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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. You're in for a real treat today. Kevin Mann joins us. He's the chief executive for the Southern California markets for Providence, and actually he's not even in that role yet.

He is, uh, starting that role in March. His current role is the EVP Chief Executive for the Physician Enterprises, for all the Providence markets. And I'm excited to share this conversation because when I became ACIO . Kevin was an executive at the organization I was at, and he helped me to really learn the business of healthcare.

Kevin has extensive knowledge. He's a technologist at heart, and I'm really looking forward to sharing this conversation with you. 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. Is to send an email to partner at this week in health it.com. 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. Today we are joined by Kevin Manon, chief Executive of Southern California for Providence. Good morning, Kevin.

Welcome to the show. Hey, good morning, bill. Good to see you. You know, Kevin, I, I'm looking forward to this conversation and I, I do have to give you some kudos. When I became CIO at St. Joe's, we worked together and I knew. I knew so little about healthcare. It's, it's almost scary how little I knew. And, and, and you were fantastic.

You came alongside of me. You explained how healthcare worked as much as you possibly could. I remember my favorite story is, uh, I don't know if you remember this, but I asked you, how do physicians get paid? And I thought, you know, this is a what, A five minute conversation. And you said, uh, alright, set some time for Friday afternoon.

And, and we sat down and two hours later you had filled the whiteboard with the different. Mechanisms and ways that physicians get paid, and I'm not even sure we finished that conversation in those two hours. It was, it was, it was kind of fun. Yeah. It's it's a complicated business from that standpoint, isn't it?

Yeah. Yeah. It was, it was kind of fun. So, to get us started, tell us a little bit about, about your role at Providence and what kind of work that you're overseeing right now. Yeah, so I've been.

A couple of different roles. Recently, I've worked with all the medical groups across the system, and we have about 10,000 providers in our organized medical groups. And so I've spent several years working in Washington, you know, Alaska, California, Texas, et cetera. But mo more recently, I'm, I'm going to be, um, running the Southern California market, which is, which is really all hospitals ambulatory.

LA and Orange County markets and, and really trying to bring all those pieces together and really make a big difference in the way that we serve our communities and really change the way that we're delivering healthcare. I'm pretty, pretty excited about it. So you, so you've moved into a new role now?

Yeah. Yeah. So the, the new role officially starts March 1st, but like, you know, whenever you get transferred into another role, it starts immediately, even though it's gonna be starting in March. Right.

What, what kind of things were you guys doing in the physician practice side? Yeah, I mean, I, like a lot of other organizations, we were trying to pivot pretty quickly and figure out how to continue to serve our patients. And, and we, you know, I'm sure you've talked about this on the show, but we, you know, overnight, really within like a two week period, we had 8,000 providers set up on telehealth and, and seeing patients, you know, through telehealth, through Zoom and, and, uh, connected into our Epic platform.

And then of course, the, the hard work was just logistically trying to figure out how to get the right PPE available. We were putting, you were standing up tents and flu clinics and, and trying to direct patients, you know, into those specifically that had illness like symptoms. It was just a big logistics sort of nightmare for the first several months, once we got the PPE components figured out and we were able to get the right structures in place for, for our, our clinics and kind of direct patients to the right place and the telehealth components.

Then it was really about how do we safely get people back into surgeries and, you know, back into procedures that, that needed to be performed and, and not delay care as much as we could. So that was the Yeah, you, you, you just put a whole bunch of 80 hour work weeks into, uh, into a couple sentences, which is pretty amazing.

You know, I mean, a couple things sort of come to mind. Did you end up with different solutions based on market or different approaches based on market? Or was it, you know, you just rolled one thing out system wide? Yeah, we actually ended up rolling one thing out system wide, so we ended up really rolling out Zoom.

Now what we did do is there were a couple different solutions that we use to complete the kind of check-in process and filling out the forms and all that kind of stuff. We used a couple different solutions for that. Which the consumers or the patients we're pretty excited about because they could schedule their stuff, they could fill out all their paperwork.

We had all that stuff that could be done, you know, prior to the visit, which obviously is gonna carry over into, you know, people coming back into the office and, and all that. That is, we were able to quickly set up is, is gonna sustain itself and, and people will be able to fill out. Do you remember the no clipboard strategy we had for years?

I mean, the clipboards are, are officially probably gone now and people stop holding on to to that, which has been great. That's been the greatest thing about this whole pandemic is there's just been a significant breakthrough in how care can be delivered and the explosion of, of telehealth and video visits are accepted and, and people are pretty comfortable with it.

Yeah. Clip.

2013. Oh my God. Probably further back, right? I mean, it was just, I feel like we take a run at this like every five years we're like, can we get rid of these clipboards? Why are we filling out a form? I mean, you're a patient. You're sitting there going, okay, how many times do I have to give you my social security number?

I filled out the paperwork like 500 times now, and so we just need to be done with that. I mean, it's just sort of a ridiculous process that we put people through and it just really makes our industry ancient. So that's been a little bit of a blessing from this pandemic is it's just forced that like, there's just, there was just no more fighting.

It, it's just over. Yeah. No, that's fantastic. You know, back when we worked together, I remember in the, in the Southern California market, we had a fair number of covered lives through a partnership, I think with Blue Shield at the time in, in a and I, I just finished going through the, uh, JP Morgan conference.

We, I listened through the, the nonprofit track. And, uh, number of covered lives. The amount of covered lives was one of those things that mitigated the, the, the financial impact and really gave those systems a, a leg up in terms of how they were able to go back into the market and do things for the community.

You know, we did really financially really well, even though we're still able to reach out to those patients and provide, you know, services. The amount of volume that we had coming through was obviously slowed down a little bit, and so that helped us financially. Now what'll be interesting is we get into the first quarter this year.

Some of performance on the risk business. That might be down a little bit. Yeah. This, this, these are the conversations I miss having with you. You were, you used to sit, sit in my office and these things, and it got a master degree in just really understanding how the business of healthcare ran. But let's talk about this a little bit, just a little bit further, which is, are there special like tools from a technology standpoint or skills from a staff standpoint that you need run?

That, that managed, uh, managed lives business. Yeah. Without a doubt. I mean, so it's really all about, well, there's a couple things that come into this. Let's just break down a few. A big part of it is really understanding and risk stratifying your population. So that's a big thing. So data is king When you come into doing any sort of premium bus, premium pay business or capitation or value-based care, whatever you want to call it.

I mean, the more that you understand your high risk patients and you can really wrap your arms around them quickly through different programs, if it's high risk clinics, nurse navigation programs, you know, really engaging pharmacists in helping people manage their medications. I mean, the list goes on, but the data really drives the ability for you to wrap your arms.

Usually about five to 10% of your population is where. You know, 80% of your spend comes from. So if you can get your arms around that population and sort of, you know, help keep them from going to the ed, embracing more, you know, hospital at home programs or just giving in places to go where they don't have to go to the emergency room, you know, if, if they're having something that that's going on with them is, is a, a big thing of, of how you can get in front of it.

So data's really, really crucial. From that standpoint. And then the second thing I would say is, you know, utilization is super important when you're looking at being in that type of business. And what you want is you want things that need to happen and, and you want it, the care to be appropriate. And this is the sort of the, the, I don't know.

It's, it's, it's what? A lot of healthcare systems need to figure out how to thread the needle here, where you have providers that are really providing, um, the right care at the right place, and it has to be appropriate care so you're not overdoing testing or, you know, overdoing certain procedures, which, which we know from national numbers that about 20 to 30% of care that is provided is, is unnecessary.

And so that's, that's the space I think where you gotta use a lot of data, get your providers together, looking at their data. And starting to have conversations with one another. And, and that's been a big part of what we've done over the last probably seven or eight years. Kevin, I, I don't know if people know this, but early on in your career, you were an IT guy, right?

So you, you worked a little bit for all scripts and so you have a, you have a technology background. Yes, sir. Yep. Spent a lot of time working with different groups across the country.

BJ Moore's gonna be calling you up after he listens to this, asking you to, uh, help write some code. But I, I did want to go back and, you know, 'cause when we first met you, you were really setting up the technology framework for the clinically integrated network in, in Southern California. And, you know, let's, let's talk about some of that.

'cause I think the idiosyncrasies of California make this.

But let's start with this. What does ACIN look like in, in Southern California? Yeah, so a clinically integrated network or a structure that allows you to bring independent physicians and medical groups together to really contract on the managed care.

You take on contracts.

Drive cost down, improve quality, and really get to better health outcomes with the population you're serving. And yeah, it allows us to kind of bring all the pieces together, but not force a, you know, a specific model. Like an employment model. Yeah. But in that case, you're talking about a lot of disparate systems, a lot of different data elements, communication platforms, portals, and that kind of stuff.

So, alright, let's just go, let's start by going back in time. So back, back in the day when you were really setting that stuff up, what, what were the, the technologies, the communication platforms and the, and the data that you had to bring together? Yeah. So probably the hardest thing is really there's so many different EMRs that were out in the community, so all the.

Physicians when, when, you know, the, the High Tech Act was passed, there was a, there was just an explosion of, of EMR implementation, but many independent physicians implemented, you know, whatever they chose to. So within Southern California, we probably had, you know, I'm probably not exaggerating, we probably had like six or 700 different EMRs that were.

Yeah. And, and people might think you're, you're exaggerating. But I remember getting the spreadsheet and it was Practice FU Fusion, this version, and even All scripts, this version, this version, this version, Meditech Epic. It, it was, it was all over the board. It was amazing how many EMRs there. Yeah, so many.

Practice Fusion, but it's what version it was. And then, you know, so it, it complicated it even more. And so we had to put in a, a health information exchange to really, you know, connect all of those systems together and drive it into a, a platform or a portal that we then hooked into our, our main EMR, which for us was Allscripts and, and Meditech.

And then we'll be moving to Epic. Kind of having that button available where you could aggregate all that data together. And if you're on a patient record, you can flip into that HIE and see more of the longitudinal view of what's going on with that patient. And that was a very complicated thing to build.

And it took us years, uh, to get that built up. And now, now we have a situation where we have, you know, thousands of physicians that have their data connected together on that health information exchange. And. Our main EMRs, as I said, and it, it's helped, it's really helped us to begin to do the real work that we need to do.

So the first thing is getting the data connected, but the real work is really closing the gaps in care and identifying when you know, patients are overdue for screenings or we need to do different quality programs, we're able to do it even though people have different EMRs because we have it all in that HIE.

So now it's kind of building on top of that has really been our focus the last couple years. Yeah. So it's, it's experience, it's quality. It, it's interesting 'cause when you talk about that, the, the simple thing like scheduling is, I, I say simple thing and you have to cringe when you, when you hear that.

But I, I remember trying to just to plow through that. 'cause on a portal, you'd come in. You, you put a portal in and they say, okay, we can do scheduling. And you'd be like, yeah, but we have to, we have to across a clinically integrated network, multiple EMRs. That's, that's a, that's a complex task. So how was, was part of that technology and automation and part of that really some, some things, some people driven processes on the backend to make it a, a better experience for the user.

Yeah, so ultimately you could kind of go through down two path. If you wrote the, you know, AP wrote into the APIs, you could schedule into that particular provider's EMR, which is more complex and a little bit more expensive, but doable. And the other, uh, flow that you could put in place is there would be like an email that would go to that physician staff that said there was an appointment requested during this time.

Slide that in to their appointment scheduling system, or they would call the patient and coordinate a time. So it could be one of those two workflows. Ideally, it would be more of a just, you know, write it into that particular software. I think, you know, if CMS does anything, they need to continue to push on the interoperability standards and really prevent EMR companies charging so much to build integration between them because it's.

Quality care and really driving the cost down. When you're delivering care in a community, we just shouldn't have to pay, you know, an enormous amount of money and it shouldn't be this complex to connect system. So I just think that's an area that we really need more, more standards around. And, and people, you know, the, the EMR companies probably shouldn't be able to charge as much.

I know Sima's been looking at that. Well, you know, one of the things way back when, so this is you and I sitting across the table, it's not that there wasn't an abundance of tools to bring all this. We had, we already had too many tools within our system, right? So we had explorers, we had had just, just a ton of them.

And for us it was sort.

Bunch of data repositories, but you really have to sit back and think through what are we trying to drive, what are we trying to accomplish? And one of the things that, I mean, that you guys really educated me on was this, this whole aspect of, of interacting with the interacting with.

Again, the number of tools that were doing that back then, it's, it felt like every time the doorbell rang, somebody was selling a different, different tool. I, I, I mean, how did, how did you go about, did you build it? Did you buy it or was it stringing different things together? Yeah, it was really stringing different things together.

We. To your point, we had a lot of software. The challenge with the CIN is getting that last mile connection in, so we had a lot of stuff on the, on the health system side that we could lean on. We just needed to get all of those disparate systems connected in. I think what we're finding today, and this shouldn't surprise anybody, but where we get the biggest uptake is.

We're able to send text messages to these patients that say you're overdue for mamography, overdue for your immunizations, and they're able to click right on their phone on that link and take 'em to a scheduling platform. And we get a lot of people that, you know, follow through on that. It's very different than sending an email saying you need to get an appointment.

People tend to follow up pretty quickly when you, when you send a text. So we're seeing that technology work pretty well and that can sit on top of. Your data warehouse or you know, whatever your main system is. And if you have independent physicians, you still can include them in there. It'll just send an, you know, the, the text message will go to the patient.

The patient will click on the link, and like I said, on the backend, it'll just send an email to the staff. But it still allows you to create a much and experience that's seamless regardless if you're with an independent physician or with a medical group physician. So we're finding that to work pretty well.

So, you know, one of the things about a clinically integrated network is the reports that that go to the physician so that they can see how they're doing and how effective they are. Is that coming out of the same system or is that a different system as well? Yeah, it's a combination of coming outta the h, ie.

And then there's two systems that sit on top of it. Our main system is gonna be Epic, so a lot of that exists in their healthy planet, but we have other solutions that we allow our independent physicians to connect into to get their quality data reporting, and we push it to them through, through, through a platform that we use that that kind of manages all of our, our quality data.

Yeah. You know, and, and one of the things I, I remember this was always a, a, a significant challenge was to create the experience that it was every time you were going to a hospital, it was a Providence, St. Joe's Hospital. But then they were going to these, again, these clinics and the, these various physicians.

How, how will this move to Epic will have you made a lot of progress in really making it feel like a seamless. A system like every doctor you go to. Your, your data's moving with you. Your experience is similar across the entire network. You know, for the, for the physicians that have committed to connect to the HIE and we are able to, we're able to do some of the scheduling things that we talked about.

It does feel more seamless to the patient there, but for the providers that haven't connected into that h ie, it probably still feels fragmented to them, to be honest. I mean, there's more work to do there. We're offering, like most of the country, you know, we're offering community connect to the independent physicians.

So those that are interested in that will will sign up for that. I mean, I think ultimately over time it's going to turn into a situation where if you're not connected to us from a technology standpoint, it's gonna be harder to participate in these, in these new contracts that really have experience expectations that.

Quality expectations that have total cost of care improvement expectations. If you're not connected in to our systems, then we're just not gonna be able to allow you to participate in it because there's just too, too much room for air. Well, people are probably gonna cringe at this, but you know, back in the day it was, I mean, we talked about hundreds of EMRs, but our, our inpatient and outpatient were different EMRs as well.

You, you're moving to Epic. It'll be the same inpatient and outpatient, uh, as we discussed. So will that change things? And then you'll have community connect. Will that change things significantly? From what I remember five years ago, it'll help everybody that's in the organized model. So if you're in the medical group or obviously if you spend, you know, if you're a hospital based physician and you spend all day in the hospital, that that information will be much more real time and seamless.

If you're an independent physician and you have your own system, we're still gonna have to lean on that HIE to be the way that we connect stuff in. So that will not go away unless you come up on Community Connect, and then it'll be part of the, it'll be part of the epic world. Then Now you, you've thrown out HIE.

Is this a, a private HIE or is this a community, IE. It's a private ie. We do connect into public ones. So, but yeah, we have the same HI that, that when you were here that we had. Yeah, no, I, I, so there was the, uh, Southern California Rio, and I forget the name of it now, but, and that was, that was available. But the interesting thing to me is that one of the largest players in Southern California didn't participate.

I'm not gonna say which one, , but I think it's pretty obvious if they know who the players are. And so that always limited the, the value of that, of that HIE. It'll be interesting to see what happens with 21st Century Cures and, you know, the movement to, you know, more open systems. Are, are you guys focused in on 21st Century Cures?

You think there's some, some, you know, what, what value do you think it's gonna create for your, for your patients and providers? Yeah, I think it's got a lot of potential. I mean, if it's seamless. As it's proposed to be, I think we can, we can really simplify these different technology solutions being able to connect.

So I, I'm hopeful that it will make it a lot easier 'cause it, it'll make the, the strategies that you're trying to do in your markets a lot, it'll be more effective to get 'em off the ground. We are limited in, in a lot of our business strategies based upon. Tech technology solutions being able to deliver and it's less on the technology solution itself as much as it's on, we have so many different versions of the technology with all these different independent physicians that we can't really put a good coordinated solution together.

Yeah. You were, you, you were a technologist at heart when, when we were working together and I remember you.

Pushing those brought Livongo when Liv was like I a months old as monitor diabetic patients and when they had areas where they started to con get concerned, if we could intervene in that moment, you know, more times than not, you could like. Figure out what to do without having them come into the emergency room.

So it was just, you know, brilliant. I mean, Glen's, Glen's great and it's, it's been a good partnership. Yeah. I mean, are are there other tools that you're looking at to, to sort of get in front or, or, or to precipitate some, some homebased monitoring of your. High risk populations. Yeah. We look at a lot of tools.

So we, we we're invested in ada, so we use that platform, um, as well to do monitoring, uh, for, and, and then, you know, we're looking at all sorts of different tools that, and partnerships. Uh, we, we have a, a partnership right now that we've put together with a Duro. One of my partners in crime, Mike Waters, has put that together.

But, you know, that's something employers use. It's a lot like. Kind of like virgin, but it has like virgin health where you remember that, where we would track steps and all that kind of stuff. But this is more around helping people with their diabetes or their hypertension, kind of know their numbers, paying attention to it, and if something happens, we're able to to intervene and reach out and find out what's going on before it progresses too far.

The, the last project that you actually worked on together, we were mapping out patient experience across. And let's talk about EE experience. That's obviously a huge topic. A lot of the CEOs at the, uh, JPM conference were talking about the, I mean, obviously they were talking about covid and, and their response, but they, they were still talking about the, uh, patient experience and how dramatically it's changed and how the workflows had to change and adjust.

As a part of that, are, are you seeing that the expectations of the, of the patients are changing in your markets? Yeah, I, I am, and I think it's a good thing. I mean, I think we're finally getting to a point where we will. Meet people where they wanna be met. So if somebody's like, Hey, I just want to do a video visit as a consult, and you really don't need to do a physical exam, we're able to provide that.

If, you know, we talked earlier about not having to fill out all this paperwork and go to the office 30 minutes early and wait for your appointment. Like, like that stuff is, is starting to, you know, be in the past. And I, I think that's such a great thing for the, for the consumers now, what I, what I, what I don't want to see happen is.

There's so many sort of convenient care options that people lose sight of the value of having a primary care physician because somebody that can really help you manage everything that you have going on, especially as you get older. I heard a really great statistics the other day that when it comes to spend for individuals, your healthcare spend, there's sort of this hockey stick effect when you hit 44.

Like it just sort of goes. Along like this, and then you hit 44 and it does that until you get to, you know, 65. So it's really appreciating that we have to have these convenient care options and you need to be able to quickly be seen for just, you know, basic acute stuff. But the importance of having that relationship with a primary care physician helps you manage, help that person will help you really manage everything you have going on, both from a, a, a physical and a psychosocial standpoint.

And we shouldn't lose sight of how important that expected. The providers to get into the space, to get into the payer space, to get in, get more managed lives, because it, it, it would, uh, appear to me that it, it just gives us such, such a better incentive to, to be a part of people's lives all along the way to, to, you know, to have those tools.

Those relationships all along the way to, to help them. I mean, because, you know, at, at, at a certain point, if you know that hockey stick exists and, and you know that, you know, bill is gonna put on, you know, 10 pounds during covid, you know, there's, there's things you can do to, to sort of circumvent that.

And when you're talking about one person, that's one thing. But when you're talking about a population of, you know, whatever Orange County is 3 million or. You're, you're talking about a significant impact to the total cost of care and, and the overall, you know, quality of life of the, the people you're serving.

I. Yeah, it really does. And the great thing about having those types of payment models, I mean, we spent the time in your office and I was mapping through like, you know, some people get paid on rvu, which is you have to be seen, you have to be in front of the physician and these other models where we started walking through this is how we can get a per member per month.

It, it breaks open all these technology solutions. I mean, the providers are no longer trying to force people to come in because. They're incentivized differently, you know, and we're paying them differently and they're like, Hey, you know, I mean, I have providers that are like, you know, as long as it's secure, you know, they'll allow, you know, patients to text them a question.

They'll be like, okay, you know, either let's do a video visit, or, you know, maybe you need to become in to be seen. But just the ability to have that connection point in with your provider and be able to. Kind of know what you need to do is something that has been missing in, in healthcare for a long time, and I, I, I think this is significant breakthrough that we're moving towards.

And, and capitation or prepayment stuff allows that, and that's just one example. I mean, you could, you could really cover dozens of examples of where technology plays a significant role and providers embracing it. And the community embracing it is, is, you know, all the, all the incentives are aligned Finally.

Yeah, so we, we have a new administration and I'm not, I'm not gonna ask you to comment on the administration, so don't, don't worry, I'm not gonna take you there. But what I'm gonna, I, I'm gonna take you is, I, I think we're gonna go back to, because you know, this president is, was under the Obama administration.

A lot of the, you know, 21st Century cures, a bunch of that stuff was, was passed during the Obama administration payment. The administration and it was making a lot of progress. Not so much under the, the last administration, but I think we'll see those things come back. What's the complexity of delivering on bundled payments and, you know, what, what, what are some of the strategies to approach that?

Well, I mean, it's really bringing the continuum of care together. When you do something like bundles, I mean, you gotta have your, your primary care physicians along with your surgeons, along with your, you know, home well. You know, skilled nursing facilities, your hospitals, I mean, everybody's gotta kind of get around the table and you figure out what parts you can do more efficiently and start to pull those pieces out.

So, for example, a lot of times you'll get like a, like a knee replacement. You'll be in the hospital for so many days, you'll go to a skilled nursing facility for, you know, a bunch of days, and we're able to, to insert rehab more quickly. Get people more active and, and maybe not have as many skilled nursing facility days and allows the bundle to financially make sense.

So it, it's stuff like that that I think works pretty effectively. Plus you can do a lot of the follow-up visits without having to be in, in-person. So a lot of those things start to, the incentives get aligned there and, and you, you're still following up with the patient. But it could be like over a video like we're doing here.

And it just makes it a lot easier for the patient than not have to figure out how to get a ride and park and, you know, double into the office. I, I appreciate you approaching that from the, from the patient perspective and what, but as the CIOI remember the complexity of that was we, we, we've gotta be able to share information across that entire continuum.

We've gotta be able to, uh, track costs across that entire continuum. We've gotta be able to manage the quality,

those skilled. Rehab facilities and, and not all of those were owned by the provider. And, and that's, you know, that in and of itself is, is the sharing mechanism getting better across that entire continuum? In some ways it's getting better. So, I mean, health information exchanges help with . Having data available.

I mean, in my opinion, the administration that we have now really needs to put pressure on EMR vendors to open up. I mean, just the, the cost to build a connection into every. Everybody's system is astronomical and sort of ridiculous. I mean, it just shouldn't be like $10,000 for me to connect into a, you know, two doctor practice that has a, a different EMR.

So I, I feel like there needs to be, you know, more, you know, regulation maybe, or just the, the demand that, you know, you can't charge those kind of prices. You have to provide. A certain amount that's standard. I think that would be, make it a lot easier. But I mean, of course, you know, we have made progress.

It's just not, I mean, to your point, I mean, you have skilled nursing facilities or you have acute rehab, or you have, you know, some of these players that are part of the overall continuum of care and you just can't get everybody's data connected in. So there's, there's big gaps that can occur. Yeah, and I've, I've tried to explain because I'll talk about, on the show, I'll talk about the need to connect in all these physicians for the integrated delivery, the clinically integrated network, and people will just look at me like, I, I don't understand what you're talking about.

I'm like, well, you have to understand California and how it's set up. I mean, we had to connect into a lot of independent practices. And different medical groups across, and that was just Orange County back then. You now have LA as well. I mean, that's a, that's a lot of connections. And, and you're not kidding.

I mean, it was like $5,000 to connect to this, 10,000 to connect to this. And I remember those bills coming in and just looking at it, going, this makes no sense to me. , it doesn't, and, and of course the consumer and the patients, I mean, most people don't even understand that that's all the craziness that's going on, on, on the backend, and they just don't understand why.

Your primary care sent you to an orthopedic physician and then the orthopedic physician. Back to your primary care doctor and there's no communication there. You know, there's, that just doesn't make sense to, to consumers. Now, obviously if you're in the same medical group, it's not an issue. But if you're connecting across, you know, markets that have physicians that are in organized groups and then physicians that are independent, that that communication and the, the, the care plans and stuff like that need to be shared pretty seamlessly.

If, if you're gonna effectively bring the total cost of care down. So I, I, I wanna go back to telehealth real quick. So you, you, you, uh, just like most health systems probably saw significant gains, uh, or in numbers. I, I'm not even sure gains is the right terminology to use. Uh, significant use in telehealth during the, you know, March, April, may, timeframes, we, we saw some of that, uh, come back.

Do you have a goal of, uh, of growing telehealth, or is it more appropriately using telehealth? Across the, across the markets that you serve? Yeah. You know, there's multiple strategies, so I can break down a few. I think for the most part, we're running about 20 to 30% of our visits are still video visits.

Of course, it varies by specialty, but when you look across our whole footprint, that's about what we're averaging. I think as long as reimbursement parity sticks, which obviously varies by state, the feds have been pretty supportive of keeping that in place. I think the video visit percentages will stay in that 30% range.

You have multiple strategies that, that we're carrying forward. You know, some are lifestyle strategies, so you have certain providers that are like, Hey, you know what? I will see patients two days a week, do all video visits. I can be home with my kids. Then I'll be in the office two days a week. And what that allows us to do is, you know, introduce more physicians into the same footprint physically, you know, and so if I had 10 physicians in an office, I can now have 15 physicians because you'll have any given day where five of 'em will be working from home and, and being able to do video visits.

So there's those strategies that we're undertaking. I think other strategies are really providing, uh, more significant care for rural communities or, you know, when you start to get into the . Out of this specific urban, you know, space. And if you think about, you know, the market that, that we worked in together, you have Orange County, but then you have Riverside and San Bernardino County where a lot of people would drive to Orange County for their care.

And now we can provide that. So the, the medical groups and the organized . You know, medicine components are, the walls are coming down and it's no longer a requirement to have a bricks and mortar to do that. So you have some of those strategies that are beginning to take off. And I think, you know, if you have a reputation to have great outcomes and provide, you know, quality care, you're gonna see your business grow, uh, because of the capability to do a lot of the visits without having to be face-to-face.

And of course, people are more than happy to, to do like two or three visits, and then if they need to come in for. A physical exam and go through, you know, the parts that you have to do in person, people are, are very willing to do that. You, you've always been a proponent of the, the physician experience as well.

I know as ACIO you used to push me pretty hard on the clinician experience. How, you know, how is clinician experience at this point are still struggling with.

Because I know, you know, the EHR has some challenges and those kind of things, but, but just overall, I mean, uh, COVID and just the, the, the stress of it and whatnot. How, how are, uh, clinicians doing through this, through this pandemic? Yeah. I mean, it's, it's one of our biggest concerns, right? Because right now there's so much.

Focus on taking care of the community. We really worry about people not taking care of themselves. I mean, as you probably remember, we had a, a program that we did a, a cultural kind of immersion that we did called Own It, and it was really about bringing people into why they came into medicine and, and really breaking open the compassion and empathy about what we do and making sure that we take care of one another, which is, you know, carries forward in how we take care of patients.

We're gonna have to reinvigorate that. And, you know, we spent quite a bit of time, you probably remember the Sacred Encounters is a phrase that we used a lot. And as this immersion program really helped people crack that open and know what it meant. And it was really the opportunity to connect and communicate with each other and really bring those, those moments where you know that you're making a difference in, in somebody's life.

And right now, physicians are so . And, and nurses too. I mean, they're just so on the ground dealing with everything that's coming at 'em. When we get to like April and May and the dust begins to settle a little bit more, we're gonna have to take a serious time out and say, okay, now it's time to take care of you.

And we're putting plans together on, on how we're gonna do that, and giving people space, making sure people are able to take time off and, you know, just give 'em an opportunity to reconnect with one another in a different way. So we have some, we have some pretty big plans to, to help. Ease people through that.

Yeah, that's one of the things I, I still remember the, the first day I, I was a contractor sitting there at St. Joe's and I was presenting to the executive team and, and it, it, and they stopped me about a couple minutes in and said, let us tell you about our, our organization. I sort of laid it and I remember sitting there saying, this organization because.

Yeah. You know, they're, they're smart people and they run a business well, but it is a ministry. And they talked in ministry terms. They talked about caring for the individuals, but not only the people in the community, but the, the people within the four walls of the health system. And, uh, and, and that, that really, really spoke to me.

Different walks of life. So some came, we organically grew from the beginning. Others were acquired through different business deals that we did. So we had all these docs that were in these different groups and had these different cultures, and they had different language and they had different belief systems, et cetera.

So the owner program was intended to reconnect people into why they came into healthcare, but it was also an opportunity for us to have a common language. And so we had communication standards. We built a service cycle that everybody connected to. So we own how we meet and greet patients we own how we show patients respect.

We own how we, you know, trans for people's care. I mean, there was this whole service component that came with it. And, and it is, the, the way it it launched is it's a four hour program. You do, uh, tables of like. You know, five people at a table. You might have 10 tables and there's facilitators that lead it.

And then at your table there's a facilitator helping you through all the different material. And it's, we, we do quite a bit of videos, but then we do a lot of table discussions and. As an example, when we were talking about Sacred Encounters, the, the table facilitator would, would explain what their sacred encounter was and sort of open the space up for other people to share ones that they have.

And it, it created this vulnerable moment where these providers who are like, you know, Superman and Superwoman, you know, gave them the opportunity to like really open up and, and it, it, it created this connection. Into why they want to be at, you know, Providence or St. Joe's and, and the difference that they're, they're making.

And, and then on top of that, we, you know, we talked about compassion and how compassion spreads. It was pretty interesting. We had a number of providers that, you know, you look at their patient experience score. This is a little bit of an anecdotal story, but I think it, it, it, it'll resonate with the audience.

We, we have providers that would. Would have these unbelievable reputations of great outcomes, but their patient experience scores would be low and they couldn't figure it out. 'cause they're like, I'm, I'm, I just feel like I'm really great with my patients. And the answer was, they are great with their patients, but guess who?

They weren't great with their staff. They come walking out of the room and they'd, you know, yell at their nurse. Or they get mad that some lab order wasn't there and they start hollering. So of course what happens when the nurse walk. Walks back into the room, you know, they just got torn up one side and down the other, so they're not being very nice to the patient at that point.

And we started to get providers to understand how you treat one another, carries on about how you take care of your patients. And so that, that was a big eye-opener for a lot of providers and, and we just saw a big culture shift then. And our patient experience scores, our caregiver engagement scores, our provider engagement scores in Orange County are in the top.

Quartile and, and decile as far as provider experience or provider engagement rather, is in the top decile in the country. And it's not all related to own it, it's, you know, there's so many pieces you have to do to get there. It's a combination of that. And then we have really good governance where physicians feel like they're partners and they're at the table.

I think those two things made a big difference for us to, to get people super engaged and, and I agree with you. It's a wonderful place to work. It's so grounded in. Taking care of everybody in the community. You know, we're not an organization that only focuses on certain parts of the population. You know, we serve everybody.

And, and it's, it's pretty rewarding. You know what, Kevin, I'd be remiss if I didn't ask this question. 'cause there's an awful lot of technology people that are listening to this going, how did this guy go from working for Allscripts writing code to being, uh, an executive over a significant portion of a

You know, the Southern California, uh, it's the Southern California markets. Mm-Hmm. predominantly. I mean, you, you're, you're over a fair number of, of, of amount of that business from a business leadership standpoint. I, I, I mean, what, what do you attribute that, that movement, does the technology background help or did it, you know, enable you, or did you really focus in on No, I have to know and understand the business and that's what propelled you forward.

I mean, to be honest with you, I think a lot of it came from trying to implement technology platforms. I mean, I, I spent time implementing EMRs. That's pretty obvious based upon what we've discussed. But I also implemented Master Patient Index and tried to put together the solutions that allowed systems to keep you in context.

So that patient context switching type stuff that seek standard. What I recognized when I was doing that work is the operations has to be behind what you're doing. And so I started to get more involved in the operations. I put a lot of work into, into leadership and then really started learning a lot more of the business side, the, the, you know, the financial contracting side and how we could drive, you know, costs down.

And technology was a big enabler and so was being able to drive change. And so I just started getting into roles where I could influence change more, and I just kept evolving from there. I , you know, I didn't really plan to be in this, this kind of role. It just somewhat came to me. And, and as you know, working at St.

Joe's and, and Providence, you know, sometimes things are calling and, and that's really how I feel about the work that I do. It's a calling, it's, it's a vocation. I have the opportunity to lead the largest health system in Southern California and. Much of it is going to be around driving towards value-based care.

And a lot of it is around, you know, using servant leadership as a way to, to get everybody to lean in if you're an independent physician, if you're part of the medical group, if you're running a hospital. So, yeah, it's, uh, the technology background does help though, because I know how to put the pieces together and I.

I'm not in the abstract as much as other leaders because I've been there. Like I know how the pieces can fit together and how you can accomplish a different patient experience or a different, a different flow and you can have your operations be more efficient. You know, that, that type of stuff I have a pretty good handle on.

Yeah, and I, I think that's the, you know, that's the, the. Your progress. Uh, I you, you really understand the technology at a deep level, but I think it was, it was sitting down with, with, with you and others and, and just, you know, and, and oh my gosh, I can't remember his name. The gentleman who was before you at.

cr cr Yeah, I mean, CR was like a machine. I mean, he just understood the business. Yep. And, uh, I think you worked very closely with him and just understood the business, the contracts, the, you know, how to, to set these things up effectively and how to negotiate with, uh, with payers and those kind of things and all that.

That was just a part of, of the natural progression. Yeah, I mean, you know, CR and I, we, we joke about this now, but when I wanted to set up the clinically integrated network, he, he, he'd asked me why I was wasting my time. And I'm like, no, no, no. We can get fee for service contracts into this CIN as long as people are committed to quality and patient experience.

And he is like those independent physicians, they'll never agree to do that, but if you really want to do it, knock yourself out. And so we put it together and now we have 200,000 lives in that CIN that are on fee for service contracts. So I, I can hear him saying that too. If you wanna do it, go ahead.

Have fun. So that had, that had to be, I mean, I guess that that was a, a sort of a support of saying, yeah, go ahead and do it. But I mean, you had to go out and have those initial conversations. So, I mean, was it, were they receptive at first or did you have to keep tweaking the model before people signed on?

Yeah, I mean ultimately we, we, we had the right independent physician leaders that, that understood the vision of putting stuff into a structure that allowed them to do, you know, better financially. 'cause we would have different bonus pools that we could tap into based upon how we performed. And as you know, we had enough independent physicians that really understood that it would help them grow their practice and it would help them build some financial stability.

And from there we implemented, you know, solutions that allowed us to understand utilization, if you remember that Roadmap Platform, which is now owned by captivity. But you know, we did a lot with that and really started educating providers on what they were doing and how they were practicing and what created more expense versus other ways that they could do it.

That would get, you know, the same outcomes, but it would be less expensive. To do it. And that generated a lot of fuel to continue to build onto the CIN and as people saw contracts come in and they were getting pretty good rates because we were driving total cost of care down. So we were able to afford to, you know, bring pretty competitive rates into that.

People really got excited about it and we've just been able to grow it. You know, we put Oscar in there, we put a bunch of our ACO work has been, you know, put into that. We have Unlimited NOx Keen, which is an insurance license in California, but. It, it's just allowed for a lot of growth outside of your normal payer provider relationship.

Direct to employers, we're able to put employer contracts directly into that CIN and, and actually do quite a bit on the Medicaid upfront. We're able to do some manage Medicaid on there, which is, you know, part of the community we're gonna serve. Forever. I mean, that's just who we are. We're gonna serve the whole community and, and being able to have the technology and the CIN to better manage that Medicaid book of business is pretty important too.

Did, did, did these strategies translate to Texas and then other markets that Providence was in or. There tweaks that you had to make, you know, it's, it's done well in Oregon and they have a health plan there, and then they have, you know, a group and a independent physician practice. So they've been able to kind of do something similar there.

Uh, we're starting to see it really take off in, in Texas as they take a look at comparing Medicare fee for service to Medicare Advantage, you know, just for everybody out there when you can take a Medicare Advantage agreement and you. More than a hundred percent of Medicare on the facility side on a yield basis, meaning that you get a per member per month on the facility side, and then you can, you can earn 120% of Medicare on that by managing it effectively.

It's a lot more enjoyable than getting a hundred percent of Medicare and trying to cut your cost to get down to. You know, serving that a lot of people try to break even on Medicare. That's been a goal for a lot of health systems and my perspective on it is move as much as you can to Medicare Advantage and let's manage it well, and then we don't have to worry about cutting expenses as aggressively.

So that kind of stuff is starting to translate more into, you know, places like Texas and Alaska even, you know, just, just outta curiosity, so. Well, we just covered, uh, a fair amount on the clinically itegrated network, but I, I, I jokingly call this the education of Bill Russell, and you've been a big part of the education of Bill Russell.

So I, I, I just, I asked this question to sort of, uh, jokingly, but, but seriously, I mean, is there anything else we should talk about?

Oh, you know, I think the, the, the technology components that help you drive a better business strategy is a whole topic that we should spend more time on. I mean, you know, when I look at what our opportunities are, I'm always looking on the revenue side, and technology really helps you enhance revenue.

Some of it's HCC coding, some of it is just understanding where you're down coding. Some of it is doing risk stratification and predictive modeling. If you're running a risk business, what's your high risk population? Getting your arms around that and really managing them well so you're not having a lot of spend.

Understanding how the technology enables the, the business strategies, I think is where we need to continue to go. So we're investing in the right technologies and we're enabling the right experiences that ultimately get us to, you know, hire well, lemme say it this way. We are looking to get more healthy people in our community, so better health outcomes and drive that quality at, at, at a lower cost.

And, and technology is just, it's the center of it. It's, it's what allows you to do it. Yeah, absolutely. Well, Kevin, thanks, thanks again for your time. Thanks again for, for educating Bill Russell. Always appreciated. Hey, next time we'll do it on the golf course. Uh, sounds like a plan. What a great discussion.

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