so prior to that, we had, we had some conversations leading up to the panel discussion, and you, you sort of mapped out, if my notes are correct, I think five areas you have, uh, Uh, a digital consumer, digital health engagement, digital workforce, digital experience, and digital garage.

Are those, is that still accurate or have you morphed that a little bit? Well, first of all, nice note taking. That's impressive. . I didn't think anyone listened to when I talked structure, but that's, that's nice. That's pretty close. The digital garage, we've sort of hold back and just that the whole, that's just part of digital business.

So we really are focusing on those three fronts. The consumer, the more deeply engaged patient and the workforce. And then that digital experience team, which is really consumer centric design ties to all of those. And that what was the digital garage is really our interface into it, where we connect with them, that role is morphed into how do we take these products and these product designs and work really closely with our IT teams to enable them.

So basically that's the same, but it's kind of the way we divide and conquer such a big space. Well, yeah. And so it, it, it makes sense. So you have, you have sort of an outward facing group that's looking at the digital consumer. You have a, uh, for lack of a better term, sort of a pop health group that's saying, Hey, look, we need to, we need to engage these people where they're actually making health decisions, which is 98% of the time not within our four walls.

Right. You have to look at the internal user, and this is one of the things we, we, uh, sort of gloss over when we're talking about digital, but, uh, everything that's happening within healthcare is, has a digital flavor to it now and is changing obviously the E H R and the digital record. Um, the, the one I'm not overly familiar with is digital experience, but I, you know, I How would you, how would you elaborate on digital experience?

What, what exactly is, is that? Yeah, these are interactive. Uh, designers. So the team are, uh, folks that come out of the agency world, out of, uh, web design, mobile design. Um, they're, they're, they're, they put the, the and they do the consumer research as well. So it's very much a, um, we start first with what does our customer want?

What is our customer telling us that they want? Then we begin translating that into a product or a solution or a service that meets that need and the digital experience very involved in. Information gathering to help us drive those solutions, uh, to something that our customers actually asking for.

Rather than starting on the, the tech side of it saying, Hey, we have a, we have a bunch of technology and solutions. What should we give to the customer of what we've got? It's kind of, they help flip that. Coin over, if you will. So you have a digital agency embedded in your group that, that is, uh, getting the voice of the, of the customer, uh, putting together communication plans, helping to, uh, design, I guess, or, or, uh, craft the features and those kind of things.

Is that, is that essentially what that is? It's a lot like that and, and, and pretty leveraged team. So we, outside of my area, we do have a whole consumer insights team in our marketing area that's doing research. Um, so we leverage all the data that we get from that. We measure n p s just, you know, constantly at every touch point of our organization.

Um, lots of verbatim things from hcaps and other things. And so that's part of it. And they, that that'll oftentimes be a starting point, but the design team will actually, as they start building digital experiences and products. They're constantly on a daily basis testing what the concept is with the customer.

We do that through sort of a crowdsourcing platform. So every single thing that we're thinking about putting into that digital experience, we run it by, uh, you know, our customers and get feedback. Oh, that's great. So, so you mentioned n p s, that's, um, you know, that's one of the things I heard from the panel was that, uh, more and more n p s is being used as the, the net promoter scores being used as the, uh, as, as a, at least a metric to augment the other metrics.

Um, so is, is that, is that something you guys are moving? What, what metrics are you using to sort of measure your engagement with your consumers and, and your internal consumers? I. Yeah. Uh, we're, we're starting to use more and more, right? I think the old metrics of just, uh, some kind of a traditional r o I like, are you getting the patient to come in and use a service or, or, you know, they don't work anymore.

So we're looking at lifetime value of a customer and these engagements, um, for example, we're doing a lot of work right now to rethink the entire emergency care experience. Well, part of rethinking the emergency care experience to the benefit of the customer is, They shouldn't be in the emergency room. A lot of times they're showing up there.

Right. And if, if the health system does that and moves them out of there, well that, that has an impact on traditional revenue streams, right? And the catchment that we use emergency rooms for, what is the right thing to do? So we've gotta figure out how do we capture the value that we're giving to the customer for doing that.

So sometimes we'll look at the lifetime value of that customer and say, okay, we did the right thing for her. She didn't come in at three in the morning with her two toddlers and spend six hours in the emergency room. Because she didn't need to be there. But now we've earned some loyalty with her because we gave her the right service that she needed by, by sending her somewhere else.

Lifetime value, net promoter score, all, all new metrics that we're using. Well that's, uh, you know, that's an interesting example that you give. 'cause it's, it's one of the conversations, this is why it needs to be digital business, I guess, because at, at, at, to some extent, you're changing the business model.

Um, Because when that person doesn't come into the emergency room, there's a certain amount of money that doesn't flow the way it used to flow. And it flows in a new, uh, in, in a new way within the organization. So how do you, how do you engage the entire business? How do you engage the c f O, the operations people, the clinicians, to sort of rethink how we've done things in the past?

Yeah. And I just noticed I lost my light in this new office. So, am I in the dark or can you see me? Okay. You know, I can see you fine. Okay. There's sort of a glow around you, which sort of works. Oh, that's, that's even better. So . Yeah. You know, it's a good question. Um, and you're right. That's, that's where digital business really is.

The way we're approaching it is different than those traditional areas. It's really how do we, how do we change the business digitally or use digital to change the business? So I like to start, you know, at a really high level, what, why does my group exist? Why are we here? At Banner, you know, we're such a unique system.

We've got everything we have. We have academic medicine, we have community medicine, we have quaternary care, we have urgent care, we have critical access hospitals in rural regions. We've got special department, you name it, we have it. It's just such a broad platform of care. Um, our charge and digital is how do we take all of that value and extend it and expand it further and further away from the traditional four walls.

So it's influencing our customer's lives, um, much more, uh, comprehensively than it's today. Whether that's helping them get into those four walls at the right place, right time, right cost, or keeping 'em out of them and still giving the care and the health that they need. So we start fundamentally with that kind of a concept and tie that right into our mission and our purpose statement as a company.

Yeah. So how do you, how do you prioritize? So clearly you. You can pick any one of hundreds of workflows and say, all right, we're going, we're gonna rethink this one. I mean, how do you, how do you sit down as a group and say, we're gonna focus on labor and delivery, we're gonna focus on orthopedics. What, how do, because you can't do it all.

I mean, there's, we'll talk about budget in a, in a little bit, but how, how, how do you prioritize? Yeah. So we, we look at, uh, those insights again, we're always looking at what the opportunities are for. To improve the experience for the customer. And by experience, I mean I include cost and quality as well.

And so again, having those channels in my area, we have priorities in each one of those. And so I'll give you an example. In the digital consumer, we realized that access was a huge opportunity for us. Our customer needed a better way to access the system, so we put a big priority on just simply accessing banner.

And I'm not talking about so much, you know, the marketing outreach of how you reach somebody and um, uh, you know, through social media or through a Google ad buy or those kinds of things. But how do you really make the system accessible? So we've, we, we've focused in on that as one example, and we built a blueprint.

We, um, we did some really interesting work with our customers rather than, and, you know, I, I don't, I kind of have this fatigue. Journey maps. I don't know if you do as well, but like, I don't ever want another consultant come in and tell me that we need to map the customer's journey. Like, I, I think we've mapped it enough.

Uh, what we lack is a solution that the customer really wants, um, not just digitizing the one they have. I. But, but we did a really interesting, uh, some really interesting work that we're in the middle of where we brought in about 25 of our customers and we just sat down and we had them tell me what the, tell us what the journey really is and what it should be.

And we did that, um, using a proxy methodology where we showed them . Here's all these other digital experiences in your life. Here's how you're using Rent the Runway to get a gown for this big event. Here's how you're using Pac Point. Tell us how you're using Pac Point to prepare for a trip. Tell us how you're using LG to buy a refrigerator.

And then each one of those, we said, now if that was a healthcare service, what would that mean? And so you, you can imagine like, okay, LG is really cool. I can stand three refrigerators up to each other side by side, and I can kind of compare cost and quality and availability. And said, why can't I do that with your services?

How come I can't compare three docs side by side? I can't compare emergency room, this doc and urgent care side by side. And so we, anyway, we took all of that learning and we built what we call the blueprint, which is an actually a, a visual representation of what it could be like to interact with this, um, digitally.

Both in both through voice assistant, through native mobile, through web, uh, through chatbot. Uh, painted this really compelling story and then to, to answer your earlier question, we take that out to all those stakeholders and say, This is what Sophia wants. This is what she's asking for. This is how we all need to fit into this.

So that revenue cycle isn't building one experience over here on the bill Pay scheduling is building another experience over here, and Patient Edge is building. They all need to come together. So those blueprints become. Helpful in bringing us all together around that customer. So, Sophia is your, uh, your digital consumer persona.

Yeah. Did I say Sophia? 'cause I, I, it's such a habit here that if I say it, I apologize for saying it without telling you who she is. Uh, yeah, you did say it. So, so elaborate, elaborate on your persona. Yeah. So this, this is really, uh, I think something that . Works really well. And this is, this is the, you know, all credit to our chief marketing officer, Alex Morehouse persona, uh, named Sophia.

And we have, you know, we have multiple personas that we might use in product development to represent different, um, you know, segmentation. But what Sophia is, is a way to take this, you know, this, this idea, this, this value that we have that we're customer obsessed and this mission statement. Um, make healthcare easier so life can be better to really start to translate that into something tangible.

That employee in this. So Sophia became the face of that, and she's a real person. Um, she shows up at, uh, leadership events. We have videos with her. Uh, we have cardboard cutouts of Sophia that people take selfies with in our hospitals. So every employee rallies around this persona of Sophia and they think about what they're doing in terms of

How does this impact Sophia? So kind of cool. It's, it's, it's really helped in digital, in all of the spaces. I'm sorry. So she's actually a real, like person who's, who's, uh, who receives care at your facility? No, I mean, she's a, she's a. An actress, I should say, for purposes of pictures of her and those kinds of things.

But you know, she needs the real face. Yeah, yeah. So you, so it's a human being that people, people know, like if you saw her and people have seen her, if you see her in the grocery store, you would say, oh, that's Span. Or Sophia, even though that's not her real name, Right. And, but what that ends up doing is, uh, personifying the, the people we already know.

It's the people we work with, the people in our community, the people who stop us at dinner parties and say, oh, you work for Banner. You know what would be great if you guys did this? So she sort of personifies that voice of the consumer saying, Hey, this is how I want to sort of interact with healthcare.

Can you guys do this for us? Exactly. And, uh, you know, yesterday was interesting. I did a walkthrough almost all day with a, a big consumer tech company. I won't, I won't mention the name, I don't know if they want me to, but you'd know who they are, right? Um, and we, they came out to explore some things that we could do together in health.

And so we walked through our cancer center, we walked through an emergency room, we walked through an urgent care center. At the end of the day, they said, Wow. Never been in a hospital system where everybody's cohesively talked about either Sophia specifically or knowing talked about the customer as the very first, uh, part of the interaction.

It would. So, so it's worked really well to help. You know, do that translation of the, of the, the mission to, to something tangible. So you have, you have internal customers too though. So you have, uh, people whose lives have been, uh, really dramatically changed by the introduction of the E H R and you know, they're ending up adding an hour or two to their day.

They're doing a lot of documentation and those kind of things. Are those areas you're looking at or are those areas you are trying to address? Well, we certainly are. The banner. I'm not as directly involved in some of the EMR optimizations on workflows and those kinds of things, some things around the edges.

'cause what we found is that our clinicians are just like our Sophias in the sense that dealing with banner is big and complex, and having the right kind of access to what you need at the right time, at the right cost. So there's a lot of things that we're doing outside of that E M R to improve that experience digitally.

Yeah. So we're, we're doing things around the edge. So, um, talk to me about your partnerships. So strategic partnerships, you, uh, you're bringing in vendors and, um, I don't know. And, and, and other innovation partners. A as we've talked about on the show before, and we've talked with others, the, the models are so varying.

You have, you know, sort of a, a, a model within health systems where they're investors, they're actually VC or even private equity you have. Um, and they're, they're really looking to, uh, almost create a new business model. Uh, but we're also finding others that are saying, you know what, we already have a.

Multi-billion dollar business, that's our business. And what we want to do is to optimize that. Um, talk to me a little bit about your, your model and how you think about partnerships and how you invite in the innovation community. Yeah. I, I think our approach is kind of in the middle of what you said. We, we certainly are looking at investments in strategic partners.

Um, I focus more on what I would consider partnership relations than traditional vendor relationships. So certainly we leverage those. First and foremost, when we are dealing with a partner, um, whether we're gonna look at investing in them or not, it's, can we show that there's real value here at Banner?

Is there something that it's really doing to enhance our business model? And then secondarily, if we believe that that is the case, we may choose to invest 'em because we think we can enhance their service to the market and help them show that the, you know, the demonstrated value in our environment.

Just a venture fund just to best for, to build our own software companies just for a go-to market approach. So the, um, you know, you have, you have to fund this group. It's, and you know, people have, uh, People have talked about this and have asked me questions about this. Uh, you know, the, the one that everybody likes to talk about is, is Providence.

'cause Providence has like 200 people in downtown Seattle that are not a part of their IT organization, but are, you know, former Amazon people and they're doing all sorts of stuff. And I've had people ask me questions like, what are 200 people doing? I've had other people say, where's the money coming from?

And, you know, at, at some point I'll get Rod Hockman back on the show and I'll ask him some those direct questions. Um, but you know, how, how do you fund this and, and what roles do you look to put in place? Yeah, so funding, you know, it's, it's just part of our capital and operational budgets is what we're doing right now.

We, we do have this notion that especially on the innovation side, we'll create this virtuous cycle where those investments will help bring money back in to drive further growth. Uh, but right now this is part of the way we see doing business. It's gonna be done digitally, and so it's an investment that we need to make to do this.

A lot of it though, I mean some of it Bill, is like the ROIs and some of this are so easy and it's just such stuff on the top, um, that it makes a lot of sense. Like an, an example, we have an urgent care, uh, service that we provide and, uh, we had, you know what a lot of organizations have, you could, the customer could come in.

Online and you could capture them digitally because they could make that urgent care appointment. But it was bad. It was a bad experience. It was an out of the box bended solution. When we tested with our customers, they didn't have a lot of confidence. They didn't really trust it. It wasn't easy to use.

So we did, did a front end redesign on that. Um, and, you know, tied into backend systems or the APIs. But the result was when you design that experience for the customer. We went from an 11% conversion rate online for people seeing that offer to check in online and actually showing up to a 42% on the day we launched it.

So that's an easy thing to say. Well, that's a good investment in designing for the customer and providing a digital product that matters because, Increase in your, um, digital capture rate for, for urgent care. That's just one. So there's a lot of easy ROIs to do in digital, still in healthcare. Uh, so there's a lot of 'em.

I mean, it's, it's not hard to find those kinds of opportunities. Uh, yeah, there's a lot. Um, I'll give you another quick example. Um, we have a Medicare Advantage population and we're trying to engage the seniors much more in their healthcare, and one of the ways is to do that is to get them in for their annual wellness visit, get that health risk assessment done.

We had about a 0% compliance on health risk as assessments for Medicare Advantage folks, and it's because we would ship 'em a piece of paper, expect 'em to fill out the piece of paper and bring it to the docs. So we asked our docs, I go, how often do you see those? I go, what are you talking about? I've never seen them

We created a little chat bot that actually, that the member doesn't even know they're filling out the H r A really. I mean, they know they're giving this information, but it's not like a form. They're just answering questions in this chat bot. And we went from about a 0%, uh, risk assessment completion prior to visit to, uh, 51% completion by putting it into a digital modality.

that had a, and that had a, an effect on no-show rates. So there was a positive correlation if somebody engaged with that digitally before the visit, their likelihood to show up for the visit also went way up. There is some, there is some easy picking still. So, so Jeff, it's interesting you said, you know, if I have another, uh, journey map, I'm journey map fatigue and those kind of things.

But, um, you know, I, I, I am still going across the country. I'm still talking to a lot of different health systems and while some of 'em are starting to build out, Some journey maps and those kind of things, they're, they're not necessarily in tune with the experience that people are. I mean, they, they know that there's areas to improve clearly.

Um, they know that there's frustrations with the consumer. They know that, uh, you know, people have trouble getting to where they need to get to. They know there's, uh, there's some obvious low hanging fruit, but Yeah, but they don't, they don't necessarily know where to start. Where should they start? Well, um, for us, we started on big access points like the emergency room and urgent care that I mentioned.

Those are just . And then we're also working on our primary care access as well. We're just not quite as far down the road as we are on that. But did, did you, did you start by saying, look, we've gotta get, uh, sort of a digital vision in place. We have to get people on board, we have to get marketing to work closely with this digital business team.

I mean, was there, was there sort of Oh yeah. Work that went ahead of that? Yeah. You know, I think just, I think part of the strategy for us is the creation of a digital team, because then you're putting a big stake in the ground that this matters. I. That there's leadership in the organization, there's accountability in the organization for this to happen.

So I always tell people part of the strategy is how are you going to, how are you gonna form the structure to pull this off? That's where I guess I would start, is, who in your organization owns this? Yeah, it's, so how do you work with it? I, I have a lot of IT listeners. So how do you, how do you work with it?

Well, hopefully very well, um, you know, we have a fantastic IT team here. In fact, part of this new move that I'm involved in, we're putting, uh, some of my digital teams right, exactly in the same floor as parts of the IT teams that we work the most closely with. So it, it's a very, very collaborative joint effort in this space.

I, you know, every organization's different. My role could live inside of it. In some organizations, uh, you know, at Banner it made the most sense to put this into strategy. Um, but I, I think it kind of depends on the organization where it makes sense. But you do need someone that's owning it, that's setting the vision, um, that's accountable for it.

Yeah, so you're reporting into, uh, Scott Norland and, and so that's, that's strategy. Yeah. It reports up through, uh, what does it report directly into the c e o or somewhere else? Reports into our chief clinical officer. Oh, interesting. That is interesting. Yeah. And then, and then marketing and my role both report into strategy and growth and to Scott.

that is, uh, that's fascinating in and of itself. Um, you know, I mean, there, there's so many different areas and I'm actually going to, uh, I'm gonna ask you a bunch more questions after, after we get on the line, and I'll share those on social media and, and those things. And, 'cause I, I think there is, you know, I, I'd love to hear, you know, how do you handle moonshot projects and, um, you know, how do you handle.

Failures. I mean, failures are a way of learning. How do you change that culture? So some of those questions I'm gonna ask after, uh, you know, after, after I do the close here for our listeners, I know they're, and this is like the third show I've done this on. I'm trying to keep it to a half hour and it's hard 'cause so much to talk to in this topic.

But I'm gonna try to collect some more. So Jeff, thanks for coming on the show. Great discussion. Uh, anything you wanna leave with our listeners, ways to follow you? Uh, interact or anything like that. Uh, you can find me on LinkedIn's probably the easiest way of love collaboration. We're trying to, you know, trying to really let the world know that we're open for partnerships and relationships, uh, maybe better than we've done in the past.

Uh, see a ton of value in that. So, uh,

Absolutely. So please come back every Friday for more great interviews with influencers. And don't forget, every Tuesday we take a look at the news that's impacting health. It. This show is a production of this week in Health It. For more great content, you can check out our website at this week in health or the YouTube channel at this week in health

Thanks for listening. That's all for now.



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