This Week Health

Today on Insights. We go back to a conversation Host Bill Russell had with Mike McSherry the CEO at Xealth. The topic of discussion was How Digital Engagement with Patients Leads to Better Quality Care Experiences and Outcomes. And Bill and Mike discuss what digital health means for patient education, decision making and the quality of the care experience.


Hello and welcome to another episode of Insights. My name is Bill Russell. I'm a former CIO for a 16 hospital system ???? and creator of This Weekin Health IT. A channel dedicated to keeping health IT staff current and engaged. Our hope is that these episodes serve as a resource for the advancement of your career and the continued success of your team. Now onto the ???? show.

Today on insights. We go back to a conversation. Host bill Russell had with Mike McSherry. The CEO itself, the topic of discussion was how digital engagement with patients leads to better quality care, experiences, and outcomes, and Bill and Mike discussed what digital health means, the patient education decision-making and the quality of the care experience.

In our definition of digital health, it spans from patient education to shared decision making tools, to apps that manage diabetes or hypertension or behavioral health. As well as the facility of prep and recovery.

So when you talk about quality in many cases, we're sending out pre-surgical educational material or pre-surgical digital pathway. Stop eating here. Stop drinking here. Make sure you bring this to the hospital system. Make sure you have this at home on the recovery pathway. And so that addresses quality, even though it's a digitized patient education experience.

So is that digital health? Maybe not in the quote app based world, but it is digital engagement with the patient that is leading to better quality and outcome measurements. So that's one definition. We've got data showing behavioral health. Silver cloud is a behavioral health app.

We've launched that at three different systems and we're enrolling about two thirds of all the patients who've ever been prescribed that app actually adopt the solution. And then 75% of them are showing improved PHQ 9s. So that is definitely an outcome and quality measurement metric against that. We do an awful lot in maternity care and maternity highly expectant mom, highly engaged against her care and the newborn child prep. The sort of what to expect when you're expecting on that level. What we're trying to do is correlate how much is in, you know, in light of telehealth that all needed to have a device accompaniment. So how is the blood pressure cuff and scale weight of the mom tracking against our healthy pregnancy? So that otherwise healthy mom checkup can be done in a telehealth experience with that added device diagnostics. So that's leading towards quality outcomes. We try to correlate that directly to low NICU events or reduced low birth weight events. But you know, quality scores solely based on digital engagement is the only kind of attribute it is probably a little difficult against all the other social determinants and other kind of considerations associated with that mom and the healthy birth of a child.

So that's quality. When we look at experience, experiences is one of those areas that's really in the wheelhouse of digital solution, a digital set of tools.

Have the habits, have the demands from the consumer changed, do you think over the last year to say, look digital first? From a safety standpoint, this is what I was hearing when I was talking to people. They were happy with their online visits. They were happy with remote monitoring for chronic conditions. And the reason they were happy is because they were told that it was unsafe to go to the hospital. And so they found a solution that they felt was more safe. But after doing that for nine months, do you think that changes a behavior? Do you think there's going to be more engagement from that perspective and conversely, a better experience all around.

Absolutely. We all do talk about the consumerization of healthcare and we can all do mobile banking transactions. We can book flights on our phones or websites et cetera. So much of your consumer life can be transacted digitally. But when you hit the healthcare world, there's phone calls, there's faxes. There's I jokingly call it the lowest common denominator. You know hospital systems, like, well if a hundred percent of people can't do something on their phone then let's go to the lowest common denominator and make sure everyone makes a phone call or comes in for a face-to-face visit. And that does not meet consumer expectations.

They can so easily transact in their consumer life against every other element of life digitally but in healthcare it sort hits this analog experience level. But that's changing and it transacts with booking an appointment, I think almost in most scenarios now you can book appointments with digitally but maybe not that specialist referral. That has to be a phone call that transacts with that, and then all the way through to the patient experience and whether it's done telehealth or virtually, and then the resulting, you know, care protocol and treatment and whether or not the person felt that they had a successful outcome.

When you looked at that whole transaction experience, compare that with like, say Uber. The magic of Uber is press a button. Phone shows up, you leave, and you don't have to give cash or pay a credit card, or you know, deal with that like, you know two minute delay climbing out the taxi, while you're in a rush to go do something.

But the ride itself is kind of hit or miss, you know, am I going to, I want to talk to the driver. You know, am I going to trust the driver? Is the car going to be clean? And especially in this kind of COVID pandemic, who was in it before? Is my mask safe? All that level of uncertainty. Compare that with the patient experience here. The pain and parking and navigating through the walls of a hospital system and just getting there and the waiting room and lobby, your little 15 minute window with that hospital system, you know that with the doctor, with the nurse, That's magical.

Everyone loves it and says, Oh, I had a great visit with my doctor but boy it's such a pain on the front end to book and transact and get to that appointment. And then upon leaving, like you're handed a brochure full of papers, or go here to get that or make this phone call to follow up on that front or it's an opposite end of the experience spectrum. And what healthcare needs to do is solve that magical middle and the bookends to create a seamless consumer friendly experience to that patient care.

It's interesting when I talk to some people they were implementing wayfinding to make it easier to go through.

I'm like, well you know, step back one step from that and figure out a way to make it so easy that they don't need wayfinding. And they sort of look at me like what do you mean? I'm like well, you know, I mean, do you remember that? I don't know if you remember this, but a CVS CMIO once talked about, they were putting Epic in and he goes why are you putting Epic in and it was a health system executive who was asking the question.

He said, you know do you think you're going to be able to compete with health systems? And he said, yeah, I absolutely think we're going to be able to compete for some services with health systems. He said well, why do you think that? He goes parking. That was the whole answer. I thought. Yeah, that's that's true. I mean, parking is one of the biggest complaints of going into a health system. The Campus is big, it's hard to find where you need to go.

Yeah. And that just devolves even further to just convenience convenience it spans a whole range of activity and interactions.

Are health system is going to be able to start to really differentiate with each other, against each other potentially, and differentiating their communities based on a set of digital tools?

Well, I don't know if the question is so much is health systems differentiating against each other or against the new entrants and new competitors.

Yeah, that's probably a better question.

There's gonna continue to be consolidation in the US provider industry, I think. And rightfully so. You don't want too much density in a single market, et cetera. But I mean take a look at the two biggest systems, not-for-profit. Providence and Ascension. Both probably do 25 billion a year in revenue.

What did United Optum do? 250 billion. National scale, 10 X the revenue. Frankly 10 X the profit probably. So they can just reinvest in these convenience, these digital platforms, these behavioral elements. And so I think that's the differentiation that hospital systems are going to have to do, is how do I remain viable and not viable, I mean, there are always going to be entities, the acuity, the ED infrastructure, and that element. But there's a lot of the low acuity and chronic care going to get siphoned off to these more virtual solutions and payer kind of directed solutions. And with payers even kind of building a lot of, you know, clinics they don't have to the high acuity surgery centers. They can just focus on the chronic care, which is the bulk of the cost in the country. And if they're, so acutely managing steerage on that front the unnecessary surgical procedures and the MSK before the spine surgery remediation, those types of options will certainly hurt the finances of hospital systems.

So if I were a hospital systems, I don't know, I'd be looking at my neighbor crosstown as being my competitor. I'd be thinking, five, 10 years down the line. How am I more effectively competing against these payers and new entrants to have have skin in the game and maintain that patient relationship.

And as we just discussed earlier, I think there's going to be 60, 40, 60% still going to be the in person care and 40% is going to go virtual. And if you use those numbers the hybrid model wins but you have to have the seamless experience that bridges between telehealth is appropriate for X, Y, Z.. You know, I'll go in face to face for this procedure or this annual wellness visit or whatnot. But if you can't seamlessly intermingled as two different dimensions for ease of consumer and patient convenience, you're gonna risk losing all.

Wow, thanks for tuning in another great episode. If you have feedback for us regarding this content and materials, or if you would like to help us to amplify great thinking to propel healthcare forward, which is our ???? mission, please send us a note at Thanks for listening. That's all for now. ????

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