This Week Health

Atul Gawande a Disruptive Insider Takes the Reigns at JPM/Amazon/Berkshire Health

Ken Lawonn CIO of Sharp Healthcare joins us to discuss the selection of Atul Gawande as the new leader of the JP Morgan, Amazon, Berkshire Healthcare venture. Also, we look at the eight most disruptive forces in healthcare.

Transcript

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 Welcome to this week in Health It where we discuss the news, information and emerging thought with leaders from across the healthcare industry. This is episode number 24, is Friday, June 22nd. Today, the much anticipated J P M Amazon Berkshire announcement is ae the right man for the job and what can do.

Plus a discussion on eight sources of disruption in healthcare. This podcast is brought to you by health lyrics. Are your strategies constrained by infrastructure or are you tied in a nod of applications? We've been in your shoes. We've been moving healthcare to the cloud since 2010. Find out how to leverage the cloud to new levels of efficiency and productivity.

Says that health lyrics.com to schedule your free consult. My name is Bill Russell, recovering Healthcare, c I o, writer and consultant with the previously mentioned health lyrics. Before I get to our guest and update on our listener drive, we've reached 180 of new, of combined new subscribers to our YouTube channel or podcast outlets, either through, um, Through, uh, iTunes or Google Play, which means we've raised a thousand dollars for Hope Builders, which provides disadvantaged youth life skills and job training needed to achieve enduring personal and professional success.

I've hired their graduates and their stories are inspiring stories, really of second chances. We have, uh, eight more weeks. Where our sponsor will give a thousand dollars for every additional a hundred subscribers. And we are just 20 subscribers away from $2,000 to, and this was really two wins for the price of one.

You get to listen to this great content from industry, uh, insiders and leaders, and give back to the community while we do it. So join us today by subscribing, tell your friends. And, uh, don't forget, we post a new video to our new YouTube channel every single day. So, um, so today's guest, today's guest is one of the elder statesmen.

I hope he's not offended by me saying that. Elder statesman for healthcare, CIOs a good friend, Ken Law cio, sharp Healthcare out of San Diego, California. Ken, welcome to the show. Thanks. Uh, great to be here. You're, you're not offended by elder statesman, are you? No, I, I definitely relate to that. You, you're, you're, you're, uh, you're, you're not too far from retirement.

We're not, we're not, we're not closing the book on your, your tenure yet, but, but you've been at this for a long time. I have, yeah. Yeah, I have. So when did, when did you start in healthcare? Uh, 1976. Wow. Bicentennial. Yeah. That's, uh, that's, that's a long time. Ha. Have you, , have you seen any changes since then?

Uh, just a couple. Yeah, just a couple. What were you doing in 1976? Were you doing mainframe or I what? Yeah, I mean, I was a, I was a programmer. Uh, they called me the junior programmer trainee 'cause I was the new kid on the block and, We were using punch cards and, uh, running on a, actually at that time a boroughs, uh, like 1800 system or something, and a couple years later went to an I B M mainframe.

But yeah, I was doing a lot of cut de developing some applications that are actually still running in some poor healthcare systems across that, that would not surprise to see. Some kid walking through going, these are the punch cards that Kendall wa built in seven six. We're still using them. I, I think that would be a good, well, I don't know.

I would find it interesting to find some of the, uh, elder statesmen to, uh, put on a panel and just talk about, uh, healthcare from 1970 to 2017 and just march through the decades and, and talk about the different changes. Um, but that's not, that's not today's show. So tell us a little bit about, uh, sharp Healthcare for those people who aren't familiar with you guys.

Yeah. Sharp Healthcare based here in, uh, uh, sunny San Diego, California. We're a integrated delivery system, uh, that's based in San Diego County. Uh, we serve about, Um, you know, the population of San Diego is about three and a half million. We're about, uh, 30% of the market. Um, we're kind of, uh, a little different than, you know, for those folks that come from other parts of the country.

We've been in this managed care business. You know, we're competing with Kaiser for 25 plus years, so we have a lot of capitated lives. Um, we have our own health plan provider sponsored health plan. And then two medical groups we work with. Uh, one is a foundation medical group, which is California's kind of approach to employment.

And then another is a, is a, a thriving i p a, which there's not a lot of IPAs that survive, but they, they do it for contracting basis. And, uh, you know, we are about three and a half billion dollars. Uh, And, uh, seven hospitals. So, you know, it's, it's a organization that's been around a while. Um, not like some of them, you know, we started in the fifties and, uh, have a really strong reputation for what we call the Sharp experience.

So we really built, uh, our last 19 years of growth around just, you know, how do you treat people every time you see 'em every day. And, um, I think a pretty, pretty reputable organization's doing a lot of cool things. Yep. I, I do want to get to, if, if in the, uh, soundbite section, we're gonna talk a little bit about your managed care platform.

Yeah. I think it's one of the areas that Sharp really has excelled, uh, in the industry. Mm-hmm. . Um, and actually it's interesting, your market is probably pretty similar than Mo to most markets, but almost identical to the Orange County market. It's a third or third. Third, right. So, Um, and I'm not gonna give your, your competitors any air time.

So, um, until they choose to come on the market, uh, or come on, come on the show. So, um, so one of the things we like to do is ask our guests, you know, what they're working on today, what they're excited about. You can really talk about anything. You can talk about, you can talk about your kids, your philanthropy, your or things you're doing at work and, and that kind of stuff.

The, but the floor is yours. Yeah, well, uh, you know, a couple things. One is, uh, it's probably not too sexy, but something that I'm pretty excited about is we're working on, uh, a set of tools that help us manage the day-to-day operations of it. Um, we started looking at, you know, how are we managing all the contracts we deal with?

And, and when I got here, sharp had this cool little, uh, application. It was really a little database that really managed and rated our vendors. And when we started looking at, you know, what are we doing around contracts and vendors, We, uh, decided to build an integrated solution that really looks at everything from the start of a contract, you know, when we're going through a relationship to how do we manage our vendors, our applications, our services, and, and uh, it just, you know, finally getting, getting there.

And it's, it's, it's a great way to really look at, you know, the people, the organizations we deal with, how we, how much business we're doing with them, how well are they performing? We, we see, we see it as a big tool for helping us through app, app application rationalization as we go into that. But, you know, it's not sexy, but it's just kind of cool.

'cause I don't think, you know, it's kind of like the, uh, you know, the, the shoemaker's kids, they don't always have the greatest tools and it is, you know, doesn't always have great tools to manage it. So it's pretty exciting. Uh, the other thing I'd say is, uh, I had an opportunity last.

It was a fantastic, uh, concert and what I was really impressed by, and I think, you know, we could learn from it as individuals and as, as an industry, is he surrounded himself with some fantastic performers, but yet, you know, he wasn't afraid to be, you know, on the stage with people that really were, were fantastic performers as well, and, and let them and his performance kind of shine through and, uh, I think sometimes we're afraid to be overshadowed by, by others, and, uh, we don't, uh, often take, you know, take an opportunity to learn from others.

And I think it's, uh, and, and, you know, have, share, share the stage, so to speak. Yeah, absolutely. That's one of the things we, um, one of the things we're both, both came here from the Midwest and one of the things I love about Southern California is just the access to, uh, just great entertainment. And I, uh, Um, I, I remember the one night at the Hollywood Bowl, Christian Chenoweth brought a, a person up to sing, uh, one of her songs from Wicked mm-hmm.

And, um, and she shared the stage with this, this, uh, music teacher she just pulled out of the audience and it's on YouTube. It's one of the most amazing things I've ever seen, and, and they sang together and whatnot. There's just so many talented people, uh, in this. In this area and we get to see such great, uh, performances.

Yeah, it's nice. Well, uh, we'll stop rubbing it in. Uh, 'cause you know, we, I have the palm trees in the back. I don't, although it's raining here today, which is like, uh, unusual. Crazy unusual. But, um, so, uh, let's go show format is in the news soundbites and in social media close. And, uh, if you're like me, I forgot to get a social media close.

Hope I I and you may not have one either, so we'll just spend more time on the other side. Yeah, I dunno, I didn't do it either. I, I'm sorry. I, you know, I do have a business to run. I, I got a little busy yesterday, so I, I apologize. So, uh, so let's get started. So, uh, first story, uh, healthcare IT News. Actually any outlet that you can find today is talking about Atul Gawande to lead Amazon, Berkshire Hathaway, uh, and JP Morgan Chase Venture.

I wish they'd give it a name. We just keep . You know, having to say Amazon, Berkshire Hathaway, JPMorgan Chase Venture. Um, you know, I, it's, uh, we know a lot about Atul Gawande. He is, he is known in healthcare. He is written some great books. Uh, he's, uh, he really exposed, uh, you know, fee for service and the challenges of fee for service way back in, uh, in the, in early, in early two thousands.

Uh, actually 2009, I think is around the timeframe. He really exposed it during that debate. He, uh, he did some, uh, really good research and, uh, wrote some good articles. Uh, he's also talked about end of life, that topic that people just tend to shy away from and really, uh, addressed it in the, his most latest book.

So he is really a, a maverick, sort of a, um, you know, he likes to push the boundaries. He likes to, uh, Really address things with a data-driven approach. Uh, should be interesting, but I'll give you the first pass on this one. You know, any, first of all, any thoughts on the selection of Aul Gwane to lead it, and, uh, any thoughts on the promise of the venture itself?

Yeah. You know, a couple things. Uh, Uh, obviously he is a, he is a, an outstanding individual who really understands some of the issues and the challenges in healthcare. As you said, he is, he's written some great articles, great books. Um, I think he's gonna be a, a very good selection or is a good selection. I think he'll do a really good job of helping those organizations.

Understand where the opportunities are, you know, with their, especially with their populations and, and how they can better manage the, uh, health of their employees and work with the payers and the providers to really, you know, to kind of drive out some of the unnecessary costs. Um, and, and I think, you know, as you said, he is always been kind of a, a, a guy who's out there and not, not afraid to challenge the kind of status quo.

So I think, you know, I think he'll be good because he'll be, um, he'll be a, a, a, a person who's thinking about things that are maybe a little outside the box. Um, and, uh, you know, it's gonna be interesting to see what that venture really does, you know, beyond what they're own employees, you know, what can they do to really help transform healthcare?

I think that's the big challenge. Even for him, you know, it's easy for people to, to identify what the issues are. The challenge is what do you do about it? And, and this is not an easy industry to, to really, you know, make significant changes in. So I think the real key will be to see what do they do beyond just their own organizations to really try to influence healthcare and is, you know, can he actually, uh, help, uh, uh, implement some things that could, could help others transform the industry.

That's really the challenge. I. We have a lot of people out there that really, you know, can talk about what the issues are. It's then what do you do about 'em? Um, that, that really, you know, I think the challenge. Yeah, I, you know, I, again, I, I agree with you. I love this, uh, I love this selection. I. Um, and I, I've been talking to some people about it, uh, earlier this week.

Yeah. And the, um, so here's the things I love about it. One is he's an insider, right? Right. So he's a physician. He's, he's been in the, in the, or he, uh, he knows just about everybody in the industry. Uh, you know, he can call up, uh, leaders of Mayo and go visit there. Stanford, uh, call either of us up tomorrow, insider.

Uh, appreciate his, uh, uh, his, his skills, his background, his, uh, his insights. Um, the, uh, the other thing is he, he does rock the boat. So, uh, one of the, when I came into healthcare, one of the articles I was told I had to read was that the cost conundrum, what a Texas town can teach us about how care it was in the New Yorker on June 1st.

Right when the a c a was being, uh, waged. And, you know, here's just a couple of things that he said. So here along the banks of the Rio Grande, the square dance capital of the world, talking about Macallan, Texas, right? The medical community came to treat patients the way subprime mortgage lenders treated home buyers as profit centers.

So he really attacked this whole fee for service model. Mm-hmm. . Um, and at the time, what he had done is he had done it and done . All this research on the, on the data and what the data said was that, uh, Macallan, Texas was, uh, was charging way more, it cost way more to care for the, uh, Medicare population than say, El Paso, Texas.

Right. And, uh, He had that quote, uh, he went on says, you know, when you look across the spectrum of Grand Junction, uh, to Macallan Grand Junction being a great example, Macallan being, uh, the poorest at that time and almost in the almost threefold difference in the cost of care, you came to realize that we were witnessing a battle for the soul of American medicine.

Somewhere in the United States at this moment, a patient with chest pain or a tumor or a cough is seeing a doctor. And the DAMing question we have to ask is whether the doctor is set up to meet the needs of the patient first and foremost, or to maximize revenue. So he really, yeah, I mean, this is somebody who's gonna rock the boat, which.

Yeah, which is good. But you know, he's also not gonna alienate people. He's gonna say, you know, we have, he appreciates the, uh, the history of medicine, the innovation of medicine, uh, and the players within medicine. So, so let's, let's take a couple seconds and just, you know, um, let's bounce back and forth. So what, what do you think he needs to do to be, uh, to be successful?

Um, His approach, I'll, I'll start us off. So his approach has been really data-driven. I think it's one of the things we appreciate, he'll help us to create a narrative, but it will be based on the numbers. So I think one of the first things he, he needs to do is probably two things, is one, analyze his population.

So he's now got this pretty significant population of these that these employers entail. Mm-hmm. . And the second thing is analyze the cost drivers. Really crunch the numbers like an economist and come back to us and say, Uh, you know what, I know what drives the, uh, the cost of this population. I know what drives the health of this population.

So these are maybe two of the places to start. What are, what are some things that, that you would, uh, offer as a suggestion to him where, where he could get started? Yeah, I, I think you're right. I think it, he's always been very data driven and I think that's a key to what he's, what he's gonna work with this organization.

I think, you know, the other thing is, um, because as you said, he's an insider, he really understands healthcare from the very basis of delivery is, I think he can help look at, you know, the, uh, resources and the, and the what those companies have to bring to the table and say, where would there be something that I think could really make a difference?

You know, so not only looking at their population using data to understand how, how can they manage their healthcare spend better, but then, you know, where should, where could they focus some of the capabilities that they have, whether that's, you know, capital or innovation. What could we really do to, to help make a difference?

Um, I think that's, that's where, for the broader scale, that's where the opportunity is. I, I have no question. He's gonna help those organizations really manage their costs and their spend and, you know, I, I think, uh, that'll be great. And, and then others can learn from that, obviously other large employers, but it's really about how can this collective, you know, Organization or venture, how can they really bring something to the, to the table that can help change, you know, fundamentally change what's going on in healthcare.

Yeah. And I'll, I'll close this out and then we'll get to your, your, uh, story here. So, um, I, I like the, I like the choice of a doctor, 'cause I think he can reframe the conversation around health and not healthcare. Um, and so when he's out doing town halls or whatever he's gonna be doing, uh, to address, The, the mission and the, the people, he can really reframe it around.

This is about keeping people healthy. It's about keeping 'em out out of the, the hospitals. Right. Um, which is, which is, you know, really I think a physician is better suited to, uh, to do, um, the last two things I would say to him is, you know, find partners who believe in your mission, which I think is along the lines of what you're saying.

It's, there's a lot of great partners out there. But the last one, uh, is, is just, it's, it's more of me pleading with him, and that is open source, your findings and your model. Oh, yeah, yeah. Do it for, you know, innovate around this, this group, and then, you know, let's, let's take it to every market. Let's take it.

Heck, let's just take it around the world. If we're able to really bend the curve, the cost curve, the health curve, uh, with this population, it really becomes a, i, I know they don't want to be referred to the it as such, but it's really a great sandbox, great resources, great technology, great leadership. Uh, I, I like the promise of it.

And I, I, and I think that's, that's what we're hearing in the news stories this week is yeah, people like the selection. Let's, I think so. Yeah. Let's see where it goes. So, um, alright, so to your story, go ahead and, uh, kick it off and, and give us, uh, give us a little background. Yeah. Um, I mean, I, you know, I, as, as everybody get, you know, the news articles that come across the, come across your desk, uh, through the internet and, uh, I saw the one in, uh, health IT news about, uh, eight most disruptive issues in healthcare.

It really struck, uh, it struck a chord with me because it, it really relates to some things that we're really trying to deal with at Sharp, at least some of those, some of those key issues. Uh, and I thought it was, uh, pretty insightful about, you know, the, the things that are really key as you look at healthcare and what are really driving, uh, change.

And, uh, you know, it, uh, it came from, uh, Holly Buckley. Uh, she's, you know, partner in a law firm. Which was also interesting, but it was at, you know, Becker's, uh, future of, of Spine and the Spine, orthopedic and pain management. So, uh, I thought, you know, I thought it was, it was really spot on. Um, you know, went through eight pretty significant areas, some of which are very related obviously.

But, um, I think that the things that are really driving, you know, we all kind of are of the realization that, that things have to change. I mean, we've got an unsustainable system. You know, we've gotta do something to not only bend the cost curve, but, you know, do a better job of, of, of keeping people healthy and well.

And, um, you know, I think for what it, what it pointed out to me, and as the people I shared with it, is that, There's, there's, uh, um, change and pressures coming from all different directions. You know, it's not only from the, from, you know, our, our largest payers like the government, but it's, it's from our consumers, from, um, and then it's from these industry, uh, giants and these people that are trying to, trying to find a way to help shape and transform healthcare.

And I think when you start looking at the collective pressures, when we. Well, you know, when we as a country really put our minds to something we can really fund, make some change, and I think, you know, for a long time there's been a lot of things talk about, well, we need to transform healthcare, we need to do this, we need to do that.

But it really hasn't had the attention of the entire, you know, the entire country and the entire set of industries. But if you look at it today, and I think as we walk through it, you'll see. How many different forces are coming at healthcare And uh, it's really putting the pressure as I look at it, is how do, how do we as providers become a part of this change, you know, continue to be relevant or, you know, or else we're, you know, we're gonna find ourself just providing some basic services and everybody else gonna control what's going on.

So, so let's do this. So there's, there's eight disruptive changes. Yep. And, um, I, I'll go through all eight. And, um, what would you tell a c i O what would you tell your peers and, and you give one, one thing you tell your peers. I'll give one thing on each one of these. So the first one, um, eight most disruptive issues in healthcare.

Number one presidential healthcare policy. So what would you tell your peers about that? Well, I'd say that's probably my least favorite of the, of the group. But, you know, I'd say that, um, this is an area where I often say, you know, we just, we just don't want to get too hung up in what's going on in, in Washington or what's going on with the administration.

We have to pay attention to it. And I think it, the one message I'd say is that we're always gonna be under this, some kind of influence from the, from the government. The more you can make your organizations, uh, More data-driven, more nimble, the better you're gonna be to be able to adapt to whatever goes on in, in DC or at the state legislature.

Um, and don't get too hung up on the details or the specifics of it, because that has changes constantly. Yeah. Um, but you know, you gotta just be prepared to, to, to have information, to be able to make some decisions and change. I think it really speaks to just let's become more data intensive and data driven.

I agree. And I, it's the one I like the least and it's the one that I think has the least impact. Uh, the, the one thing I will say about this is I think with this administration, um, you know, they're, they're rolling back regulations, so Right. We actually have a breather. Uh, if I'm talking to my, my i o peers, I know the, uh, Eight years or so that I was sitting in the C I O chair.

I mean, every year there was millions of dollars going towards regulatory compliance. Mm-hmm. . Uh, and I think we have a reprieve, which we were asking for, for every year. I was there to say, you know, can we, can we spend some money over here on innovation instead of, uh, uh, instead of compliance? So, yeah, I agree.

We, it has been a bit of a reprieve and, and actually seeing some stuff being rolled back instead of continue to add on. So, and, and, you know, and that ebbs and flows we'll, it'll, it'll come back eventually. So we'll just have to take that as go. So, eight most disruptive issues in healthcare. Number two, private equity investment in healthcare.

So what do you tell your peers about, uh, you know, the, the trillion dollars that's being pumped into, uh, the investment in healthcare? Yeah, I, I guess the thing I'd focus on is that, uh, you know, we're out, out here in California and there a lot of other parts of the countries that are really, have some really innovative and, and incubator to kind of start up, uh, ventures that go on is that, you know, this continued investment in healthcare and you have all these smart people trying to see how they can, how they can make a difference, you know, uh, whether it's through some kind of technology, through some kind of analytics.

And, you know, I think what, what I've seen over the last couple of years is that it's, it's really started to drive me as a, as a c i o and even my vendor partners to say, how can we work with these people better? You know, they've got a lot of ideas. Um, we can't solve all the problems, you know, the epics of Cerners of the world.

They can't do everything. So, you know, I think it finally driving us to say, let's open up our, you know, kind of our platforms and let's, let's look at how we can innovate on the edges. And, uh, so, you know, I think to, that's my advice to CIOs is, you know, we've gotta figure a way to really help these folks, help us.

And, uh, you know, we all get inundated every day with phone calls and people that, you know, come want to do some things. And, and I think it, you know, if we can find a way to, to more effectively embrace what's going on, And say, you know, a lot of this stuff is not gonna, not gonna make it, but if it, if we can help figure out how to get the data available, how to let them try to drive some innovation and uh, and, you know, work with our partners to say, let's, you know, let's open up the data.

'cause the biggest challenge is always how do I get 'em the data and then how do I build this back into the workflow? And I think it's really forcing the industry to kind of respond. And Ken, I, I'm not sure I could say it any better. I, I, you know, I would just close, you know, private equity, trillion dollars coming into the healthcare and, uh, healthcare market.

If I were your c e o talking to the C I O, I would say what is our plan to have some of that money work for us as a system? That's, I think that's you, you really nailed that one. So, uh, number three, most disruptive issues facing healthcare, artificial intelligence. So what are you telling your peers about artificial intelligence today?

Well, I think, um, this is the promise. I mean, you know, it's, it's a disruptor, but it's also a tremendous uh, uh, I think opportunity and promise for healthcare. I was, I came away from, uh, the annual hymns show this year for the first time in several years, being kind of hopeful. 'cause I saw a lot of things that maybe they weren't real today, but, you know, how do you leverage artificial intelligence to really drive some

Some changes in, in the way in which we do our business from, you know, how do you take steps out of what a physician's doing every day? You know, uh, and you thought about it and I started to think about it and, and put it in the context of, look at what we're doing with, you know, with Siri or with, uh, Alexa and in our personal lives.

And when people think about the combination of voice recognition and, and artificial intelligence and machine learning on the back end. There's so much data and so much of what we do and providers do is, is driven around, you know, understanding conditions, understanding what's been done for understanding, you know, uh, what's gonna be effective.

And, and I think if we can leverage computers to help us, you know, mine and process the data versus just continually throwing human. Humans at it. Um, I just think this is a, this is one of the biggest opportunities and the biggest, uh, promises out there is how can we leverage. Data and, and computers. The way in which every, every, every other industry, every other part of our personal life is, uh, in this, you know, probably the most data intensive, uh, industry in the world.

And, you know, whether it's, you know, I, I kind of combine voice recognition with AI because it's really about . If I think about a physician not having to use the computer or, or charting or whatever it is, but, um, you know, just speaking to the machine and having it help them, uh, find the information they need.

So, yeah. You're, you're cheating now though. 'cause we're not talking about voice, we're talking about artificial intelligence, so, yeah, I know, but I, I, I just see them together. I mean, I think, yeah. Yeah. I can see it. Yeah. It just, you know, I, like I tell my folks, We, we didn't, when we're thinking about anything we're doing today, it's, it's gotta be consumer or patient-centric, whatever you wanna say.

It's gotta be, you know, you gotta think mobile and you gotta think, how can it be powered by ai? How can we leverage, uh, you know, understanding the data, using the computer to help us make decisions and help us drive things. I think, you know, it's a big promise. Yeah. So we're in violent agreement, so I won't repeat any of that.

I'll just get a little pragmatic and say, uh, I would say start today with your financial data and your bedside monitors. The data is clean and the technology is more mature than what people are, uh, letting, uh, letting leading us on to believe it is. The, the technology is there to really start doing some interesting things.

Mm-hmm. , uh, number four, most disruptive thing coming at healthcare. Precision medicine. Um, you know, the thing I would say about precision medicine, I, I will try to pick this up a little bit. I get, I get in trouble for going too long, so, okay. Precision medicine. We can't do precision medicine without data. I would say we have to start collecting data.

Geisinger, uh, is leading the way there. They're starting to collect, uh, genomic data, uh, in their primary care visits, which I think is an interesting model. Uh, have a plan for what you're going to do to implement precision medicine. Uh, it is the future, I would say, get in front of it. What would you tell your peers about, uh, uh, precision medicine?

I think you, you hit it right on it. It's about getting, collecting that data and being able to incorporate it in, it's a key to, you know, getting around, you know, personalized medicine. Uh, most effective treatments is to, to understand the genome and, and how it relates to treatments. And so I think you gotta figure, start thinking about how are you gonna collect and use that data?

Are you gonna do it internally? You're gonna partner with somebody, but you need to start thinking and having conversations about how do I get this and where, where do I start? Uh, and you have some great partners down there in San Diego, so, yeah. Uh, uh, next disruptive number five, uh, disruption in healthcare retailers as primary care physicians.

Uh, what would you tell your peers about this one? Well, I, my biggest c challenge here is be talking to your, uh, to your primary care. Partners, your physicians, about how do we continue to be relevant? Um, you think about a pharmacy and if, you know, many of us travel over in Europe and think about what you can do at a pharmacy without a doctor's orders.

Uh, I think this is a huge, uh, potential disruptor to the traditional primary care model that we've grown up with where everybody, everything kind of runs through your primary care physician. You, you know, you go there for any kind of diagnosis, referrals, treatments, and, uh, you know, people are, people are disrupting that and saying, Only do, do a lot of individuals not want to go through that model.

But there's a, there's a lot of other people who could, could take up that space on the kind of the, you know, the self-treatment, the wellness, the kind of the, um, you know, what do I need to do and, and where, where do I kind of go to, to get.

I'd say you need to be looking at how do you compete or partner. 'cause you don't always have to do it yourself, but how do you compete or partner in this space because, um, if you don't, you're gonna become irrelevant as a primary care provider. Right. And, and, uh, the, the term in other industries is called disintermediation.

And if you allow someone to come between you and your consumer, you are just asking for a world of hurt and. What, uh, some of these players thinking about the way they're partnering with the payers, you know, getting into this business and that's all about where they're gonna direct the care. Yeah. Um, alright, so the three more are millennials as consumers, internet of things, and non-traditional entrance into the market such as Amazon, Berkshire, jp, p m, you talked about that last one a bit, but yeah.

So, uh, what would you tell your peers about those last three things? You know, consumers, IoT and non-traditional entrant. I'd say, you know, consumers kind of goes along with what we talked about on the retail side. They, they talked really about the millennials and, and, you know, they don't want to go through the traditional process.

So I think you, you have to start thinking about, you know, how do I serve, uh, a different kind of population. It's really about transforming what we've grown up as kind of a, an operational automation of points of care. And, and and removing the complexity internally, and we've shifted the complexity to our customers, and we really have to switch that model around and think about how do we take the complexity out of the interactions that we have with patients and consumers?

And if we have to move a little complexity back inside, then how do we work on, you know, on automating and, and, and streamlining that. But you really have to shift your thinking as an organization from a. What I'd call a process and operational driven company to a consumer or retail type company. And, and, uh, and as part of that, you know, the Internet of Things is all this information that can be collected and the patients are on their own, is what's the plan for incorporating that?

You know, how are you working with Apple or whoever to bring that data in to make it relevant to providers? So I think it just, it causes us at, for me it's really shifting and everything has to be thought of as more of a patient, consumer focused, uh, thinking not about how can I make this part of my operation more efficient, but how can I make that interaction?

Because as you said, you know, you don't wanna lose the, you don't wanna lose the, the relationship. Yep. And, uh, you know, I'll just close out this section with my story around our portal. So, when I became the c i O, we had a portal project underway. And first of all, the fact that we called it a portal said we didn't really understand the consumer.

Um, but the next thing is that, uh, we had a list of eight things that we said, these are the priorities and it, and I sort looked at the list, I said, you know, where this list from? Come internally.

You have to develop a new set of muscles. And those muscles are, how do you listen to the consumer? And so mm-hmm. , we decided to actually do focus groups. Uh, we just, we did a couple of things to get the voice of the consumer, and it turns out that our list of one through eight was backwards. They took number eight and they thought it was the most important, and our number one was their number eight.

And so, you know, number one was, you know, get that medical record right. And we were spending tons of time. You know, getting the, the data just right within that medical record. And what, what the consumers told us is if you could do patient scheduling and you can do, uh, uh, uh, essentially text, uh, secure texting with their provider, those would be the two most important things they wanted.

Yeah. And I was like, what 90% of our effort is around this? What is number eight in priority? And so it's just, it's just a different set of muscles. Yeah. It just, it's just a different, different lens. Yep. So, uh, uh, soundbites, so I have five questions for you and, you know, you know, one to one to three minute answers, closer to one minute would be great because, Uh, let, let's start with the easiest one.

So what makes a great vendor partner, uh, to a healthcare c i o ? Uh, yeah, that's a, uh, that's the easy one, right? Um, you know, I think it's just, it's about two things. It's about relationship and it's about an interest in, in helping the organization be successful. Um, you know, you talk about it a lot, but it's really getting to understand.

The organization that I'm, I'm working for, and, you know, what are their drivers and what do they need to do and, and what can that vendor do to help, help drive success and then trying to get aligned around that. Um, you know, the more and more that, uh, people are, are driven and, and incentive around what they sell and what the transactions are, I think the less the partnership can be.

But how do you align yourselves around success? And if we're successful, then I, you know, I think they're naturally gonna be successful. Yeah. And I, I would say the same thing is, uh, along those lines of, You know, stop talking about, you start talking about me. Yeah. There's enough stuff written about Sharp Healthcare that they can go out and read it before they come into my office Yep.

And start pitching their stuff and realize, hey, what, what, what I'm pitching may not be relevant here. Mm-hmm. . Um, so, and you'll, so, uh, next question. How do you prioritize IT initiatives within your health system? How do you determine which ones get the resources, the funding? Um, the priority. Yeah, it's, uh, sharps, uh, uh, for a long time has had a great, uh, what I call a governance process for it.

And it's just, you know, we're just kind of embedded at the hip with the organization, strategic planning. So first of all, it starts with, you know, what are the overall strategy organization, how is it enabling or driving, helping drive that? So you set some big rocks, you know, some of the big things that have to be accomplished to help the organization be successful.

And as part of our five-year planning process, we, we look at capital allocations, resource allocations around those things. And then we have kind of the bottom up, uh, governance where we have, uh, You know, our is, uh, steering committees that really help us manage and prioritize on a day-to-day basis around those changes in those, in those small things.

So it's really being connected with the business and, uh, you know, and, and then, you know, being there helping drive overall organizational strategy. And it's just, you know, today there's really not a separation of it in the business. Everything in the business really has an IT component to it. So I think it's in our mind, in our process, it's pretty easy because it's just, it's just a natural part of organizational, uh, prioritization and uh, and capital allocation.

Yeah, and I think part of that is you guys have such a great culture, which leads to the next Uhhuh question, which is, you know, sharp has had two CIOs in the last 30 years-ish. Mm-hmm. , uh, you know, what aspects of your culture do you think allow for such longevity in the role of the. Uh, you know, I think it's, uh, this journey that called the Sharp Experience that we've been on for over 19 years now.

I think, you know, if you go back 20, 25 years where Sharp went through some really difficult times and. And looked at actually doing a lot of outsourcing, maybe even selling to a a for-profit organization. And they came out of that. That didn't happen, but they came out of that thinking, we've gotta change and we've gotta do something different.

So they, you know, they did this whole study about, you know, they looked at the book from Good to Great. And what happened as a part of that is the leadership of the organization not only bought into it, but it really became embodied it. And so, you know, there's been tremendous longevity across the leadership of Sharp.

C e o has been here for, you know, 20 over 20 years in the c e o role. We just had a new C F O that, uh, came internally, but the previous one been 25 years. So they just, you know, they got into this journey. They embodied it. It became really part of who Sharp is and the culture, and people just, I think, just kind of committed to, you know, this is who we are, this is the journey we're on together.

And, and you know, when you have. When you have stability and senior leadership, I think it helps drive stability across the organization. Many healthcare organizations have people stick around for 20, 30 years because they, they see it as a mission and, and something that they buy into. But, you know, sharp, just, uh, embodied this sharp experience.

They didn't have the fad of the, you know, of every three years. It was, uh, it was all about that and everything kind of evolved around that. So it's kind of, you know, you kind of became part of that journey, realizing it was a multi-decade journey and, and people just stuck around and, and, uh, and it's a great thing, you know, I've never seen an organization with such tenure in their senior leadership.

So I'll change one of the questions on you. Was it, was it hard to follow somebody like Bill Spooner who'd been there for decades? Um, and, and what's it like following somebody who's been there for that long and, you know, and how do you, how do you make that transition? Yeah, I mean, I think it's, it is hard, obviously, uh, it's hard to step in and, and follow someone who's been such a success in such a large part of, not on the organization, but the industry.

Um, but I think it's really about, Yeah. You know, for me it wasn't about what's, what's Ken Lewan, you know, gonna be compared to what was Bill Spooner. It, it's what, how can I help Sharp continue on its journey? And, and I think if you get, you know, in, in many ways it was great because we had a very successful organization, very stable, uh, organization that had, had valued it and made a lot of investments.

I didn't feel like I had to come in and make my own mark, right. I just had to come in and, and try to say, how can we make this even better? How can we look at. Slightly differently, take it to another level. Right? Just, just don't screw it up. Just keep it on its trajectory. I keep telling Bill I, you know, I've been here over a little, over four years and I almost got all his messes straightened out, but

But yeah, it's, I mean, I think you can't get hung up on who you are versus who Bill Spooner was. You gotta think about it. How do I step in now and, and be, I'm not gonna be Bill Spooner, I'm not gonna replace Bill Spooner. I've come in and, and kind of, uh, just help this. Yeah, great perspective. Uh, last question.

So, um, sharp has a lot of patients under managed care contracts. We talked about that earlier. Uh, give us an idea, alright, let's focus in on this. So give us an idea of how the health system gets data and information into the hands of those that can utilize it the most. If they're managed care contracts, the data becomes.

Uh, critical. So how do you get it to the point, the point of care and the places that it needs to get to in order to be effective? Yeah, uh, well Sharp recognizes it, got into managed care, recognized how critical data was. So, you know, we started the, the, uh, data warehouse 25, 20, 25 years ago and started bringing that data together.

Um, you know, whether it was clinical data, claims data, whatever, excuse me, to, to really be able to understand how we were performing. As we evolved in that, we started identifying, you know, what is it? What do you need to really effectively manage and where, where are you going to get the most bang for your buck?

So we started identifying those high risk patients and we'd, you know, we'd understand a population and, and we'd take, okay, here's our diabetics, or here's our heart failure patients, and we'd get that out of the data warehouse and we, we transfer, you know, we didn't have the all the greatest sexiest tools, but we just say, here's the list.

And then we give it to the care managers and then they start looking at how can we develop some criteria about stratification. So they actually built their own risk stratification profiles in Excel and uh, and then they said, you know, we can understand where we wanna focus. Um, so it was really about knowing you needed the data and, and taking the investments and the steps to collect that data and then start figuring out how to, how to get it there.

Now, I would say we probably are much better at understanding how we manage retrospectively than we are day to day. And that's where we're really trying to drive to now, is how do you really get more predictive and more real time in what you're doing with the data. Um, That, that can really help us, I think, um, you know, scale the efforts we've had because we're throwing a lot of human efforts at it.

And if we can really automate some of those steps and say, and then even automate some of the interactions, we can really scale this managed care, you know, this care management population, health management, whatever you say. So, but it's really, it is really the data you gotta really grasp the fact that data is, is the key.

Yeah, that's, uh, you know, that's just a fantastic answer to, to close on. So, um, you know, thanks for coming on the show. I really appreciate it. So, Ken, is there, is there a way for people to follow you? Where do you normally, I know you're a full-time c i o so you probably not posting all the time on social media, but when you do, where, how can people follow you?

Yeah, I, you know, I, I am out there once in a while, but, uh, you know, just Ken Lewan, uh, the handle and I out on, uh, Twitter. Once in a while you'll see some posts from me. Uh, but you're right. I'm, I'm not one of those people that's out there a lot. Um, so you probably won't see a lot of, a lot of, uh, a lot of stuff from me, but, uh, well, you, you will see a lot of Ken Lewan this week on social media.

So it'll be out on Twitter, it'll be out on, on LinkedIn. Um, you'll be out on our, our YouTube channel with seven or eight videos. So,

So, uh, you can follow, you can follow me at the patient cio, uh, my writing at Health lyrics, uh, website. Don't forget to follow a show on this week in h i t on Twitter and check out the website this week in health it.com. And, um, uh, obviously the video videos as well. And don't forget our drive right now.

Uh, you know, share it with your colleagues. Share it with your peers. If you're like Ken, you could share it with. Uh, interesting, uh, tidbits around this. We now have 168 videos, I believe, and after this week we'll be up close to 180. So, um, so you can catch all those videos on the, on the YouTube channel. Um, and again, thanks Ken.

Um, yep. Appreciate it. Listeners, please come back every Friday for more news information and a commentary from in industry influencers. That's all for this week. Thank you very much. Bye.

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