This Week Health 5 Years

Contributors

January 20, 2023: What does the role of CTO for the federal government entail? This position provides a one-of-a-kind perspective on healthcare in the United States. Aneesh Chopra, previous holder of this position and current President of CareJourney, joins us to discuss fiscal policy, and how the C-suite might consolidate and build to scale. What are the tech trends and people trends for 2023? What’s going on in the markets, and how can CIOs grapple with growth and cost savings optimization?

Key Points:

  • CEOs are now looking for product development from their CIO
  • Innovation is taking all the things that you have and doing something new
  • What CIOs need to know and understand about bulk FHIR
  • CareJourney

Register now for our February 2nd webinar: Priorities for 2023. A CIO Discussion with Academic Medical Centers. Only available LIVE!

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Transcript

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

Today on This Week Health.

You're not really building a lot of the tech in most health systems. You're mostly buying and managing and maintaining. But the data piece is critical. I believe data governance is a. Probably the biggest gap from best performing organizations to least performing organizations.

Thanks for joining us. This is Keynote a This Week Health Conference show. 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. For five years now, we have been making podcasts to amplify great thinking to propel healthcare forward. Special thanks to our keynote show partners for choosing to invest in our mission to develop the next generation of health leaders. Now onto πŸ“ our show.

All right. Today we're joined by Aneesh Chopra First CTO for the United States Government and Co-Founder and President of Care Journey, which is a healthcare analytics firm. Aneesh, welcome back to the show.

Bill, thanks for having me, and always a pleasure to join you on, I hope, the hot topics of the day.

And if I can help dispel myths and share ideas about the public sector's role and public private collaboration, I'm eager to do so with you.

Well I appreciate you coming on the show. One of the things we're doing to start off our five year anniversary, As we went back to every year and got the Moses listen to shows, and I went back to those guests and said, I, I, I want you to have have you on in the beginning of this, this five year anniversary.

So I, I appreciate you were on in the first year, in fact, the back-to-back weeks of your classmate John Halamka. And you really set the tone for that first year. And I, I really appreciate you guys taking the time to come on the show. Thank you. Hey. We usually, I mean, we go all over the place, but before we go there what have you been up to? What are you doing these days?

Well, I basically pretend I'm still in the government. And I say that half-heartedly. The Biden administration is a lot of my old friends from the, the Obama years they have not yet named a cto. So occasionally I'll ping my friends and say, by the, , if I were in the role, I'd be thinking about this, that and the other, and might that be useful?

winter, I should say, of, of:

So while everybody agrees in principle that we should be collecting and, and, and screening for social. How to do that, who to share it with, what actions can be taken on it. That's still T B D. And so we got a coalition of the leading E H R systems, a bunch of the health systems, a bunch of the plans, and a bunch of the S D O H network.

So we said, let's, I know we've been at this for five, seven years thinking about these things broadly. Let's get a focused effort to real world test, how we're gonna share and what we're gonna do with the social needs data. And I'm just so grateful that the group came together so quickly. And so launching sync for social needs helping launch project clarity around price transparency.

I'm working on a Teca fire pilot proposal and something around provider data. It's a, an opportunity to do public private collaboration. I'm just wearing my private sector hat rather than my government hat, and I spent a lot of my time thinking about those things. And then obviously in the day job care journey continues to grow in value-based care.

ue-based care arrangements by:

Being

a CTO for the federal government, as I listen to you talk about these things, one is you have to have a long-term perspective. Clearly you have to be a connector Like, you just, you're constantly pulling people together and you have to be a, a I don't wanna say the inventor, but it's somebody who can generate ideas and say, Hey, we could, if we bring these people together, we could do something here. And you sort of get it going. Is that essentially the essence of the, if somebody's thinking of sending president Biden their application, is that essentially the.

job

Yeah, the, the joke I think was that I was more chief collaboration officer than tech officer. And, and it comes from this philosophy bill and I, I do hope many more of the CIO community think about these issues. Cause it is a struggle. There's a ton to do on the day job, but the fundamental up at night issue, whether you're President Obama, president Biden, even President Trump or your own local health organization president. Am I maximizing the value of technology, data, and innovation to do X? And what ends up happening is executives know what X is.

Grow our commercial revenue base, expand in the Medicare advantage embrace some type of virtual hybrid integrated offering to expand access. There's lots of things to be done and the nagging question of whether or not technology, data and innovation are being optimized, it's a little bit of a gap in the market.

So there's a strategy and a business team looking to do the growth objective or the quality objective or the consumer experience objective, and they have some understanding of technology. They may come to the CIO for guidance. More often than not, they're getting educated by vendors and they come to the CIO for deals.

And so there's a little bit of a chicken and egg issue If, if I were in the role today, the way I was in the Obama years, I would be building relationships with the key cabinet members, secretary of Health, secretary of Energy, secretary of Education, and so forth, and asking them for their goals and objectives to hit their priorities and then learn where technology and innovation can be brought to bear.

Inevitably, we're under leveraging the internet, and so my philosophy was always like, embrace the internet make the internet more secure and extend its, its. And then think about applications that are built for purpose that can run on, on internet platforms. And so inevitably there isn't a healthcare strategy on the market today that couldn't do more, be more impactful, get more results if it had fully taken advantage of technology, data, and innovation.

And in this context, regulated technology data innovation, which I think is a unique aspect of the healthcare market, which is different than a. Conversation about FinTech or some other issues.

st of of:

What are the tech trends? What's coming down the pike? I used to lay out a five year, Hey, these are the things I think are gonna impact us. Not only look at the tech trends, but look at the people trends, what's going on in the markets. People our people. Well right now we have remote work and a bunch of other trends going on.

You have to always be aware of those cuz you employ. 30, 50, a hundred thousand people, you gotta understand how they're thinking and moving. So you have the tech trends, the people trends, but then the business trends are so important. And that's where I wanna start with you. the, CIOs today? It used to be, Hey, optimize the E H R, get us a new ERP do this, do this.

It was almost a task driven project, but. Where are we missing the strategy piece, the stepping back at the end of the year and going, all right, where is this going? What are the things I need to keep an eye on? And be that that person who's maybe out in front, or at least they're head above the water looking around saying, okay, for our organization, I'm gonna come back. This is, this is what I'm gonna bring to the table. The cio at this point,

I, yeah. And so here, here in lies, Maybe let me peel this onion. Three layers. Okay. Let's start with the first layer, a little bit of a state of the union. In healthcare, we are entering a period of aggregate fiscal constraints. There's always a moment every 10, 15, 20 years where we, we ebb and flow where the country screams.

No mas and we ended up with some version of the balanced budget Act of X Y, Z year that slashes rates and puts healthcare on a diet. And we react to a lot of pressure, feels a little bit of an across the board slash and burn frustration, not very surgical and probably detrimental to overall patient care.

And yet we find ourselves in these rhythms because healthcare is growing faster than inflation. When you're printing money and you don't really care about the debt and the deficit. You can kind of get by with printing more money. But we're entering a period where that, I wouldn't call it a gravy train, but that financial model is gonna hit, hit a proverbial bli brick wall.

And so there's gonna be a great deal of aggregate pressure to constrain healthcare inflation. The individual markets are rife with their own operating issues. I need more revenue. , I need to constrain escalating costs in labor, in supplies. And so you might optimize for your local health organization's fiscal priorities.

But in the aggregate, if everybody optimized it only accelerate the fiscal response, which is gonna be a slash and burn on anything. So the challenge for the c i o, given the first layer of the. Is that you kind of have to anticipate where we're heading to revisit whether you've got the right approach on technology, data, and innovation.

And the only way out of a fiscal calamity is if we can solve for bettering the care within the existing healthcare budget. May. Intensive inpatient care, more of a shift to outpatient, which is already happening, maybe a little bit less in person. If we can replace with lower cost virtual maybe god willing, more value-oriented investments of prevention and wellness so we can re force all the progression of disease.

And if we start to think. Growth and cost savings and optimization in the context of where our organization will hit this proverbial national constraint. Well then you wanna know the question, what are we doing to contribute to overall savings for the system, but allow us to still thrive locally? And my guess is the C-suite and the.

Is grappling with this issue and making big strategic moves? Do I have to consolidate and build scale? Do I have to position myself as the absolute. Most important provider in a in a network and command a kind of premium rate structure. As a result, am I willing to make the bet that I can deliver better outcomes than my neighbors and put some revenue at risk as on account of that commitment.

If you don't know where the strategy of the organization's going, it's hard to anticipate backwards what the technology requirements are, which leads me to my third layer of the cake Bill. Compliance is minimum viable. We have to be ready. The Cures Act rules have come out. Not only do the EHR systems you work with, have to ship products.

o the CARES Act no later than:

I may not do much. I may simply flip the switch on and, and allow them to operate, but I, I kind of know the movie, but the Cures Act adds a physician access API and a population level a. How am I gonna open up an app store for my doctors? Am I or am I gonna make them continue to su struggle interacting with the electronic systems that we have put in front of them by hook or crook?

Will I engage in a more population level sharing relationship with health plans, public health agencies other strategic partners? And if so, what will that look? So my view is compliance is minimum. You gotta turn on the lights, but the real question is, are you gonna use any of this infrastructure?

Are there use cases that you've been told by your colleagues about how to unlock this information? Or worse, are they telling you without telling you? I think a lot of the demand signal for some of these new technologies, the regulat. They're embedded in other use cases. Hey, I wanna improve my Medicare Advantage quality performance.

Well, that, that may not speak to you about how the Cures Act will come into play, but it may be a critical factor in how you interact. With the health plans to jointly identify patients that are in the community that are not getting the care they deserve. So I think Bell three layers understand that what you're doing for your day job against the backdrop of the national priorities, that's gonna come into some struggle sooner than you may think.

Two making sure that you've got a little bit more awareness for the underlying drivers of. and then map the new capabilities that are coming online such that you're prepared to educate your peers on what they can do with that information to be successful.

nd. It is priorities for:

Cuz you say a lot in a very short period of time, and I had to, I had to write it down to see it. So you, you said, look, this is what we're looking at. Aggregate fiscal constraints. We are going to, we have individual markets sort of going at, at. Local markets and national markets, depending how larger our labor supplies costs in general that we're optimizing for.

And then there's this whole compliance aspect that we need to understand the things that are coming together. One of the things, and you've used the this terminology pretty often, and I it's probably you, you're probably gonna laugh when I just throw this back at you, like, it's like it's some sort of framework, but tech, data and innovation.

Yes, sir. And the reason I throw that back at you is the old thing about the CIO was they're tech driven, right? They keep the data center running, they keep this going, they, they implement new systems.

These are nouns. I have to buy things, maintain things. Yep. Right? That's, that's the tech

and, and the tech moved from hardware to software to cloud, and we feel like, hey, we're being. Innovative and those kind of things, but we're not really being innovative. We're not taking all the different levers and things we have. Innovation is really taking all the things that you have and doing something new, something different than the way you've done it before. And it could drive cost out of the equation, could drive quality, could drive something that strategically helps your health system, product

development.

to me, the three layers. So the tech part of the job is a sourcing G P O job. You're not really building a lot of the tech in most health systems. You're mostly buying and managing and maintaining. But the data piece is critical, right? I believe data governance is a. Probably the biggest gap from best performing organizations to least performing organizations.

Just a, a little bit of a non-sec, I'll get back to innovation in a minute. But on the data issue, I often ask the question, do you remember that letter epic sent right before the Cures Act went final. I nobody can forget that letter. That letter. Oh my God. And I, I, I do tease my friends at Epic, and I do love everybody.

I love Epic, I love Cerner. I love everybody. I was jokingly referring to that as like lobbying malpractice. Okay. It, it was organized after the thing was already written. For what purpose? I don't know. It's, it wasn't gonna change the outcome. It was just gonna create more frustration. or get people's hopes up.

I dunno what it was, but here's my point. Embedded in that letter was a lot of kind of concern that third party applications would be selling data to call it pharma, whomever. Yep. I would go to health system CEOs and say I, whether they signed the letter or not, I want to, I won't get into the details of who signed, but are you selling data?

What? . What do you mean? I'm a hospital. I do this, I do that. I'm like, oh. Are the B D A A contracts that you've signed constraining any of the vendors you work with from selling data? What, what do you mean? Where do you think all this data's flowing? It's data comes outta your systems. Oh, it turns out.

Indirectly directly, you're getting a discount when you purchase the technology. If you allow the data to be used in a de-identified way, so it doesn't violate hipaa, but you could be. So I'm like, wait a minute. So what are you saying? You are or you are not? Do you have your arms around like data rights and use?

Are you organizing yourself to understand the markets in which you're operating? Like, walk me through your data, not your tech. I get your tech, you're buying things, you're up. , where's the asset? And so I do think there is a data governance gap that best performing organizations make it clear that we wanna retain control over access and use of the data.

We will use regulated technology i e bulk fire APIs and the like. So we can make it easy to interact with the data, but we wanna retain. . And so I do think a big part of the technology data and innovation question is you got the G P O issue on the tech, you got the data governance issue. What rights do you have?

What? How do you reduce harm? How do you maximize the good? And then on the innovation side, who leads product development? What's the digital front door? What's. Harry Potter sorting hat that says you need a consult. Let's make sure you're connected to the very best person, not the first available random list of my go to the, go to the average hospitals, find a doc page bill.

How does it sort by last name, by specialty, right? Is that a way for me to match.com? My clinical needs to. To the faculty that you've got or the, the, the affiliated clinical network. So innovation is what's the product development experience, what's the user experience, physician user experience, nurse user experience patient user experience community user experience, and how do we think through a way to harness all the assets in the organization to give them a better experience?

πŸ“ πŸ“ In:

πŸ“ πŸ“ All right. So, but I'm gonna bring you back to the first. Aggregate fiscal constraints. Yeah. Not good news. Well, not good news. And you're talking about developing new capabilities, product development data, some data governance. I mean, we all have data governance, but e essentially expanding that and doing a better job.

So the. . The challenge around that is as people hear this, they're like, what do you expect us to do? The innovation side of it is going to slow down over the next couple of months. But one of the things I was gonna say to you as you were sort of talking through these challenges, first of all, there's always winners in a down

economy.

By the way, why should the innovation engine slow? It shouldn't.

I mean, it's the case I'm about to make it, it, it can't. In fact, there's always winners in a down economy and those that are able to innovate during that down economy are gonna be able to position themselves well, coming out the other side, and we're not even sure.

No one at this point is saying to me, Hey, this is this is the, I mean, you said a normal 20 year cycle, it's, it's down, it's back up and that kinda stuff, but no one's looking at me saying, yeah yes, we had the pandemic. Yes, we're having a recession, but yeah, we're just, we're gonna bounce back out of this in two or three years.

I don't hear anyone saying that. I don't know if that's gonna happen or not. . We always need healthcare, so it would lead me to believe that we are gonna bounce that back out of it. But the challenge is health systems operate on such thin margins as it is, and they really only make money from like three or four things.

They have to innovate out of this. They, they're, there has to be, it's not, Hey, let's wait for a new model. Let's wait for a new, you have to innovate out of this. What are some of the ways you're a former cto? I'm a former C C I. , what are some of the ways we innovate out of this? We grow our market share. We, I mean, what are we, what are we thinking about at this point?

Yeah. Life is about threes. Job number one will probably be a cost savings product development portfolio. So, so let's go back to the Cures Act. So now every doctor. In every health system in every corner of the country has certain rights, rights to data, and more importantly, the rights to install third party software to help them become more productive in on, on top of these sort of regulated platforms.

Healthcare is the only industry bill where we spent all this money on it and productivity went. , right? Only industry. So part of that is we sort of jammed certain capabilities into the organization. They weren't built for the kind of productivity gains. They somewhat argue, oh, blame the government. Anish, what are you talking about?

You're part of the problem. You, you made us to do all this extra paperwork. And I get, there's a lot of debate. How much prescription we put into the electronic health record certification rules and how much we were anticipating value-based care, and that would've been fuel for that future environment to be more productive, but may not have been as productive in the fee-for-service era.

What, whatever the circumstance, imagine unleashing every one of your pods, clinical pods to say, you know what could you do the job we ask you to do? 30%. . Well, if we did X, Y, and Z things with the information that I have access to, but I'm reentering everywhere or I'm, I'm, I mean, bill e faxes are going up not down from certified electronic health records to other health organizations, which means, oh, I've built this cool technology that can optical character recognition the.

and convert into the fire format, and I can put it back into my data warehouse, right? Innovation, no, massively unproductive. So if we unlocked all of the tech platforms thanks to the Cures Act, maybe we fast track productivity enhancing solutions, some of which could be made by kids in a garage. Like a get the go to the local university and say, Hey, I'll put a $10,000 price competition for the app developer that helps a doctor do X, Y, and Z.

And of course, now your audience is gonna say, oh, an you fool. What about security? High trust can't do that. No, you,

you can do that. Everybody knows you can do that. You can create

sandboxes. So the point, thank you, layer one, unleash the platform. For a democratized menu of cost saving, productivity enhancing capabilities, and let's call that incremental innovation next layer of the cake.

There's some revenue challenges we need to compete for business. Well walk over to your marketing officer and say, what's our strategy? Well, we've got billboards on I 95. We've got ads in the physical papers. If, if that's a thing anymore I wanna harness technology, data, and innovation to get folks who'd be great customers of ours because we're excellent at delivering service A versus B.

You might say in the innovation space, how can we unleash the power of thoughtful, compliant, approachable personalized outreach so we can recruit the kind of folks that we wanna bring in May, maybe it's folks we used to care for in the past, or have seen an affiliated physician and we wanna reach out to them.

We can do so much more, bill to build a better intake product. To get folks to decide Harry Potter, sorting hat, that would be a great place for them to get care. So maybe that second category is in the revenue growth bucket, and it's, again, unleashing what is possible in consumerization of healthcare.

And we, we may get into the details here, but they're entitled to good faith estimates for price transparency. They can figure out who the high value doctors are. There's a whole litany of things we can do to discriminate on copays and deductibles for, for certain high quality services that can make this more affordable for people.

So that's basket two. And then my dream is basket three. What if we actually took the expected total cost of a patient for a given year and took that responsibility and said what we can do is we're gonna reallocate the things that we do with that individual and overall lower that total cost of care.

This is again, you said December 1st. So later on Thanksgiving, CMS released the first year results for the Medicare Direct Contracting program where they created this capitated budget. Organizations like Peace Health, Metro Health Intermountain, they're all in that A C O Reach program. All of them made three, 4% net savings rates, millions of dollars on a very small pool of patients because they figured out a way to better coordinate that care.

And if, if you are the c I O and you're not thinking about product develop, That's all about the 95% of the patients in the community who are not coming into your health organization to get care that day, but need some outreach and thinking about that c r m capability, thinking about decision support, thinking about ways to activate individuals to kind of stay, I wouldn't use the word adherent, but active on their care plan.

As a team all of this is possible. Bill. We can build products and services, cost savings, growth, total cost of. Wow.

Product development, it's interesting cuz that has a connotation to it, but that's, this is exactly what the CEOs are looking for from not only the c i O, the Chief digital officer, chief strategy officer, chief Medical Officer, they're looking for innovation creation.

New ideas, new thinking around, hey, how can we do this differently, better in different approaches? And one of the things we're not looking for anymore is the person who, who's sitting in there going. yeah, I can acquire this technology for you. I can acquire this technology for you. I can get you a shopping list of things.

Hey, I found a product that does these things. It's more if I hear you correctly, it's more about looking at all the things that are coming, looking at the, the regulatory things that are coming down, looking at the innovation that's going on in the space. It's looking at the people that you can tap.

and say, Hey, you know what? We don't have all the ideas. Let's see what ideas they can tap into. And creating that not only a sandbox of technology, but a sandbox of innovation where they can come in and start plugging in and doing things pretty rapidly on de-identified data and on systems that are not tied to our production, that they can prove things out and go.

I think we can save that 30% you were talking

about. I think a lot of the ideas may be to open it up within your walls. So a lot of the conversation on your show is, Hey, how did you manage this? Did you onboard vendors? Did you how did you find those tools? For sure. That's a thing, and a lot of your audience understands how to go about learning the landscape of new capabilities on the market and figuring it out.

The exciting thing for me, with all these rules, Your best innovators might very well be on your staff. Secretary Seci and the VA did an internal innovation competition. Every 90 days we he would organize this like competition to say, gimme the problem you wanna solve and then let's go find ways we can sort of, MacGyver.

A solution. And that let's celebrate almost like a, a celebration prize more so than a monetary prize kind of the best of those teams. And he would ask all the VA. Local pods, the, the vis and within the vis the community groups to come up with those things. And there are so many examples, bill.

People would say, oh to get someone qualified for disability benefits in the va, I have to fill out a 15 page form, 80% of which is content that's already in the E H R, but I have to reenter it all. Simple, obvious things. Oh, what if I had a pipe that prepopulated? Oh wow, you just saved like a huge chunk of my time.

So there's a lot, a lot of stuff we can do. If you. , if you put the goal, the problem you wanna solve out first unlocked the assets thanks to all the regulations, and then celebrate it with your colleagues who can do the best job. But maybe it's vendor partners, maybe it's in-house staff, maybe it's platform partners the big cloud platforms, the, the CVSs and the Walgreens and the Googles and the Microsofts and all that.

What,

what does the CIO need? Know and understand about bulk fire. Bulk FHIR, to me, is one of the most interesting things out there that maybe there's, there's still some confusion around where it's going to be used.

I think we first need a basic understanding of APIs versus interfaces. Most of your friends and colleagues understand the language of interface.

each one is purpose built. Then we saw market innovation where companies came in and said, we can create a pipe and then reuse that pipe to others. And so there's like an interface per use case or an interface pipe for many use cases. And they're all interesting, but they are all architected on the interface engine, right?

APIs a allow us to embed governance. In the data flow, and that is what I think is the most revolutionary muscle for a cio because now you can grant and create a p i tokens that meet specific use cases. I'll unlock the medical record one time only for the purposes of getting real-time adjudication on prior authorization for a much needed cancer.

or I will share all of the information for a full year with my risk-bearing physician network partner. I can take the same underlying assets and the marginal cost of creating a token is negligible minutes, hours at the most, and I can build very tightly defined constraints. The APIs. Today's APIs are either binary, all patients or one unlocked by their username and password to their patient Portal account.

Bulk fire gives us that Goldilocks happiness. In the middle, I'm working with a strategic partner. Let's just say Walmart and I share. A thousand patients with Walmart mutually agreed bulk fire allows me to build a key constrained to just the thousand patients in my relationship with Walmart. And so I can hand Walmart access to my underlying APIs, the fire infrastructure, but I'm careful that I haven't allowed them to misuse that token to query for someone that may be shopping at a Walgreens or a cvs and I control.

Through bulk fire, I will have a regulated tool. I can log into this tool and I can create the parameters. What are the parameters? One, what's the underlying population for which I'm willing to expose access through the key? Two, what content will I give them? Access to? All of the fire resources or a few?

Three, for how long will I grant this access Immediate. always on until revoked, or a time limited duration tied to some contractual agreement that we've mutually agreed upon. Bulk fire is the new regulated appliance, kind of like opening up Excel for the first time. It could sit there gathering digital dust, doing nothing, or we can learn to program it to optimize our daily challenges.

that we're entering the year:

This isn't about the blockchain. You don't need to know machine learning. You just have to understand basic a p i management.

Yeah. We're coming up on our time. I love our conversations. I wish we could have more of them throughout the year, but the let me let, let's talk about strategy for a minute here.

One of the challenges that I've seen in the. Is I will talk to CIOs and they'll ask me some things and I'll say, well, what's your organization's strategy? And they will look at me and say and they'll gimme some generic answers and I'll go, no, no, no. What's your organization's strategy like, what are You What are you focused in on? Like, we had a, and I'd give 'em an example. We had a six pillar strategy and the six pillars were around quality and, and community and access and and I'd talk about each one of those and this is what we were doing. And they'd look at me and go, yeah, we don't, we don't really have something to that level.

It's more along the lines of whatever. Who here's what I want you to do. I, I'm, the easiest way to not put you on the spot is to say, think about an organization that you're like, man, this organization really has it together. Yeah. What, what does it look like? What is, what is the interaction? What does the development of the strategy look like and the interaction of the players look like?

Clearly, you're gonna hear a lot of this from organizations on the change. That is to say, if we've been doing the same thing for 10, 15, 20 years, but just slightly better, slightly faster, slightly cheaper, the strategy may not be articulated as net new because it's the same strategy of the past. Just needs to be refreshed with new tools on the market allow me to do more things to accomplish the mission objective.

By the way, there's value in that. It's the change organizations, the ones that are saying the following, I need to. H c a level operating performance. If I'm going to sustain my health organization, which means I've gotta turn 10% administrative SA savings by being much more operationally efficient, go down our,

and our metric was we wanna make money on Medicare.

Like that was a metric for us. Perfect.

And, and not only do I love that, it's me. We know what it takes. It's about identifying early length of stay improvement opportunities. Cause you got a fixed pot of revenue. It's thinking about appropriate handoffs. So on the way in, you're already beginning to plan for next discharge.

So what's the relationship like with the primary care doctor? So how many patients have been admitted today where the database says PCP not found? Okay. Yeah. . And, and, and to even go a step further, how many people looked at the c m s requirement that we must turn on a d t feeds to community doctors as an annoyance and a frustration and a burden and a vendor thing, not a thing that they have to solve for because you, all these things come together.

You wanna get to Medicare profitability, which by the way, everyone should work towards Medicare profitability if you are not calling the pcp, when that patient's in the emergency room to plan. Their entire length of stay, you're gonna set yourself up for failure on the Medicare breakeven goal, interoperability becomes a must do, not a burden on compliance and, oh, what's the security and how do I figure out who everyone's primary care doctor is?

And just all this, it feels like annoyance unless you understood the strategy. Medicare breakeven fixed revenue, slightly enco. Uncoding, slightly accurate. Is this patient morbidly obese? And if so, what would that do to us on our sort of reimbursement intensity and post-discharge follow-up.

So there's a very clear strategy on cost growth. Same question. Where are patients coming from? What share of the patients who come to us get care from competing organizations for other parts of their health need? How do we communicate the value of integration? So these are. Fairly tried and true strategies that you don't have to have like the perfect crystal ball to figure out the future of the country.

To know, gotta be cost effective, gotta grow my revenue base and maybe, maybe, maybe value-based care becomes a thing. I've gotta organize the total cost of care as a bigger, bigger, bigger D R G and manage that in a more effective way.

Anish, always fantastic to catch up with you. Hope to be catching up with you at the JP Morgan conference or wherever.

Yes, sir. We happen to run into each other. Would be fantastic to sit down and grab a cup of

coffee. I can't wait. Thanks for having me and my friend and God speed to you and your family on the πŸ“ holidays.

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