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November 10, 2020: Welcome to News Day. What does the Intermountain Sanford Merger tell us about the future of healthcare? Can mergers get too big and unwieldy? There’s been a reported 10% drop in hospital admissions in 2020. What pre COVID behaviors were the most detrimental to health? Will our new habits change forever? Telehealth visits grew by 2000%. Now it's time to step back and ask what did we really do? Did it improve our efficiency? Did it improve our care? And is Zoom the king of telehealth platforms?

Key Points:

  • What are the nuts and bolts behind a strategic merger? Is it as simple as a shared belief in how healthcare is going to be procured and delivered? [00:03:50
  •  We should be applauding 10% less hospital admissions but is it sustainable? [00:12:05
  • You really do have to rethink your security model [00:17:45
  • How much will health IT change as a result of the election? [00:17:55
  • One of the conversations that keeps coming up is telehealth [00:22:05
  • Don't NOT solve a problem because you can't solve a hundred percent of the problem [00:32:00



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 Welcome to this week in health it, it's Tuesday News Day where we take a look at the news, which will impact health it. Today we're not gonna talk about the election, or not a lot, to be honest with you. We're gonna talk about health it, so I'm looking forward to it. We have a lot of, we have some merger conversation to have.

We have a telehealth conversation. A bunch of, uh, interesting things have happened even though the election is going on. My name is Bill Russell, former healthcare . CIO coach, consultant, and creator of this week in health, it a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders.

I wanna thank Sirius Healthcare for supporting the mission of our show to develop that next generation. Uh, their weekly support of the show has given us the ability to expand this year to, uh, provide new services to the, to the community, and we are incredibly thankful. Three x, Dr. Even though Drex isn't here to remind us this week, three x Drex is a service of Drex to Ford and he's a frequent contributor to the show and we are so glad to have him.

It was fun to talk politics with him last week. That will be the last time we talked politics for another four years, so. Hopefully you got enough out of it from that one show. But three X Drex is where Drex sends three texts out three times a week with three stories vetted by him to help you stay current.

Uh, I use it to do research for this show and uh, if you want to be a part of that, to receive those texts, text Drex, DREX to 4 8 4 8 4 8 and that'll get you signed up. Alright, well, . We've, I just wanted to be clear. We've gone to a little different format. I'm trying to engage with you guys directly and how I'm doing that is I'm posting every day of the week.

I'm posting out on LinkedIn, and you guys have not disappointed. We have had a lot of back and forth, a lot of great conversations on LinkedIn. I have posted my largest, let's see, largest discussed post so far on LinkedIn. Let's see. How many people have viewed this thing? I've done a lot of posts. When you do one a day, it just starts to, starts to stack up.

Here it is, 50,000 people have viewed this post 395 likes or whatever else you can do on LinkedIn these days, and 54 comments, and that is what does this merger tell us about the future of healthcare? Okay, so Sanford and Intermountain are coming together and what I did is I posted some of the facts of the deal.

And asked you that question, what does this merger tell us about the future of healthcare? Let me give you some of the facts on the deal. Combined its 70 hospital system with about 15 billion in annual revenue. Uh, the deal is gonna close in the summer of 2021. That's if the regulators allow it to close that quickly.

Sanford drew almost 7 billion in total revenue in 2019 and produced 3.1% operating margin, which means that they are . Operating at a profit six months ended June 30th, 2020, which is this year. The system drew almost a hundred million in operating income. In the first half of 2020 on 3.1 billion in revenue.

Uh, so they're still profitable. This year, Intermountain Drew 374 million in operating income on 7.6 billion in revenue. In 2019 combined, they're going to employ more than 89,000 people. Across 435 clinics across seven states, Sanford operates in North Dakota, South Dakota, Northwest Iowa, Western Minnesota.

While Intermountain is in Utah, Idaho, and Nevada, the resulting system would ensure 1.1 million people with systems, with the systems combined health plans. And the proposed system is going to be called Intermountain Healthcare, and it would be led by Intermountain, CEO Mark, Dr. Mark Harrison. . So, and I made the comment, we expected mergers born out of operating distress, but this doesn't appear to be that this appears to be more strategic, a shared belief in how healthcare is going to be procured and delivered.

Wow. And then we got a ton of comments, so let's dig into the comments. One of the first ones here is from our friend Ed Marks, who says, we will see continued consolidation and we'll end up with four to five super systems. Just like most other industries, appliance, automotive oil, most industries have, uh, four to five companies that make up 80%.

And uh, ed has a couple of fans here who agreed. I don't necessarily disagree, to be honest with you, that that is the direction that we're going. I just think the pace is gonna be an awful lot slower than what people think. So to predict that at this point, one of the things that's gonna happen is people are gonna say, didn't you say we're gonna get to.

A few major systems. It's probably gonna take a decade for that kind of consolidation for a couple reasons. One is healthcare just moves slower. Number two, the regulatory environment. Having gone through a merger of two major health systems, the the attorney generals in these states are really leery of the.

A monopolistic power that large health systems can wield, even though they really didn't have much of a problem when the payers went down this path, and they allowed that to happen pretty significantly. So, but when, uh, providers go down this path there, there's two things. One is the monopolistic pressure.

The second is the loss of jobs. Remember that all these health systems are the largest employers in their, uh, market. And as such, one of the jobs of our elected officials in each state and understand this has to go through. It's crazy. These things have to go through each state. The attorney general gets to take their, whatever i I, their pound of flesh essentially from each system.

And I say that because having gone through one of these mergers in California, that's exactly what they extracted. I. Concessions and other things that just, quite frankly, were not good for the overall merger and the economies that were going going to be gained. It just delayed 'em all. But at the end of the day, it saved, uh, some jobs over a three year period.

So from that perspective, they're doing exactly what they were elected to do. Mike McSherry, CEO of Zel. Uh, really cool digital app. We'll have to have him on the show. At some point, hospitals will need to consolidate to compete with payers, United National . United and the others national scale. 250 billion in revenue, 20 billion in profit, 250 billion in revenue.

Think about that. Alright, so that's the largest payer, 20 billion in profit plus they're trying to get into the provider space as well. 25 times the revenue profit versus even this very large mega system that just was formed with this merger, United buying, uh, care delivery, optimizing telehealth, virtual health, uh, relegating hospitals to ER and acute surgery centers.

This is a point that Jonathan Manis has made as well that we're gonna be. Relegated to, uh, that health systems, health system providers are gonna be relegated to high risk, low margin, high acuity services somewhere down the road if, uh, we don't get ahead of this consumer. And what Mike's making the point is, uh, consumer, uh, driven, uh, model.

And one of the points that Mike is making here is essentially that, that the payers are much better. Positioned to, to make this move because they have more revenue, more scale, and with with that revenue, with that profit, with that cash, they can continue to make moves. And plus, COVID was very kind to the payers, at least at this point.

Dale Sanders also frequent guest on the show, frequent. He's been on the show I think three times, and somebody who I respect significantly. Says, in keeping with my personality, I'll celebrate when I see these mergers turn into better care and lower costs for patients stoic. Until then, so far, none of these m and a deals have had a major notable benefits to patients.

In fact, there's more evidence to the contrary across all industries, M and as underperform the expectations about 90% of the time according to McKinsey and Deloitte. And one thing that I observed having worked at Intermountain for eight years, my first step into healthcare. Followed by broad exposure to US and international healthcare.

After that, the success of Intermountain is not easily easy to export. And he goes on to talk about the homogenous nature of that community. Their, uh, statistic. He's, he's a data scientist really by trade at this point. And, uh, just talks about the makeup of that market, which makes the services that Intermountain delivers very distinct.

And sometimes the model that Intermountain would, would employ, would not work, say in a Chicago or in a Southern California. In fact, I had a, uh, hospital president, major health system. Uh, just tell me that. 'cause I asked them, you know, you know, if Intermountain does this well and they do very well, their margins are really high, but we see those every year at the, at the JP Morgan conference.

Their margins are high, they're operating efficiency is very high. And, and, and so you just ask the question, why, why don't we do that in Southern California? And I get some variation of this, which is, it's a very different community, very different model. These comments go on and on. This is, these mergers are very.

They're, again, positive and, and not positive. Catherine Sullivan, PhD. There's gonna be a big bubble that will burst soon. Remember the movie, the Big Short, the the next movie will be about how the pharmaceutical insurance industry destroyed US healthcare. You have that range of, of it's gonna, this is bad, bad for healthcare, too few players making decisions.

We're not gonna get in front of social determinants. Although, to be honest with you, if we get this kind of scale, we might be able to get in front of social determinants. You have stoic optimism from Dale Sanders, and then you have the, there's a lot of potential here that could be unlocked if the right health systems become the mega systems with, again, the right values and capabilities and funding behind them.

Right? So pretty interesting and, and again, pretty interesting, uh, back and forth. A lot of, you know, a lot of people . I've been through a merger. I, people are, people ask me, what do you think of this merger? I don't know the, uh, specifics, to be honest with you. I think every merger has to be looked at in, in its own merit.

I don't think you just throw all mergers out, per se. And I also don't think, I also don't think that you just applaud all mergers because it's a step in the right direction. I think Dale's right, we have not seen . The benefits. I've made note on this show before, and I love the people at Providence and I think they do good work and they clearly, they have, uh, enough money on their balance sheet and they're doing just fine.

But I have not seen them present an operating profit at, not that it's the only measure, clearly it's not the only measure, but they, since the merger, uh, with St. Joe's that I was a part of, I'm not sure they've posted a profit since then. And, which is funny because when I left St. Joe's, it was wildly profitable, so.

It's just one of those things that you just scratch your head and say, sometimes these things might get too big and unwieldy, and it's hard to drive, uh, the efficiencies across the entire scale of the organization. Reduce the, the clinical variation, all the things that's required to be an effective hospital, drive quality, drive down the cost of care for the community.

And that's really what we're looking to do. I'm trying to think if I talked about this one before. Let me see. This was one week ago. No, I don't think it did. So let me share this one. So the, uh, Kaiser Family Foundation, 10% drop in hospital admissions, uh, reported that there was a 10% drop in hospital admissions in 2020.

And it was interesting because I saw a little back and forth on this and people were like, Hey, this is bad for hospitals. And I thought, wait a minute. Let me think about that one for a second. I, I, I think I'd like the data scientists to go work on this. I'd like for them to come back to me and tell me if this is a good thing or a bad thing.

Now, if people are deferring care, clearly that's, that's not a good thing. It's a bad thing. We don't want people to defer care that actually need care. But on the other side, we should be applauding 10% less people are being admitted to the hospital. That's, uh, that seems like a good thing. Now the question is, is that a blip?

Is it sustainable? What is the cause? And I, I'd like the data scientists to really, uh, dig in on that. My, one of the things I started thinking is, have habits changed? Right. And how have they changed? How has, has the, how has the impact of Covid impacted our health? Are we, uh, more, uh, more aware of health during this time than we ever were before?

Is wearing masks helping us with other things that we don't even, uh, recognize? The fact that I don't travel on airplanes. Oh, heck, I can't remember. I, I haven't traveled on an airplane since February. Does that make me more healthy? Does the fact that I get to see my family every day, is that healthier? Is that healthier from a mental health standpoint?

Is the fact that I'm getting outside more? I know it sounds weird, but I'm actually doing more like things in nature and walking and, and playing golf and those kinda things that I did in my normal schedule. Is that healthier and. And with this question, what pre covid behaviors, uh, do you think were the most detrimental to health that may may change forever?

And one of the, one of the thoughts I have on this is we may want to look at our assumptions going into next year's financial year and other things based on what trends have changed. And then I posted a . I posted another story, which is the, there was a story on the real estate market in New York and what will it look like next year?

And I, I posted this with just that same question, which is, have we baked new trends into our assumptions for our 2021 operating models? Just something to to consider out there. Let's see. Did I get any back and forth on this 10%? I did. Let's click on it and see what you guys are saying. Let's see. Went back and forth.

Dan Howard, M-B-A-C-H-C-I-O-P-M-P. Uh, that's more, more initials than I have after my name, which I, I have, I'm always impressed with. I hope that the investment in efforts in education and patient engagement strategies over the last, uh, several years are resulting in healthier communities and populations.

And I agree with Dan. I think it's optimistic, and I hope that's the case. Uh, I just wanna make the point are we baking these trends into our 2021 numbers? All right. Let's see. . Two days before the major cyber attacks happened, I posted this post and I said, and, and, and direction. I talked about it just about ransomware attacks.

And what's gonna happen. And so Drex and I went into these, we actually talked about some of the comments, so I'm not gonna talk about, talk about 'em again. And we also talked about the, the, the breaches. Now since then, there's been, uh, a couple more systems that are either under attack, have reported that they're under attack or have been compromised.

These compromises are, are serious deals. I, when you think about getting locked out of everything, if you're not gonna pay the ransom. To get decrypted and, and by the way, I technically, I guess paying the ransom is against the law. So if you're not gonna pay the ransom and it's encrypted, I have a feeling you're not gonna be able to decrypt a lot of this stuff.

Let's just play through this scenario a little bit of what that means to your health system. Essentially, all those boxes you have in your data center, they are just that they're boxes, they are storage, . They are compute and they are just processing. That's all they are. And so what you have to do is you have to rebuild.

You have to rebuild from scratch and you start with active directory. You have to rebuild your active directory. You have to reestablish your accounts, you have to, uh, have people log in for the first time. All people log in for the first time and, alright, so that's where we're starting. We're starting from standing up, active directory.

Think about how far back that is. So what else was encrypted? If all of your cl, hopefully your EHR wasn't encrypted, and if you get by unscathed on your EHR, you're better off than most. But then you start just meandering down the systems. How is your ERP doing? How's your PAC system doing? Can you imagine if your PAC system has been encrypted and you lose all your images and you don't have access to your backups?

Just play that out for you, for yourself, uh, for a minute and think through what the ramifications of that are as you're having, if as you're having these thoughts start to think about your presentation, uh, to the board when you are trying to get money for next year and they say, we really can't afford to fill in the blank.

You might wanna ask the question, if we lost all of our PAC systems, what would that look like in terms of, well, you'd have to re-image. Everybody who's in the hospital, everybody who's in active care would've to be re imaged. Uh, you're probably not gonna get reimbursed for that, right? But the second thing is you're gonna have to, everybody who comes in the future is gonna have to be reim imaged.

Some of that will get reimbursed, some of it won't. You will likely have lawsuits. There's an awful lot of things that, uh, you just go down the, you go down the list. And by the way, we're just on, on the PAC system. We haven't even, um, we haven't even opened up some of the other systems that you're gonna have to rebuild the amount of hours you're gonna have to spend in it.

Uh, consulting dollars, uh, remediation, verifying that what you have, rebuilding your security model. 'cause it would really stink to stand it all back up and get, get hacked the, the week after. You really have to rethink your security model before you start standing all this stuff up again. I assume you're standing it all up as you're unplugged from the, from the network.

So anyway, next thing I posted, how much will health it change as a result of the election? Right? And so directions before I dove into this last week, and so we have a little bit more information. I told you I wasn't gonna talk about the election, but I'll, I'll talk about it from this perspective. The answer to that question is a, a little and.

Not as much as if we would've had a majority or if we would've had the same . Party and, and actually at the time of this recording, we don't know who our president's gonna be. I'll just be honest with you. It is, uh, I'm recording before the weekend so that my production team can get it out there. And so it, it really doesn't matter which way this goes.

The Senate is going to be, uh, Republican. The house is gonna be Democrat, whichever way the president goes. It's gonna be a, a, a split Congress, which means that there's gonna be an opposition and oppositions are good. I, I've made this point on the show with Drex, and the reason they're good is 'cause it, it forces compromise.

Somebody has to compromise. It means that the conversations have to happen. It means that, and if you're not gonna compromise, if you're not willing to come to the table and have the conversation and listen to the other side, then nothing's gonna get done over the next four years. Or the only things that are gonna get done are executive orders and gosh, and just the normal operation of the government.

And as I said last week on the show with Drex, I'm okay with that. To be honest with you, I, I don't like sweeping changes and, and radical movements. 'cause I don't think that's what America, that's not where we're at right now. The electoral vote most in history, only split by about 3 million people. And to think that's a mandate is kind of silly.

And to see it go radically in one direction or the other would be bad. And by the way, I feel that way regardless of which party wins. What I, I really always want a split Congress. Let's see. I did, uh, I did one on voting on the voting day. I've got a lot of, uh, response and I think it's, I think it's good.

By the way, just the one comment I wanna make from this one, I. Is, and I, I make this comment towards the end of this thing where I say I'm con concerned that so many people have started to identify themselves by their party. In politics, we are, we are more than the candidate we support. You're missing out on being friends with some great people.

When you become so dogmatic that you can't stand to be in the room with someone from a difficult, different. Political persuasion, and someone came back to me and essentially said, when one person's vote hurts someone else, it's not being dogmatic. It's letting your voice be heard. That oppression of any kind is unacceptable.

My comment back to that was I would imagine that everyone would agree with your statement that oppression of any kind is unacceptable, regardless of political persuasion. I have not found that people from the opposing party, from the things that I believe to be unreasonable people. In fact, I think that's the message.

The message I want Washington to hear is we don't, the generally speaking, uh, we are not that dogmatic. We are not that combative. We can have conversations, we have conversations with each other all the time. And, and I'm, I'm really concerned about the next generation, to be honest with you. The younger generation, uh, who feels the need to, uh, put people into a category and then

Brush them aside and label them and brush them aside. Because at the end of the day, you know, there's people who, who vote Democrat, who have very good intentions, and there's people who vote Republican who have very good intentions. And I know you find that hard to believe, but if you take the time to have the conversations, uh, I think you will find that there are some very fair-minded and smart people, uh, on both sides of the aisle.

So I, I did post about some of the medical ballot issues that were out there. I'm gonna, you, you have heard 'em all at this point, so I am not gonna go into them. The next thing I post is a, uh, story about TriHealth switches to Zoom. Actually, I just used that story because I wanted to talk about telehealth.

And the reason I wanted to talk about telehealth is over the last couple of weeks, I think I've talked to probably about 25 ish CIOs. Uh, and, and one of the conversations that keeps coming up is telehealth. And I just posed the question, which video platform was the biggest winner of the telehealth explosion?

And it's important, and every time I talk about telehealth, it's important to note that there's . There's, telehealth is a broad category. There's subcategories, which is virtual visits, consults, and remote patient monitoring. Each subcategory represents a different set of use cases and a different set of technologies.

Typically, there's some foundational technologies that might be the same across all of them, but generally they have, uh, some aspect of different technology. Here's what I'm hearing. I'm hearing that Zoom was the big winner. Wow. And, and I'm hearing that for, the reason I'm saying big winner is 'cause first of all, I don't remember Zoom even being a player.

In telehealth prior to Covid, and now I'm hearing Epic, Cerner, you name it, whatever the, uh, Meditech, whatever the EMR is. I'm hearing people use Zoom, and I think they're using Zoom for the same reason I use it to record our podcast. It's easy, it's just easy to use. It's easy to set up. It runs across low latency.

It makes up for some of the choppiness. And those kind of things. So from a just instantiating the video communication, it's easy for patients, it's easy for providers, and that's why I think it's winning. And by the way, that's why I think most technology wins. I don't think it wins on speeds and fees. I think it wins based on its usability.

The Epic Twilio solution is gaining momentum. But to be honest with you, it's half-baked at this point, is what I'm hearing. It still has it still, it feels like it needs to go in the oven for a little bit. The other thing is it lacks some basic video capabilities, multiple participants on the same call.

Uh, that's what I'm being told. I have not used it, so if I'm wrong on that, please set me straight. Uh, more than happy to be, be corrected. Which means it's probably designed for video visits and not really designed as much for video consults, 'cause consults in a lot of cases have multiple clinicians on the call having a conversation.

We're also finding that MS Teams has made some inroads. I think it's one of the reasons you're seeing MS teams want to get on the App Orchard platform and be, uh, certified or . Or, or, or, or for the Epic platform. And I think the reason for that, to be honest with you, is not that it's an exceptional platform.

It is, it's a great platform. It's being used by a lot of health systems, but I think it's mostly 'cause we're already using it for administrative collaboration and collaboration across the health system. So your physicians are getting used to using it. You already have the license for heaven's sake, and there's no reason to fire anything else up.

And if all you're using it for is to instantiate the, uh, the video call, then . It may work for you internally. My only warning on that, to be honest with you, is having been somebody who has had to connect from the other side to multiple different organizations, MS teams, it is not, it is like a quarter as good from a connection, ease of connection standpoint as Zoom.

So I just, just, . Word of caution out there as you're heading down that, or if you have some say into what Microsoft's doing, let them know that they can make that, that end user experience a little bit more easy and, uh, frictionless, as we say on the show, American Well and Teledoc have done well and I, I noticed that Cisco is absent.

So back in the day for us, the virtual consoles was all our, our telepsych and telestroke programs were all done on Cisco platforms. I, I'm not hearing Cisco all that much, and I don't know what that means if they have been relegated to the side. I know that WebEx is still out there. I, I still communicate with some health systems via WebEx, so that's still a, a major platform, but that doesn't seem to have made the

The jump WebEx didn't make the jump as much as Zoom and MS teams did into that, into that space. So I, I asked the question, what solution is your health system using, and do you believe that solution will be the solution that you're using a year from now? I find that to be an interesting question because again, talking to a lot of CIOs, they are evaluating that right now.

Do we, this, this is what we did during Covid. So Covid, you had to respond and you responded quickly and you put something in there, kudos. You scaled it up, you did what you needed to do. You, you grew your telehealth visits by 2000%, but now it's time to step back and say, what did we really do? And did that improve our efficiency?

Did that improve our our care? Somebody made the point, uh, I don't think on this post, but before that, . The HE DDIs measures didn't move at all as a result of telehealth, and is this really the right platform? And so it's, uh, I think that those are the questions that are being asked right now, as well as evaluating the technology.

It's integration into the workflow, it's integration into the process. And is that really working for your health system? Let's see. So we got a bunch of responses. . And a little free advertising here. Jeff Carr, vice President of Business Development for, let's see. Actually, it doesn't say, I'm gonna have to click on something else to find out.

I will tell you once I figure it out, I think it's URA Lemme tell you what Jeff said 'cause I thought it was pretty interesting. I re recommend looking at which telehealth providers and IT platforms are accredited and certified following best practice standards matters. Good medicine delivered on bad platforms is still bad medicine.

To which I, I responded, I said, I'm wondering how that really works. Clearly there's a security component that I understand why you would wanna get certified, but. What other things would I need to have video platform accredited and certified for? Is the phone accredited and certified? Do we certify the platform or the workflow and the system that is using it and he comes back and says, great questions.

Here's the standards at a glance. And so here's the free advertising, if you're wondering. So I pop over here to look at the tele telemedicine support services program that his company has out there, and they have . Let's see. Course section. They have business requirements, professional oversight, quality of patient safety, clinical workflows, risk management, consumer to provider, uh, provider to consumer, and then provider to provider.

And they have . I don't know, maybe about five or six points underneath, uh, each one of these that you define. And really what it looks to me like is our old policy documents that we had, uh, at the health system where it really defined all the aspects of the program, the clinical procedures, the end user technology, the proficiency of that technology of the patient to provide a relationship.

You get an idea. It's a, actually, it's a pretty well, uh, thought out list and . My comment back is, I, I thought it was a great telehealth program checklist. So if you are evaluating your telehealth program, you want like a checklist of things, go ahead and hit that post on, uh, LinkedIn. And he, he gave a, uh, link to it.

But I do say to him, you're gonna have to sell me on using it unless it's mandated. And the reason I say that is . I might use the list to work with my team to make sure we have everything covered that we need to have covered, but I'm, I'm not sure I would want to get my telehealth program certified. It, it doesn't seem, and, and again, I might be shortsighted in this, he comes back and says, and I said, I think it's gonna be, you'd have to sell me on it.

And he said it's selling itself. Since Covid employers, as part of their RFP process are starting to ask. If their virtual benefit provider is accredited, independent validation matters. Some organizations may use telehealth standards to build their program while others. . More so on cost avoidance, reduced risk quality, and marketing promotion.

The drivers of Telehealth accreditation are rapidly changing since c Ovid 19 when employers and payers are starting to ask the question. If Telehealth providers are accredited, that's a game changer and he's right. If that's happening, I, and again, I haven't verified any of the stuff. I don't know if that's happening.

I, but if that does start happening, then you may have to look at getting your . Telehealth program accredited. I guess it depends on what market you're in and what kind of penetration and mindshare that this is. This is getting ge. Ben Raheem says The lack of broadband access was also a challenge for many solutions.

Some require minimum bandwidth that simply isn't possible and. In this post I focus on video of a specifically, but the reality is a lot of telehealth was done across plain old telephone. In fact, I was surprised the, a couple of the health systems I talked to, that was their primary method. They didn't even try to stand up video, they just did phone support.

'cause they're like, look, at the end of the day. The only thing we're looking, doing with the video is making eye contact, but for the most part, most of the other stuff we're just asking a series of questions. Where does it hurt? Those kind of things there. So it's probably limiting in some clinical procedures and, and clinical evaluations, but, but they were using the telephone.

So, so that's one aspect. The second thing I said is I, I think a lot of these video solutions now work pretty well across four G, and when you look at a map, uh, four G has a pretty, pretty wide coverage. It's not, again, not perfect, and I know there's areas that still aren't, I, I'm not unaware that the broadband challenge exists.

There's also solutions on the horizon. You have SpaceX doing what they're doing and others, but again, those are gonna be pricey. Who knows what's gonna happen, but here's my thing on this. Solve the 80% problem regardless of what people are saying to you. Oh, health disparities, and you're doing this. Solve the 80.

Solve the problem you can solve, and then don't stop until you solve it for everybody, but solve the problem you can solve. Don't not solve a problem because you can't solve a a a hundred percent of the problem. , right? Solve it for the 80%, then get to 81, then get to 82. Don't stop. That's how you, that's how you take care of health disparities and those kind of things.

But at the end of the day, don't not do a solution because you can't do it for everybody, do for one. What you wish you could do for everybody is the general principle there. All right, let's go over to the, where are my headlines here? They're. Lemme pull those up. Let's see what's going on on the headline front.

Articles. So clearly this was a heavy election cycle, which is where a lot of the, a lot of the discussions and a lot of the articles focused on over the last. A couple, but let me give you, uh, a couple of the headlines that I, that I've been following. So, uh, health Evolution Summit, and I'll probably cover this article at some point because it is a really good article.

Uh, health Evolution Summit, they did, uh, two, uh, two-part series. Let me open it. Hello? There it is. So they did a two-part series on That's, sorry, . But they did do a two-part series. Where is it? Health Evolution. There it is. Are CEOs obligated to address social determinants of health? The second of two-part series, focusing on how chief executives, uh, can lead healthcare organization in advancing health equity with data and community partnerships.

I'm probably gonna this story, so if you're interested in having a back and forth on this, it's really well. . Done. They talk about Social Health Evolution forum. Preliminary survey, uh, data illustrates how participating healthcare organizations are approaching the following social determinants of health.

Transportation currently do not address 33% partner with community organizations. 25% use a combination of internal programs and external partnerships. 25% run an internal program or initiative. 17%. They do that for transportation, housing, food insecurity. That's really well done. Article. You have some, some

Uh, senior level people weighing in on it. Tom Sullivan does a great job. He is, uh, now writing articles for Health Evolution and it is really, uh, a really good article. Let's see, Damo Consulting Healthcare gets ready for its Starbucks moment. Alright, I'm gonna open this one up. So this is, uh, Patty, who was on the show, Damo Consulting.

Uh, this is a good article. I, uh, Patty writes some good articles. They're, they're, uh, generally short, which I is , which I appreciate, uh, trying to read as much stuff as I do. But what he goes into is this whole concept of, uh, creating. These seamless care experiences combining the digital with the physical, and he talks about drive-throughs and Starbucks, buy online, pick up in the store, creating those that safe distance, if you will, to receive care, and low contact and contactless experiences.

These are all really important concepts as we move forward, especially this low contact and contactless experience, that whole thing. He goes on. He said, according to Richard Isaacs of the Kaiser Permanente Medical Group in Northern California, that their transformative transformation underway could move more care out of the medical facilities and into homes and specialized centers.

It may well be the amazon-like e-commerce experience where you order online and have it delivered to your home to overnight is coming to healthcare again, I think . That is a phenomenal statement of really thinking through the, the physical and digital and how they're going to interact. I imagine ordering your healthcare, right?

I order the nurse comes to our house, order the, well, you fill in the blank and they come to their house. It really should start with the telehealth visit. The in-office visit should be pushed down in priority. We need to think through what the priority, what is the best way to service certain. Certain conditions in the safest, most effective way.

There's a good story in healthcare IT news CIO's perspective on the promise of digital transformation. So some good, some good back and forth there. They talked to, uh, Penn Medicine Chief Information Officer Mike Ucci. Rest says strong leadership is needed to capitalize on technology's potential, but people are the real enablers.

Having talked to, again, I just completed a consulting project, talked to uh, a bunch of, uh, leading CIOs across the country, and it's amazing how they keep coming back to this concept of how important their people are and how important it's to take care of your people, how important it's to create the right culture, how much time they spend.

Spent on building the right culture, on cultivating the right, uh, environment on, uh, providing the resources that their people need to be successful on, uh, encouraging them just. It, it, it was really, it was really, I don't, I, I wanna say the word encouraging again, but I don't wanna be repetitive. Uh, but it was encouraging to me, it was encouraging to me to, to listen to these great leaders just talk about how much time they spend just building a great team.

They are the Bill Belichick of Health, it across the, across the country. And some of you work for great leaders. Some of you are great leaders. And I think that's what makes it so exciting to do this show and to do what we do. And we really appreciate you and that's all I'm gonna cover. Looking at the time, I am really at the end of what I can do.

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