Bill Russell: 00:00 welcome to This Week in Health IT News where we look at as many stories as we can in 20 minutes or less that will impact health it. It's Tuesday news day and here's what we have on tap. Providence Saint Joseph health acquires epic consulting firm Blue Tree, a Philadelphia's Hahnemann university hospital files for bankruptcy and why no single health incentive works. New England Journal of Medicine Catalyst. Look forward to covering that. My name is Bill Russell, recovering healthcare CIO and creator of this week in health it a set of podcasts and videos dedicated to developing the next generation of health it leaders. This podcast is brought to you by health lyrics technology coach for health executives. Let's talk visit health lyrics.com to schedule your free consultation. want to support the fastest growing podcast in the health it space. Here are five easy ways you can do that. One, share it with a peer. Number two, follow our social accounts, linkedin, Twitter, Youtube.

Bill Russell: 00:59 Number three, interact and repost our social media content. Number four, send me feedback. I love getting questions, recommendations, uh, stories, suggestions, uh, you know, just phenomenal to get your feedback. Really appreciate it. bill@thisweekinhealthit.com and subscribe to our newsletter on the website. So let's get to the news. Providence Saint Joseph health acquires epic consulting firm Blue Tree. This is a pulled the story from hit consultant.net by Fred Pennic. Let's get to it. So providence Saint Joseph Health and national non for profit, not for profit Catholic health system announced today that it will acquire blue tree and epic consulting and Strategy Company that helps healthcare providers maximize the use of their technology based in Madison, Wisconsin, which I guess would tell you which technology they're focused in on. And with offices in Denver, in New York, blue trees integrated team approach helps healthcare providers realize higher returns from their epic EHR platform investment.

Bill Russell: 02:00 Uh, let's see, what are the benefits for providence by acquiring blue tree? Providence St Joseph health will expand its current offerings to increase the value it delivers to other health systems across the country. There's number one. The acquisition is part of a strategy to, to diversify revenue, to support patient care in the mission of Providence Saint Joseph Health. That's number two. And with the addition of blue tree, providence Saint Joseph health now has two of the top EHR solution companies in the country. It will also engage, which has a, it also owns engage, engage. It's the name of the company which has grown to become one of the largest meditech solution companies in the United States. So what is Mike Butler president of strategy and operations for Providence said a many health systems have invested heavily in epic as the backbone to provide seamless patient care. The value add of EMR consulting is modernizing talent management, revenue cycle and operations.

Bill Russell: 02:57 So providers can focus on their core strengths of delivery of care instead of pouring resources into technology investments as one of epic's largest customers already, blue tree will enable us to build new revenue streams by expanding these services to other health systems. Uh, let's see, is there anything else in this story? I, one last thing. So providence Saint Joseph Health announcement comes on the heels of other enough innovative ventures designed to diversify revenue to support its mission. In February, 2019 providence at, at Saint Joseph Health announced, Ayin health solutions a population health management company. Additionally, the health system acquired Lou medic, a next generation revenue cycle management platform based on blockchain technology. Wow. So, uh, this is interesting because this was a, a not a recommendation, but I got a bunch of questions from people on this acquisition. What does this mean? Um, you know, is providence still an opportunity for us?

Bill Russell: 03:57 Uh, if you don't know, providence has a, a date of like 2020 to, uh, to migrate an additional 16 hospitals onto the epic platform. So, you know, so what's the, so what for this it, I think the answer to this is, uh, this makes perfect sense for providence Saint Joseph Health. Uh, the, they have a, the upcoming implementation, which I discussed, 16 hospitals going to epic. I have a feeling the details of the financials on this were not announced, but I have a feeling it'll pay for itself in just those 16 hospitals being implemented. Um, you know, and so the transaction itself makes sense. Uh, I think they needed the in house expertise. It's part of what they, their value proposition as they go into the community and they talk to other health providers to either partner with them on, uh, extending their, uh, continuum of care or it's a part of their strategy for acquisition and growth is being able to, uh, integrate those other health systems a lot quicker, uh, in with, um, you know, I guess more defined programs around the EHR consolidation during those, uh, during those consolidation events.

Bill Russell: 05:08 So, um, and I think the other thing that's obvious is it's going to grow the, the critical shared service, uh, revenue, um, that they're looking for. So, uh, it's, it's interesting because the conversations I've had have primarily been with solution providers and they say, what does this mean? Well, I think it means you just gained a competitor. I mean, blue tree was always a competitor, but now you've gained a competitor that's also a client. So you may have lost a potential client in the process of gaining a competitor. The other thing I would say about this is you can't underestimate the relationships with these hospitals have a networks across the country. When you look at it, uh, the innovation groups from these various, uh, organizations across the country, they work closely together to, uh, to either, you know, get these startups off the ground or to fund their second rounds and you see them coming together more and more.

Bill Russell: 06:03 I think this is another one of those situations where, uh, you know, providence is going to have a leg up on some of these EHR implementations, uh, because they have relationships. They're seeing these people, they're having the conversations. So, uh, I think you have gained a competitor. I think you've lost a potential client. Those who are looking to get into that a 16 hospital rollout. Now with that being said, an epic implementation across 16 hospitals is going to take hundreds of people. And I doubt that a blue tree is going to provide all of those. There's going to be specialty services. There's still gonna be a lot of staffing, uh, associated with that. I imagine the big players are going to be around Leidos and others are going to be looking at that revenue. Uh, so there's still an opportunity there. Um, you know, the good news, I guess there is good news for a, a solution provider in this is that a other systems might look to follow suit and compete against Providence, which could create a market, uh, for these.

Bill Russell: 06:58 Uh, I think that the players that make the most sense are the players that are focused in on EHR only not a hundred different services, but really focusing on EHR. There's sort of a niche player focusing on EMR implementations or even ERP implementations. And there could be a market for that. Now you could see a large health system, uh, a 10, $15 billion health system say, hey, that move makes sense to me. That will provide revenue so that we can do our internal think, Amazon, AWS, Amazon, AWS, essentially funds all of it. And then some for beyond that, for, for Amazon at this point, if you can grow your shared services revenue, uh, as a percentage of your overall revenue, that's going to fund a lot of technology initiatives. So a interesting story. I thought I'd start with that one just because I got so many questions about it.

Bill Russell: 07:49 Thought I'd just throw it out there. Our second story and um, this is not as much of a fun story, but it's a, it's one that's uh, very, very much talked about on social media and definitely talked about in the city of Philadelphia. So Philadelphia is Hahnemann university hospital files for bankruptcy. This story I pulled from WPI, uh, ABC in Philadelphia and it, uh, the parent company filed for bankruptcy for both Hahnemann and Saint Christopher's hospital for children. And now the cities trying to intervene changes already are already happening at Hahnemann with emergency department. No longer accepting trauma patients as of this weekend. And that was before the 4th of July weekend. Uh, Saint Christopher's has said to remain open, but there's still a lot of unanswered questions that from both hospitals, although it seems like the intention is, well, I'll go on, I'll just read it. Uh, this morning, the parent company, Philadelphia Academic Health System, voluntary voluntarily filed for chapter 11 bankruptcy saying it will ensure an orderly wind down of operations of Hahnemann while assuring patients safety, it will facilitate a restructuring of Saint Christopher's, which will enable it to remain in full operation.

Bill Russell: 08:59 Uh, nurses at Saint Christopher's say morale is low and there's a lot of, you know, back and forth in terms of, uh, not really knowing what's going on and what's next. I mean, meanwhile, Drexel University says, lawsuit filed against the hospital owners to block, the closing to get back a compensation for its partnership with Hahnemann to train physicians has now been referred to federal bankruptcy court in Wilmington, Delaware. So, um, let's see. A couple more things on this. So, uh, they've not exactly been the best to work with. It's driven by a personality of one person and that personality can be erratic at times. Uh, said PAHS owner, Joel Friedman. If this was a nonprofit company, we'd have the ability to force situations. But this is a private nonprofit, are a private nonprofit. He continued. I'm worried that the health community and jobs and the employees and the doctors that were going to do our best to put our best foot forward says Freedman.

Bill Russell: 09:58 Uh, let me give you some of the numbers here. So in the filing phs said it had liabilities between 100 and $500 million. Liabilities, meaning deficits, debt, uh, with only 10 to 50 million in assets. Um, I don't think that, that, that can't possibly include the hospital and the land it's sitting on the land it's sitting on is easily covers that debt. Um, because it's downtown Philadelphia and an area that's being revitalized, but regardless, a hundred to 500 million in debt, 10 to 50 million in assets a, the company abruptly announced on Wednesday that it would shut down to 495 beds, center city, Philadelphia Hospital, and began diverting patients from it's level one trauma center. PAHs owes $20.1 million to tenant healthcare, Ottoman and Saint Christopher, uh, former owners, uh, oh 14 point $1 million to Drexel university, which operates Hahnemann's medical school and nearly $700,000 to the city among other debts.

Bill Russell: 11:03 So there are some numbers. Oh and the last number Hahnemann handles 56,000 emergency visits each year in addition to the thousands of other patients, uh, at its center city location. Um, you know, so what for, and I'm going to do this from a health it perspective and as much as I possibly can, I was treated at Hahnemann as a child. I grew up not too far from Philadelphia, had to go down and I was wondering those rural communities where you go to the city for some specialty care. So I, I was treated at Hahnemann. Uh, you know, this is going to be hard for the staff. It's really hard for the people involved, hard for the staff at hard, for the medical residents, um, heart for the local residents. Um, you know, I've been through this multiple times in my career and, uh, you know, it's just flat out hard.

Bill Russell: 11:47 It does impact families. It's their difficult conversations. Um, and so I don't mean this to insensitive. I'm really, I'm just good from a health it business perspective. Um, but you know, at the end of the day, there's five academic medical centers in Philly. Uh, they're not at a loss for healthcare. I, there was this map on the Philadelphia Inquirer, which showed all the health systems and the geographies that they served. And this is surrounded by other really high ranking, high performing health systems. Um, you know, there's several eds and the closest of which is, uh, is I, I think it said less than a mile. So the Jefferson health, uh, ed is less than a mile from where Hahnemann is. The city technically is probably overserved in terms of health care. And the eds is, is less than a mile. And when I think about if say a, say Saint Joseph health were to close in Orange County, the closest ed would be 10 miles.

Bill Russell: 12:46 And that's a major city. That's, uh, you know, it, when you think about that 10 miles, I think has an impact. One Mile is not that much of an impact. Now I understand it's a, it's a community that doesn't have a lot of money, that there's a, a lot of homeless, a lot of Medicaid, uh, care and those kinds of things. And they're saying that that one mile can make a difference between them getting care and not getting care. I can't really speak to that. That is probably true. Um, but I think there's an opportunity here, and I'm going to go into that in a minute. The reality is the business is broken. It doesn't make money. This surprises, no one, surprises no one. Um, the, you know, it's a for profit business and they really can't be forced to stay open.

Bill Russell: 13:34 So, uh, so it is going to close. You know, I, I think this will make the overall ecosystem in Philly as a result. Uh, better. There's going to be pain in the process, but it's going to be better, uh, longterm. And, uh, you know, here's, here's some of the things from a health it perspective. Um, number one, health systems, health innovators. Th th the Ed continues to be overused. I mean, one of the biggest complaints about this is the Ed because quite frankly, if you're doing a specialty care at this point, you're going to Penn, you're going to Jefferson, you're going to a temple, you're going somewhere else already. Uh, really what this is about as the Ed shutting down and it, reality is the ED is overused. Um, and from a health it perspective, we need new solutions to route people to the right level of care, period.

Bill Russell: 14:23 However that's done, we should be thinking through that with [inaudible], which I think gets to my second point, which is we need to be thinking outside the four walls. That hospital is not necessary. It's, it's just, it's just not needed. There are so many things, so many different form factors that can be put in there that would be much better. Um, we need to be thinking outside the four walls and how are we going to deliver care where it's needed. How are we going to get people to the place where, um, where they can get the right, the appropriate level of care at the right time. more times than not, it's not the Ed. They, they had a story about a person with a 104 degree fever are not 104, 101 degree fever who went to the Ed said, well, I don't know what I'm going to do now that the Ed is not there.

Bill Russell: 15:08 I'm like, CVS, Walgreens, there's, there's a lot of places where we can deliver care to that person with a fever for heaven sake. So, um, and which gets to my last point, which is new venues of care. You know, banks are being reimagined as a cross between a Starbucks and an apple store, you know, even complete with a genius bar on financial services. So, Hahnemann and others should be replaced with more appropriate. And you could read that financially sustainable locations for health and care. Think across between, um, I dunno, like, like a health food store, like a GNC. Um, oh no, food. Food would be better. So a food store and uh, and you know, like a fitness store, you know, complete with access to a genius bar with health services and all those, those physicians and nurses and whatnot don't need to reside in that store.

Bill Russell: 16:01 There, there could be ways to access those health services, but think of genius bar that you can go and ask those health questions that you want to ask or if you're sick, you could actually talk to somebody. And there is a way to, uh, to direct people to the right level of care. Um, you know, as, as the poster on my wall says, my daughter, uh, painted me a great, um, rendition of the old apple. Um, the old apple, uh, ad campaign think different. And, and uh, I have, um, I have this thing right up here, which it says to me every day think different. And I think we need to think different. That hospital doesn't need to be there. There's a lot of other venues that could be there and that community would receive far better care. And that's, that's not a knock on the people that the people are serving in an old model and an old building, um, that has been underfunded and, and people can rethink how care gets delivered to that center city population.

Bill Russell: 17:00 And I think this is going to be one of the easier transitions. If this were to happen, say in Kentucky, in a rural county, California or even rural Pennsylvania, this would be a problem. It would be 40 minutes to two, your level one trauma care. But here we're talking blocks. So, uh, I'm not trying to sound insensitive, I'm just saying, I think this, this care, any care gaps that get created will be closed very rapidly here. And, um, you know, on a side note, just expect more of these more consolidations, more uh, closures. Um, and, uh, I would say from, again, from a health it perspective, be thinking this way. I'm amazed how few health systems have it, MNA strategies before the, the acquisition actually occurs. Uh, you know, get a plan in place. Okay, enough. Uh, let's, let's go to one story here. So, um, and this is from the a New England Journal of Medicine Catalyst by a Charlene Wong, MD, & Namita Seth Mohta, MD.

Bill Russell: 17:58 And this is why no single health incentive works. And they did a survey responses to a survey in the New England Journal of Medicine. Catalyst Insights Council members in January, 2019 suggests that the financial incentives alone are not enough to move the needle to realize patient's health goals. The most effective approach to engaging patients to realize health goals is family friends support, excuse me, which was chosen by 35% of their respondents followed by education. 30% clinicians support 30% and financial rewards for healthy behaviors came in at 27%. So Charlene Wong goes on to say she's the assistant professor of Duke University, Department of Pediatrics amongst five other titles. Uh, she says that financial incentives have a reputation for providing uneven results when it comes to modifying patient behavior. And I'm going to focus in on that modifying patient behavior statement because I want to come back to that. Uh, and number two, uh, the presence of real sustainability is limited.

Bill Russell: 18:57 Patients change their behavior. While financial reward is on at. But when the financial reward goes away, their behavior tends to step back. Uh, along with a lack of sustainability, the impact of monetary rewards can become minimized if delivered in the form of biweekly paycheck or if they're award takes, the form of premium reduction that comes once a year, uh, at insurance plan time because it's not in their face enough, I guess is the reason that it's not really stated well there, in contrast approaches rooted in social aspects such as the support of friends and family may have more lasting impact because people involved will at least theoretically have permanence in patient's lives. And, uh, I don't think anyone's going to disagree with that. Let me get to some of the verbatims cause the verbatims I think are interesting. Um, so these are the, uh, some of the responses to, you know, what would work.

Bill Russell: 19:51 And number one was explanation for this person, which is a clinician as a small nonprofit government health organization in the West. Uh, one explanation from providers two level of understanding of patients. Three level of commitment on patients to follow what he or she understands. And four, we have enough tools to monitor improvement. Uh, Vice President of large nonprofit health system in the south says, and engaging persuasive, passionate, caring doctor is the only thing that will work. Well, I'm not sure it's the only thing that will work, but it's a very bold statement. Uh, director of large nonprofit teaching hospital in the Midwest, reduction in benefit costs for healthy behaviors like smoking cessation, colonoscopy, mammography, weight targets, et Cetera. So, uh, and actually in this study it does note that some of those incentives do work better for those very specific items. So our clinic, a developed food pharmacy, which dispenses healthy food by prescription from health, from physicians to our patients with diabetes.

Bill Russell: 20:49 That's a CMO at a small nonprofit clinic in the West. And um, and it also has the, uh, has the chart family and friend support education, clinician support, financial reward for healthy behaviors, making healthy choices, easier through design, a benefit design and incentives, financial penalties for unhealthy behavior and peer pressure, et Cetera, et cetera. So, so wide on this one, it's the right question. Uh, how do we get better health behavior? It is a behavioral question. Uh, you know, I get the results of the Diet that I sustained. How do you change my behavior? Becomes the right question. Uh, too many of our digital tools are lacking this analogy, uh, analysis and, uh, efficacy on behavioral change. You know, we measure the success based on did they get series a funding, B funding, c funding, uh, have they obtained Unicorn status? And to a certain extent I say, who gives a rip?

Bill Russell: 21:47 Um, you know, does the health system get the right press and the trade rags? Can we brag about our accomplishment at the next peer meeting? I'm not trying to, I'm not trying to, to, uh, you know, point fingers at anybody. I'm just saying essentially, are we, are we measuring the right things? Are we getting better health as a result of it? Are we just looking at our success in this new math, uh, that we're, we're looking at for healthcare systems? Um, you know, I really only care about how well a digital tool can help people like me and my family to live, uh, really live a healthier life to, to save us money, to simplify the navigation of health, uh, to live with a chronic condition. I mean, those are the kinds of things I care about. Give me a toll that does one of these things.

Bill Russell: 22:28 And I, and I think you've, you've really done something, uh, finally, if you haven't thought through behavior change in populations you serve and, and, and, you're not, I just don't think you're going to be able to get me to be healthy. Just throwing education, uh, in front of a medical record is not going to get me to skip ice cream tonight after dinner. Uh, and quite frankly, that is what is going to have a lasting impact. That's what's going to be able to, to, to, uh, make a difference in my health and my diet. So I think behavioral change in your digital tools. I, you know, I love talking to digital health startups about their tools, their business models. Um, you know, there are such great promise there and I'm glad they're getting series a, B, c funding and I'm glad health systems are investing in these things.

Bill Russell: 23:15 This is really exciting stuff. Um, but let's see if we can't cross a digital and behavior at digital tools and behavioral change, uh, and really make a dent in, uh, in my poor eating habits. So there's a, there you have it. So that's all for this week. Uh, you know, this Friday I'd love for you to tune in. We have a, a really cool startup out of Philadelphia and I have a great conversation with them. I've looked forward to, uh, uh, sharing that with you. Uh, and I recorded that a couple of weeks ago when I was in Philly. Um, you can check out this past week we talked about security and a couple of weeks ago we had a conversation with a Dr Steven Classico and Nasser Nizami. Those are on the Friday shows. As always on Tuesday, we cover the news, hit any of those shows, some of that stuff is still very fresh and exciting. Hopefully you're enjoying this. Um, really appreciate you, uh, uh, tuning into the show. I keep the comments coming to bill at thisweekinhealthit.com. Good, bad, or indifference. It really all helps. The show is a production of this week in health it for more great content. You can check out our website at this weekend, health it.com or the youtube channel @thisweekinhealthit.com/video thanks for listening. That's all for now.