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 Today, on this week in health it, we realized the traditional legacy business of healthcare, which is treating people within hospitals, needed to be disrupted. And either we were going to be driving that disruption or it was going to happen to us.

Thanks for joining us on this week in Health IT Influence. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in Health IT a channel dedicated to keeping health IT staff current and engaged. Special thanks to our Influence show sponsors Sirius Healthcare and Health lyrics for choosing to invest in our mission to develop the next generation of health IT leaders.

If you wanna be a part of our mission, you can become a show sponsor as well. The first step. It's to send an email to partner at this week in health it.com. I ran into someone and they were asking me about my show. They are a new masters in Health administration student, and we started having a conversation and I said, you know, we've recorded about 350 of these shows, and he was shocked.

He asked me who I'd spoken with and I said, oh, you know, just CEOs of Providence and of Jefferson Health and CIOs from Cedar-Sinai Mayo. Clinic, Cleveland Clinic and all these phenomenal organizations, all this phenomenal content, and he was just dumbfounded. He is like, I don't know how I'm gonna find time to listen to all these, all these episodes that I have so much to learn.

And that was such an exciting moment for me to have that conversation with somebody to realize. We have built up such a great amount of content that you can learn from and your team can learn from. We did the Covid series, talked to so many brilliant people who are actively working in healthcare, in health.

IT addressing the biggest challenges that we have to face. We have all of those out on our website and we've put a search in there. Makes it very easy to find things. All this stuff is curated really well. You can go out onto YouTube as well. You can actually pick out some episodes, share it with your team, have a conversation.

We hope you'll take advantage of our website. Take advantage. Of our YouTube channel as well. Alright, this morning we have a great conversation. We are going to be looking at the activating your health data supply chain. And I liked this topic. It's one of those that really interested me. This is part of our ongoing HIMSS coverage.

What I did is I went through all the presentations that, uh, were happening at HIMS and I tried to find the ones that I wanted a little bit more information on. So today we're gonna look at activating your health data supply chain. We have two gentlemen with us. Michael Muey, the COO of Arcadia, and David Dirks.

Interim, CEO of Castel, and VP of Strategy for Intermountain Healthcare. Good morning, gentlemen. Welcome to the show. Hey, good morning, bill. Morning. Thanks, bill. This presentation is interesting to me 'cause I think it, it represents a different way of approaching data. Back in the day when I was CIO, we had one way of approaching it, which was to really empty our EHR and other systems and move it all into a single repository.

Try to normalize that data, spend a bajillion dollars. And it was, it was extremely hard and we did not get really the value out of it that we wanted to, and, and we were doing all that for a lot of different reasons. I mean, you could obviously use it in your value-based care contracts and those kind of things, but it was needed all over the place.

Our clinically integrated network needed things, whatnot. And to be honest with you, when I saw this topic, I thought this represents a different way for me to think about this. And so I really, I'm looking forward to this conversation. This is straight from your slide deck. You're, you talk about the compounded annual growth rate of healthcare data is 36%, and that really rings, treats to me.

We talk a lot in, in data that data is power and the people who own the data are gonna win the competitive race. And Dave and I talk a lot about this, that it's not the data, it's both. Information and the data and, and then what you do with it. There were tremendous numbers of factors that drive this growth and the data captured.

Remote patient monitoring, the continuing evolution and shift of services to more and more outpatient and home settings. Virtual care. You look at the last 18 months and almost everyone has had a telehealth encounter, even people who've never considered having one before the pandemic. So there's this explosion of information, but not all data's good data and just because you have data doesn't mean you necessarily need it.

I think what we're seeing more and more, and Dave you likely have some, some very concrete use cases here, but throughout the pandemic there have been ever increasing needs to understand social determinants of health. Who are the individuals who. It didn't have a home to be bound to, and they're dealing with housing crises and social services are dismantled because there are fewer individuals who are willing to go out and work in soup kitchens or food pantries.

So we've seen a, a growing need to understand the social factors that influence an individual's ability to manage their health. We've seen a lot of novel uses of data from third party sources like Fair Isaac and TransUnion to try and profile patients relative to their social needs. And then really too, you got groups like Castel who are actively managing a, a really large panel of managed patients, needing data from all of the different telehealth vendors and the wearables vendors to try and understand

What's happening with their population since they're not seeing 'em in person as frequently. David, we had Mikel Moore who was with Intermountain, as well as Bill Krimm, I think, who was with United Way, and when we were talking about social determinants and, and the, the work that they're doing in Inter Intermountain, it struck me as what a challenge that is to orchestrate all that data because there, it's a different set of data than we normally deal with, but it's so relevant to the health of the population that you serve.

Talk a. About some of those use cases that Michael was alluding to. You mentioned earlier the explosion of healthcare data, but to your point, we have to look at a, a holistic view of the person, not only the data that's being produced from a healthcare perspective, but the other things that need to inform care.

Broadly with the change we're trying to affect in healthcare, you think of, of the way healthcare is operated for centuries is who is coming to me and, and being seen that has a problem and then I'm reacting to the problem that they're coming to me with. What we're trying to do is fundamentally change that perspective, so rather than a primary care physician.

When she enters the office every day thinking about, okay, who's on my schedule today? What we're trying to do is change that and say, who needs to be on my schedule today? Who do I need to see today? And that's a very different perspective and takes a whole different. Approach to data and analytics to be able to know who do I need to see?

So it's not just healthcare data, but it's also social determinants data and forming a relationship with patients to being able to use that data to affect change. One of the examples. That we like to use. That was the real patient, was the traditional healthcare approach to someone needs a colonoscopy is, well, I'm gonna call 'em.

I'm gonna try and get on a schedule. I'm gonna send a mailer to them to try and get them to get a colonoscopy. And if they don't, well then I really don't have much of a recourse to get 'em in and get that preventative care done. What the approach that we're taking is to say, well, they need to get in to see a colonoscopy.

But we know that they're probably gonna have transportation challenges. We know that they're probably gonna have problems or concerns paying for that colonoscopy. We know that there's gonna be some follow-up issues that we need to have. And so if we have that information at the ready prior to making that call, what we can do is make sure that we're aligning all of those components up at the time when that call happens and say, Hey, how do we get you in for a colonoscopy?

How do we make sure you can get to your appointment? Let's take care of any of the financial concerns upfront. And any of the other exigencies, which may be standing in the way of receiving that care. All of that workflow and workload needs to be informed by analytics and a holistic knowledge of our patients.

I. And that's how we're using that data. Supply chain is not, to your point, let's just load as much data as we can and then hope we can find a use for it. We start with the end in mind, which is, what are we trying to accomplish? What are we trying to get done? And then let's back into it and say, okay, what are the data assets that we need to line up in order to be able to inform and make those decisions?

And, and Michael, I think I, I teed you up for this a little bit. How have we traditionally approached this problem in healthcare? And I, I think you're just gonna essentially regurgitate back to me exactly what I said. We used to think about, Hey, we can build this ourselves, put it all into a big repository and we can figure it out later.

But that approach is changing, isn't it? Yeah, and I think that's exactly right. I think there's another piece is traditionally there was this interface soup. It was everything needed in interface. Everyone wanted ACCD or an HL seven or an ADT or a fire interface. And we're moving to a point where data needs to be a little bit more liquid.

And, and that's not me saying that there's not a place for interoperability because there certainly is, there's a ton of use cases that are still served by traditional interoperability pathways. But where I think . Castel and, and Arcadia and, and others who've innovated around data have, have really advanced their models is being able to go right to the, the data lake and kind of normalize data in real time versus having to go through this protracted process of data, aggregation, normalization, construction, to a, a standard data model, mapping terminology, mapping, all of that.

You bring the, the business stakeholder, the analytics product owner, and I'll get back to product owner in just a second. And you bring the executives to the table and say, what result do we want? And then how do you deconstruct what you need from there? And where I think Castel has done an excellent job in helping to activate their data supply chain is treating their outputs like products.

Because that's the other challenge in the historical way that we've handled data is I need a readmission rate or I need to know how many patients need a colonoscopy. , and that's the deliverable. It's a rate or a number or a list. It's not asking the question, what do I do with that rate, that list, that denominator.

How do I get it in the hands of someone who can act on it? And how do I improve it based on user feedback? Maybe we get that readmission rate and we say we wanna layer over it a bunch of social indicators to understand, are there social programs we could spin up in communities to help impact reeducation when patients are discharged to home so they don't get readmitted?

And then we're providing them the right support. And as we do that . Does the product need to evolve and it becomes a living and breathing asset that can be integrated into workflows, and that's one of the areas that Castel has done a really nice job in is building these assets in their workflows of the people who could impact change and consistently maintaining those and evolving those as their performance evolves.

Yeah, I would just, I would add to what Michael has said. When we set out to build Castel, we made a conscious decision that all of our workflows would be. Directed and informed by data and analytics, right? All of the choices that we make around our process. Mapping at each one of those nodes, we knew that we wanted it to be informed by data so that we knew it ha we would have the greatest impact.

We. On the population with the least amount of resources being as efficient as possible. And so as we did those very detailed process maps, we said, okay, at each point along the way, what is the data that we need to surface? Who does it need to be surfaced to? How do we get it there? And that's why Arcadia has been such a critical partner because trying to do that on our own without understanding what is all, what are all of the components that need to come together in order to inform that, that workflow at every point in time, we, we couldn't just do that on our own.

It takes a lot of work to make sure not only that you're able to get all of that data in, but that people trust it. And you can deliver it at the right place, at the right time in the hands of the right person, which is why we like this comparison to the traditional supply chain because right, if you go to talk to Intermountain supply chain representatives, that's their job, right?

How do I get the right supply in the right hand of the right person at the right time at the lowest cost? That's exactly what we think about in the data supply chain. How do we get the right piece of data or insight? In the right hand of the right person at the right time. We often don't think about data that way, at least for a long time.

Right? It was a retrospective report. We'd spin out a dashboard, we'd sort of provision everyone who might be curious about this data on it, and quite often it never got used because while it was interesting. It actually didn't inform workflow. It didn't inform the work that we were trying to do. That sort of sits at the, at the core of what we're trying to accomplish with Castel and why Arcadia is such a critical partner.

In order to enable all of that, it seems to me the health data supply chain. Is is a different concept and what it gives you is agility. And one of the things we just came through with the pandemic is that we recognize the need for agility at, at a pace we've never had to experience in healthcare, at least in my lifetime, where we didn't know what the problem was until the problem presented itself and then it, it was sort of almost like the demand generated the need and then we had to figure out how to respond to it.

And the health data supply chain seems to me to be. A better way of not spending as much time. Normalizing the data and spending more time actually generating benefit for the organization. Michael, is that, does that capture it and how does it do that? Well, yeah, I think that that captures the essence and I think what we are trying to turn on its head is, and, and Covid is a great example and we, we have a great story about how we partnered on that rapid response.

And where the health data supply chain came in is we said, well, hold on. Arcadia has a a, a reference data set. It's about 150 million persons that we've collected. We do a bunch of research on it. We have customers in Boston, New York, and Seattle, three of the, the earliest outbreak centers in the United States.

This was a time where testing was widely unavailable. You had some skunkworks testing projects going on in different cities, but what we did have was diagnosis data coming in from ADTs or from EHRs. And so we were able to build a little machine learning model, and I say that and it's not anything fancy.

It was pretty simple at the time. I. To say what symptoms are we seeing that tie to what the CDC is reporting we should be watching for that tie to the limited number of positive tests that we have so we can then back into a registry of risk factors. And everyone at the beginning of the pandemic said, Hey, it seems that, like, it seems that folks who are overweight or folks with multiple chronic conditions, elderly are, are more susceptible to complications from covid.

That was just a hunch. And so we were able to build these models, get them in the hands of Dave's care traffic control team and really rapidly spin up an outreach program to those patients. And, and Dave can talk about the outreach program, but what was great about the supply chain was I. Like every, like any traditional supply chain, there's always an effort of supply chain optimization.

We were able to take feedback from their calls and use it as an input to the model to help the model get smarter. So as we continued to build these risk strata and cohorts, they were getting smarter and more refined each time. And I think Dave can speak to some of the great findings and some of the great support that that Castel Intermountain were able to provide to their patients through these efforts.

Yeah, I mean if, if you think about where we were at that point in time, right? The delivery system was all reacting to the surge. How do we stand up testing? And it was in a very reactive position by necessity. And the conversation was how do we begin to. Get ahead of this. How do we begin to, to some extent, begin to take the fight to Covid and what was happening and the one of the key roles that we at Castell felt like we could play because in all of the other components, we felt helpless, right?

It was our ICUs and eds and others sort of fighting that battle. We said, how can we identify those folks where. That are in their homes. They're scared. They have a lack of information. They don't know what to do if they get symptoms. They're very concerned. The Arcadia team was very quickly able to generate that list for us that Michael walked through, and then we had resources that literally just began making calls and saying, Hey, we're concerned about you.

What can we answer? How can we help? What that then evolved into, because we already had that supply chain built, is when it became time to get the word out about vaccines. We already had those lists. We already had connections with those folks that we knew were high risk, and so we were then able to begin to make those connections and say, do you know now you qualify for the vaccine?

What questions can we answer and concerns? What we were also able to do is leverage technology to. Through those lists and through Arcadia to do that through a text campaign and through calling, you know, we were able to get some uptick numbers in the hundreds of people that we were able to call and get a vaccine.

But it was in the tens of thousands of people that we were able through that data supply chain to actually get, you know, confirmation on vaccines or at least a message out through texting. So, because that supply chain was built, because we had already had that connection point. As Covid evolved, we were able to meet the needs of people all along that continuum as the sort of the disease and the pandemic played out in a very easy way where we weren't trying to re-engineer things multiple times, and we were very reactive and able to move.

I. Very quickly based on the changing nature of how the virus progressed. Yeah. Michael, I'm gonna come back to you. It's interesting as I listen to this Castel, Arcadia Intermountain partnership, it's essentially a, a marriage of operations of technology and bringing those things together. So a lot of health systems are sitting back today probably going, well, we have a data warehouse.

We can generate some of those insights, but taking them through to the operation and actually delivering on those promises. That's an awful lot of work, and I assume you guys have the, the workflows and the processes around there. You talked about your, uh, care traffic control center sounds like a ba set of tools and processes that a, a, a health system can take and start to run with.

Is, is that pretty accurate, David? I. Yeah, that's the whole idea around care. Traffic Control is literally like an air traffic control, right? I have visibility to what's happened and I'm making sure that I'm directing people to the right and appropriate place, and nearly all of what they do is informed by data and analytics.

So the layer between producing those insights and taking those and actually creating action, there are very few layers within care traffic control. They're using those realtime insights. We, we call 'em triggers or signals. That data platform sort of spits out the signals and data they're taking that information enabled by, number one, a knowledge of the healthcare system and a knowledge of that particular member and their primary care physician, and marrying all that together to be very effective at meeting people's needs.

Whatever it is, right? All the way from I need to get into a doctor tomorrow. I'm being discharged from a post-acute care facility, and I need to make sure I'm making that connection to, there's a food, food insecurity issue that needs to be addressed. All of that runs through that center with a set of defined protocols and workflows that at each point, as I mentioned, is informed by a data point to help make those decisions.

I think about the maturity scale, right? So if you have health systems that are right around a billion . They're saying, look, we have an enterprise data warehouse. We're gonna rely heavily on our EHR provider and their analytics, but they probably don't have the capabilities that Dave just talked about.

Right. They're trying to figure that out. But then you have the, the slightly larger 3 billion, 5 billion, $6 billion health systems. And from the maturity standpoint, they probably have some data skills, right? So they're listening to this going, Hey, yeah, we did some of those things during the pandemic. We collected those analytics and those kind of things.

We struggled a little bit to activate them and engage them, but we, we have some of those skills. How should they be thinking about this? I'll just leave it a broad question, which is. When we talk about healthcare, it's a lot of different things. It's not just integrated delivery networks. It goes all the way down to one in two hospital systems.

How should they think about their data maturity? Some of them are relying heavily on an EHR provider or some partner, but they're not getting the whole picture like we talked about earlier. And the larger ones might be able to get the whole picture but don't know how to operationalize it. I think that's a great question.

You think about the, the top end of the market and you've got . Very, very deep penetration of tools from Epic and from Cerner at the top of the market. And what's really fantastic about those platforms is the ability to connect insights into the clinical workflow. So my conversation is always how do you do a, a capabilities assessment to understand where your gaps are and how do you fill those in?

Our mission as a business is not to go to a health system. I'll pick on your, your former employer. I'm not gonna go and say, Hey, you shouldn't use Epic. It's how do we augment what you've invested in Epic? And with Epic specifically, we have App Orchard apps that bring some of these insights into the point of care workflow.

But at the same time, if you're doing advanced data science, there's a time and a place for that. And that's, in my opinion, not inside of the EHR ecosystem, but what comes out of that data science effort. Can feed back into it to then feed those workflows. It's never an EHR or a platform like Arcadia. It's always an EHR.

And then when you get to the bottom end of the spectrum, you might deal with some smaller, less technically mature EHR platforms, much more transactional in nature. And that's where you have an opportunity to engage a partner like Arcadia to, to outsource the entirety of that supply chain. And when you think about those platform partners, it's evaluating the points of interconnectivity to say, how do you work well in my ecosystem?

And that's what I think . Dave, you and I talk about this all the time. We never set out to say we wanna replace Intermountain's ZDW, we don't wanna replace the investments made in Cerner and iCentra. We wanna augment and lift the capabilities of all of those platforms and all the folks using those tools on a day-to-day basis.

Yeah. And that's why I think this concept of a supply chain is, is super helpful, is that concept of data in the right place. And for Intermountain's Medical Group. The best and the right place is in the EMR. It's in iCentra where they're doing the documentation. And we do that, right? We take those insights and we make sure that those are embedded For some of our affiliate partners, it may be in their EMR or it may be a different tool set, so that that's where for us, it's been value of thinking about this as a supply chain because there's lots of different places where I need to deliver those supplies, different contexts.

And if you think about it that way, that. That's where we've been able to find the greatest progress is actually delivering something that that's useful and applies to that specific context of the person that has to use it. And that may take a bit. So Bill, to your point, if you're thinking about that level of maturity, COVID was a great example.

Health Systems did amazing things, right? They were able to pull together teams and accelerate a lot of work. The point I would make is how do you capture that? How do you capture what you were able to do and how do you build an infrastructure that allows that to be repeatable, right? Across then a number of different problem statements that you're having.

And that's what we've tried to focus on, right? We didn't have to pull a whole bunch of teams together to do that work when Covid came. 'cause it was, it was an infrastructure already built. And what I would say is started building that infrastructure. Pick your top two or three. Problems that you want to impact, build towards that, but do it in a way that that process is repeatable and scalable.

And once you have that, our abil, what we've seen is our ability to make change very quickly then and expand. Our impact has been greatly improved because we focused on building infrastructure first. Michael, in the middle of this presentation, you have a, a story of two IT projects. I, I, I want slides. Who they are in, in the story so that they can maybe see the distinction between maybe where they're at and what is possible.

Yeah. It's interesting. So I, I'll cover these. I want to quickly just revert back to the supply chain analogy because it, it overlays nicely in our presentation in Las Vegas. We talked about Blockbuster and Netflix, and people use this all the time as a great analogy to supply chain disruption and how new markets are created through innovation.

For those closer to the story, they know that Blockbuster actually had a direct mail service at the same time that Netflix did. The reason why Netflix was more successful was because they innovated around how to deliver product faster, and they were able to get DVDs in the hands of consumers faster than Blockbuster.

And what it came down to was Netflix had more distribution centers. Blockbuster had three, and Netflix had, I think 30. So they were able to get ADVD in the hands of a consumer within, I believe it was two days. Whereas Blockbuster, it would take three to five days. And so if you were a, a movie buff or you had a bunch of kids and you were constantly sending DVDs back to Netflix, checking out new ones, checking in new ones, they were much more able to meet the user experience.

So keep that in the back of your mind as I cover these two IT projects. 'cause that's the grain of what's different in the traditional technology project in healthcare. Hey, I've got a new vendor that I, I want to integrate with, or I have a new report that I need. Maybe your care coordination team needs some.

Insights on social determinants of health. So the business submits an IT ticket request and says, Hey, I wanna get the data out of prepare surveys out of my EMRs and maybe some community EMRs, and I want it, uh, I wanna build a report that shows me the social needs of my population. So that gets, you know, groomed into a sprint, prioritized into a queue.

You might have to contact your EMR vendor to adjust or update an interface. Maybe add some columns to your enterprise data warehouse. Map, normalize that data in, build the report, and that process can take 12 to 24 weeks depending on the, the responsiveness of your vendor, what other projects are in front of it.

If you're in the middle of an EHR upgrade, you forget it. It might take six months, eight months. So you've got that kind of, that one project. The, the second project is. Is how we start to think about disrupting the supply chain. The first thing is you've got a business stakeholder who says, I wanna stratify my population by social needs.

And the product owner, the advanced analytics team, . The analytics product team says, okay, well what are you gonna do with that data? What do you want? Do you wanna then take that information and make referrals to, uh, a community service that has food support program or a housing support program, or refer to community partners who help with social and, and mental health issues?

Oh, you do want to, you wanna automate referrals? Great. So let's think about this product as not just a report you want . An actionable report that integrates into the referral queue in our referral system. So you start to then unpack what the actual endpoint is. So you've got this user experience layer you put on top of the new project, and then second to that, you're sitting there with the business stakeholder and they say, Hey, we want data from these prepare surveys.

You have your data and analytics team go right to the lake where all the information you're capturing from your transactional systems, from your third party systems is already sitting. It's not transformed. It's not normalized. We were able to dive into and start to say, okay, here's what information we have coming outta these surveys.

Is it enough? Is it the right data? What other data we have in the lake available to support this? Maybe we have LexisNexis or Fair Isaac or some other SDOH data that we can bring into this. You can then merge into the same query. So the difference is the connectivity of the business, the technical stakeholder, and focusing on the ultimate outcome.

Netflix's outcome was more movies in the hands of consumers faster. Blockbuster's outcome was, we wanna change the way we deliver movies to our consumer. They didn't answer the question of how do we make the experience better? As a matter of fact, there's a lot of nostalgia around the blockbuster experience.

People remember roaming through the aisles, picking up candy, the smell of popcorn, and that's, that's gone. And Blockbuster had that experience cornered and Netflix. Netflix took that, that mail experience and made it better. And then they disrupted it again when they started delivering content over, you know, the internet public utility.

And then they've disrupted it again as they've opened their own studio to control the entirety of the content supply chain. And so what I think . And, and Dave can talk through this, but I think where innovative healthcare organizations are really disrupting the supply chain is not just thinking about user experience, but thinking about how do you make multiple disruption hops, not just one.

As I'm listening to that story, the two questions that pop into my head, one is data quality. At any time we were, we were always worried about having people access the data lake, or in our story it's the enterprise data warehouse directly, because we needed people who understood the data. Length of stay was, was an interesting term that had a lot of different definitions and so we were always concerned about that.

So how do you manage that specifically? And then Dave and Michael, I'd like for you to answer that. And then David, I'd like to come back to you on health. I. How this gets applied to really addressing health. Because when you talk about experiences, Michael, and I'll come back to this question later. 'cause Michael, I really want you to answer that one around data quality.

But when I, I think about experiences today, we're thinking about traditional experiences. I. But in the future we might be thinking about completely different experiences of actually keeping people out of the hospital and keeping them healthy. And I'm wondering how this drives that, but I'll come back to that in a second.

Michael, data quality, are we making progress and how do you give people that kind of access without worrying about the data quality? Well, that's why you partner them with someone who can, can kind of control for it when you're going right at the lake. There is inherently quality issues. You haven't mapped, you haven't normalized, you haven't transformed.

Maybe the data hasn't been through your NLP engine, but that's where the analytics product owner becomes so critical. To being part of the solution because they understand, hey, we're gonna go dive in. The assessments outputs table, that's a messy table. There's a lot of free text, so you can set expectations appropriately.

You talk about length of stay, and this is actually one of my favorite examples of data governance problems. We have customers who ask us for length of stay calculations and they'll say, well, that doesn't match what, you know, my, my internal team is saying. And you say, well, how are you defining length of stay?

Well, we're defining it this way, and you're like, okay, well we're defining length of stay another way. It should be a simple concept. It's like how many days elapsed from the point that a person hits the head, hits the bed to the point that the head lifts off the bed. But there's a bunch of different definitions and some of it's payment related, some of it's for reimbursement.

I. End users are becoming much better about not treating the EHR like a giant post-it note. And so you're seeing a much better data quality, uh, at the point of capture. And at the same time, NLP and OCR technology has gotten so much better. And so you're able to use a bunch of transformed technology to make the unstructured data in the EHR much more reliable as structured concepts, but it's a, it's a journey and that's part of this feedback loop on the product and user experience.

Also understanding why you need to know that output on those covid risk registries that we talked about a few minutes ago. I think we spun those up in, in a matter of days, and the conversation was, we don't know what we don't know. So you're gonna find patients in here who we think are high risk, who aren't high risk and is triggering some algorithm we're gonna, we're gonna learn from that.

And so set that expectation that this is what you can expect versus. Hey, I wanna pay a list of patients who are diabetic at this point in time. That should be a pretty locked down list from a data quality perspective. So David, I, I love going to the JP Morgan conference and listening to your CEO and your CFO stand up there.

First of all, you guys have some of the best financials in the industry. Second of all, they're always really pushing the, the envelope. And when he was talking about stories, when Michael was talking about stories of Netflix and Blockbuster, I think if anyone's really gonna change what healthcare looks like, it's probably Intermountain.

Given the parameters around which you guys operate in those markets and the partnerships that you have and whatnot, and I'm wondering, as you guys are looking at it, you know, we went from Blockbuster, go to the store, mail order, Netflix, then essentially online and now being the complete, and I think about healthcare and what it could be, and, and I'm tapping into your VP of, of a strategy here.

Healthcare can really be different. We can keep people healthy, we can keep 'em out of the hospital. All these things get talked about every year at the JP Morgan conference. Data becomes an integral part, and these kinds of operational systems become an integral part. What could healthcare look like if we continue down this path with some of the things that we've talked about today?

Yeah. Bill . Intermountain, we began this, this journey really 10 years ago about doubling down, saying, okay, we've gotta transform healthcare. It's way too costly. We're treating illness rather than understanding how do we keep people well and how do we keep 'em out of our hospitals? And, and we doubled down on that.

We really accelerated that when Dr. Mark Harrison came the the CEO and we realized. The traditional legacy business of healthcare, which is treating people within hospitals, needed to be disrupted, and either we were going to be driving that disruption or it was going to happen to us. And probably more important than that is doing the right thing for the right patients where we should be focused.

So what we realized though, is that causing that disruption within the context of a 23 bed hospital system, I. Wasn't gonna happen. We were sort of running into each other. And so we restructured the organization into two different divisions. One was our community based care division, which their charge really is how do we keep people well and out of the hospitals and then our specialty based care group where when people do need care, how do we provide it in the most convenient, least restrictive, least, um, costly space possible.

So with that separate business where, you know. To, to some extent, we, we take this seriously and say what we need you to think about every day is how do you put our hospitals out of business? Right? And the best possible scenario for us is that we never need another hospital again, because that means people are healthy, they're not getting sick, they don't need that higher level of care.

What that did and sort of creating a very clear sort of separate component of our business where we could say. We're gonna align the financial model, right? We're gonna align the incentives in the right way. We're gonna allow people to innovate very quickly on how do we keep people? Well, we've seen a massive transformation around just moving from the traditional healthcare environment.

So if you think about where healthcare is headed and where Intermountain is trying to be out in front of that is. How do we leverage digital and virtual tools to meet people where they are and provide all of the care possible in a virtual digital environment, right? How do we make it so that people don't even have to leave their home for most of healthcare, or if they're on the go, they can get their healthcare by the phone?

So we've made huge investments in our digital front door, which really is all things that you need in order to be able to. Interact with the healthcare environment if you do need care, if you do need to go somewhere in bricks and mortar, we're making massive investments in care delivery models that are actually outside of the hospital, right in an ambulatory setting.

So that if I do need in-person care, it's super convenient, it's low cost. And then we're beginning to look at, okay, what do the hospitals of the future need to look like? And the the answer is, they look very different than what they look like today. Because so much of what . Is done within the walls of a very expensive hospital today.

You actually can do in a different way and even the traditional hospital interaction. We have a hospital at home business. There's lots of other groups that are moving towards hospital. At home. We're finding the opportunity for a. Patients who are traditionally inpatient acute, we can actually care for them very effectively in their home, in a home-based setting.

So what we hope healthcare looks like in the future is you have a level of convenience, um, and service that you expect from Amazon or any of the other USAA or any of these other companies that are known for. A seamless, extremely convenient, high quality experience. We expect it to be much lower cost because now we're able to leverage tools and technology and assets in a way.

They're much less expensive, and how do we make it frictionless? While at the same time, people don't like to be unhealthy. If you go to people and say, do do you want to be unhealthy? The question is no. So you have to think about, well, what are all of the barriers standing in the way? Is it education, health, education?

Is it financial barrier? There's a myriad of things and humans are complex. Those factors are different for everyone. A combination of those. So what we're trying to do is. How do we understand each person as an individual and what their individual needs are, and then tailor our approach and what they need.

So we recently added. Equity as one of our strategic imperatives, and while that's certainly important for a lot of reasons outside of strategy, from a strategist perspective, equity is important because if I can understand each individual and their individual context and deliver them a set of tools that helps meet their health needs.

Just purely from a strategic perspective, I win right now. It also turns out that that's really great for society and making sure that, um, wherever you live and whatever your ethnic background, that you're getting the best care. That's the outcome we want. It's also profoundly strategic and to bring it back to this conversation, the only way I can understand people at that level and tailor those services.

Is if I have a very effective high performing data supply chain in order to inform that, yeah, you need to get to an end of one. And as you were talking Yeah, that's right. I thought I would much rather pay for health than I would pay for insurance. It seems like I'm not paying for the right thing. I, I, I want to be healthy.

I want live a healthy life. And yes, I, I mean, I do understand that there will be acute care visits in my future. But I, I'd still rather pay for health all along the way and then hopefully have somebody take care of me when we get to that. Michael, I want to ask you a question. This shows this week in health.

It, I have a fair number now. Of students who are watching this show and they send me notes from time to time and say, Hey, when you have these smart people on, can you ask them what I should be studying in school? If somebody's listening to saying, Hey, I wanna be Michael when I grow up, what should they be studying?

What, what should they be diving into in, in college and, and maybe even their master's program? I mean, so personally I studied economics and I had a, a focus in business and entrepreneurship. I don't know how much of that translates to healthcare. When I'm hiring today for Arcadia, what we typically look for are kind of two or three different profiles.

The first is we do a lot of hiring outta liberal arts schools, mostly on the business side of our organization, so the account managers, implementation managers. We look for people who have. A well-rounded skillset in with knowledge domains across a number of different sectors as a means to say, Hey, you're smart and you can solve any problem.

And more so in the generalist category. We look for folks who are excited to solve a bunch of different problems and get their hands dirty. In the technology side of our business analytics, our BI teams, our engineering teams, we cannot hire computer scientists. Folks with engineering backgrounds fast enough.

It is an extremely hot. Labor market. If you've got a comp side degree and you're looking for a job, I'm sure you can find my contact information through Bill's, uh, podcast. We'd be, we'd be happy to chat with you. When I talk to students who I mentor at my alma mater, I'm always encouraging them. If they don't wanna study computer science, at least get your feet wet.

Take the one-on-one course. Understand how systems work. It's a really valuable skillset. Almost everybody on my generalist side of the team, we send to a little bit of a schooling on SQL just to understand how data works, because so much of our world is going to be driven by data and informatics. And then I think that's the last area is informatics.

How do you bring data together and, and pull it into insights and present it the way to, to motivate action. So I think those are the areas that we're, we're commonly looking for. Fantastic. I have my economics degree as well, and my son got his economics degree. He said, dad, what should I study? I'm like, well, I mean, you can study anything, but if you, if you learn economics, you'll learn how to solve problems and look at things and a lot of different, you'll be able to yourself just look, take, take on the different lens and, and look at different things.

And I, I find it to be a, a pretty good background on a lot of different things. I don't know how we end up in technology, but we do, we do. David, if somebody's listening to this saying, say, VP of of strategy for a integrated delivery network, I mean, is there a path to get there? No, not, not a traditional one.

What I would say is, is what we look for increasingly as someone who, who sort of can live at the intersection of creative thinking and critical thinking, right? What we're trying to accomplish, certainly at Intermountain are problems that have not been solved before. There's no playbook. There's no way you're going learn this.

We do need people to be extremely creative about developing solutions. We also need that ability to have critical thinking. So some of the people that, a lot of the folks that we have on our team come from a variety of backgrounds, from economics to English, to philosophy to political science, and then go on to get an MPA or a Master's of public health or or healthcare administration to get that knowledge.

But whatever it is that's going to give you that ability to, number one, think creative as well as critically, and how do we work through problems and bring solutions. If you can mix that in with a little bit of analytical and financial ability as well, that's helpful. But those are the two things that we look for And, and again, what I've found is there are a lot of different pathways that people have taken in order to be able to, to get those things.

And so part of it is what's gonna allow you to get that, but also make you energized every day to kind of go to school and learn and be able to apply 'em. Actually, I think it's a. One of our most talented leaders in the business majored in Russian. And so I think it's that. It's really, you gotta be motivated, you have to be interested in what you do every day.

But I like the way Dave said it. It's this intersection between critical and creative thinking. 'cause that's what we need. We're charting into a lot of uncharted territories and that's a really important. Skillset. Yeah. In just about every industry, not just healthcare. It's really interesting. Gentlemen, thank you for your time.

So Castel and Arcadia and Intermountain Healthcare, great partnership and if people are interested in more information, they can just hit the show notes and we'll have some information down there for you, maybe a link to the presentation that we're referring to and, and some contact information. So thank you again for your time.

Really appreciate it. Thanks. What a great discussion. If you know of someone that might benefit from our channel, from these kinds of discussions, please forward them a note. Perhaps your team, your staff. I know if I were ACIO today, I would have every one of my team members listening to this show. It's it's conference level value every week.

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