Completing the Puzzle: Where does Virtual Care Fit in Patient Expereience

Transcript

• 00:08Wonderful. Well,
• 00:08I'd like to welcome you all today.
• 00:10My name is Doctor Lee Schwam.
• 00:12I'm the Vice President of Digital
• 00:14Patient Experience here at the Mass
• 00:15General Brigham Health System in Boston,
• 00:17and I'm going to be today's moderator.
• 00:20This is our session on clinical
• 00:22appropriateness in virtual care.
• 00:24And again, thank you for your
• 00:25participation and interest in the session
• 00:27and thank you personally very much.
• 00:29To all the panelists who are an
• 00:31extraordinary group of leaders in
• 00:33the field who've joined us today,
• 00:35all the sessions will be recorded
• 00:37today and they'll be available
• 00:38after the symposium at
• 00:43www.virtualcareconsensus.com.
• 00:44Remember to use the Q&A
• 00:46function during the panels.
• 00:48Panelists will do their best to try
• 00:49to answer the questions, but if not,
• 00:51we'll post additional answers on
• 00:53the website after the session
• 00:55and if you have any difficulty
• 00:57technically during the session.
• 00:58You can either e-mail digital
• 01:01media at partners.org or call
• 01:04857-282-6470 and we can try to
• 01:06resolve the problem for you.
• 01:07So as you know, this is now an annual
• 01:10tradition and we bring together
• 01:12subject matter experts from across
• 01:14the country and across organizations.
• 01:16We did our first session in 2020,
• 01:19which really focused on rethinking
• 01:21curriculum competency and culture
• 01:23in virtual care in the context
• 01:25of the COVID-19 pandemic.
• 01:26We really focused on defining A
• 01:29framework for assessing competency
• 01:30for training our residents and a
• 01:32junior faculty in virtual care and
• 01:35also addressing the challenges along
• 01:37with the workflows and the strategies
• 01:40and the best practices around that.
• 01:42That work was published last year.
• 01:45And in 2021,
• 01:46our second symposium really shifted
• 01:48to focus on quality frameworks,
• 01:50how they've evolved over organizations
• 01:51and how we need to think about
• 01:54and align in person and virtual
• 01:56care quality frameworks.
• 01:58So that brings us to today and you know,
• 02:01virtual care is basically become
• 02:03a mainstay of healthcare now,
• 02:04from treating chronic conditions
• 02:06to more acute changes in health.
• 02:09Providers all across the country are
• 02:11using virtual care really across
• 02:12a wide variety of of indications.
• 02:14And I would say that we would
• 02:16all agree on this panel that in
• 02:18this modern digital world,
• 02:19health systems have to continuously
• 02:22evaluate what modality is right for what
• 02:25setting and how do we turn this into
• 02:27a conversation about appropriateness,
• 02:29appropriateness as it relates
• 02:31to clinical indications,
• 02:32payment models and breaking
• 02:34down the barriers that exist for
• 02:37patients both personal.
• 02:38Digital and the social
• 02:41determinants of health as well.
• 02:44So we'll also cover some of the
• 02:47complexities and the barriers
• 02:48around reimbursement and and how
• 02:51how challenging that can be for for
• 02:54patients sometimes for providers and
• 02:56health systems and and the patchwork
• 02:58that exists across the country.
• 03:00We're going to have five panels today and
• 03:03we'll walk through the sort of spectrum of.
• 03:08How virtual care fits within the big
• 03:11broad digital patient experience?
• 03:13How we can think about better job
• 03:15achieving digital HealthEquity?
• 03:17How to dismantle the silos between
• 03:19virtual care and mental health
• 03:21that currently exist,
• 03:22thinking about clinical appropriateness in
• 03:25individual patient care delivery models?
• 03:27And then lastly,
• 03:28what does it take to really achieve
• 03:30payment and coverage parity for
• 03:32virtual versus in person care?
• 03:34So let's go to the next slide.
• 03:39And again here, just a reminder,
• 03:41you can see where you can find the
• 03:42slides and how you can reach someone if
• 03:45you're having any difficulty. Next slide,
• 03:49I've talked to you before about the
• 03:51overview of the symposium and here's
• 03:52the reference to academic medicine,
• 03:54where our first symposium was
• 03:55published and our second one is
• 03:57under review at another journal.
• 03:58Next slide. And I just gave you
• 04:03the overview of today's symposium.
• 04:05And now let's pivot going to the next
• 04:07slide to talk about the first panel,
• 04:10panel one, which is going to be
• 04:12called completing the puzzle,
• 04:13where does virtual care fit
• 04:15in with patient experience?
• 04:16And take me to the next slide please.
• 04:19And one more.
• 04:20So here we are.
• 04:22And the next slide I believe
• 04:23we'll have our yes.
• 04:24So I am really delighted to be moderating
• 04:27this conversation with two of my.
• 04:29Colleagues,
• 04:29one I met recently and 1:00 I've
• 04:31known for quite some time,
• 04:32Sara Vaisi,
• 04:33someone I've known for quite
• 04:35some time who is the Executive
• 04:36Vice President and Chief
• 04:37Strategy and Digital Officer for
• 04:39Providence Saint Joe's Healthcare.
• 04:42This health system is a really
• 04:45remarkable health system,
• 04:46I think more than 50 hospitals,
• 04:471000 clinics, 5,000,000 patients.
• 04:49Sara has really deep experience
• 04:52in developing and leading system
• 04:54strategy and thinking about.
• 04:56How to fit together all of this cross
• 05:00collaboration between a different orgs
• 05:02within a large corporate structure
• 05:04and drive digital innovation forward.
• 05:07I'm joined as well by Alex Morehouse,
• 05:10who is Chief Marketing Officer and
• 05:12Chief Digital Officer for Banner
• 05:14House where she's been since
• 05:162015 and has basically overseen,
• 05:18believe it or not,
• 05:20a half a billion dollar transformation
• 05:23of digital initiatives.
• 05:25That have increased customer
• 05:28experience transactions taking
• 05:30digital transaction volume up from
• 05:323,000,000 to over I think 200,000,000
• 05:34a year and has implemented an A,
• 05:38I and machine learning platform
• 05:39for for customer experience.
• 05:41She's had numerous years of experience
• 05:43in and outside of healthcare and
• 05:46and major American corporations.
• 05:49So I I really,
• 05:50I couldn't speak more highly of this group.
• 05:53And so let's flip to the next slide.
• 05:56And these are the objectives
• 05:57that we're going to talk about,
• 05:59the three of us as we go through
• 06:02this moderated session.
• 06:03But before we do that and dive
• 06:05into these questions,
• 06:06which I'll bring up again at the end,
• 06:07I'm just going to run through a
• 06:09quick set of slides to sort of
• 06:10level set us for the conversation.
• 06:11So next slide,
• 06:13So what is virtual care as opposed
• 06:16to telehealth, telemedicine,
• 06:17a lot of these terms are synonymous,
• 06:19but virtual care has come to.
• 06:22Embody really the broad array of
• 06:25of virtual direct to patient and
• 06:28provider to provider care that
• 06:31is blossoming under the COVID
• 06:33experience Next slide.
• 06:35And so this is a an article that
• 06:37I was editorial I wrote in Health
• 06:39Affairs almost a decade ago that
• 06:41was really talking about back then
• 06:44this upcoming disruptive innovation
• 06:45and transformation of healthcare
• 06:48that that telehealth which was
• 06:49the term we used at the time.
• 06:51You know,
• 06:51ought to adhere to if we were going
• 06:53to get real value out of this.
• 06:55And I would just highlight a few things,
• 06:56untethering traditional revenue
• 06:58expectations for this work.
• 07:01After COVID,
• 07:02we're going to have to be thinking
• 07:03about that again quite carefully,
• 07:04really understanding expectations,
• 07:06deconstructing the healthcare
• 07:07encounter and building it up again
• 07:10with the component parts and
• 07:11really being open to discovery,
• 07:13something that I think my 2 panelists
• 07:15have have really done an amazing job at,
• 07:18and redesigning care to improve value.
• 07:21Which is really important.
• 07:23Next slide,
• 07:24so this is a slide from Craig Clay
• 07:27Christiansen's work talking about
• 07:29the nature of disruptive innovation.
• 07:31And I think what we need to remember
• 07:33is that we've built systems that have
• 07:36performance sometimes in some cases
• 07:38that are more than customers can
• 07:40really use or access quite frankly.
• 07:42And disruption generally comes
• 07:44from innovators who start off
• 07:46offering services that are.
• 07:48Non competitive,
• 07:49they're not services that the that the
• 07:51established company in blue wants to offer.
• 07:53They're they're low margin,
• 07:55they're low yield,
• 07:56they're viewed as inconsequential.
• 07:58You might think of virtual
• 07:59urgent care in that bucket.
• 08:01But those organizations grow
• 08:03in competency and skill.
• 08:04They learned quickly and before
• 08:06long they dethrone the the,
• 08:09the existing champion and I think
• 08:10we're at that moment in healthcare.
• 08:12We really have to think carefully
• 08:14about what we're providing and
• 08:15what our risk is of disruption.
• 08:17Next slide.
• 08:17You might say that face to face
• 08:20evaluation and what I call pixel to
• 08:22pixel evaluation reflect that that
• 08:24transition zone and and so we really
• 08:26need to think about how to embrace
• 08:28this or risk being dethroned by it.
• 08:29Next slide,
• 08:32this is just a example from a
• 08:34paper we published from our own
• 08:35experience showing you that looking
• 08:37at the traditional adoption curve.
• 08:3995% of our providers adopted virtual
• 08:41care within six weeks of the start
• 08:43of the pandemic and once they adopted
• 08:45they largely continued it indefinitely.
• 08:47And so this is not your typical
• 08:50innovation adoption curve,
• 08:51this is an exponential adoption curve
• 08:53and I think we've we're likely to
• 08:55see more of that in the near future.
• 08:59Next slide,
• 09:00so I love this slide OO which is old
• 09:05organization plus new technology
• 09:07equals expensive old organization.
• 09:09So we better be really careful.
• 09:10We don't throw a lot of technology onto
• 09:12an old governance model and expect miracles.
• 09:15Next slide,
• 09:15I'll just let you know that percolate
• 09:17in your minds.
• 09:18So our own experience here at Mass
• 09:20General Brigham has been to start
• 09:22looking at all of our different
• 09:24platforms and start collapsing them into
• 09:26a single digital front door for care,
• 09:28so that our patients have a more seamless
• 09:30experience whether they're in patients.
• 09:32Ambulatory in a doctor's office in
• 09:34their home wearing a remote monitor.
• 09:36We've got to make it simpler for people.
• 09:38Next slide.
• 09:42And this is just a metaphor I've used before.
• 09:44The digital mall, right?
• 09:45This is really inspired by work
• 09:47from people like Sara and others
• 09:49who've really been thinking about
• 09:51consumer engagement platforms.
• 09:52But if we lock ourselves into identity
• 09:55only through the epic My Chart feature.
• 09:58Where people have to be fully identified
• 10:00and bonded before they can have
• 10:01any digital interactions with us,
• 10:02we're going to be dramatically
• 10:04limiting the kinds of services
• 10:05we can provide and the kind of
• 10:07personalization that people are,
• 10:08are looking for.
• 10:09So we've got to build a mall around our EHR.
• 10:12We've got to really build a mall
• 10:15that's designed explicitly for an
• 10:16exquisite patient experience and it
• 10:18has to be accessible to everyone
• 10:20with all types of limitations,
• 10:22be they physical,
• 10:24cognitive or other forms of disability.
• 10:27Or whether they be limitations in
• 10:29digital literacy or or you know,
• 10:32English proficiency next time.
• 10:35So the more we know about you,
• 10:37the bigger that door is going to be.
• 10:38So if we don't know anything about you
• 10:40and you're just an anonymous browser,
• 10:41you're not going to see very much.
• 10:43The more we know about you,
• 10:44the more we can offer you.
• 10:45And when you're fully identified,
• 10:47that digital front door is wide open.
• 10:49So part of what I'm going to be asking Alex
• 10:51and sorry to think about is how do we,
• 10:52how do we figure out how to make that door
• 10:54as open as possible as early as possible.
• 10:56Next slide.
• 10:58So that brings us back to our
• 11:01panel objectives and maybe I'll ask
• 11:03Collaborative Media to just take the
• 11:05slides down and bring us up on screen.
• 11:07And so I think what I'll do
• 11:10is I'll start by asking Alex,
• 11:12spend a minute just talking to us about
• 11:16like where do you see us headed post
• 11:18Pandemic with virtual care delivery?
• 11:20Is it going to be here forever?
• 11:21Is it a, is it a, you know, passing fad?
• 11:24But we even recognize it five years from now.
• 11:27What are your thoughts Just
• 11:27sort of kick us off?
• 11:30Great question. Nobody knows.
• 11:31But I think we can go back to nursery rhymes,
• 11:34which is we're trying to put Humpty Dumpty
• 11:36back together again because everybody,
• 11:38including all healthcare consumers,
• 11:39sort of scattered to the winds.
• 11:41All of us have personally changed our
• 11:44habits and all the way from just staying
• 11:46out to engaging in very different ways.
• 11:49And so cost of entry is really different.
• 11:52And we're trying to get
• 11:53people in on their terms.
• 11:54So we have to make it easy
• 11:56to find a doctor digitally,
• 11:57to schedule a doctor digitally,
• 11:59and then give small,
• 12:01medium and large choices for how to engage.
• 12:03Do you want a chat bot?
• 12:04That'll just be a symptom checker.
• 12:06Do you want to call a nurse hotline?
• 12:07Do you want a virtual visit?
• 12:09Do you actually want to come into clinic?
• 12:11Do you just want to go to urgent care?
• 12:12So I I think that's here to stay.
• 12:14I don't think we.
• 12:15Know where it's going yet because
• 12:17none of us as individuals know as
• 12:19patients and you as a physician we
• 12:21don't know where this is going but
• 12:23we know that it is it is in play.
• 12:25So we we are literally playing 52
• 12:28card pick up here and and it's
• 12:30going to be in flux for a while.
• 12:33Awesome Sarah opening thoughts
• 12:36you know I think Alex hit on a lot of
• 12:39the the elements which is that it'll be.
• 12:43You know, your example of a mall,
• 12:45actually let me just start.
• 12:46There is an interesting 1 Lee because
• 12:49in many ways it's, it is like a mall.
• 12:52Even malls don't have a single front door,
• 12:54right. And and so the door,
• 12:57like there's a main door that goes
• 12:59into Nordstrom, there's a mall,
• 13:01a door that goes into the store itself
• 13:04or into like the kind of main main
• 13:07thoroughfare where all the store,
• 13:09other stores connect.
• 13:10And so I think that's how it's going to.
• 13:13Be right, Alex hit on it.
• 13:15It's fragmented.
• 13:16It's kind of decentralized and there are
• 13:18they're going to be kind of tech enabled,
• 13:21digitally enabled mechanisms that connected.
• 13:23We know that and there will be different
• 13:26types of stores that are there, right.
• 13:29We also know that,
• 13:31but how they interplay,
• 13:32how information is shared across them,
• 13:34what the overall experience is,
• 13:36is it a really high end mall,
• 13:38like what kind of stores are in there,
• 13:40How does it, what's the look and feel,
• 13:42what kind of how much do you have to pay?
• 13:46You know, like all of those kinds of details
• 13:49I think are still going to be worked out.
• 13:52So I think we can agree on a few things
• 13:53like there will be different stores,
• 13:55so in our nomenclature it will be multimodal.
• 13:58It will have a variety of
• 14:00different ways to be accessed.
• 14:02There isn't going to be a single door.
• 14:04Google will have part of the door.
• 14:06We'll all own a part of our own door and.
• 14:10And it will be,
• 14:11I think to your point authenticated,
• 14:13right.
• 14:13It has to have an element
• 14:15of knowing who we are,
• 14:16whether it's fully authenticated with
• 14:18like a full on digital identity or
• 14:22authenticated sort of in a more anonymous
• 14:25way like just through cookies and I P
• 14:27addresses and those kinds of things.
• 14:29So I think you know to to Alex's point,
• 14:32we don't know exactly what
• 14:33it's going to look like,
• 14:33but certain elements will definitely be true.
• 14:37Yeah, I mean it's interesting you
• 14:39as you extend the metaphor, well,
• 14:41first of all, the pop up shops in the
• 14:43middle of the mall might come and go,
• 14:46but in fact the mall might look
• 14:48very different for Sarah when
• 14:49she enters and it does for Lee
• 14:51because with hyper personalization,
• 14:53especially based on the level of
• 14:55authentication you've offered
• 14:56at the time of your visit,
• 14:58the mall might, you know,
• 14:59really look different to you.
• 15:00And and maybe for me,
• 15:01Nordstrom's is tiny and Best Buy is big
• 15:03and maybe for you it's the opposite.
• 15:05So I I think.
• 15:06What we're what we're trying
• 15:08to lay the tracks for,
• 15:09which I agree with Alex
• 15:11just doesn't exist yet,
• 15:12is can we create a digital
• 15:15experience for patients that feels
• 15:18as concrete as walking into a mall,
• 15:21looking at the little billboard
• 15:22that tells you where all the stores
• 15:24are and navigating your way around?
• 15:27Or are we going to not be able
• 15:29to achieve that and and it'll
• 15:32feel either more generic.
• 15:33Or more confusing because right now it's
• 15:35I I think we all agree it's awfully
• 15:38confusing for patients and providers.
• 15:40And so my my hunch is it's,
• 15:42you know, the,
• 15:43the car I drive today looks
• 15:46somewhat like the Model T Ford,
• 15:48but only on the outside.
• 15:49On the inside,
• 15:50it's a completely different vehicle, right.
• 15:52And it's a,
• 15:53it's a computer with with
• 15:55an engine and wheels.
• 15:56I have a feeling that's the,
• 15:58that's the right metaphor for this.
• 15:59The next wave is going to look.
• 16:01Familiar someone on the outside,
• 16:04but what powers it underneath,
• 16:06I think is a lot of foundational
• 16:08work that needs to be done.
• 16:10Do you think,
• 16:11Sarah,
• 16:12that will recognize five years from
• 16:14now that people will still recognize
• 16:16a virtual visit from what it looks
• 16:18like today or do you think it's
• 16:20going to be radically different?
• 16:25That's a it's a I go back
• 16:28and forth on this one.
• 16:29Partly because in some ways,
• 16:33in order to make an effective
• 16:36digital transformation,
• 16:39we're not trying to teach
• 16:42folks new things necessarily.
• 16:44We're trying to ride alongside
• 16:46intuitive ways of doing things
• 16:48that folks have gotten used to in
• 16:50other parts of their lives, right.
• 16:53And and so.
• 16:57I don't know, I don't know
• 16:58what the answer to that is.
• 16:59I think we're not trying to retrain
• 17:02individuals to engage with providers
• 17:04necessarily in a completely different way,
• 17:07but but we are trying to arm folks with
• 17:10tools that make it more accessible,
• 17:13more sort of navigated and with
• 17:17information that they need.
• 17:20To to get the job done right,
• 17:22whatever that job is.
• 17:24And so you know,
• 17:26I think it's it's probably the experience
• 17:29in advance of a visit is going to
• 17:31look very different similar to like.
• 17:34You know when you in the early days,
• 17:36you know the difference between the
• 17:38cab and the Uber is the experience
• 17:40before you then still ride in a
• 17:42vehicle that other people have ridden
• 17:43in and you get to your destination.
• 17:46But the the way by which you
• 17:48access the service,
• 17:49knowing you know where the car is,
• 17:52how far it is from you,
• 17:54how it's heading towards you,
• 17:55how you've paid, you know,
• 17:56all of those types of things are where
• 17:58it's really going to look different.
• 18:00And so I think that's the place,
• 18:01those are the places where it
• 18:03may be unrecognizable.
• 18:04But then getting to the essence
• 18:06of the actual virtual delivery,
• 18:07I think the delivery is likely going to
• 18:10look similar to what we experienced today.
• 18:14Yeah. What what do you think Alex,
• 18:15I was I was struck by some of our
• 18:17previous conversations and the when
• 18:18we think when we think you know
• 18:20sort of strictly US and and you
• 18:22know kind of higher margin markets,
• 18:23I tend to agree with you Sarah.
• 18:25But I wonder about India, China,
• 18:27other parts of the rural parts
• 18:29of the country where there are
• 18:31no providers are we going to see?
• 18:33A virtual visit with a chat bot
• 18:35or with an avatar or you know,
• 18:36are we going to start leveraging
• 18:39a I as better than nothing as
• 18:41opposed to compared to you know,
• 18:43seeing an expert at one of
• 18:45our academic health systems.
• 18:46What do you think Alex?
• 18:48Do you think that we're going to
• 18:51see massive delivery of healthcare
• 18:54at scale with non human elements
• 18:57simply because of the unaffordable
• 18:59nature of of delivering,
• 19:01you know,
• 19:01person to person virtual care?
• 19:06Thinking, thinking,
• 19:07thinking and it's interesting.
• 19:09So first, first of all,
• 19:10if you don't have an Internet connection,
• 19:12if you're in a deeply rural part of India,
• 19:14that it's not even an option.
• 19:15And I'm also thinking
• 19:17because my family's in Asia,
• 19:18I grew up in Asia and it's
• 19:21very different model there.
• 19:24And if you have national nationalized health,
• 19:26they of course have the incentive
• 19:28to deliver it that way.
• 19:29I thought I spent most of my career
• 19:32in financial services and I think it's
• 19:34going to have to be anchored in the one
• 19:37and leveraged by the other and by that.
• 19:39So I was at Schwab when when
• 19:42online trading commenced and you.
• 19:44Only earn the right for online
• 19:46digital access if you have the
• 19:48ability to pull the rip card.
• 19:50So rip for it and you know that Joe's
• 19:52my broker doors in that corner office.
• 19:54If something goes seriously sideways,
• 19:56I can go down and talk to Joe once I
• 19:58know that I I have my and in this case
• 20:00it would be I have my like with a physician.
• 20:05Then I'm totally so during the
• 20:06pandemic is a good example.
• 20:08So I knew my position I was perfectly
• 20:11comfortable using the portal for
• 20:13questions using you know virtual
• 20:14visits but I needed that anchor.
• 20:17So I think you're going to have
• 20:19to you always need the anchor and
• 20:21then what we're essentially trying
• 20:23to do is leverage we we have.
• 20:25Not enough anchors,
• 20:26meaning not enough physicians and
• 20:28providers and too many patients.
• 20:29So the only way we're going to get there
• 20:31is by scaling all the wraparound part.
• 20:33So I think it's going to be that
• 20:35combination of the the anchor
• 20:36is going to be the physician is
• 20:38going to be that primary provider
• 20:39and then we just need to leverage
• 20:41the heck out of that with these
• 20:43ancillary digital access mechanisms.
• 20:45That's great.
• 20:46That's that's really well said.
• 20:48So let me let me pivot us to sort
• 20:50of Section 2 now with that comment.
• 20:54Do you think that?
• 20:55Do you think that we hit a watershed
• 20:57moment with the rapid adoption
• 20:59of virtual visits during COVID?
• 21:01That is really fundamentally change
• 21:03the adoption barrier to this concept
• 21:05of consumerism in healthcare,
• 21:07which I would have to say has
• 21:09been talked about in meetings
• 21:11that I've been at for the last
• 21:1210 years with almost 0 traction,
• 21:14except in some of our disruptor competitors.
• 21:17You know, the Minute Clinics,
• 21:19Walmart Health, you know, CVS,
• 21:21Amazon, that kind of thing.
• 21:22Do you think that that this is
• 21:24going to be a turning point around
• 21:26consumerism and healthcare or do you
• 21:27think that the medical side of that equation,
• 21:31it is still not,
• 21:32still not ready for consumerism?
• 21:36What do you think, Alex? Yeah,
• 21:37sure. Alex, take that one. So I.
• 21:41So I would say that it's
• 21:45interesting because for for.
• 21:48Much of the conversations
• 21:49that I'm participating in,
• 21:50it's like did televisits get to a
• 21:53tipping point and we're not going back.
• 21:56What we observed and be curious what
• 22:01you Lee and you Sarah have experienced
• 22:03is that we saw a 300% increase in
• 22:06portal enrollments and people who.
• 22:09Would normally call, make an appointment,
• 22:12get their car, drive in.
• 22:13It's sort of the equivalent
• 22:14of when it was the last time.
• 22:16Think think about when you had to,
• 22:17like, drive in to a bank to deposit it.
• 22:20I mean, that just seems hopelessly outdated.
• 22:22Once you got comfortable with your
• 22:24financial institution taking a picture,
• 22:26you know, emailing the image in.
• 22:30I I think it's that was the the
• 22:33tipping point for us once we got
• 22:35that many people enrolled a massive
• 22:37inclusion in the portal and whether
• 22:39or not they use the portal per se,
• 22:42they we had a huge increase
• 22:44in people who said oh.
• 22:47I have another way of contacting
• 22:48my provider or my health system
• 22:50other than making an appointment,
• 22:52get my car and driving in.
• 22:54And by the way,
• 22:54I don't want to drive in anymore.
• 22:56And I think that was the tipping point.
• 22:59And people that's the that's the
• 23:01the connection that's been made.
• 23:02How it will be continued and
• 23:04leveraged I don't think anyone knows,
• 23:06but I think everybody and who to myself,
• 23:08I I didn't go.
• 23:08I'm working healthcare and I
• 23:10didn't go once in three years.
• 23:11I had virtual visits and you know
• 23:13I messaged through the portal.
• 23:14I don't particularly want to go back in,
• 23:16you know if I break my leg
• 23:18that's something else.
• 23:18But I that has been the the biggest
• 23:22tipping point for our our patients
• 23:24is well there's another way to make
• 23:28contact outside of bricks and mortar.
• 23:32Sarah, I see you nodding your head
• 23:35vigorously. Give us your thoughts
• 23:37first. I really like the way that Alex.
• 23:40It separates, you know, kind of stratifies.
• 23:43How do you engage from a portal or or
• 23:47other engagement sort of channel and
• 23:50vehicle perspective relative to actual.
• 23:54Telehealth or virtual visits,
• 23:55So I do think those are different
• 23:58and we we saw an increase in both.
• 24:01We've seen sort of a sustained and growing
• 24:04engagement with our app for instance.
• 24:07That's one of the big channels where
• 24:09we drive engagement both in terms
• 24:11of registrations and engagement.
• 24:13I should say that has continued to grow
• 24:15on the actual delivery side of things.
• 24:18With respect to virtual care,
• 24:21that spiked and now has gone down.
• 24:24For a number of different reasons,
• 24:26bad provider experience,
• 24:28bad patient experience,
• 24:31a lot more friction in terms of
• 24:33logging in and having the right,
• 24:36you know,
• 24:36like it just added layers because
• 24:38we took this very,
• 24:39I would say substitutive model like
• 24:41just swap out a visit that was in
• 24:44person where you get all this context
• 24:46and you know like a much closer
• 24:48connection for something that is more
• 24:50removed without a whole lot of added.
• 24:53Benefit including like the payment model
• 24:56frankly isn't really supportive of it and
• 24:58there's all sorts of other shortfalls.
• 25:00So.
• 25:00So I think ultimately what
• 25:04it comes down to is,
• 25:06is there an actual improvement
• 25:08in the experience or not and our
• 25:11answer definitively was not.
• 25:13And so while there was a pickup from an
• 25:16education and sort of awareness perspective,
• 25:19that doesn't last forever,
• 25:21right.
• 25:21The experience actually has to
• 25:24improve and and so you know,
• 25:26we're working on some of those things,
• 25:27but I I think that's going to
• 25:30be the determiner of whether
• 25:32this has longevity or not.
• 25:34I was talking with another health
• 25:35system and they actually said,
• 25:36you know our patients actually
• 25:38prefer to interact with us.
• 25:40Either via phone or in person.
• 25:43And I said,
• 25:44well,
• 25:44did you make changes to your
• 25:46processes when you layered on
• 25:48technology or lead to your slide,
• 25:50which is, you know, old?
• 25:53Old incumbent company layer on technology,
• 25:56now you just have old incumbent company with
• 25:58it that's more expensive with technology.
• 26:00But you didn't change any of
• 26:02the underlying processes, right?
• 26:03That's ultimately what happens,
• 26:04right.
• 26:05So they we get like false signal to noise
• 26:07around those kinds of things that we think,
• 26:09oh, people don't really want
• 26:11to engage in technology.
• 26:12Oh,
• 26:12we haven't really overcome the barriers.
• 26:15In terms of driving adoption among users
• 26:17and the fact is we kind of haven't,
• 26:20not because they don't like it or because
• 26:22technology doesn't do the right thing.
• 26:24It's because we didn't change the
• 26:25underlying thing and that's what I
• 26:27think we're seeing and governance,
• 26:29you know, operations,
• 26:31clinical,
• 26:31workflow etcetera,
• 26:32those are the big things that are going
• 26:34to influence that and then payment
• 26:36of course. Yeah, we have a whole
• 26:37session about that at the end of today's
• 26:39symposium that I'm really excited about.
• 26:41You know, you, you triggered a couple
• 26:42of thoughts of me as you both made
• 26:44those really insightful comments.
• 26:45The first one is, you know,
• 26:47we're in the middle of this transition from
• 26:49a production economy to a service economy.
• 26:51You know, people don't want to own cars.
• 26:52They want to, you know,
• 26:53they want to leverage transportation
• 26:54when they need it, the banking,
• 26:56music, you know, you name it.
• 26:59And I think we're still.
• 27:01Mostly a production economy,
• 27:03we're producing visits or repairing hips
• 27:05or you know for dispensing prescriptions,
• 27:08I think hospital at home and remote
• 27:10monitoring and the portal engagement is
• 27:12starting to transition that into more
• 27:15of a like we're here when you need us,
• 27:17not we are here when it's convenient for us.
• 27:20But I would say that you know
• 27:21one of the fallouts for us,
• 27:22we also had massive uptake
• 27:24in our portal adoption.
• 27:25We're now like one of the leading
• 27:27I think health systems in Epic
• 27:29in terms of portal uptake.
• 27:30But that's led to an in basket swarm, right.
• 27:33The volume of communication that's
• 27:35coming through is just so much greater
• 27:38and is really challenging to manage.
• 27:41And you know unlike phone calls
• 27:42where people will just hang up
• 27:44sometimes if they get the,
• 27:46you know the message that there's
• 27:48voicemail for the practice,
• 27:49nothing stops them from uploading
• 27:50their in basket message.
• 27:51So I I do think that it is
• 27:53highlighting a challenge that we have.
• 27:55It's part of the reason why I talked about,
• 27:56you know the bots and the.
• 27:58Other mechanisms of thinking about
• 28:00can we can we also start to promote
• 28:02more of a self-service kind of
• 28:04functionality or at least shift to
• 28:06a different skilled level provider
• 28:08to to help address some of this
• 28:11other thing you reminded me of.
• 28:12Sorry with your comments about
• 28:15substitutive is well first of all
• 28:17I'm old enough Alex to remember
• 28:18when you had to go to the bank with
• 28:20your passbook to get money out and
• 28:21I think many of our listeners don't
• 28:23even know what I'm talking about but
• 28:24you literally had to bring like a
• 28:25passport with you and the teller like.
• 28:27Did like minus 50 and then gave
• 28:29you $50.00 and then handed your
• 28:31book back with your balance, right.
• 28:33So we're a long way from that,
• 28:34but I remember the first digital watches,
• 28:36they were just analog watches
• 28:38that were digitized, right.
• 28:39There was number new functionality,
• 28:40it was just a digitization.
• 28:43I think that's largely what
• 28:44we've done in round one.
• 28:45We digitized the in person visit and
• 28:47made it available in much the same
• 28:49way but without a lot of the high
• 28:52touch components that wrap around it.
• 28:53And it was a pretty good trade off
• 28:55against the risk of dying from COVID
• 28:57on your way to the doctor's office
• 28:58and spending a lot of money and gas
• 29:00getting to and from the doctor's office.
• 29:02But we're going to have to do better
• 29:04if we want to stay innovative.
• 29:07And I think we're going to have
• 29:09to figure out what are the parts
• 29:11that are best served by virtual,
• 29:13what are the parts that are
• 29:14best served in person?
• 29:15Can we can, we can We even jigger
• 29:17around the the in person pieces so
• 29:19that everything you can get done
• 29:21before the visit is already done.
• 29:24So your visit is really high
• 29:25value when you're sitting there in
• 29:27front of in front of the provider.
• 29:30But it raises the question,
• 29:31is digital access to care or digital
• 29:33care actually what patients are
• 29:35longing for or are they longing for a
• 29:38digital patient experience that starts
• 29:40to feel more in line with the other
• 29:42digital experiences they have as consumers?
• 29:45So let me now flip us to kind of
• 29:47the next segment and the final
• 29:49segment that we'll spend our time on,
• 29:51which is like.
• 29:52What does it mean to redefine
• 29:54digital patient experience Or as
• 29:55Alex said to me the other day,
• 29:57define it right?
• 29:58Because for many organizations,
• 29:59they they haven't even defined what it is yet
• 30:02rather than even never mind redefining it.
• 30:04So what's the right path forward
• 30:06for crafting this responsive,
• 30:09desirable, maybe, God forbid,
• 30:12joyful digital patient experience?
• 30:14And where is it going to come from?
• 30:16Is it going to come from health systems?
• 30:18Is it going to come from disruptors?
• 30:20Is it going to come from payers?
• 30:21Is it going to come from someone
• 30:23we haven't even thought about yet,
• 30:25NASA, you know, or I don't know,
• 30:28Tesla, you know,
• 30:29Is it going to come from
• 30:30some from some other place?
• 30:32And is it going to resemble
• 30:34more what it came from?
• 30:37You know, like, you know,
• 30:40like Neanderthal,
• 30:40you know,
• 30:41is it going to look more like
• 30:44medicine and with a little digital?
• 30:46Surface around it or is it going to
• 30:48look a lot more like shopping on Amazon
• 30:50but where what you're buying and
• 30:52selling and and moving around our our,
• 30:54our medical experiences,
• 30:56big topic.
• 30:58So sorry,
• 30:58why don't you take this one first.
• 31:02It is a big topic,
• 31:04lots of directions we could go with it.
• 31:05So I'm kind of thinking you know,
• 31:08I I do think fundamentally.
• 31:11There are some differences in in
• 31:13healthcare that you know we've
• 31:15got this like 2 by two kind of
• 31:17flywheel or we've got a two by two
• 31:19that we use to kind of think about
• 31:22the digital patient experience.
• 31:23But I would just say the experience right,
• 31:25the consumer experience in general
• 31:28in some industries you've got the
• 31:31margin structure to support high
• 31:34marketing spend so that you can be top
• 31:37of mind and in some you have lower.
• 31:40Margin structure and and we happen
• 31:42to be in that on that axis,
• 31:44that part of the axis right we we have
• 31:47very low if not negative especially if
• 31:49we look at the last year or so margins.
• 31:52And then there is sort of frequency
• 31:55of interaction with the user.
• 31:58Some industries have very
• 31:59high frequency of interaction.
• 32:01Starbucks,
• 32:02you know like those kinds of things,
• 32:03you go every single day.
• 32:05It's a low cost product and it's also
• 32:07just something that you get hooked on
• 32:09And so you're there every single day.
• 32:11There's some that are much lower.
• 32:14Frequency,
• 32:14because you only purchase them once
• 32:16in a in a while, right.
• 32:17There's like property casualty
• 32:18insurance is an example, right.
• 32:20We happen to be in both low ability
• 32:22to spend against marketing and low
• 32:25frequency of interaction in terms of
• 32:28our core business and what we call that
• 32:30internally is like the disruption zone.
• 32:33Now,
• 32:34because that means every single time
• 32:36you want to acquire a customer,
• 32:38you got to pay pay a ton of money
• 32:39if you want to reacquire them.
• 32:41You're basically paying the same amount
• 32:42that you would have if you were trying
• 32:43to acquire them for the first time,
• 32:45because they haven't seen you in so long
• 32:47anyway and and you don't really have.
• 32:51Though that many reasons outside of
• 32:54historically like the kind of the
• 32:56clinical interaction to have more
• 32:58frequent interactions with them
• 33:00anyway because you've been saying oh,
• 33:02you know either you came in for a
• 33:03surgery like something more high acuity,
• 33:05acuity or like how often can you tell
• 33:07people come in for your preventive care,
• 33:09come in for your preventive care,
• 33:11you know, it's like primary type stuff.
• 33:13So,
• 33:13so we're in this disruption zone and I
• 33:17think the role of digital is to move up.
• 33:20Kind of into that.
• 33:21You're never going to be able to
• 33:23spend that much more on marketing,
• 33:24but you are going to be able to
• 33:26create a personalized based on
• 33:28an authenticated experience,
• 33:30create a personalized experience
• 33:32that at least gets better.
• 33:35In terms of how frequently you
• 33:36interact with the individual,
• 33:38because you can not only anchor in the
• 33:40clinical, but also in nonclinical,
• 33:42but relevant products and services.
• 33:45And I think ultimately like at
• 33:46the highest level,
• 33:47that's what digital experience
• 33:48is trying to do.
• 33:49It's trying to create that
• 33:52authenticated personalized experience,
• 33:54hopefully a better one that's not just a
• 33:56veneer on top of a whole bunch of terrible,
• 33:59you know, antiquated processes and.
• 34:03And and do so in a way that's you
• 34:05know more affordable both for the
• 34:07system as well As for the user and
• 34:09provide access to you know new business
• 34:12models and those kinds of things.
• 34:13I think that's the goal.
• 34:15Now the question that you,
• 34:16the second part of the question
• 34:17that you asked is like where do we
• 34:20think that's going to come from?
• 34:21I, you know,
• 34:22and this might be an unpopular opinion,
• 34:24I think that we hate on incumbents a lot,
• 34:27right?
• 34:28Like everybody kind of talks about how
• 34:30slow we are and how old school we are,
• 34:32and we can't move that quickly and the
• 34:35disruptors are going to eat our lunch.
• 34:37And you know,
• 34:38and with things like Village Village,
• 34:41MD acquiring Summit,
• 34:42like all of the hype around the
• 34:44disruptive space just gets more and more.
• 34:47The fact is we're the only
• 34:48ones that have gotten to scale.
• 34:50And that we deliver the lion's
• 34:52share of care today and have
• 34:54the greatest breadth of services
• 34:56and the closest relationships,
• 34:58often with the largest number of patients.
• 35:01Now not consumers but patients.
• 35:03And so I think that there's
• 35:05a lot of value there.
• 35:06However,
• 35:07we're not going to be able to
• 35:09do it alone and I think the.
• 35:11There is a lot to be said for how
• 35:13we can partner both on the products
• 35:15and services side as well as on the
• 35:17technology chassis side to accomplish it.
• 35:19But I do think that it will come,
• 35:21it has to come somewhat from the IT
• 35:23has to and it will come somewhat from
• 35:26the incumbent care delivery organizations.
• 35:29I'm just given our relationship that
• 35:31we can leverage with with our users,
• 35:35well lots of really lot of meat.
• 35:38On those bones, Sara particularly,
• 35:41although unspoken,
• 35:42I think the issue of trust.
• 35:44We own the patient's trust.
• 35:46And in that regard,
• 35:48in some ways our lack of embrace of the
• 35:51modern marketing technology may have
• 35:53protected us in some ways from from,
• 35:55you know, being viewed as yet
• 35:57another organization trying to,
• 36:00you know, influence their behavior
• 36:02towards spend in our direction.
• 36:04I I do also think that there's.
• 36:07There's a really important concept
• 36:10here around pivoting away from episodic
• 36:13illness relationship to more of a health,
• 36:16Wellness or performance orientated,
• 36:19you know, experience so that patients
• 36:23come to us as a companion like that.
• 36:27The engagement platform becomes a
• 36:29place that people like to check in,
• 36:31see what's new.
• 36:31It's part of their news feed, right.
• 36:33We become part of their life.
• 36:35I do think that that's.
• 36:37A space that we,
• 36:38we probably want to try to think
• 36:40about entering and I love your,
• 36:42I love your your framing of the
• 36:45disruption zone as this space where
• 36:48you don't you they're not your customer
• 36:50for very long and once they leave you
• 36:52they're vulnerable to being picked off.
• 36:54And we have a low margin business
• 36:56and I would also argue we
• 36:57have an unpredictable margin.
• 36:58If I put out a a big advertisement
• 37:00to come to my hospital who knows
• 37:02what I'll get because I don't get
• 37:04to set the terms of the pricing.
• 37:06And so that makes the results of
• 37:09marketing very, very challenging.
• 37:10Alex,
• 37:11you've been in the marketing business
• 37:13for a long time and you've been
• 37:16thinking a lot about this and you
• 37:18committed together with your leadership
• 37:20a pretty substantial amount of capital,
• 37:21the cost of building a new building basically
• 37:24to build out this new digital platform.
• 37:26So talk to us a little bit about how you're,
• 37:30how you're convincing your
• 37:32organization that this digital path.
• 37:35Forward actually is the right way.
• 37:37It's better to build this
• 37:38than a new building.
• 37:40Talk to us about that journey a
• 37:41little bit and where you see the
• 37:43digital patient experience leading to,
• 37:44to bring value.
• 37:47Sure. I think so it started at the board
• 37:49level to get that kind of funding and I think
• 37:52about the journey a little bit differently.
• 37:55I don't think of it as digital versus analog.
• 37:58I think of it and and you both touch
• 38:01on this moving from transactional
• 38:03to relationship based.
• 38:04And it was exactly as you said, like coming.
• 38:07You get a flu shot, you leave,
• 38:08you get your hip, you leave, have your,
• 38:10well, woman visit, you leave.
• 38:12That's very different than a
• 38:14relationship built over time.
• 38:15And that's what all of us as
• 38:18consumers are looking for.
• 38:20It was I I think Banner got there
• 38:23because they realized with high
• 38:25deductible health plans,
• 38:26people are paying.
• 38:27You know, it's no longer free.
• 38:28Healthcare isn't free anymore.
• 38:30Not a $20 copay. Oh my gosh,
• 38:32it's $5000 deductible that I better.
• 38:34Attention here.
• 38:35And then somehow it clicked over to, huh,
• 38:38okay, If patients are behaving like consumers
• 38:41before they ever get to be a patient,
• 38:44we better start treating them like consumers.
• 38:46And that is if we go back to the we're
• 38:48stretching the metaphor too far here.
• 38:51But if you go back to retail, that retail.
• 38:53Got us there first.
• 38:55Oh, if you bought these shoes,
• 38:56then you might want those
• 38:58socks or whatever it is.
• 38:59But that is built on a relationship
• 39:02model and the biggest investment
• 39:05frankly is in your database,
• 39:07your customer comprehensive
• 39:09360 customer database.
• 39:11And interestingly,
• 39:12we have gotten the most leverage from that in
• 39:15something that is never considered digital,
• 39:17but of course now it is no
• 39:18one's used to landline,
• 39:19landline in forever,
• 39:20but our call centers have seen
• 39:22enormous increases in volume
• 39:24because people have figured out.
• 39:26So if I call in, they know me.
• 39:28And they not only know me,
• 39:29they know my husband, they know my kids,
• 39:31and I'm caring for older parents.
• 39:32And we've actually seen,
• 39:33just just this year,
• 39:35we've seen a 23% increase
• 39:37in appointments per call.
• 39:40Because while they're on the phone,
• 39:41they'll say,
• 39:42oh,
• 39:42can you schedule a flu shot for
• 39:45my husband or can I get my mom
• 39:47in for for a screening visit?
• 39:49So by demonstrating that we actually know
• 39:51you and and and Sarah to your point,
• 39:54it's not a high frequency business.
• 39:57So we're lucky if you know if
• 40:00we're interacting with them.
• 40:01I think the CDC says it or no,
• 40:03it's NH as it's average of three
• 40:06transactions health interactions per year,
• 40:08which means for many people
• 40:09it's much less than that.
• 40:10Yet that there are a lot of people
• 40:12with chronic conditions who are coming
• 40:13in 10 times or coming in none but in
• 40:15order to be there whenever they do show up.
• 40:18We need to indicate,
• 40:20oh, we know who you are.
• 40:21We remember what happened last time.
• 40:24You're you're pretty cranky about a
• 40:26billing interaction that you had last month.
• 40:29Oh,
• 40:29we we know that your insurance
• 40:31has changed and we have to set
• 40:34up that kind of if then.
• 40:36Relationship building the logic and I
• 40:38agree with with Sarah because I think
• 40:41the incumbents have something that none
• 40:44of the disruptors have which is high
• 40:47volume of data and comprehensive data.
• 40:49So it's it's just math.
• 40:52If you have a lot of data points,
• 40:54you can have much smarter algorithms that
• 40:57are much more likely to be accurate and you
• 41:00can much get much better at personalizing.
• 41:03And then and you're personalizing everything
• 41:05when somebody shows up to your website
• 41:06and you know the last time they came,
• 41:08it might have been a year ago,
• 41:09but they're interacting
• 41:10with diabetes content,
• 41:11then you serve them diabetes content.
• 41:14Likewise if they view a a Peeds blog,
• 41:18then you send them content on Peeds and
• 41:21so you're you're constantly improving
• 41:22that and I don't think any of these
• 41:25disruptors have anything close to that.
• 41:27So that's that's how I'm thinking about it.
• 41:29How do we move from.
• 41:31Interactions or or transactions
• 41:34to relationships and then I I
• 41:39use the the ROI model that.
• 41:42That points exactly what Sarah said.
• 41:45Boy it's it's industry number is farmer map,
• 41:48but it's it's roughly 15 cents
• 41:50on the dollar to keep a patient
• 41:52rather than get a new one.
• 41:54So huh that math falls to the bottom
• 41:56line pretty quickly if you're saying
• 41:57why don't we just keep the people we
• 42:00have build on that relationship before
• 42:01we go out and knock on the one door.
• 42:03So that was how we got to buy in.
• 42:06That's great. I mean what a what a really.
• 42:10What an interesting story and,
• 42:11and how interesting too that the consequence
• 42:15of the relationship can can be that the
• 42:18services being delivered are now no
• 42:20longer delivered just to individuals.
• 42:22You're really delivering services to
• 42:24their social network, their husband,
• 42:25their kid, their their uncle,
• 42:27whatever it is that you're you're getting
• 42:30more than one appointment per phone call,
• 42:32essentially. Right.
• 42:32As the more you know them and the
• 42:35more they they they believe that they
• 42:37can access the services they need
• 42:39in one portal one point of entry,
• 42:42the more you can leverage that
• 42:44call or that relationship.
• 42:46It. It is a big change though
• 42:49for the provider system,
• 42:50right and it's a big change for
• 42:53providers to start relinquishing that
• 42:56level of understanding connection,
• 42:58personalization from the secretary who.
• 43:02Staffs you know my clinic versus the contact
• 43:05center agent who has a unpopular right,
• 43:08has a huge you know has a huge
• 43:10machine learning enabled database
• 43:12about my experience expertise
• 43:15needs preferences etcetera.
• 43:17So it is a big shift in the locus
• 43:19of control and and that that to
• 43:22me is another component not to
• 43:24underestimate right is the is the
• 43:26digital transformation impacts
• 43:28on the existing organization.
• 43:31Yeah, and that trust with
• 43:32the position it's earned.
• 43:33It isn't demanded.
• 43:34Because until I know
• 43:36you're at least as good,
• 43:38at least as safe as my beloved and
• 43:40trusted person in the front office,
• 43:43you're not going to get there.
• 43:45Well, it's really
• 43:46going to bake our noodle,
• 43:47I would say is even beyond that, right?
• 43:49There's. There is that relationship with the.
• 43:53There's sort of like the autonomy and
• 43:56the relationship with the person who
• 43:58knows you as a clinician and your front
• 44:00desk and whoever manages your practice.
• 44:03There's also sort of if you blow that out at
• 44:05the macro level for the system as a whole,
• 44:07the system may not be the deliverer
• 44:10of all the care period even, right.
• 44:14And so and there is an
• 44:17increasing decentralization of.
• 44:19And distribution of where care is
• 44:21delivered and we talked about those,
• 44:24those disruptors out there,
• 44:25they are delivering some care and even
• 44:28though one of them each individual may
• 44:30not have gotten to significant scale
• 44:32yet though with like Summit being
• 44:35acquired by Village and do now they are
• 44:36a fairly sizable entity and they will
• 44:38be delivering a fair amount of care, but.
• 44:40In general that's not the case.
• 44:43But taken all together that is a big trend.
• 44:46And so we are seeing distribution
• 44:49of care and and there is valuable
• 44:53information being generated by those
• 44:56as well as valuable economic sources,
• 44:59right.
• 44:59And so imagine a scenario in which not
• 45:03you don't fight that and instead you as
• 45:06an incumbent are able to essentially.
• 45:09Capture that opportunity to say
• 45:11Okay care is going to keep going
• 45:13to where it's going to go, right?
• 45:14Demand.
• 45:15You can only do so much to capture demand
• 45:17and to control it where it needs to go,
• 45:19where you want it to go.
• 45:20At some point it's going to
• 45:21go where it's going to go.
• 45:23And instead let's create an
• 45:24economic model around that,
• 45:26that demand going wherever it wants
• 45:27to go that works for us and capture
• 45:29the data from it in a meaningful
• 45:31way within the mall, right.
• 45:33The mall is not just about our own services.
• 45:35The mall is about.
• 45:36Pop up shops and other things
• 45:38as you described it, right.
• 45:39So I think that's even another layer
• 45:42of sort of change management and just
• 45:45understanding of what's going to happen
• 45:46that we need to get comfortable with.
• 45:49Yeah. And and Sarah,
• 45:49I think we have about 5 minutes left.
• 45:51So I'll make one comment and then I'll
• 45:53give you each an opportunity to sort
• 45:55of make some some closing remarks.
• 45:57I think there is a battle for
• 45:59the eyes of the customer,
• 46:00you know there's that.
• 46:01The battle that Google has one of
• 46:03having the eyes of the browser,
• 46:05right it's it's the starting point for,
• 46:07you know for for 90 plus
• 46:09whatever percentage of searches.
• 46:11So how will we figure out how to play
• 46:17in that space with some of these
• 46:20disruptors in a way that benefits our
• 46:23patients but doesn't put us at risk
• 46:26of being disintermediated and then
• 46:28feeling like we are actually losing?
• 46:31The relationship,
• 46:32so how do we share the relationship?
• 46:35How do we have a a distributed loving
• 46:39relationship with our patients
• 46:42where the data flows with the
• 46:44patient wherever they go, right.
• 46:47We not, we're not being,
• 46:48it's not concealed from us these
• 46:51other healthcare interactions,
• 46:53but it's designed to be seamless so
• 46:55when they do go to you know an urgent
• 46:57care clinic and then come to us.
• 46:59We still know them and we know
• 47:01they've had that event and that
• 47:03I guess relies to some extent on
• 47:05real true data interoperability.
• 47:07And we're not there yet even though
• 47:09we have legislation that auto have
• 47:10created that we're clearly not
• 47:11in that place yet.
• 47:13So I guess I would say let's end with,
• 47:15I'll start with Alex first.
• 47:18You have your magic wand.
• 47:19You get one major change in the
• 47:21healthcare system that you think will
• 47:23enable us to be successful in this journey.
• 47:25What would you change if you were
• 47:28granted temporary authority to
• 47:29make one major sweeping change?
• 47:31Well, Lee, you and I met at the Health
• 47:34Management Academy and everybody
• 47:36there was wailing on the EMR vendors.
• 47:40I I do think that the two largest,
• 47:44we they will remain nameless,
• 47:45but they deliberately design
• 47:47themselves to be walled gardens
• 47:49they don't want to share and until
• 47:51we demand that they get over that
• 47:54because that that's the superhighway,
• 47:57it's sort of and again I come
• 47:59from financial services,
• 47:59there's you know there's
• 48:01federal credit ratings,
• 48:02I mean there's credit ratings
• 48:04that everybody share.
• 48:05Does it matter for your Visa or
• 48:06MasterCard or which issuing bank is
• 48:08everybody wins by sharing that credit
• 48:10rating until we get to that place I
• 48:12think it's going to be very tough.
• 48:13So but it's something we're going
• 48:15to have to demand and I'm guessing
• 48:17both Sarah and I are are party to
• 48:20repeated grumpy conversations with
• 48:21our vendors to try and like what
• 48:23the heck can we just make this easy
• 48:24not hard and it doesn't have to
• 48:26be custom they shouldn't standard
• 48:29awesome. Thank you Alex for
• 48:30that comment and all of your
• 48:32comments so far on the panel.
• 48:33Sorry, I'll turn to you.
• 48:36Amen to everything that Alex just
• 48:39said and I would say specifically
• 48:41around enabling identities that
• 48:44can that can federate to third
• 48:47parties and a healthy ecosystem.
• 48:49That's really the big, the big
• 48:52specific ask that I would have is Okay,
• 48:54you want to build every feature under
• 48:56the sun that's clinically related
• 48:58and sort of around a transaction
• 49:00you still need to let me on.
• 49:02Or let us as health systems sort of
• 49:05own that Federated identity that
• 49:07can partner and can be built on a
• 49:10set of like functional AP I's that
• 49:12that share information at the right
• 49:14level of granularity and you know
• 49:16we can we can really work with it.
• 49:18So that would that would be my big ask.
• 49:21The other one would be much more of an
• 49:24internal one which is that you know.
• 49:27How we can all organize around
• 49:30sort of standardized,
• 49:31modernized processes and
• 49:33operations internally within
• 49:35our within our organizations.
• 49:37Because you can't layer technology
• 49:39onto a ton of variability.
• 49:41And so that would be another thing
• 49:43that if I could wave my magic wand,
• 49:45that's what I would
• 49:45do. Sarah Sarah cheated by having two wands,
• 49:49not one, but but that's OK because none
• 49:52of us actually have that magic wand.
• 49:55Terrific session.
• 49:55Thank you both so much.
• 49:57I think this was really inspiring,
• 50:00triggered a whole bunch of new thoughts
• 50:02for me as I think about this space.
• 50:03And so, thank you so much.
• 50:05And with that,
• 50:06I'll wrap our first panel.