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 Welcome to this Weekend in Health. It, it's Newsday. Today we have a new sponsor. We have a new co-host. We have a lot of new things. We're gonna talk about the, uh, transition for ACMO to go into health tech. Uh, we're gonna talk, actually, we're gonna. And we're gonna talk about the transparency rules, so we, we've got a lot to talk about today.

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Dr. Sines, who is the Chief Healthcare advisor for Worldwide Technologies. Prior to that, she has, you know, led digital health startups com therapy. She was a part of chief Operations and commercial officer. Is a pediatrician by training. Good morning San San and welcome to the show. I was so close to saying your name right every time.

Sorry about that. You got it right. Two outta three. Good morning. Thanks for having me. Well, welcome to the show. I'm looking forward to this conversation. You have a phenomenal background and I'm looking forward to not only having this conversation with you, but introducing you to the community. And you, you know, you started as AP pediatrician.

How, how did you get the technology background? How'd you get into technology? Yeah, so I started out as a pediatrician, pediatric hospitalist with Providence Health many years ago. Practiced for a few years, uh, with them. And you know, the EHR happened to be quite quite honest with you. And I started to see all my colleagues, you know, very talented physicians, uh, start to experience dissatisfaction, you know, all the extra clicking, you know, two hours a day.

Of, of extra clicking. And so I thought there's just gotta be a better way, right? Like you don't build an iPhone and never put any apps on it. So I kind of went on a quest for my, my own passion, you know, driving that to, to see what was out there. And so that led me on a 15 year pretty. You know, windy career path that brought me here.

But yeah, I went in search of, you know, applications that could actually make workflow better and automate some, some work off of a physician's plates. And that's how I landed there. And who knew that the EHR, uh, implementation and meaningful use would drive so many physicians into the, uh, technology world.

But it, it, it is a great transition. So you, you not only did that. Because a lot of physicians stopped there, but you then took the, the leap and went into the, the startup world. What, you know, how did you, how did you decide to do that and learn as an entrepreneur? Yeah, so after I. Did about six or seven years in, in larger organizations, you know, content and and CPOE companies back in the time, you know, back in the day I realized that, you know, for technology vendors that are building software solutions that you know, sometimes in these larger

Larger organizations, things just aren't moving fast enough. Right? And so with health tech and healthcare needing things happening, you know, yesterday because that industry moves slow enough as it is, I was really drawn to that startup space and I was really fortunate, um, in my first role to be pulled into some incubator work and

Some venture dollars that were set aside by Hearst Healthcare. That was one of my, um, first employers. And yeah, that's when I met, you know, three guys in a garage that were PhD dropouts of , university of Wisconsin. And you know, after looking at about 30, 40 different companies, it was amazing. You know, what they were doing at the time with workflow automation and.

So that's, you know, I got the bug and that was Help Finch in Madison, Wisconsin, led by Jonathan Baron. And, uh, yeah, I was with them for a few years and then stayed on and did a couple more startups in Madison. And, uh, the most recent was, uh, CEO of a teletherapy company called.com therapy. So yeah, it's been, it's been a great ride, you know, and you learn something new every day and it's great to also look back to see we've actually moved the needle, you know, for folks like me that were crazy enough to, to make that leap.

So it's rewarding. Yeah, it's What's the, what's the number one thing you learned at being an entrepreneur? You know what? There's always a way. There just has to be, right? I mean, there's times you just think there's. No way through this wall. And you know, one, the founder actually at CEO at the dotcom therapy taught me like, you know, who moved my cheese?

Like, you just, you gotta get to the other side and get to your cheese. Right? . And so I always hear that, her mantra, um, in my head, but it's true. I mean, the highs are high and they're ecstatic and they're wonderful when you get, you know, that venture capital money wired in after a year and a half, uh, journey, but the lows are low, you know?

And so you just have to keep remembering that there's just, there's gotta be a way. You know. Yeah. You don't even get to ask the question, who, who's my cheese? It doesn't matter who moved your cheese . You still have to find the cheese. So keep looking. That's right. That's right. . Oh man. So you're now helping, uh, organizations through worldwide technology and you know, where do you find yourself spending your time these days?

What kind of challenges are, are health systems focused in on? So, yeah, I had the unique opportunity to join worldwide the day the world shut down with Covid. So last, uh, March 26th is when I joined. And, you know, it was a really crazy time to come into a company like worldwide with such a large footprint and, you know, healthcare provider, payer side, as well as life science and doing it all remotely and doing it where, you know, your customers are also in a, in a, in a frenzy.

So it was a steep, uh, learning curve for all of us. So it's, it's been interesting, you know, my time the first three to four months, probably like a lot of other, you know, guests on your show was spent with Stop the Bleeding. You know, how do we get tents up? How do we get infrastructure put in place for, you know,

The Army Corps of Engineers to do, you know, covid treatments and how do we quickly put up virtual care solutions. We had one organization that called us on a Wednesday, and we had them up and running on video for visits by the following Tuesday, you know, across, uh, you know, a thousand different sites. So there was a lot of that, you know, the first three, four months.

And then I, I was just amazed, you know, talk about moving quickly, moving slowly in healthcare, you know, people moving so, so quickly. And now probably like other folks that you speak to, you know, it's, it's kind of moving in a, in a different direction. We realize that a lot of these things are here to stay.

So yeah, we're working with folks on how do we scale teletherapy, what do we learn by putting up the, the quick solutions that, um, may not be sustainable? What's the next frontier? You know, remote patient monitoring. How do we make that meaningful? A lot of work around ai, machine learning. I think organizations, especially also in life science have have seen the importance of having that structure in place and being able to really drive meaningful use out of their data.

And so I'd say, yeah, those three categories. And then I think what we're gonna see more of, we do a lot of work with our. Application services and AI team with revenue cycle, you know, and I think when everything's kind of, everyone can catch their breath, you know, there, there's a lot of things to fix that got, you know, broken there, obviously with, with the financial impact.

So we're starting to see a lot of people kind of planning for that as well and for the, for this year , so, so there's a few things going on. Well, and that's, you know, we're, we're doing the CIO interviews and that's, that's what I'm, I'm asking, one of the questions I ask every one of 'em is, what are your priorities?

And it's interesting, they break it down into two categories. It's like the priority to get through the pandemic and then the, the priority to really sustain the digital gains because one of the silver linings from this is, has really been the digital transformation that we had been pushing for the better part of a decade or or more seems to have really accelerated over the last nine, nine or 10 months.

A hundred percent. Yep. Things that were on a roadmap, you know, that were like on a six to 18 month roadmap happened within six to eight weeks now. And it's amazing to, to kind of wa watch that that happen. And I think they're amazing that, you know, they're surprising themselves that they can do that. So it's, it's pretty phenomenal.

Yeah. It should be interesting. Alright, so the first, we're gonna get to the, so the news first story.

From reporting to investing, but she, uh, still produces content, and this is a really good one. She breaks down the jump from being in medical practice to becoming a CMO for a health tech startup. So this is in your wheelhouse, I assume? It is. Yeah. I've actually, you know, I, when we chatted about this.

Online, I, I've actually given talks on about this to like developer, you know, conferences for folks, building apps for like all scripts and things like that. So yeah, I got a chuckle. Lot of a chance to chat about this today. Well, it's a great, you know, it's an SEO piece actually, search engine optimization piece.

It has. If you now search for becoming a, you know, health tech, CMO, I'm sure this piece is gonna rank really high because it an, it answers so many questions like, you know, the types of different roles and where do you CR CMOs and you know, do you continue to practice or not, right? It answers a bunch of the, the core questions.

So let's just mark March through some of these. I thought her first distinction was pretty interesting in that the roles, and this wasn't, was just people IED different types of CM roles that. You have AC of, and these are probably one of the more rare, but these are the people who are actually physicians who are leading the product development roadmap and, and those kind of things.

Then you have the CO of sales and, and they say, and I agree with this. A majority of the, of the physicians who get hired into these organizations end up in seat one a, flying around the country, acting as the spokesman for, uh, that product. And I don't think a lot of physicians know that they're signing up for that when they sign up for it.

But that's, that is one of the roles that ends up happening. Uh, CMO clinical operations, this person who into the workflow and sure that it's well.

The physician really to be the person you roll out at the conferences and they, they write papers and, and those kind of things. They're, it's about, you know, how it's about making your product synonymous with, you know, high, high-minded clinical, uh, studies and those kind of things. So it's, it's, it's connecting with those two things.

How have you seen this? I mean, I, I've seen all four of those. How have you seen the Cmmo role in health and, you know, categories have. Yeah, no, I think, uh, this is, this was a great article. I, I actually kind of disagree with a few, few of the categorizations from Christina. So hopefully, uh, you know, she, she won't be listening to this.

But, um, you know, in my experience, I, I think that the sales CMO is the hardest role to find. I mean, in the 18 years that I've been doing this, I think I can count on . Less, less than the five fingers on one hand, how many physicians I've met that can really get in there and do that sales position. And I think it's fundamentally the DNA that is required to, to draw someone into, you know, eight years of university and four years of residency and, you know, many years of practice.

I mean, that's a very different DNA. Than someone who, you know, is, is a hunter and, and a gatherer and someone that can actually ultimately, you know, drive something to, to help close. So that's really, I mean, across the board that's been what I've seen. And when physicians are brought in into that sales side of the organization, it, it's what you're describing where I think it's more of a clinical subject matter perhaps.

Right. And I think that expert, and I think that that works. But a, you know, just, I, I, I think, you know, we're trained to be like lone wolves, right? Like it's not a team sport really to be a physician, despite how much movement we've had towards, you know, . Patient-centered care and people working in collaboration, that's still solid, but at the end of the day, at three o'clock in the morning, the diagnosis is still yours to, to make over the phone or in the er.

And so I just think that it's been a real struggle, I think for a lot of my colleagues who've tried to make that jump to then, you know, kind of flip that and say, the center of everything I'm doing is this perspective customer or this customer, and I'm gonna actually, you know, listen and I'm gonna take in input and, you know, I'm gonna be comfortable being disagreed with and, and, uh.

You're being rejected, you know, and having divorce at my face and it's just, it's just different DNA so that, that has, uh, you know, been my, my observation. So, so put your, put your CEO hat on and you're, you're hiring so you know, you're, you're gonna hire a sales manager, you're gonna hire a sales organization.

You're gonna put them out there. You finally got your series B and you're ready to really scale up. But you know, if you start putting those people out in the field, they're gonna get hammered in those meetings. They're gonna sit across from physicians and clinical leaders. They're gonna say, you don't understand the EMR or whatever.

So you have to put somebody in a room who, who has the credibility and can say, Hey, I've been in your shoes. Lemme tell you how this works. Lemme tell you why it's valuable to you. So you're not really putting them out there to, to sell. You just, you really want the sales organization to sell and the sales manager to manage that sales organization

really want them in that room. To be that subject matter expert, but I, I, I think I agree with you in this respect. I see a lot of 'em burn because they, they, they sit there after a while and they, they, you know, they're in their 15th meeting of the week and they're going, what have I done? I mean, this is, this is not what I signed up for.

Yeah. And I think it's so personal too, because when you've practiced, I mean, I'll, I'll use Health Finch as an example for myself, right? You know, when I practiced, I did refills all night, you know, in the evenings. Like that's what I had to do. And that was our product, you know, automated refills. And so I had my methodology, I had my, what I think about I.

Refills, what my emotions are about, about that workflow and my experiences. And so I think as a physician coming in sometimes and in a sales role, uh, you, you really need to understand that like your experience isn't what that potential customer's experience is. And, and, and holding back that urge to say, you're doing it wrong,

You know, or like that, that's not how you know. And, and I think because when you're doing, you know, when you're in. Sales, you're not necessarily the user of the product that you're selling, right? When you're, when you're a sales individual, that's not a physician. And so that's sort of where I've seen a little bit of challenge.

But all that said, I think it's all about setting expectations and really making sure, and that's one thing where startups particularly who has time right? To even to, to create a lot of these processes. But I think the more you set expectations and, and let them know, like to your point, you know, your job is to

To be the expert and to just be able to, to relate and, and offer that credibility. I think it helps, but it's hard. It's hard to find those individuals to, that are comfortable, you know, doing, doing that type of role. So, you know, the other challenge too is a lot of startups sort of build the product first and then bring in the clinical folks.

I. And so I think getting someone in early that's that physician product expert is just, is so important. You know, I always say there's like two types of founders. There's the clinician founder, and then there's the, you know, uh, tech founder. And without, I mean, individually, there's a lot of challenges with them.

So getting those folks in sooner is, is, is huge. You know, it's, it's, it, I, I've watched this sales as a startup. I, I've watched the, the sales cycle on this thing, and, and, and the, the old adage is really true. 80% of your sales is gonna be, you know, word of mouth. Essentially, it's gonna be me talking to another health system and saying, Hey, we've got this challenge.

They're gonna say, I use this thing, call this person. That's a, that's a majority. And then your, your team has the lead comes from that, and then they go on from there. Either that or your team comes in, and then I make three. Identify the other health systems that are using it. The, the catch 22 is if you're a startup, uh, you have to decide how am I going to get that reference client?

And what a lot of people do is they sell ownership to get that client right. So you, you end up with. You know, money from Providence, money from a Cedar-Sinai Accelerator, or a Mayo or a Jefferson and that kind of stuff. And then you have to grow. And each one of those halves has their like network of health systems that are looking to them on how, how do we innovate?

And so you get a built in little sales thing, but then the next hurdle that you have to go over is you get, you sort of sell into that whole little swath of organizations and then you have to break out of that. Sometimes these health systems aren't in competition, so, you know, as, as, as accelerators or investors and that kinda stuff, sometimes you see them cross.

Yep. Cross. But other times it's like, nah, we, we have this solution and we're gonna use it 'cause we're a part of UPMC and you know, and, and, and this is what they're doing. There's so many barriers to, to. There is, and you know, I think really about qualification. So, you know, my, my whole spiel that I usually bring into an organization is really setting that engine.

I. And trying to, I mean, just like healthtech itself, automating previously manual workflow so it can go smoother, better, faster. So as much as you can do that qualification, there's so many tools out there now, you know, that you can use to research. And so even knowing that, okay, I'm selling a solution that's gonna work better in a centralized organization, like a centralized call center type organization because of the, the way that product works.

And then really Ty to hone in on finding those first eliminates a lot of pain, a lot of like duplication of efforts and, and just futile efforts, honestly. And to your point, you know, landing in a third meeting only to find out that, well, that's just not gonna fit because they're doing it this way or they're already using this product 'cause of the way they're doing it.

And so it sounds simple and you would think, you know, people probably say, well, everyone qualifies, but they really don't, you know, being able to qualify against, you know, these particular things saves a lot of headache. Well, absolutely. Uh, great article. She goes on to talk about the cultural challenges and some other things.

The, it's, it's out on, you can probably just search for it by title. Uh, the Ultimate Guide to Hiring Doctors Into Digital Health. Alright, you're gonna tee up, let's see, whatcha gonna tee up? You're gonna tee up price transparency. Look forward to this conversation. What do you got? Yeah, yeah. That's been near and dear to my heart.

We've worked with several clients on that pretty deeply for, for some building it, you know, from the ground up. So it's been interesting. I mean, I've been following that for I guess almost a year now, and I think, you know, it's really the first chance we've had to, you know, as a nation try to bring some of this transparency,

Unheard of right? Five years ago. Like consumers knowing the prices of their, don't you just go to whatever your insurance, you know, tells you to do. So I, I love that. I think it, it has the potential to, to really, uh, disrupt things. But of course, like anything that comes from the government. You know, it, it doesn't necessarily go through an outcomes review or an outcomes focused discussion and it gets put in place and there's a lot of arbitrary deadlines and things that have to be met without a, not a lot of focus.

So of course there's downstream consequences. But yeah, no, I think, I think it's, it's interesting what we're seeing, you know, at Worldwide is I. There are the large organizations where you would look to them and say they have the luxury of having staff, you know, having engineers and resources that can build this.

'cause there's some pretty complex requirements of, you know, machine readable files and you know, it has to be able to pull this information from multiple applications within your EHR and pr, you know. PM systems. So you would think, you know, these large organizations, they have the staff, they're gonna be quicker to do it.

And what we've actually seen is a lot of these large organizations are on multiple instances of EHRs, multiple applications for their rev cycle. And so we are actually helping organizations like that because it's so much more complex. Those are the ones where you have to build it from the ground up.

You can't just use Epic's price transparency module, right? 'cause you've got 18 different instances. So that's the, you know, there's that group and then of course the smaller health systems just don't have the resources to do it. And, and then the ones in the middle that are on one instance of Epic, they're winning

Like I'm seeing where, you know, I'm going to websites just, uh, just to do due diligence and you know, the ones that are able to just plug in the epic modules and customize it are, are doing great, but . I mean, it's January what, 30th and we haven't really seen it being standardized across the board. And I'm kind of concerned of, you know, health systems are gonna make this deadline.

Yeah. So, so help me to understand is, is this a dynamic price list or is this something where you can go in and do the research, plug the numbers into a, a spreadsheet, make it into readable file and put it out there? Yeah, it's, it's, it's dynamic. I mean, you have to be able to, based on that. Consumer's Health Plan, be able to, to access this information.

So, you know, you're pulling information from your contracts, applications up, your negotiated rates with your, your payers. You're pulling information from your charge master, which for a lot of these organizations, there's a lot of cleanup and, and work that has to be done there. And then being able to, you know, display that in a, in a consumer friendly, which is actually like, I think the wording in the, in the transparency role format.

So it's, it's, it's pretty complicated on the backend as far as the data sources, unless you're in a unified single instance of, of a lot of these different applications already. Yeah. So the, the article goes on and, and talks about it a handful of things. One is, you know, the, the challenge with this is clarity.

You know, they don't tell you. It's like, just put it out on your website. Okay.

Of certain hospitals pull all that information in, but I have to find it on those websites. It's not, uh, readily available. And then, you know, as you noted earlier, you know, it has to be in a, in a patient friendly format and that's really not something that's really well defined either. And so you end up with some people actually publishing a sheet you download take.

Uh, a tool, an actual tool that you put in some information and it pops some information out. Yeah, and so there's a lot of, a lot of different ways to do this. I, you know, from where, from where I sit, the, the federal government is doing the price transparency makes perfect sense. If you're trying to drive down costs, transparency is one of the ways that you, you drive down cost you where to.

I understand why the American Hospital Association is actually fighting this a little bit, and I assume they're fighting it because it's, it's not as clear as it could be, and they have to, you know, essentially put their pricing out there. I mean, yeah, we, we don't go to Walmart and say, you know, show us all your negotiated prices.

Yeah. And go to, I mean, we, there's no other industry we do this in. So, yeah, I mean there's been First Amendment, you know, challenges, arguments around this, this whole thing. You know, I think in, in my opinion, and I'm just, you know, a nobody, but I think that, you know, we probably are gonna move the needle more if the next rollout of this is upheld, which is up in the air right now, but.

Having payers do this, right? Because I think, like, you know, if you live in a mid-size to small community and there's only like one health system and maybe another one an hour away, I mean, it's great to see like what the pricing is, but do you really have that much, um, control over what you can do with that?

Right? I mean, it's what is your insurance cover? Who's negotiated and this is where you're gonna go? I think it's, I think it's good just holistically that it's putting pressure on . Hospitals to examine why is, you know, colonoscopy, I'm gonna make up this number, like $5,000 here and like $33,000 here.

Payer, it's, you know, $4,000. And I think then we're really creating a competition in the marketplace. And I think that, in my opinion, that's, that's really where we're also gonna see probably more value from this type of transparency. Yeah. Well, to a certain extent you get some of that transparency with this because if, if they're showing the negotiated rates to see, see some of it.

Yeah. And that's the kind of stuff tra you only see that through transparency. Yep. And you know, here's the other thing from a, from, again, a startup standpoint. I, I think there's a whole bunch of data companies right now. Chop it at the bit to get at this information, put it into a tool and you know, put it out on the app store, put it out on the Apple App store to say, okay, we, we now have information go in and look at services.

Much like GoodRx services everybody. Yeah. And I. I, I've actually read a lot of articles around, you know, the value of it, and then if you fold in these, you know, 'cause with the payers it'll be beyond the shoppable. Like, it's like they're, they're gonna be asked, I think, you know, by whatever year if it, if it's upheld all of their codes and, and the charges for it.

So, yes, I mean, I, I'm reading that startups are salivating at the opportunity to then, you know, curate this information and do all sorts of, all sorts of things with it. So it'll be interesting to see. Well, we're, here's what we're gonna do. We have some, uh, predictions here. We have a, a fierce healthcare article with seven predictions for healthcare, and I'm gonna go through them and you, and I'll just go back and forth a little bit on, on each one.

New. I mean, let's say it this way, the patient's experience has gotten a lot better. There are, there are more options, but to say we're in the driver's seat, to say consumers are in the driver's seat, I think is, is, is probably more aspirational than, than, than practical. What, what are your thoughts on that one?

Yeah. I tend to agree with you. You know, I think though that it, it has been . You know, we've actually seen where, where patients are now actually voting with their feet. I mean, we, we've had talked to a couple health systems that said, boy, we were so under prepared. You know, what we consider the patient engagement tool at our organization is our portal, right?

Like our EHR portal. That's, you know, like written in, you know, the code from who knows when. So, so as consumers it's like three in the morning, do I have covid? You know, I wanna be able to go and do some sort of, you know, . Triage, like a digital triage or, boy, my telemedicine experience was so bad, you know, I had to open three different apps and then it didn't work, and then I couldn't get, you know, and we've heard them say, and, and we're losing patients like the, the health system down the road, especially in like, you know, cities.

Has a much better kind of retail like experience. So it's the first time I'm sort of hearing that and I think, you know, consumers are feeling more empowered to say, this isn't good enough. Like, I want the Wayfair experience or, you know, the, whatever apps they like to use. So yeah, I think it'll fall somewhere in the middle of that where you know that they're gonna feel more empowered because of what they've experienced with this unprecedented, uh, surge for need, need for care during the pandemic.

You know, the word portal sort of says it all, doesn't it? It's sort of like having an AOL email address anyway. Yeah, yeah. And also, uh, bill, I think being able to, to go to the big box, you know, offerings now, like, okay, I can't get what I need from my health system. I'm just gonna go to CVS and, you know, or, you know, go to the hub or go to X, Y, and Z.

That didn't, that wasn't as much of an option even, you know, a year ago as it's gonna be and continue to be as we move forward. And the number of tests that CVS Well, that's, I think they're number seven prediction, but we'll get to that. But I think CVS probably did more tests than any health system in the country.

Uh, just because of their, just because of their scope. And my guess is when all is said and done, they will probably do more vaccinations than any health system in the country. That's my, I agree. I agree with you. Number two, virtual care services. But there will be risks. What's take on? Yeah. You know, I'm always kind of following this and looking at what CMS is doing here and there with these regulations.

I, I do think that it's, you know, I mean, I'm, I'm not the first one to think of this, but I do think it's, it's here to stay, right? I mean, I think there's gonna be a rollback on certain things. Like for example, like we made physical therapy virtual care allowed for the first time ever an emergency. Is that gonna continue?

Like, who knows? Like, some of those things might reverse, but I think that . The, the surge numbers, like where were we, like close to 50% at some point of usage of virtual care and now we're predicting somewhere what, like between 20 and 30? I think that's still a lot more than like five, right? Like where we were before.

So I think, you know, I know actually like every organization I talk to, there are no plans to pull back on their virtual care solutions. It's just about how do we tighten them up, align 'em, you know, unify them and scale them moving forward. Yeah. Virtual care will, the 20 to 30% is a, let's just say a, an appropriate correction.

We sort of threw everything at, at telehealth, and some of those things weren't real well suited. But during a pandemic, that's what you do. So it comes back 20 to 30. That's, those are, those are decent gains. We should, we should, uh, cement those gains and call that a day and then start building off of that, start going home care and other kinds of things.

So I think that's, you know, I mean, that's. That's a no kidding kind of prediction. Virtual care services will expand, you know, we're still in a public health emergency. Of course, they're gonna continue to expand. Yep. And this the, the next one I'm not gonna ask you to comment on because it's also a no kidding.

Pivotal, uh, in what way? Yeah, I kind of chuckled at that one because I, you know, I've almost been doing this for two decades. Like, how long have we been hearing like, it's the ear of AI and machine learning. I mean, I remember going to HIMSS many, many years ago, and so, you know, I don't mean to be cynical, but I mean, it, it, it's always been top of mind.

I think, you know, what's interesting now is that it's. I don't wanna say like commoditize, maybe democratize, where health systems themselves, as we talk to them, are saying, oh, we've, we've hired data scientists, like we've hired, you know, PhD data scientists that are helping us build this and that for, you know, social determinants of health or, you know, and, and you didn't hear that like three or four years ago.

So I think that. To that point, then yes, obviously the prediction is accurate, that if anything, just the inequities that we've seen and our inability to capture that information. I mean, 80% of that is like narrative information, non-structured in an EHR, right? Like how do we even know someone's social situation?

And then more importantly, how do we, you know, reach out to them? So I think, yeah, I think it's just more they, it's more widely acce, widely accepted now that there's a role for it in health systems and then in life science and pharma, my gosh, trying to crank out a, a vaccine, right? In three to four months.

If you don't have a strong AI machine learning play in your r and d acceleration, if you don't have high performance computing infrastructure to support it, then you're behind the times. And we saw how that played out with the organizations that that kind of won that race. I would say the, in addition to that, I would say the, the other area, we'll see this is RPA, robotic process automation.

We'll see back, back office systems, we'll see more IT systems, security, machine learning, and AI being layered in. So I, I think it is gonna be a, a year that it's significant growth in those areas and the clinical side pace safety. Right. So. It, it's almost like introducing a new drug. You can't just introduce new algorithms and say, Hey, you know, let's, let's launch this and do that.

But in the clinical setting, it'll remain, it'll continue to go slow, and the research and the research and development area can go fast. And the administrative side, it can go fast. So we'll see what happens. , I'm, I'm not gonna ask you to comment on this one. Shift to cloud will ramp up. Cloud has been ramping for a while, so.

And number six, Walmart will redesign healthcare and so will Amazon and Alphabet. I think they're all three of those are gonna do it a little differently. I, I think, you know, Walmart is already scaling up. Well, I mean, they're, they're already rolling out their, their larger clinics. They used to just pop 'em into a store and now they're actually building larger facilities in the parking lots.

Those are, uh, pretty integrated type facilities. I.

Imaging they have, you, you name it. It's, it's a, it's a pretty well thought out model to build those out. Now there's only maybe five or six of 'em in the country right now, but yeah, that'll scale out. Amazon's doing Amazon Health with their employees and we'll see where that goes. And then Alphabet is really their partnership with Mayo.

Be the player that you take this health data to, you anonymize it, and you generate insights from, so each one of those are gonna make, uh, different contributions to redesigning healthcare. What, what are. No, I, I absolutely agree, and I think, you know, if we touch on Walmart, I mean, just how much they've already invested in scaling, how many clinics we know they're rolling out in the next two quarters.

I mean, it's working. I mean, I think about myself, like I have a, I, I go to a very well-known national health system for my, for my care. I have. Had times where I've called like three, four times within two hours and I can't even get a human to answer. I'm wadding through layers and layers of, you know, just people and, and barriers.

And wouldn't it just be great to walk over to Walmart and get my care? I mean, it would, and I think that there, health systems, we touched on this earlier, but are gonna see some competition there. And I think it's, uh, the consumers are gonna accept this. You know, quite readily as they start to experience this new kind of retail experience of care where you're not on hold and you're not being, you know, forced to, to wait and, and be told things when you really wanna be able to give, be given a choice and have it be done on your time and, and your convenience.

Yeah. And that, that gets pretty close to one of my, one of my predictions, so I won't go there. Social determinants effort. Last one. Social determinants efforts will shift from aspirational to operational. Uh, I, I hope that's the case. We did an interview with, uh, Intermountain and the United Way and the stuff they're doing in Utah is, is, is fantastic.

But you also hear when you.

It takes institutional will. Uh, I, again, I just think it's, it's aspirational. I'm, I'm hopeful that that will happen, but given that a lot of health systems took a, you know, I mean when we did, when we did the elective surgeries and we took those out for three months, that that hospitals.

And I had the fortune of working with a company called Pieces Technology. I think they go by pieces now, and they've been working on this for over a decade. And when you look at how complex it was, you know, they really kind of pioneered working with local community organizations. They're all on different technology.

Platforms, right? They're all using different CRMs and things like that, so they had to overcome that. And the, the health system, ut Southwestern Parkland, you know, health system at the time, they had to invest the dollars, like, to your point, and that they, they recognized the value of that, the ROI of that, of the reduction of readmissions and identifying people proactively to treat them differently upon discharge.

They were very forward thinking. And I think to your point, it hasn't been widely accepted and now the dollars may not even be there. But I think it put it on the map and I think that, you know, with organizations looking at, at the forward-thinking, ones that knew this was coming almost a decade ago, I'm hopeful that we are gonna see, uh, uh, uptick on this maybe for the first time as, as a, as a health, as a healthcare, you know, a company and a country of how we're delivering healthcare.

Fantastic. So. You know, it's, it's pretty easy to sit here and poke holes in other people's predictions. Let's, let's some of, let's. I mean, I don't think I'm the first to predict this. I think we touched on it, but I think there's gonna be a lot of, well, expansion of how we already think of remote patient monitoring, but also some disruption and innovation on how we think of, you know, remote patient monitoring.

I think before the pandemic, you know, there was some focus on chronic disease populations, right? I mean, they over utilize healthcare resources disproportionately to the percentage of what they represent in the patient population. So, you know, diabetics and . Going home with glucometers or congestive heart failure, patients with scales and things like that.

But even then, it was a very, very small percentage of health systems that were doing it and. So absolutely. I think that's going to scale. As we've seen what's happened to Heart family, we have 50% increase in mortality for heart failure patients during the pandemic because they couldn't come in. So, you know, health realizing that, boy, we should do a better job taking care at home.

But I've been really excited about the work we're doing with organizations around even acute care, remote monitoring. Right. So, I mean, COVID obviously triggered that. Let's send people home and from the ED with the pulse oximeter. And, and collect that data, data, you know, passively and, and react to it. But just seeing it in general, you know, pregnancy, what if we sent everyone at high risk for, you know, preeclampsia during pregnancy, home with, you know, blood pressure cuffs and things like that to pre prevent.

I. What if, even in urgent cares or eds, when people have three hour waits, you know, putting them on some sort of a data collecting, you know, uh, device where we're able to track and send the, you know, appropriate notifications. So there's a lot of that going on and, you know, we're actually kind of working on some of those first time solutions in those spaces.

So I think that, I predict that that's really gonna take off as well. Yeah, and I, I think one of the enablers for that, and not, not to comment on yours, , on your prediction, one of the enablers for that is gonna be, I think the digital divide last year became really apparent. And the, you know, the fact that we sent these kids home to study from home and they, they didn't have broadband, they didn't have computers.

There were people that, that, uh, tried to get into telehealth and whatnot and couldn't. Complete the call. So I think one of the first things you're gonna see is in the infrastructure project outta this administration, and part of that will be to address this, this broadband and this digital divide that exists.

Yeah. Uh, and, and I think healthcare is gonna be at the center of that conversation. And, and that's gonna, that's gonna give us a even broader foundation to deliver what you monitoring.

Sorry about that. Um, no, I agree a hundred percent . So yeah, my prediction on this one is that the federal health emergency is gonna continue through the end of this year. I, I, I don't think we should anticipate any change to, to that status. And what that means is that the telehealth funding will remain in, in place through.

So now the design, whatever you do around telehealth and.

The funding won't always be at parity. It will, it will change based on research that'll be done this year based on the, the data that was collected over the, over the pandemic. Obviously you'll see in behavioral health services, I think that will continue to be funded at parity moving forward. Other things, they're gonna look at what the.

You know, the amount of usage and the, uh, quality and the outcomes and determine what, what level it's gonna be funded at. But the good news is you have a year, you have a year to build this out, to really, uh, cement those gains and to build out a program. And with funding for a year, there's a, there's an opportunity to build it with an eye towards, okay.

Maybe in a year from now, we have to find our own funding source for this, and it could come in the form of lowering the cost of delivering services. It can come in improved efficiency or even in outcomes, or it can be, as you were talking about earlier, the ability to draw more people into your health system because you're offering those services and.

So that's, that's sort of my prediction for the year. The, the, unfortunately the federal health emergency will continue, we'll have a funding source for telehealth and, uh, health systems will have a really, now about an 11 month runway to really cement the gains in telehealth. Yep. I agree. How, how about you?

What's the next one? You know, uh, it's a. I hope it happens maybe more than it's a prediction. You know, I was really, as a pediatrician, I've always sort of followed alternative treatments for things like ADHD. It, it's amazing how much of that we see as pediatricians, right? I mean, you only hear about the cases where they're hyperactive and you know, you put them on Ritalin and you know, they're disruptive.

But it is so much more common than, than we know, and it's sometimes the more subtle cases where it's inattention, you know, having trouble kind of focusing on things that you need to focus. Quietly, so you may not be as, uh, disruptive. And so people don't notice. So I've, I've always been really fascinated and hopeful that there's other solutions.

And so I think with digital therapeutics, you know, for the first time we've seen, you know, FDA approved digital therapeutics that are software based and, you know, when we look at, you know, I believe is the one that did the one for, uh, software for ADHD and like proven efficacy. You know, at the level of therapy or even medication, I think that that's really exciting for me as a health tech.

Person to see us doing that for the first time. So things like substance abuse and mental health challenges around, you know, insomnia. Even like with I think, para therapeutics. So I'm really excited to see more of that happening and I've known over the years just chatting with entrepreneurs from idea stage to, okay, we've received, you know, series A funding and we wanna get this done.

That pivotal acceptance with the FDA happening this year, I'd love to see that market explode. Fantastic. My, my last prediction and then we'll, uh, we'll close up is yeah, there's gonna be a return to bundle payments and, uh, an emphasis on bundle payments. This is not rocket science. Because this is what we saw during the Obama administration.

I think we'll see return to that in the Biden administration. And the reason I, I look at this as ACIO is because orchestrating the continuum of care becomes critical and it's really from diagnosis until recovery and, and in some cases the patients are moving in and out of your health system into.

Different care venues that aren't controlled by the health system. So, but the, the main entity is responsible for controlling quality and cost across that continuum, regardless of if, if you are the hospital or, or if you have the, the, the recovery in the rehab, or you don't, you have to still control it from one end to the other.

So we're gonna need technology to orchestrate the experience. Manage me, measure the quality, move the data around the ecosystem is gonna be critical and likely move people into lower cost venues as quickly as possible. So there's just something to keep an eye on. When those bundle payments come back, we are going to be really tasked with making sure that the data moves across that entire continuum.

We track it well and we can deliver at a high quality level. So. That's, and so if people wanna comment on our predictions, feel free to do that online. We would love to get your feedback. Ena, thank you for, thank you for joining me today. This has been a, a wonderful conversation. Yeah, thanks for having me very much.

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