HIStalk Interviews Bret Larsen, CEO, EVisit

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

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.

HIStalk Interviews Tom Cox, President, Experian Health

Tom Cox, MBA is president of Experian Health of Franklin, TN.

Tell me about yourself and the company.

The mission of Experian Health is to simplify administrative processes and improve operational efficiencies so that we can improve the healthcare journey. We primarily do that through patient access, revenue cycle management, and identity services. I’ve been with the company for two years, having joined through the acquisition of MyHealthDirect.

We’ve heard for years that collection of patient financial responsibility would become significant, and not only has that finally happened, investors are rewarding companies whose technologies and services support that collection. What trends do you see?

You will continue to see an acceleration of the digitization of healthcare. Certainly we’ve seen that through the pandemic, as folks were operating in a more remote environment. We saw the digitization of registration scheduling and even telehealth become more important. That trend was absolutely accelerated by COVID and I think you will see that trend continue in the future.

That dynamic of consumers paying a higher portion of their healthcare will drive a number of facts. First, it will require the whole healthcare system to operate much more like the rest of the economy. That is, to provide a better consumer patient experience from the beginning of the process through payments and collections on the back end. That will continue to accelerate.

From the provider’s perspective, the patient is paying a bigger portion, and what the patient pays is the hardest part to collect. Getting the right data upfront and collecting as much of the cost upfront will also be important for all providers and health systems.

How will healthcare use technology more other industries that use technology instead of handing their customer a clipboard and photocopying their documents?

You touched on a number of them. You will see scheduling, registration, and payments being digitized. You will also see healthcare start to use more data about consumers to improve the process of reviewing social determinants of health, understanding what challenges people might have in accessing the healthcare system, to make it easier for them to access the healthcare system and to improve their healthcare results. We know a lot about individuals that we’re not taking advantage of today to improve the healthcare system. You’ll see that change over time.

How do you see providers using consumer data insights, rather than just their own EHR data, to engage with their patients differently before, during, and after a visit?

That is still pretty nascent in healthcare. That provides a big opportunity for a company like Experian, which has a lot of consumer insights. The retail environment reaches out to individuals based on their desires and their wishes, engaging them in the process and then all the way through the process. That should happen similarly in healthcare. We know when patients need to engage in the healthcare system, so we should reach out to them proactively and get them engaged in the healthcare system so that they get the care that they need in a timely manner and improve their overall health. That’s what I think you’ll start to see changing going forward, but it’s still pretty early.

What technologies does Experian offer that would help providers treat their patients more like members?

We have a number of those tools to help the patient feel more like they are a valued patient, which is maybe is a better way to say it instead of as a member. I always worry about member because that tends to get associated with a health plan. From the consumer insights on the front end to anticipate the needs of an individual patient using our data and insights on consumers, to using our tools, to engage staff members through outreach, and to patient communications. Then facilitating the entire process, making that process easy for the patient along the entire journey through digital scheduling, digital registration, and online payments as a seamless, touchless process.

How do you see propensity-to-pay being used in a consumer-friendly way?

Having a propensity to pay will have help patients make more informed decisions. One of the challenges with healthcare, historically, has been that you make a very large purchase decision without any knowledge up front. Many times you only find out about that purchase decision on the back end. We are doing  couple of things to help that process. We provide estimates to patients so that they can make make an informed decision. Then, based on your ability to pay for that, you can then arrange different ways to pay for those services. Most healthcare systems are flexible in their payment terms because they know the patients need the care. They want to make that process as easy for them to get the care as possible.

Some diagnostic radiology practices offer patients a big discount if they pay cash upfront instead of using insurance or being billed. Will we see more of that?

I absolutely think that providers will continue to do all that they can to get the payment upfront. Providing that estimate is the best way to collect that upfront.

I recently experienced that myself with a procedure. I was offered a discount to pay in advance and certainly wanted to take advantage of that. The key to that process, though, is ensuring that the estimate is accurate so that there is no surprise on the back end. You are creating an expectation with the patient or with the consumer that your estimate is correct. When you make that advanced payment, you are not expecting to get another request on the back end. An accurate estimate is critical.

A significant part of patient satisfaction comes from the front end, such as ease of getting an appointment, to the back end, in getting a timely, accurate, and understandable bill. How are providers using those practices for competitive advantage?

In the US, the healthcare that individuals receive is always of really high quality, so you don’t get many complaints about care. The complaints come from the administrative processes, both on the front end of the process — scheduling, registration, asking for the same information repeatedly — and then on the back end, the lack of understanding of the billing, the explanation of benefits, and the statements. Providers are definitely realizing that improving those front-end and back-end administrative processes is a way to differentiate themselves in the market. Convenience and simplicity are the easiest outcomes to measure in healthcare and they drive how how many healthcare consumers make their decisions.

How important is it that providers react to negative patient feedback as part of their marketing efforts?

It’s important for the healthcare systems to engage with those patients who didn’t have a positive experience so they can learn and improve their processes going forward. Again, it’s most likely not related to the care that they received. It’s going to be most likely related to something on the front end or the back end of the administrative process.

What are the benefits of identity management beyond the obvious ones of efficiency, fraud prevention, and patient safety?

A number of benefits come from our identity solution. The first is eliminating any duplicate records that might be created when you’re going through the registration process or the intake process. Understanding that an individual may have moved or changed their names and making sure that you’re not creating a duplicate record. That has downstream effects of making sure that you have a complete view of that individual when you’re providing care, so that you don’t have a fragmented health record and information showing up in two different places.

A key element that we are seeing with identity getting access to digital tools. With COVID vaccinations, most health systems drove patients to their portals to register and then schedule the vaccines. Ensuring that the right identities and the right patients were getting the right vaccinations and attached to the right records was a key component that drove a lot of our growth for identity through the pandemic.

Would having a national patient identifier provide the benefits that people expect?

Having a unique identifier would certainly simplify things in healthcare. We have 328 million unique individuals that are represented through our universal identity manager tool. Using a tool like that, having a universal identity would make it easier to link your records from disparate systems to provide a holistic view of medical information.

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

We are excited about the future and feel like the company is well positioned for growth. We think that many of the trends that were accelerated by COVID, like the digitization of healthcare, will continue. We think we are well positioned for that trend and are excited about our opportunity to deliver on our mission of simplifying the healthcare journey for all.

HIStalk Interviews Stephan Landsman, JD, Emeritus Professor of Law, DePaul University College of Law

Stephan Landsman, JD is emeritus professor of law and organizer and director of the Clifford Symposium on Tort Law and Social Policy at the DePaul University College of Law in Chicago, IL. He co-authored “Closing Death’s Door: Legal Innovations to End the Epidemic of Healthcare Harm” this year.

What malpractice risk is involved when clinicians conduct virtual visits?

One of the things that is most concerning is the need for continuity and follow-up. If you are going to conduct medical care by telephonic means, you need to have a reliable system that will keep track of what you’ve advised, what you’ve observed, what tests you need, what the results of those tests are, what follow-up is necessary, what medications ought to be prescribed, and so forth.

Care is not a one-shot deal. It’s not a one phone call kind of thing. It’s a heck of a lot easier to keep track of folks if they show up in your office. It’s more challenging when they don’t. 

The same is obviously true with respect to the kinds of data entries that you make as well. Medical records are incredibly important. Tracking care, tracking information, building up the profile of what the patient’s issues may be, or how they develop or what the reaction to medications is. All of that stuff needs to be entered, needs to be available, and needs to pass before the eyes of the person who was given advice.

By analogy, the hardest time in hospital treatment is the time when one doctor passes the care of a patient off to another. In that situation, you have to have effective communication. You have to have a kind of underscoring of what’s valuable. The same thing is going to be true if the tele-treating physician is not practicing alone, but rather is in a large group, which is usually going to be the case. You need good systems, good data management that’s will get everything of relevance to each of the physicians each of the times that contact, care, or assistance is being done.

Is it sustainable in a litigious environment that telehealth doctors who don’t work for health systems often don’t have access to the patient’s medical records?

There are a couple of kinds of considerations that we ought to think about. The first one that comes to my mind is helping the patient understand that this is real medical care — it’s not a one-shot deal. It may require follow-up, and if follow-up is what we’re thinking about, is there a local physician? Is there an appropriate testing facility? Is there appropriate laboratory? All of that stuff needs to be worked out between the patient and the doctor so there is no perception that you have a one-shot deal. Even if the patient thinks that, the doctor and the treating organization have got to work on the assumption that it isn’t so. That it’s not simply a sore throat and an appropriate prescription that is going to kill a bug, if it’s that kind of thing.

This seems to me to be a very important cultural change to make, both patients and for medical organizations, that when there isn’t an understanding that medical care and medical examination is an ongoing process, then you get particular problems that can lead to legal claims to malpractice and a big mess.

What risks would you warn physicians about as they consider doing virtual visits for a for-profit company as a contractor rather than an employee?

That creates the possibility that there won’t be follow-up. That there won’t be that connection and commitment to patient care that I think is important. That model is one that needs to have some pretty clear ground rules, and some of those have got to come from the physician providing care. He or she has to understand that it’s not ever going to be a one-shot deal.

Lawyers at our school, or at least when I do it, are taught that you can’t give advice without being ready to follow up on that advice and without being committed to the relationship. That first conversation is only the beginning of a relationship. You have to understand this set of situations, patients and doctor, as presenting very similar sorts of demands.

We’re in the midst of culture of change here, and it ought to be emphasized that the treatment via contacting a doctor on the telephone is a very valuable plus to extending care, especially into parts of the population that for financial reasons, psychological reasons, or whatever are very resistant to real face-to-face medical care. But it’s got to be thought of as a relationship. These are not one-shot deals. That’s when you get in trouble, when you think that they’re one shot and don’t have follow-up and don’t have understanding. That tends to be the place where we are likely to see the greatest trauma.

The pandemic led to a relaxation of regulations involving state licensure and requiring initial visits to be conducted in person. Will this loosening of requirements, whether temporary or permanent, raise new legal concerns?

I think it will, yes. We’re feeling our way here. We’re moving in new directions, and the professional responsibilities that will arise out of those new sorts of relationships are ones that we haven’t fully and completely defined. The requirement of face-to-face first has generally not done well in court and has been viewed as a restrictive protection of in-state doctors.

We need to extend the umbrella of care, but having said, that it’s not one phone call. One phone call does not address chronic conditions like diabetes. One phone call does not address progressive heart failure. It’s got to be understood that there’s more going on here. That is part of the change in the universe.

Medical malpractice has often been a signaling device by which medical profession is informed of things that are just not good enough. I’ve done that with things like informed consent, and with a variety of kinds of decision-making between patient and doctor. You’re going to see some of the same kind of considerations being hashed out in future litigation. I certainly would advise to have good insurance coverage in providing this kind of care for any organization that wants to do it, and at the same time, a very careful kind of assessment of what good medical practice requires.

Some investor-funded companies sell prescription products such as unproven COVID-19 treatments and vanity drugs online and use telehealth providers to prescribe them. Does the pressure to issue the prescription increase clinician exposure to risk?

I think that it does. It’s hard to say because it really depends a lot on what’s said, what’s required by the people who are paying the rent, and all that kind of thing. My mind immediately jumped to the time in the United States when online or similar sorts of pharmacies were providing opioid prescriptions through call-in or online mechanisms. Eventually the Congress said, we can’t live with that. That really is in essence of way of fueling what we now believe is the opioid epidemic. Now if you think about that as a model where the danger is fairly substantial, you can say, we are again as a society going to see those kinds of problems and we’re going to react to them.

In the interim, it’s going to be a fairly unpredictable situation. I would not think that it is wise to offer what is in essence medical advice and treatment in situations where your hands are tied about what reactions you can provide and what products you have to present or sell or whatever.

What due diligence and malpractice insurance review should a physician consider when considering doing contract virtual visits for a telehealth company?

You would really want to ask all of those sorts of questions. This is going to sound excessive, but you probably want expert legal advice. We are in a changing field. I would not want to be committed to providing care that was limited in ways that I knew or should have known were handicapped to the patient’s detriment. Part of that is medical due diligence and part of that is legal inquiry. Each of the states is different with respect to these matters. It seems to me that you want to be pretty darned careful about this kind of thing.

I think physicians are pretty concerned about exposure to med mal when they sit down with patients. They should bring that concern to the situation where they’re providing medical advice over the telephone. Part of that is medical scrutiny. Is it good enough? Does it meet the standards? That’s really a question about the profession in the particular state. But part of it is also, where are the courts? Where’s the legislation? What’s been happening?  You need some legal advice. I’d be careful about this kind of thing. 

It’s a great area. It’s a changing area. You miss something if you don’t see the positives here, because I think there really are substantial positives, but  you know we are talking about people’s lives and people’s health and their safety. When that’s going to be jeopardized, you’re going to see a social reaction and there interested parties who are going to push that. Medical societies are not particularly happy with this stuff, they’re going to push, and they have some clout.

HIStalk Interviews Mike Linnert, CEO, Actium Health

Mike Linnert, MBA is founder and CEO of Actium Health (formerly known as SymphonyRM) of Palo Alto, CA.

Tell me about yourself and the company.

Actium Health helps health systems and payers with CRM intelligence. We take all the data they have about their members and identify “next best actions” to drive lifetime value for the members. Before founding Actium Health, I grew up doing similar things for companies in the wireless and financial services industries, and before that, I was investing in consumer internet companies.

What could “next best action” look like for me as an individual consumer, both inside and outside healthcare?

Starting outside healthcare, the goal is to drive lifetime value for a customer relationship. Some “next best actions” don’t have revenue or profit associated with them in the near term, but their investment is in the long-term relationship.

I’ll give you some of the simplest ones I started with. When I was in the wireless industry way back in the early 2000s, you might have called the call center with a question about your bill. While we had you, we might have observed that last month you could have saved $3 had you been on the 100-messages plan instead of the 50-messages plan. You as a consumer would think, “Great! That’s great,” and we as the wireless provider would feel like, “We helped you save some money, but also we probably encouraged you to do more texting, which is something that we wanted you to do anyway because it attaches you to your device more.” Things that you liked about our service, and in the long run, we probably decreased your propensity to churn. And if we increased your usage of text messaging, we hopefully increased the value that you saw from us.

As you get more complex, you can think about perhaps your wealth advisor at your bank. At any given time, your wealth advisor might know that you forgot to make your 529 education contribution for one of your kids, you didn’t make an IRA contribution this year, you haven’t rebalanced your portfolio, or mortgage rates have gone down and you could potentially refinance your mortgage and save some money. The ”next best action” involves which of those things is most valuable to you. I’m a wealth advisor, so my job is to stand by you, not to stand by the products and broadcast out to you, “Hey, this product fits you.” I stand by you, you tell me about your needs, and then I say, “Here’s the most important thing. I know your kids are important to you. If we only have five minutes to talk today, let me focus on the 529 plan.” But to do that, I have to come up with what the most valuable thing is for you. We bring AI to do that on behalf of the wealth advisor or the health advisors here in healthcare.

Is it uncomfortable for providers to think of the lifetime value of a given patient and to reach out to them to offer more services, either to bring in more revenue, to benefit the patient, or both?

It shouldn’t be. The goal is to drive the lifetime value of the relationship. If I ever slammed you products you don’t need, I should assume that you’re going to turn and go somewhere else. Maybe there’s some near-term profit, but over the long run, you’re not going to be with me any more. You’re going to find somebody who takes care of your needs better.

In the financial services example I gave, the goal was to say, “What is most valuable to you and to our relationship?” In healthcare, let’s assume that I’m on a value-based care model with my local health system. The health system knows that I’m past due for a colonoscopy, and maybe they know that I haven’t seen a primary care doc in the last three years. Maybe from looking at their data, they suspect I’m high probability for having kidney disease and don’t know it.

At least for me as a patient, I would love it if the health system didn’t worry about whether they were violating the revenue goal, or violating something about our relationship, and instead felt a moral imperative to reach out and tell me, “Hey Mike, based on the data we have, we think it’s worth you taking this health risk assessment for kidney disease” or “here are the top three reasons that you should come in and see your primary care doc.” I would like them to be reaching out.

Certainly what I don’t want, and what would be violation of HIPAA marketing, is for them to be hawking drugs that may or may not fit me, or to let me know that they have a new partnership with a local imaging center and I should consider going there. Those aren’t the things I want. But I do want things that help drive health for me and my family.

Some patients, especially younger ones, don’t necessarily see the value of ongoing engagement with a health system or primary care physician. How do providers convince them of the value of that engagement or use “next best actions” to address their needs?

You have to step back and, again, talk about what drives lifetime value. Your point is exactly right. What drives lifetime value for my dad in the health system is very different from what drives lifetime value for my son in the health system. My dad wants to know that the health system is proactively thinking about him, looking at the data they have about him, and proactively reaching out to engage him. My son wants to know that they are there if he needs them, so maybe they let them know that he can schedule through text messages or which simple conditions could be managed at urgent care at a lower cost and shorter wait time than the ER.

You have to think about what these things are for each cohort. That is the whole point of the “next best actions” approach. We are developing one-to-one dialogues that for each customer, think uniquely about the things that we have that can create value. I’m not trying to upsell and cross-sell so much as I’m trying to up-serve and cross-serve. If I serve you better, that will drive the loyalty.

I’ll give you a stat so you have a sense of why I think this is important. If I look at Verizon and AT&T, I might say it’s customer churn. I haven’t looked in a while, but last time I looked, it was around two to three percent. Two to three percent of their customers leave them each year. Health system churn, from our back of the envelope math, is between 20 and 30%. It is 10X. What we think we provide is a highly personalized, highly customized solution. You have to ask ourselves why that’s happening.

Healthcare switching costs might be lower than for changing cell providers, and some degree of unavoidable churn occurs because people change employers or their insurance changes. Some people also don’t need or have any provider interaction in a given year. Is healthcare different where they might come back to a provider when they need them or decide that someone else might address their problem more readily?

The difference between total churn and addressable churn is absolutely important. Someone may have moved away someone or switch to plans your physicians aren’t in. But that doesn’t put a big enough dent in the 10X difference that you would say, “This isn’t important to me.” For a lot of health systems, if you haven’t been in to see your primary care or other doctor in two to three years, they make you re-onboard. You have to go see a nurse again before you can see the doctor. We don’t want to do that.

We especially don’t want to do that for the younger generation you mentioned. We’re just helping them. They may not want to see a doctor for one to two years. But during those years, those patients have been thinking about their health. I saw a study that said that the average American spends 11 to 12 hours a month online reading about health information.During that time, I promise you that the people online who are giving them that health information —  it could be Google, it could be other health websites — they want those members, patients, or customers as customers of theirs, too. People realized that the lifetime value of having a customer relationship centered on healthcare is very high.

The other big trend that’s happening right now is value-based care coming on scene. Value-based care is enabling a lot of competitors to build lucrative businesses around having deep customer relationships. In the old model of healthcare, to make a lot of money, you had to have a lot of specialists, because that’s where the money was. In value-based care, you can make a lot of money by keeping people healthy and having good, loyal relationships. You see people like One Medical, VillageMD, Walmart and CVS getting in and saying, “If there’s a new way to have consumer service-based relationships with patients and healthcare, that’s an opportunity.”

How does a health system run “next best action” programs for both their population health and marketing programs without confusing the consumer and making sure that each campaign’s messages are appropriate?

This is where you have the two-canoe problem, with fee-for-service and value-based care competing. But if you scratch a little deeper and look at individual contracts and different incentives, you probably have closer to a 200-canoe problem, with different people and different incentives. But that’s the whole point of the “next best action,” one-to-one dialogue approach. We want to figure out for everybody, what is the most valuable thing we can say to you based on what we know about you?

Let me give you an example of what the differences could look like. I’m going to give you some directional numbers that aren’t exactly correct. If I was a health system, I might ask, what is the value to me as the health system of bringing someone in for a breast cancer screening? Of course there’s value in that I am supporting my patients, but if I look at it on a dollar basis, I would say for every 100 screens I do, I’m going to do about 10 diagnostic follow-ups. I’m probably going to discover one case of cancer, and about half of those I’ll end up treating. Just ballpark numbers there.

For most health systems, if you did the expected value of the margin at each level there and multiplied them up, you’d get about $250. And if I get really good at predicting that women in this cohort are six times more likely than average, reaching out to those women and getting them in is potentially worth $1,500 to me, six times more than average. If I flip it around and ask the community, “What’s it worth if I reach out to you, invite you to come in, and we find that you have cancer and you weren’t otherwise going to come in?” it’s a lot. Because if you didn’t come in, that cancer was going to be much worse by the time we found it.

In a value-based care world, where I make money is by not finding cancer, or finding it so early so I stave off the later costs. That’s worth $250 for an average fee-for-service, but double that on a value-based care contract, closer to $500, to be doing those screenings to avoid the cost of finding later-stage cancer. That’s in addition to bonuses that I unlock or business value I unlock because I hit five stars on my screening, or because I met some threshold in a contract, and I’m able to market my Medicare Advantage plan differently. If you start to take all those into account, you start to realize that for health systems that are truly in value-based care models, there’s enormous value to proactively reach into the community and find people who have cancer and don’t know it. Or reaching into underserved communities and pulling people in that need care from us.

A survey written up on your website found that consumers perceive that their doctors and hospitals ignored them during the pandemic by not answering their phones or reaching out. What is the opportunity for health systems to move ahead from that?

I’m going to give you three quick examples. From January 2020 until now, our customers have increased proactive digital outreach by 10X, and I think there’s still another 10X to go. I think my health system should be reaching out to me at least once a month proactively with, “Here’s your family health income statement and balance sheet” or “Here are new services we have” or “Here are things you should know about what’s going on in the community.”

Second, I move around between health systems. Kaiser is not a customer of ours, but I’m going to mention something they did. During COVID at the peak, Kaiser was sending me three emails a month or even per week on some occasions. Three emails a week. And they were valuable, meaty emails. I liked reading them. They were telling me about positivity rates in my community. Stuff that I was really curious about and stuff that, had they not said it, I would have gone on Google. Kaiser was providing me a service.

The third thing is that last year, cancer diagnosis in the US was down by about half. We didn’t cure cancer last year. What did happen is that half of all the cancers that we probably would normally have discovered got worse. They went untreated, they went undiscovered. Health systems, to my way of thinking, have almost a moral imperative to be reaching out to people, to be looking through the data and saying, “Where are the communities that are most underserved? Who are the people that we think are at higher risk of breast cancer? How do we reach out to them and get them in for screening?” Most of those screenings are free. We have a free service that helps you discover and stave off cancer. That’s not to say anything about kidney disease and all the other diseases that went unaddressed faster that we need to get back to.

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

We’ve been talking for a long time that healthcare is a consumer service. If we are a consumer service, then there are some things that are fundamentally true, and you can look around at other consumer service industries. Most importantly, we need to stop thinking about patients as customers. We need to start thinking about people as members. Members have a recurring relationship with you. It’s enduring, it needs to be taken care of, and if you don’t, other people are going to come take your members. And if we have members, then we need to be thinking about how to drive value, delight, and loyalty among our members. Value means value they get from us, delight how happy they are, and loyalty our ability to influence behavior. We do that with “next best actions.”

Value-based care is the sport of the future. It may take a while, but it is the sport of the future. That pay-vider model is coming fast. New competitors are coming in to take advantage of that if our current health systems don’t. Our job is to work with today’s health systems and payers to say, this what’s coming. We can help you bridge the gap to this membership model. To this proactive engagement, where you drive value, delight, and loyalty. We have the portfolio of “next best actions” to do it. At least as I know it today, we are the only company that is working with healthcare providers that hang expected values on “next best actions,” and that is critical to investing and making them happen.

HIStalk Interviews Shawn DeWane, CEO, TransformativeMed

Shawn DeWane is CEO of TransformativeMed of Seattle, WA.

Tell me about yourself and the company.

TransformativeMed focuses on the clinical workflows of physicians and nurses. Healthcare is a team sport and COVID-19 has made this a focal point. We are looking to bring a revolution to healthcare IT by delivering smart technology, smart algorithms, and the organization of clinical information in an intuitive manner so that clinicians can effectively and efficiently impact patient lives with a strong patient safety aspect.

We got our start in rounding and handoffs, then moved into other smart care capabilities, such as diabetes. The focus of our company has always been around research and development, done in partnership with our customers. Some of those customers are among the most prestigious in the country, so we have some great thought leadership as a result. Clinician satisfaction is high, in the 95th percentile range. Our implementation experience is exceptional. The product is sticky and clinicians love it. We are in 26 health systems around the country and we have one overseas. We have over 170 hospitals that use the products. There are a lot of hospitals that we are not in and a lot of beds that we’re not servicing at the moment, so we have a lot of opportunity, a lot of green space in front of us.

I grew up in rural Northern Illinois in a Midwest farmland culture that emphasizes hard work and fair dealings. I’ve hade a successful career in healthcare IT and technology and have developed a system of sorts that I can assess, grow, and scale businesses with great talent. My focus has always been around relationships and a fundamental commitment to delivering success to customers and my teams. Some of the key bodies of work that are most significant for me in the past are a 13-year run with IDX, then McKesson, and most recently with Hayes. My wife of 37 years and I live in the Chicagoland area. We have three great kids, all adults and on their own.

How would you describe the relationship between Cerner and Epic and companies that develop embedded or connected apps that extend the capabilities of their core EHR products?

I’ve had a great deal of experience with large enterprise EMR production systems through McKesson and IDX. They typically can’t handle the level of precision a clinician needs for problem-based care. With the changing landscape that COVID brings to the table, it makes it even harder for an EMR system to be both nimble and effective in addressing patient care. Problem-based care and the precision of what the clinician needs is at the heart of why a company like TransformativeMed exists. Recently a CMIO of one of our customers, a large health system, told us that we come in with the eyes of a clinician and know exactly what they need. That’s really what it boils down to.

User testimonials on your website talk about how your product improves clunky EHRs, provides financial benefit, and increases clinician satisfaction. Do those comments get back to the EHR vendors in highlighting seeming shortcomings in their products?

Some of that probably does happen. My experience with large enterprise production systems do just that. It’s hard for them to be nimble and focused on the moment and the issue when you’re standing over a patient, whether you’re a nurse or a physician. The ability of a system to be able to gather information, suggest a treatment of care, and then document that back into the EMR — that level of efficiency in a fluid situation is difficult for a large production system to handle. At some point it is what it is, but we make the EMR what the user thought they should have gotten.

How much of clinician EHR dissatisfaction and burnout is caused by plain-vanilla implementations that avoid personalization for individuals and clinical specialties?

Each specialty has its own angle that they’re coming at in terms of the problem that the patient presents. You have to have smart care algorithms to address the unique needs of the specialty and by type. Not just the needs of the physician, but of the nurse as well. The cumulative nature of what happened, what is presented in the moment, what to do, and then the further documentation along the lines of that specialty is what TransformativeMed does, which is what users like the most.

Some issues are time-based, where I get 15 minutes extra a day or 30 minutes extra a day or two hours extra a day back into my life so I can see more patients. Bed capacity management, especially these days, is chronic. How do I treat the patient as effectively as possible and move them into a discharge status so I can make that bed available to another patient? All of that is expedited and made more efficient when you have specialty-based algorithms to provide them the information they need.

Does the underlying architecture of EHRs support real-time capabilities and user personalization?

EMR systems are sound technology to store batches of information like lab data, nurse documentation, or physician documentation, but it’s gathering up that into an efficient way to present those findings to the provider at the time of care for the patient. That efficiency of gathering that and presenting an algorithm for care is where TransformativeMed fits in. The ability to gather effectively, present it in a smart manner, and then — and this is the main thing — to be able to document back to the EMR while in the event, the moment with the patient. That’s the part that creates the efficiencies.

How much of the company’s efforts will be driven by which EHRs you work with and how you work with them?

We are embedded at the EMR level through FHIR API kind of technology. It’s important to get that connection and linkage done correctly. It’s also important to make sure that all of the rich features and functions that the clinicians need are intact. We have some partnerships with clients to make sure that from a qualitative point of view, everything works the way it should. We have some other partners lined up to make sure that that happens.

Whether it’s Epic or Allscripts, the quality of the connection and delivery of the function for efficient problem-based care delivery are the focus. We are on that journey, it’s moving along pretty well, and we’re going to continue that journey. We are going to take a more qualitative approach and make sure that it’s done right.

Is it difficult to create or maintain a brand identity when clinicians may not be able to tell which parts of the system were provided by the EHR vendor and which parts came from TransformativeMed?

Because the embedded nature of the solution, the clinician really doesn’t know that they are in TransformativeMed, because it is just brought in from the Cerner screen or the Epic screen. There’s a seamless nature to it that is very attractive to clinicians.They don’t have to toggle in and out of one system to another.

From a branding point of view, CORES is the brand title. Physicians who have used CORES want to use it again. If physicians are thinking about getting a solution that CORES addresses, the referrals are made. We get inbound interest from clinicians who want CORES because their colleague used it at a different health system. There’s a seamless usage of that through the UI, but the CORES brand is very strong out there.

Has their been interest in making the company part of a vendor or consulting organization?

Valuation and general value are dependent on the revenue you have coming in, your customer satisfaction, and the breadth and depth of products that you have. Right now our focus is to grow the company in a sustainable manner. If our customers are happy, they will stay with us and our revenue will continue to grow. We will have to see from there.

Where do you see the company’s recent work with the VA in Puget Sound leading?

We are super excited and honored. I’m very excited to be able to have an impact on the care of veterans. It’s a nice mission for our company. We have a great culture, but it’s a special honor to be able to do this.

This initial site will go fairly rapidly. We should have some pretty good results in the next two or three months. With that said, as we make progress through the rest of the VA, we will have some great use cases as a result. We are looking for other avenues with the government as well. It’s going great so far and we expect great results and are looking forward to further use of the product throughout the VA.

How will the VA and your other customers determine the impact of implementing your product?

We always do a compare and contrast of the situation before we were installed and afterwards as a use case. We document what the problem was, what we did, and what the results were. We will be doing the same thing with the VA.

The specific aspects that we will look to impact here will be around rounding and handoffs, and also with diabetes care and management for both the physicians and the nurses. They will be permeated throughout the VA. We expect to chart and document those results. 

In the short term, we will be able to coordinate care better. As I mentioned before, healthcare is a team sport. Statistically, you’ll see in a typical episode that maybe 50 clinicians of one sort or another are involved in a patient’s care. We’ll be able to coordinate that better. We’ll be able to hand off that information better and they will use their time more efficiently.

On the diabetes side, diabetes care is fluid and it’s conditional depending on a number of factors. We will be able to coordinate that better, especially with the CMS regulations that are coming out around performance and generally regulating diabetic care. We will be positioned to affect the diabetic care of the veterans that we’ll be serving.

Where do you see the company’s future over the next three or four years?

We are focused on adding new customers, keeping our customers happy as they typically are while expanding the footprint in our customer base. We are going to look to a lot of revenue growth, a lot of expansion into both the government and international markets. We will invest in additional product development, research and development for new modules to help support our customers. We are looking at not just solutions for residents, hospitalists, or endocrinologists, but a number of other areas to continue to expand our footprint.

HIStalk Interviews Bob Bailey, Founder, Healthcare IT Leaders

Bob Bailey is principal and founder of Healthcare IT Leaders of Alpharetta, GA.

Tell me about yourself and the company.

I’ve worked for 25 years in enterprise IT professional services firms that I have owned and operated. Our company is focused on enterprise applications, deployments, clinical information systems, business information systems, and a practice we’ve launched for COVID called Healthy Returns.

How has your business changed during the pandemic?

Our business changed dramatically as work-from-home became a strategy that we all had to get our arms around. Specific to our industry, a lot of our projects went offline by definition. We had to rethink who we are and what we do. Healthy Returns was a nice practice that we were able to establish in finding a way to be helpful to the communities we’ve served for the past 10 years. That has been a lot of fun and it has become a great success, so we are happy with that.

But it was clearly a time where we all had to sit back, reflect, and think about the business we have today and what might it look like tomorrow, then pivot in a number of directions to get it back on track. As the revenue came offline in the systems, a lot of these projects just started to disappear. It was a challenging time.

What changes are you seeing in the kinds of people who want to do consulting work?

I would say that we’re a work-from-home winner, our industry being professional services and software support. It has opened up wonderful opportunities for consultants, by and large, because they have so much more flexibility in their personal and work life. To us, it has been a tremendous uplift to employee morale internally and also externally for those that are working on behalf of our clients.

What services are health systems most commonly seeking?

We are a heavy Epic firm, as a good two-thirds of our revenue comes from the word Epic. There continues to be a dominant stance for that company, and therefore, a lot of work that we do on behalf of Epic-related clients and also due to continuing consolidation within the industry. We have also seen a tremendous uptick over the last two years in the business systems applications such as Workday, ServiceNow, Oracle, and Infor. Our business was built to support both the clinical systems and the business systems that an enterprise would have to implement and support. We are in the mid-innings, in a baseball analogy, of the overall business systems refresh that is going on in the health system.

Your mentioning Epic made me think of the consulting services arm it was launching a few years ago. To what extent do big software vendors support third-party consulting?

Epic and Epic Boost do a very good job inside of their customers, who then become our customers. Oftentimes we’re working side by side. We don’t see that as a threat to our business, but rather as complementary. If you look at Cerner, they traditionally have had a professional services organization on the ground implementing their software and we work very closely with them as well.

The key to working well with those two large vendors is understanding how they like to support their customers, what they want to do in addition to the software license sale itself, and then how we can cohabitate with them. We have found working with both firms to be a pleasure over the last 10 years. It’s a different set of challenges between those two organizations when you’re working with them, but once you understand what they’re looking to do and then how you can work with them, it becomes harmonious. Success for the client is what we’re both interested in. It has been good for us as a business.

What is the future of conferences such as HIMSS and Epic UGM?

In the healthcare enterprise, we talk about digitization. I think digitization of the conference world is a healthy thing, because we can get together more frequently and with less cost. It’s good for the customers. It’s good for the end clients of the software firms. It’s good for the vendors, in our case, the services firms. That’s healthy.

On the other hand, we are humans and we need to see each other and be around each other. The conference of old, let’s say HIMSS using that as the example, will never be as large as it once was. That’s actually a good thing. But we need to have a little bit of both.

How is the CIO role changing?

We were talking with a client recently who brought in a chief technology officer, who works for the CIO, from the retail industry. We have a number of those scenarios across the system now, where it used to be the CIO and his or her staff was always from the healthcare space, because it’s a unique space today. The good news is that we are starting to see that turnover and we’re starting to see a lot of the outside influences. When we talk about consumerism and healthcare, that’s an interesting thing to say. but does the CIO over the last 20 years really understand what to do about that? These outside influences that are coming in at leadership levels is helpful to that.

But clearly the CIO’s role was changing dramatically. The CIO has to think not only about traditional security, which is an incredibly complex topic, but now they have to think about the same thing for their at-home workforce. It’s a huge challenge. How do we secure Tim’s office, Bob’s office, and the devices they are working on? In addition to digitization, it’s the security piece, both inside the four walls and also now with the work-from-home piece of it.

A lot of the CIOs historically are clinically oriented, as they should be. They are driven to satisfy the chief medical officer and the clinicians with the applications that we bring to life. In today’s world, there’s this massive shift going on to large business systems implementations. They require a totally different set of personnel and leadership techniques. That’s the HR line of business or the finance line of business versus the clinical line of business that they are accustomed to supporting. That CIO seat is a challenging one these days.

How do you balance the value of bringing in outside experts in technology or consumerism who suddenly find themselves trying to understand the complexity of healthcare?

I’ll use as an example B.J. Moore, a friend at Providence who I’ve known going back to his Microsoft days, when he ran their finance division and we were helping them at the time with call center software called Siebel about 20 years ago. Since he came to Providence, you see them moving light years ahead of so many other organizations that are in healthcare. They are acting like a large enterprise, a large corporation, as relates to technology. Providence has been a long-time client of ours as well and they have tremendous healthcare domain expertise inside their IT organization. What they were missing was somebody with a vision to say, what do we do in this new world? How do we turn on the consumer? How do we interact with the patient? How do we treat the clinicians in a different way, to engage them and pull them into these systems that are so important for a place that large? How do we look at our EMR and how do we think about running that EMR as a mature client to reduce the cost of ownership? How does cloud impact our budgets and how can it help us scale our business and secure the business in ways that we’ve never thought about? Those influences are terrific and he has done a wonderful job.

My personal background is that I come from corporate business services for many years and started in healthcare when I created Healthcare IT Leaders 10 years ago. We are happily at our 10-year anniversary right now, so I have a perspective that is a little different than others that have been in the industry for 20 or 30 years. I think it’s wonderful. You need more of that kind of thinking, particularly now as we’re trying to get out to the consumer and make your life and my life that much easier before, during, and after our encounter with said health facility.

Providence has gone deep into providing commercial services as an IT vendor under the Tegria umbrella, while Ascension has decided that IT is not its core business and is outsourcing almost all of it. How are health systems defining IT as core competency?

Whatever industry you’re in, you’re going to have people that think about that question differently. You look at back to what Mercy was doing years ago and today, and look at what Providence is doing today. And then to your point, Ascension, with much different philosophies on core competencies. Providence and Rod Hochman and his team there are very much leaders and visionaries in how they are thinking about healthcare and healthcare IT services. They are looking at it as ways to increase revenue, being as important as it is when you’re an organization that large. Ascension is obviously an incredibly large place as well with a totally different viewpoint on this.

I’m not 100% sure what the right or wrong answer is, but I think you will see both of those models persist depending on the leadership in an organization. I like what Providence is doing. On one hand, it is competitive to what we do, but on the other hand, it’s collaborative. We work together to support Providence in partnership with Tegria. In my view, that’s all good.

Going back to Ascension, no question, that’s a great strategy.  We know a lot of the people there and the leadership and they’re doing wonderful things on behalf of all their clinicians and the patients that they serve. That model is working very well for them as well.

What near-term changes do you expect that will affect healthcare and your business?

Our business was created to satisfy the most important element in the IT organization, which is the clinical information system. But then after Meaningful Use came and went, we turned the chapter on clinical systems in 2017. We will always be there to do the good work we do, but we put a lot of focus and investment in business systems because we knew there would be this natural refresh cycle. When I look out three to five years, from our company perspective, we want to be an organization that is understood by the CIOs to be able to handle the clinical systems and the business systems.

More and more, this Healthy Returns practice becomes important with President Biden’s recent mandate on how you test, trace, and maintain the credentials of employees, vendors, and patients. We start to get into consumerism and pulling all this data together to say, it’s safe for Tim to enter a building and it’s safe for Bob to enter a building based on our policies as a health system. That will persist long after COVID comes and goes because we will never, ever allow ourselves to come offline to the extent we have during COVID times.

Over these next three to five years, those three elements and cornerstones of our business will continue to be dominant trends in the eyes of the CIOs, CFOs, and CMOs that we support.

An HIT Moment With … Ajay Kapare

An HIT Moment With … is a quick interview with someone we find interesting. Ajay Kapare, MBA is chief strategy and marketing officer of Ellkay of Elmwood Park, NJ.

How was the HIMSS21 experience for Ellkay and what are your plans for HIMSS22?

The team at Ellkay had a very successful HIMSS21 and our overall experience was just fantastic. And of course we would also like to thank you for the special shout out during HIMSS. This year’s HIMSS was smaller than in years past, for obvious reasons. However our team found a way to make the most of the opportunity and finally meet with industry colleagues in person again. Although we have accomplished a lot through virtual experiences over the past 18 months, nothing beats making personal connections face to face. It was really great and exciting to see how all of our hard work and planning had such a big impact and result.

As for HIMSS22, our planning is very much underway as it just around the corner. At HIMSS21, we had the chance to start new relationships, rekindle old ones, and revisit other facets of previous partnerships. We want to build on this momentum. Our goal now is to ensure we keep our HIMSS presence strong and establish the most effective methods of engagement from our HIMSS21 experience.

How do you go about setting goals for a conference like HIMSS and then developing a plan to achieve them?

Like with any marketing initiative, the first step was to evaluate Ellkay’s purpose of presence at HIMSS. We researched whether our own attendance would increase the chances of achieving strategic objectives, based on who we anticipated attending. Once our executive team determined the HIMSS audience would be an asset, we knew we wanted to make valuable use of our time there.

We take on an integrated and holistic approach with our marketing. Team Ellkay does not take on a project unless we can do it well. It’s like “Moneyball “in healthcare. We believe that many small things, done well, add up to make a big difference. All of those small items from our efforts, whether it’s training or graphics or social media posts, add up to make the event the best that it can be.

To pull this off requires collaboration between all of our contributing teams. The marketing team was essential in planning a dynamite, functional booth and scheduling innovative activities for sales to invite attendees to enjoy. The sales team then collaborated with strategies that attracted customers, colleagues, and of course prospects to our booth. We couldn’t do it without our product and operations teams, which have given us the foundation for compelling conversations and solutions we can be proud to demonstrate.

What advice would you give to to a small health IT company about developing or expanding its marketing efforts?

Ellkay’s event strategy is proactive marketing and sales collaboration. We did not just set up a great booth, then sit and wait for people to show up and ask about our products and services. Instead, we had already taken valuable time to build relationships and a reputation. Our colleagues at HIMSS intentionally sought us out, knowing we were there. The sales team was also in full partnership with our marketing efforts.

Each team member from Ellkay that attended HIMSS knew the type of HIMSS attendees and who they should connect with at the conference. This involves extensive research and pre-work for our sales team to set meetings in advance.

Ellkay is known for its conference giveaway of honey from its own bees. How did that come about?

Our co-founder and president, Lior Hod, had a long-held dream of raising honeybees. In 2015, there was a lot going on in the news about the declining honeybee population, so Lior decided to act. He called his beekeeper friend, who set up the first 36,000 bees on Ellkay’s rooftop. Our honey is harvested right at headquarters for our friends, colleagues, and conference attendees. Today, we have more than 1 million bees on Ellkay’s rooftop from 22 active hives. Every event we attend, we find the honey to be both a great conversation starter that really reflects our culture, as well as a memorable takeaway. Year after year, we have people returning for our honey, and of course good conversation.

How should a marketing team work effectively with the company’s executive team and its salespeople?

Events represent a significant investment of time and resources for every company. Before committing to an event, the executive team needs to evaluate whether it is a good fit for their strategic objectives. Once they determine if the event’s audience and message are advantageous to the business goals, the marketing team steps in. Marketing develops a strategy to provide the sales team members with the tools they need in order to achieve substantial relationships through the event.

All teams involved should be aware of the purpose in attending the event, the audience, the company messaging which best appeals to the specific audience, and the strategic targets all parties must try to achieve. We spend significant time internally strategizing and communicating to ensure everyone is on the same page and recognizes the significance of the event.

Additionally, no team should enter an event without a plan for evaluation afterwards. All teams must have metrics in order to assess how they performed at the event, and how event attendance helped the company achieve its overall objectives. The evaluation plan should be shared before attending so all teams know how their performance is to be graded.

After attending an event, our team always asks for feedback from all members of participating teams. This allows our colleagues to share their personal perspectives on areas they found that could use improvement, or methods that were particularly successful, for consideration on future event participation.

HIStalk Interviews Steve Cagle, CEO, Clearwater

Steve Cagle, MBA is CEO of Clearwater of Nashville, TN.

Tell me about yourself and the company.

I’ve been with Clearwater for about three and a half years. My background is all healthcare, over 20 years working in a number of healthcare-related firms building businesses. At Clearwater, our mission is to help our healthcare customers protect their patients and their data to help them be compliant and to develop capabilities that allow them to be more effective and efficient at the business of cybersecurity, which is becoming extremely difficult in today’s age.

We talk about pandemic fatigue. Are we experiencing cybersecurity fatigue?

We as an industry had to pivot quickly to work-from-home for employees and in patient care and patient delivery. That involved a lot of new technologies and deploying those quickly. At the same time, threat actors recognized the enormous opportunity to target the healthcare industry. The data is so valuable, and the historic underinvestment in cybersecurity, more so through the pandemic, made it a juicy target. 

There may be a bit of fatigue with regard to what we’re seeing with ransomware, unfortunately. We will have to continue to understand that, because we are probably still at the beginning of where we need from a maturity perspective in healthcare.

Has the cybersecurity significance of employee behavior changed, especially with regard to ransomware?

It’s very significant. Cybersecurity is not just about the tools that we have in place. It’s really about the people and the organization. It’s about establishing a culture where everybody in the organization understands they have a role in keeping their information safe and being vigilant. We have to continue to remind people through training and not just rely on tools. Security processes become important as well.

The top healthcare cyberattack threats remain centered around ransomware and email phishing. That’s an important part of how we need to deal with the problem.

What is the maturity level of tools that can prevent that single employee click from bringing down the enterprise?

Unfortunately, there is no silver bullet. There are some important controls that all organizations should put in place from a baseline perspective. We hear a lot about multi-factor authentication, encryption, having good protection on endpoints, and identity access management. A number of security practices should be employed. But every organization needs to have a thorough assessment and analysis of their specific risks. 

When we talk about risks, we’re talking about vulnerabilities based on the specific information systems that they use in their organization and threats and the threat actors that could exploit those vulnerabilities. We have to assess the effectiveness of those tools and other types of controls, administrative controls, physical controls. How effective are those controls in preventing that threat from exploiting that vulnerability?

We also have to think about not only the likelihood of an event being successful, but also what the impact would be to our organization. That’s a risk discussion, because when you think about what you’re going to do in your organization to optimize security, it’s about your risk tolerance. Everybody’s risk tolerance is going to be a little bit different. There’s no way that we are ever going to eliminate risk completely, but we can make better decisions about where we’re spending our limited resources and our limited time by understanding, through a risk analysis, where those risks are and what we can do about them.

Health systems have recently reported some huge costs from ransomware attacks. How do they tailor what they can afford versus the possibility of huge losses due to downtime?

University of Vermont is a great example and Scripps Health incurred about $112 million in lost revenue and other expenses. What stood out there was that their insurance covered only covered a fraction of that. That was the same for University of Vermont, if I’m not mistaken. There was a time where we would hear, “We have insurance and we can cover that if we need to.” But it’s not just about the financial aspects — it’s about patient safety, it’s about brand and reputation, it’s about mission to provide safe and effective care. When you hear about health systems diverting ambulances to other hospitals, you’re talking about precious minutes where those patients who need emergent care aren’t getting that care as quickly as they could be.

There is a cost perspective. Those costs are getting to be more expensive. Insurance premiums are going up – we are hearing more than 50%. We are hearing from CFOs about limits on what will actually be covered in terms of their insurance policies and needing potentially to buy multiple insurance policies. Insurers are becoming more prescriptive when it comes to specific security controls that are in place, and the security questionnaires are getting to be more extensive.

Certainly we need to look at all those implications. For many healthcare organizations, there has been historically an under-investment relative to what we see in other industries. At the same time, healthcare is going through this digital transformation. We are deploying all these new technologies. We will need the appropriate amount of investment in security as well to ensure that we can keep our applications secure and keep patients and patient data safe.

What can health systems do about the risk introduced by their business associates and vendors?

Through the first half of the year, somewhere around 40-plus percent of healthcare breaches resulted from business associates, third-party vendors, or other third parties that have electronic protected health information that was entrusted to them by a covered entity, a provider or a payer. Healthcare is shifting to cloud, using third-party service providers, generating a lot more data, and sharing and accessing that data from many more endpoints. As we continue on that journey, the threat landscape and the vulnerabilities that are created through that type of model are going to increase.

Every covered entity under HIPAA needs to ensure that they have a business associate agreement with their third parties, but that’s really not enough. We are seeing healthcare providers and healthcare payers turn up the dial in terms of what they expect from third parties, from their vendors, and from anybody that wants to do business with them who is going to receive that electronic protected health information or other sensitive data. It is still the covered entity’s responsibility to ensure that data is being protected.

What role will the federal government play in health system cybersecurity?

There have been some good efforts, public and private partnerships. The Cybersecurity Act of 2015 resulted in the establishment of the 405(d), the cybersecurity working group and task force. They recently came out with a good best practices guide that has, for small, medium and large organizations, the top 10 cybersecurity practices that can be used as a baseline. That’s been a great effort that is supported by 150 or 200 members. In January of this past year, there was legislation H.R. 7898, which basically said that healthcare organizations that are implementing or have implemented best practices — which include the NIST Cybersecurity Framework or 405(d) best practices — should not necessarily have a safe harbor, but should be looked at a little bit differently from regulators when it comes to audits or potential fines and penalties after a breach.

We have had some good momentum coming into the year. We’ve seen some good activity from the Biden Administration to work with private industry and to some communication that we’ve seen suggests that there will be more support. The recent executive order that required additional security practices and controls to be in place from government contractors hopefully will also transcend to the healthcare industry. Obviously there’s a lot of technology providers out there that support the VA, for example. 

There’s some good movement there. We would like to see more. The healthcare industry just lacks resources, dollars, and people. Those are things that the government can do to support healthcare, as a critical infrastructure industry, to respond to the challenge.

What developments will see in healthcare cybersecurity over the next few years?

The challenge of cybersecurity will continue to be more complex. That’s a result of the increased adoption of new technology and the vulnerabilities that come along with that. For the future, organizations have to develop core competencies in cybersecurity and in risk management in particular as part of cybersecurity. They have to get good at identifying, prioritizing, and responding to risk, and doing that in a methodical way and a programmatic way.

We are already seeing a lot of movement at the board and leadership levels, conversations that weren’t there before, when cybersecurity was considered to be an IT problem. It’s not an IT problem, it’s a business problem, and it could potentially be one of the largest risks to the overall organization.

HIStalk Interviews Coby Skonord, CEO, Ideawake

Coby Skonord is co-founder and CEO of Ideawake of Milwaukee, WI.

Tell me about yourself and the company.

Ideawake helps large healthcare systems or providers create a highly engaging experience to capture, evaluate, and implement ideas from frontline employees. The biggest customers we work with in the healthcare space are UnityPoint, Advocate Aurora, and Sanford Health.

To what degree are health systems underusing their workforce as a source of ideas for innovation and improvement?

We are seeing a large uptick in getting better utilization of frontline staff, especially once they implement our system. A lot of the time when we come in, there’s a large underutilization, because things they tried in the past, like running one-off contests, didn’t work all that well. A lot of the time, systems are built on top of SharePoint or another solution that’s already internal. Since you don’t run these often inside of the system, things will fall through the cracks and you don’t get the results that you want. There’s no action plan after the fact. 

Once we come in, we see much better utilization. It’s easy to get started, but it takes a couple of cycles of running these challenges to get a lot more adoption across the large swaths of the organization. We normally like to start pretty small.

How much does using a technology platform democratize the process to avoid having the highest-ranking person choose their favorite idea?

One hundred percent. You hit on a great point. The best ideas to improve patient experience and process come from those who are closest to the patient every day. To your point, we democratize the process of capturing ideas. We do this in a couple of ways, but it empowers anyone at the front lines of the organization, regardless of role or title, to make their voice heard based upon the quality of their idea versus their job title.

What kinds of ideas are health systems looking for?

It’s all over the board. About half of our use cases, or challenges as we call them, are around continuous improvement. General process improvement within the system ties a lot to quality improvement programs. That’s pretty much exclusively how Sanford Health, as an example, uses the system.

You can also go to the other end of the spectrum, which would be product innovation or solutioning, which is split pretty evenly. How might we better attract millennials? How could we reduce patient anxiety before, during, and after care takes place? We’ve seen challenges that focus on solutions to better enable the aging in place trend that’s happening in the market.

The challenges focus on the major categories of healthcare trends that are being talked about from a consulting perspective. What trends will affect us? Then, putting those in the  form of a question and asking frontline staff for input on them.

Is this a way for health system executives to avoid paying consultants to simply talk to their employees and then report back a summary of what they said?

I like to say that we are more fun than consultants. The system is gamified. Users earn points as they submit ideas. There’s a leaderboard and you can offer prizes. Unlike having consultants interview employees, we create a transparent experience that allows for peer-based recognition. Employees can like each other’s ideas.They can track their idea from when it’s submitted to when it’s decided upon and ultimately implemented. You complete the loop of, hey, I gave input and something came out of it.

Health system executives sometimes solicit employee input on such decisions as choosing an IT system or how to implement it, but then override the frontline employee vote. How do health systems handle cases where a popular idea isn’t considered workable?

We do our own primary research. It’s important to complete the loop and to make sure that there’s transparency around where ideas go and why. We did a survey of 700 employees throughout the continental US, who told us that the number one reason that people who had ideas stopped sharing them – 20% of respondents – was because they didn’t hear feedback on where a previous idea they shared went and why it went there.

As far as prioritization, certain ideas that flow to the top from the frontline staff might not be workable for several reasons. But we have a transparent prioritization process where leadership who reviews the top ideas can say why something will or won’t work. That is communicated back to frontline staff automatically.

How do health systems decide who they want to participate and then encourage them to do so?

Our philosophy is the more, the merrier. We believe in the wisdom of crowds and the power of large numbers when you have the ability to sift through the ideas automatically using our technology. Our rule of thumb is if you’re under 5,000 participants when you get started, you can target that entire population. If we go over 5,000 or you have a complex network with a lot of locations that span several states, we’ll normally roll it out to a specific service line across several locations, or do it in a region and then expand out from that. But overall, we believe that everybody has ideas to improve quality of care and outcomes, so we try to make sure that everybody is involved.

Would the best prospect be a health system that has a track record of innovation, or should they just have a general interest or a specific idea to try?

Most health systems have some type of quality program in place. We see the easiest way to get started is making that quality improvement process more collaborative. Many health systems, regardless of their organizational makeup or culture, have that baked into the culture. We can help significantly improve the results. 

From there, looking at the innovative side of things. Innovation is happening in healthcare all over the place. If you don’t innovate, you will be left behind. Look at Blockbuster to Netflix, taxi cabs to Uber, or Amazon Care. Where primary care is getting disrupted now is on the fringe, but events and trends will continue. Health systems will have to be innovative and center their overall care model around the patient, continuously getting that patient input and feedback. If your culture doesn’t support it yet, then the best place to start is quality. But if you hear words around patient-centric care, and investment is going on around patient-centric care, we would be a great fit.

Are for-profit companies interested in paying health systems to participate in product evaluation or development?

We haven’t seen too much of that yet. In my past life, with the inception of the company, we were doing something similar that was entrepreneur focused versus enterprise focused. What we see most commonly now is an enterprise reaching out with an open call to startups for solutions, instead of just focusing internally on employee ideas.

Do health systems invite patients to be part of the process?

We are seeing the first iteration of that right now. It has been talked about for a long time. There’s a hesitancy to go directly to the patient or to replace some of the things that are in place currently, but it is something that we are starting to see. We should have our first rollout to those in early 2022. We just need to work through some obstacles such as security and compliance and making sure there are no concerns about HIPAA. When you go internal to employees, there’s a lot less concern. Sometimes there is more of a fear about working with patients, but we have the technology to do fully anonymized feedback.

What is the future of health system innovation?

Employee engagement and employee experience were already critical, but with COVID-related attrition rates, retention strategies are becoming even more important. Our system is being leaned upon more because of the need to engage employees and empowering them with a voice. That trend will grow. Most health systems think that their culture doesn’t support innovation, but every culture inside or outside of healthcare can support it. It’s a matter of where you start it. There will always be a leader in a region who will support the initiative. The sooner that leaders realize that, and more and more are realizing it now, the easier it will be to bring innovation and patient-centered care into the mainstream.

HIStalk Interviews Jay Colfer, CEO, Fivos Health

Jay Colfer is CEO of Fivos Health of West Lebanon, NH.

Tell me about yourself and the company.

I’ve been in healthcare for 30-plus years. I joined Fivos Health last October as their CEO.

Fivos was previously known as Medstreaming or M2S, two companies that provide three things in the marketplace — a software solution for ultrasound specialties, a technology platforms for societies and registries, and data analytics for device manufacturers. The common thread is vascular medicine. Each business line solves for specific problems, but collectively they lead to driving towards quality in that specific area of vascular medicine. We have over 1,000 clients clients in the specialty providers of office-based labs and hospital and health systems, combined with medical societies, registries, and device manufacturers. 

We relaunched the rebrand of our company to Fivos recently as part of the “one company” initiative that we developed to help unify our clients and our employees and make it simpler for them to work with us. People ask what Fivos means and how we came up with it. The short answer is that it’s easier to come up with a name than finding an available URL. We wanted to make it a short. We didn’t want it to be something that began with an “M” because people would deviate back to the old M2S or Medstreaming. Fivos is an alternate name for the ancient Greek deity Apollo, which is the god of light, truth, medicine, and healing. It stuck with us because remind us what our focus is. Even though our roots are in vascular, we are focused on medicine and our commitment to create insights around healthcare and around quality, particularly in the vascular space and in some of the other modalities that we serve today.

How are registries populated and used?

A registry is typically formed by a society. We got our start partnering with the Society for Vascular Surgery. They formed a Vascular Quality Initiative that has 14 registries. A registry in this case might be for carotid artery stents, with a clinical site, a hospital site, contributing data around that clinical procedure and as well as follow-up information to that care.

Today, we have more than 800 healthcare organizations contributing to various registries on clinical procedures in the vascular space. It becomes a repository of data for clinicians to be able to figure out, how are we doing from a quality perspective? Are there things that we can do from a clinical outcomes perspective?

How do registries get information from provider EHRs?

There’s some complexity to that because there are multiple parts. An example is our work with device manufacturers. Because of our partnership with Society of Vascular Surgery, or SVS, we have the ability through their patient safety office to take that data from a quality perspective, anonymize it, and provide it to device manufacturers. They are looking to use quality clinical data for pre- and post-approval studies or device trials. We provide that data to them. A number of them use that specific data as they are working with the FDA for their regular regulatory and compliance issues.

Who pays for that movement of data?

Device manufacturers, via their patient safety office. The PSO is purchasing that anonymized data for their specific devices. That revenue is split between the technology company, Fivos, and the society, SVS.

Before registries, was the only available option for these kinds of projects the commissioning of new studies?

It was. The VQI was started probably 15 years ago and has evolved over time. It started in the Northeast. Our chief medical officer, Jack Cronenwett, MD, who was out of Dartmouth, was one of the founders. They started as a regional group that grew over time and expanded geographically to the point where they had to make that a formal organization with SVS. This vascular registry it is the largest one in North America.

What is involved in transforming hospital EHR into registry form?

One of the biggest issues is extracting data from the client’s EHR. A lot of our data sits in unstructured notes. For years, a lot of companies focused on on natural language processing and AI to try to figure out how to bring that back. We are working with our partner SVS with the major HIS vendors, leveraging our relationships where they are committing to building structured report templates as part of their base system that would provide an easy way for us to be able to extract information. Over the last 20 years, while there have been advancements in machine language and AI, part of the work is still extraordinarily manual. We are working with the major vendors to create that structured note to automate that data abstraction and that information can flow into the registries.

You must also need to avoid impeding the workflow of clinicians or adding extra work for them.

Correct. It takes time working with the vendors to say, how do you come up with a clinically appropriate templates that will capture the relevant information and not impede their normal practice? That’s a challenge.

What led to the decision to change Medstreaming’s business by acquiring a registry company and combining those business into something new?

As I mentioned, there are three parts to our business lines. Our workflow solutions started in vascular as a platform for being able to help reduce reporting times for providers. Our system helps build patient reports in an ultrasound modality that is complete with images and anatomical sketches and allows the documentation to happen as the exam is occurring. That then feeds into the EMR or EHR, depending on what the environment is, and allows for better and faster reporting times. As a patient, the frustrating part is having to wait on results when you’ve had that type of an ultrasound. That model for workflow solutions allows us to help quickly get reports back faster.

Where that ties in is that our workflow solutions have expanded from vascular to cardiovascular to women’s health, and we’re now looking at building for all general imaging modalities. From an ultrasound perspective, we create a baseline for a lot of clinical data in a structured environment that can then be fed into registries.

In our vascular world, we have 14 registries. We have expanded into neurovascular registries. We are having conversations with orthopedic societies that are starting registries.

We are looking to bring this under one brand to expand our general imaging modalities to be able to provide our technical platform for societies. Then, combine that with the whole data piece, with data abstraction as to being able to pull data from our workflow solutions into the registry, or directly from the EMR or EHR into the registry.

Those are the three growth areas as we take Fivos forward.

Where do you see the company going? 

Fivos has been around for 15 years, which probably surprises a lot of folks. We want to become agnostic as it relates to ultrasound platforms. There was an international organization that was looking to replace their ultrasound system. They told the five major ultrasound device companies, “All of your products are great, but if you don’t have the piece that Fivos provides, don’t participate in the tender or the RFP process.” We are building our brand with those organizations so that our solution can be the front end to getting information into the registries.

Then on the back end with the registries, to be able to look at that data from a quality perspective and say, what improvements can we make? Not only from a device manufacturer perspective, but also from a clinical perspective inside of research. Whether that’s vascular, cardiovascular, or neuro, we can analyze the data that contains that information.

We think there’s an ability to even enhance that for healthcare organizations that say, how do we marry up our clinical data with charge, cost, and pharma information and make that available back to our clients? They have a lot that data already inside their organizations, but how do we bring that together for them? We are going to be focused on that.

HIStalk Interviews Stephen Hau, CEO, Newfire Global Partners

Stephen Hau, MS is chairman and CEO of Newfire Global Partners of Cambridge, MA.

Tell me about yourself and the company.

I’m a serial entrepreneur and an experienced company operator. Much of my misspent youth was dedicated to building companies and bringing innovation into the marketplace. Today, at nearly 50, I’m the CEO and chairman of Newfire Global Partners, a company that, you guessed it, helps clients build companies and bring innovation to the marketplace.

Newfire is headquartered in Cambridge, Massachusetts, with nearly 400 team members worldwide in Europe, the Americas, and Asia. Our services include advisory work, staff augmentation, managed services, pivots and turnarounds, and de novo starts. About 80% of our business is in healthcare, spanning provider, payer, consumer, and life sciences. Much of our work includes elements of data engineering, data science, and replatforming. We are expanding our US footprint, opening an office in Canada, and exploring operations in Singapore to support our global supply chain of the best talent. We envision having thousands of team members within the next three years.

What are the challenges and benefits of operating in several countries?

When we started the company, it was quite organic. A company that I was associated with was getting acquired. The acquiring company, which was much larger, decided to release the engineers, who were in Eastern Europe. They were great engineers, so I sent out 50 job offers, and about 35 of them stayed. I just thought they were great engineers. I didn’t even have work for them, but I have lots of friends who are venture capitalists, private equity people, and CEOs who run technology companies, so we just did some matchmaking.

Over the course of the last few years, it’s grown from 35 to now nearly 400 people. We’ve chosen our locations strategically. I like certain profiles in Eastern Europe, especially in areas around data science and engineering. We have dual offices in Ukraine and Croatia. We have an office in Costa Rica and of course we operate in the United States. We have an office in Kuala Lumpur, Malaysia, and we’re probably opening an office in Singapore. Having these locations also provides redundancy. For a lot of our customers, I represent a key part of their supply chain, so we have gone to great lengths to protect that pipeline chain to have as much diversity as possible.

How are digital health companies working around any limitations they find in interoperability and data maturity?

Our customers represent a subset of the market, but if I generalize from my personal experiences, interoperability is key. New companies in this space discover the challenge pretty quickly. More experienced folks appreciate that it’s just part of the cost of doing business in this space. The good news is that maturity of tools and options exists. FHIR is not yet a perfect solution, but it has given a lot of technological optionality and advantage to digital health companies, especially new entrants.

In terms of data maturity, that is a common theme that we see across clients that we work with. A common theme in healthcare is data, data, data. People incorporate data as their primary strategy, or they may be a company that has been operating for a while and see data as a new opportunity. In both situations, there is a challenge of data maturity and sometimes what I call data liquidity, which is having data in computable form that can be used to fuel things like predictive analytics and machine learning and so forth.

For data maturity, there are many elements to support clients. Some of it includes things that are not particularly glamorous, such as data cleansing, which quite frankly is extremely manual. What a lot of people don’t realize is that in this vision of a data-driven future, there is a lot of behind the scenes work that requires a fair amount of manpower.

How do you see the ecosystem shaping up between big EHR vendors like Cerner and Epic and all those well-funded startups?

It’s an interesting dynamic for sure. It’s hard to predict how the future will play out. Obviously the existing EHRs have tremendous market share and there is a high switching cost to convert to something that is maybe more modern or innovative. Obviously it is difficult to innovate when you have so much installed base. Those are all challenges.

Some exciting new capabilities are being developed by new entrants into the market, companies that may only be four or five years old. Some of the tools can be tremendously helpful to the healthcare ecosystem and ultimately drive impressive outcomes to help patients and consumers. I’m a free market guy, so my hope is that the duality can coexist. The market will adjust to allow the innovative technology to be utilized and incorporated by the existing players.

What influence do you see coming from big technology companies like Microsoft and Google, whose healthcare involvement seems to come and go?

These big horizontal players historically have come in, they’ve left, and sometimes they come back again. That highlights or spotlights the unique aspects of the healthcare ecosystem. In our own journey, we’ve seen the market from the provider perspective and the payer perspective. In some ways, they are two sides of the same coin of some of the problems that they’re trying to address. On the provider side, they think in terms of prior authorization, while on the payer side, they’re thinking in terms of utilization management.

This is an example of why it’s so difficult for a horizontal to come in and to think that there’s a “one size fits all.” These large players obviously bring tremendous resources and pretty cool innovation. But the reality is that it has to be focused on specific, achievable, valuable problems in our market to be relevant, then move the needle in a way that it can provide lasting value and then become a longstanding player in this space.

What are the keys to success for new health IT entrants?

I’m a believer that the investment fuels innovation. Obviously I’ve been a beneficiary of venture capital in my career. Where we are now comes down to outcomes. We gave a lot of new ideas and a lot of old ideas being reapplied. At this point, there is a real focus on what actually moves the needle. One example is that, over the last 10 or 15 years, we have seen a rise in consumerism, and that has led to many cool opportunities. We have seen a class of wellness applications or applications that allow consumers to support their own health. We have seen some great examples of companies that have made a positive impact.

The focus now is that people are shifting from acknowledgement of great ideas to whether they ultimately translate to improved patient outcomes. That will ultimately be a filter for many companies in the market to decide which companies survive and continue and which ones do not.

What does it feel like to see PatientKeeper still going strong 25 years after you founded it?

I started PatientKeeper in 1996 with Joe Bonventre, MD, PhD, a professor at Harvard Medical School. I started Shareable Ink 2008 with Vernon Huang, MD, who’s a former medical director at Apple. Both of my co-founders are physicians. Our teams did some amazing work and we had some fun. But at the same time, it’s a little bittersweet for me because I never got to use the products that we worked so hard to build because I’m not a clinician. I’m sure many of your readers can relate to that.

In contrast, what’s exciting about Newfire is that I have been a consumer of the services we provide. Our product is extremely relatable to me, which gives me an advantage in terms of how we support our customers.

What’s in the future for the company?

We are in a golden age for technology in healthcare. I have a privileged vantage point because I’ve gotten to work for the leaders — providers, payers, consumer, and life sciences. We are seeing some real opportunities for meaningful innovation. It is inspiring to watch the management teams of these companies turn ambition to reality. My hope for Newfire is that we will continue to be a trusted partner for our clients that supports them in their journey to bring innovation into the marketplace.

HIStalk Interviews Guillaume de Zwirek, CEO, Well Health

Guillaume de Zwirek is CEO of Well Health of Santa Barbara, CA.

Tell me about yourself and the company.

I started Well six years ago out of personal frustration. I was an athlete, an endurance athlete at the time. That was my hobby. I wound up in the emergency room. They had concerns about cardiac issues. I loved my doctors and I loved the facilities, but the process of coordinating my care was super frustrating. I just couldn’t escape the thought that I was in an industry that was in the top five in terms of gross domestic product, but worst in terms of customer service despite having everything going for it.

What drove me nuts was the phone and having to navigate many different people in the health system. I thought, how great would it be if there was a technology system sitting on top of all the individual systems and technologies at a hospital so that I could save one phone number in my address book, get all my needs handled, and something behind the scenes would take care of the logistics and coordination? That was the inspiration for Well.

Health systems could me automating communication and engagement to improve the patient experience, but some may be focused on the potential to save FTEs. What motivation are you seeing?

I’m glass half full. I rarely encounter health systems that are trying to reduce FTEs. Most people came into this field for the reason of bettering patient health, and they live that in the conversations that I have with them. Usually it’s about providing quicker resolutions to common questions, elevating their staff to the top of their pay grade where they can handle more complex issues versus routine, rote communications that really aren’t sophisticated and aren’t a good use of people’s time.

I also want to add that I don’t believe in automating the patient interactions. I actually think that has the potential to do a lot more harm than to help. You should only automate when you are positive that you can give patients the answer they are expecting. The rest of the time, you need to kick things to the right live agent. That’s where there’s a lot of sophistication, routing, rules, logic, and escalations.

I’ll give you an example. My wife is pregnant. If she is texting her health system because she has cramping, that should immediately go to a nurse to respond to her over text or call her to resolve her query. If that’s getting stuck in an automated machine, you’re just going to frustrate patients more than help. It might look like you’re saving FTEs, but really you’re hurting patient health. If you’re on any value-based contracts, you’re probably hurting your margin. That’s my point of view.

How are health systems managing their use of those systems to make sure that messaging is consistent, understandable, and appropriate based on patient preferences?

That’s part of the reason this should exist in a single technology provider that handles the last yard of patient communications across the entire life cycle of the patient journey, from acquisition into the health system through discharge and long-term health maintenance and chronic disease management. If you don’t have everything in one platform, it’s impossible to manage.

A patient going in for a primary care visit may need to get an MRI, go to radiology, and see a specialist like a cardiologist, like I did in my case. If they are all using different systems, you are guaranteed to burden the patient. If you bring all the communications into one engine, you can see what workflows are configured. You can see where there might be over-communication. You can control language and make it consistent across the enterprise. That’s why I think it’s so important to bring everything under one umbrella.

There’s still a lot of work that I don’t want to diminish. There are operating work groups that need to be set up to define the tone that we want to have and the frequency with which we want to communicate with patients. Analytics departments need to look at the data and determine what’s working, what’s not, and what’s most effective. Usually there is central administration, where you set specific rules that are consistent at the enterprise level. Then, let the individual practices customize things for their specific workflow needs. All of those are considerations that we’ve built over our six years of having Well in the market.

But it’s precisely what you’re describing. It’s hard to manage and it’s complicated, and that’s why I think it needs to be in one system. That’s the only way you get the visibility.

How can technology offer patients the “they know me” experience?

I’d like to answer this without centering on Well. When you think about the “they know me” concept, most people think about Customer 360, and they think about CRM, customer relationship management. EMR, CRM, and patient communications all live in a similar format. We personally are focused on giving you a complete history of the patient communications across departments so you’re not having to repeat redundant questions and tasks. Then, displaying that information in context of all the patient demographics and information that might be relevant to them.

CRM takes it a little bit further in terms of the context of the patient, bringing in psychographics and other things across different systems, applications, and licensed data. That can be a complement that we embed and integrate into EMRs and CRM tools to provide that full picture. We are focused on that entire communications history.

Going back to my wife, true story. She was going into labor and it was in the middle of COVID, so she was wearing a really thick mask and was concerned about giving birth in that mask. She texts and says, “Can you please greet me with a 3-ply?” When the health system gets that message, they know that Katie is 40 weeks pregnant. They understand that she is on the way to the hospital for her delivery. They can respond and say, “No problem. We’ll meet you at the front door.” That’s what happened.

There’s a lot of noise. There’s a lot of different solutions to solve for this. We’re focused on displaying that comprehensive record of all the interactions you have had with the health system so they can respond to you in context without repeating a bunch of questions.

Sorry that I’m talking a lot about pregnancy, but it’s highly relevant for me. We went through this recently because my wife is pregnant again. At 12 weeks, she had really bad cramping and it was like 4:30 in the afternoon. We were at a different care provider that doesn’t offer convenient access to patients — you have to call. So we called on the phone at 4:30 and they couldn’t recognize the phone number. I had to give all of my wife’s information. It took about 25 minutes just to get to the right department and get everything documented. At 4:55 p.m., the person on the phone said, “So, Guillaume, I’m putting a note in the record to have someone call your wife. But to be honest, I don’t think anybody will. If you can call us back in five minutes, we transition to our after-hours call center and they can help you.”

I said, let me get this straight. You want me to call you back in five minutes and go through all of this information again so that I can get an on-call doctor to give us a call back? She said yes. I was really frustrated. It would have been great if I could have had that same experience that we did with the 3-ply and just texted and said, “Hey, my wife’s having cramps, we’re 12 weeks in, and we’re concerned. Can you have the on-call doc call me back?” That to me is a great experience that will make my wife and I never leave that institution and get all our care there for the rest of our lives.

What have we learned from the pandemic-related rollout of conversational AI chatbots?

A lot of people are surprised by how accepting patients are of talking to somebody over digital mediums. Symptom checkers are a great example. A lot of companies sprung up to help patients self-triage and decide the next best course of action. I think the market as a whole is much more receptive to communicating with patients over different mediums that aren’t the telephone. That’s a really good move for the industry.

I believe where we need to go is to help the market understand that they can start with a use case, but they really need to think about the end-to-end patient journey and patient experience and deliver that level of access across every step of the life cycle. If they started with a symptom checker, great. How do we expand from that and start building workflows for post-discharge or transitional care management or pre- or post-operative directions? There are thousands of workflows that can be enabled through digital mediums that don’t have any friction and that relieve staff from a burden and allow them to act at the upper end of their license.

And when I say staff, I don’t just mean doctors, MAs, PAs, and NPs. I mean call center staff too, folks that can deliver a lot of value for healthcare, but are spending a lot of time cold-calling patients to try to get them to act and adhere or answer really, really simple questions that can be automatically resolved without a human being.

How can this kind of technology be applied to patient payments?

There are regulatory restrictions to what you can communicate with regard to billing and payments. There’s a special consent that you have to get. That and marketing messages have a different threshold of requirements under the Telephone Consumer Protection Act.

We have proven that establishing a strong, two-way, consistent relationship with patients, providing that access, will make them more likely to do the things you want them to do. It’s human nature. When you build strong relationships, you feel a sense of burden to deliver on your side of the relationship. If you go in to get care and you are responsible for a co-payment, being asked that in context of that relationship makes it much more likely that you will adhere.

There’s a lot of interesting things happening in the payment space. Companies like Experian and RevSpring are licensing data on your behaviors from companies like Amazon and others to determine what your propensity to pay is, and if they should offer you a payment plan or waive the payment completely. They deliver that to health systems. That’s a valuable asset for healthcare. We’re pursuing integrations with a lot of folks in the space to deliver that information natively over the same thread, where you’re having conversations about the 3-ply mask going into labor, your pain at 12 weeks, and your postoperative directions to handle your C-section after-care.

Weaving that all together is a really compelling message. We’ve proven that patients are more likely to adhere when they have that relationship. Armed with the intelligence that a lot of these rev cycle companies have, you can be precise with what you offer to the patients. It not like a catch-all, spray-and-pray method. You owe 30 bucks, I’m going to send you a mailer, but it costs me $2.50 to send. I can be thoughtful that Mr. H has different socioeconomic needs and he’s unlikely to pay, so let’s just waive this payment and not even bother chasing him. Perhaps somebody else would be more appropriate for a payment plan.

I’m seeing a lot of interesting innovation on the rev cycle side. Our goal is to integrate with those companies. I want to be Switzerland. We have the APIs to deliver that information in the context of a really strong relationship and increase the likelihood that the patient adheres.

Where you see the company’s focus being over the next several years?

I want to be the underlying technology that powers every interaction between patients and their healthcare providers. We started deliberately in the space of care, coordinating your care for the administrative logistical items. We did that because the laws were different six years ago and that was a space that we could enter that had little friction. It had a clean path into the healthcare organizations.

As I mentioned earlier, we want to own the end-to-end patient journey, starting from patient acquisition through to discharge from the health system and long-term care management, which will extend to the home and other areas. Over time, I think establishing a strong relationship will provide a lot of value up the value chain. Think payers, pharma, and life sciences. All of those industries exist to serve patient health. If you can inject and influence the patient journey to lead to the best healthcare outcomes and have a platform that handles that end-to-end last yard of communications, it can be really, really powerful. There are applications for clinical trials. There are applications for drug discovery. There are applications for changing jobs and your insurance changing and your historical provider no longer accepting your insurance. All of those things can be proactively intercepted when you have a strong relationship with patients.

HIStalk Interviews Jessica Cox, RN, Director of Product Solutions, Holy Name Medical Center

Jessica Cox, RN is director of product solutions for Holy Name Medical Center of Teaneck, NJ.

Tell me about yourself and the hospital.

I’m the director of product solutions at Holy Name Medical Center. The hospital is located in Teaneck, New Jersey, with about 360 beds. It’s a regional health system serving the patients in the Teaneck community and surrounding communities in northern New Jersey and also folks in New York.

My role at the hospital is to manage the product offerings for software products that are deployed throughout the hospital and the health system itself. Mainly for the last two and a half years, I have been leading the development of a new in-house EHR that we just recently deployed in May in the hospital’s emergency department.

What led the hospital to decide to self-develop an EHR?

The hospital has always had an interest in technology. Close to 30 years ago, the hospital developed its own EHR, long before EHRs were prevalent and certainly long before they were mandated in the industry. The hospital, up until about two and a half years ago, was still running on that same system. It was certainly time to make a decision – do we buy, or do we build?

The hospital and the health system believe in a good mixture of both, but the leadership felt like the needs that Holy Name has were not going to be met by any EHR in the market today. The focus of Holy Name is an enterprise solution and a person-centric solution. Often systems claim to be interoperable and they are, but they certainly don’t fit the needs of an enterprise with multiple physician practices, health centers, and hospitals in the network. So the decision was made to build, and that’s what we did.

What was the makeup of the development team and how much effort was involved?

With this decision came a new leader, a new chief information officer, at the hospital. He started about three years ago and the team that he had was zero, so he had to form a team. He brought me in to manage the product side and my colleague to manage the development and architecture side. We formed a team from there. Three years ago, we had no one in place to manage this type of technology. The folks that were in place are still managing the existing legacy software.

We started with a team of basically three of us and now the team is greater than 50 folks. We have a mixture of onsite and offshore developers, QA engineers, and product managers. We are a nimble team. That’s where we’ve gotten our success and the ability to go from a concept to a minimum viable product, MVP, in just a little over two years. We are hands-on, close with our team, and we work pretty much around the clock to get the job done. We can remain agile and nimble and give the hospital what they need, but also some of the newer features and technology that they might not have even thought of without us bringing that to the table.

What does the tech stack look like?

The existing software was very legacy, as I mentioned. It was a technology that I was not even aware existed until I came on board. It was time for something new. It’s a web-based platform developed mainly on a Microsoft stack. We pride ourselves in the UI. We would love to share it with anyone that’s interested, but we brought some of the latest and greatest techniques for the UI and certainly for the behind-the-scenes architecture. We felt like it was time to modernize. A couple of other new features that we brought were facial identification for person management and person recognition when folks are coming in to be registered.

The software itself is modernized, but has some new technologies there as well. We feel like instead of looking at this as just a replica of existing EHRs, we wanted to bring technology that is not as often used in healthcare and bring it into that space. What technology is available at airports? What about banking software and technology that we can bring to healthcare and make the workflows of the hospital much more efficient?

What features were you seeking that commercial EHRs don’t have?

One of the hurdles that we had to achieve while we were developing for our own peers and our own colleagues at the hospital was that we were asking a lot of them to completely change from what they had been used to using for so many years to something from scratch. We knew that this was an MVP product, meaning the first deployed product is not going to be the most robust that can be. We are releasing new versions constantly.

Part of that advantage that you asked is to get a little buy-in from our peers. We wanted to provide them some neat, exciting kind of new-age tools that they could be excited to use. But more importantly than that, we feel like there’s a lot of advantages that we can improve the workflows that exist in the hospital today by using these technologies that aren’t traditionally in place. Our goals have been to get buy-in and interest from our colleagues, but make sure that that software is usable and that we’re not only meeting their needs, but we’re exceeding them. So far, we’ve gotten some really nice feedback.

How did your approach of using Medicomp’s Quippe differ from that of a vendor that doesn’t use it?

I will say that we are the first hospital EHR that has engaged with Medicomp to use their Quippe solution in the EHR. I really can’t imagine our charting feature without Quippe. When faced with the decision of how to manage physician, nurse, and clinician documentation, we knew that we had to have a competitive advantage there because physicians are counting seconds and counting clicks. They have high expectations that their documentation not only be complete and satisfy regulatory requirements, but that it is also readable and provides the narrative of that patient story.

The decision was to build our own database of clinical findings, or maybe integrate with another system that has just a simple database of findings, or to engage with someone like Medicomp, which provides not only that dataset, but the relationship between the findings and the ability to thread those together to tell a nice story of the patient, but also provide all of the data that’s necessary for reporting and quality measures. We feel like our chart is one of our most special features in the system and we’re really most proud of it.

Is a demo video available that would make it obvious how your product differs from commercial EHRs?

We don’t have one as of yet. Our main focus has been to ensure that Holy Name is well taken care of. Migrating to a brand new EHR is difficult. In my past, I worked on the physician practice side, and common practice was to reduce the schedule by about 30, 40, or 50% to make sure that the volume was low and everyone could ease into the new implementation. Certainly you can’t do that with the ER. So our focus has been on them and making sure that their needs are satisfied.

But we certainly would love to do that and to share. I will say our colleagues and friends at Medicomp, every time they see a demo of the software, they’re so excited and they feel like it’s something unlike anything that’s out there in the market today. We are very excited to share it with other hospitals when that time is right.

Will you commercialize the system on your own or partner with a vendor to acquire or license it?

The plan is commercialization. The route that we take, we are still navigating. But yes, I think our leadership at the hospital realizes that technology can enable hospitals to achieve much more than they currently are. I think a lot of hospitals feel like technology slows them down, and we feel like there is a need for this type of solution that is usable and easy to implement. We feel like that need is there in other regional hospitals like ourselves.

The plan certainly is commercialization. Our roadmap also involves expanding into other areas of the health system beyond the ED. I think maybe next year, when hopefully HIMSS is in a little bit of a better place, we will be excited to share what we’ve been doing.

What other technologies are you looking at or considering or developing?

We’ve been working closely with a couple of departments. One is our facilities management department. When the COVID crisis hit , our area of the country in northern New Jersey and New York was one of the hardest hit. We have worked hand in hand with our facilities management group to provide state-of-the-art exam rooms and hospital rooms that not only protect the patient, but protect the nurses as well.

Another technology that we have just implemented with our ICU — we renovated and completely built a new ICU right after COVID – is smart screens in each of the rooms that identify the clinician via facial recognition. There’s no need for tapping on the screen to access the patient’s record. There are tablet devices on the outside of every ICU room that provide indicators for the patient. They provide access into the room. 

We are continuing to dive down the software development path with our roadmap to expand, but we’re also engaging with our biomed and our facilities department to enhance the experience, the patient experience, at our hospital too. That’s been something really fun and interesting.

What advice would you give a nurse who wants to become more involved with technology?

Dive right in. Nursing is one of the best fields that anyone can enter because it is so diverse. I realized after a couple of years that bedside nursing wasn’t quite for me, and I just happened onto technology about 12 to maybe 15 years ago now. Now, I would never look back. My advice would be to work hard in nursing and make sure that you learn everything you can about patient care, but then take it further.

This industry needs nurses that have the knowledge of clinical needs and background, but who also know the workflows of the day-in and day-out of taking care of patients. That’s something that a lot of tech companies are missing these days. We need to take a step back and make sure that we understand the needs of the folks serving on the front lines of the hospital. Sometimes it’s a little more simple than we think, and so having more nurses in technology to convey that will only make us better over time.

HIStalk Interviews Carrie Kozlowski, COO, Upfront Healthcare

Carrie Kozlowski, MBA is co-founder and COO of Upfront Healthcare of Chicago, IL.

Tell me about yourself and the company.

I started as a clinician, practicing as an occupational therapist in the first one-third of my career. I worked in a number of care settings and saw the opportunity to impact patient care at a bigger level. I toyed between going into public health or into business and made the decision to follow the business side. I did my MBA and have been in the healthcare IT space for almost 20 years now, mostly involving workflow applications, making things more efficient and easier for providers, care managers, and now patients and the operations teams that support them at the health systems.

Our company started about five years ago. Our focus has always been, how do we help make sure patients get the care they need? We started this company as technologies continue to evolve and as health systems continue to evolve in their adoption of technologies. We think about digital health — how can we iterate on our approach to make sure that we are helping patients get necessary care?

Health system marketing used to involve renting billboards and bragging on awards to bring patients into profitable service lines, while clinical and administrative engagement was minimal. How do you see those areas changing or perhaps converging?

The biggest change is the evolution of how we think about consumers across all industries. We are seeing that now being applied in healthcare more specifically, which is the need for personalization and to tailor the communications to the needs of the individual patient. That’s the shift that folks are making. Obviously the more relevant the information is, then the more engaged the consumer will be, the patient in this case. That’s a big change that we are seeing, going from these broad billboards and radio spots into these specific patient engagement solutions.

Most people live their lives without a lot of health system involvement, which may or may not affect brand loyalty. Are health systems segmenting infrequent versus frequent patients and communicating with them differently?

I don’t know if they are communicating to them differently. I think you are hitting on that explosion of the retailization of healthcare and what we have seen in the last five or seven years in that regard. People were focused on acquiring patients, but not keeping patients. We did a lot of analysis on that about five years ago with a couple of engagements with some big health systems, and you could see it obviously lay out in the data.

But what we have seen since then is increasing competition. That has made them rethink what loyalty is and how you build it. Going back to the personalization aspect, how do you help this person by making it easy for them to get the care that they need? And offering specific direction on how to get that care from your health system, as you have offered more services and you think about the explosion of the front door. Folks have moved in that direction on the health system side, but people don’t know which front door to walk through sometimes.

Health systems may think that most patients want ongoing engagement, while many of those patients are looking for unconnected, as-needed care episodes and to be left alone in between. Can the health system meet the communication needs of both kinds of patients?

You’re getting at, what is my relationship? Is it transactional, or is it interactive content where you’re sourcing all your information from the health system, in which case those ginormous marketing websites are super helpful?

This goes back to using the patient data. Understanding what they need to do, but marrying that with engagement data, and then this third leg of the stool — which I’ve just come to understand better over the last two or three years – of health communication. More than health literacy. If you are a person who doesn’t want that information – “just tell me what I need to come in for” versus “I need help and support because I have a chronic disease” — you are motivated differently. The information that you want to consume needs to be organized differently. How do you leverage that health communication, understanding the person and marrying that with the personalization of  “this is the thing you need” so you are providing it in a highly relevant way? I think that it is that segmentation. It’s important to take those persona-oriented segments and then bring them all the way down to the personal level so that it is a one-to-one kind of experience.

Are health systems competing for the patient’s attention with similar health messages from large, technologically savvy players such as chain drugstores and insurers?

Well, that’s a loaded question. It’s a yes and a no, right? If it takes multiple teams of people to make sure that patients get the care they need and they are focused on the outcome and the care, great.

I do think it is confusing for the patient the way our health system, our healthcare in general, is organized in the United States. Everyone can think you are their patient. To your point, I think that messaging can get a little bit mixed up. The idea, and I see health systems and digital transformation officers pushing it around, is, how do we think about this as a hub? We want this experience to be a holistic one for the patient. We want to make sure that all of the communications that we need to send, or all of the digital health tools we’ve invested in, are organized in a hub so that it is feeding the patient what they need when they need it, but then directing them where to go.

How do we avoid turning technology such as chatbots into this generation’s PBX system, where we intentionally make it hard to reach a human even if they need empathy or lack technological comfort?

I don’t support taking the humans out of healthcare. It’s important to scale the human interaction and apply it in the right places. If we have humans doing all of the tasks, those people who need the most empathy, the most concentration of discussion, and the most support will be underserved. We can digitally communicate, “Hey, Carrie, it’s time for your mammogram.” I’m fine with that transactional kind of communication in that case. But that human piece needs to be there.

I’ll go back a little bit on the last thing I said, going back to personalization. We can make an empathetic experience that is personalized and relevant and can be delivered digitally. But we’re not going to ever go — and I would never support that we go — 100%. It’s all about the best modality to reach the patient to help them get the care they need. In many cases, that might be a human being, and should be.

Are hospitals trying to make their automated outreach messages seem more human given the intimate nature of healthcare services?

It goes back to that health communications piece. Communicating with empathy and making it personalized. It’s a broad message.

We all get the exact same letter mailed to us, auto-generated about, “You need this thing.” It’s not specific to where I live. It’s not specific to other circumstances. It’s not specific to where I went last year when I needed that same care. It’s obviously some auto-generated technology.

Health systems have rich data sets that can be leveraged for these needs. You can take that rich data set, process it, and apply it in a way that says, “It’s time for you to take this action, to get this care, and here’s where you had it last year. Let’s make it easy for you. Here are some options for scheduling that care at that location right now.” Then it is actually serving me, making my life easier. I know you’ are talking about me and you know me. Then you are complimenting that human experience with that personalized experience that is delivered in a digital fashion.

How important is it to focus the messaging on “here’s what you need to do next?”

It’s the most important. It is the key. We are all doing this because we want patients to get quality care and have the best outcomes. As the incentives are realigning in the same way, with quality and value-based care, that’s great news, but ultimately we are here to make sure patients continue to get the care they need. That should be the focus.

This is where I see a lot of health systems building strong bridges between their digital transformation and digital innovation with their integrated care networks, their medical groups, and their operations leaders. They want to apply innovation and digital engagement in a way that serves the needs of the patients. I just love seeing those connections being made more and more, especially with the clients that we work with, but across the board in general. That’s where you start to make good use of technology.

We talk about a unified patient record, but that doesn’t always include communications, especially those messages that were created in a mass campaign or as a patient response to one. Should we expect to have all messages from all modalities incorporated into the EMR or a patient CRM-type system?

That’s where we sit as an organization, as we see that need. It is marrying the data from the EMR and engagement data and bringing it all together in this unified patient view of, when did they engage? What was the outreach? Who did they communicate to? Did they attend the visit? When was the visit? It’s all about the interest, again, of making sure patients are not only scheduling care, but getting the care, and we can support them.

To your point earlier, are humans going to come out of it? No. So if a human needs to interact, they should know, “Hey, Carrie, we tried to message you a couple of times. It’s really important that you get this care.” We need to apply those same things we are doing on the digital side to the human side, making sure that the patient feels like we know them and they are a member of a health system that is connected and unified in the way that we are communicating to help them get care.

Should the messages encourage people who don’t see the value of having a primary care provider to engage with one?

Having a primary care provider is a key part of ongoing health. However, I also don’t think there’s anything wrong with a young person who’s healthy using the urgent care twice a year for a UTI and a sprained ankle. That’s where the data is important, looking for trends in the use of other care settings outside primary care to identify when someone needs to elevate into a primary care relationship. 

We are doing this with one of our clients. We are looking at how many visits the patients are having with urgent care. At what point do we decide, “It looks like you’ve been to the urgent care quite a bit. It might be better for you to establish a primary care relationship to help coordinate and oversee your care.” 

But creating that relationship and forcing those visits into primary care consumes limited primary care resources. We are going to compromise the patients, whether they are older or have chronic conditions, who need that capacity to serve their needs. Retail exists for a reason. It’s a valuable part of the entire ecosystem for urgent care or whatever word you want to use to describe it.

Where do you see the market and the industry moving in the next few years?

We are supporting clients who are trying to drive patients to get the care they need. Outcome-oriented population health is a portion of that, but adhering to those visits is an important part. We are then building in how we coordinate closely with the human interaction, allowing, for example, a bi-directional chat to support making sure that the patient gets what they need and making sure the outcome is actually achieved. That is what we are focused on. All of that is grounded in making sure we have a sound, relevant, personalized patient experience. But the experience isn’t the end goal. The end goal is the outcome that the patient has, a good quality of life and an excellent health outcome.

Do you have any final thoughts?

I’m excited about where we are in healthcare. I’m not excited that we’ve been through a pandemic for the last two years, but I feel like it has been the catalyst or the accelerant to think about how we deliver healthcare differently in a way that is patient centric, but supports the patient in succeeding at being there at the center of their care or their quarterback of their care. We are enabling that in a way better way. The speed at which we are seeing change right now makes it an exciting time to be part of all of it.

HIStalk Interviews Ashish Shah, CEO, Dina

Ashish Shah is co-founder and CEO of Dina of Chicago, IL.

Tell me about yourself and the company.

I started with Dina six years ago. I was previously the CTO and head of product for Medicity and was there eight years, before and after the acquisition by Aetna. Dina offers an AI-powered care-at-home platform and network that supports hospitals and health plans as they transition to monitoring patients in the home and other post-acute settings. We call this Care Traffic Control.

We’ve talked before about my father, who passed away suddenly shortly after Aetna acquired Medicity. I was a healthcare executive who had helped thousands of hospitals connect to ambulatory care sites, but that didn’t improve my dad’s situation. He had home health aides and spent time in senior centers, but those caregivers had no way to share information.

What effect has the pandemic had on the demand for at-home care as well as the company’s business?

The pandemic shined a bright light on what we need to do and accelerated it even further. Prior to the pandemic, Dina was 100% focused on organizing all of the resources outside of traditional facility-based healthcare, whether that was post-acute rehab facilities or in-home services. We knew we needed to do a better job to support the silver tsunami, the 10,000-plus people each day who are turning 65 years old. 

We would get a lot of head nods, and that was important, but COVID unfortunately accelerated that tsunami and gave us a glimpse of what it’s like when the traditional healthcare system is overrun. That cemented our place in the market. Clearly, complex things will continue to happen in the high-quality facilities. That’s never really going to change. There may be some automation and further optimization that takes place, but that’s still the right care setting for the right types of things.

Virtual care, whether it’s telehealth or some combination of remote patient monitoring, became critical. But these things need to be complemented by a third important delivery vehicle, which is in-home care. Not just traditional home health, but mobile lab and imaging, courier services, and a host of other capabilities that can be brought to you. The world was trained on things coming to you through the pandemic, not just in healthcare, but in all aspects of life. So in many ways, it made it super obvious for everyone. Now the race is on to equip the industry as fast as we can.

How do you see that shift away from the four walls of a hospital or a clinic being a threat, an opportunity, or both to the traditional health system?

It’s tricky. It’s hard to be a health system leader today because you have your feet in two different boats, two different business models. It’s hard to look away from how healthcare has been financed to date in a fee-for-service world. That creates some real challenges. Many health system operators were challenged in COVID by not having a consistent revenue flow, either through capitated payments or other at-risk payments.

It was interesting that in a industry that doesn’t have enough labor as it relates to physicians or nurses or other support staff, some organizations had to contemplate reducing headcount. I guess it was necessary to make the money work, but it was definitely challenging to witness that.

The opportunity as we hopefully come out of COVID is to accelerate health plans and providers having conversations around creating predictable revenue streams that are more based on value-based care type programs. The art is to make sure that there’s no attrition in revenue. In many ways, it’s the same type of conversation from 10 years ago when I was at Aetna. But now that we’ve had COVID, that took it from a theoretical concept to something that we need to solve as an industry.

What does the typical care network look like for a senior who has one or more chronic conditions and how do the members that participate in that care network coordinate or communicate with each other?

It’s very, very complicated. A typical senior or somebody whose health is complex could be on seven plus medications. They may need support with activities of daily living. That’s a non-medical home care service, which is different than a certified Medicare home health type service that may provide skilled nursing and physical therapy, really an extension of a service that you would get in a facility, but now being delivered in a home. So complex med management, personal care support with activities of daily living, perhaps some skilled needs that are required. That’s not even including primary care and specialty interactions as well.

A lot of what we are looking to do is to coordinate all of those logistics so that you can match or exceed the experience that you would receive in a facility. The market definitely wants it, but it’s easier said than done.

How does that care team structure or those care decisions differ for someone who is covered by a Medicare Advantage or a Medicaid Managed Care plan instead of traditional Medicare or Medicaid?

When I work with many folks on the home care side of things, they’re so passionate and they are wonderful organizations. But one of their biggest challenges and obstacles that they face is, how do we ultimately get that care financed that they know that the market needs and that creates value? I love what Medicare Advantage plans and Managed Medicaid plans are doing right now.

I’ll start with Medicare Advantage, because it’s a little bit more progressive and new relative to Managed Medicaid, which has been doing some of these things for some time. Medicare Advantage has introduced the concept of supplemental benefits — the extras, if you will, above and beyond Medicare fee-for-service — that will allow the Medicare Advantage plan to innovate and introduce new offerings like non-medical home care, nutrition support, transport, or other types of things that are not covered by a traditional Medicare plan. In the effort of delighting the member, addressing in some cases social determinants of health or other healthcare needs that can bend the cost curve, but also help that member meet their healthcare objectives. Really neat programs. We are in the early phase of this, but this is bringing online non-medical services or social determinant-oriented services that are being paid for, that are attracting members, but also change the outcome story.

Medicare, and CMS in particular, were wise to hatch the program years ago and then continue to invest in it and then allow the free markets to innovate. They have a  program called VBID, value-based insurance design, that is a vehicle for registering and testing for new types of benefits. If they work, then they ultimately graduate into the scope of things that MA plans can reimburse for. So it’s a really neat program.

On the Managed Medicaid side, in-home services, for example, are covered under what’s called LTSS, long-term support services. This is the goal of trying to meet the member in their home and community and unlocking alternatives to traditional long-term nursing home care. It’s a neat program that has been around for a while, but there’s some complexity in trying to manage that.

We’ve seen insurers that range from tech-heavy startups to Optum go big into Medicare Advantage, and some of those companies are providing health services directly. How will that change traditional hospital care, home care, and long-term care?

For Medicare Advantage plans, it’s bringing members online in a race or land grab moment that hasn’t existed before. The only option if you were a senior before was to be on Medicare fee-for-service. You could have bought your own private health plan, but now with Medicare Advantage plans, there’s a race to go manage outreach to these members, unlock a superior experience, and turn on new benefits that we know can change the arc of healthcare and the finance of healthcare.

Three years ago, 25% of Medicare-eligible members enrolled in a Medicare Advantage plan. Now we’re north of 40%, so it is growing rapidly. Many solid organizations are innovating. I think it’s wise that they are trying to establish a direct connection with the person to better understand their needs. Some go as far as delivering the care themselves, while others have invested in care coordinators or counselors who take a more proactive role in navigating that member through all of their needs. It is neat to see.

There are a lot of innovative organizations out there. Not just on the MA side of things, but organizations that partner with MA plans, like Oak Street Health, for example, or Iora, showcasing for the market a brand new community or home-based delivery model. I think we will continue to see that scale because it makes sense. Not to mention that people like it, which is sometimes hard to say about things that we do in healthcare, to get people to actually say that they enjoy the experience.

A problem has always been that outside the 9:00 to 5:00 window, people who weren’t hospitalized or in a SNF had to call 911 or go to the ED to have any changes in their health evaluated, including those that turn out to not be urgent. Have those insurers who have skin in the game addressed the unnecessary use of those services?

It’s clearly a problem that people have been studying for a long time. We’ve tried a lot of different things, from raising awareness to your health plan or the ACO to let them know that when somebody is in a emergency department. But in many ways, that’s too late, even though it creates intervention opportunities.

I’ll give you an example of a company like Dispatch Health. We know some of the folks there — we overlapped inside of the Aetna portfolio companies going back, so we are fans of them, the company, and the model. They took a new approach. They started by bringing urgent care to you rather than having you come into an ER, which was costly and had a lot of other ramifications. Not to mention that maybe you didn’t actually need to be an emergency room. They’ve started to chip away at the problem by redeployment of almost like a paramedic model to your home to manage triage for routine things, then escalate and navigate you to another site of care if it’s needed. In some cases, it may not be needed. In some cases, it may translate into something that leads to a telehealth encounter with a specialist that they bring into the mix.

There’s a lot of creative solutions that are coming into place. It’s not one size fits all. It’s not whether it will be telehealth, or in-person visits, or home care. The challenge for us as an industry over the next five to 10 years is to bring the best of all of that together with the right care at the right place at the right time. It sounds cliché, but that’s the challenge that we all have, and that’s what Dina is working on.

How do you see the company changing over the next several years as these market conditions change?

We no longer have to convince people why we exist. In the early days when you start a company, that’s a lot of the discussion. Tell me about the problem that you’re trying to solve, tell me why is it a really big problem, and tell me why it’s a big market opportunity. It was clear to many, including our early investors, when we talked about the aging demographics in the country and globally. COVID has expanded our market opportunity to include all people that are struggling with some sort of healthcare-related need. 

For us, it’s really about execution.To simplify our story, we use terms like “care traffic control” to create a visual of equipping hospitals and health plans with the infrastructure to be able to move from monitoring patients in ICU units and in hospital beds and shift that paradigm to coordinating, navigating, activating, and monitoring patients in their homes and communities. The solution we put into the market is a network of resources that are medical and non-medical in nature. We’ve got lightweight technology that allows us to engage with patients and families and understand what’s happening when a healthcare person is not in front of them. We do a lot with data. We bring all that information back to create opportunities to proactively delight that person and meet their needs on a continuous basis.

The organizations that are attracted to that today are health plans, like MA plans or Managed Medicaid, but also large provider groups that have started to go down their path to value-based care. I think that in five to 10 years, this will be everywhere. I don’t think it’s farfetched to think that every home is going to operate like a virtual primary care clinic, where it’s not just your residence, but an actual site of care that the healthcare ecosystem knows how to interact and work with.

It’s exciting. It’s what I wanted for my family before. I can see the convenience for it in this day and age. Our challenge is to make it happen now.

HIStalk Interviews Justin Dearborn, CEO, PatientBond

Justin Dearborn is CEO of PatientBond of Salt Lake City, UT.

Tell me about yourself and the company.

I started with PatientBond as CEO in January of this year. Prior to PatientBond, I was CEO of Merge Healthcare from June 2008 through October 2015, when Merge Healthcare was acquired by IBM and formed the basis for Watson Health for a while until their next big acquisition. I took a pause after that in healthcare, went and did a few other things in different industries, and then found my way back to healthcare.

I took your 12-question Patient Classifier psychographic segmentation survey. What are health systems learning about using consumer insights in their outreach and messaging?

I saw you took the classifier, so thank you. You and I are both priority jugglers at a high rate. You fall into multiple categories, and then we segment you based on the highest category, and you are very high and I’m very high on the priority juggler spectrum of the model.

What a health plan, payer, physician group, or specialty pharmacy is trying to activate in their client, member, or patient determines how they start using the psychographics and segmentation platform. Ultimately it is to trigger and activate positive behavior, such as keeping an appointment, filling out a survey, or all the way to collections or the financial side. It is triggering that process.

What all of our clients and most health systems are starting to realize is that they need to treat their patients similar to a consumer. One size does not fit all. Some segments of the population react well to physician-based messaging, where your doctor wants you to do X, Y, and Z. That segment of the population will do that without any other prompting or any other pushing needed. But a large portion of the population that doesn’t react the same. 

A lot of healthcare is messaging is towards the one segment. We dynamically personalize it based on what segment we’re speaking to. The customer doesn’t need to understand the concepts, but they are seeing the results in better engagement with the patient, more engagement, and getting across the spectrum of things from marketing outreach to medication adherence to really involved specialty pharmacy workflows.

It really depends on the workflow you are trying to achieve. But the bottom line is better engagement with your patient or member because you are speaking to them in a modality they want to use, in language they want to hear, and in words that they need to see to be activated.

Do providers ask their patients questions specifically to create a more accurate psychographic profile, or do they infer it from existing information?

Our system learns. We think you want to be communicated this way, in this frequency, and using these words. If it’s an ongoing communication path, our system will learn. We thought you would like text messaging and you need to see one message a day to activate this behavior, but it turns out now that one message a week in an email is better. We can learn from that and personalize the communication path based on that.

Health systems have done a great job, and are getting better all the time, at using AI to harvest their claims data. If it’s an existing patient, they have that data. They might have some socioeconomic data or social determinants of health data. If the health system has those components, we say, great, let us append the psychographic segmentation model to that – it will be even smarter, better outreach because you’re going to have historical data, which is informative for sure.

But what psychographics really gets to is the why and the how. It doesn’t focus on the historical. The historical can be informative, and there are certain things you can tell from a ZIP code or a salary that might impact payment ability, but really what the psychographics does is get behind the why and the how. This came out of Procter & Gamble and a number of high-quality, consumer-facing companies have used this for decades to segment consumers on a mass scale, as well as individual, and we can do both as well.

The classifier allows us to segment you with 91% accuracy. If we didn’t have that relationship, or if you were doing a marketing outreach to attract patients that you don’t know, we would take a national compiler’s database and append our model to it. That would be three times more accurate than chance on segmenting you properly, but it’s still not the number we get if you do the 12 questions.

Many people heard of psychographics in relation to Cambridge Analytica or Facebook collating a lot of data without user knowledge or permission to study their behaviors. Did these examples teach us that psychographics does or doesn’t work, especially in healthcare where the results would be used to improve the individual’s outcomes instead of trying to influence them for less-noble purposes?

I’ll start with the last piece of that. We believe in the health systems that we are working with. We believe in the payers. It’s really about activating positive behavior — making sure you take your medication, making sure you do your annual physical, or prompting you the best we can to get your colonoscopy. I think we would all agree that these are healthy behaviors. We’re not showing the data. In that case of Cambridge and Facebook, if the hospital did license the Facebook data — which we did at Tribune Company, for instance — that would still be separate data. That would go more to the social determinants of health datasets, and we could still use that and append psychographics to that.

To the first part of the question, part of our challenge with PatientBond has been awareness. Since I came in with the Series C investment round, we have been doing more on the outreach, more brand-building. We have started engaging with KLAS and Advisory Board and things like that. Frankly, the company didn’t have the budget to do it in the past. Half of our engagements are evangelizing, so a couple of calls will involve explaining the psychographics model, the history and genesis of that, how we get the data, what the clinical efficacy is, etc. 

Usually light bulbs start popping on. The client, the health system or payer, will start coming up with use cases. Could you do this? How do we operationalize it here? It’s a little bit of, I’ll say, free consulting and evangelizing. But once we get into a pilot mode, it pretty much takes care of itself. Then someone from the marketing or strategy group typically owns the project.

Absolutely awareness is still a challenge, but we’re working on that daily. There was a great paper put out by McKinsey about a month and a half ago that mentioned psychographics a number of times and the way they engage patients more effectively. That was unprompted by us. They found us and did the research and didn’t call us on it. Same with the Advisory Board. They put out a good case study with TriHealth and we were not contacted, but we were named. They both had some great results. So it really is about awareness.

Last year, of course, it was difficult to get mind share with the obvious situation at hand with the pandemic. This year is around awareness of PatientBond and the mission. It’s hard to say in healthcare IT. I was at Merge Healthcare and we had great products, but it’s hard to differentiate yourself. Most of the segments in healthcare are pretty crowded with vendors, but I can say there is no other company doing psychographic segmentation modeling and has our platform. 

There’s a lot of M&A on the AI side that do claims data analysis. Systems will recommend what they think would be the outcome based on historical, which is good stuff as well, but really nobody uses psychographics. A lot of the situations we are in are not competitive, but involve evangelizing and explaining in the first couple of calls.

Are health systems reluctant to apply marketing techniques to patient relationships that are more intimate than just consumer awareness campaigns? Or have their marketing folks not been involved and that will change with the new emphasis on consumerism as overseen by C-level executives?

I truly believe it’s the latter. It’s just coming of age. I’ve spent 10 years in healthcare and I can remember growing up that you didn’t see marketing from health systems, your doctor, or your hospital. I grew up around Northwestern Hospital and they didn’t advertise, but they do now. They have marketing budgets. They have data scientists.

That has evolved for the better. How to engage. How do people want to be communicated with, like text messaging versus email or IVR? Or, do you need to talk to a human being? We are informing them on how to best communicate.

That has been going on in CPG, consumer packaged goods, for 30 years. CPG used it effectively. Proctor & Gamble are masters at consumer marketing, but they don’t necessarily have the one-to-one relationships that can be built at health systems. You’re not as intimate when you’re buying Tide detergent, so when they are applying psychographics to something like Tide, it is more of a carpet bombing. They’ll profile an area and say, this area is over-indexed for priority jugglers, and here’s the messaging, here’s the labeling, and here’s what we need to do to resonate here.

But with health systems, it is truly one to one. Once they are a member or patient client, it’s one to one, and we truly personalize it for each one. That’s a huge, huge upside and more productive.

I truly believe it is awareness. In none of the calls that I’ve been on in the past six months — and there have been a lot —  did the chief marketing or chief strategy officers not get it, not believe in it, or decide that “we’re good with what we’re doing.” It’s more of, this is really intriguing,. How would we operationalize this? How does this work with our CRM? How does it work with our EMR? There’s has been a lot of great commentary, feedback, and follow-on loops.

I would say it’s coming fast. We probably would have seen a bigger uptake last year but for the pandemic, but as hospitals get back to normal a little bit, it is all about treating the patient as if they have choices, which they do. Probably this year or maybe next year, people will be paying 50% out of pocket for their total healthcare costs. We’ve been talking about it for 10-15 years, but the patients will be in charge. They are starting to make decisions somewhat based on price, how they like doing business, and how they like the relationship. That has been evolving for a while, but it’s going to cross the 50% threshold here very soon, and patients will act like consumers. It’s coming and it’s going to come fast.

We’re seeing that increasing COVID-19 vaccine uptake isn’t a simple as informing people who are uninformed, so now we are trying to understand their beliefs and nudge them accordingly. Has that raised awareness that targeting patients who meet some criteria and hitting them with cookie-cutter messages probably won’t work?

That’s a great analogy. We surveyed 4,000 people with 400 questions around motivation for vaccination. We came out of that with a ton of data. It is coming to light right now that you can’t treat everybody the same. It’s not all about just being an anti-vaxxer. There are other motivations and other things you can point out, and it’s information. Some people need more information. Some need to have their clergy talk to them about it. It’s all starting to come out as we hit the wall. We predicted four months ago that we would hit the wall in June at about 65%. We were spot on. We had this great data built into the platform as how to basically get people who are close over the hump and off the fence.

We have been trying to get that data out there. The challenge is who ultimately is motivated and incentivized to get people who aren’t vaccinated to get vaccinated. Now it has become more of a public service. For health systems, it’s for the common good, but do they even have a relationship with people who aren’t vaccinated their community? Not always. Early on, employers were being hands off because it was a hot potato. It was hard for us, and it still is hard for us, to find a group that has the incentives to get behind this.

We are willing to share the data and share our insights on how we feel that you can move the needle on that. But that has been a challenge because there has been no ownership. The federal government is supportive of it, but other than making it free, there’s really not much else. To your comment, we are absolutely, definitely informed that you can’t treat everyone the same. You can’t have one billboard. That’s not going to resonate with all the groups.

What will the company’s strategy be over the next few years?

It’s about marketing awareness. We’ve tripled the go-to-market team, the sales team, in the first six months of the year. We’ll grow 100% this year, and I think we’ll continue that path. The really attractive piece for me coming in was that we have a somewhat “friends and family” board of directors. There’s really only one entity of professional money, which is First Trust, who has a legacy investment and is a great partner. The rest are family office and individual. It allows me to manage the company for growth and to see this thing through.

We have a huge runway ahead of us. I don’t have any investor pressure. There’s no timeline. We have enough of a platform, and it keeps growing weekly, that we can remain private and self-funded for eternity. Eventually we’ll come to a decision point in a couple of years about an IPO or something else, which is the natural evolution of an early-stage growth company, but the good piece for me was not having external pressure from traditional venture capital investors.

An HIT Moment With … Steve Shihadeh

An HIT Moment With … is a quick interview with someone we find interesting. Steve Shihadeh is founder of Get-to-Market Health of Malvern, PA.

What advice are you giving clients about participating in HIMSS21 and HIMSS22?

I am very hopeful that HIMSS22 will return to a more normal trade show to meet the pent-up demand on both the vendor and provider side. 

With all of the COVID churn, mask debates, and travel challenges, we are advising clients who want to go to HIMSS21 to be surgical about their investment. By this, I mean that they should have a narrow list of who they want to visit and what they want to accomplish and generally be in and out in a day or so to keep expenses to a minimum. 

I get the sense that vendors are being cautious about investing, and a quick look at signups bear that out. If vendor attendance is light, I would have to guess that provider participation will be down significantly as well.

How are companies changing their marketing strategy?

With in-person trade shows effectively non-existent since March 2020 — by the way, every client we have talked to has felt that the virtual shows were a bust — companies have adapted marketing significantly to keep their businesses vital.

A few clients have upped their webinar game with real thought leadership and way more nuanced selling than in the past.

I continue to be impressed by how much mileage our clients are getting out of social. They are making use of multiple channels and keeping it edgy and interesting. The really sophisticated companies are getting participation across their employee base, which is greatly amplifying their messaging.

We have participated with our clients in a number of focus groups, and while you don’t get the reach of large-scale events, you certainly get to go way deeper. It seems like picking the right attendees and having a solid structure to the events reaps the most reward.,

How has the sales process changed post-pandemic?

Value prop, value prop, value prop. With in-person meetings dramatically reduced in both number and time allowed on site, companies need to more than ever translate their bells and whistles into things that matter to the client. How exactly does it save money? How exactly does it positively impact clinical workflow and outcomes? How exactly does my taking a meeting with you help my organization dig out of this COVID hole?

What are the most important things you look at when asked to perform due diligence for a potential health IT investment or acquisition?

Value prop, value prop, value prop. Just kidding, but not really. Investors get this more than anyone and want to deeply understand a company’s storyline and associated ROI. Investors at different stages – seed, venture, growth equity, private equity, strategic — will have different expectations, but they all need to understand how you truly differentiate and how you truly help a provider with a key challenge.

What clues will the HIMSS21 exhibit hall provide about the direction of the health IT market and the companies in it?

The health tech market is coming back red hot, in my opinion. The pandemic has broken the status quo and providers are finding new ways to use technology and new problems it can solve. Hopefully HIMSS21, albeit with a lighter attendance than in the past, gives us a glimpse at how companies have responded to the many opportunities presented by the COVID crisis.