This Week Health

Health IT leaders Weigh In On Biggest Moments of 2021: Sarah Richardson & David Bensema

December 29, 2021: What were the biggest moments in healthcare IT in 2021? What do you think will be the biggest movement in 2022? Bill is joined the Advisors to This Week in Health IT, Sarah Richardson of Tivity Health and David Bensema, MD. We are still in the pandemic. Are we making progress? What was the impact of shutting down non-essential surgeries? What do Big Tech giants Amazon, Walmart and Best Buy have up their sleeve for healthcare? Is healthcare getting better at partnering? And what is the future of telehealth? 

Key Points:

00:00:00 - Introduction

00:09:30 - Big Tech realized that healthcare is very hard

00:15:30 - We are developing new muscles in healthcare. How to work with the state better. How to work with entities better. How to get better at partnering.

00:16:30 - I think we've come a full decade in a year and a half, in terms of public health IT capability

00:25:00 - Work to your strengths and make sure you collaborate, delegate and outsource as much as possible when you feel out of your depth


Health IT leaders Weigh In On Biggest Moments of 2021: Sarah Richardson & David Bensema

Episode 475: Transcript - December 29, 2021

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Bill Russell: [00:00:00] Today on This Week in Health IT.

Sarah Richardson: It's about how you really do manage your wellness. And where do you get the opportunity to link your lifestyle and your habits together inside of a Walmart, inside of a Target, inside of a CVS. Cause you can get a flu shot, you can get cat food and you can pick up some romaine lettuce. And so when you bring everything together, whether it's hitting an easy button or it's creating an easy space that you can go to or get delivered, you're more likely to consume multiples of any [00:00:30] product where you have an affinity and an affiliation and something that you can also get affordably.

Bill Russell: Welcome to This Week in Health IT. This is one of our end of the year episodes. I hope you enjoy. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week in Health IT, a channel dedicated to keeping health IT staff` current and engaged. I want to thank you again. In December we do a bunch of end of the year [00:01:00] episodes. I think you're going to enjoy them. We do two with our advisors. I did one just me talking through chronologically the news of the year, and then we're going to do two, one where my staff selects the best news day episodes from the year.

The second is you're going to get to meet the team and they're going to come on and talk about things. So this is one of those episodes. Before we get there though I want to remind you that for next year, we have some changes to This Week in Health IT. We're gonna have four channels. Four distinct channels on iTunes next year. We're going to [00:01:30] have this week health academy, this week health community, this week health conference and this week health news. So, if you are already subscribed to the Today show that will become the this week health news show, and you're gonna have the today show and the newsday show in there.

If you're subscribed to This Week in Health IT that will become this week health conference. And that's where we're going to have keynote. And we're going to have solution showcases and some other campaigns around specific topics. This week health academy is new.[00:02:00] It's really around education.

We're gonna have a show called insights in there where we take the highlights from the last four years and we break them down into 10 minute episodes. They're going to air three times a week. I would use this show to mentor people, to talk about what the various leaders in the industry have said over the last four years and how it relates to what you're doing at your health system. I'd also use it to bring people up to speed. If you hire somebody new into healthcare this is a great channel for that. And in this week health community is the channel where we're going to have guest hosts [00:02:30] who are going to tap into their network.

And we have CIOs. We have CMIOs. We have clinical informatics. We have data scientists who I've tapped on the shoulder and asked them if they would essentially interview people within their networks about topics that are a little closer to what you're doing on a daily basis. And we're excited about airing those channels again. Four new channels.

If you're not subscribed to all four of them, you're going to be missing some content. We'd love for you to subscribe to all four. Go ahead and hit [00:03:00] and there's information there on how to subscribe. You can also hit iTunes and search for this week health. Any one of those academy, conference, news or community.

And you can subscribe that way. And we would love to have you be a part of the community again next year. Special thanks to our influence show sponsors Sirius Healthcare and Health Lyrics for choosing to invest in our mission to develop the next generation of health IT leaders. Now onto our show.

Here we are for another one of our end of the [00:03:30] year shows and we have two of our advisors here to discuss what happened this year and what's going to happen going into next year. We have Sarah Richardson and we have David Bensema. Welcome back to the show for both of you.

David Bensema: Good to be here. Good to see you both.

Bill Russell: I guess the news of the year has to be Sarah Richardson took on a new role as CIO, is that one of the biggest news events of the year?

Sarah Richardson: Maybe in my household, I don't know, generally from an industry perspective, but yes, it did significantly change [00:04:00] our life again.

So that's a, I'm always grateful to my husband for just kind of go along with the show most of the time.

Bill Russell: I was reviewing some of the clips from when I interviewed you earlier for another show we did before our end of the year show. And it was interesting, at the time you were right in the midst of meeting the entire team, the entire IT team, and you committed to having a one-on-one with everybody on your team. In a pandemic world that had to be very different than what you had done at previous organizations I would imagine.

Sarah Richardson: It was [00:04:30] incredibly different and primarily because I interviewed for my entire opportunity here at Tivity via zoom. And I didn't physically meet anybody in my company to almost 90 days after I started. So that journey of interviewing all the way through starting onboarding and getting settled in my company was close to six months.

And that was how long before I ever physically met anybody in person, which was kind of daunting at the time. I hadn't never done that before. And I did. I met every single full-time colleague [00:05:00]one-on-one for 30 minutes within the first hundred days. And now I consistently do that with anybody who's new.

And also contractors who are with us for long periods of time. And I commit to it at least once a year with everybody. So we'll start that cycle in about what 31 days or so.

Bill Russell: Are you starting to meet them in person now or are still remote?

Sarah Richardson: I would like to believe it's probably close to 85% of the team I have met in person because we still have two primary hubs.

And yet we are one of those employers who believes that you hire talent where it is. So we are able to employ in 49 states. We [00:05:30] just don't do it in Alaska. So we literally have people in multiple states. In fact, my VP team lives in four separate states. So me plus my four VPs in IT, we live in five different states and there's some people you don't ever get to meet in person because simply of where they are, and even the cost of trying to collate some of the people for different meetings.

So that, that space of like meeting people in person, if they happen to be located in Phoenix or Nashville. Otherwise you're literally shipping people to locations for different [00:06:00]conversations, which during travel restrictions and other components of what we've been facing and even going forward still remains a challenge. Not everybody feels safe traveling.

Bill Russell: Your VP team number of times zones?

Sarah Richardson: Four. Like, me, but Arizona sometimes is different, but then I'm the one that gets the short end of the stick because I'm on Pacific time. They're mostly Eastern and Central so if I don't want to schedule them past 4:00pm, ideally, especially noon on Fridaysto give everybody a little wiggle room. My day starts at 6:00am.

Bill Russell: Absolutely. [00:06:30] Well, David you've stayed busy in your retirement. I'm not sure why we call it retirement anymore for you. Every time I try to touch base with you, you're at a an AMA meeting or you're coordinating something or you're launching something or you're in the fields working on the barley fields and those kinds of things.

Probably one of the busier retirees I've ever run across. But the story of this year has to be the pandemic. Right. So, no matter what we talked about, everything sort of has this backdrop of the pandemic. As you look at this year. again, I'm going [00:07:00] to tap into your physician.

Does it feel like we're making progress with regard to the pandemic? In the beginning of this year, I was looking at some of the shows and we were talking about, we feel like by the end of this year, we'll be stepping out of the pandemic and now we have new variants and other things.

I'm curious, just give us a little of your thoughts on that.

David Bensema: Yeah, there's, there's definitely progress. I mean, the vaccines are without a doubt, huge step forward. The vaccine resistance, we're making minuscule progress there. I think we've pretty much run up against the very [00:07:30] strongly resistant group now.

The convertible individuals we've converted. The hard liners are where they are. But the vaccines make a difference. The place where I see the progress is as we talk about Omicron we already are talking about how does the disease act in vaccinated individuals versus unvaccinated individuals who are already gathering data and disseminating that data?

So we have a better understanding of what are we really up against. It doesn't mean that the markets don't do what [00:08:00] the markets are going to do when they get nervous, but at the same time, those of us who have been vaccinated and particularly those who have been vaccinated and gotten the booster are going to have a very predictably mild course of disease. That's a lot of advance from where we were in January of 2021. There's still a long way to go. We do know already that the monoclonal antibody is not going to be, the Regeneron product is not going to be. Adequately effective against Omnicon. But we [00:08:30] also know how to change that and create a monoclonal antibody quickly that responds to this new variant.

So we're not light years, but months ahead of where we were the last time we had to deal with the original, the Alpha and the Delta variants. We're light years almost ahead but we're months ahead in our ability to flip and create new products and have disease modifying regimens out there.

Bill Russell: So here's what we're going to do. We're going to talk about, clearly[00:09:00] with the backdrop being the pandemic we're going to talk about the biggest stories or the biggest events or movements of this year. And I gave you guys a little prep to be thinking about that. To get the conversation started, I wanted to walk through some of the things that were happening back in January.

And as I was looking at this list, some of the things kind of surprised me. We reported on Haven's end. Right? So JP Morgan, Amazon Berkshire Hathaway go their separate ways. And we have Haven coming to an end. It's interesting because that was [00:09:30] again seen as big tech or the outsiders realizing that healthcare is very hard.

That was one of the lessons that people really felt like we learned. But the reality is there's enough stories as we go through this year of Amazon moving their Amazon care program forward. Signing the parent company for Peloton as a user of Amazon care. And then towards the end of the year, they signed another, big name as well.

So you thought at the beginning of the year, Hey, this is another one of those cases where they hit a brick wall and they're stopping, [00:10:00] but really it wasn't much of a stop for Amazon. They just kept plowing through there and they expanded what they're doing with PillPack. Expanded the PBM space, expanded the Amazon care space.

When you think about what big tech's doing, when you think about what these outsiders are doing, is that one of the stories for this year, do you think?

David Bensema: I think so. I think the iterating that Amazon's doing is exactly what you'd expect of Amazon. It's not wholly, unlike what Walmart has been doing since I started dealing with them in 2008, [00:10:30] 2009 when we started retail clinics in their stores. And they iterate, they try something out, but they're smart enough to quickly abandon what those didn't work. But I think the parallel story that has been interesting with these outsiders to me and the success story of the year in that area has been Best Buy.

And while Best Buy was working on this couple of years ago with some acquisitions, their acquisition of current health this year and their ability to have their call center and their [00:11:00] geek squad supporting the setup and management and support of the products in the home for monitoring seniors, et cetera.

That's been kind of remarkable to me. Showing that in outside the traditional healthcare realm organization can actually have success. But I like how they've done it, because it's seems to have been a very thoughtful, pragmatic approach to it.

Bill Russell: It really is interesting best buy. We talked about it last year Best Buy the healthcare company.

Cause they've made all these [00:11:30] acquisitions and continue to make these acquisitions. But they're not really a competitor per se to healthcare. They're coming alongside. It's almost the same thing that Walmart is trying to do. They're trying to come alongside as well and say, Hey, partner with us, we're going to be able to reach rural health in places that aren't being served that well. One of the stories we touched on this year, which was interesting is Dollar General hired a Chief Medical Officer.

Dollar General. Sarah, you live in this space. Are we starting to think about health more and starting to move [00:12:00] beyond just delivering healthcare and starting to think about how do we keep people healthy?

Sarah Richardson: Oh, absolutely. So many you think about Best Buy getting into the mix. Any of the brands that you trust.

I mean, you think about any kind of licensing opportunity. It's about brand loyalty. And what you trust and what you know. I always think about Amazon. You think about anything they ever got into with somebody else. They went and learned to figure it out and then made it obsolete. Like they basically took over the postal system in some cases. They learned streaming literally from Netflix and have dominated that space. [00:12:30] When Haven started, I thought this is nothing more than an experiment to see what it's going to take. I'm like, they'll go in, they'll figure it out. They'll disband and they'll create their own activity.

You go to their websites. I teach this stuff for CHIME. We want to make healthcare the easy button. So if you're already remember you, I think bill it was you and Drex that had the podcast about Amazon have handled the vaccinations across the country because you trust certain things to come into your home and your houses.

Every study that we look at from different [00:13:00] wellbeing, polls find that American lifestyle is a main factor in determining longevity. Well, no kidding. People who exercise stay healthier. Really? Like weight loss, linked to healthy eating and good habits. Like no kidding. And yet there's all these research articles keep coming out about that because it's no longer about taking the pill pack to keep you out of the hospital anymore.

It's about how you really do manage your wellness. And where do you get the opportunity to link your lifestyle and your habits together inside of a Walmart [00:13:30] inside of a target inside of a CVS. Cause you can get a flu shot, you can get cat food and you can pick up some romaine lettuce, as an example. And so when you bring everything together, whether it's hitting an easy button or it's creating an easy space that you can go to or get delivered, you're more likely to consume multiples of any product where you have an affinity and an affiliation and something that you can also get affordably in most people's cases, because access to care is something that dollar general, I posted on [00:14:00] that article got more comments than anything that I mostly posted this year because people enroll areas like, oh my gosh, my parents love dollar general. It's where they go for everything. Why wouldn't they endeavor at some point, potentially get healthcare at a location like that too.

Bill Russell: Yeah. And it was a big deal when CVS really started to take health care seriously. I remember when that happened and they started taking some of the products. They took cigarettes out, tobacco out first, and then they kept making it healthier and healthier. Now you can still get a bag of Doritos [00:14:30] at CVS, and I'm not sure how healthy that is, but at the end of the day, it became healthier just to shop there.

And if, if that alone happens at Dollar General, that, that could be a big movement. As I'm looking at this, you brought up the episode I did with Drex and we've talked about if Amazon had handled vaccine distribution, it would have gone much better. Because we were trying to coordinate states and new websites and new scheduling things and all this other stuff.

And I think Amazon would have just said, yeah, we have all these components. Let's just pull it together and away [00:15:00] we go. That was sort of the joke, but that was one of the big stories this year. When we started the year, not a lot of quantity of the vaccine. We had people in my area in Southwest Florida driving 200 miles to get there, to get their shot.

And we get to a certain point and we're ready to do these mass vaccinations. And we covered, two different stories, which I thought were interesting. One Atrium Health, and the other was University of Colorado. Health system. Both partnered with one partner with NASCAR and other partnered with [00:15:30] baseball, MLB. They partnered with Honeywell for some of the systems. They partnered with the state to make sure they had enough vaccine.

I think. It feels to me like we develop some new muscles in healthcare, like how to work with the state better, how to work with entities better. I think for me that feels like it was one of the stories of this year that we got better at partnering than maybe we've been in the past. David do you think that's true?

David Bensema: I think it's true. I think we found some of the incredible neglected areas within every[00:16:00] state public health department. The IT world within state public health has been abysmally neglected over the years. And they were able to partner with some of the larger hospital systems in the states and come up to speed because they were sharing expertise.

And so became, state needed the data brought in, they needed to have the immunization rates, et cetera. And the health systems had the ability to collect that data and transmit it, but creating that interface, back [00:16:30] to interoperability issues, creating that interface. And that interaction was a much bigger lift than it should have been at this point in time because of that neglect.

But I think we've come a decade in a year and a half in terms of state public health IT capability, and we're going to keep moving forward. I've seen some of the strategy from CDC and some of the strategy within the states and it's impressive how quickly they are evolving. Cause the money's there as part of it, it the influx [00:17:00] of the federal funds has really helped to accelerate that let's hope they put some of that aside for maintenance and updates and upgrades.

Bill Russell: I'm going to hit a couple more stories real quick, and then I'm just going to, to take the reins off. You guys can talk about whatever you want. Kaufman hall came out mid year and talked about the impact of doing the shutdown of non-essential surgeries and what that did to the financials of health systems.

And so there was a significant for the health systems that didn't have a big you know bankroll [00:17:30] behind them. There was a significant stress that was put on the system. We have price transparency this year. That was pretty interesting. We had the Scripps breach had to be one of the bigger stories, cyber security continues to be one of the stories that kept recurring. I think if I looked at this, it felt like every three days I was talking about some exposure and Azure, some exposure and you name, it was coming up. And then we had the actual, the breach of of Scripps, which the financial said about $110 million [00:18:00] loss due to the ransomware attack.

And about 30 days where they were without their EHR and had to go on diversion for much of that time. As I look at the rest of the year, we had some interesting things. The vaccine credential initiative came out as we came to the end of the year, and people wanted to know, is it safe to be coming back together?

And I think that is one of the stories of this year. We did come back together, the health conference in Boston, they actually had testing onsite. And tested some 4,000 people [00:18:30] took about 20 minutes per person to a test. Everybody was social distance up until the point that you got your your okay.

Of those I think 4,200 or something to that effect people that they tested, there was only three positives. Two ended up being false positives and one actual positive from that event. And I didn't hear of anyone going away from that event. HIMSS came back together this year. The CHIME fall forum happened this year.

So we, actually started to come back together. RS and A's happening. Although they said that the attendance is [00:19:00] 60% less than it was in 2019. So, and I think all the numbers are generally down, which was to be expected, but we're starting to come back together. Those were just some of the stories. I'm curious with the background of what is the things that were impactful this year. Sarah I'll start with you. What things do you think were the most impactful?

Sarah Richardson: What I see being most impactful and continuing on through next year in the next couple of years is the space of both M and A as well as overall partnerships occurring. It's not a [00:19:30] day that goes by that there's not an M and A conversation that's, that's hitting the news wires or something about a partnership that's occurring. Or even some cases, some of these healthcare systems or insurance companies earnings. Even today on the news wire, I think United is reported that they're going to have a huge quarter and a lot of that's from that delay in services. But we saw that in 2008, when the housing market crash, there was a gap of a couple of years of people getting the healthcare that they needed, that acuity rose. And then there was this massive expansion of people needing different kinds of services.

[00:20:00] So paying attention to where things are coming together. How elegantly they come together. Just because a groups agree to have partnerships in M and a space. Those of us that have done that for much of our career know how messy and complicated it gets. And so in all of that, how do you find the space, it comes back to being simplistic. Because we often talk about the experience of both the patient and the physician.

There's a space, we talk about consumerism and write up fresh on the heels of fall forum was the talk about the [00:20:30] humanism approach to what it is that we do. And so for all of the complicated M and A partnership activity we have, at the center of all of that, we are all patients and we are all human. And the need to be able to bring experiences forward, to create something that is bigger than just your wellness. It's the actual affinity of wanting to be associated with something that makes you feel better overall. And so, as a CIO, our role has completely shifted because the [00:21:00] technology's there. I say the technology often is the easy part of our jobs. It's that ability to be that true leader, influencer, strategics, and innovator, and bringing all those pieces elegantly together that is making the biggest difference, at least for me and how we strategize and deliver our plans for 22 and beyond.

Bill Russell: As I think about that, Sarah, the question is who's going to build the experiences and I'm sure you've seen this study, this trusts survey that they do and the the nurses, I think are the most trusted.

The doctors are the second most trusted, and then it sort of goes down and the insurance company is like trusted [00:21:30] by .. The numbers abysmal, it's like 38% of people or 28% of. It's so low. And so my question becomes you have these behemoths. United is so big at this point. I mean, whenever I say their revenue number, I have to check it cause I'm like, it can't be that big it's it's massive.

Is that the player that's going to build the experiences that we as a customer finally go yeah healthcare is starting to feel like it's moving into the 21st century.

Sarah Richardson: I'd love to hear David's thoughts on this, but yes, literally United today says they [00:22:00] expect 317 billion in revenue for 2022. That's their estimate for 2022. What they are good at though, and yes, there are the, the huge there that the hemophilia is all, look at all the companies underneath them. And all those niche spaces that they have been acquiring and partnering to create. They are very good about finding where those next opportunities are.

And for the most part, leaving them alone to flourish. They just say fund them to be the best version of themselves. And then when it's something that can be replicated more effectively, [00:22:30] that's what they go and do. I've got that background from being with Optum, obviously. And I trust them in the sense that they're not going to buy something or they're not going to invest in something that doesn't significantly move the needle forward.

It's how it's done. And it remains to be a space that, for the most part obviously has to be ethical, but you can trust in the smaller pieces that are coming up and out of the, out of the woodwork. Where the VCs are getting involved and where some of those startups are occurring. When you see a small product be purchased by one of the biggest players, [00:23:00] that's the trail that you want to follow. Because what's worth the investment and has a future to do something that isn't being done well enough yet, which is why they've gone down that path.

Bill Russell: David, do you wanna weigh in on this?

David Bensema: I think the comment about the insurance companies, having the wisdom and the knowledge to collect products and other companies that they can own and utilize but keep at arms length, you don't want them too tightly identified with the insurance company [00:23:30] that I'm going to rail against. And they're smart about that. And they keep that degree of separation so that folks will accept the things they bring out.

But I think, the one that's been most interesting to me, again, getting back to my Best Buy I guess, obsession at this point, is Best Buys ability to create this in-home relationship and social work relationship and call center support for emergencies and folks are really comfortable with that.

But the value I [00:24:00] also see in it is that that type of relationship experience that they're creating also reduces my system security exposures. If you think about all the concern we had at the beginning of the pandemic with all our employees going off site, and then all of a sudden we had all these additional points of access, and we're trying to figure out how to keep ourselves our systems clear.

Then you add home health and remote monitoring and all these the IOT [00:24:30] the home monitoring of products. As a health system, if I was still a CIO, I'd be really happy to have that come through a vetted partner, like Best Buy. And Best Buy, then single channelled, transmitting that into my EHR where they've already done some of the protection, some of the filtering so that I don't have those incredible innumerable sites of access or points of access.

I would think it would make my CISO a whole lot calmer if I [00:25:00] was able to do that and offload it. And it brings up, Sir Richard Branson had a thing today on LinkedIn. And one of the quotes out of that is work to your strengths and make sure you collaborate, delegate and outsource as much as possible when you feel out of your depth.

And I think that's one of the lessons of this year. And one of the things the insurance companies already understand. There's certain things they're not great at, but they can acquire that capability. Hospital systems thought we were going to be good at primary care. We really are not [00:25:30] for a cure hospital.

Thought we could be good at home care. Well, it's nice to capture that loyalty, but we're not really great at that because you got to maintain that workforce in a geographic dispersion. And it's hard to maintain the control that at least acute care hospitals that I know of like to have. So we have to think about how do we collaborate?

How do we outsource as much as possible and quit trying to do. Yeah, we're out of our depth and so little [00:26:00] long-winded sorry, but I really think they just keep tying together. You have to watch how each thing affects the other and this webbing networking of the interactions is something that I'm not sure everyone's always willing to think through. Because it does take a lot of thought. And it's one of the things that you bring is that ability you know Kinda think about multiple areas and not neglect the fact that it's complex.

Bill Russell: The complex [00:26:30] word is is pretty interesting to me. It seems like every company is trying to become a different company. You know, United, Optum hiring a bunch of physicians.

So they're becoming a different company. You have Providence and all those players launching Truveta. Providence, Ascension, there's an article about Ascension Ventures and the fact that they're pretty much a massive VC firm. They have invested in a lot of different companies and they're in a lot of different businesses serving healthcare.

I mean, I guess that's the common thread, but it gets to a point where a bunch of your revenues now coming [00:27:00] from these ventures that didn't used to be part of the traditional acute care. You have Best Buy getting into healthcare. The CEO essentially stating we are a healthcare company. Just sit there and you go, everybody seems to want to be in the other business and they're going to head and I hear CIOs talking about their digital capabilities and all their they're going to be doing and you know so healthcare is trying to I don't, this is probably a stretch, but trying to [00:27:30] become big tech or at least big tech capabilities and tapping into those things you have you have the larger health systems that are becoming VC firms and acquiring all sorts of additional services. I mean, Providence itself has a whole team that does EHR implementations. They do infrastructure support and all that other stuff. I mean, they acquired companies like Nav and half D and traditional players that did consulting and did work for various health systems around the country.

And that's now an [00:28:00] arm of Providence and you sit there and wait a minute. They're serving health systems across the country with their Meditech and their Epic implementations and those kinds of things. And you sort of step back and go isn't that what, a lot of these and they acquired blue tree and others.

I mean, it seems like everybody's trying to get into a different business than the, than the one they're in. Is that just the nature of where we're at today, that you have to diversify?

David Bensema: I think it's part of the sporting of the risk. Diversification is how we've always spread risk. And I think health systems, [00:28:30] again, when you shut down the acute care surgeries with beginning of COVID and then with the Delta virus, they saw what happened to the revenue streams.

And I guarantee you, every board is telling their CEO of their health system you got to find a way to smooth out the curve. You can't keep having these abrupt drops and then climb out and you can't climb out. And the climbing out is done by increased schedule or expansion of schedules operating the, or until nine o'clock, 10 [00:29:00] o'clock at night wearing out teams that are already wiped out anyhow. That's not a viable option for these health systems to recoup lost revenue. They need to have that diversification to smooth out that experience.

Bill Russell: Let me ask you about telehealth. Future of telehealth. So the public health emergency continued through the end of this year. It might continue into, it will continue into next year, but we just don't know how long. But that helped to fund a lot of the telehealth ventures. We seem to have established a new norm, [00:29:30] which I think McKinsey said is probably about 60% above what it was pre COVID. Now everyone wants to compare it to like the weeks of the peak of the pandemic and go, oh, look how much it receded.

But the reality was it had gone from, maybe a 1% usage to now, you can almost see across some health systems you're seeing a maintained rate of somewhere between 15 and 20% telehealth usage. And that says that's a significant uptake. If somebody had told us two years ago, without the pandemic, [00:30:00] we would get that kind of growth in telehealth we would be doing cartwheels. What's the future of telehealth? Where are we going from here with it?

Sarah Richardson: I'd like to look at it as a space of more of the on demand activity. And I literally say that because. There are certain times when you want and need to go to the physician, like not get your annual physical on in theory, some of your preventative care, just doing a video visit.

I mean, we have telemedicine as an option for us in our company. I've used it three times this year. So haven't [00:30:30] had COVID thank goodness. And yet had three separate sinus infections from being out in public, out on the open road and just picking up general cooties is what I like to call up. So never had COVID, but you have a sinus infection and you get something else going on with you.

You don't have to really, unless you're going to obviously going to get tested, you don't have to go to the doctor for that. You don't have to literally physically go into the office and say, I need this or this component, if it's a recurring type of thing. And so the convenience factor for so many people, I remember five years ago, having calls with our pediatrician groups.[00:31:00]

They wanted like five things that parents could just literally do a video visit form. One of them was pink eye. When you're a parent, if your kid has pink eye, you don't want to drag the whole brood in because everyone's going to get sick or kind of thing. You got three kids at home and one sick.

You don't want to go to the doctor, especially when you know what's wrong with them. So the convenience factor back to the, the human approach. If it's an on demand capability for that percentage of all of us that want to be able to do then absolutely. My father-in-law's 93. He hates telemedicine as he should at his age with all of this, all of the different things he has going on.

But when you [00:31:30] make it something that's easy for people to use on demand. And it's, it's an option to really expand the type of care that they're receiving, you'll likely find that people are healthier because it's easier to get in. If you have to call your doctor's office and wait on hold to get an appointment, and you're likely not going to do it for something that could be nipped in the bud.

So until it becomes more of mainstream for people for certain types of conditions and we start to learn those more effectively, that on-demand component of what telemedicine is from the ease of convenience is what attracts people to a brand and the repeatability that they can expect from receiving that type of service from a [00:32:00] place that they know they're gonna have a good experience.

Bill Russell: You know, Sarah, my United plan. I get free telehealth before I go to the local physician. And at least twice, I never ended up at the local physician because they just looked at me and said, essentially, here's what you have. It's over the counter. Go take this and, call us back if there's any symptoms and sure enough, I was fine and never saw the local health system. That on demand really preceding the primary care doc, I think it has the potential to [00:32:30] fundamentally change how we think about primary care.

Because every time I do telehealth, I'm not going back to the same doc. It's kind of a different kind of deal. And maybe that's my age, right. So I'm only. I actually I'm 54 now, I got to think about that these days. I'm 54. So maybe I should have that recurring primary care, Doctor,Bensema is going to shake his head here in a minute and tell me I should have that ongoing relationship.

But to I moved to Florida and I, I haven't established that relationship yet. And I think a lot of people are in that category right now. We've sort of [00:33:00] disconnected from our local care and we almost need to be plugged back in cause it's been two years of doing things remote and putting things off. And I think you've sort of alluded to that earlier.

David Bensema: The other thing that's going to happen for telehealth is as more states get legislation that requires parody and payment to be sustained. You know Obviously during the pandemic we had a Medicare jump up. And so then the other payers came along. But in the state of Kentucky, we [00:33:30] passed the parody law almost three years ago now. We're way ahead of the curve. For the anyone who thinks that Kentucky is a laggard at some things we lead in and one of them was parody for telehealth. But with that, we have physicians in the state now who are saying, I want to set aside 20% of my time. And have open hours telehealth meaning, from eight to 10 in the morning or eight till 11 four days a week, I do telehealth and patients can [00:34:00] access pretty much on demand. It's not quite as fluid, but you do get to see your regular primary care physician. And so we have a lot of folks in the state of Kentucky doing that. And I talk to a lot of my friends at the American medical association who would love to do that. If they felt that it was going to be a sustained model for them, then they would be willing to be participants in telehealth.

That was part of the resistance for the physicians before we know our patients. The convenience, the lack of having to drag your [00:34:30] three children into the doctor for something that's perfectly taken care of on a telehealth visit. Mental health, not having to go in, not having the stigma of walking into an office, et cetera.

That has been huge. And that's gonna continue for sure. Mental health is going to stay kind of the lead or the, the yeah, the leading wave of telehealth going forward. But I think you're going to see most physicians being willing to do 20 plus percent of their time as tele-health once they know that it's a sustainable business model.[00:35:00]

Bill Russell: It requires policy change. It requires funding. And so just for clarity, is that Medicaid and commercial, because I mean, clearly

David Bensema: I stayed in Kentucky at the parody laws for all payers.

Bill Russell: All payer. But not CMS?

David Bensema: They cannot do it through medicare. Yeah. So getting Medicare to sustain that would help.

But if you think about, where was telehealth first going to be adopted. It was going to be with the younger patients. To Sarah's point about a 93 year old father with multiple medical complications. That's not going to [00:35:30] be a telehealth But my 42 year old son. Yeah. Telehealth makes a lot of sense.

He doesn't want to come in out of his business or have to figure out what to do with his son. So telehealth is great thing for those groups. So the United healthcare is the Anthems, the Humana being on a parody with in office visits has been a huge boon in Kentucky.

Bill Russell: Yeah, that's awesome. All right. So let's turn our focus towards 2022. I I'd love to hear what you think is going to be the big movement going into 2022. [00:36:00] Sarah, we're going to go with you. You're generally have your eye on the future and have a good feel for what's going to be happening.

What's the big movement we should be watching for in 2022.

Sarah Richardson: I'm going to go with two brief items. The first one is paying attention to the future workforce. And literally, like we learned all these adaptations throughout the first phase is what I will say of the pandemic to wait to the endemic state.

It's literally what I have even had to spend time researching and learning more about is the mental health [00:36:30] aspect of our workers. The remote, the talent acquisition, the resignations that are occurring. We get them constantly. And it's not because people are dissatisfied with our company. It's because they literally are getting offers that are doubling their salaries to go work for companies completely outside of healthcare.

Who say, oh, you're that kind of programmer? Oh, you're that kind of individual. We want you to come work for us. You can be remote. We're going to pay you this much. Here's the experience. And so, the leadership qualities and the capabilities that are needed to be attractive enough to bring people in, because to David's point, he may be able to [00:37:00] source the things that you're not great at doing, or that are not in your particular wheelhouse with different partnerships, even acquisitions etc. At the end of the day, you seem to have fantastic leadership and fantastic skillsets in your organization to still be true to what is at your core. And so a lot of that is then to the medics piece, being supplemented with the greater and deeper understanding of things that you, that you can't give away.

Security, risk, regulatory compliance, interoperability, innovation. The influencer perspective, all those things that we continue to do. We have to build literally [00:37:30] better mouse traps, every single moment of every single day and figuring out what that complete refactoring looks like and how to do that in a way that is cost-effective that is attractive and supports the strategy organization.

That takes up way more time than anything I've ever done in the past year. It's rewarding work, but it's also something that is not necessary fluent to most of us that have grown up as technologists, like literally shifting all aspects of things you've ever done and in a data center and other [00:38:00]components to do work that needs to be invisible and allows the provider, especially we talk about nurses being the most trusted individuals on a healthcare. Nurses are asking to be able to literally just hold a patient's hand. So how do we make that possible? It sounds so simple. If your job is to make a nurse, make time for a nurse, to be able to hold a patient's hand because they don't have anybody or the family hasn't been able to come in because of the pandemic cetera.

How do we as technologists [00:38:30] create that type of environment? So it's thinking about solving problems and creating scenarios in ways we've never done it before. That can be super uncomfortable but necessary that allows us all to challenge ourselves in a way that we had never had before.

Bill Russell: Wow, fantastic. I'm glad I'm not following that. David?

David Bensema: Actually, Sarah has set me up for one of my two, which is ambient technologies. Ambient listening technoligies. Because how are we going to get the nurse to be able to hold the hand? How're you going to get the position to maintain eye contact with the patient?

We're not going to do it through the old data entry that we [00:39:00] thought we needed for the EHR. Is we're going to do it through ambient technologies, ambient monitoring technologies and automated note creation. That's going to be key for the nurses and for the doctor. So that's one of my big things for next year.

I think this is still a nascent area. But it's evolving very, very rapidly. The quality keeps getting better. I don't think we're that long way. Of course I used to always chide the people who said, oh yeah, we'll have this in two years. And I'm like, no, we'll have a prototype in five [00:39:30] years. And we've only had have the technology for 10.

Now I'm going to say within two years, I think we're going to a viable, ambient monitoring and note creation process that most primary care and inpatient settings will be able to support. The second one is we're going to be in the security race forever. But I think this coming year, it's going to be really important as we are coming I hope out of [00:40:00] some of the pandemic focus in, into the realization that we have all this stuff to clean up. I remember when I became a CIO in 2013, I asked my one executive director who was over infrastructure and security what he needed. He said, I need budget for security. And he said, we're getting killed.

And I said, but we haven't had a breach. He says, yeah, but I can't keep up on the current budget. And what I ended up creating the analogy with my team was that we were in a race with the hackers with the nefarious [00:40:30] actors. And we were at risk of losing sight of them. It's not just that they're ahead of us where we're going to lose sight of them if we didn't start investing.

And I think we're back there again, just because of how rapidly we had to roll things out. And I think we've got to get back to where least, or within striking distance or vis visual distance of those nefarious actors. They're always going to be ahead of us in this race. If we think that we can get ahead of them, we're delusional.

I think we have to think about [00:41:00] how can we keep becoming aware, more rapidly of what their next evolution is because they're going to get more precise in the coming year. It's not going to be the throw the net wide and hope cut out type of attack. It's going to be the spear fishing, the better assessment in advance, knowing what your system, what your health system has to offer them, what the viable outcome from a monetary standpoint is, and then targeting the right individual.

I think it's going to become much more [00:41:30] precise in the coming year, and we're not ready to catch up with that yet.

Bill Russell: Well, the old adage is if you're the smartest person in the room, find a different room. So clearly I'm in the right room. With the other group, what I said was automation is going to be key.

I thought I'll do something a little different. And the reason automation is going to be key is the biggest thing at the top of mine right now is this battle for labor. Battle for staffing. It's amazing what is going on right now? And part of it could be this Zoom culture that we're living in and somebody can get a phone call or a zoom call from a recruiter, get offered [00:42:00] $10 an hour more and do the same exact job they did yesterday.

And if you're not a good manager, not a good executive, you're struggling to keep and build that culture. As a result I think there's going to be a call for much more automation. We also have the nursing shortage, which is going to be close to 500,000 down. And it's not like in 10 years, they're like saying in two years we're going to be half a million nurses short.

So automation is going to be a significant driver going into next year. So maybe that's a no kidding kind of thing. So I'll go with a different one. And that is I think [00:42:30] VR in healthcare, virtual reality in healthcare as a means for treating and helping certain conditions will start to really get elevated.

Now we have some interesting things that were going on at Cedar Sinai and some of the other academic medical centers, but I think it, it starts to become mainstream. I think with the launch of, of Metta and other things that VR is going to take a significant step forward. And we're going to have really smart people stepping back and saying, okay, how can we [00:43:00] almost help to create these environments that people can heal better in and those kinds of things. And also along with VR in healthcare comes the downsides of VR. We're going to have a new rash. I'm not sure what symptoms or conditions that are caused by people spending too much time in VR.

We know that there are risks to doing that and we're going to introduce that to a new generation. And I have a feeling we're going to start seeing these patients that it's going to be VR related symptoms. And so I think we'll start to see that in [00:43:30] 2022, but really come to the fore and 2023. How's that for out there? Is that out there?

Sarah Richardson: I love it.

David Bensema: You're in mental health already. So you're, you're not far off,

Sarah Richardson: No and I love the whole space of VR, because if you think about how people respond to a tranquil or hypnotic states for the right reasons we think about complementary alternative medicine and acupuncture, massage, hypnotherapy. Those are all aspects that help people with chronic conditions that are not treated with pills as an example. And so if like anything, [00:44:00] if you use it with the intentions and I won't say regulatory and compliance, but if you monitor the usage and the different effects for the right reasons, it becomes one more tool in your toolkit versus a panacea of something that's just going to replace everything else.

Even just pain management in general. And what VR can do for people that have pain management. It's pretty incredible. You look at the research it's out there today.

Bill Russell: So another year is in the books. I want to thank you guys for being advisors and people from time to time will come up to me and say, it's amazing how far that you've gotten in this thing.

And you guys have been there all along the way.[00:44:30] Keeping me on the rails and I really appreciate your support and encouragement and guidance over the years. And I really want to thank you for your time and sharing your insights into the year that was and the year that's going to be next year. So thank you very much.

What a great discussion. If you know someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to this show. It's conference level value [00:45:00] every week. They can subscribe on our website or they can go wherever you listen to podcasts, Apple, Google, Overcast, which is what I use, Spotify, Stitcher. You name it. We're out there. They can find us. Go ahead. Subscribe today. Send a note to someone and have them subscribe as well. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health IT leaders. Those are VMware, Hill-Rom, StarBridge Advisers, Aruba and McAfee. Thanks for listening. That's all for now.[00:45:30]


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