This Week Health

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June 23, 2020: What sort of staying power does telehealth have? Why does the Pentagon struggle to catch up with Silicon Valley? What is the number one problem in healthcare? Tune in to find out the answers plus the NHS announce a coronavirus tracking app, the misconception that patients own their data, the 21st Century Cures Act and what sort of staying power does telehealth really have?

Key Points From This Episode:

  • Why agile software is a double edged sword
  • Why do we continue to build and purchase software that saddles our health systems with unnecessary costs and complexity?
  • Agile with the right architecture is magic
  • Why Space X now runs circles around Boeing 
  • What sort of staying power does telehealth really have?
  • The 21st Century Cures Act 
  • The misconception that patients owns their da
Transcript

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

 Welcome to this week in Health it. It's Tuesday News Day where we look at the news which will impact health it. Today, software is killing healthcare. . Walmart makes a digital health acquisition and another round of Telehealth's future articles. This is a really packed episode. I'm gonna try to get through it in 20 minutes.

My name is Bill Russell Healthcare, CIO, coach, creator. This week in health it a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. Reminder, we are now doing three shows a week instead of five. We've been, uh, we have been normally dropping. We'll be, uh, closing out our Covid series in June.

Uh, no live show this month, mostly because I've been too busy to plan one. Uh, the next topic will be, uh, work from home and specifically bringing people back from work from home. We're gonna look at how different organizations are approaching that I. Uh, I have no guest lined up. So if you're interested and you're an IT decision maker around this topic and want to participate, drop me a line, bill it this week in health it.com.

Uh, we're working on something called clip notes, which I'm still not allowed to talk to you about, but we are really excited about it. Um, another detail, oh, I'm speaking at the Atmosphere Digital Conference for Aruba. Keep an eye out on that for that. Um, . Finished recording that last week. It's, uh, it's really a culmination of what I've learned during the c Ovid 19, uh, pandemic, uh, and what health systems are facing.

Um, I'm also hosting a panel discussion on the edge with Dr. Zafar, Shari, uh, the CIO for Seattle Children's and Rick Allen, the CTO of Navicent, uh, healthcare at the Edge, the convergence of devices, data patients. Provider and care should be fun. Uh, I'm recording that one actually in about an hour and a half, so that should be fun.

Uh, looking forward to that. This episode and every episode since we started the Covid 19 series has been sponsored by Sirius Healthcare. It's their commitment to making this content available that has made. Our coverage, uh, during this time possible. And I wanna give a special thanks out to Sirius for supporting the show's efforts during the crisis.

Okay, let's get to the news. 10 stories, 20 minutes. Start the timer. Let's go. Uh, DOD, agile software Development. Still too slow, GAO, breaking defense. Um. Let's, uh, take a look at this and I'm going to tell you why this is relevant for healthcare. As the Pentagon struggles catch up to Silicon Valley. And by the way, uh, special thanks.

Still, Sanders highlighted this in LinkedIn. This is how I got to this article. Uh, as the Pentagon struggles catch up with Silicon Valley, top officials have loudly embraced the private sector software development strategy known as Agile, but in the gaos annual survey of 42 major weapons programs. . While 22 claimed to be using agile methods, only six actually met the private sector standard of delivering software updates to users every six weeks at most.

Uh, why does Agile software development matter? Because what modern technology I. Uh, can do in business and on the battlefield. Often depends on software as much as anything else goes on. To explain why that is, I think we understand why software is important and why it's more agile and can make things a different agile word, but, uh, can make things happen more, uh, effectively.

I. And they give another example. Each F 35, for example, has expanded its capabilities of the air aircraft just based on software updates alone. Uh, Agile's double-edged sword Warned David Berto, a former Pentagon Official who now heads up the Professional Services council. An association of it and service contractors.

Agile in the commercial marketplace is driven by a competitive dynamics, including the need to stay ahead of the competition, be first to market, go fast as possible, et cetera. Alberto told me the result, updates that always, always need correcting another another week or two, uh, I would argue that, but

That's fine. That's his opinion. By contrast, bill Greenwald, the, a former Hill staffer who wrote many of the acquisition reform laws now in place, was far more enthusiastic about using agile development for the Department of Defense, the Defense Innovation Board software study. It was PR pretty clear that the DOD does a poor job of software development.

This is not probably news to anybody. There may be some things that cannot be met by Agile greenwall acknowledged. I don't think we will be flying planes using the first minimum viable product from an Agile software development. Uh, project, obviously, you'd run the software in a simulator many, many times before you put test pilots.

Uh, lives at stake testing is critical, he said, but Greenwald argued the current Pentagon acquisition system isn't actually great at testing. While commercial software is often pushed out to early inadequate testing and full of bugs, traditional weapons programs start serious testing too late when they've completed design and development.

The results is costly and time consuming. Uh, fixes to problems that could have been solved more cheaply and quickly if they had been discovered early on, which is a tenant of agile. By the way, if you don't know, uh, Dodd's traditional way, ex exudes confidence that we always know the end solution, he said, so testing comes late.

My gosh. If, uh, at some point I'm gonna have, uh. A, a, a, a board of some kind to talk about agile because this is one of those terms we do not understand. We take bits and pieces and we speak as if we are incredibly knowledgeable about it, and it really does frustrate me a little bit. But that is a topic for another day because I only have 20 minutes.

I wanna give you the so what on this? And the, so what is the number one problem in healthcare? It is the way our software is written, which leads to a tremendous, tremendous amount of tech debt on the day we roll the software out. We fundamentally don't understand software architecture, and because of that, we continue to build and purchase software that saddles our health systems with unnecessary costs and complexity.

Uh, I said a lot in that, in those couple of sentences. . I firmly believe this is the case. Uh, in all my experience in healthcare, uh, very little of the, of the software is actually written correctly. It is not written in a services framework. It's not written, um, in components that can be updated readily. We spend millions of dollars updating the software We have to take outages, uh, sometimes significant outages, uh, to update the software.

We're writing poor software. And, uh, the reason this is, uh, top of mind for me is I'm doing a consulting project right now and I'm helping a founder to, uh, write some software. And he brought in a development team and I started talking about Agile. And you would think I was speaking a different language.

They had no intention of writing it, uh, as, as a. Uh, services framework and, and anyway, it, it was, it, it, it is one of those things that continues to pop up in healthcare and we as CIOs need to understand software architecture and understand what we are investing in when we invest the millions of dollars that we've been entrusted with.

Okay, so here, let me, I'm gonna touch on this a little bit. So Agile is a process, a method of developing code, but doing Agile in an old architecture world can add some benefit. We did do this on top of our legacy architecture. We did, we did implement some agile processes, but there isn't any magic in Agile itself.

Agile with the right architecture is magic. I've seen, I've seen companies drop code updates on a weekly basis, really never taking a downtime. I sat with Ken Ner, who was, uh, at, at dinner one night, and Ken, if you don't know, Ken was the CIO for SpaceX and Broadcom before that. And, uh, he was telling me the story about Elon Musk told him he wouldn't support him buying an ERP solution from a major vendor, and he wanted him to build one.

Now every CIO listening to this is cringing. But Ken accepted the challenge and he told me that they built on a microservices architecture that was taking hundreds of u updates on a weekly basis. Uh, you know, many of you listening to this would consider this, uh, you know, almost wildly irresponsible. But the last I checked, SpaceX was the first commercial entity to be trusted to carry human astronaut astronauts from the United States to the Space Station in close to a decade.

They now run circles around Boeing who is saddled with old systems that cannot be adapted quickly. My so what is stop buying and building poorly architected software? It's killing healthcare. Okay. Story number two. How will the NHSC Ovid 19 contact tracing app? Work and when will it go live? Uh, the NHS has announced the IMM imminent launch of a coronavirus tracking app that will let users know if they've been in close proximity to someone infected with coronavirus and need to self isolate.

Um, I highlight this 'cause this is an example of a well-written agile process, right? So, uh, VMware actually did this. Pat Gelsinger, uh, actually, uh, . Uh, wrote an article here. Uh, I didn't write an article, but had some comments in an article on this. He said, when our VMware team set out to partner with the National Health Service in the United Kingdom to develop their contact tracing app, we knew two things.

We had to get it out quickly. I. We needed to the right people at the table as the app is developed, rolled out, updated, and continuously improved, which, think about that. Those are the tenants, right? You get the code, get it written quickly, have all the players at the table get the right requirements. So what were some of those things?

NHS needed to bring a variety of experts together to answer many important and diverse questions. For example, medical and public health professionals, epidemiologists and medical data scientists were asked, will the app help us save lives? Right? That's of utmost importance. Political bodies were asked, is this the safe and proper tool as part of a wider approach to ensure us to move forward as a country, right?

Because you can't just . Develop this code in a vacuum, and you can't just get the epidemiologist in a room to develop the code in a vacuum. It's still in a vacuum. You have to think of the entire system, and there's a political aspect of this, there's a privacy aspect to this, and they brought this in, so they also brought in ethicists and privacy experts.

Is this the right balance of near and long-term clinical research requirements and personal privacy and . Lastly, they brought in the technologists who were asked, is it, is it implemented well, ensuring that we have the highest security and data protection is performed superbly, right. So that's what they were looking at.

And, uh, you know, in a matter of weeks, VMware developed an application, uh, to support the NHS, uh, contact tracing and testing efforts. They worked, uh, quickly to develop a viable product that can be rapidly deployed and saved most lives. It's currently, uh, in a pilot in a city in the uk and, uh, it will be scaled up from there.

So what is the, so what, uh, I purposefully put this right after . The previous story, uh, you know, 'cause we did a deep dive on contact tracing if you want to listen to that. I did it with Drexel Ford on a Tuesday Newsday show a little while back. Uh, and you can refer to that episode for all things contact tracing.

I went deep into a, uh, Harvard Business Review, uh, article and uh, it's a great article. And really laid out all the different aspects of contact tracing and, uh, it's worth taking a look at. But why did I pick this article right now? Because, um, again, what are we looking for in architecture? We're looking for, uh, architecture that can, that, um, that can really scale up and scale that as we need.

And, and that's what containers are, right? Containers are VM machines that don't require human intervention to start them up so that when we have 10 users and we have two servers sort of running this thing and it gets to, you know, a million users and it needs a hundred servers, it ramps up automatically by itself and then it ramps back down.

So we need a containerized solution that utilizes a service mesh, right? So service mesh service architecture, uh, with API centric framework. Um, . You know, if you develop on a services framework, it will be much more resilient because you're only updating services. You won't take down the entire app. You'll be updating services.

You'll be able to test really small parts of the code to make sure that it's working. So, uh, and you won't take long down times. You'll be able to migrate it from one platform to another. And, uh, . Uh, you know, and, and quite frankly, you'll be able to maintain it with fewer people moving forward, which I think is another thing we are seeing in healthcare.

We have huge organizations in healthcare supporting these applications, and, uh, it's a problem. It's a problem when you have a reduction in your revenue and now you need to support that. It's one of the reasons that healthcare costs are so high is we. Buy and implement bad software. And then it requires a lot of people to maintain it and a lot of people to, uh, to run it.

Alright, that's enough of that rant. Need to get through some stories here. Let's see. I'm 11 minutes in advisory board leaders, a mixed picture of telehealth's near term and medium term future. Uh, this is a great article, by the way, if you get a chance. Healthcare Innovation. And it was, uh, based on a, uh, let's see, on a webinar that was done by the, uh, the advisory board.

Uh, which is now a, uh, part of Optum Telehealth. How can providers make it sus make it sustainable beyond c Ovid 19? Which is a question we've been asking a lot here. And the next three articles are gonna cover this. Christopher Kerns, advisory Board's Vice President, because Executive Insights has a bunch of really good insights here, so I'm gonna give them to you.

Uh, league stated that a lot of credit goes to Medicare because of . Its policy provisions during the pandemic. The big change, he says, has been allowing patients to access telehealth from home and no longer requiring a telehealth visit to originate from healthcare facilities. In addition, allowing new patients to attain telehealth visits, to allow telehealth visits using smartphones to allow audio only visits to be reimbursed, to allow all providers to provide telehealth visits with no penalty for limiting or eliminating copays or deductibles.

And, uh. He adds as the pandemic lifts, how many of these provisions will remain? Uh, the only one of those that I'm confident will stick around is after the public health emergency is over, is patients accessing telehealth visits from Home League told Kerns, uh, the extension of eligibility. For telehealth visits being extended to providers in nursing homes, et cetera, should probably stay, but I think the other provisions will be rolled back.

The issue is lack of security in terms of platforms like Skype. Most folks think that FaceTime and Skype modalities are going, going to go away, as will audio only telephonic visits. Okay. Among the uh, statistics that league. Shared, I'm sorry, John Lake, senior consultant for, uh, the advisory board. I forgot to mention his, uh, full name.

Uh, among the statistics that league cited, uh, blue Cross Blue Shield of Massachusetts saw 3500% increase in telehealth claims, NYU Langone four 4500%. Uh, I, I mentioned UCLA and others on the show. I. It'd be massive upticks. Right? But what about May once, once many patient care organizations had reopened in-person care delivery?

To some extent, in most places, telehealth visits have declined by as much as 50%. Okay? As patients have continued to respond in the ways they always have, advisory Board has found that when patients try telehealth services, they continue using them. Three quarters of the patients express high satisfaction.

In Press Ganey compared overall satisfaction with telehealth visits satisfaction, and they found that the patients rate virtual visits as highly as regular visits. Actually, I find that hard to believe. I think it would be higher, but that's just me. Uh, turning to Telehealth as a commercialized enterprise Link told Currents, it won't surprise you if I tell you that Telehealth is a segment of the industry where the money has really been flowing so far in the first quarter of 2020 alone.

Telehealth companies raised nearly $250 billion in investment. You have Amwell, you have, uh, they're doing an IPO, uh, just a bunch. Right? Um, let's see. Uh, Kern said he was, uh, skeptical about this money. Uh, we've heard this before telehealth and about a lot of disruptive technologies, but I also know that health plans and CMS.

Uh, haven't tipped their hand as the Rea roseum going forward, which I don't think is true. Uh, they talked about it a little bit that Cima Verma has said, we're not going back. Uh, she told them more access to telehealth from home and from nursing homes as needed. Uh, but she did note that Congress has needed to make a change to the law.

CMS will do what they can in their regulatory capacity, but also she has pretty flatly said that she did not see reimbursement between Telehealth and in-person as being one-to-one parody. And I don't think anybody does, right? You should in theory, be able to do more telehealth visits. Um, they are a little easier to document.

I mean, the whole process, once we get the scheduling and other things down, it should be a lot better. Uh, I think the question, so the question is, what should providers do? And it's a great question to ask. This is a, this is a really good webinar that they did. I did not attend the webinar. I'm just reading the article.

I think your question points to a dilemma with the telehealth that goes beyond Reimbursement. Lake said The problem is . Is that simply substituting a digital interaction for an analog one is valuable, but not the only way to connect providers to patients. There are asynchronous applications he noted, including remote monitoring, and that's where I think we're gonna see a boom and we have to look at how that is going to be reimbursed.

That's my words at the end of that. Uh, I'll go back to their words, but, but of those . Both of those are valuable, but they require payers to think about reimbursing telehealth in different ways. So who's using them and who's paying for them? You get the idea. These are, these are good questions to be asking, and we need to look at not only the, uh, the value and the efficiency, but we need to look at the outcome in order to determine where we should be placing telehealth in the future.

Uh, there's also questions around senior adoption. Absolutely. Seniors are our biggest consumers of care, and if they take, uh, if they take the telehealth, it will drive . It's long-term. Durability League replied. Uh, the reality is that the results are kind of a mixed bag. Seniors like everyone else are responding favorably in surveys, not quite as favorably as younger people, but favorably, and we want them to use it in terms of preventing infection, et cetera.

Unfortunately, a lot of them haven't used it. He cited a number of recent survey. Only 24% of seniors in Medicare Advantage plans have used telehealth. According to the survey, by better Medicare Alliance, 81% of the consumers 55 to 64 and 84% of the consumers age 65 plus have not had a virtual visit according to Sage.

Growth Partners still like noted Medicare Advantage seniors rank their telehealth experience as favorable. As you would expect. Alright, um, what investment should be made now secure? Uh, and I love this list by the way, secure telehealth. The second is integrated with your platforms. Third is, uh, get scheduling right.

Press Ganey noted correctly that uh, a lot of the negatives around telehealth visits have been around scheduling and how it's easier. People are saying it's easier to schedule an in-person visit than a telehealth visit. So that's something to consider. Something we need to . Act on clearly. Um, and they're saying get everybody involved.

That's probably enough for that story. I'm gonna, so the, so what Secure your environment integrate the workflow awareness and acceptance. They talked about that I didn't cover it. That, uh, we're gonna have to, you know, it's been talked about every day in the news that's gonna go away and we have to fill that void and make sure that people are aware that it's still available.

Um, and we want modalities that drive outcomes. Next story. What sort of staying power does Telehealth really have? Uh, I think it's difficult to predict right now. This is a story from Healthcare IT News, and this is from Heather Oliva attorney. And, uh, I thought the interesting thing in this, what I think the interesting thing in this story, it's, uh, worth a read.

Oh, she talks about, uh, a handful of things. One, broadband is . Uh, is going to continue to be a problem, and it's defining the haves and the have nots in our economy, and it's really time to address that, that gap. Uh, she also talks about the need for medical interpreters, and that is that, um, I. What I, I've been describing, describing them as data brokers that are gonna be able to interpret our medical information.

But the 21st Century Cures Act is going to allow data out into the wild with the patients. And, uh, I'm now gonna need somebody to help me make sense of it. She talked about that. And then the other thing was mental health is almost a no-brainer according to her. And I agree that, uh, mental health via telehealth is, uh, is a perfect fit.

Um. She also talks about this barrier state licensure barrier and, uh, my so what on this is be careful what you ask for. Health systems want . Uh, I want the barrier of state licensure to come down so that you can practice telehealth anywhere in the country. But the barrier also protects you from com, uh, competition.

So I'm just saying be careful what you ask for. Uh, if you are in the state of North Dakota, if you're in the state of Wyoming and you're like, Hey, I, you know, I want people to be able to practice from all over, uh, once you bring down that barrier. It means that yes, people from California and New York and Pennsylvania are gonna be coming into your locations via telehealth.

Uh, likely, most likely, uh, by, by and last thing on telehealth, bipartisan group of senators ask that telehealth access expand under Covid to 19. Um, I, the title really says it all. You know, we have long advocated for increasing access to telehealth because of its potential to expand access to healthcare.

You know, typical, uh, . Speak, uh, you know what's, what's, and, and again, the title says it all. Bipartisan group. What's the so what? Um, this is gonna get funded. You can bank on it. There's no political downside to funding this. People like it and it's a bad thing to take away things from people who vote in an election year.

So, uh, this is gonna get funded, has bipartisan support. They're gonna figure out how to put money towards . Uh, telehealth. C Mc, Verma wants it. CMS wants it. Uh, users want it. We haven't introduced it to enough seniors, but at the end of the day, we should be looking at this strongly and we should be setting our strategy.

Alright, next story. The missing factor, standing between health It and its ultimate promise. You know what? I'm gonna virtually skip this story so that I can get to the others. The so what on this is . Think about the title, the Missing Factor, standing Between Health It and its Ultimate Promise is we are not building stuff that people want.

Measure your investments. Build them around what people actually need. That's what this, they did a survey and people are saying, Hey, they're not giving us what we need. Go figure. Hey, let's ask 'em before we build something, let's ask them before we buy something, make sure we, uh, are, are doing the investments in the area.

We need to, uh, next story, the growth of Covid 19 in the us uh, organized by state peak data and uh, this is really cool. So early on, covid 19 cases were more centralized. We know that sort of spread now to the south and west and other areas. But, you know, the, my my, so what I love these visual cap capitalist graphics.

Um. And, and really my, so what on this is there's an uptick in cases in many states. Great. The graphic, uh, this graphic, uh, includes the number of cases in the peak in those states. It also talks about the death counts in those cases. But I, you know, I'm not commenting on covid per se. I'm not saying it's great that the numbers are high or low or whatever.

I'm not a doctor. I don't talk about such things. But I will say the use of analytics around the pandemic, uh, to create meaning of the data. Is exceptional. And this visual capitalist article is really good. In encapsulating that data, I can see where it's peaking, where the death rates are going. I can see that cases are leading, uh, to deaths, or at least they were in the timeframe of this, uh, uh, of this.

And, uh, we need these data storytellers. To, to really help us around the numbers that we're hearing on a daily basis. And these pictures are really worth a thousand words. So, uh, more of that, more pictures, more graphics. Uh, love what the, uh, the data storytellers. I don't know what the title is for that, but the data storytellers are some of my favorite people.

Alright, there was a great, uh, there was another great webinar, uh, put on by Google, uh, John Halamka, Christopher Ross, and uh, . Barie, Daniel Barie, uh, got together and they talked about, uh, some of the things that they had done, uh, during the, uh, pandemic. And, uh, I'm, I'm not gonna summarize the, the, I did, I did attend this one.

It, the, the, these three are some of my favorite people in healthcare. They've all been on the show, and I'm gonna continue to have them on the show and, and just share some great and wonderful stories of, uh, how everybody came together and the amazing things they were able to accomplish. Um, I did hit the q and a.

'cause they didn't have time to do all the q and a. So they, people submitted some things and they answered 'em later. And there was a document, and I, I'd love this. This misconception keeps coming up, which is one of the questions was, who owns the patient data, payer provider or patient? And how do you balance the between interoperability and privacy?

And the answer is, the patient owns the data and consents to permission for the data to be used and shared in a compliant manner by providers and or payers, which is not true. Just, just it's, it's just not true. It's only true in one state. I keep coming back to this 'cause people have a misconception that the patient owns the data.

The patient has a right to access the data, but the creator of the data owns the data. I. Okay, so it, it just is, that is just how it is. And there's only one state that by law gives the patient the ownership of the data. Now, it is true that we have to provide consent for the, uh, for the provider or anyone else to use our data in certain ways, and that is a good thing.

So, uh, and they talked about the use of anonymized data in, uh, in search of a cure and those kind of things, and that's fantastic as well. But I just wanted to address that they also addressed how the, uh, 21st Century Cures is going to, uh, uh, really impact things and. What did John have to say? The ONC information blocking rule and the CMS interoperability rule will, uh, markedly improve ease of patient access to structured data via APIs.

It's the combination of evolving technology, fire, Google Health, uh, Google Cloud, healthcare, API policy, funnel rules and psychology. Um, what's the, so what? Uh, the, the so what on this continues to be the outcome of the 21st Century Cures Act? The center of gravity of patient data is going to shift dramatically in the direction of the patient.

I, I don't just, we need to get that into our heads and start to start to move with the gravity of the data. Uh, this represents probably one of the most significant opportunities for digital health startups. If you have a, um, if you are, if you have a startup or an incubator or something to that effect, I would be looking strongly at this.

Right. If you're, if the startups have weathered the storm and they're coming in, I would be looking at this, uh, at, at the 21st Century Cure Center of Gravity. And what this means, uh, you know, this, it really, it, it represents a significant mind shift and it's just something to keep in mind. Alright. Am I way over?

I'm pretty far over. I have, uh, two more. Uh, this one's simple. I'll just give you the title. Court strikes Down the Trump rule that drug makers disclose pricing. And the, so what of this is, it's just a matter of time. Transparency is a goal for everyone. Uh, I don't wanna violate anyone's free speech rights, which is what they claimed and what they won with the, the, uh, pharmaceutical manufacturers.

Um, but there has to be a balance between free speech and keeping information for people that could materially hurt them. And high cost drug prices can hurt people. They need to know what their choices are, and part of that choice has to be the price and the cost of the drugs themselves. Sorry. Um. Next story when workers can live anywhere.

Many ask where, why do I live here? Um, and this is a Wall Street Journal article. Really, uh, interesting article. It does exact. Wall Street Journal has these kind of articles often and they, they sort of paint this picture of a couple who chose to live somewhere else. And I, I could just tell you my story.

I now live in Florida. Uh, twice in my career I've been given a chance to live anywhere in the country. And I choose places where I have access to, to, you know, people I enjoy being with, to, uh, great baseball and great golf. Right. When I have the choice, that's where I gravitate to. But I also look for cost of living and some other things, uh, quality of life.

Uh, those are the things I look for. The article had some really good graphics in it. It had graphics of where are the people who are leaving New York, moving to where are the people who are leaving Atlanta? Moving to where are the people who, who are leaving Chicago, uh, relocating to as well. Um, and the answer to that is cheaper and higher quality of life is where they're going.

So, uh, my, so what on this is, uh, be careful. You know, can your people work from anywhere? Probably. And, uh, we found this out a long time ago. We can have them work for anywhere. And then the HR department came to, actually, the finance group came to me and said, okay, you need to stop hiring people from other states.

'cause every time you do, we have to file all sorts of forms and do also in HR as well. We have to do all sorts of administrative tasks to have people work in those states for our organization. So we want you to pick the states and stay within those states. And manage the other states as exceptions. So there are going to be cultural trade-offs we know about, but there's also some administrative challenges as our people start to move out and go to go to other states.

Uh, we need to keep that in mind. You just can't hire somebody from all 50 states because that's an awful significant. Administrative load. Uh, the last story. Walmart acquires care zones, health services, digital technology, so, uh, families can use the app. Uh, lemme see. CareZone has developed a mobile app that helps individuals and families manage medicine and chronic illness.

For each member of the households, families can use the app to scan labels or insurance cards to speed and simplify the process. Uh, Walmart's statement. Acquiring a technology platform of CareZone is another example of our continued commitment to help lower . The cost of healthcare for our 160 million customers who shop Walmart each week while offering convenient options across multiple channels to help them manage their health and wellness.

According to a survey of US customers, cost is a top barrier to healthcare for 43% of Walmart shoppers, followed by convenience and access. So what. I love this story and for a couple reasons. One is Walmart knows its customers. Do you hear that? They're 160 million customers. They know their number of customers, 43%.

Of them, gave them the reasons why they struggle with healthcare. And, uh, I, my question is, do we know our customers that well? They're also building a set of capabilities that are designed around their customers. They don't consider, consider them like shared customers between, uh, the healthcare organization and the market and them, they're their customers.

They want to be the ones that direct their care. They want to be the ones that provide that first level of care and then say, okay, you need, uh, an escalated level of, of acute care, and we're gonna help you to decide the one that's gonna give you the best outcome at the lowest cost. I guarantee you that's how they're thinking with's, how we've heard them speak at conferences.

It's how they talk about their employees, which by the way, one of the largest employers in the country as well. Um, and they are gonna be a force to be reckoned with. Continue to be keeping an eye on the Walmarts of this world because while we have the, uh, the Amazon Berkshire and uh, and uh, JP Morgan thing floundering a little bit, Walmart, uh, knows exactly what they're trying to do.

They have already built out the organization and, uh, there's a lot of things to really appreciate about their approach. . In fact, if I were, uh, if I were at JPM in Berkshire and uh, Amazon, I would hire somebody away from Walmart, uh, to, to run your, run your thing. They have, they have a good model. They know where they're going and uh, they're doing some really interesting things.

That's all for this week. I'm sorry I ran through all 10 stories 'cause I wanted to see how much longer . I was gonna end up going over and it looks like I went almost a full 10 minutes over and I apologize for that. Uh, I'll get better at this. Special thanks to our sponsors, VMware Servers Advisors, Galen Healthcare Health lyrics series, healthcare Pro Talent Advisors for choosing to invest in developing you the next generation of health leaders.

This shows the production of this week in Health It. For more great content, check out the website this week, health.com, or the YouTube channel if you wanna support us. Best way to do that, share it with peer, send 'em an email. Direct message, however you do it, let 'em know that you're listening to the show.

I am so thankful for the people who recommend their show, this show to their peers. I heard another great story this week of a department head recommending it to the whole department and, uh, that is, uh, just warms my heart and I appreciate that. Uh, please check back every week, uh, as we were going to continue to drop more shows.

In fact, you can check back a couple more times this week. Three shows a week, remember? Monday, Wednesday and Friday. Thanks for listening. That's all for now.

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