This Week Health

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December 16, 2023: Welcome to a special End of Year episode where Bill sits down with our regular Newsday hosts. Drex DeFord from CrowdStrike, Patty Hayward of Talkdesk, Dr Colin Banas of DrFirst and Ryan Witt from Proofpoint. If you could sum up the biggest 2022 healthcare IT news headlines in a couple of words, what would they be? What are CIOs and CEOs doing to tackle these issues? How can we shape tomorrow so that the future of healthcare embraces more technology, more information, more innovation and a different delivery model with the patient as the ultimate consumer?

Key Points:

  • Healthcare is ripe for more disruption which is going to be painful for traditional providers
  • If you spend all of your executive leadership time figuring out how to survive, you don't actually ever figure out how to thrive
  • We need automation that has a good hard dollar return

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

Hello and welcome to this Week Health. My name is Bill Russell. I'm a former C I O for a 16 hospital system and creator of this week Health, A set of channels dedicated to keeping health IT staff current. And engaged. This year marks our fifth year of making podcasts that amplify great thinking to propel healthcare forward. Through these years, I have always enjoyed learning from each episode I get to record. Today, I wanted to share that experience with my guest host from the Newsday Show. I'm joined today by Dr. Colin Banis. From Dr. First Drex de Ford from CrowdStrike, Patty Hayward. From Talk Desk and Ryan Whit from Proofpoint we have discussed so many news stories this year that I thought I'd pull these people together. And today what we're gonna try to do is look at the themes for this past year and talk a little bit about predictions. It's that time of the year. That's what we do. So special thanks to our Keynote show sponsors Sirius Healthcare, VMware, Transcarent, Press Ganey, Semperis and Veritas for choosing to invest in our mission to develop the next generation of health 📍 leaders.

All right, here we are. End of the year show. This is newsroom. This we call newsroom and we have five, five including me, of our newsroom guests who have been on the show about six or seven times this year to talk about the news that shaped this year in healthcare and healthcare it.

And I'm just gonna go around here. I don't do this often, but I have the Brady Bunch sort of picture. I will change this in a minute because otherwise people will comment how Patty's not interested in what Drex is saying or that kinda stuff. And so I just, I we go to the big screen so that you just see the person who's talking.

But around the order here, we have Dr. Colin Banis with DrFirst Drex DeFord with CrowdStrike. Patty Hayward with talkdesk and Ryan Witt with Proofpoint, and you should know them. They've been on the show. We've talked about the news all year, and I'm looking forward to this conversation. the premise for this is real simple. What's the news that's shaped 2022 from a healthcare and a health IT perspective? We have a lot of news stories to choose from, but if I ask you, Pick a theme and we'll stay in the Brady Bunch theme for a second. what's the theme?

Do you think? Without too much around it, just what theme would you say if you were gonna name 2022 as a movie title, what would the movie title be? We'll start with you, Drex. What do you. Man, I think it has to have something to do with the pain of the financial stress that the entire system is under right now.

And it's, it's financial stress, it's resources, it's people, it's people resigning, it's people kind of quitting in place. It's all of those sort of resource challenges that I think healthcare faces right now. absolutely could be. We'll see if somebody else has a better answer, we'll go to, no, sorry, , I don't wanna do this like a game show, but Patty, Patty, we'll go to you.

What do you, what do you think? Oh I think the word is disruption and that can encompass the financial side. It can encompass all of the new entrances or continued entrances into the market from retail technology, et cetera, to just how do we recover from. Something that's really not going away, right?

I think we keep saying we're at the end of Covid, but we're really not, and how do we continue with sort of it's not even a new normal , right? It's just a brand new day and how do we, how do we change? So I think disruption is, for me, the word. Yeah, absolutely. Colin, you're next in line Patty stole it. I was, I was really gonna focus in on the non-traditional entrants or the march of the non-traditional entrance into the healthcare space, whether it's.

your Amazon and OneMedical or CVS essentially building its own vertical within the last quarter all the way down to the Walmart stuff. I think as I said last time you and I talked, it's time for The traditional clinics and health systems to be on notice that these guys are, it's actually becoming a reality now.

And I think we saw a lot of that in 2022. What I called sort of poking the poking at the barrier, trying to figure out what works to break in and really change the paradigm. Yeah. And it doesn't take much, right? We're, we're talking about a three or 4% margin business. They don't have to take 10% of the business, they just have to the profitable business. Enough of the profitable business. Ryan, how about you? I had the advantage of going last year, right. So I agree with the financial turmoil. I agree with the introduction of interlopers taking a significant portion of the healthcare pie. This industry is, is ripe for digital transformation.

It's kind of late to that party, but I'll go with a new topic, which is, this is the year maybe. In, in a bad way. Cybersecurity really has arrived at healthcare doorstep. It's been a problem for many years, but I think the difference in, in 2022 is the understanding that a cyber event can have a direct impact on a patient outcome.

And the realization at the, at the executive level and the board level, that this really is a patient safety issue. Now. It's not just about reputational harm, financial risk, loss of patient data. It's becoming a patient safety. issue All right, I'm going to the speaker view, and so whoever's talking at this point, you'll be on the screen and the rest of us can take a drink of water.

But I really want this to be a discussion. I, I wanna start with cybersecurity. Two years ago we had, was it two years ago? We had scripts, and then this year we had Common Spirit. I think that's how people will remember it that we've had a very major event last year and very major event this year.

Will that continue in 2023? Do you think we will have another one, another major health system that will get breached or ransomed in 2023? Ryan I'll start with you since this is, this is your area and Drex, I'm gonna come back to you in a minute. I mean, there's every indication that that's going to happen, right?

So there's no reason to think, think it's gonna change overnight when the calendar ticks over to 2023. Additionally, you're seeing a lot of financial pressure on the industry right now, which means We're gonna retreat, we're gonna start taking budget. You're gonna see some of those defenses, some of those budgets are not gonna be spent.

The threat actors are having more challenges. Trying to make money from their side or pill for money from their side, so they're gonna be more motivated. So I think it's it's kind of a, this proverbial perfect storm. So I can't see , how it doesn't change in 2023. There's no pending regulation coming down the pipe that's gonna say, okay, all of a sudden there's a pot of gold to go make investment in an investment that wasn't necessarily.

You can't see right today. So I, I, I can't imagine why 2023 will be any better right now. I don't want to be a doomsday, but I can't imagine it's any better than it was in the last couple years. And we probably will see very large brands, household names have massive disruption and their ability to provide patient care in the way that they plan to or in line with their mission is highly likely gonna be compromised.

Drex thoughts on this? I can't disagree with anything Ryan said. There's nothing that indicates to me that there's gonna be any sort of disruption in this pattern. I think we'll probably see Continue to see several health systems hit with ransomware, data exfiltration that will disrupt operations as Ryan sort of talked about and it is a patient safety issue.

I think the Warner Report that just came out talks a lot about that. Certainly has some promising language in there. Around some version of maybe a meaningful use for cybersecurity like program for healthcare, but we'll, we'll see how that goes. The devil's in the details. Every time that we do something like this, there's always some significant unintended consequence.

yeah, I don't see anything on the horizon right now in the near term that. Is gonna lead me to believe that we're not gonna have more continued regular drumbeat of ransomware data xFi impact on patients and families. Every time somebody says Warner's thing is meaningful use for cybersecurity, I think somebody in Warner's, like staff just goes.

Ballistic. Just like I can't, we've gotta get the messaging right. These people have to stop saying meaningful use. Yeah. Cause it's, it's the meaningful use term itself. That is the thing that, you know, because it seemed like such a good idea and then it had a lot of unintended consequences. I think that's the same, that's the same burden this will be saddled with.

It's gonna be hard to get it right if that's what they decide to do. Too much baggage. By the way, it, since none of you asked me, I'll tell you. I mean, my, my theme, about the middle of the pandemic, I said, I believe that we will mark time in healthcare on the pandemic. We will essentially say healthcare before the pandemic, healthcare after the pandemic.

And I think we've seen the tipping point and we're not going. So the question becomes, if, if that were true, that's my premise. But if that were true, then things like the clinician experience is gonna change, the patient experience is gonna change what health systems, how they approach those things have got to change.

And so Patty, I'm gonna come to you. I mean we've talked experience all year, especially around the consumer. And for years leading up to the pandemic, we would talk about the consumer experience and sort of get brushed off, like, yeah, they're not going anywhere, right? I mean, they're coming to us anyway.

How's they gonna go? ? Yeah. I mean, but are, are, are, do you think that's gonna change? Is, is that one of the things that's just fundamentally changed that health systems now are saying, no, we've gotta treat. Consumers and our patients, like Amazon treats their consumers and patients.

Yeah, I I think we're, I think we're all realizing that the patient experience and really you're a patient, sometimes a consumer, always, so, Really looking at folks beyond just what happens when they're in the four walls is really important. If you look at what the new entrances into the market are doing, that's where they're focusing, right?

They're focusing on how do we look at those more high profit areas? How do we look at areas that we can really disrupt and for good reason? I mean, if I had my own healthcare event this year, and being a patient sucks , it's really difficult. It still does happening, and anybody else have that experience this year?

I mean, every time I go, I'm like, It hasn't gotten better. No, I mean, even as an insider, right? Even right. People who work in health systems who can grease the skids for themselves. It still sucks as an experience. It does. It does. I, I laughed because I had to go to a specialist and I got I, I tried to call this office, I don't know how many times in a row during the week, and all I got was voicemail and leaving all the information I was supposed to leave and saying, okay, this is the second time I've called.

This is the third time I've called. No call back. I finally get a text message from them saying, Hey, we've got, we've, we've got your referral. You should call us . So I sent a text back saying, I left five messages and I got the hey, if this is an emergency, call 9 1 1. Otherwise if you have a problem with we don't understand what you're saying.

And it just, it, it, everything is so fragmented. I think people are trying to adopt technology with good intentions. I think that that. Probably thought, Hey look, we have a problem with referral leakage. Let's try and solve it. So, hey, let's send people text messages when we know that we have their, but they didn't solve any of the problems and nothing's connected.

And I think that typically we see, especially when we look at in health systems, when we adopt stuff. We take this perspective of, let me look at it from one department's perspective. I'm gonna solve the problem that's right in front of me, and they're not taking holistic views, and we have so many stakeholders that all have to weigh in that by the time you end up at the end of it, you're two years in and you haven't really solved the problem to begin with because it's gotten so muddled.

It's a bit like congress. Yeah. Well, I, so I'm gonna tee up one more story, but before I do that, I have to tell this story. I went to roll out a portal as CIO for St. Joe's and rolling out the portal required us to do it to our ambulatory physician network and whatnot. Well, we didn't employ them.

They were part of a foundation and there was five boards. So to roll out my, my the portal that we were gonna roll out, They told me, Hey, you gotta go get approval from these five boards. So I went and got approval from the first board, but they wanted their physician to weigh in on it. So he had a bunch of changes and he changed it.

I then went to the second board and they said, well, we have a physician who needs to weigh in on blah, blah, blah, blah, blah. And that whole process going through five boards and invariably number of whatever was well over a year. It was almost, it was like 14 months. It took us to roll out a portal that essentially.

Very basic. I mean, it was just the medical record and a couple of order your prescriptions. We weren't even doing scheduling at that point. I mean, it was but yeah, it took 14 months. I don't think things could take 14 months anymore. No, I mean, if you look at who's coming into the market Amazon already started and asked an entire business model and is moving on to the.

I mean, these guys know how to rapidly innovate and they know how to fail fast and how to continue to iterate on models. If they're gonna want to stay competitive, the ability to do some of the things they did during the pandemic with some rapid adoption of technology, like we learned, we had to.

So we did. That's gonna have to continue to stay and become a little bit more agile. A lot more agile in order to stay competitive. I. So I'll tee up the third thing, which I think is indicative of the stories that we talked about this year. I mean, there's others and, but after I do this, I just want you guys to cross talk and go where you go.

Colin, I wanna come to you. This is, this has gotta be the year. We talked about clinician burnout, clinician shortage, clinician inefficiency. I mean, just not enough technicians, you name it. They, they got to the breaking point. They left the industry. They like, they didn't come back to work.

They just a lot of really crazy things happened. Are we gonna be able to fix that? Which I think we all know the answer. There's, there's no fixing it at this point. This has been more, more than a decade. So lemme come up with a better question. What's this look like going forward with fewer clinicians, with a clinician set that is no more happy with the experience than patients are they wanna deliver a great experience and have been frustrated that they can't?

I mean, what's it gonna take? For that group to turn the corner and start to really enjoy practicing medicine again. Oh man. If I knew that it, it's bad. I mean, to, to go to your earlier point, it's bad. I think when you and I talked it was 25% or contemplating leaving in the next year, like leaving all together.

And it's not just the doctors, it's not just the nurses. It's actually all the way down to. The folks who clean the rooms or transport the patients. I mean, I think hospitals, health systems, clinics are having trouble hanging on to anyone. And of course it's set up this really sort of awful cycle of having to hire traveling folks to do things at triple the cost.

And Hopefully trying to find innovative models to, to still continue to provide the care. I think one of the things that we've seen, and I think that needs to be accelerated is the, the more of an advent to team team based care. So everybody working at top of license, can I get a medical scribe?

Can I get a medical assistant? Can I offload some of the minutia that perhaps some of the doctors are facing and, and equally distribute that I think that works in some clinics, but I still think there's some specialties that it just doesn't lend itself to at all. But to come full circle, it's bad.

It's and by the way, we're not just gonna commiserate on on how bad things are because things are, are challenging. I mean, we just went to some events and we talked to some people that are challenging. I just interviewed John Halamka the other day who we, our first conference episode for the new year, and he was talking about Mayo and he had to go have essentially he has a problem with his ears.

He had to go and he, he said, He saw three specialists by 11 o'clock in the morning. Then he saw his primary care physician who sort of wrapped it all up and said, okay, here's what we found, blah, blah, blah by noon. All right? And when he just, when he got done describing it, I just sort of, I'm like, John, I mean, you just described four months for most health systems.

Like to go from that specialist to that specialist, to that specialist, and then back to your primary care physician to have it all wrapped up into bow. Why is more healthcare not like that? Where it's like, you know what we need, we need this stuff. We need an M r I. We need this. We are, we already know basically what we need.

Why can't we make it more efficient and better, not only for the consumer, but probably the clinician if I thought about it? Yeah, I think we're, I think we're terrible at logistics. I think there's also competing priorities, at least back in my old C M I O days when you were mixing imaging between inpatient and outpatient there was a certain pecking order of who got to go when and perhaps the specialist you need isn't always available to Lyme.

That Mayo is very unique in that. They're getting referred very specialized cases that have already had some semblance of a workup for the most part, at least from my understanding. And so there's a little bit of pre-planning you can do, and I don't think that most healthcare lends itself to that kind of pre-planning.

But to come full circle, the logistics that we use is no nowhere near what other industries have in terms of being able to deploy and, and move assets around to make sure that everything's efficient as possible. It almost sounds like by proxy we're giving our main prediction for 2023, which is more disruption for healthcare, right?

Yeah. We talked about burnout, we talked about disruption. Anyway, we talked about healthcare account. Moving quick enough, we're talking about others entering the space, low margin business. It sounds like it's ripe for just more, more disruption. And, and it's gonna be painful for traditional providers.

It might actually be quite exciting and interesting for health consumers as the alternatives proliferate and those experiences have a opportunity to be better than they are today. I think some of it comes too from. Outsiders look at healthcare with no preconceived notions and no handcuffs on what they can or can't do.

They just look at a piece of it and they decide that's where they're going to disrupt. And insiders spend a lot of time saying, this is why we can't do things, because they've grown up living in a culture and structure that in a lot of ways is sort of many different. Processes that are just kind of clues together.

No one's ever really sort of taken a step back and said, here's if we could empty out the box. Here's how we'd redo it at our health system. And that causes a lot of. These handoffs and, and challenges we and, and things Patty, you described kind of, well let's add text messaging to this referral process.

Right. So we've taken a train wreck and we've added a, made it a really fast automated, a bad process, right? By adding an automated process. And so we've gotta get out of our own way. Change is hard and it's really hard for people to get out of their own way. And so I think Ryan, you're kind of on a good path.

I think there's gonna be places where we're gonna, we're gonna continue to see sharks take bites out of the whale that is healthcare today. The advantage of being able to be very discerning and just picking off the parts that are either easier, more profitable, the one that are more aligned to.

So the whale is gonna have alar, very hard time functioning and that sort of environment where the sharks are going out for the most most enticing pieces of, of, of meat. So to. Yeah, my boss always says, the same person that drove you into the ditch is probably not the same person that should drive you out.

And I, and I, I, I think that's really, I'm really fascinated by what Walmart's doing with United. down in the rural parts. I mean, it, think about it, it addresses multiple things. It addresses social determinants of health and access equity. In these rural areas, they're going after Medicare advantage first, but you know, that whole idea of being able to see and, and go for a day of healthcare and go and get your teeth done and your eyes checked and get the labs drawn and all these different things.

And then, oh, hey, let me teach you how to. Appropriately for your new type two diabetic diagnosis that you just received, or high cholesterol or hypertension, whatever. Let me help you understand how to do that. And they're, they're empowering all their employees to learn this. They're not just going in and saying, we have to hire healthcare experts.

They're actually allowing their folks to volunteer. Hey, if you wanna learn to help people, Shop appropriate shop healthily, shop differently, and really change their healthcare. We're gonna teach you how to teach people how to do that. I mean, think about the empowerment in, in that, and that's really looking at whole person health in a very unique and different way.

And I know that our rural health systems have been probably most affected by this financial crisis. And if you think about the need and the help for access out there I'm, I, I keep looking at that particular piece and and just from. Altruistic sense. I, I just, I'm really excited to see what they do.

We have a problem with the business model, and the problem with the business model is it's not aligned with what I want and what you want. Mm-hmm. . Right? And so the whole idea of volume, yeah. It's like Hey Patty, thanks for coming in. We wanna give you this test, this test, this test.

We want you to see this doctor or this doctor, or this doctor or this doctor. And you're sitting there going, But I just have a cold. Can you just gimme a z-pack? I mean, I just I know I had this before, whatever, and, and you're like, but the health system can't make money if, if you just do a tele visit and get your prescription and don't come in and don't do any tests, by the way, you're not getting your prescription from them likely.

The healthcare can't make money if C V S keeps ticking that business and Walmart and everybody else, because that's how patients want to consume those sort of services. And so either healthcare has to adapt or face the consequences, which could be quite dire. Well, that was the interesting thing in my interview.

So I, I get both sides. We look at the news and I do a lot of interviews and I was talking to several CIOs and I'm like, so this is essentially a wage inflation problem. They're like, not only said, look, our payer mix has changed pretty dramatically recently, and it's, and that's just the economic.

Realities of what's going on, their payer mix is changing. So it's like, okay, so what does that mean? It's like, well, we have more Medicaid. Well, we don't make money on Medicaid. It's like, and and more Medicare, more Medicaid. Well, the baby boom generation, we know Medicare is gonna grow.

That's just naturally gonna grow. And now we're seeing Medicaid grow. They really only make money on commercial. So anyway, so the payer mix is changing. That's one aspect. And then the other is their volumes are. . And so why are their volumes down? Their volumes are down is cuz we have more health options and we have more, like with United, I've United as a a carrier for our, for my staff.

And when, when they get sick, I'm like, look, just go to their website. They have a telehealth solution right there on their website. So I don't, they don't go to the local hospital or they don't go to the ER or whatever. Seven by 24, they go to the United Healthcare site and boom, they're talking to a doctor.

And if it's, Hey, go to the Go to the clinic. They go to the clinic immediately. But if it's not, which is. With the age of the, of the population of my company, I'm clearly the oldest one here. Most of them just talk to the doctor and it's like, th that's it, they're done. So the health system got zero and United got all of it.

so the volumes are down. The payer mix has changed. Wage inflation staff shortages. This is, this is why I think we're at a tipping point at this point for healthcare. How does healthcare get, this is the million dollar question too. I mean, Colin, you're gonna tell me, it's like if we could answer this question, we'd all be CEOs.

But how do they get aligned with what we want? We want convenience, we want lower cost for our healthcare. We want, and not only lower cost, we want transparency. We wanna know if you tell me it's gonna cost this, this is what I want it to cost and you can't even tell me what it's gonna cost.

Obviously we want health. I'd rather it's one of the industries where I'd rather not see you if possible. How do we start to get aligned if you're a health? Because there are some health systems who are making money. you follow the dollars, right? You, you, you changed the way and the incentive for how we care for our patients.

So we used the word volume a second ago I'm assuming, referring to a traditional fee for service, there's models out there that, you know capitated models and the Kaisers of the world and whatnot that do very well because they've changed the incentive of how the providers care for the patients and the expectations.

Short of that, there's other models still even in a fee for service landscape who have recognized the power of organizing patients into cohorts and managing entire populations with great effect as well. But to me it's, it all traces back to the incentives.

why do I write the note that I write as a doctor because I want to get paid. And because like first and foremost I have to write it that way because that's tho those are the rules of the system that get reimbursed. And so until you change the rules, you're sort of just banging your head against the wall in perpetuity.

Yeah. a lot of the rules come from your government, right. Medicare and Medicaid. They're in most health systems, 50 to 90% of their business. Is Medicare and Medicaid. And until the government changes their rules around the stuff Colin's talking about. If you're gonna submit a bill, you have to have this kind of documentation, which means you need to say all these things which contributes to physician burnout.

Writing those notes over and over again, our copy and paste problem and all of the other things we have going into the, the data analytics issues that we have, it's hard to run a better business and I agree with that, but I also think we need a change, a mindset. I mean, this is healthcare's Tesla moment. Tesla came on, disrupted the auto industry. What happened? They, they seized the marketplace for a while, but now, gm, Ford, Audi, everyone's pushing back and that the plethora of EVs coming is amazing and the quality of those cars and vehicles look. Look like they're very high.

So I mean, we're gonna see how this's gonna adapt to that. But healthcare, this is healthcare's Tesla moment. What are they gonna do? Are they gonna sit back and, and are, and, and give all the reasons why they can't do it? Are they gonna now seize this moment and try to go make that transformation?

It's not the similar to what Microsoft had to do with moving from a licensed model to a subscription model. I mean, all industries go through this. And so healthcare has there. There are playbooks about how to do this. And it's not easy, of course it's not easy, but there is a roadmap about how to go do this well.

So Tesla's interesting cuz Tesla redesigned the model three bumper and it went from, I forget the number's high, like 25 parts down to one. And when they were interviewing Elon Musk about it, he said you just have, you have to drive that level of efficiency. He goes, but the future is, we essent stamp a car, like we stamp a toy, like boom, here it is. It's one piece, and away you go. And, and that's the, that's the kind of like, Hey, this can be done differently. Let me give you some examples. I interviewed Christopher Chen probably about two months ago. Chen meant they do something completely different and they are successful in some of the poorest areas in our, in our country.

Serving the Medicaid and the Medicare population really well, and their outcomes are far superior than most. So that was an interesting interview. You mentioned Kaiser. Kaiser has a different model. I remember about, It's like four years, four or five years ago at the JP Morgan conference, Intermountain got up there and said, Hey, we're getting into the payer provider space in a big way.

And they launched, I forget the name of their health plan, health First. It's not Health first. I forget what it's, but they launched their health plan. Well, they now have 1.5 million people on their health plan. So when the pandemic hits, the provider side takes a hit, but the payer side did not take a hit.

They actually did quite well, and their financials have been pretty good. Sharp is a similar model. Sharp has a fair amount of, of of the population that they have taken risk for. And so there is a different model that's already been mapped out. The question is are, are we going to be able to have enough of our systems.

Look at it and say, Hey, we can do this differently than how we're doing it today. We can do it more efficiently, we can do it with fewer people. We can still give people a high touch. The crazy thing with ChenMed is he, he tells me that they see a lot of their patients on a weekly basis.

And when he was trained at Harvard, it was like, no, you give him the medication and if they come back, they come back. He's like we give him the medication and we say, yeah, we'll see you next week do you actually have the medication so it doesn't do you any good to hand someone a prescription and then have them never fill it, which we see so much first fill, abandoned I think that when you look.

The pay vis out there. I mean, you could argue United is a, is a big pay vi. I mean, they have a huge number of providers that, that, that work for UnitedHealthcare, like you just said. I think, yeah, they, they, their revenue on Optum now exceeds their, their, yeah. It's crazy. So, I mean, aligning incentives like that, if you can align those incentives, you have great power to work on your model in a way that you, you can actually put a good stamp on it.

I, I think we're gonna see a lot of consider. in the provider world, I don't, I don't think you can have as many entities as we have and be super successful. You look at any other industry, you're not, you're not like even the payer world, there's four major. Payers out there.

You don't have 20 . Yeah, that's what I was gonna ask the question of the panel. so all the mergers and acquisitions you see folks out there doing their best to try to land more space and diversify by merging with others. Patty Sounds like we're gonna see a lot more of that, in your opinion.

I think so. It can't just be a merger though. It has to actually be, how do you look at a different model that, that this larger market share can a afford you? Right? So if you just sort of do more with the same. You're not, you're just gonna lose money at a faster rate.

Yeah. I think but having that market share allows you to have power and ability to do different things in the marketplace. And they're gonna have to have some some really good foresight in order to figure out how to adapt to those, to those things and, and aligning those incentives and gives them some ability to have better negotiation power as well with the payers.

And being able to have those discussions to how do we align these things So we're all getting a good bite at that apple, but, but is this just the steel industry all over again? . I mean, seriously. I mean, you had mass consolidation in the steel industry before they started shutting down cuz they just could not compete.

I'm just curious. Because when the attorney generals look at these consolidation efforts, they look at the numbers and they're like, look, the cost security does not come out. The quality of care does not go up Cybersecurity. We could make that argument from one of the stories from this year did not improve across the they had one strong system and one weak system, and that weak system still got breached.

So there's a lot of data now around these consolidations that don't bode well for the consolidations. Agreed. I think that's why you have to take that power and change the models and be able to look at things in a different way. I, I think you, again, I don't think you're gonna solve the problem with the same mentality that folks are going with.

I think that you're going to have to align incentives, and if you don't, you're not gonna be able to do any of the changes that allow you to do what you need to do If you're just chasing. The same model that you always have and sort of just getting you market share on that same model. It's not gonna work.

📍 📍 All right. We're gonna be doing webinars a little different this year. I've talked to you a little bit about this. We got together with our advisors. They told us, Hey, you gotta do 'em different. They're just not serving the community well. And we said, what do you want? They said, community generated topics. Great contributors. Not product driven. They want a more honest and open discussion. And they said what we want is not no on-demand webinars. We want once and done type webinars on a consistent date and time. So every first Thursday of the month. Our first one being January 5th first Thursday a month, one o'clock Eastern time. We are gonna be doing a webinar. You can count on it. Put it on your calendar every first Thursday of the month at one o'clock Eastern time. We're gonna do a webinar. The topics are gonna be generated by the community, and we would love to have you there. Our first one, January 5th, priorities for 2023. A CIO discussion with Integrated Delivery Networks, February 2nd, we're gonna come back with Academic Medical Center CIOs talking about their priorities. And then we're gonna hit some of the other great topics that they've given us for the year, and we would love to have you join us again this week,, top right hand corner, it'll have our current webinar and our upcoming webinars. You can sign up right there. And if you miss it, it's not on demand anymore, so. We would love to have you there. Make sure somebody from your team is there taking notes and bringing stuff back to your staff. So we hope that this works out. Any feedback? Go ahead and send us a note. We would love to hear about it. 📍 📍

I'm gonna make you all CEOs. I'm gonna make you a CEO for a 15 billion I don't know, five major market. Integrated delivery network. We're not gonna go with academic, we'll just go with integrated delivery network. A little, little less complicated. A little less opportunities for revenue though, cuz AMCs have other revenue sources.

But regardless, you are now the c e o 15 billion health system. What's your strategy going into 23? You have labor issues, you still have all the regulatory requirements that you have to hit, you have new entrance as you guys what are we doing? I'll make it a little easier later.

I'll make you CIO instead of c e o, but I'm gonna start with c e o. What, what do you do going into to 23? Who wants to lead that conversation? Survive. I, I don't know. Case could be made that that's, that's the mode we're in. Like, Hey, we're gonna get on the other side of this. There's another side.

Oh from a financial perspective, and me being on the vendor front, now I'm starting to see it. I'm starting to see the pullback to hey, what you got is great, but you know, call me in six or 12 months, because right now we gotta dig ourselves out of this. Yeah, so survive, CEO 15 billion, dollar multiple cities.

I don't know, Ryan, you seem pretty outspoken. I, we just made you a c e o. What, what have you got to say? ? I don't know if I'm a ceo. Material . Yeah. I, I, I like survive I think we are in survival mode right now for sure. You have to go look at, in parallel though, where is the opportunity to grow your business from a digital transformation sort of standpoint?

Where are. The Amazons and the Apples and the CVSs and the Walgreens and the Walmarts, like what are they doing and how do you counteract that? I don't think you can allow them to constantly nibble away at the sides and expect to have a viable 15 billion business going forward. So I think there needs to be some attempt there to go counter that sort of, that, that thrust with your own digital health sort of offering and offering of services and improving your patient experience in, in line with what I think consumers want going forward. So it's kind of a nebulous answer admittedly, but that's probably where I would be thinking about at least.

Look, I, I think we're getting nebulous answers from many CEOs at this. To be honest with you, I, because it is a, a daunting challenge. Who wants to go next? Drex. I mean, I think you've got the, the typical hard problem of surviving and if you spend all your executive leadership time just figuring out how to survive, you don't actually ever figure out how to thrive.

So there's gotta be some division of labor in that executive suite that says, I think Ryan kind of alluded to this, here's where we're going. This is what we aspire to be and here's how maybe we're going to get there. And then there has to be the rest of the team, the operators the daily operators who are surviving, but also. Tasked heavily with finding efficiencies. And that means sometimes cutting out processes that exist today, cutting those processes out completely because maybe they should have never been part of the whole delivery of care process. But if you don't spend time thinking about where you're going and you only spend time surviving, you will only survive for a finite period of time.

I think you've gotta. get You gotta, you gotta make some kind of a division there and say, these are our strategic thinkers and they've gotta figure out where we're going. Everybody else can survive and create efficiencies so that we can eventually bridge the gap to that plan. It's it's, it's gonna be one of the hardest periods of time I think healthcare's gone through.

Yeah. I agree. I was, I was thinking something similar along the lines of taking a step back and s you know, what do we want, what do we wanna look like at the end of this? What's our, what's our goals? And then I would really strategically look at where are the areas that I'm weak, where are the areas that we're growing?

And then I would also look at. From a partnership perspective, can I work with, right? Because you're not gonna be able to be all things to all people. So what are these areas that I can strategically partner in? What are the areas that I need to cut? Because they're just draining resources and draining capital.

And then I need to also look inward and figure out. What is my culture about who are we, how are we going to retain and continue to grow our people? Because I think that human capital is something that so often when we get in these times of crisis, we, we sacrifice cuz we keep cutting things.

We keep cutting things. And I think it's really important to figure out how do we get that human capital to be our our, our stars, right? Because cuz everybody wants to do the right thing, but they're drained. They're, they're really having a hard time. And I think really understanding the areas that the reasons and how can we help and mitigate and how can leaders get in there and really help motivate and bring to life people's.

Pride back in what they're doing right. And figure out how do they, cuz it used to be healthcare workers. There were such a pride and such a, the reason why they were there was really wanting to care for people. And I think that that is, Been so tainted over the last couple of years and it was starting before but just got really exasperated and the trust factor has just gone out the window.

And building that trust back is going to be, I think, key to getting people through as well as sort of the things that Drex talked about. Yeah. Next question's gonna be cio I'll answer the c e o question. The c e o question. I, you guys, you guys set it up really well, right? So you, you have to reduce your cost.

So you're engaging your leadership team, Hey, identify efficiencies so that we can reduce our costs. You have to take into account the people and the cultural aspect of it. You can. Given where the culture's at right now, you can't come in and slash and burn if you slash and burn, it's gonna more burn than slash you have to include those people culturally in the decisions.

They have to understand why the decisions are being made. They have to understand the financials at a level they haven't understood them before, so that they can say, oh, I understand why we're doing that. In, in this spirit of never let a good crisis go to waste. There's an opportunity here and it's to say, Hey We're really backed into a corner.

It seems like we've been backed into a corner for the better part of four or five years. Maybe we should be doing something a little different. And I would take a, a group of, I don't know, out out of the box is kind of cliche, but out of the box thinkers is, is what I'm thinking, who are gonna go over into a corner and nothing is sacred.

And when I say nothing is sacred, I mean like we're gonna downgrade from Epic and go to Meditech cuz it costs a third to run it as a health system. And everyone who hears this right now is going you. That's sacrilege. How could you possibly say that? Oh my gosh. But I talked to a, a small health system, I mean small rural health system.

They just went to Meditech. Proudest moment in this CIO's. And I'm sort of scratching my head. I go what'd you go from? He said, well, we went from this, this. I'm like, great. I said if you don't mind me asking, how many people did you have in clinical informatics prior to going to Epic? He said, we had, we had 28 people in clinical informatics.

I said, all right now you're in the optimization phase. You've finished the implementation. Yeah. I said, how many people you have in clinical informatics Now he goes, 120. . Okay. And I said, well, how could you cost justify that? He goes, oh, we consolidated a lot of applications. A lot of applications have been consolidated.

Yeah, but you're gonna pay that amount every year for the a hundred more people you have on staff. For i, i, the, the, the thinking of, Hey, this is what the industry's doing. This is what we should do. This makes perfect sense. No one steps back and says, did that make sense? For a small rural, not, they didn't go community connect, they went full-blown epic.

And it's, it's a pretty small area. And I was, so I would've a group over there who's, who's throwing out sacrilegious things. I heard an organization that went to a different they actually, in their words, downgrade it to a different system for voice for dictation and voice and, and other things because they, they could not afford the cost of the thing that they had done, there's a reason that H C A had Epic in a couple of their hospitals and just chose to do Meditech across the board. Yep. Because they're for profit. They have to hit a number and I would put people in a room and say, nothing's off the table. You guys go in there, throw things up on the board and let's talk about it.

Everything's on the table. Let's have a discussion. And then you have to change the business model. Just have to change the business model. I'd get your smartest people in the room and say, All right. How do we get the first dollar? How do we make sure that the first dollar doesn't go to cvs? Doesn't go to United?

Doesn't go to Amazon or Walmart. The first dollar comes to us because they trust us to keep 'em healthy, to keep 'em out of the hospital. And if we don't get that the first dollar, we're not intended to keep 'em outta the hospital. We're not aligned with what they want. So as a C E O, I'm like, we gotta change the business.

And I realize how hard that is, but we've gotta do that. Sorry. That's, that's me ranting. It happens every now and then. Cio, Hey, CIO just got asked to same system, just got asked to cut his budget by 7%. Ryan, how are we gonna do this? Well, if I was a cio, I'd like to transform my job and become the Chief Innovation Officer, as quick as I possibly could.

Doesn't really answer your question, but there's still some things you wanna focus on, right? Yeah, there are. There are. But I would rather be on the growth transformational side of the equation, not on the operational side of the equation. Not just me though. I, I think you hit the nail on the head attitudinally that you have to rethink broadly.

What is your overall tragedy going forward? I, I don't wanna be disparaging towards any one of any one of the EMR vendors, but why we would just. Kind of like lemming life, just keep choosing that same solution over and over and over again without maybe given some consideration to what else is out there.

I, I, that's the type of a approach we don't need going forward. That's the kind of approach that kind of got healthcare to where it is today. That's the kind of approach that allowed the auto industry completely to seize the landscape to Tesla. And it's the kind of approach that if. Carry on down that path.

I think using Drexel's radiology, you will survive for a finite period of time. And I don't think that's what we're talking about here. So I would be rethinking everything. Yes, there's be the operational, how do I do cut 7% for this next year going forward? And that would be more, that'd be more tactical.

But I, in parallel, I'd be really thinking long and hard about what is the strategic vision for how we need to run our IT operation going forward. Patty, how do you keep the consumer initiatives going forward? When I just asked you to cut 7% as a cio, really good point. Well, we also just talked about the human capital aspect of things too, and the, the knowledge that we're probably either going to have a, a great amount of attrition or just really difficult time attracting bodies.

But automation that has a good hard dollar return, right? We need to be able to look at things and make sure that we're able to realize the results that are promised. I think that it's going to be a really important aspect to automate all the things that we possibly can.

I mean, we're using the Tesla thing over and over again. I mean, he talked about how can we just stamp one part versus 30 for a bumper. I mean, you're gonna have to do that. We've, we've cut so many things into so many different processes and for no reason other than we've always done it that way.

So I think the processes have to really go out the window and you have to think about what's the end result that you want, and then go straight to that instead of going back and saying, well, how do we. Make this process work in this world because those processes are broken and all we're doing is automating bad processes over and over again.

And the difference between usually a really great installation of any product and one that fails is not usually the product. It's usually because we haven't adopted anything from a cultural or process perspective. And that's gotta change. Yeah, people process tech and the fast efficient train wreck analogy.

Exactly. I mean, I think if you're gonna do, if you're gonna be asked to do more with less, then there's a calculation that has to happen in there. We either actually have to do less with less, which means we can keep doing the same things that we're doing. We're just going to go to all of our clinical business and research partners and say, what systems do you wanna stop using so that I can get a 7% budget cut that's gonna go over.

I, I've had those conversations before. That's usually when all of those people ride your rescue though, and you don't take the budget cut that you thought you were going to take. But the other part of is, as Patty said, you gotta, you gotta find efficiencies and you should be doing that all the time.

Looking for efficiencies, renegotiating contracts, looking at where you have duplication, effort standardizing on application sets, all those kinds of things that you have to beat up on your business, clinical and research partners to get them to go along with these program. But all in the context of kind of radical transparency, I'm gonna be asked for a budget cut and before I am, let's make sure that we're showing the entire organization that we're being as efficient as we possibly can be.

So that when we're asked, we can, we can tell 'em exactly where they're gonna have to remove the things that they need to remove for us to spend less money. And, and again, this is really hard to do, but you have to be just really, really persistent about it. This is probably why I'm not a c o anymore, but when when I came in, I, I interviewed Daniel Barney.

He said they, their IT governance was three people at New York Presbyterian. And because I was talking to another cio, He said we have a culture where 99 to one is a tie. So if you have 99 physicians saying one thing and one says the other, yeah, that's a tie. And when, when Daniel was describing his thing, he is like, look, it's, it's essentially the C m O here, the c m O here and me.

Cuz they, he had two academic medical centers under, well Cornell. And he goes and we make all the decisions and we've only disagreed on one decision in, I forget a number of years, but it was a number. Four or five years. We've only disagreed on one thing. When I came in as CIO at St. Joe's, we went from a 26 person IT governance committee.

I sat through the first one and I was like, this is not gonna work. Like, we're not gonna this is like everybody voting for their best thing. And we, we called it down to three people making decisions. Now, I only got away with that for three years, by the way, and then we had to bring other people in.

But at the end of the day, We were able to move very quickly. Culturally, I like the stuff you teed up there, drex, cuz culturally we know what to do. We just can't do it If it offends one person. There's a counterbalance to this, right? That, I mean, if you've ever worked, I mean, I've been a CIO in Academic Medical Center, we always used to sort of joke about how the issuance of a policy actually was just an invitation to debate.

It wasn't actually ever a policy being issued. And so this whole thing around governances. You can have big, wide governance and lots of transparency, but you also invite a lot of debate. You've gotta have a really tight process built around that that helps you get to a decision rather quickly. Or you can have a very small governance group, but you will.

You will provoke the illusion in the organization that all these deals are being made in smokey back rooms and nobody else gets to have any input on them. Yeah. So pick your poison maybe. But when it comes to budget cuts, those are the kind of models that you're looking at and you gotta use one or the other.

And whichever one you think you can culturally get away with in your organization, maybe that's the best choice. So so Colin, I wanna come to you and give you the chance to be the CIO for a day. And then I wanna come back to these two security people and ask them what I do with a five to 7% cut to make sure I don't get breached next year.

But Colin, how about you cio? Oh yeah, I just found my 7%. It's in my cybersecurity budget. Cybersecurity budget. , there's, I'm, I'm just telling you, there's not enough money to make up 7% in your cybersecurity budget. No, I I think the key themes have been stated here. Automation is, is the biggie that I was thinking of.

Getting rid of stupid, stupid stuff G R O s S what can I automate across the clinical enterprise, not just from the clinical perspective, but also. In it, in in any of the other service lines. The second is of, of all the things that, that my colleagues just mentioned there still have, there's a focus on data.

And so if you haven't doubled down on your data strategy or if your data is all over the place and you can't access it in order to get the the information you need to make these decisions. You're sort of swimming against the current constantly. So I I, of all the things that I would slash and and burn as you stated data would be the last on the list in my opinion, man.

We are, we are up against this, so we've got four minutes, by the way. I love that answer, Colin. I mean, we have to pick the things that are going to move us forward and not. Touch them too much, like they need to keep pulling us forward. And data is one of those things that has the potential to pull us forward.

Ryan, I've, I've put you on the spot more than I put Drex on the spot, so I'm gonna put Drex on the spot for this one. You can, you can come after him. Drex 7%. Cut. So the CIO's coming to you as the CISO and saying, Hey, you've gotta be a part of this cut. How are we gonna do it? So how are you gonna make sure that we don't cut things that are necess.

To ensure our that we're. I mean, I just, I think just like we're talking about a lot of the rest of the business when it comes to transformation, you have to think about what you've been doing in cybersecurity differently. And up till now we've always talked about build taller castle walls and deeper, wider modes.

Keep the bad guys out and clearly the bad guys getting across the walls. So you have to think about cybersecurity differently and, and that. For a lot of places that have traditionally built all of their own things and have 60 or 80 applications that they're using and are, are trying to do all the stuff themselves, think about that differently.

Who are you gonna partner with? Who are you gonna use as a service to make those expenses more predictable and prioritize your risk? To, to take the biggest, most likely exploitable risks out of the equation In a conversation, you're gonna be left with risk. But again, if you're transparent about it and everybody knows and understands what that risk is, they're making a decision with their eyes wide open.

Yeah. Risk. Risk based decision making. Ryan, you're gonna get the last word on this show. What are your thoughts? I would say the Nirvana state still. Getting credentials. Like that's almost every attack you see in the news is credentials get compromised somehow. So I would make sure you don't cut anywhere That inhibits your ability to protect credentials.

Phishing in the most case. So I would just, that's, that's the divana state. That's the initial point of compromise that leads to all sorts of different forms of attack. Cause they go through that reconnaissance phase. And so I would not cut anywhere that safeguards against credential.

Protection. I, I really wanna thank, well, I wanna thank you for this episode. This was a lot of fun for me. I hope it was fun for you, . It was fun. But I also wanna thank you for coming on the show throughout the year. It's, it's fantastic. I get a lot of comments from people when I run into 'em at the conference.

I just got a phone call from somebody today. They're like, Hey, every, everybody in our organization listens to your Newsday show cuz you guys cover the news and it's great. and I really give a lot of that credit to you guys and just taking the time to come on. So thank you again really appreciate it.

We're gonna start this again in January Drex, I think you're kicking us off, if I'm not mistaken. I think I'm, I just got a note from your staff, so I'm looking forward to it. Fantastic. Hey, thanks everybody. Really appreciate it. Thank you 📍 guys.

What an awesome conversation. I wanna thank these wonderful guest hosts for all the amazing conversations we have been able to share with the community. This is another one of those great conversations. I really appreciate them being a part of the show. Please continue to pass our content to any peers you think would benefit. From this information and again, we appreciate that they can find us wherever you listen to podcast Apple, Google Overcast, Spotify you get the picture. We are everywhere. We want to thank our Keynote sponsors who are investing in our mission to develop the next generation of health leaders. Those are Sirius Healthcare. VMware, Transcarent, Press Ganey, Semperis and Veritas. Thanks for listening. That's all for now.

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