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June 14: Today on the Conference channel, it’s an Interview in Action live from HIMSS 2023 with Tracy Chu, Chief Executive, ACO/Corporate VP, Population Health at Scripps Health, and Cynthia Church, Chief Strategy Officer at Xealth. How did Xealth help address the problem of low patient engagement and underutilization of health services and programs? How can healthcare systems effectively engage patients in the digital era and adapt to increased consumer choices? What are the key success measures and outcome measures used to evaluate the effectiveness of the Xealth implementation in improving patient care and engagement?

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Welcome to this week, health my name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week Health. A set of channels dedicated to keeping health IT staff current and engaged. Today we have an interview in action from the 2023 Spring conferences, vibe in Nashville and hymns in Chicago.

Special thanks to our cDW, Rubrik, Sectra and Trellix for choosing to invest in our mission to develop the next generation of health leaders.

You can check them out on our website this week,, now onto this interview.

All right. Here we are from hymns 2023 in Chicago, and we are joined with Cynthia Church and Tracy Chu. See how I did that without the badges? I feel pretty You did well done. Zeel and Scripps Health out of San Diego. Correct. I'm looking forward to this conversation because Zeel one of those things that the first time I've heard about it, I was like, Say it to me again.

Exactly what I, I like, I didn't get it. And, you know, as a former cio it took me a little while, but then now that I'm hearing implementations, I, I really get it and understand it. So I'm gonna start with you. Sure. What's the problem you were trying to solve in bringing Zelle then?

Well, as like most health organizations, we have a lot of problems to solve, and I think the biggest area that we saw was getting our patients to really engage in our existing services and programs we had available.

We had a lot of different population health services and programs that. They were eligible for, but they were being underutilized and we were making it really difficult for them to engage, to enroll, to even know that they were eligible for that. So we really focused on trying to close those gaps with self, try to create an automated process to outreach to them.

To then provide them with educational materials and then get them to easily enroll to the app or to the service, and then help kind of create a portal or a process to then bring that information to the provider so that they can then integrate it into their care. So it was just kind of a. A way to, to further that engagement and education for our


But that first step of getting them, taking away the friction, right? I mean, cuz we see it over and over again. It's like, oh my gosh, three clicks. Are you kidding me? I mean, I have to do this and then fill out this form, then do this. Yes. And it's, you just don't get that engagement unique.

Well, a lot of the processes we focus on initially were um, dependent on manual enrollment and manual intervention by our providers instead.

So what we did was we said, where are we doing manual things that we could automate and make it easier? Easier. How do we make this easier for our clinicians and our staff and then our patients? And so when we really focused in on that, we didn't try to solve too many big problems. We really tried to focus on small problems and then say, how could we use this platform to really engage that?

We were really, to be honest, quite surprised at how quickly the adoption from our patients were, and. Just how engaged they were with the, with the platform itself. It just, it made it so much easier for them to say, oh, I had no idea that I was eligible for this. And it's just one click to enroll and oh, by the way, look at all this educational material I have at my fingertips.

So it was, it was almost like opening up a door to information they always had but didn't know they had to open the door to,

to get to and having a digital runway to that. People know digital, it's not like you have to. No one has to teach a child how to use an iPhone. Right. They just pick it up and start using it.

And that's the, that's the point we're at today. It's like when people talk about healthcare, it's, you know, give, put it, put it on my phone, give me the information. You want me to track something, you know, gimme the tool to do. Yeah. Is that a, a typical problem that health systems are looking to solve this health?

Or are there

others? Yes. So that problem of, I mean, everybody has some sort of labor shortage right now. That's, that's nothing new. And how do we make. The teams that we have, how do we make their jobs easier, while also helping patients to get the information, the care what, whatever that they may need. So, I mean, Tracy and her team have been great with the speed that they could move.

Like they just made decisions and that's part of it. So there's a lot of discussion around like, how should we do this? Which patients do we want to reach out to? How do we wanna automate? When do we wanna do this? Or if you just make decisions, you can always update and tweak and make changes later, but just make a decision, get it out the door.

Get these things in the patient's hand. So that you can relieve the pressure. All that admin pressure on staff that are having to, having to deal with the downstream impacts when they're not engaged.

so we're hearing a lot about financial pressure and whatnot. Yeah. So I'm gonna ROI quality mm-hmm.

Experience. Mm-hmm. Both on the clinician, the patient side. Yep. Talk to me about how that changed as a result of, the direction you went.

Well, so core to any decision we make, we kind of focus on the quadruple aim, right? Which is that patient population health approach to patient care, making sure they're engaged and have a good experience, making sure the providers and staff have a good experience and are engaged, and that, that it's, it's reducing the total cost of care.

So those four pillars kind of are part of everything we do. So when we looked at the south implementation, we really focused on how do we make sure that we have a scope of work that really addresses all four of those pillars and. So I think that's important to the core of that. And then making sure you have a governance structure and a process where you're identifying, where you're actually deploying the intervention and the people involved at the front levels to cover all four of those areas.

So we had clinicians, we had frontline employees and staff. Participating in the development we had, you know, our finance team participating and that allows you to make that ROI case better cuz then you can really not just demonstrate the cost improvements but also all the other pillars that are important.

Cuz you can't, you should not do one at the detriment of all the others, right? You have to have a balanced approach. So making sure you kind of. Approach. The problem solving in that way helps kind of make sure that all the stakeholders in the organization have buy-in to getting this done.

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It was cute. Right? She's gonna cure cancer with a lemonade stand like only a four year old would.

But from day one, it just exceeded anything we could have imagined because people responded so generously to her.

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We are asking you to join us. You can hit our website. There's a banner at the top and it says, Alex's lemonade stand there. You can click on that. And give money directly to the lemonade stand itself

now, back to the show. 📍  

Well, one of the things I like about Scripps, I saw a presentation from someone from Scripps and they, they showed me clear KPIs.

Yep. They showed me measuring a project once it was done. Right. It doesn't happen all that often in healthcare. I'd love to say that it happens all the time, but it doesn't happen all that often. Yeah. there was a, sense in which, hey, you know, here's the quadruple aim. Yep. We're going to implement this.

This is what we expect. And then getting done and looking at it and saying, this is, this is what

we, yeah. And the way we approach that is we, we really approach it in two segments. You've got your success measures me measuring the process, so the process to actually get to the improvement and then the outcome measure itself.

So process measures are things like, Are you following the right workflow? Are you seeing adoption in terms of enrollment in the application itself, or are you seeing patients engage more and more in the application and then the outcome is ultimately what we're all working towards, which is their quality of care is better, their adherence to their care plans better, their health is improved, and we can measure it by X.

So making sure you have KPIs in process as well as outcome is critical. And we try to do that. We're a lead organization and we try to make sure we follow. Principles of

KPIs. Cynthia, have you, have you guys? It's interesting. I was listening to uh, CIO panel and they were talking about ROI models and published studies.

Mm-hmm. They said these are very important things. I, I assume you have ROI models as you go in and you have success stories and, and studies that you've looked

at. Yes. So a lot of the roi, it comes down to patient engagement. How much is it worth to you to have that patient engaged? So, and that's.

Health system by health system. Like it's not for me to put a dollar value on that. Like you have to tell me what that's worth and then I can tell you what the volume of patients you have at any given point in that engagement funnel. And the other is time saving. And this one, back to the automation point.

This one's a bit of a softer measure. It's like how much is a click worth? How much is three clicks worth? How much is five minutes of admin time worth? How do you measure that? How do you quantify that? And I think that's one of the challenges that digital health in general faces is that some of the measures, although intuitively you know, Yes, there's a benefit saying it's exactly this many dollars down to cents is, is really challenging.

So you have to philosophically believe, yes, this does have a dollar, you know, tied to it in the end, in this range, and not get bogged down in the precision that you might want in other clinical studies,

the, the clinician experience in this, mm-hmm. Now, I mean, what you described is more of a population health thing, right.

But I, I've heard systems who are using Zeal, where essentially they are putting things in the hands of the clinicians where they can engage them with digital tools. They can essentially prescribe digital tools. I mean, we talked to Ashner and, and some others who are prescribing digital tools.

Right. And have you gone that far with the tool yet, or?

We have, but I think, again, core to our principles was how do we make sure the clinicians. Protect the time with the patient was, was protected. I mean, we were actually really trying to get our clinicians away from interacting with the EMR or with digital tools, right?

So that they, because what we found, and I think you hear this all the time, the relationship between the physician and the patient is, is why we're in healthcare. Right, that's, patients don't come to your clinics and your hospitals to experience a weight line in the registration. , they go there to really have that relationship with the doctor.

So our job was to try to protect that and to make sure that we were doing everything possible to support that. So providing communication before the visit, providing education, before having the patient be empowered to a prompt, a physician to ask questions about it. That is much more effective as a tool, right?

Because now the ownership's on the patient too, and they feel personally, you know, accountable to adhering to this program or whatever. So to me you know, population health is about empowering patients and giving them the tools so that they have what they need to take care of themselves, not to make the physicians give them the tools to do it.

And I think if we focus it that way, you're actually gonna get the win on the provider side.

Right. It's really interesting and I, I, I think we'll, close with you is I, I think, about digital engagement. the interesting thing from the consumer side is they have more choices today than they had before.

I think about our health plan, our health plan with my employees. They can go to the payers site and hit that and actually have a telehealth visit before they go to anybody else who happens to be potentially local. And so now they have a lot of, a lot of different choices. One of the distinctions that a Scripps will have is that personal experience is that eye contact is it's really maximizing that over in.

As we talk to as different health systems sort of explore this, they've gotta start to figure out how to compete in a digital world. And I realize we're still the biggest users are faxes in the, in the

world. Yes, yes.

This is true. Only users. I think,


that could be true. Keeping the fax machine in business, that's healthcare


Right. But, but this is, I mean, this becomes foundational of, how do we engage consumers digitally. How do we engage patients digitally in the automation aspect of it with an eye towards what we do well? Are there other examples of how Xealth is working with other clients,

In terms of engaging patients digitally and, and differently?

Yeah. Um, I think the variety of ways that you can use digital outreach. Anything from wayfinding through to device monitoring, like it's, it's the whole range. And the idea of, well, digital health is just downloadable apps. and Programs or you know, it's only for a specific thing. It's really how do you engage with your patients as a person.

So think about their daily lives, think about what they're doing. Everybody knows what is it, 98% of healthcare doesn't happen within a healthcare environment, So how do you think about what the. Person is doing in their daily life. And incorporate your messaging and incorporate your, the timing of when you deliver things into times that make sense.

So when they're thinking about healthcare, so we have a lot of automation that goes out, like around an appointment. Because that's when it's on your mind. Your going to the doctor next week. In advance of your visit, do this, I just got discharged following discharge. Here's some information. So having things in context is what a lot of our health systems are looking at.

Fantastic. Well thank you for your time. Hopefully you have a great rest of the

conference. Thank you very much. Thank you. Thank you.

    another great interview. I wanna thank everybody who spent time with us at the conference. I love hearing from people on the front lines and it's phenomenal that they've taken the time to share their wisdom and experience with the community. It is greatly appreciated.

We wanna thank our partners, CDW, Rubrik, Sectra and Trellix, who invest in 📍 our mission to develop the next generation of health leaders. Thanks for listening. That's all for now.

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