HIStalk Interviews Rob Culbert, CEO, Culbert Healthcare Solutions

Rob Culbert is founder and CEO of Culbert Healthcare Solutions of Woburn, MA.

Tell me about yourself and the company.

I started with IDX in the 1980s and worked with them for almost 10 years before switching over to the consulting side of the world. I started Culbert Healthcare Solutions in 2006, so it’s our 15th anniversary, although we didn’t get to celebrate it yet because of everything that’s going on in the world. We have been able to continue our passion for working with healthcare providers around the country, helping them improve the patient experience, improve financial performance, and solve strategic business problems.

How has the pandemic affected your business?

Initially, it was a shock, as was to everybody. It changed our business on a dime. For the first time in my consulting and work experience in 30-plus years, in April and May, we had zero invoices with expense reports on them. I never have experienced that in my life.We had a lot of things in place to be able to flip over to remote work. We had some projects pause, some ended, and some new ones kicked in, but we were able to make that transition as best we could.

We are a pretty conservative company and privately held, so we focused on making sure that we kept our people and took great care of the customers that we had and the new ones that had needs. We tried to be as creative as we could be to help them through their own crises. While I don’t think any of us are out of the woods yet until this thing really gets behind us, we have been able to weather the storm and continue the good work we try to do.

How are hospitals and health systems looking differently at their relationship with patients?

Pre-COVID, we dedicated a lot of effort to helping organizations improve patient access. There are lots of systems and functionalities out there. When you are doing a large-scale implementation like Epic, Cerner, or Allscripts, you don’t get to become an advanced user overnight. A big portion of our work has been helping to look at the patient access functionalities. It’s all about making sure that the physicians and the clinical staff have all the tools in place to be able to maximize utilization, to be able to have the right information to take good care of the patient before, during, and after the visit, and make that as seamless as possible. Some of that was for financial improvement. A lot of it was to prepare for changes and and the way payers pay providers for their work.

When COVID came, it was an easy process to flip to being as touchless as humanly possible. We had several engagements where there could have been pauses on the project, given all the uncertainty. But in the areas of patient access, customers said, keep going. The work that you have done so far has made those practices able to change on a dime. How do we deal with nobody in the waiting room? How do we remove all of the in-person touches that typically have happened? They were able to more easily adapt their schedules to follow best practice COVID protocols.

Are you seeing a lot of provider interest in buzzy technologies such as AI, robotic process automation, and life sciences research?

We are. Machine learning is, as with robotics and data analytics, a term everybody uses that means different things to different people. But everybody is dying to start using the data more effectively to make their jobs better. Especially during COVID, but we had started seeing it in the last few years. 

There’s a lot more for-profit investment firm interest in healthcare technologies. When a for-profit entity is looking to acquire a healthcare technology or provider, their approach to evaluating it, doing the due diligence, and then the speed of moving to realize the full value of that investment is different than what we historically have been used to in healthcare. It’s a welcome change, and in many cases, a needed change. It has been quite a transformation to see how more investor-led organizations are changing healthcare, much more that we saw in the first two-thirds of our healthcare career.

How will consolidation of both companies and health systems change the experience and outcomes of patients?

Unfortunately, the complexity of healthcare technology that we are trying to optimize is overwhelming for smaller organizations. It is more difficult and challenging for them to take full advantage of that technology, whether it’s from an expense standpoint or a skills perspective. There are definitely opportunities for larger organizations to be able to offer more complex technology with better support and more cost effectiveness. Economies of scale definitely make a difference.

There are different motives for some of the getting bigger. Some of it is to spread costs amongst the larger population. For others, it’s a business opportunity to be able to leverage that cost and provide a better service.

We have definitely seen cycles where there was lots of coming together, then there was lots of splitting apart. We’ve seen it come and go. This time, because of the complexity of the electronic data and the opportunities to streamline the healthcare process for the benefit of patients, it will be rocky in some cases, but the end game is going to be positive.

What is driving the sudden emergence of the chief digital officer title?

It’s a huge positive. When EHR implementation started, you had a lot of physician champions. The CIO was very much about managing risk and managing costs for those systems. It was much harder in the beginning to prove an ROI compared to the traditional revenue cycle system that makes your revenue cycle cheaper and more effective.

The concept of chief digital officer is different. It’s not just about managing the Epic system or the bread and butter system. It’s about managing the experience of the patients for the benefit of providers, so that they can have access to the information they need to do their job in a cost-effective and well-informed way.

Some of the vendors will hate me for saying this, but there is no one technology that does it all. We constantly see customers trying to take full advantage of the collection of technologies to be able to do as good a job as they can for the patient experience. That ranges all across the board. We have seen companies like CueSquared , which provides a mobile pay technology to allow patients to view and pay their statements on their phone. The world of self-pay has changed dramatically over the years, but that’s just one small example.

That digital experience has been interesting to watch, because a lot of organizations have created a serious digital approach to their world. Where does this fit into the patient experience we want? That’s where technologies get dropped and that’s where technologies get put in. Technologies that prioritize what’s important to the patient and help provide the patient great service, which might not have been given a look in the past because they aren’t a module within the larger system, are getting opportunities. They are doing some pretty cool things with it.

How will the cancellation of HIMSS20 and the delay in HIMSS21 affect the industry?

I don’t think it has had a negative impact on our company. I say that because the whole world has had to change on a dime. Everybody recognizes that as much as those in-person conferences can be invaluable for learning and networking, it just is impossible. But I’m still amazed by the amount of virtual opportunities that have, as best they can, replaced the in-person conference for now, the explosion of using Zoom, Teams, and GoToMeeting to be able to try to have some of that face-to-face.

One of our strengths as a company is that we have deep relationships with the industry and our customers. For those organizations that we know and they know us well, it was easier to go into a remote engagement opportunity. We were known quantities, there was a trust, and there was a relationship in which you knew that both sides were going to get good value. We were going to kill ourselves to make that remote process work, given historically that it was always an in-person or on-site type of opportunity.

For those that don’t know us and vice versa, it’s harder to build that trusting relationship. We have slowly started to see some of our engagements where there has been a strong desire to at least have some sort of on-site presence. Some of those have gone very smoothly. We have been creative, such as people staying over a two-week window as opposed to coming Monday and leaving for home Friday, to get through the window of time to build that relationship. And, to manage the COVID travel policies of the state that the consultant is going to and the state that they are coming from. That has probably been the toughest one for us, to make sure that we are managing those travel requirements between the two states.

We are starting to see many of our consultants getting the vaccine. We have had opportunities where they have qualified for the vaccine based on the work that is being asked of them. So far, that has made life a lot easier. Many of our consultants have no issue with traveling, because they have been doing it almost their entire careers. Others have been nervous about it, but we have been able to manage those nerves because we have been able to keep a fairly large percentage of our business on a remote basis. Each month that we are able to continue waiting for the world to be ready for the ongoing travel, then that concern will keep going down.

We are on the 10-yard line of hopefully the vaccine helping us to get to the other side of this thing. Just a little more patience is what we expect. Our people and clients have been flexible around managing that in a good way.

Do you have any final thoughts?

I am hopeful for everything that is going on with the vaccine and all the lessons learned to get us through this thing. Every customer and every business that we work with has had to adapt. We are at the top of that list as well. As hard as this year has been, it has been an exceptional learning experience. We are doing things that we probably never would have thought to do prior to COVID. In many cases, those things are incredible positives.

I am very positive in terms of the outlook. While this hurt everybody, we are going to benefit tremendously for years to come from some of the changes that were forced upon us. Creativity will stay with us in a good way for a very long time.