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HIStalk Interviews Patty Hayward, VP, Talkdesk

February 23, 2022 Interviews No Comments

Patty Hayward, MA is VP of strategy, healthcare and life sciences, of Talkdesk of San Francisco, CA.

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Tell me about yourself and the company.

I’ve been in healthcare IT for the past 25 years. I’ve worked with several organizations to transform processes and procedures in areas such as medication safety and revenue cycle. I worked at Aetna, helping with the first ACOs. I’ve had a lot of stints in population health. Now I’m working with patient experience.

Talkdesk has been around for 10 years. It offers the first cloud-native contact center as a service. It was born out of a hackathon from Twilio. There was a niche in the market that needed to be worked on. The company has kept over 50% of its employees based in product and R&D, which is a huge commitment to innovation, looking at how we can transform and disrupt different areas.

About a year and a half ago, the decision was made to look at specific verticals, with healthcare being the first. That’s when they brought me and other folks on board. For us, it’s all about how to reimagine that patient experience, reduce friction, and help providers offer a different experience than is typical. We want to make sure that it is synchronized across multiple channels and is personalized and convenient.

How do large health systems tailor their digital health strategies in the face of potential competition, but while operating at capacity and with record profits?

Interesting and unique forces are definitely in play. There’s a lot of change in the market. Large retailers are jumping into the market, bringing their experiences to target areas such as primary care, population health, and chronic disease management. That’s going to give them a lot of ability to steer. Whoever you’re dealing with most — your primary care doc or someone who is working with you to manage your chronic disease — is who you will listen to on where you go. Younger generations are interested in different ways of doing business and thinking about healthcare in a different way. Record profits make it attractive for people to jump in, and you are seeing that.

Amazon has the luxury of catering to a self-selected customer base that is comfortable with an online-only relationship. Do providers have a different challenge in accommodating people who may prefer interacting in person or via telephone?

You are seeing this a lot with Medicare Advantage plans. They are obviously targeting the senior population, but they are tech savvy and tech forward in their approach and are using it in a smart way. They are giving a lot of choice and a lot of opportunity to utilize technology selectively, but also using care guides to guide folks through the system, which is much needed when you think about chronic disease patients in the Medicare population. It is difficult to navigate. They are allowing their members to come to them as they can, or as they would like to, whether that’s via voice or via technology. They are also using technology to make their agents efficient. So there are multiple ways to look at technology and how to implement it. It doesn’t have to be patient- or member-facing.

How are health systems using their contact centers differently?

Health systems are starting to look at their contact center as a strategic asset versus just the cost center it was in the past. It is the front door, typically the first touch that a patient has with their organization. We went the NGPX patient experience conference at the beginning of December and one of the things that struck me was that about 95% of the presentations were on HCAHPS scores. Those are acute focused, inside, did we do these certain things. When I had conversations with a lot of folks, the Mayo of course jumped out and started talking about patient experience in a very different way. They still do HCAHPS, because you have to, but they have jumped over to using Net Promoter Score as a measure of patient satisfaction. That’s unusual in the space.

People are starting to think differently about how they can transform to “how did we make you feel” versus “did we do the right things all the time.” A lot of forward-thinking folks are looking at how to do this differently. You are also seeing CMS start to push member experience as a huge piece of how they reimburse, making that one of the biggest metrics that they are using for star rating.

Providers used then-modern technology such as PBX systems or online contact forms to prevent people who needed help from easily accessing their employees. How are they thinking differently about tailoring communications using someone’s preferred method and personalizing the message?

People are talking about things like digital front door. Health systems, especially those that take risk or have their own plans, want more interaction with their patients in the right way. Being able to do things like send a text reminder that is interactive versus “say yes to confirm or no to cancel.” They want to keep that revenue stream going, because if you miss an appointment, that’s money out the door. They want to continue to have those record profits. There are a lot of ways that you can work through that whole aspect.

During COVID, the volumes that hit their switchboards were unmanageable. I talked to several health systems whose entire phone systems were taken down by the volume. People quickly automated as much as possible, standing up IVRs to give automated answers to quick questions, offering chats, and adding FAQs to their websites. Taking simple things that could be easily answered by automation off their switchboards to give their agents time to answer questions and have good interactions.

Forward-thinking ones are looking at the disruptors that are coming into the space and taking patients off of their books. How can we keep up with them? Amazon Care is going after employers, not necessarily patients themselves. Hilton was their first big one. There’s some big innovation in not only the care that is given, but in how they get patients on their rosters.

Most businesses assign a single customer identity and a defined way to interact with them. How well do health systems coordinate the many reasons they might be communicating with someone – clinical care, marketing, reminders, population health, billing – and give their employees a single view into every one of those communications?

The key is integrating with the system of record. If it’s the EHR, you want to make sure that you’ve got a connection to make the API callout so you can see snippets. You aren’t trying to duplicate the EHR – you want the highlights of things that are of interest. We are completely customizable, so we can build that to the experience that you would like. You may have different groups that need different visions. Someone who is in revenue cycle and billing wants a different look than those who work in patient access or care management.

You would want to be able to see if they started it off with a chat. You would authenticate to have a real conversation, be able to see who they are, and be able to do things like patient scheduling. Then if it is escalated, to be able to bring all of that information to that agent’s workspace so that they can see what’s happening and they don’t have to listen all over again. You see that in other verticals, where when people call in, they start with a discussion with an AI agent and then escalate to a human who says, “Give me a minute to get caught up on what you’ve said.” That’s an important aspect that we don’t tend to have in healthcare as much. It’s important to have that integration into the EHR.

Patient portals used to be viewed as consumer-unfriendly, but suddenly they are the well-received launching point for most interactions with patients. How do they fit into the ideal consumer experience?

Patient portals are not going to be real time. I just had my annual physical and it took a week to get a response from my physician. The patient portal can automate things that make sense for patients to do when they are on their computer, such as scheduling appointments, rescheduling, paying their bill, things like that. But a lot of times, people are on their smartphone and want to be able to start a conversation using the chatbot in the corner of the web page.  

Ideally, it’s all tied together and you can see the history. If there’s an interaction that’s recent, you want to be able to pull that in, create intents, and use AI to determine that the person is calling in because they’ve asked their question three times. You should see that as you’re answering the phone call. It’s important to be able to synchronize all these things, which typically doesn’t happen today. You call in and they have no vision into what you’ve been doing. I’ve been with my primary care provider for 19 years and it’s like I’m brand new every time I call.

Providers used to just hang out a shingle and people lined up, so nobody worked too hard to attract new patients. How are chief digital officers or chief experience officers who come in from other industries working with health systems who aren’t used to having to be consumer-friendly?

They are bringing in all sorts of people for these roles. It’s not just folks who are traditional healthcare. You have people coming in from Disney, Best Buy, the retail sector, and the entertainment sector with a viewpoint of what it could look like. They are bringing a different and unique lens to how you can capture more of the populations and become a destination place where people want to go. Mayo Clinic can dictate the kind of patients it wants, and other systems are, like you said, taking the approach that their shingle is out and people are coming.

Disruptors that are coming into the space are going to peel off those more valuable individuals, those who have more money to spend, and offer additional services that they are willing to pay for. If you look at that Amazon Care video, it’s pretty cool to be able to have a virtual visit, and if they can’t solve it on videoconference, they will send someone to your house or your place of work and then deliver your medications in two hours. There’s this full circle of care that can happen that makes it convenient and easy for you to seek the care you need.

Otherwise, folks will avoid doing that and then end up in a worse position or in the ER, which may be profitable if the ER isn’t taking risk. But if they are taking risk, all of a sudden the cost situation flips. That’s where the change is. Fee-for-service loves that ED visit, but with fee-for-value where you take on risk of the population, it’s a different discussion. We are seeing a lot of push towards fee-for-value. It has been going on for over a decade, but we are seeing more folks jumping in and offering different opportunities to grab onto that fee-for-value area and show value back to the government or to employers who are paying the bill.

What developments will we see with the company and industry in the next few years?

You will see AI take a bigger role, both in the things that are easy to automate and those that are not. It will take a huge role in helping the agents with their work, so that information is easily accessible and correct so that you can get it done quickly the first time. Agents will be able to spend more time and emphasis on that empathetic journey that you would like to show to your patients, at least those organizations that do it well.

You’re going to see a lot more emphasis on providing what in retail they call a delightful journey. Not too many people would call healthcare’s journey delightful. You typically come there stressed out and having a lot of interactions, so being able to deliver an experience like that is important. As we get folks to take care of themselves in the way that is prescribed, how do we activate the patient? How do we get them to think about how to take care of themselves and make the right choices? All of that will start to come together. Smart watches, devices, and different areas will allow you to get a lot more help and a lot more ability to, when you want, get guidance in real time.

HIStalk Interviews Amihai Neiderman, CEO, Nym

February 21, 2022 Interviews No Comments

Amihai Neiderman is co-founder and CEO of Nym of New York, NY.

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Tell me about yourself and the company.

I’m an engineer by training, in computer science. I did my bachelor’s in math and computer science when I was 14. Later on, I joined the Israeli army and did mostly cyberintelligence. After I left the army, I was influenced by my wife — she’s an MD-PhD ENT surgeon – and I started Nym. We do autonomous medical coding.

How do you distinguish autonomous medical coding from computer-assisted coding?

Computer-assisted coding is a tool that helps coders, giving them suggestions on the most appropriate code to use. It doesn’t make the final decision. Our fully automated solution requires zero human intervention. We code a chart in around two to two and a half seconds on average, then submit it directly to the billing systems in our clients’ facilities without anybody having to review those charts to make sure that the coding is correct. From there, it’s usually being sent directly to the payers. We completely remove the human from the loop.

Do payers trust the system’s consistent coding more than that of humans, where human coders may not all code the same way?

That was one of the reasons that it was hard to do automated coding until now. There was this lack of trust between the payers and providers, for obvious reasons, probably. The unique approach that we took when we started Nym is language understanding into clinical intelligence, what we call today clinical language understanding.

We can generate an audit trail that gives providers an end-to-end explanation of our entire thought process. If one of our clients ever gets a denial, an audit request, or even just during the onboarding process, they can assess and understand how we’re doing our coding. They can review those audit trails. We’re not hiding anything. We’re proud to show our internal thought processes and how we ended up deciding the right codes to use.

Payers who are receiving our audit trails are starting to become more interested in learning more about our solution, because we are not hiding anything and we have full transparency into our logic. They are usually afraid of fraud, waste, and abuse. We can show on the fraud part that we have nothing fraudulent in our process. It addresses that trust issue in a very interesting way.

Do you test in parallel with the customer’s human coders during implementation to measure the impact?

Yes. We know that our clients are moving something that is business critical for them. If we make a mistake, they could be exposed to compliance risk. They could lose revenue. We do a shadowing period, where when we do side-by-side coding for 30 or 45 days, depending on the client and the complexity of the project that we’re doing with them. During this shadowing period, we will have weekly or biweekly meetings with them and let the client choose choose any charts that they wish to review. They have access to our audit trails through a dashboard.

Sometimes they understand for themselves why we code something in a different way than their coders. Sometimes they’ll want to surface it up to us for an explanation of why we coded it this way when they might have done it differently. If we need to, we reconfigure our system based on their standard operating procedures.

How often do payers ask to review the audit trails, both initially and after they become comfortable with the system’s coding?

The payers don’t have direct access to the audit trails. It’s only if our clients decide to submit the audit trails as part of their appeal process if something was denied, or for an audit process that they have with the payers. Our relationships are directly with the providers who are our clients. But we do see from some of our clients in our periodic review that there is a significant drop in denials rates. Mostly because one of the things that we’re striving for is high coding accuracy, following the guidelines to the letter. You won’t see a lot of deviations.

That’s one of the beauties of using software to do coding. It is deterministic. You’re going to get the exact same results every single time. Once you become confident that you know that the results are up to your standard, you’re going to have reproducible results every single time.

Are issues with fraud, waste, and abuse usually caused by improper coding or are the provider’s notes themselves inaccurate?

We only code charts where we are fully comfortable with our understanding of those charts. If we see ambiguity, contradictions, or missing documentation, we drop those charts and let them go through the client’s ordinary process. Coders can reach out to the physicians if they need to. We code charts only when we are 100% certain that we fully understand everything in them. If there is any missing information, or if the chart might have any issues that will lead us to have wrong coding, we will just drop them. We are not taking any risk there.

Do clients implement your system primarily for efficiency or for accuracy?

Every organization has their own reasons for using our system. Sometimes it is speed. Provider groups that take five days to a week and a half to get their charts coded now see it happen in two and a half seconds. That reduces several days from their days in AR, giving them more cash on hand to operate their business.

Sometimes organizations, especially those who have tried outsourcing, usually offshore coding, encounter compliance issues and quality issues. Running an entire operation to try to reduce the compliance risk is expensive and not usually as fruitful as they believe. They are looking for a better solution to help them from a compliance perspective. This is where we come in.

In other cases, it’s reduced cost and improving their overall revenue cycle operations. We show the client that we are not just impacting directly their coding operations, but we will do it much faster than any one coder will do and we’re going to have a reduced number of denials, meaning fewer people that have to do scrubbing and running the appealing process. We affect the entire revenue cycle process downstream from us on the coding side.

Companies, including Google, are using natural language processing to support searching electronic charts and extracting data from free text notes. Will Nym use its experience in extracting chart information to extend beyond billing functions?

Definitely. When we started the company, we took a whole different approach into language understanding. What you see most of the bigger companies doing, almost all of them actually across the board, is using language models or AI solutions that weren’t tailored for healthcare, which has its own unique needs and problems. You gave Google as an example. They have an AI solution that solves their issues for search for understanding websites or news articles, but it’s not necessarily tailored for healthcare.

We built our own. We take a lot of pride in this. We built our own AI stack for language understanding, for clinical language understanding, and for coding that is specific for the healthcare domain. We’re a great coding company, but what we are really good at is capturing clinical narrative. Capturing the true clinical picture of what happened to a patient. Once you understand this, coding is a relatively easy thing to do. Because we built this strong technology and invested a lot of time in doing this, we can expand to other product lines or areas, using this technology to power new products.

Why does Israel produce so many successful entrepreneurs?

The vast majority come from a couple of well-known intelligence units in the army. One is the unit I served in, called 8200. It’s not the army that people envision or what they’ve seen in a movie. You get a lot of responsibility at the age of 18. You can become an officer when you’re 20, commanding soldiers and being tasked with some of the most complex things that could change the course of our history. They encourage you to do whatever it takes. 

There’s a mandatory army service, so people get replaced all the time. You come in, do your three years of service or four or five if you extend it. New ideas are being surfaced all the time. People come in and challenge what people have done before them. You have a huge number of new ideas coming all the time and people are energized to try them. I was lucky enough to serve in a place where I was constantly asked to innovate and was given the backing of my commanders to do it.

What parts of your background have been most relevant to being an entrepreneur? What do you find most challenging?

I was doing cryptoanalysis in the army. When we started the company, we knew that we were going to tackle a challenging problem that some of the largest healthcare key companies have tried and failed to solve for the better part of the last 20 years. We needed some of the best problem solvers in the world to work with us, so a lot of our R&D folks are people who we knew back from the army. My co-founder Adam Rimon and I both served in the cryptoanalysis department, which was a good place to find great problem solvers. That has helped us with the early work of trying to prove that the unique approaches that we took to solve the problem could actually work. We had the right people to do this.

The challenge is that the army doesn’t teach you how to manage a company. The army has a very different management style than what you’ll see anywhere else. I felt pretty relaxed because of the nature of the business that we were doing back there, but it’s still not very similar to what you’ll see in a company. We had to learn a few things the hard way, but we try to fail fast, learn from it, and not repeat the same mistakes again. As long as we have a smart team that can follow the same kind of principle, then it’s OK make mistakes. 

We just run, run quickly. We try to learn as fast as we can. One thing that we want to bring into the company and to the healthcare space is rapid prototyping. See if something works. If it doesn’t, you throw it away. If it does, great, you iterate over it and it creates value almost from Day 1 of the company.

Where do you see the company going in the next few years?

We are building great business in the coding space. The quality of our product and our results speak for themselves. We get our clients just from word of mouth, and our clients are highly referenceable. It sometimes amazes me that we are coding several million charts per year. We have three coders right now on the team who are serving as subject matter experts, but are not doing the coding itself. We are building a great coding company, bringing in work, adding to the client base, and expanding our footprint. We are going to be the top coding company in that area.

While we are doing this, we are also maturing our core technology. Our CLU engine gets better all the time. The more clients that we’re seeing, the more edge cases that we’re seeing, the better it gets and the smarter it gets. This allows us to take this unique core technology that we built and apply it in other areas that we’re still exploring. Coding is interesting because it sits between the clinical side and the revenue cycle side. We have the opportunity to influence the clinical side, to assist physicians both in the documentation side of the house and the revenue cycle process downstream from us.

HIStalk Interviews Brian Yarnell, President, Bluestream Health

February 17, 2022 Interviews No Comments

Brian Yarnell is founder and president of Bluestream Health of New York, NY.

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Tell me about yourself and the company.

I got started in healthcare 10 years ago. Prior to that, I worked in digital media, consumer behavior, and data-driven analysis for retail, manufacturing, marketing, and sales. I have quite a bit of background dealing with consumers and big data. I sold my first health tech company about seven years ago to Hillrom. That was a business called Starling, where we built a replacement for a nurse call system that routed out throughout the hospital and used intelligent workflows.

We shifted gears and founded Bluestream after that, with the idea of figuring out a better way to bring real people, through video, to a patient’s bedside. At the time, we didn’t really anticipate what was going to happen outside the hospital. We were thinking through how we could better provision these relationships between a remote provider and a patient.

Providers rushed to offer telehealth services via whatever video platform was quick and easy to roll out, but the novelty of interacting with patients by video has worn off. What virtual health platform capabilities are needed to provide a good patient and clinician experience?

Things have evolved fairly quickly. I think of it as a continuum. Those technologies that you mentioned were effectively video, which is a commodity at this point. Beyond the basic video connection, things have evolved from telehealth all the way to what I would call virtual-first healthcare. If you think of it in that context, the video piece is the last mile, but it’s really about opening up front doors for patients and meeting them where they are and how they want to be engaged.

The idea of patient portals and downloadable apps has generally not succeeded. The big things that people ought to be focusing on for virtual care is, how do you get in front of a patient, wherever that patient is, and however that patient feels like engaging? Then for clinicians, starting to take some of these brick-and-mortar workflows and make them virtual so that you can do all the great things that you might do in person, but do them remotely.

What elements of a virtual visit most strongly affect patient satisfaction?

We recently added Net Promoter Score, thinking about my marketing background prior to healthcare, to the platform. We know specifically what impacts patient satisfaction. It’s not just the bedside manner of the clinician. It’s what happens when somebody shows up a day early, an hour early, or 20 minutes early for an appointment. You can’t leave people in limbo. You have to be “consumery” in terms of how you engage folks and walk them through this process, even if they show up at the wrong time.

Making experiences that feel like a consumer-driven website. Give people information, expectations, and tools to engage, even if they are not necessarily at the front door at the right time. Then, post-visit, what happens when you wrap up with a clinician? What happens when something goes off the rails and you have to reconnect? All along the way, from showing up early or showing up on time to the visit, dropping the visit, concluding the visit, providing a real framework that still hand-holds the patient and has that consumery feel without being overly technical, overly burdened with lots of bells and whistles.

What virtual options can be offered to patients who have limited technology or bandwidth?

One of the things that we’ve seen as being successful is getting folks like MAs and assistants to tee up the call for physicians. You certainly don’t want the physician troubleshooting cameras, networks, and things like that. But you can have lower-cost, higher-availability resources work with the patient first and do a handoff.

But as you said, some folks aren’t going to get there in terms of tech. What we’ve seen be successful is automation to reconnect these people, to literally point out where you have to click to accept camera permissions. But some folks, like my mom, will never get there, and in those cases, you have to be willing to work with telephones. We’ve seen people doing emergency medicine consults , ET3 [emergency triage, treat, and transport] programs where the reality is that a large portion of the population is going to pick up a phone and dial it. You have to be able to route those visits in with the same attention and same priority as the people who are fully into the smartphones and video.

Health systems initially saw virtual visits as a distraction that should be turfed off to third-party companies that provided not only the platform, but the providers. Now that virtual visits are here to stay, are they treating them more like a full-fledged, branded patient experience?

Absolutely. You hit on a really important point. If you gave a hospital a $1.5 billion a year and a half or two years ago, they would have built a new wing. Now, they have to be thinking about how to build virtual experiences.

These vendors that you talked about that offered a lifeline of virtual visits with the provider network behind it will compete for those patient relationships with the hospitals as the world shifts towards more consumer-facing, on-demand care. The hospitals need to think about how to implement these programs to prevent their vendors from cannibalizing their core business. That becomes important in a transition into a value-based framework.

How does virtual health avoid becoming commoditized, where consumers see all encounters as equal and just choose the cheapest or first-available provider?

Consumers expect it immediately and pervasively. What you’re talking about is this preponderance of front doors that appear to come from all different places.

We and other vendors are starting to equip health systems and traditional healthcare delivery platforms with the ability to cast this wide net. Even though you may come through an insurance company’s website, a phone number on the back of your insurance card, a kiosk in a homeless shelter — very different experiences and a different type of front door — you’re going to start funneling those visits into a common pool provider. People like Teladoc have done that for years. The difference is that health systems are getting smarter about getting in that game and funneling visits from non-traditional places into their provider group.

Healthcare didn’t follow other businesses in looking at the lifetime value of acquiring and retaining a customer. Is that changing?

Absolutely. We have customers all across the spectrum, from people who just pay the bills of ambulatory visits to those who fully participate in these risk-based programs. The more sophisticated folks are looking at the cost of acquisition and  the cost of attrition.

What happens when a non-traditional player, such as Walmart, CVS, or Amazon, gets your patient? They’re not coming back. When you get into this modality where you are getting compensated for the cost of keeping the patient healthy, the lifetime value of patients goes up substantially. Smarter health systems, more strategic entities like some of the pay-viders, are playing that game of, how do you capture as many relationships as you can and keep them? Because you want to be on the winning side of that equation of people who are getting paid to manage a population effectively.

How does a health system’s marketing strategy change when those relationships are established during virtual visits and that involve consumers who may not require a health system’s services for a long time?

We’re seeing more sophisticated health systems, even the traditional ones, get smarter about using tools that let them take the providers they already have. A lot of them are large physician employers, and they have a pool of providers. What they don’t have is access to a patient until that patient has a heart attack or gets hit by a car. To empower those providers to get in front of patient, they are establishing commercial partnerships with large, self-insured employers, with insurance companies, and with municipalities that need healthcare coverage in housing projects and homeless shelters. Establishing lots of diverse front doors — whether it’s a walk-in clinic in the inner city or a health clinic in a Federally Qualified Health Center — and proactively identifying.

They cast a wide net to get patients. The branding might not even be their own, but they’ve got to be funneling those patients to the providers that they are already paying to be on the bench.

Are we in the early days of virtualizing the clinician workforce, where most of them already prefer to live in urban areas?

The hub-and-spoke model is a real thing, being able to have centers of excellence and making them accessible to remote communities, whether it’s because they are socioeconomically disadvantaged or because they are physically remote. The big risk is brain drain. You don’t want to be in a situation where you have no local providers who have expertise any more, because if somebody walks into a hospital and needs follow-up care, they want to have a good experience with a local community member. You’ll start seeing some of that shift into more urban hubs or more centralized hubs, and it’s a little bit of a risk.

Most people would be happy if virtual primary could deliver results equivalent to in-person visits. Are areas that can deliver arguably superior outcomes, such as behavioral health and chronic condition monitoring, drawing equally enthusiastic interest?

We do a lot of behavioral health. We do it inside acute settings, like emergency rooms and inpatient units, and we do it outside of acute settings. The big difference is, are you trying to keep someone out of the hospital and from incurring healthcare costs, or are you trying to adequately address somebody’s needs when they set foot in the door? Either case is a big one, low-hanging fruit with an event that has the potential to cost a lot of money and cause a lot of headaches if you don’t address it up front.

Behavioral health is a good one. We see the measurable impact with our customers and our partners. We can bring in a behavioral health expert, such as a clinical psychiatrist, to write an order for a patient in well under an hour, when in an ED, it might otherwise be a one-day or a three-day wait. It’s a big difference.

Outside the hospital, I would lump in behavioral health with access to things like emergency medicine, these mission-critical things that cause people to go to a hospital or to incur additional costs. We have 911 and ET3 programs that drive down the number of visits by 50%. It’s a big deal, and there’s a reason people are focusing there.

Are health systems interested in having their providers virtually help paramedics, long-term care, and home health providers who otherwise don’t have many options except to send the patient to the hospital’s ED?

Definitely, and even more so as you think about the systemic cost of care delivery. New York City Health + Hospitals is one of our customers. They tie directly into the 911 system. They deliver their services down into SNFs. They tie into first responder devices in ambulances and fire trucks. 

The underlying theme there is that they don’t want people going to the hospital. So when you dial 911 and it’s not life-threatening, they are going to get you in front of a clinician. If you need a paramedic, they’re going to try to get you virtually in front of a clinician. Even when you show up in person, they don’t want transport you, because the systemic cost of moving someone from a SNF back to the hospital is somewhere in the range of $10,000. You can absolutely prevent that from happening if you have the right safety net in place in terms of clinicians and folks like that.

What changes do you expect to see in the virtual visit concept and in the company’s business over the next few years?

What will drive the evolution of our business as a platform provider, and probably more importantly the business of traditional health systems and payers, is this shift towards value-based care and on-demand access to care. That’s just ubiquitous, and it will be painful for health systems to adapt to do that, because they are used to filling beds and physically getting their hands on people.

There are a lot of new folks coming into the market. Amazon and Walmert are better equipped to present consumers with what they want, when they want it. A lot of work will go into equipping these traditional providers with the tools to rise to meet consumers where they are. The mantra of the American consumer is that “I know what I want, and I want it now.” This notion of trying to make a better patient portal and that type of thing is never going to succeed. You have to give people what they want and then work out how to route these things intelligently and drive critical outcomes from them.

HIStalk Interviews Matt Scantland, CEO, AndHealth

February 16, 2022 Interviews 2 Comments

Matt Scantland is founder and CEO of AndHealth of Columbus, OH.

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Tell me about yourself and the company.

AndHealth is a digital health company that is focused on helping people reverse chronic illnesses. We started with migraine and are seeing patients for that now. We are soon launching for some of the most common and disruptive autoimmune conditions.

I’ve made a career of combining technology and healthcare. I started college thinking that I would be a doctor and ended up being a programmer, so I combined these two things in my career. Probably the biggest advantage that I have had is to have worked alongside an incredible team for my entire career, in some cases, literally going back to my internship in college. Many of these folks helped us build our last company, CoverMyMeds. They have been joined at AndHealth by a new group of telehealth experts and clinicians.

Each of us have our own “why” that we are at AndHealth. For me, I knew I had to do something like this because my own doctor helped me realize that I needed to participate in my healthcare. That was back in 2011, when my first son was born. At the time, I was busy with CoverMyMeds, but I knew that if I ever had a chance to do another company, I wanted it to be a company that helps support patients to participate in their own healthcare. That leads us to where we are today.

You intentionally use the term “disease reversal” as opposed to “disease management.” How do you distinguish those?

For many years now in our industry, we have focused on this idea of disease management, which is to try to tamp down the progression of cost and disease escalation. We now know that many chronic illnesses can be brought into remission if we can get the patient to change the behavior that is responsible for about 80% of our health. Once we understand that reversal is possible, the key question is, how do you achieve it? The answer is that you need to engage patients in a course of change. We have built a disease reversal company. We have built the whole business around how to support patients in making that change.

How does the approach differ from traditional office-based encounters?

The big idea is that we can get to reversal when we can get patients to participate. The core question then is, how do you get people to participate? We’ve built the company around what we’re calling a digital center of excellence that helps to make that participation easier. One important element of it is moving from delivery of care of that’s episodic and on-premise to one that is continuous and virtual.

For example, one of our early patients suffered from chronic migraine. She had moved around our healthcare system for years and years, never able to get to a state of disease remission and never able to figure out exactly, in the moment of a migraine, how to cope with the situation other than going to the emergency room. By moving this care to something that is continuous, we were able to dramatically shorten the feedback loop between trying a particular healthcare step and seeing whether it worked, to the point that we were able to optimize her acute medication and also identify the root cause of her migraine.

When we optimized the acute medication that kept her out of the emergency room, we had time then to work on actually reversing the disease. Her root cause ended up being a food intolerance issue that, despite many years in our healthcare system, had never been found. Once we were able to identify that food intolerance issue, we had moved this diffuse idea that we have around behavior such as “eat better” to the equivalent of a shellfish allergy, where just this one step was the difference between illness and health.

The tightness of that feedback loop makes it such that people with shellfish allergies almost never are eating shellfish. But compare that to someone with a cardiometabolic disease, where sticking to a nutritional program is hard. The only difference is how clear that feedback loop is. By moving to this style of care, we are able to shorten that feedback loop.

When we do that, we help the patient achieve a high return on effort. We don’t need to turn the patient into an Olympic athlete when we know the precise root cause of their illness. We just need to address that particular root cause. When we combine that with focusing on diseases that patients are highly motivated to solve, typically because of pain and disruption, then we are able to achieve a higher level of engagement than has ordinarily been seen in these digital health services, which have tended to focus on diseases that, while important, are pretty difficult to engage patients in early in the progression of the disease.

That’s why we started with migraine and autoimmune conditions. They share common root causes with these other illnesses. We can engage the patient in something they care about today because of the pain and disruption, but because of the shared root causes, we end up solving these other issues as a side effect.

Some of the app-focused programs assume that patients will change if offered education videos, scripted coaching, and reminders to modify their lifestyle. How much of your program will be based on psychology rather than technology?

We have built the DNA of the company around the science of how behavior happens. The more we have learned about that science, the more we have learned how big the opportunity is to do better. We do that by understanding the difference between health aspirations and health behaviors. The biggest lever that we have in our healthcare system to create behaviors that support health is to make them easier to do what we call create ability. For many people, we can create ability by making something that used to be time-consuming and expensive quick and inexpensive or free.

That psychology, building around the behavior design, is super important and is a through line in the company, from our technology to our business model and to the actual healthcare delivery. One important distinction between what we are doing at AndHealth and a lot of what has happened before is that we are actually the patient’s doctor rather than a wellness app. When we are the patient’s doctor, we are able to harness the credibility that comes with that.

Patients have shown our healthcare system that what they want is the most specialized expert care that they can get for their particular condition. Each of our reversal centers of excellence is staffed by experts in that therapeutic area, who take on the patient in the practice of healthcare so that we can manage medications, do labs, and have the whole set of healthcare services at our fingertips.

No one disputes that a percent of a patient’s health is behavior. The question is, do people believe that it’s possible to help them change? A core idea that we have at the company that comes from my own life and the life of the people here is that everyone can change if we give them the support to do so, and if we ask them to make a change that they care about.  That’s why we focused on these areas and why we think this delivery model can help support people. It’s tougher to engage people with the garden variety app that counts steps. That’s not solving a problem that patients care about. That’s why we think this is different.

How does a patient’s primary care doctor participate?

That collaboration is such an important idea that we named the company AndHealth to reflect the idea that we can’t do this alone. We see ourselves as part of what I think will be a transformation in our healthcare system that we do mostly outside of the company, rather than inside. While we become the patient’s headache specialist, there are about 40 million migraine sufferers in the United States and only 2,000 headache specialists. This is one of the key challenges that we are helping patients solve, the problem of access. Even if you have good health insurance, the ability to get into a care team that understands how to treat migraine is hard.

By moving this care to a model that is more accessible and is available continuously, we are able to make a big difference in the lives of these patients. You can think of us as a referral from a patient’s primary care doctor or from their employer, because we are an employer-sponsored health benefit that helps complement the healthcare that the employer is providing to their employee.

How hard is it to convince employers and health plans to pay for your service?

Ultimately, we need to prove that we are achieving life-changing results for patients. If we can do that in this area, it will be an important new way that patients get access to care.

One of the reasons that we started with migraine is that leading employers are starting to recognize it as a silent issue, lurking just beneath the surface, much like how the best employers started to recognize mental health five years ago. It had historically been dismissed. It had historically not had great treatment options. It wasn’t generating the claims that caused it to get on anyone’s radar. It was a chicken-egg issue. If there wasn’t good access to care, there weren’t many claims, so it didn’t get onto the radar of employers. 

But we now know that migraine is the leading cause of short-term disability for most employers. It’s a huge contributor to turnover. Because it disproportionately impacts women and people of color, it’s a lever against diversity, equity, and inclusion objectives for employers. We think that a proposition that is focused around increasing access to super high-quality care in a therapeutic area that impacts many of these employers, 20% of the employee base, and is actionable because patients are engaged around this disease, will be taken up by many employers. We are seeing that so far in the market.

Can you survey employees or look at company records to identify the opportunity, unlike wellness apps where employers may get some non-specific value from helping their employees with weight, exercise, or stress?

Exactly. It’s rare that we’re in a meeting with an employer where someone in that meeting doesn’t say, “I have migraines. That has been an incredibly difficult part of my life that has made it difficult for me to show up in the way that I want to at work.” Because it’s common, and historically patients haven’t seen a lot of good treatment options, we are hearing from employers that this is important to solve. Now that we know that it is solvable, there’s a lot of interest in engaging.

It’s similar in autoimmune conditions, although what’s a little different in autoimmune is it has gotten a lot of employer attention because the costs are so high. For the conditions that we are treating, simplifying a little bit, there’s about $40,000 in costs per employee, per year for those who suffer from the conditions. A good bit of it is pharmacy cost, but there’s also significant healthcare cost. That has gotten more attention, but migraine employees are expensive from a claims perspective and especially from a productivity perspective.

AndHealth isn’t primary care, where we need to be able to treat a patient who shows up with anything, and where we have a relatively diffuse cost or value proposition to an employer. This is something that’s targeted at the disease states that, one, are the most expensive and disruptive, and two, by narrowing, give us an opportunity to have a learning system that gets better really fast.

One of the underappreciated elements of digital health is the degree to which when we narrow and then run this through software where we’re force-multiplying the expertise of clinicians, we move to a learning system that is improving quickly. We have a credible chance to move in these therapeutic areas from a new company to the foremost expert quickly by narrowing. That makes achieving results for patients dramatically easier than if we tried to see a patient who shows up with any condition.

What are the most important lessons you learned from starting, growing, and selling CoverMyMeds?

The biggest lesson was to find a way to collaborate with the healthcare system. Because if we want to do something big, we need the help of the people that are already here. We can be transformative without being disruptive. That idea is so important. That’s why we called the company AndHealth rather than OrHealth. That’s a really important one.

The other is the idea of people first, putting not just the patient first in everything we do, but winning through our employees. We ended up being on Glassdoor as one of the top 20 employers in the country in the past. While we think the tactics that will get us there are different, because the world is different than it was 10 years ago, we are focused on being a place where clinicians and technologists can come to build something that makes a big impact for patients, but also makes a big impact in their career. Those two things are core DNA in the company.

What would you like to see happen with the company in the next few years?

We have already shown that we can produce what we think are life-changing outcomes. In our first study in migraine, we were able to get to a 60% remission rate for patients. What we want to do in the next couple of years is show that we can do that at scale for employers and in a way that generates a value proposition that makes this part of the benefits package for the leading employers. It’s about showing that we can create those life-changing outcomes with patients, in collaboration with employers, at a scale that ends up making a difference for the world. If we can do that, that is success.

HIStalk Interviews Gidi Stein, MD, PhD, CEO, MedAware

February 15, 2022 Interviews 1 Comment

Gidi Stein, MD, PhD is co-founder and CEO of MedAware of Ra’anana, Israel.

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Tell me about yourself and the company.

I started my career as a software engineer many years ago. I was a VP of research and development and the CTO of several startups in the early 1990s. At some point, I vowed never to do startups again, changed my career course, and went to medical school. I was the oldest medical student in Tel Aviv University. I graduated, specializing in internal medicine, did a PhD in computational biology, and held executive roles in one of Israel’s leading hospitals. MedAware is a software company that uses artificial intelligence and smart algorithms to identify medication-related risks and save lives.

What points in the process of ordering and administering medications are most likely to introduce patient harm that existing systems won’t detect?

The flow that begins with the prescriber ordering the medication, the pharmacy approving it, and then administering it or having the patient visit an outpatient pharmacy — all of these situations are basically covered, in some way, by existing systems. But after the patient is already on the meds, after they are  home or are already admitted, things can go wrong. Laboratory abnormalities are found. Vital signs change. Patients can deteriorate into shock or have acute renal failure or anemia. These changes impact the risk that is inflicted on them by their meds, and some have drug events that are related to the medications that they are receiving. Current solutions are usually not good at tracking this, monitoring these patients, and picking up those risks in the post-prescribing, post-dispensing period. Most of the problems we find are there.

What are the alerting challenges that are unique to smart infusion pumps?

Smart infusion pumps are IV pumps that “know” the medications that are being provided to the patient by that pump. The nurses program these pumps in terms of the medication to be administered, the patient’s weight, the rate, the dose, how long the infusion should take, etc. In each of these steps, there can be a typo, a click of the wrong button, or mis-programming. The current systems are similar to the electronic medical record in being not very good at identifying these risks. The alerts that they generate are mostly false alarms, which drive alert fatigue. It’s similar to what we do with electronic medical records — we know how to identify pump programming errors and do this through our partnership with Baxter.

How do you identify an exception to normal practice to generate an alert?

We assume that nurses, physicians, and pharmacists know their jobs. They don’t need MedAware or any of us to teach them how to practice. But you can be the best poet in the world and still have typos that a spellchecker will find. You can be the best doctor in the world and still need that intelligent spellchecker to identify these typos in prescriptions or the programming of pumps. This is where the outlier piece is more relevant.

We published research two years ago with Sheba Medical Center, a large hospital here in Israel, in which we analyzed the errors that physicians make when they’re tired, overworked, or don’t have specific experience with the medications they are prescribing. Two times, three times, eight times as many errors are made when physicians are tired, overworked, working in an overcrowded ER, and especially when they are prescribing medications that they are not used to prescribing. We’ve seen that more and more with COVID in the last two years.

How does the technology coexist with an EHR to reduce alert burden?

What is unique about our system is that the alert burden is very, very low. Current systems can generate alerts in about 20% of medications or medical orders. We provide less than 2%, almost 1%, of the alert burden. The accuracy of the alerts we provide is very high, more than 85% as compared to less than 5% in the current solutions. In most of the cases, physicians — and we monitor this continuously — change their order following our intervention. Instead of applying rules like current systems, we do something more intelligent in applying more sophisticated algorithms to understand the prescription patterns in each hospital, in each care setting, and identify the outlier behavior as a potential error. These are usually consistent with the physician saying, “Oh, I didn’t mean to do that. I’m going to change that.” We see that every day

Are the EHR alerts suppressed by replacing them with yours?

It depends on the client. It depends on the workflow. In some cases, we completely replace the current systems and we are able to generate very few alerts and change the whole experience of providers. In other cases, we focus more on the pharmacy, where all the medical orders are funneled to, so we’re able to surface the catastrophic problems for the pharmacy to focus on. Our engine can be applied in different settings and in different workflows. It really depends on the client and the setting, even inside infusion pumps.

Does the alerting intelligence use the clinician’s individual patterns, or does it look only at their facility’s collective experience?

It’s more detailed than that. It’s at the level not only of the institution, but of the specific department and boiling down to specific prescribing patterns. It really depends on the amount of data that we have in each institution and our ability to model the “normal” behavior based on this data. The more data we have, the more accurate we can be. We can drill down to more refined accuracy and resolution.

How does an organization analyze their alerting patterns to determine that your system can help?

It’s common knowledge. We don’t have to persuade the customers that the current alert burden is too high and that they are ignoring most of the alerts. The challenge is to persuade them that it’s not necessary — they could do it differently and it could be a different experience for the provider. They find that hard to believe. One of the things that we do in most of our clients is take a little bit of historical data and show them what we find. This is the “aha” moment, because with most of the stuff that we find, they were not aware that it is happening in their own back yard. That easily triggers the “OK, I want this.”

How much of the capability that your system has was made possible by advances in AI, and where do you see AI finding a place in healthcare?

Our solution uses many type of algorithms, from the simplest statistical analysis to really robust AI with deep learning, neural networks, and all the buzzwords that come with it. We use the most sophisticated part of AI for specific use cases, one of them being to identify cases in which the patient receives the wrong meds. Either the physician clicked on the wrong patient or drug was given to the wrong patient.

Understanding the clinical context of the patient and the relevance of this specific medication to that patient’s profile is an extremely hard task to do. We’ve been able, for several years now, to identify and to classify the medication as, is this relevant for this patient, or is this not relevant for this patient? It doesn’t have to be even something dangerous. It could be a two-year-old male child who is ordered birth control pills. It wouldn’t kill him, but he definitely doesn’t need it and it’s a complete outlier for that child. This is an extreme case, but there are a lot of more simpler ones that are hard to detect by anything else than using sophisticated AI. Our point is that we would rather use the simplest methodology to fix the problem, but in some cases, you need something that is more complex.

The use of AI in healthcare will find its place. It’s still struggling. W see very nice solutions in the imaging world where companies identify risks in CTs or MRIs and surface them up to the clinicians that hey, you have pulmonary emboli, CVA, or a critical event that you have missed –put it on top of the file.

The fine line is understanding and comprehending that we are not here to replace the clinicians. We are here to help them make better decisions. We are not here to teach them medicine. We are not here to tell them what to do. Just being that safety net to make sure that they don’t type the wrong thing. This approach can grow into more helping with diagnosis and procedures and providing a better prescribing and platform for clinicians, as long as we don’t even think or say that we can replace them or do their job, because that just doesn’t make any sense,

Where do you see the company in the next few years and the use of technology like yours in healthcare?

We have developed a unique engine that can be applied in different places in the industry. Our strategy on the business front is to partner with larger companies that have embedded solutions — in medical devices, decision support, or anything in the medication delivery space — where we can make their data smarter. We can make their systems and devices perform better. This is the path of growth to the company going forward. Baxter is one example. We have more that are coming and the future is looking good.

HIStalk Interviews Clay Ritchey, CEO, Verato

February 10, 2022 Interviews No Comments

Clay Ritchey, MBA is CEO of Verato of McLean, VA.

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Tell me about yourself and the company.

At Verato, we are identity experts that enable better care everywhere by solving the problem that we believe drives everything else, which is knowing who is who. Our mission is to be the single source of truth for identity that provides healthcare a complete and trusted 360-degree, longitudinal view of the people that they serve. I’ve spent the last 20 years in healthcare technology, with a passion for helping people leverage technology to deliver better care, better outcomes, and better patient experiences. I’m excited about Verato’s ability to do just that with identity resolution.

What is the extent of mismatched patient records in an average health system?

It is not atypical to have 8% to 10% of medical records be mismatched, either as  duplicate medical records or overlays. That’s very common. That problem has been exacerbated as we move into digital health. The ecosystem is more complex and the information is even more inaccurate as you try to aggregate that data and those identities across not just one or more EHRs, but over 20 to 30 different inputs or data sources that are collecting data on patients.

Is patient identity harder to manage with hospital acquisitions and increased interoperability?

Yes. Unfortunately, we’re still in a world where most health systems are thinking about how to drive interoperability inside their own physical enterprise and virtual enterprise. Even in that scenario, mergers and acquisitions create a challenge with how you take a patient census that is sitting in different EHRs and combine them into one so that the patient experience isn’t harmed or important information is missing so that I can’t treat the whole patient. That’s a key driver as health systems think about expanding and need to welcome these new patients and deliver the service they expect.

How well do EHRs detect patient matching problems, especially now that using Social Security number as an identifier has been eliminated?

There’s two significant challenges with the EHR’s ability to prevent identity mismatching. One is the fact that most EHRs only have visibility into the data that they house themselves. As you start thinking about all these additional channels of data and data sources outside of the EHR, they don’t have the ability to reconcile those data sets from an enterprise perspective.

The second challenge is that the typical EHR identity matching technology is driven by probabilistic matching or algorithms, looking at information that you have physically about the patient. We think a better approach is using referential matching, where we have data that might not be sitting in the EHR about that person and we can connect the data points and fill in the gaps with that information to provide better matching.

Have you seen interest in uniquely identifying people who aren’t necessarily patients, such as public health organizations that try to match vaccination data to their medical records?

The pandemic drove a lot of wonderful things for the future of healthcare. One of the most important is that it created a reimbursement model for telehealth. We are seeing 38 times as many telehealth visits as we had before, and it is stabilizing at around 17% to 20% of all outpatients. With that is a change in the mindset around how consumers want to be treated. Consumers who plan to make an important purchase go online 85% of the time to find information first. In a post-pandemic world, healthcare is seeing that number upwards of 90%, where people consult online resources about their symptoms before they talk to their doctor.

Because of all these different channels and digital engagement around the consumer, health systems have to understand who is who. How can I create a 360-degree view of all those interactions to create an experience for that patient, showing them that I know who they are, I have empathy for them, and I can solve their problem holistically?

What are the competitive advantages of accurate patient identification?

Forward-looking health systems are committed to offering a patient experience that is based on a simple premise – you have to show them that you know them. They are using an identity management platform to create and curate an experience for the consumer who is thinking about consuming a service from them. It might be somebody doing research about a knee or hip knee replacement. You need to understand who they are and be able to tailor your communications with them, so that as they continue to interact with the health system, that health system already knows that they have been on the website, downloaded a white paper on hip replacement, and are now calling in. Can I help you find a doctor who can help you answer questions around those types of things? Accelerating the acquisition of patients requires understanding the identity of the patient and then being able to deliver better care.

Finally, as health systems are moving from fee-for-service to fee-for-value, population health, and social determinants of health — and being able to manage both in-hospital and out-of-hospital concerns — it becomes critical to understand the patient identity, to proactively identify them as having risk factors, and to proactively give them a care plan to prevent a chronic condition or to better manage their chronic condition. All of those things contribute to happier customers, happier patients, lower cost of treatment, and overall better outcomes.

Outside of healthcare, customers uniquely identify themselves via a loyalty card or a website login that allows a business to then understand their behaviors. Can we learn from those industries?

Yes. Healthcare doesn’t have to look far at all to figure out how to delight the patient and deliver an exceptional patient experience. Loyalty programs, being able to know who you are as you’ve logged into their website, and from there to present them with information that is relevant to what we know about them. If we know that you are a cancer survivor, we should be delivering content to you that can help with your journey.

There are many examples across other industries that you can draw from. One of my favorite airlines is Delta Airlines. They seem to be able to anticipate my needs as a traveler even before I have them. If there’s a delayed flight, they are already thinking ahead about giving me options for rescheduling. We are starting to see forward-looking healthcare systems think about embracing consumerism and applying these types of technologies. Over 50% of millennials today don’t have a primary care provider, so they will be looking for experiences similar to how they buy something from Walmart or Amazon. To do that, we have to transform the way that we engage them.

Health systems experimented years ago with patient loyalty cards that also allowed medical records lookup. Why hasn’t that been adopted more widely?

The reporting from a year go on Ascension and Google Health showed a lot of privacy concerns that exist in America with respect to healthcare, our privacy rights, and protecting information about our health. I believe those basic concerns around privacy are pervasive. There’s a lot of conversations going on about universal patient identifier. That would be helpful and necessary, but we don’t believe that it alone will ever be sufficient. There’s just so many ways for patients to engage with the health system and so many front doors they come in, whether physical or digital. The idea that that patient will always have that identifier with them and present it in a confirmed way is challenging.

That’s where you’re seeing this pervasive, long-term need for additional technologies on the back end that continue to piece together these stories and be able to help us identify them. That being said, I do believe that we’re going to see the industry move towards a more trusted identifier. That may be through a trusted private sector opportunity versus the government. We have to work through how to get something that is safe, secure, and trusted before we can break those barriers.

What problems would arise or remain unsolved with the implementation of a universal patient identifier?

You mentioned Social Security number. Isn’t it already a universal patient identifier? Why hasn’t that been sufficient? The idea of using a universal identifier as a key into a lock that it gets you access to a health system, your health records, and information about yourself has a lot of goodness, but you’ll still find that it’s not practical to have a key that can be trusted and validated everywhere it would be used. Our own experience on the consumer side is that we have to find ways to create that experience that don’t rely on that type of unique key. I believe that a universal patient identifier will move forward, but while it is necessary, it won’t be sufficient for delivering the value proposition that we all hope for.

Where do you see the company in three to five years?

We see Verato continuing to enable this idea of better care everywhere by focusing on enabling the interoperability of digital health and the digital health transformation that is happening across the health system. Today, it’s health systems themselves. Tomorrow, it’s going to be across the care continuum. Being able to make that information portable, so that a patient can visit a health system in Pennsylvania and then while traveling on vacation to Florida and being able to visit the health system there, having that type of interoperability across health systems. I believe that Verato will be a part of that transformation as we move from interoperability within a health system to interoperability across the care continuum.

We’re also working on partnerships. We believe that having a common view across the care continuum — pharmacy, pharmaceuticals and biotech, medical devices, HIEs, providers, and payers – that trusted, protected, secure common view will help us eventually get to liquidity of data so that it gets to the right place at the right time to deliver a better outcome.

HIStalk Interviews Kyle Silvestro, CEO, SyTrue

February 9, 2022 Interviews 1 Comment

Kyle Silvestro is founder, president, and CEO of SyTrue of Stateline, NV.

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Tell me about yourself and the company.

I’ve been in the world of clinical natural language processing for almost the last 17 years. I started SyTrue a little over nine years ago, thinking about how to solve challenges around archaic workflows where we still require humans to read medical documents, especially from the perspective of CMS. And, how we automate a number of processes by eliminating inefficiencies within the system.

How has the need and the ability to automatically extract information from medical records changed over the years?

The need has been there for more than a decade. The awareness is coming to the forefront. We are truly understanding the value in information. The advances in AI and ML have highlighted that. Most of those advancements have been more around structured data and what is possible. Looking forward, organizations are understanding the value of the unstructured clinical note that still comprises the majority of information created in healthcare today. We process more than a billion pages of these notes annually, and that’s just scratching the surface. That would be on data created within the last 12 months. The majority of information is still in this format.

It depends on where you are in the process from the point of care to the point of need. At the point of care, maybe you can get high quality data quickly, but most organizations are not. They are downstream of that information, and it’s packaged up more often than not in a PDF. It’s not even unstructured data — it’s an image. That image is shared with organizations and data is often needed 20 ways downstream. If you don’t have a way to create this exponential uplift, then you can’t start addressing the challenges we see in the system. This problem has been here for a while and there are truly no good solutions addressing it that have a critical level of adoption.

Do PDFs usually come from outside facilities, meaning that it’s an interoperability problem, or are they self-generated because the source system doesn’t capture the data discretely?

It’s a combination. More often not, this is a byproduct of a record release process. Thousands of people go on site to facilities every day to get data from hospitals or provider offices. There are some electronic exchanges now, with CCDAs being sent across the wire, but that’s really the two ways that they are getting this data. It’s definitely an interoperability issue, but it’s more of a misalignment of incentives that is potentially preventing wider adoption.

What are payers and CMS doing with the data?

We have a unique challenge within the payer market. So much of what they get is an image, a PDF that can be thousands or tens of thousands of pages long. The only answer before SyTrue was to assign a nurse to read the document, go through the 4,000 pages, and find the eight or 10 pieces of information that answer the question. But more often than not, the 5,000 other data points that are in that PDF document that could be driving exponential uplift within an enterprise are left behind. They’re saved as an image, so they are being lost. The knowledge that is in front of them is gone. Our solution addresses the efficiency challenge, but we can also liberate all of that information to drive exponential downstream value on an enterprise level, to be able to create standardization and interoperability that can drive change.

What is involved with taking a PDF document and turning it into useful information?

This is a differentiator between SyTrue and everybody else. I had the privilege, or the advantage, of failing more than most people in pushing an early technology into the marketplace. Before I started SyTrue, I implemented NLP across life sciences, payers, and providers across a number of use cases, but had also seen challenges at failure points. As somebody who doesn’t like to lose, I remember those failures. 

When we architected SyTrue, we knew that it’s not just about NLP. If healthcare data is clean, NLP is easy. It can read the document, parse it, and extract it. But the problem is that we are dealing with inconsistency from organization to organization, physician to physician, EMR to EMR. How do you account for all this dirty data that was created by a million physicians that generate billions and billions of notes annually? And if those notes are needed 20 or 30 ways downstream, you’re creating a exponential data problem that you can never throw enough humans at to solve.

That’s what we thought about. We thought about that document life cycle. We thought about the creation sources. We thought about who needs it along the way. The question that we asked ourselves is, how can we make people money along the way? How can we add value? That approach allowed us to look at it from a longitudinal perspective, because we thought that if you can get to a longitudinal data and you can do it accurately, everything else downstream becomes easy. You have all the Legos, you just have to actually assemble the house or build the car. The structural components of the information are in that longitudinal record. It’s a matter of how you are combining them. 

With HEDIS, you need problems, procedures, and HCPCS codes. Risk adjustment. You’re looking at problems and supporting conditions and payment integrity. You’re looking at elements that would roll up to make a determination — is this truly an acute kidney injury, or is this sepsis? If you have that baseline data, the downstream questions that you’re asking or the objectives that you’re looking to get out of that information become a lot easier. You can do it across many domains, as represented by our client base and use cases that they leverage.

How will the healthcare entry of big tech firms affect your business, such as Google’s work with EHR search?

How soon before they call it quits again? They’ve all taken bites of this apple, only to fail miserably. I honestly think that’s the trajectory they are on. They do the market a bigger disservice than they do a service. They push early-stage technology that’s not prime time into our marketplace. They suck the oxygen out of that marketplace, and organizations that are small and may not have the $100 million marketing budget get squeezed out. True innovation never gets bubbled up to the top because you have these massive enterprises send 14 sales reps into a client to push a product that’s half baked.

You see that in Amazon Comprehend. They just reduced their price by 95% and now it’s this big announcement around SNOMED. Great, right? If it wasn’t good to begin with, it’s not going to be better when it’s 95% discounted. We’ve had SNOMED for nine years. It’s not new. It’s not really an announcement. Talk about how you’re making people money, talk about how you’re changing the system, and don’t just make noise. That’s what a lot of these organizations do. They truly don’t understand the problem and they truly don’t understand the solution that they need to create to solve it.

IBM Watson Health had some pretty grand ambitions and failed miserably.

MD Anderson Cancer Center. The trail of tears goes on. The billions of dollars that were invested into a technology that played “Jeopardy!” and then thought it could solve healthcare was amazing. They had 5,000 people at one point. It had a lot of data. But they couldn’t roll out anything that was meaningful, except for marketing hype. That is true of many of these big tech players getting into healthcare. They don’t understand the problem that they are trying to solve. They see dollars, they think they can throw enough money to grab market share. Unfortunately, I think they do the overall marketplace a humongous disservice. I haven’t seen truly significant impact from companies that took something that was playing a video game and thought it could solve healthcare.

How do you see the investment buzz over AI playing out?

There’s real opportunity in the technology. But I think you apply technology where it makes sense. You just don’t try to brute force everything, and because there’s a new technology out, think you can solve all the problems. We take a pragmatic approach. Use technology where it makes sense to apply it. As we get downstream, AI is going to be really, really meaningful. It’s going to be important in healthcare. But we have a foundational problem today in healthcare that is going to prevent that from becoming a reality for a little while, unless organizations start to realize it. If you’re not creating an interoperable base of accurate information that you are basing your models on, you are building a house of cards. I wonder how many of those actually exist today versus true value.

There’s a lot of hype, but when you actually get into the information, what impact is it actually making? Marketing has latched onto it. Not a lot of people understand it. Everything is a supervised model. Unless you get to accurate datasets at high volume, you’re somewhat playing with fire. But we have clients that actually do this and they see significant improvements in accuracy, sensitivity, and the impact it has on an organizational level, because they are working from an accurate, interoperable piece of base-level data that’s a solid foundation.

Where will the company focus on the next few years?

SyTrue is positioned to be a dominant player across many different solutions — HEDIS, payment integrity, fraud risk and abuse, risk adjustment, social determinants, expansion of radiology, expansion in oncology — all with a single platform and with the focus of making organizations money quickly and being able to get them live fast to enable that ROI. I see great things for SyTrue. I see us going from just shy of 40 employees now to a significant number in that period of time.

HIStalk Interviews Russell Branzell, CEO, CHIME

February 8, 2022 Interviews No Comments

Russell Branzell, MS is president and CEO of the College of Healthcare Information Management Executives of Ann Arbor, MI.

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Tell me about yourself and the organization.

I have been president and CEO of CHIME since 2013. I have held chief executive positions at UC Health and Poudre Valley Health System and some CIO positions  before that, including at one of my favorite places I started after I got out of the military, which was Mercy Health System in St. Louis. Before that, I was in the military and did medical administration and some other stuff that, like everybody in the military, you don’t talk about.

CHIME is a great organization. It has been around since 1992. I joined as a member in 1997 or 1998. It serves the purpose of supporting CIOs, digital health leaders, and the new titles in this space. We have over 5,000 members across the globe. We have members in 58 countries and chapters in 11. We have other associations that are part of our organization to include security and application technology officers. But in the end, we focus on one thing. One member at a time, we want to make sure they are exceptional leaders positioned to transform health and care. That’s what we do every single day. Everything we do revolves around our members and our industry, and we try to make it a little bit better every day.

How do those new titles and new roles such as chief digital officer fit into what has traditionally been a CIO world, and how does CHIME meet their needs?

I experienced some of that in my professional career, as the role of CIO changed fairly dramatically from the tech purveyor to a leader in the C-suite and transformation.This is just the next level of maturation.

It takes a lot of people to manage a digital enterprise. Eventually, you’re going to start hearing about the digital skills that are necessary for chief executive officers, chief financial officers, and so many others. Some CIOs, as they progress up the ranks, are positioned and ready to help lead an organization to that digital challenge and the digital journey they are going on. Some aren’t. People come and go depending on how their skills progress in the industry. The most important part for us is that we will do everything we can to help people move through that.

Our industry is in massive disruption. You’re also going to see that reflected in titles, skill requirements, and positions. Not just in the C-suite, but across the entire healthcare enterprise and ecosystem. We’re going to feel that every single day. We do everything we can, through a vetting process through membership, to identify those people that fit in that digital health ecosystem bubble. That’s who we want to serve.

What education and support does CHIME offer to technology leaders who are coming into healthcare from other industries?

It’s great that we are seeing more of them entering in the industry, mainly because more opportunities are available than ever for those leaders to transition into healthcare. It is a steep learning curve, although not insurmountable. We’ve always had some of them attending our CHIME Healthcare IT Leadership Academy, our ViVE event that is coming up soon in Miami Beach, and our Fall Forum. We’ve always tried to focus on building everyone’s skills up, and they plug right in.

The primary one for experienced people transitioning into healthcare, even though they may have 20 years of IT leadership or digital leadership in another industry, is our Healthcare CIO Boot Camp program, where we spend a lot of time working on and understanding the role of leadership inside healthcare. Part of that is digital health. Part of that is IT applications. But the primary thing is that you need to be a healthcare leader first to be able to apply those.

Then we help along with other things like mentorship programs, connecting them with a friend or a buddy along the way and trying to get them involved in the community. CHIME is a relational organization. We want to plug them into a support group and an environment where they feel like they can lean on people when they have those questions that maybe are a little bit too difficult to answer right there in a boardroom some days.

Has connecting people with peer support or networking changed now that in-person conferences aren’t the only option, or maybe at times aren’t an option at all?

COVID is a horrific thing that has been tragic and difficult for so many people, but it accelerated things that we thought would take five and 10 years, which is the acceleration of digital connections and digital thought. Part of that is exactly what you described. People have come to rely on feeds of information from a digital format. Your site is one of those.

But we sometimes live in a world of isolation, because so many people work in a remote environment. We count on those connections digitally to accelerate as a relationship. That’s the part that is still a little bit hard. We are human beings. We are relational beings who still need to see and talk to each other. Sometimes Zoom and our cell phones don’t meet that need. There still is a need to come back together, and we are experiencing that across the entire human race as we speak. We’ve seen that isolation maybe is not a great thing.

Healthcare is also different in that even multi-billion dollar organizations often compete only locally or regionally, which allows people to share information freely with people outside that area.

Most healthcare is still local. That has been a cliché for so long, but it’s true. You get most of your healthcare locally, where you live. With healthcare at a macro level, it has been — maybe “inspiring” is too strong of a word — at least motivating that I’ve never met any of our peers or any CHIME members who said, “I’m never going to talk to my peers about IT. It’s my true competitive advantage.“ It’s an enabler, and people are always willing to openly and freely share that. Even those who are on the cutting and bleeding edge are more than willing to share their lessons learned. That’s what’s great about our industry — people will tell you everything they’re doing just because they want to share and improve healthcare.

What led to CHIME launching a graduate degree program under CHIME University?

This has been a journey. We launched CHIME University initially as the umbrella for all of our education and development programs, which includes certification and long-time programs. We started getting feedback from people that there were no programs that met their needs on a realistic basis of “this is the way I work, this is where I think my career is going.” We got that feedback in multiple forums.

We started the journey of considering it, going out and asking questions. Some of the questions we asked were simple, such as, “What did you really love about the graduate programs you were in, whether that was a master’s or doctorate?” We were amazed that there was almost nothing they really enjoyed about their graduate and doctoral process, with a couple of exceptions. One was engaging with professors and lecturers from the real world who had been there, done this, lived this, or are living it currently as part of the curriculum. The other was that it’s real-world applicable and current, not a textbook from five years ago. It was applicable to me now and in my near future.

When we asked them what they didn’t like, the list was long. They hated synchronous learning, that they had to be there at a specific time. I’m a professional — who knows what my life is going to be like tomorrow? They hated the fact that it was almost always a structured environment that had to start and stop on a specific date. They said, that’s not how we work, it’s not how you work, and it’s not how our digital lives are.

Just as importantly, they wanted something that was going to be tailored towards their life, not towards a purely academic mindset, even though this will be extremely academic as we go through this. We boiled it down to a simple program that was a true, self-paced, convenient way to operate. If you need to take a month off, take a month off. If you want to go really fast in some part of the program, go really fast. We made sure this was applicable to our industry’s digital leaders.

But most importantly, the thing we heard the most was, why the heck is education so expensive? I’ve got a dear friend who is six years and $200,000 into a doctorate program. We said, we’re going to offer this at a reasonable cost. We’re going to use our leaders and real experts. We can offer this at an affordable cost so participants can keep their career going and and truly advance their education.

What led to developing the ViVE conference with HLTH?

We’re in a disruptive period of time. We are in a place where we need to do things differently and bring the right thought leaders in. What CHIME has always done really well is bring serious thought leaders together who want to collaborate and find ways to do things differently, to create something in a unique way.

We’ve been working with HLTH for a few years. We worked around innovation and collaboration skills and did some different things with them at their events. It was a symbiotic relationship, one of those rarities in life where one plus one equals a much higher number than two. We really felt good about that, but what we still felt was truly missing was a place where executives, leaders, innovators, disruptors, investors, and startups can come together and work an environment that tries to advance the industry at a much faster pace, questions the status quo, and finds something that we can all agree upon in different little increments all over the place to work in a different way.

HLTH has done an amazing job at reinventing what an event looks like. CHIME has done a good job of focusing on what leaders need to improve their skills. This isn’t intended to be a giant trade show floor. It will bring digital health leaders together who want to work collaboratively, exchange thought leadership, and do things in a meaningful way. We feel good about where we are with that.

How do you walk the line between wanting to grow as an organization but making sure that vendors aren’t driving the agenda or that membership becomes so diverse that people don’t have much in common?

The great part about this, and the direction of our board with our strategies and direction of CHIME, is that CHIME will still be CHIME. CHIME is still the entity for the senior digital health leaders. We will still have our CHIME Spring Forum, which is exclusive for those members and our small number of vendor or foundation partners. There will be a larger conference called the ViVE conference that wraps around that, which will have a lot of speakers and a lot of other opportunities. That’s for those leaders who need that level.

But the CHIME part stays CHIME. For lack of better term or analogy here, it’s the nucleus that sits in the middle that we will always hold sacred and always make sure we’re supporting. We can get bigger. We can support the industry. We can look at the whole ecosystem. But we also need to be true to our roots and true to what we do well for our CHIME membership. We think we can balance both well and in a meaningful way, and at the same time, look at a larger ecosystem that needs support and leadership, because there’s a lot of people out there who need to continue to advance, improve their skills, come together, and collaborate.

How did the ViVE conference end up being so close to the HIMSS conference in both timing and geography?

I’s always been a hallmark that we think we’re doing the right thing for our members, the right thing for our leaders in the industry. This was the right location, the right timing.

If you put it in perspective, the last two major events in the industry since the easing of COVID — I don’t in any way want to suggest that it’s over — was our Fall Forum last fall and now this event in collaboration with HLTH, ViVE. We want to continue to make sure we’re supporting the industry, and this was the right location and the right timing for us. There are places for everybody in the industry who wants to make sure they are doing the right thing and supporting the industry as a whole, but this is what we are going to focus on. We are really, truly not going to worry about other people.

Are you seeing increased membership from those folks with those new digital health job titles or those who work outside of provider organizations, say for health plans or drug chains?

We’ve always had some members who work in non-traditional roles outside of acute care, ambulatory care, and large medical groups. Our primary membership for years has been the provider sector, which was mostly the acute and the ambulatory environment. But we’ve always had some members in things like long-term care, nursing facilities, rehab facilities, and payers. As we see that ecosystem continuum come together and there’s so many pieces — some through acquisitions, some through relationships and partnerships — we see more and more of those come in.

Now we have not gone out and said, “we’re going to go out and try to get every payer into CHIME.” No. What we say is, we have programs and activities for leaders regardless of where they are and where they want to fit in. But even today, we have members such as the CIO of Walgreens Boots clinic structure, payers, and long-term care. It really comes down to whether it’s a vendor foundation partner and they fit in our foundation model, or they are a deliverer of care of some type and they fit in our CHIME model.

What developments will most affect CHIME and its members over the next few years?

Our board spent a majority of the 2019 strategic retreat discussing this for multiple days. No offense to any of our previous retreats, but it was by far the most productive, forward-looking retreat we’ve ever seen, where we talked about where the industry is going. They shaped a model of our 3.0 strategy, some parts of which you’ve already addressed, such as absolutely doing everything we can to help people advance in their skills, whether that’s small training and certifications and support, or if they need an advanced degree to move forward and continue to advance their whole educational aptitude. That was part of that strategy.

The other is that we have a higher responsibility to more than just the CHIME membership. Absolutely, we’ll never take our eye off our CHIME membership and do everything we can, but there’s a lot of up-and-coming digital leaders, a lot of people who will need support and need that vision that CHIME provides to them. We will look to the larger digital health ecosystem to make sure we’re doing that along the way.

The third leg of that stool is that not everybody’s going to connect in an in-person event. As a matter of fact, a vast majority will not connect in an in-person event. We need to provide everything from a digital connection engagement perspective, where they can do those things just as much as in-person in a digital format around the globe.That’s one of the things we can do in an easy way. We can leverage all the things that we’re doing to connect the entire ecosystem to raise all the boats while actually putting the same effort toward those.

We feel good about addressing the large ecosystem, staying true to what we are, but also advancing the whole industry to a place that will look dramatically different in five years. Healthcare will be almost unrecognizable, with the amount of technology and opportunities to improve care in the next three to five years, and then the next three to five years after that. We are in the revolutionary stage of healthcare delivery.

HIStalk Interviews Torbjörn Kronander, CEO, Sectra

February 7, 2022 Interviews 8 Comments

Torbjörn Kronander, PhD, MSEE, MBA is president and SEO of Sectra of Linköping, Sweden.

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Tell me about yourself and the company.

Sectra started out as a cybersecurity company in Sweden. In 1990, I had just completed my PhD and started up the medical imaging side of the business. Our first foray was in teleradiology and then we moved into radiology. We took what we learned in radiology, and we’re now focusing on enterprise imaging and have added modules for cardiology, ophthalmology, orthopedics, and pathology.

We are seeing the same trend in imaging that we’ve seen in EMRs, where there was a separate information system for every single department of the hospital. Then Epic and Cerner came around, and the CIOs said, we want as few systems as possible, and consolidated all the departmental information systems on one EMR.

What are the most significant trends in medical imaging?

Efficiency is important. There is an alarming risk of burnout among US physicians. You need to have systems that are fast and effective to use.

We see a trend toward consolidating to as few IT systems as possible. Having multiple systems is expensive and people underestimate the costs involved. You may have 100 IT people on your staff in a hospital, but without consolidation, a lot of them are doing the same thing on different systems. We are the only vendor who can manage all images in one system.

Cloud is also becoming increasingly important. Having a lot of hardware on site is expensive, and it is challenging to stay on top of the many updates of the underlying operating systems. If you can use Google or Microsoft to manage the cloud operations, they are, cybersecurity-wise, in a better place than almost any on-prem solution.

Combined, we see a large trend towards cloud and a single system for all your images — let’s call it a “pixel EMR,” which is a quote from one of our customers — and then within that space, digital pathology, which is rapidly coming along.

What role does AI play?

AI is very interesting. It will be large, but it will not be as fast as people anticipated. There is a famous quote that the first law of technology is that we always overestimate the impact in the short term of transformative new things, but we also inevitably underestimate the long-term impact. We see this exact trend in AI.

AI is not where it was a few years ago, when people predicted there will be no more radiologists needed to be trained after 2022, which of course is not a bit true. But we will see AI gradually coming into prominence. I’d like to quote one of our customers, Dr. Langlotz of Stanford, who says, “AI will not replace radiologists, but radiologist who use AI will replace radiologists who don’t.” It will drive efficiency, but it will not replace the radiologist. You will still need that human being in medicine. 

We see a lot of AI vendors right now in the market. At Sectra, we have said that you can’t compete with the hundreds and hundreds of AI startups, so we are going with the open systems approach. We have the Sectra Amplifier Store, where customers can use any AI application that they like. If we’re going to accept the AI software for their use, we will do the cybersecurity evaluation on it and ensure that it is secure.

Cybersecurity is a grossly underestimated trend in medical IT systems, because ransomware attacks are increasing, and healthcare is a primary target. Eighty-five percent of Sectra’s business is medical IT, and the other 15% is cybersecurity, which gave us our name — “SECure TRAnsmisson.” We are one of the most prominent cybersecurity vendors in all of Europe. We protect networks with high-level security. We provide secure mobile workplaces and phones for the entire European Union. We are using that same knowledge when we build our IT systems.

Is the company’s cybersecurity expertise a competitive advantage over companies that just sell imaging systems?

That is a very true statement. For many years, we have run our security and medical divisions in parallel. Over the last two to four years, this philosophy has increased in value. Cyberthreats are dangerous for healthcare because typically health systems have to pay the ransom. If other industries get attacked by ransomware, most of them will not pay if they can at all avoid it. But in healthcare, patients die unless you pay those who are responsible for ransomware. The cyber mafia knows this.

We see huge benefit from having defense-level and national government-level security knowledge in the company. We build our systems to be as safe as possible. We are one of the highest-ranked cybersecurity companies in the entire medical sector today. To have that knowledge in house is important. It’s also interesting to see that KLAS now ranks vendors for their cybersecurity preparedness and they consider Sectra to be very mature and safe in that aspect.

What challenges and opportunities have arisen due to the pandemic, especially with telehealth and teleradiology?

I would say the largest impact has been in telepathology. Pathologists are embracing the ability to digitally send images for second opinions as well as to read from remote locations. Previously, a pathologist had to sit at the site of the biopsy and wait for the sample to arrive from the operating room. Now they can see the slides digitally and make quick and easy diagnoses.

How would you assess the status of image sharing?

That is an important question, because sending images in a taxi from one end of New York City to the other is not very effective and it’s also dangerous for the patients. Sectra has the largest image-sharing network in the world, located in the UK, in which every single hospital is connected through our system which sends approximately 40,000 exams per week. There are no CDs in the UK anymore, thanks to us. We are also applying this technology to some places in the US, but the UK network is our biggest reference as of today.

How much of the company’s strategy and product design has to reflect the healthcare policies of the US that don’t apply anywhere else in the world?

The US is our most important market at this time. We have a market share of greater than 50% in many Northern European countries where we operate, whereas we have about 10% in the US. We do, however, have the happiest customers, as evidenced through KLAS and the Best in KLAS awards, and that gives us the ability to grow. We have some important American partners that we collaborate with for research, and some very prominent hospitals as customers. We spend a lot of effort and emphasis on the US market.

There are differences between regions in the world, but not as many as you might think in the imaging space. Images are images, and the way you need to work with them to complete the diagnosis is very similar in all countries.

You’ve said that the way you beat big imaging competitors is to have better employees, stick with your goals, and treat your customers better. How do you make that happen as a global company?

I’m a good friend with Judy Faulkner of Epic, and she told me once that the only way you can become big in the US is by having more happy customers. That resonates very well with my basic philosophy of life. You need to make money, but there’s more to life than money. Happiness is also very, very important. You cannot create happy customers without happy employees. We work a lot with employee satisfaction and recruiting to finding the best people.

It’s very interesting that the competitive advantage for product innovation is a fairly short timeframe. If a vendor introduces a new feature, by the next year, everybody has it embedded in their product. But that’s not the same thing with customer satisfaction. The only way you can sustain a high level is if you have happy employees who are motivated and who will do the best for customers. That culture will always win.

We also recruit the best possible people to join the company. I personally interview every single one, worldwide, before they get an offer. To maintain exceptional quality, every interviewer has the right to veto a candidate. We also have high employee retention, with many people working at Sectra for 15 or 20 years because they like it. And of course, if they like it, they also do a good job for our customers.

What will be important to the company over the next few years?

As I mentioned earlier, enterprise imaging is crucially important. The CIOs cannot afford to have multiple IT systems and they need to partner with companies who can manage all their departmental images in one single system. We have changed to a subscription-based, SaaS model which allows the customer to acquire new technology without large capital investments and we guarantee the cost for the underlying cloud infrastructure which no other vendor does, to our knowledge.

HIStalk Interviews Eric Rosow, CEO, Diameter Health

January 26, 2022 Interviews No Comments

Eric Rosow, MS is co-founder and CEO of Diameter Health of Farmington, CT.

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Tell me about yourself and the company.

I’ve been in healthcare tech for about 30 years. I’m a co-founder of Diameter Health, along with John D’Amore, and I serve as the company’s CEO.

I started my career as a biomedical engineer with Hartford Healthcare. I’ve always been drawn to solving problems that are at the intersection of tech and healthcare delivery. What I especially love is being part of building, and helping to build, mission-driven, high-performance teams. Our mission at Diameter is simply to make data universally accessible, organized, and actionable for better health and more efficient healthcare. 

We have been at this for almost 10 years and we stay focused on this core capability, which we call upcycling. We have been able to process clinical data and patient records for nearly half the country across multiple market segments, including payers, federal and state governments, HIEs, life insurers, and HIT partners. The common thread across all these folks and partners is that they all recognize the challenges and complexities of wrangling multi-source, multi-format raw clinical data that is often dirty, inconsistent, and incomplete.

Has wider use of technology building blocks such as FHIR and APIs exposed the problem of data that falls short in quality, usability, and interoperability?

We are excited about FHIR and the standards that it brings to offer a much more efficient means to exchange data and to pull data. In our early days, we thought of data as digital, but it is like crude oil. It’s in the ground, in tanks, and in trucks. It’s digital, but it’s crude. We look at the market in three broad segments. We need pipes to move and aggregate the data. We need the refinery to clean up and enrich that data. Then we need to address the use cases where you need high octane fuel to run different engines, whether it be a moped or an F-16.

FHIR makes the pipes much larger and puts a lot more pressure behind it, so it is amplifying the need for cleaning up the data. We think that’s a critical challenge that people are seeing now. FHIR is amplifying the understanding of how dirty the data is in terms of incompleteness, duplication, and just plain old dirtiness.

What did you think of the recent study that found that even sites that use the same interoperable EHR can’t necessarily exchange data?

That’s the driver of why this company was founded. I was moved years ago at the HIMSS conference by hearing Google’s Eric Schmidt give a keynote where he talked about how healthcare has this compelling need for a second tier of data. He concluded that these primary data stores of EHRs have to be supplemented, not replaced, with that second tier. He went on to emphasize that in his 40 years being in enterprise software, he has seen this phenomenon repeat itself over and over.

That’s exactly what is happening today in the interoperability landscape, and frankly, what is needed. It’s also super exciting because the second tier of data can unlock massive opportunities for innovation, better workflows, and better outcomes.

To give you a real-world example of a second tier of data, we all use and benefit from apps that use GPS coordinates, such as Uber, Lyft, Waze, and Apple and Google maps. None of those apps would work if GPS locations were inconsistent, because you can only have one set of coordinates for a given location. In healthcare, we literally have hundreds of ways in which diagnoses like CHF, or COVID status, or lab values like HbA1c, even from the same EHR, are inconsistent and are unable to be exchanged. We feel that it is critical to let these innovators and developers focus on innovating and not the dirty work of normalizing data. Once you can do that, then AI and machine learning algorithms work superbly at scale when they can ingest clean data.

How can we improve healthcare when we look at dirty data, when 80% of the allergies are not coded appropriately — and we’ve found in our work that 30% have no code at all — 70% of lab results don’t use the right vocabulary, and almost half don’t use LOINC? We’ve also found that over 40% of medications don’t have the right coding to run quality measures. That is ubiquitous and why this is such an important field that we are so committed to.

What business models are being created or improved with the wider availability of healthcare data?

As I look back at our journey for almost a decade, it has been following the data. We went after the health information exchange market in 2014. Willie Sutton said that he robbed banks because that’s where the money is, and in our case, that’s where the data was. We wanted to go there, not just because they had Epic, Cerner, Meditech, Athenahealth, or Allscripts, but they had over 100 certified EHR vendors. 

Cutting our teeth at that foundational area where all the data is being aggregated has been so valuable. The experience and scar tissue that we developed during those few years allowed us to expand into other markets, including the VA, payers, HIT vendors, and even life insurance, which wasn’t a market we were thinking a lot of before COVID. But it’s an interesting example of how you can have one core capability that crosses multiple markets and therefore multiple use cases and business opportunities.

The early goal was for hospitals to be able to exchange data, but now many players are creating data that should be part of a longitudinal patient record. Is technology adequate for creating that patient record from sources such as pharmacies, urgent care centers, and insurers?

If I go back to my analogy of pipes, refinery, and use cases, our rebranding to what we call upcycling data is where it all comes together. It’s all about powering innovation, efficiency, and better outcomes across the ecosystem, but it fundamentally comes down to the data quality.

I once had the honor of being introduced as a speaker by Micky Tripathi before he took his role at ONC. Knowing how dirty and incomplete clinical data is, Micky introduced me as “the sewage treatment guy.” I laughed, but I took that as a badge of honor, like Mike Rowe in the series “Dirty Jobs” crawling through sewer pipes with rats on his head. Cleaning up this data, upcycling data, can indeed be a dirty job, but it’s so important. It’s not easy, but it’s so necessary to do it at scale. Turning all that potential from the disparate sources into power is to enable these downstream use cases is key.

What level of data exchange is happening between insurers and providers?

COVID has certainly put a highlight on that ability with life insurance, for example. Efficiently accessing and utilizing clinical data coming out of the EHR supports more cost-effective and timely underwriting. Because in a world of COVID, people could not literally go into healthcare settings and pull charts and scan charts. They realize that this is an opportunity. We’ve done some exciting work with Swiss Re, the world’s largest reinsurance company, that sees that not just as a US opportunity and challenge, but a global one. The data interoperability landscape is so exciting right now, but all these technologies are challenged by solving the big opportunities around the data.

But it’s also confusing. A lot of companies are describing capabilities using a lot of the same language. That’s where we wanted to come up with a different way of how to position and explain that. The pipes, as I call them, are going to continue to be more and more commoditized. FHIR will drive more and more ability to access data. The real challenge is in how to make it usable and actionable. That’s why we are excited by this notion of upcycling, because I think it can transform the industry by having that clean, precise, clear data to run these downstream use cases.

Much of the expense of healthcare is administrative, such as in prior authorizations where the clinician’s eyes on the screen and hand on pen or keyboard become the insurer’s EHR interface. Do you see the systems of providers and insurers being connected to meet each other’s needs electronically?

I do. Value-based care is really is the only way forward, but you have to align the incentives and the risks. You have to accurately measure and quantify outcomes that can be enabled with respect to access, quality, and cost. So, we need to be really clear by what we mean by and how we measure value. At the same time, as you look at this co-opetition of pay-viders, that new model or new business paradigm that can save money and be more efficient for one cohort is taking away the revenue and the profitability of another. There’s always going to be an inherent aversion, in the short run, to change from one business model to another. But in the long run, this journey is going to be Darwinian, in that individuals and organizations have to evolve or risk declining or going away altogether.

Should those who are holding useful healthcare data be paid to share it?

I think they should. That is what defines value. If you, as a payer or a provider, have to spend hundreds of thousands of hours to clean up that data and make it actionable, then it will be worth the cost and the value that comes from that. This whole notion of a clinical data optimization enablement that can leverage today’s API architecture is really what is foundational to enabling these new use cases. But the devil is in the detail, and it’s easy to talk about but so hard to do.

To make it the data valuable so that people are willing to pay for it, you have to do a number of things. You have to semantically normalize the data to national standards. You have to enrich it with metadata through streamline analytics. You have to reorganize it so it can be found in the expected clinical sections of a document. Then most importantly, you have to duplicate it and summarize it back into that longitudinal comprehensive record that you mentioned.

I’ve talked with so many clinicians and I’ve heard things like, “If you give me a 70-page CCD, it’s like 68 pages too long.” Or, “If you give me eight CCDAs for a patient, I’m not going to look at any of them.” That’s where the value is going to come. If you can save a busy doc time, then it’s worth it and I think people will pay for it.

I’m not a clinical informaticist, but I’d love to give you an example of why I think this can be so challenging and also so beneficial. Let’s say you have a patient show up and their record indicates that they’ve been prescribed the brand name drug Vicodin.That could either come across in the machine-readable or the human-readable portion of the document. The first thing you need to do is recognize that that brand name Vicodin is a combination medication of acetaminophen and hydrocodone.Then, you need to compute and reevaluate so that each ingredient can go into the respective RXNorm codes.

This all gets back to prior auth and how you need the right data to make the right decisions. After that, you have to leverage clinical grouping standards and indicate that hydrocodone is an opioid agonist and map that to the NDF-RT, the National Drug File – Reference Terminology. Finally from there, you can add on another meta-tag to indicate the severity of that medication in the case of hydrocodone, or Vicodin by transitivity. You can indicate that this medication is in fact a Schedule II controlled substance. All of this needs to happen to this transparent process.

If you can do that while maintaining visibility and data provenance, you have so much power. For example, you can make a query from a single field in a given state or region say, “Show me everyone within that region, or across the state, that’s been prescribed an opioid.” You can do that from a single field by having that metadata layered on top. Not just doing it for drugs, but for allergies, labs, immunizations, vitals, procedures, and demographics. That’s the opportunity. That gets back to that second tier that Eric Schmidt spoke about to enable all these different downstream use cases and business models.

How will the move to the cloud affect the possibilities?

It absolutely enables innovation and speed to value. It most certainly amplifies the network effect of propagating new knowledge and best practices. We are certainly seeing that across our customer base. I recall reading an interview that you did sometime not too long ago where one of your interviewees made the analogy that on-prem is like waterfall software development, whereas cloud is more agile, lean, and creating minimally viable products. That’s where the cloud has been so exciting, knowing that it can be secure, HITRUST and HIPAA compliant, and people can access that data and share that data securely anywhere. In our case, all of our clients, except a few that require an on-prem environment, are in a hosted environment in the cloud.

Where do you see the company in the next few years?

There’s a lot of interesting opportunities going forward. We’re going to continue to see a tremendous amount of data continuing to come in at exponential rates. I like to look to the future by looking back, and I’ll just share with you what I think might be of interest to your readers. When John D’Amore and I co-founded this company, we had this common vision to address and focus on what we believe is the biggest barrier in healthcare, data quality and usability. We heard of a physician named Larry Weed, a professor from the University of Vermont Medical Center. There’s this incredible YouTube video of him presenting a grand rounds lecture at Emory University over 50 years ago.

Dr. Weed so eloquently spoke to how the patient record cannot be separated from the caring for of the patient. The record is the patient, and that is the practice of medicine. He goes on to say how patient care is intertwined and how important the complete longitudinal record is in determining what the clinician does in the long run. So even 50 years ago, before the adoption of Meaningful Use and the proliferation of EHRs, Dr. Weed had the humility and the perception to recognize how the human mind simply can’t carry all that information without error. 

He also made that cautionary prophetic statement that we’ll either be a victim of poor data quality or we’ll triumph because of it. As we look at the volume of data, two-plus years into a pandemic, this is a hauntingly accurate prophecy. Enabling data in the largest industry in our economy to be actionable, accessible, and organized has never been more important. We are super excited about what the future holds in terms of continuing to improve data quality.

There has never been a more exciting time to be immersed in this world of healthcare IT, and in particular, data quality, or as Micky would say, sewage treatment. It has been an exciting journey. Working with such a special team has been so rewarding. I’ve always believed that the greatest product an entrepreneur can create is other entrepreneurs and leaders. As a rowing coach and a former coach and a rower, I would love to conclude with an analogy that I love being in this Diameter Health boat, being part of a crew that works so hard for a common goal. I can think of no goal more important than transforming healthcare and the ecosystem by enabling better healthcare with better data.

HIStalk Interviews Russ Thomas, CEO, Availity

January 19, 2022 Interviews 2 Comments

Russ Thomas, JD is CEO of Availity of Jacksonville, FL.

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Tell me about yourself and the company.

Availity is the largest network in all of healthcare, connecting 2 million providers and every health plan in the country and transacting 13 billion healthcare transactions a year. We have a broad scope and broad scale in driving a lot of cool impact in the transformation of healthcare. I’ve been the CEO since 2012 and have loved every minute of it.

To what degree do you see EDI, networks, and clearinghouses still being innovative and vital for digital transformation?

My buddy Sean Wieland, the analyst at Piper Sandler, told me a few years back that he would love to see how we make clearinghouses sexy again. I kind of laughed, saying, “I’m not sure clearinghouses were ever sexy, Sean, but I’ll do my best.” You have to be transformational and innovative. Otherwise, it’s a commoditized business where you are selling essentially transactions at fractions of a penny. If you don’t innovate and evolve, then you become irrelevant pretty quickly. That’s where we’ve been super successful. We have always focused on real time. The company was started as a real-time network.

When you say EDI, I think batch and days in transaction processing and transfer versus milliseconds. That’s a real opportunity for businesses like ours, to take what today is a large network of very important transactional activity and evolve it into a network of interactions between providers and health plans and make sure that, on a real-time basis, you’re serving up content. We’re in the information business. We have to be able to serve up content to the right provider, right time, right patient in ways that can meaningfully improve that patient experience. I think that 21st century clearinghouses and networks like ours have to be able to do that and demonstrate that value in order to thrive.

Your most recent investment was from Novo Holdings, which has life sciences connections. Do you see an opportunity to expand into real-world clinical research data?

That’s not where we’re headed, to be candid with you. We are in such a trusted place with our customers — our health plans, providers and ultimately the members and patients that they serve — that I don’t think we need to go there. Just being a data broker isn’t particularly exciting to me. What’s exciting to me is this evolution of transactional relationship between providers and health plans to an interaction, meaningfully moving to digital engagement, digital platform between providers and health plans.

Today we live in this pretty siloed transaction environment where you run an eligibility check and you get a response to that. It may tell you to do something else. You run an authorization, you get a response to that. Then down the road, you submit a claim, you get a response to that. That’s not how healthcare gets practiced. Physicians are practicing in real time, and they are making real-time clinical decisions about how best to treat their patients.

The administrative networks haven’t kept up with, or at least haven’t advanced, to support that type of real-world relationship between providers and patients. That’s where we are focused, moving to this intelligent network that discerns information from the very first encounter between a provider and a health plan around the patient and helps that provider think forward to what they need to know during the patient visit and when they are making the referral. We need to follow the trajectory of the patient visit more than some sort of made-up transactional flow that has persisted for decades and doesn’t support the workflow in the provider’s office.

Where do you see the line between provider and payer blurring and what are the transactional needs that are involved?

There’s this opacity in healthcare between providers and payers, between providers and their patients, and between payers and their members that just has to get fixed. Payers clearly have to continue to demonstrate value in that, for lack of a better term, the clinical decision process. But that ultimately is a provider’s responsibility as the professional who makes the decision about what’s best for the patient. Where I think we can help, and I don’t have the ultimate answer, is to be able to move that decision-making process to something that feels more like a real-time, intelligent workflow. That would be a great start.

We know from our providers and even our payers that authorizations are the bane of their existence. No matter how big of a smile you put on it, it’s still just seen as a brute force utilization management tool. But payers have information about a member that might not be readily available to a provider, and when that is served up in the context of a real-time workflow process — whether that’s an authorization or referral or whatever it may be – it can drive a ton of value in that overall patient experience. That’s where we are focused.

One of the things I’ve always said about Availity is that we’re not an arms dealer. We are not provider centric. We are not payer centric. We are solution centric, and f we can create more transparency in those complex workflows where both the provider and the payer are bringing value to the table, then there’s a lot of upside for us and a lot of growth potential. 

We can start to knock down some of these walls between providers and payers around who is bringing value and at what point in the cycle. Providers would say that, by and large, payers don’t bring a lot of value in a clinical review process. The payers would say they need to keep a close eye on these providers because in the absence of utilization management processes, you get a significant overutilization and abuse of the healthcare system. I don’t know that I believe that either one of those is true. Value can be delivered on both sides of the equation.

To what extent are providers using clinical information that they can get only from a payer?

Our model is that we sell products and solutions to payers and we sell products and solutions to providers. We sit in a unique place where we are able to grow our business through our relationship with both sides of the equation. The answer to your question is that is growing. We are seeing more utilization of clinical data going both ways. We are seeing more clinical data being served up to our provider network from our payers to help close gaps in care, particularly in the Medicare Advantage space to get to the right utilization for HEDIS and other scoring purposes. We are seeing more and more data flow to the providers and then come back.

We’ve done a lot of integrations into provider systems to be able to pull out clinical data, attachments, charts, other things that are then consumed within a payer’s system to try to help come to a better and faster solution to an authorization workflow, for example. We are doing real-time, automated authorization workflows where we are reaching into the provider system, extracting clinical data in the provider context, translating that to payer-speak, and using that to help automate the authorization workflow within the payer systems. That is a big area of growth in the market and for us.

What challenges remain with building a network and integrating with EHRs?

You have to look at the endpoints on the network, which in healthcare are its users. We have solved a lot of the core administrative network issues, getting to the right person within the billing office, the front office, or other places where historically the adoption of technology has been pretty high. But we are still not nearly 100% penetrated into the parts of the provider organization where clinical decision-making is being done. We’re not penetrated into the clinical coordinators, the nurse practitioners, and the folks that all day, every day are trying to help manage these more complex clinical workflows with unstructured data and that sort of thing.

As a company, we have 2 million connected providers into our network, but we haven’t gone deep and created connectivity to the right users in all of those offices and all those facilities. There’s a real focus on expanding the use of Availity within a provider organization to make sure that we are bringing value not just to the scheduling person, billing person, or front desk intake, but also to those clinically oriented professionals within the organization.To a large degree, we have only scratched the surface of the value proposition there.

I think you build that all from a single network. There’s no reason to have a clinical network, an administrative network, and a financial network. When you do that, you create silos that then create more opacity in the process. But there’s work to be done to get to that nirvana state of a true holistic network.

What is driving investor interest in companies that offer patient payments technology?

We’re pretty small in that space right now. We help a physician collect a deductible upfront, but it’s not a big piece of our business. The interest comes from the right place. What we’ve done over decades is fairly completely disconnected the consumer from the provider. It’s the only section of the economy where we’ve done it quite so thoroughly.You and I as consumers of healthcare are still mostly ignorant to what a service costs, what the options are, and what is being billed versus what is being collected. We’ll do $2.5 trillion of billed claims through our network this year, of which 50 or 60% actually gets reimbursed. Where did the other trillion dollars go? You and I as consumers certainly don’t know where it went.

The desire to move into the patient billing and patient reimbursement space comes from the right place of saying that to drive the demand-side healthcare economy, you’ve got to connect the consumer with the provider of a service and the cost of that service. Strategically, I think that’s where these companies are trying to go. I’m not sure that anyone has completely figured out the timeline the process to get there. But it comes from the right place, even if it’s just to create awareness with a consumer that even though my responsibility for the services is only $50 or $100, I want to know what it really cost and what the options are, because there may be an option where I don’t have any deductible or there may be a higher quality option. Today, it’s just so difficult for us to get any visibility into those choices.

What will the company’s focus be in the next few years?

We’ve built a great culture here as a company. By and large, people really like working here. We have a revitalized leadership team with some great new leaders who joined us over over the last year. One of the things we’ve learned is that COVID has changed the way we work, changed our business, and changed the way we run the business. I’ve been in healthcare tech for over two decades and the energy around change and faster evolutionary processes is higher than I’ve ever seen it. It has to be.

The move to digital should be user experience driven, not technology driven. This move to a digital platform and a digital experience for our users is going to be our top area of focus. Moving to this interaction-based workflow within both our products and the way that we serve up data to our B2B customers is a great place for us to be as a company and a place where we can both grow and bring a lot of healthcare system. As we sit here today, we transact, by our estimates, half or so of all the healthcare transactions in the country. We sit in a pretty interesting place to be impactful if we try. We are going to give it a hell of a try.

HIStalk Interviews Guillaume Castel, CEO, PerfectServe

January 12, 2022 Interviews No Comments

Guillaume Castel, MBA is CEO of PerfectServe of Knoxville, TN.

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Tell me about yourself and the company.

I’ve been with PerfectServe two and a half years. We offer clinical communication collaboration software. We have put three main assets together covering optimized scheduling, clinical communication, and patient engagement. We believe that putting the three capabilities together three years ago is what the market needed to provide collaboration at scale the right way. Prior to PerfectServe. I spent time as an executive in a health system and then a few years with The Advisory Board Company, which was an amazing experience. I grew up in IBM and Cisco Systems.

How are health systems using your platform creatively to address clinician burnout?

This is a bit of an overused term that has lost a bit of its integrity, but we have been in a number of discussions with clients of all sizes about helping with the most important issue that health systems face today, which is to find good talent, retain them, and help them provide care for their patients. We help in a number of ways, but the most practical is probably through our scheduling capabilities. A fair, balanced schedule leads to a better work-life balance and a better disposition for clinicians to provide good care to patients.

We allow administrators and practice leaders to understand who has been on call more than others and who hasn’t received the schedule they wanted in the last 3-4 weeks and therefore is likely to be disappointed and at a high risk of burnout. We allow for that data and analytics piece to be available to the majority of our clients. We also do spot surveys for users of our technologies to say, are you happy or not happy today? We try to balance that in contrast that with the reality that is showing up in the data. We’ve been involved in not just diagnosing burnout, but also predicting it.

Your competitors Voalte and Vocera have ended up being owned by huge medical equipment companies. What drove that?

First, I have congratulated the Vocera team for their news last week. Vocera is a high-quality company, and I’m happy to be collaborating with them on a number of contracts, clients, and locations. 

A great deal of consolidation is happening. You’ve seen it in our space, and it’s happening in other spaces. Clients want to deal with enterprise-grade vendors. There’s this connectivity around patient care that stays in place and goes occasionally past the communication lens. What some are trying to do is connecting medical device with clinical workflow, which makes good sense. People have wanted to do that with beds for a long time. I suppose they are trying to connect it with other areas of the care continuum.

We believed that we had the right thesis three years ago. We believed and continue to be a strong proponent of the fact that collaboration at scale, no matter the care setting, is what is going to win the day. For that to be successful, you have to have intelligent scheduling. You have to have cloud-based, rules-based clinical communications. You have to have the ability to engage with patients wherever they are. We know that care has moved from mostly being inside the hospital to being in the outpatient setting, the ambulatory network, to now increasingly the physician’s office. More and more we are seeing that care is going to be done at home. We’re focused on ensuring that we equip and help all of our clients with the ability to seamlessly deliver good collaboration and good communication among their care teams, regardless of the care setting.

You told me last time we talked that your goal was to make acquisitions where the whole is greater than the sum of its parts. As someone who has done that, how hard is it to find complementary offerings, figure out how they fit, and then actually acquire a company? [note: PerfectServe announced the day after this conversation that it had acquired anesthesia staff case assignment software vendor AnesthesiaGo].

The hardest part by far is to have the right pieces. I can tell you that I’m grateful for the thoughtfulness we put into thinking about what pieces to put together. The second piece is integration, which is something that people don’t want to talk about a lot. It’s a lot more exciting to talk about deal terms and multiples, but the reality is you get true value by integrating the pieces properly.

In our case, it has taken us at least 18 months to get to a place where we could start to see the equation equal or exceed “one plus one equals two.” Now we are far in excess of that, and I think our clients see it. We are continuing to be focused on messages getting to the right person, care going faster, care providers finding happiness again, and being an element at the disposal of large health systems all the way down to small physician groups to allow them to gain productivity and anticipate the next phase of care delivery changes. We’re very happy that we made the acquisitions three years ago. It has taken real work to get them to work in a way that made a difference for our clients.

How do you see the company responding to market demand for remote patient monitoring and chronic condition management?

The way your platforms are architected will either help you be flexible and go beyond where you shine — either inside the hospital or in the ambulatory network — into the patient’s home, or not. In our case, our premise was to be present across the continuum. We had that ability to have a technology that was flexible enough to branch into areas that we weren’t known for. Our PFC, Patient and Family Communication offering, was put in a bright light during the early stages of COVID, where we engaged with patients wherever they were. We helped health systems deal with an onslaught of patients who were in the parking lots waiting to be seen because they thought they had COVID. I’m simplifying a situation that was dire, confused, and tricky for health systems to manage.

What we believe now is that it was easy for folks to say that telehealth really jumped through that period. Yes, virtual care visits increased. They’ve come back down a little bit, but we’ve made a lot of progress, all of us, in allowing care providers to do virtual visits and care delivery with patients wherever they are. That is good progress for our clients and good progress for society.

What we believe is happening now is that virtual care is just one aspect of changing the way care is being provided. Increasingly sophisticated and innovative health systems will want to actually touch patients in their homes to the extent possible. If there isn’t a reason for someone who is not well to get in the car and go back into the emergency room, the person should stay home. The health system and the care provider should be able to serve them and care for them in the safety and quality of their homes.

Remote patient monitoring — and it goes beyond that to the ability to do remote exams — is going to be core to the next level of delivery. We are deeply embedded in continuing to ensure that communications flow naturally with that new care model. It’s not just about engaging patients, it’s about ensuring that the engagement is routed properly, that care teams are aware of the feedback loop, and that actions are being triggered and taken. That’s what good care looks like. It’s much more than just a bunch of solutions that are solving very small problems.

How  do you see the industry and the company changing in the next 3-4 years?

We are committed to making certain that we have a very direct impact on accelerating speed to care. Everything we do at the end of the day is in a search to allow our clients to accelerate the way they provide care and improve the care they deliver to their patients. Full stop. There are adjacencies that we are very interested in that fit into that. We want collaboration among care teams to be increasingly more intuitive. We continue to believe that schedules and the routing of messages to the right person using the right channel in any care setting and at home is a differentiator.

We know that we’re having a good month when usage of our platforms is up. We track this religiously because it tends to be a good indicator. There are areas that we continue to track pretty closely. Extensions of our capabilities and our scheduling suite of products. Extension of our capabilities and our ability to engage with patients differently. Extension of our capabilities with our core clinical communication products, which could include the ability to track devices that are being delivered at patient’s homes so that we can enable this remote patient exam paradigm that is upon us. We are looking at a ton of stuff.

We are excited about where we are. We are grateful to have patient investors who like what we do and respect what we do, and we’ve done very well with it.

HIStalk Interviews Lisa Esch, SVP, NTT Data

January 10, 2022 Interviews No Comments

Lisa Esch is SVP/provider industry solutions leader of NTT Data of Tokyo, Japan.

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Tell me about yourself and the company.

I’ve been with the company for a little over a year. I get to work with our clients and our customers as we tackle the challenges of healthcare and how IT supports that with services and technology. I’ve always been in healthcare. I started out as a clinician. I’m a dietitian by training and I worked for non-profit and for-profit health systems. I worked in the space around healthcare systems for many years, then in startups as well as large IT global systems integrators.

How will health systems use technology differently as they grow in size and geographic scope?

We’re seeing a lot of the innovation come out of the nimble, small companies, the ideas that can be executed and how we problem solve. There’s a balance between the large and the small, what the large can accomplish at scale versus what the small can do in driving innovation. There’s this blending of both that we need in the marketplace to drive the change that’s happening and to keep the patient at the center of what we’re trying to accomplish in this healthcare transformation, this digitization of healthcare.

Are health systems more consistently using their corporate approach and brand so that patients feel known at any of the health system’s venues?

Having the health system know them is a conversation that we are having with many of our customers. There’s this balance between “creepy know” that you get from commercial businesses that we interact with online versus knowing you so we can improve outcomes, engagement, and personalization.

You shouldn’t have to repeat things in your healthcare experience. You shouldn’t have to have nine portals. Even though you’re accessing in multiple places, it’s a single system, so personalization needs to come together. There’s a lot of fear around information and being proactive because of some of the rules and laws we have about how you communicate with patients, and the difference between marketing versus education and those types of things. But convergence is coming together with commercial industry and healthcare, and we have to figure a good way to make that happen.

What are health systems considering when developing their digital health strategy?

A lot of it involves how to humanize the digital experience. How we bring in information and data around people that isn’t traditionally healthcare that can help us drive engagement, make it more personal, make it a better experience, and make it a better outcome for the clinician as well as the patient. We are having conversations around that. We are building into our digital accelerator things that are AI driven, next best actions, personas, and different things that help with that digital experience and make it more personal.

Some organizations are more ready to have those conversations than others. Some react with, “Amazon knows more about you and Google knows more about you than you know yourself.” That’s not what we’re trying to get to, but how do we leverage the good that’s coming out of those things to bring together the clunkiness that we have in healthcare today? Imagine having a unified patient experience for someone so that an organization’s brand can stay connected to a patient as they traverse this healthcare delivery system where more is happening outside the four walls of the healthcare system than inside. There’s risk with brand and with connection. Patients have a lot of choice.

Is anyone looking far enough down the road to connect a variety of services and tools together to create an Amazon-like experience?

We are working on that strategy now. We’re putting together a marketplace where we can make it easy for organizations to have a problem to solve. We have partners that are pre-built or pre-vetted to make that process easier. We also have the capability of the technologies that can bring those things together, to make them all work together and better to get more out of them. We’re tackling this with our customers right now. 

A lot of decisions were made a couple years ago early on in the pandemic in buying technology. I need this and I need that. Now organizations are sometimes stuck with a bag of rocks. We are beefing up our healthcare consulting chops and advising organizations on, maybe we pull the plug on this. Let’s have a strategy here, and put more of a strategy around this transformation versus having the world put all this pressure on organization and people just buy things because they need something. 

Who is in the best position among healthcare players in getting the consumer’s attention as an information source or service choice?

The organizations that create this unified personal experience are further ahead. What that unified experience is is key. When I talk about a unified experience, I’m not talking about a single EMR across an enterprise. It’s much more than that. Patients become engaged in many more ways than just that their portal, which they don’t use except when they need to pay their bills. There’s this much more enriching experience, and patients can sometimes get that more easily from outside their healthcare system in other industries. Those other industries are obviously looking at healthcare.

The term “provider” is being redefined. There’s lots of ways healthcare is being provided lately. So it’s going to require partnering with people that you haven’t thought about and doing things in new ways. We’re tackling hospital at home, health at home, and it’s really complex. It seems like it shouldn’t be that hard, but we know that it is. That’s going to require a new way of thinking about delivering healthcare, new partners, and non-traditional things to move to that space. The ones that will win are going to be driven by experience and those that will invest in that unified personal human experience. Health and wellbeing is going to be delivered outside of just healthcare systems.

Is it hard to segment the wide variety of patients that a health system would serve, such as by preferred communication channel or the desired depth of the ongoing relationship?

That ties to a healthcare persona. It really is an engagement persona — how frequently they access and what kind of communication. It still is an omni-channel strategy. Some people still want to be communicated with or educated on paper. Some people want pure digital. The omni-channel experience is key, but the persona is a big part of it. We’ve tackled a lot of what we do with, “Here’s the technology. Just plug everybody into it.” Beyond that, we have a lot of research around engagement that can be driven digitally. We probably need to look outside of healthcare a little bit more to bring those capabilities in, to drive that and have it become part of our digital strategy as we transform the healthcare system.

Will we have enough providers in the right locations to support the business models involved in offering services in new ways?

Telehealth fit a need. A lot of clinicians move to it that because, wherever they were in their careers or whatever they were doing, it worked for them. Telehealth is here to stay and we are going to have that capability. Health systems need to balance out how they will deliver it because telehealth is still going to drive a different demographic, and when you look at the lifetime value of a patient, that experience will be important as people move and age through the healthcare system.

The partners you have how telehealth is delivered needs to ensure availability, but a lot of the telehealth that was stood up was disconnected from the health system and from the records. It was disconnected for the patient. They got what they needed in that moment, but it wasn’t part of a connected healthcare journey or their healthcare experience. That’s the part that’s a little messy still, and we’re working on determining the best next going-forward strategy and how we  balance that out.

Banks deployed ATMs so they could get rid of tellers, but also addressed an unmet need of customers who ended up rarely needing to interact with a bank employee anyway. How will the rollout of technologies such as chat bots benefit patients rather than just limiting their access to clinicians?

When AI and chat reduce access, there are probably unintended consequences that aren’t so positive. It’s finding the right place to leverage that and to have it improve and enhance the experience and not be a way to block the experience. There are times where certain personas will engage with that and others won’t. That’s part of the strategy with AI —  how do you find those who will engage with that and those who will not?

An example where it worked great was putting together a SOAP note prior to a visit by having the patient chat with AI before they saw the physician. They found that patients shared more with this bot than with a human being, so they got a more robust background prior to that visit. That’s really cool technology. Sometimes AI can be a better experience than the human one, while at other times, it’s not. We  have to sort all that out as we build this strategy. There will be a place for it, and there will be a place where it’s not helpful.

Where do you see digital health and the company advancing in the next few years?

The digital health innovation that we’re going to see over the next two to three years will be similar to what we’re seeing now. The ideas, the startups being disruptive, and then elements of those things moving into mainstream. I’m also seeing the big transformations that have to happen in healthcare, the digital ecosystem and how we deliver healthcare, as that is also being transformed. We’re going to see AI and robotic process automation. We’re going to see all these small things find the right place in the bigger picture that will drive the transformation. We are excited about is helping with the roadmap, the strategy around that, and helping to find those partners and put those things together that are unique to a healthcare system.

It will be exciting to see what that transformation will going to be. We will see this transformation of, who and what is a provider? How is healthcare provided in the community? With COVID, everyone in the workplace is in healthcare. An employer is responsible for understanding and keeping their patients safe and healthy, so this definition of health and wellbeing is also being redefined and identifying who is responsible for that in our communities. This conversation is going much more broader than just healthcare providers. We’re in the middle of all of that, trying to bring that together and help communities deliver.

Digital healthcare and the digital ecosystem are patient driven. There’s a consumer aspect to it, there’s a technical aspect to it, it is driven by innovation, and it is driven by tradition. These things are coming together in a new way than we’ve seen before. It requires all of those different points of view to move forward, and that’s what I’m so excited about.

HIStalk Interviews Rajesh Voddiraju, Group President, Health IPass

December 15, 2021 Interviews No Comments

Rajesh Voddiraju, MS is founder and group president of Health IPass, a Sphere Company of Oak Brook, IL.

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Tell me about yourself and the company.

Sphere is a payments company that, across multiple industries, streamlines the payment process for consumers and in healthcare in particular. We are all about taking friction out of the payment process through an integrated solution that meets the needs of large health systems all the way to the smallest of the healthcare practices.

To what degree is healthcare still using clipboards and badly designed paper forms instead of electronic systems for collecting check-in and billing information?

As we look at how the industry has evolved, the first generation of solutions effectively came up with electronic ways to change these forms from paper-based to an electronic clipboard. Maybe a kiosk, maybe a tablet, and having folks, when they come into the clinic, be able to use electronic mechanisms in terms of the data capture.

We’ve always believed that’s just a starting point. The more you enable patients to be able to do it in advance, the better. The second generation of the evolution focuses not just on doing it in the clinic, but enabling people to do it on any device, any time, with a mobile-first kind of a strategy. Baked in there were some really cool innovations, such as enabling the patient to take a picture of their driver’s license to validate their identity or to take a photo of their insurance card. Being able to read information and ensure that we’ve got a good capture, just like your banking apps do when you scan a check, for example. That type of innovation was a second generation.

We’ve always focused on predictive analytics way beyond just the data capture, how that can streamline the billing process and ultimately make that experience good for both the consumer as well the healthcare provider.

As patients become a significant source of revenue for provider because of health plans with high deductibles, there’s a real pain around collecting patient responsible dollars in a streamlined, easy manner that both educates the consumer as well as makes it easy for that transaction to occur. It’s not just about replacing the electronic clipboard. That is now table stakes. It’s enabling that workflow to occur any time well in advance, on any device, with the right kind of smarts embedded into it.

The third generation is to take it one more level in solving the key issue in healthcare, which is that the consumer doesn’t know what things cost and the merchant — the healthcare provider — literally has no guarantee that they’ll ever get paid. Solving that in a way that educates the consumer and enables price transparency so that there are no surprises later is a big part of the transformation that we as Health IPass and Sphere have brought to healthcare consumer engagement.

Does that inability to tell patients what they will owe upfront limit their willingness to leave their credit card information on file as they do in almost every other industry?

I’ll answer that from two standpoints. One is the regulatory implications. The No Surprises Act is the next evolution of regulatory intervention by both state and federal government to avoid surprise billing and to make sure there is advanced notice for the consumer in terms of what their out-of-pocket is going to be. From a technology standpoint, providers have often struggled to have the right type of technology that enables them — as they become in-network with various insurance companies — what that contracted rate is.

The first part of a triangulation that we do within our platform is to know what the contracted fee schedule is with a particular provider across the different insurance companies. The second is to be able to set up the right kind of rules to say, for example, that if you had a surgery and multiple procedures were done, how does that affect the reimbursement in terms of what the provider would get paid? These were rules that were here before in a black box, where nobody quite knew except the super specialist in billing. Technology now has been able to bring in and codify all of that information.

On top of that, we need to know how that affects a particular patient at a particular point in time. Luckily, through the Affordable Care Act and the administrative simplification that was put forth many years ago, the black box of where a particular patient is in meeting their deductible, the balance remaining, their max out-of-pocket, and the plan design data are easier for companies like us to access.

We built a robust solution around being able to, for regular office visits all the way to surgical interventions, compute, based on all three of these factors, what the patient’s out-of-pocket is. We present it to the patient so that there is no surprise. Then it becomes easier for the patient to opt in and leave a credit card on file because they know it’s not going to be hit for just any amount, that payment assurance is being procured or secured in conjunction with the estimate that has  been provided. We get incredible adoption rates across millions of patients every month and every year.

If a patient checks in through Health IPass, the healthcare provider typically gets paid almost 97.5 cents on the dollar, which is unheard of when most healthcare providers get 50 to 60 cents on the dollar with paper-based practices and the surprises it yields. An educated consumer is definitely a better payer, and our data and our history has proven that for the healthcare provider, that is absolutely the case.

How do you tune the various factors that impact the likelihood of being paid, such as insurance history, provider specialty, the emergent nature of the encounter, and the level of co-pay and deductible involved?

There’s definitely multiple layers of complexity to your point. The first is to take the payer-specific rules and create a library of rules that can be set up across providers. I mentioned the example of multiple procedures, where perhaps the first cohort is paid at 100%, but is the second cohort paid at 50% or is it 33%? Those are typical rules that you could layer a global set of rules. On top of it, we need to always be able to model the individual contract. If you are at Northwestern here in Chicago, for example, who’s a client of Sphere, you have a special contract with Blue Cross Blue Shield of Illinois that enables you for a different reimbursement model on that multiple procedure example. We have to be able to overlay that with a provider-payer specific set of rules within our platform. 

On top of all of that is the variability of where an insured patient is at that particular point in time. We have real-time connectivity with 926 insurance companies across the country. In real time, we know that the patient has this much money remaining on his deductible and this much money on his out-of-pocket maximum, both at an individual level as well as a family level. There’s a lot of computation and artificial intelligence / machine learning that is in play here in terms of making it simple at the end of the day to educate the patient that for a suggested procedure, here’s your out-of-pocket.

Ultimately, the card-on-file mechanism enables the consumer to have peace of mind. The provider is still filing a claim with their insurance company and letting the insurance company adjudicate the claim. Only when you have it down to the penny, the exact amount that is truly the patient out-of-pocket, does an electronic bill get presented. Patients get a text message or email, whatever they prefer as a consumer, and they still have the opportunity to ask for payment assistance or things like that before their card is auto-debited for the exact, down-to-the-penny amount as adjudicated by their insurance company.

Dentist offices make sure that outstanding balances are addressed before they schedule the next appointment. Is it hard on the medical side for practices or clinics to discuss the balance owed, a low propensity-to-pay, or a possible financial hit for patients who are early in their benefit year when they haven’t met their deductibles?

The big difference between dental and medical is typically when you go to a dentist, the dentist knows exactly what is going to be done. A treatment plan has been pre-established. That’s not always the case in the medical world. That’s part of the reason, along with lack of the right tools, that we have surprise billing. There’s a lot more complexity to in-network and out-of-network. The best practice is to embrace this notion that transparency creates better patients and better patient engagement. Obviously that has to be assisted with the right technology.

We’ve taken pride in helping clients remove this paper and these black boxes, whether it’s on the front end of the process or post-visit engagement. We talk about how can we streamline the entire appointment to payment journey as part of our patient engagement process. It’s about allowing the patient to schedule themselves, answer the appropriate screening questions, get on the schedule with the right provider as most convenient for the patient, and take the journey all the way through in terms of setting the expectation based on the type of visit, how the patient has answered a certain set of pre-screening questions, the expected out-of-pocket, and educating them on what the insurance company will and will not cover and where they stand on their benefits early in the process.

Certainly if the patient has outstanding balance — regardless of whether that bill came from a specialist visit like a dermatologist, an orthopedic surgeon who is part of the group, diagnostics, surgeries, or labs — being able to present a consolidated single bill at that moment of engagement by the patient. Eliminate getting 16 different bills that all come at different times. It’s too confusing for someone who may have a household with a few more interactions with the system. Transparency into what their outstanding balance is and presenting payment assistance or payment plans that may be available for that particular patient, as determined and customized by that healthcare provider, is an important step of what we do.

As I mentioned before, the more you educate folks in advance for future care, the more you are able to secure their payment assurance through a card-on-file and streamline the electronic billing process. It works out well for all parties involved. The patient is happy. They don’t get surprised. They don’t have to go look for a stamp. They don’t have to go look for a paper checkbook. It’s very, very good for the health system that was getting 50 or 60 cents on the dollar to suddenly realize that moving to 97.5 cents also creates better patient engagement and better patient satisfaction.

What factors will have the most impact on patient payments and healthcare in general in the next few years?

Number one is increased transparency into patient out-of-pocket expense. We welcome this and are certainly glad to see regulatory intervention, including the No Surprises Act, that will put more impetus behind creating that level of transparency. The second is owning more of the patient journey. We now do everything from upfront patient self-scheduling all the way to, after you’ve had your surgery and you’ve gone home, what are called patient-reported outcomes. What’s your range of motion? How is that improving over time? Being able to leverage technology to provide that type of clinical insight to the surgeon, in this case, to be able to intervene properly with the particular patient.

That’s the range of capabilities that are important, so you don’t have a hodgepodge of vendors that are doing different things and you can create a more streamlined experience for the consumer. Those two big trends is what we are excited about. We feel that we are in a great spot to be able to service the needs of consumers.

HIStalk Interviews Steve Shihadeh, Founder, Get-to-Market Health

December 13, 2021 Interviews No Comments

Steve Shihadeh is founder of Get-to-Market Health of Malvern, PA.

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Tell me about yourself and the company.

I have spent my whole career at the intersection of healthcare and technology. I worked for SMS, Shared Medical Systems, right out of college. I grew with that company and ended up running sales for them when Siemens took over. I did that for a few years, then went to Microsoft and ran their US healthcare business. I got involved with the Health Solutions Group through Amalga and HealthVault products. I then went to Caradigm and was their chief commercial officer. 

I started to Get-to-Market Health about almost five years ago to help healthcare technology companies improve their go-to-market activities.

Does the number of recent eye-popping funding announcements mean that the old rules have changed, or is it more of a situation where those companies, who may be new to healthcare, need to learn some hard lessons about carving out a niche?

They are eye-popping to everybody. I see good that comes from it and also some challenges. When the right company gets funding, it helps them go faster. We’ve been working with a company in the medical device space that is well funded, on a really solid track, and they are just able go faster than they would be. The investor is betting on a long-term bigger return by letting them go faster now. We have seen examples of telehealth companies that just got incredible valuations. Whether they hold up over time is the question.

Every company we talk to or work with is in the middle of some sort of funding discussions. It’s healthy overall that entrepreneurs can get capital to build a business, but there are some messy spots to it. Think about Practice Fusion, which ended up being worth maybe a fifth of what people thought. Allscripts had to pick up the pieces. Theranos is still in the news every day. So there certainly are some not-pretty pictures, but on balance, equity investors, private equity investors, venture investors, and hospital-backed venture funds are trying to do their due diligence. They are evaluating companies. Saying that it is spawning a renaissance is maybe a little strong, but it is certainly spawning a lot of interesting companies.

The Silicon Valley model involves grabbing market share and chasing growth at all cost. Is the healthcare investment model still valid that assumes that companies need to be able to improve outcomes or reduce cost?

It’s no surprise to anyone that healthcare is slow. Nobody is imagining that they are going to build a real, honest, billion-dollar business in three years. There’s no confusion that healthcare takes time and it’s a complicated business. What is encouraging is that most of the investors we see today are people who only invest in healthcare. They understand it, they get it, and they know the successes and the horror stories.

Providence has a fund. I think Jefferson has a fund near me. Hopkins has a fund and has launched an interesting company. Those folks clearly get healthcare and they are pretty long-cycle investors. They have more patience than some pure private equity company that maybe spend its mornings in manufacturing and its afternoons in healthcare. You have a little smarter investor than you had even a few years ago.

Is it good or bad that the line between investor-funded companies and providers is blurring as providers start funds and companies and companies are opening clinics and telehealth practices?

There are certain things that a for-profit hospital can do a good job on. I’m not sure you or I would want to go get the most complicated surgery ever at a for-profit hospital. They have different niches. For-profit investors have a different horizon in terms of when they want their money back, and their tolerance is low for any hiccups. There will be a fair amount of appeal to the hospital-backed venture and maybe growth equity funds, because the entrepreneur will look at them and say, they get healthcare. They know how hard it is to get things going. I think they will be pretty successful.

They have a lot of work to do to become as capable of investors as the private firms. Whatever you say about the private firms, they know how to crunch the numbers. They know how to value companies. So probably there’s room for both, and I don’t think it’s bad to have them both in the space. If I was an entrepreneur, I would consider both. There’s going to be a better fit depending on what the business is, the model and how much money you need, and how long you’re going to take to build your business.

How will executive job changes affect the plans of companies?

I wonder if what’s behind that is new investment or a need for new investment. Companies that are taking a round of money or have just taken a round have to demonstrate that they are making changes. A lot of times, the investor comes up and says, let’s build a big go-to-market plan, let’s go to three countries instead of one, or let’s go into some new markets. That is probably a big part of the exodus that you see — there’s a financial transaction coming or has happened, and for whatever reason, they decide they want to bring in a new regime to help steer things, or there’s an exit and those folks move on.

We’ve gotten called in several times to help people build go-to-market plans for a new market because they are anticipating some investment and they want to be able to demonstrate to the investment community where they’re going and how they’re going to get there.

Private equity companies are rolling up companies and acquisitions to earn rich returns, with Athenahealth being a recent example. Will that trend continue?

Five years ago, private equity was somewhat of a novel thing in this space. They were able to buy multiple companies, invest in them, and grow them. They are finding out that it’s not so novel. An alternative to buying lots of companies is to buy one and then buy some smaller adjacencies around it to build a bigger, more complete company. HBOC tried to do that, but had trouble integrating all those pieces. I suspect there may be some issues around the corner for those companies. You can buy companies and put a common brand in front of them, but getting them to work together is a big challenge.

Does a successful exit require customers to be satisfied?

It should 100% matter. If I’m an investor and I’m buying a business that has a bunch of unhappy customers, I’m sure not going to pay $17 billion for it. Either there are a bunch of happy customers that the investor found or they didn’t look carefully enough. My thesis is that a company is only worth as much as its customers are willing to stay with them and willing to pay. Happy customers that are renewing, adding on, and buying new things are worth a lot of money. But you look at some of these companies that have disgruntled customers, it’s hard to imagine that the math works. I would think that investors have figured that out and are taking that into account.

Epic would be worth so much money because they have a loyal, happy, renewing, expanding, and growing customers. They are worth more than another EMR company that might not have happy customers and might have lots of negative press. In our experience, the companies that are doing well are worried about taking care of the customers. It’s not all math. They can’t just think that just because they sold 10 systems, they are a valuable company. They have to have happy customers who are going to renew and buy more stuff or else their future value isn’t what they think.

What kind of help do companies need to support their intention to do more than just make short-term sales and instead to position themselves for long-term success?

Getting your product and your company to be viable in the market includes making sure you have a product that customers can understand, value that they can understand, and that you are serious about a happy, successful deployment and an ongoing relationship. We spend a ton of time in that area, because maybe the investor or CEO who doesn’t have a ton of experience in healthcare may not grasp all that. 

If you’ve been around healthcare, you know how important it is to ensure that you have happy customers, that you invest the time and money, and that you have an empathetic viewpoint about what it takes to make customers happy. An unhappy customer is far more important than 10 happy customers. You have to focus on it, and we absolutely get pulled into those discussions all the time.

I had responsibility for our overall customer satisfaction at SMS, Siemens, Microsoft, and Caradigm. I appreciate it. It’s hard. It’s hard to keep them all happy. But if you take care of your customers, even if you have tough times, they reward you for it. They get how hard it is. When Epic or Cerner fixes a rough customer situation, those customers are loyal to them for a long time.

Do you think HIMSS and RSNA exhibitors were as happy as those organizations claimed that professional in-person conference attendance was down two-thirds?

Those conferences are like a stock market that gets overblown and it takes a drop. It’s actually healthy in the long term. RSNA and HIMSS are doing what they have to do, which is putting on as good a face on as possible. But I’ve talked to enough people who were at both shows to know that there was a real lack of potential buyers. If you were interested in meeting with vendor partners, it was helpful, but it was out of balance between what the vendors would have hoped and expected to see in terms of potential buyers and who was there. The shows have gotten too big and too full of themselves and they need to reorient.

I thought the HLTH conference was pretty good. They had a better balance.They didn’t have a ton of buyers there, but it didn’t feel as out of balance as HIMSS and RSNA have felt to me of late.

They are putting a good face on it, but it wasn’t the show that everyone hoped. I talked to some vendors who had a great show at RSNA, generally the newer entrants that had something exciting, innovative, and disruptive. I don’t think the big mainstream players in any of those shows felt good about them.

How have health IT sales and marketing changed as the pandemic approaches the two-year mark?

We have one client that has never had the luxury of a attending HIMSS or a trade show. They have built their business on having connected advisors who can make introductions for them. They built a comprehensive easy way to showcase and demo their product remotely. They figured out a low-cost way to deploy it and even trial it. They never knew the old way since they are pretty new, and they have seen tremendous growth. 

The old model was to get ready for product announcements in the fall, release them in January or February, go to HIMSS, show them, do a couple of events for customers during the year, and then go back to HIMSS. That model was broken and is broken.

We have clients that have done a phenomenal job with social media. They are on every day and they are using customers and third parties to help promote and educate people about their product. We have one client that has done a great job with social, and as we have helped them go to other countries, people in those other countries are already aware of them. They haven’t spent any energy or time yet in those countries because social is global and they’re on their LinkedIn or Instagram pages learning more about them.

When I was at Siemens, I think we had 600 people at RSNA. Clearly HIMSS and RSNA were multi multi-million dollar investments for those big companies. That model is going to change for sure. After RSNA, most of those companies are going to say, OK, next year we’re going to do something different. They will be at at RSNA, but they probably can’t justify as much space.

I did hear from one client at RSNA that there weren’t a lot of middle- and lower-level people at RSNA. The company sent fewer people. They were able to connect with executives who they wanted to see to talk about a product or an issue or something they had. They felt better about that. I don’t think it was all bad, just not a home run.

How will the vendor-CIO dynamic and conference focus change as health systems create more C-level roles that carry IT and digital responsibilities?

The CIO and IT department  are as critical as they’ve ever been, but I don’t think they are the front line any more. The front line is the ultimate end user of the product. Then you have to persuade and educate the CIO, CISO, and the IT department and make sure your product fits in with their protocol around security and IT tech and that you meet whatever their criteria are. I still think that there is benefit for IT folks, including the CIO, to attend HIMSS, especially if they want to get a quick look at 10 different companies, if that’s really the best part about it.

There was a day not that long ago where you would sell an EMR or a piece of medical equipment to IT. Now the CIO defers and says, who’s the champion within the health system who wants and needs this product? Then, how do you help that end user understand the product? What’s the market fit for it? How’s the price? Then the CIO has to judge it and figure out whether it fits in their environment.

What industry changes will we see in 2022?

I’m impressed by companies that meet three key things that separate them. They have an innovative product and an innovative pricing approach. They are disruptive, in a good way, to what has been done before. They have a compelling story behind them.

Every company that has done well in this business has a compelling story. Think about Judy building Epic from one scheduling app at University of Wisconsin into a giant, successful company. Her attention on customer satisfaction and all that. There’s a compelling story there and in other companies where the entrepreneur has believed in his or her niche and built the business.

Successful companies are thoughtful about the business, have a disruptive product and/or pricing model —  because people just can’t spend unlimited money — and they have a compelling story that people can latch onto. When I was at SMS, the two founders had put together a business that met a key need, people could understand it, and there was a compelling story. That helped people buy it. That’s still very true today.

HIStalk Interviews Steven Scott, CEO, VitalTech

December 1, 2021 Interviews No Comments

Steven Scott is CEO of VitalTech of Plano, TX.

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Tell me about yourself and the company.

I’ve been doing healthcare for much longer than I like to think, probably about 30 or 35 years. That includes the areas of senior housing, long-term care facilities, large hospital groups, software analytics, and healthcare IT. I joined VitalTech three months ago. What brought me here was that services are getting more and more pushed out into the home setting and we have the ability to provide services there that are driven by information and data. Remote patient monitoring is just one aspect of that. Using the biometric information helping people make decisions and helping them age in place — those are the concepts that attracted me to VitalTech, which does that on the remote patient monitoring side.

Will we see new advancements in wearables, sensors, and in-room technologies that will support advancing that concept?

If you look back just two years ago at the things that were available versus what’s out there today, there have been pretty good leaps in technologies in both size and connectivity now that 5G is out there. The ability to leverage and move data around from the home, which is helping the hospital-at-home concept, and the types of monitoring that we know will be done in the hospital that are being pushed out in the home and the companies that are looking at leveraging the technology.

In a lot of aspects of our lives outside of healthcare, technologies are advancing rapidly. We’ll see more devices that have an even higher clinical capability, if that’s a way to describe it, as complexity in the types of patients that need to have that at home come online. Technology is rapidly advancing. What we saw two years ago versus what we see today to what we’ll see two years from now will grow prior in a capability perspective. Connectivity has had a big impact in that, too. We’re just now beginning to realize what 5G is to recognize and utilize it.

The remote care market includes platform vendors, telehealth services, behavioral health providers, remote patient monitoring, senior living support, and patient engagement. How do you see that market of providers and vendors either consolidating or changing over the next few years?

There will be some consolidation. Some of that will be driven by not just the people who are out there providing the services, but also in the payer world. UnitedHealthcare just announced a couple of weeks ago that they basically have a digital-first health plan as the first level of engagement with their patients. The premiums are paying for those digital cares services. Virtual care is here. Virtual care is being adopted, both on the payer and the provider side. When your benefits start to align, you receive those services at home, and you get your equipment through your payer, you’re going to see he adoption grow significantly.

Then for those people that provide services in and around that — as technology advances, as the investment community takes a look at that as owners, and vendors and physician groups and those things engage, you’ll see some consolidation. That’s a normal progression that we’ll see over the next three to five years.

How will the payment policies of insurers and employers as well as patient spending lag or lead adoption?

It’s a little bit of both as it shifts. A lot of that is driven by government programs. CMMI has had a lot of initiatives around that. The physician fee schedule, remote patient monitoring, care coordination, and chronic care management leverage those virtual care aspects. Those are now reimbursable and they are changing the codes along those lines, which influences the fee-for-service world or an ambulatory setting world. You see in the risk arrangement side of the world where people — whether they are managing a population, a disease state, or interacting with their high-utilization chronic care members — leveraging technology, remote patient monitoring, and care coordination services for the home setting and the managed care environment, and it’s HCBS type services are getting deployed and moving along that line.

The incentives are all being aligned from a reimbursement perspective, an outcomes perspective, and a care delivery and services perspective. This has been in motion for several years. It’s just starting to snowball. A lot of that was influenced by COVID, where we needed to manage chronic care patients or were dealing with a high-risk disease state where we couldn’t have them come to the office. When you couldn’t have them in the hospital and no one was showing up in the ER, you needed to be a more proactive. When you look at how telemedicine intervened, people realized that we also need to get the biometric data. We need to see what going on with the weight gain or the weight losses or the glucose monitoring.

Those types of things were highlighted during COVID. People were looking to provide those services. Commercial and government programs and large employer groups recognize the need to provide those services outside the hospital walls.

How will health systems participate in the hospital-at-home concept, which otherwise threatens their revenue?

Some of our largest clients are hospitals. It’s usually because hospitals are involved not just as the provider of services, but also on the payer side, whether that member or patient is most likely part of an ACO arrangement. They’re responsible not only for the inpatient stay, but what happens on the outpatient world also. Hospitals have grown in their physician practices and in their marketplace, staying engaged with the patient post-hospital, whether it’s a readmission prevention type of a thing or trying to improve an outcome. Staying engaged with the patient, not just a phone call, but staying engaged in the actual care and the care delivery, whether that’s remote patient monitoring or care navigation. Keeping them within the network, utilizing their provider groups or the groups that they’re aligned with. Hospitals are probably more active in that today than they have ever been.

Hospitals have some number of lives where they are in a risk-sharing arrangement. Even if it’s still a fee-for-service patient, there’s some kind of a shared savings program. It’s relatively low incremental cost to run a virtual care program that keeps that patient engaged, that keeps them utilizing within their network, that keeps the readmission rates lower. It’s the net sum impact of that, not the small incremental cost, that they are shifting their focus on. As those arrangements become larger and more lives are doing it, hospitals are reacting.

How much does the local mix of patient payers, such as Medicare Advantage, lead hospitals to decide how actively they want to be involved in remote care?

A lot of those Medicare lives are in some kind of an ACO arrangement on the fee-for-service side. Large employer groups in a regional market that has a large employer footprint or a heavily managed government program — whether it’s managed Medicaid or managed Medicare — are influential on that. The commercial is looking at that also and seeing the impacts and the outcome improvements to do that. They are all aligning together and the hospitals are right in the middle of all that.

What are Best Buy’s ambitions in healthcare?

They’ve been doing a lot of acquisition in and around the homecare-bound services side, whether that’s in the senior area or just the general population. People are more interested in monitoring their own health at home with the evolution of the Apple Watch, the Apple Health app, a multitude of apps and  peripherals around the Fitbit and those types of things. They see an opportunity there, from being a vendor of the hardware, but also on the services side. They have bought services companies to be a player in that space. Just like Amazon, to some extent. Healthcare is such a huge segment of the general business world right now that they are looking to how they can participate and do that. Then just by size and leverage, they can bring some economies of scale that other vendors don’t have.

Does the ability to scale remote patient monitoring depend on AI that can monitor the data and then alert humans when interventions are needed?

The biggest part of remote monitoring is people who monitor themselves. I have an iPhone, I’m counting my steps, I’m capturing my heart rate, I can do my own EKG, and I’m looking to see if anything is wrong. That’s the largest portion of who’s doing it.

As you go up the complexity of the medical condition, when the payer gets involved and the provider gets involved, they are actively monitoring a condition. They are doing it with their own staff or using a third-party vendor, but as  you move up the acuity chain, that’s where you start seeing the other service vendors actively involved in that case. Case management, care navigation, care coordination, or your doctor wants to know weekly what your average blood pressure has been for the last three days as he is working through your medication regime. That’s where service providers start to get involved. But the largest market and the largest number of people are just monitoring themselves.

I have an IPhone and I have to walk 10,000 steps. What does that mean? I get on my scale that I just bought at Best Buy and hooked it up on Bluetooth, so now I weigh myself every day. I’m entering my nutritional data. I’m putting the barcode in, or talking about how much I had and what I ate. I’m monitoring my sodium level. I just got diagnosed with cardiomyopathy, so I’m managing my own care. Then when that condition worsens to a point where the service providers, the doctor, is more involved, I need that help, and assistance evolves into that.

Maybe I wasn’t doing any of that. All of a sudden I had a sentinel event, and now I need to be involved in that and I need a service provider to step in and do it. There’s several different scenarios of how that plays out. But as we adopt more and more technology in the home, we monitor our home security. We know who when FedEx drops off the package. We have the Ring doorbell so we know when people are at the door. This monitoring your health and that evolution that adoption of technology getting out into our daily lives is growing.

What are the most valuable lessons you’ve learned from helping companies find a successful path?

There is so much opportunity in healthcare to make a positive impact, as a business, but also in making sure that a patient is taken care of correctly. Are they getting where or what they need on time? The information that they need? Then as a business, are you providing that service and is there value-add? The businesses that I’ve been involved with have been in the early development of the market, where people are trying to figure out what’s going on. 

I was involved with one of the original hospitalist programs. The hospitalist has a huge amount of value, but people didn’t understand what they did. We got involved in a high-risk member management in another company when people weren’t really sure how to start providing services and finding these people in the home. Then here the same thing with remote monitoring – we are starting to leverage technology and gain information that can make a huge impact on the delivery of care. There is so much opportunity in that.

From a business perspective, where do you focus and how you make that impact? The performance of a business will come along at that point. One thing that attracted me here is that coming through COVID, people were realizing we have this technology and we can leverage it. We can improve a grandmother’s or a young child’s life by knowing this information upfront and getting it to the right service provider.

The business will follow in doing that. People see that. They see the value of it. They see not only from an outcomes perspective, but also from a business perspective and the ability to do that. That’s what’s exciting. That’s what I personally like doing. I think that’s one way you give back.

HIStalk Interviews Bret Larsen, CEO, EVisit

November 17, 2021 Interviews No Comments

Bret Larsen is co-founder and CEO of EVisit of Mesa, AZ.

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Tell me about yourself and the company.

EVisit is the market-leading virtual care platform. We help the largest health systems in the country craft excellent consumer experiences for care delivery. I’ve been in telemedicine for the last decade, give or take. I started originally on the national provider network side with a company that was acquired by Teladoc. I saw an opportunity to help simplify healthcare delivery for local healthcare infrastructure.

Telehealth boomed not because consumers were demanding it, but because regulations and payment rules were adjusted to support virtual care as the only safe way to conduct encounters. To what degree do those temporary changes need to become permanent to keep telehealth as a mainstream service?

Telehealth needs to be an option in care delivery. Gartner estimates that telehealth utilization will normalize at about 30% over the next three to five years. As CEO of a virtual care platform company, I wanted to believe that the pandemic had accelerated and changed telemedicine and the utilization of telemedicine forever, but what I think it actually accelerated was the consumerization of care. It has caused local healthcare infrastructure, health systems, and hospitals to take a close look at their care delivery strategy and when and where to apply specific delivery mechanisms — whether it’s in-person, virtual visits, or asynchronous — to make sure that they are helping to support the delivery of the right outcomes.

Insurers are offering virtual-first health insurance, which should expose even more people to telehealth. Will those consumers remain in the telehealth fold?

We started the company to help local healthcare infrastructure maintain the relationships they have. Those virtual-first plan approaches can only work if they connect patients with local providers. A health plan or payer’s job is to manage and mitigate risk. I think that down the road, as we look back at the data, the outcomes diverged with the utilization of national provider networks, like call center-based national provider networks. They are working to do good. They are trying to change accessibility for the better.

But we will see a massive disconnect when you pull a patient out of the ecosystem and the PCMH that knows them best. Those will struggle to find efficacy, because when a patient needs specialty care, where does that patient get referred to? Does the provider on the other end of that virtual-first encounter have context of the market to know where to refer them to ensure the continuation of the right care for that patient?

How will the market shake out between companies like yours that sell the platform versus those companies that sell clinical services, which may augment but also compete with those offered by the local health system?

If you look at the strategic roadmap for these national provider networks – and don’t hear me saying “shame on them” – they are working to do what’s best for the end-user patient. But if you look at the strategy that they’re driving at, look at what they’re acquiring. They are acquiring specialty groups. When these large national provider networks showed up on the scene, there wasn’t a ton of concern from the health system side, because they were going after an ambulatory side of the business where we lose money anyway as a loss leader to feed our specialty groups. 

But the reality is that the acquisition strategies show that where they are headed long term is specialty groups. They are acquiring respiratory and chronic care groups, so they are moving into the specialty side. For health systems, that means that when a patient is in need of specialty care, and their first interaction is with one of these national provider networks, they will refer to their own specialists, not to the local group. Health system executives need to keep a close eye on this.

Health systems need to answer the question of, how do I craft an excellent consumer experience? Because that’s what they are competing with. The pandemic accelerated the transition, not necessarily the adoption, of telemedicine long term, because admins are still going to refer back to where they did from muscle memory. But rather it accelerated the consumerization of care. As consumers, many of us would never bring our business back to a service provider that didn’t show up on time to an appointment or was 45 minutes late. It’s really about, how do we craft excellent consumer experiences to serve the consumer, not the patient?

Some providers created ill will among their patients who felt abandoned during the pandemic, as offices were closed and calls weren’t returned. How much education or marketing do health systems need to provide to get consumers to value an ongoing relationship and to trust them to deliver it?

It’s a business strategy question. Where do your strengths lie? The strengths that I would expect health systems to have is in the care they deliver. There’s a lot of responsibility on the health system to educate the consumer and to help repair some of that disconnect. Having the right tools to accomplish that will make it easier. I would rather pull out my phone and order dinner from an app than call the restaurant and order it over the phone. Consumers want to be able to navigate to their own outcome.

I have allergies, so I could self-diagnose, but having the support of a provider to make sure that’s actually what’s going on and helping navigate efficiently to that reality and the corresponding care that I might need — if it isn’t allergies and is a sinus infection, a cold or the flu – that’s important. It can go a long way for health systems to help to start to find the right technologies to help consumers navigate to the most appropriate point of care for the issues they are experiencing and the value that comes with the downstream impact of that when they need more hands-on care.

From the food delivery analogy, we don’t yet know if telehealth shifts demand from in-person care or creates new demand. How will telehealth volume impact the availability of providers?

I saw a stat recently that for every hour a provider spends in delivering care, they spend as much as two hours charting care. That’s staggering. If you look at the top 10 compensated roles in commerce, in industry, those top 10 are all physicians. The number 11 is CEO. In a health system setting, it makes more financial sense for the CEO of the health system to be charting care than it does for the providers who are delivering it.

At EVisit, we are big believers that the best interface for a provider is no interface at all. The tools need to come around the provider to help support the delivery of that. The provider’s willingness to adopt that technology will be directly correlated to how easy that technology makes their job.

I hesitate to say this because I’m not looking to be confrontational, but the only reason that electronic health records have a business today is because the people who buy it don’t have to use it. If they did, they wouldn’t buy it, because it’s not easy to use. It is solving a super complex problem. There’s a bunch of various issues that it needs to address. But it’s not built for users.

If I were on the strategic side of a health system executive team, it would be about choosing and crafting the tools that are around a provider to help them more efficiently deliver care in a remote setting versus forcing them into a two-way video visit where it requires seven more people than it would need to, hundreds more clicks, and three or four more interfaces that makes care delivery more complicated. The way health systems should be thinking about it, especially from the provider adoption side, is how do you make it as simple for the care deliverer as possible?

Unless the business model is different, providers still need to document for billing and legal purposes, recording the same information that is required for an in-person visit. How can virtual visits reduce that documentation burden?

My point in bringing that up isn’t the fact that they will have to document less, it’s that technology can make it more efficient. We are working on using natural language processing for auto-charting. The microphone that is listening to a provider can differentiate between what the provider is saying and what the patient is saying, pull out the relevant information around self-diagnosis and the provider diagnosis, and pull together a fairly accurate depiction of what’s happened in that visit, how it should be coded, and where it should be submitted. All with cursory review by the provider, not with the provider having to sit down, or use a scribe to sit down, and run through that interaction and spend the two-to-one ratio of time against it.

How many early adopters of offering video visits are revisiting their technology choices and what are they looking for?

The vast majority of them are looking. The sound bite that we consistently hear from CIOs of large health systems is, we recognize that two-way video is not virtual care. It’s not the same thing. Video visits are not the same as virtual care. We have some great data around the margin impact of using a two-way video solution like a Skype, FaceTime or Zoom versus using an all-in-one comprehensive virtual care solution like EVisit. The margin impact is almost triple on the gross margin side, because patients are able to self-serve through much of the experience.

Early video visits involved just the two-way video conversation. Will we see them evolve to look more like in-person visits, with waiting rooms where information is collected upfront and satisfaction surveys and patient education afterward?

Two-way video is a commodity. You can go to a number of places and find great solutions. It’s the workflows and the efficiencies that can be gained around that. The advancement of that is moving outside of just a single interaction of, I have a sinus infection, I need a Z-Pak, so let me go through this workflow to get it. How does it fit into the care delivery strategy that you’re crafting? What does it look like? When should a patient present to a synchronous video visit versus an asynchronous chat visit versus in person?

There’s an outcomes question there. There’s a financial implication question there. It’s important to answer that question appropriately, bring the right tools and the right integrations with the core electronic health record to make sure that the data is all sitting in one place and that there’s a comprehensive view of who the patient is and what they’ve experienced, and determine how that informs care going forward. The ecosystem grows by moving ahead.

Other forms of virtual visits got lost in the excitement over virtual visits. Doctors might provide expertise via email messages, telephone conversations, or asynchronous messaging that is appropriate given the patient’s need and preference, with the only difference in outcomes versus a virtual visit is that they might not bill for their time or get paid for it. To what degree will the choice of communications options be driven purely by payment?

It’s absolutely an important mechanism to consider. At the end of the day, we need to make sure that as an industry that we can support the services being delivered financially. I think what you’ll find is that many patients would opt to pay out of pocket in certain scenarios where convenience or accessibility comes into question. If an asynchronous visit isn’t reimbursed, I still would be willing to pay a fee for service.

Our data shows that one provider can handle up to 200 interactions in a shift asynchronously for minor things like sinus infections, UTIs, colds, and flu. But the efficiency gained there, if you look at the productivity of that provider and a nominal out-of-pocket fee in that scenario, is interesting. It’s also interesting from a patient retention perspective. As a business, I would rather provide a service that ensures my customers continue to come back to me. I may eat the cost on that rather than have them go elsewhere and potentially lose the opportunity to bring them back to my services when the time comes again.

We’ve seen a lot of investment, separately, in telehealth and remote patient monitoring. Do you see the services or the business of those two entities converging?

Yes, yes. In a lot of the RFPs that we’re seeing, remote patient monitoring is a key question. 

One of the key trends, and this existed before the pandemic, is that health systems and hospitals are trying to figure out how to transition care to home and the RPM ecosystem. How that plays into it is going to be a very important component of that. That transition’s happening, not because of the pandemic, but  because you can deliver care more profitably when the patient can be out of the physical setting and can be monitored and that feedback can be quick. When and where the patient needs physical attention, that can happen where appropriate. It absolutely will continue to converge. The market and the landscape are in early days in how that’s being addressed, but it is on every health system’s five-year strategic roadmap.

How do you see the company and the industry moving along in those areas that you monitor?

The key question that all healthcare IT companies need to answer is the consumer question. How do you craft an excellent consumer experience? The pandemic forced us as patients to become consumers. It helped us recognize we have choice. To your point, there were certain avenues that were closed to us and we had to find other ways to receive care that we needed. As you look at the various players in the market, what that turns into, and how it is shaped, the key question is, how do we create excellent consumer experiences that support the right outcomes? That is the question that we’re hearing most health systems ask themselves, either explicitly to the market or via the RFP questions that end up coming together. That entire ecosystem of how a solution handles acute ambulatory and RPM. Health systems want to deal with one vendor that can address a lot of the value chain versus cobbling together nine or 10 different point solutions that drive a semblance of that same outcome.

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