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February 27, 2023: Priscilla Sandberg, Strategic Alliance Manager at Pure Storage joins Bill for the news. 2022 was a bad financial year. The pandemic has brought a new outlook on finances and health systems are looking at where their expenses really are. Do we need to rebuild the current financial system and is that even feasible or do hospitals need to start spending money to make money? The nature of primary care is shifting and places like CVS and Amazon are breaching the space. Is it time to adapt and partner? How can we manage nurses better to maximize their talents and ensure retention long term? How is toxic positivity hurting our work environments?

Key Points:

  • Hospital median monthly margins lingered in the red throughout the first 11 months of 2022
  • Kaiser posts 4.5 billion net loss for 2022
  • CVS Health acquires Oak Street Health for 10.6 billion
  • Pure Storage

News articles:

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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.

Today on This Week Health.

outreach, tracking, getting a handle on your patient population. Those are the kind of things that are going to start saving people money and making people money in the future. (Intro)

welcome to Newsday a this week Health Newsroom Show. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week health, A set of channels dedicated to keeping health IT staff current and engaged. For five years, we've been making podcasts that amplify great thinking to propel healthcare forward. Special thanks to our Newsday show partners, Cedars-Sinai Accelerator, Clearsense, CrowdStrike, Digital Scientists, Optimum, Pure Storage, SureTest, Tausight and VMware for investing in our mission to develop the next generation of health leaders. Now onto our show.

(Main)

β€Š πŸ“ All right. It's News Day, and today we are joined by a new co-host, Priscilla Sandberg, healthcare Strategic Alliance Manager for Pure Storage. Priscilla, welcome to the show.

Great. Thanks for having me.

Well, I'm looking forward to it. This is your first time on the show.

So tell us a little bit about your role, Pure Storage, what solution you bring to.

Sure. So, I've been at Pure Storage for about four years now. We have a dedicated team of healthcare specialists at Pure Storage cuz we understand that healthcare, even from an infrastructure perspective, is a little bit different than what I like to call regular business.

So, we work with our prospects and our customers to help develop. Solution specific to what they're trying to achieve from a business and clinical outcomes perspective. And we work with all types of folks who, payers, providers AI companies both here in the US and also globally.

Globally. Wow. It's interesting. I came into healthcare from outside. I think everybody does at some point come in from the outside. But when I came in, I'm like, how different can this be?

Yeah.

And it turns out it's very different when you cannot have a downtime at all.

Like the person coming in for a cancer treatment today does not care that, some little thing went wrong. All they're thinking about is, I'm coming in for cancer treatment today. Mm-hmm. , and you cannot, divert that appointment. This stuff has to be running and whatnot.

And I knew that in the back of my head, but I didn't realize, it really all has to work all the time.

Exactly, I sold E M R systems for many, many years and that was at the advent of, computerized physician order entry. And a lot of our hospital clients were really pushing back on the technology because they'd been coming from paper, right?

And so that paper was easy. It was always available and it. Over the last 20 years, it's really fascinating to have watched these organizations that kind had nothing to do with technology to demand, the 24 7, 365 availability of these systems. And the IT struggle is involved with not only managing the application, but also the underlying infrastructure supporting that application.

Because now the physicians, the same ones who didn't wanna put an order in via computer. If the system's down, they're just not having it. So it's been an interesting healthcare journey for me personally.

Yeah. I did get in an argument once with a physician about, he said, the paper was always available.

And I'm like, no, it wasn't . Let's just, let's just be honest. I mean, I just, my personal experience, there's times where the paper gets misplaced. It's, somebody didn't write the note, that kind stuff. He goes, yeah, you're right. It wasn't, alright, alright. And . We've got a lot of news. We have a bunch of financial stuff, a bunch of quality stuff.

We have some stories that CVS acquired Oak Street Health. The aha recommending that hospitals partner with the disruptors, I think is an interesting one. And there's an article on toxic positivity from Sach and Jane, which is really interesting. and I'm trying to figure out, we rarely get through six stories, so we'll try to do this.

tially the numbers are in for:months of:rthy aspect of the fact that:

Well, health systems have had predictable revenue for many, many years and you could always extrapolate what you thought you were gonna make and then you could use that, for the next year's purchases, the next year's investments.

But I think, ever since we've seen the covid come through these hospitals, it's not only disrupt them from a staffing perspective, but it's also looking. Where are their expenses? This year they obviously had, some leftover from last year. You can't reinvest last year's profits, then you're in a bad position this year.

So I think it's really just about how are hospitals gonna learn, or how are they gonna adapt to a less predictable financial model in the future, and what adjustments are they gonna have to make as it relates to spending or budgeting that's different than what they've been doing in the past. Right? So that become, More of the forward thinking.

Yes, we had a bad year. Okay, what are we gonna do about it? Let's just look at the ways we can change our business practices, perhaps to make it a little bit easier to predict costs or expenses.

Well, it's

interesting because I'm not sure It can be incremental changes anymore at healthcare, we used to always be like, ah, we had a bad year.

It'll bounce back. Ah, it is just gonna come back and is it gonna come back? Yes. It's not gonna be as bad as it was last year, but it's gonna be a slow return. We still have challenges with staffing. We have wage inflation, we have inflation in general, inflation and goods and services and those kind of things.

The staff shortages are still acute, and that's not just in the clinical areas. It's just across the board. We have staff shortages. We have an assault on primary. Which is one of our pipelines into the health system, and any number of players are trying to become navigators to navigate to the lowest cost provider, which we didn't have to deal with before as hospitals and health systems.

I mean, there are so many factors coming at this right now that I'm not sure. Hey, this is gonna bounce back business as usual. We'll cut back this year. Don't worry, we'll spend next year. That has been the response for, I don't know, three decades, and I'm not sure that's the response anymore.

I think the response now is, all right, are there technology solutions that fundamentally change how we do things? Are we gonna implement ai? Are we gonna implement computer vision? Are we gonna, I. R p a because, we're not gonna be able to maintain the same cost structure and potentially, we need to break the model apart and rebuild it in a way that's sustainable.

Yeah,

absolutely. Well, you think, you even see even on the payer side, those are some of the folks that are embracing this type of unpredictability with things like ai, right? So let's do some AI forecasting to see what we can pro predict for membership, what we can predict for revenues and even on a, from a payer perspective, who are our sick patients and what can we do to intervene, right?

So that's, you're reigning in controlling your costs by taking a more forward-looking approach. So, to your point about new technologies, I. , when the hospitals can invest in these new technologies as it relates to patients, patients health and, costs, that's where it's gonna, it, it needs to be more forward thinking as opposed to, like you were saying, reactionary.

Well, we didn't do well this year. We'll do better next year. Well, let's think three years out or five years out to see if we can plan for that. But yeah, you're right. I think you're right. You can't, it's no more business as usual anyway.

Business as usual. Well, just as if, if people are wondering, ah, things are getting.

billion net loss for:

However, Kaiser salts operating expenses. 4.5% from 92.5 billion to 96.7 billion. So again, it's that cost factor. It's the new norm. I don't think the costs are gonna be going down anytime soon. So we have a lot of things working against us and it's requiring us to think differe.

Yeah. Well, and I think

if you look at that article, one of the things that they have been investing in, which is what we were just talking about, is community health programs, right? So sometimes, you gotta spend money to make money in a situation where you can really get more sort of boots on the ground.

And even in the primary care setting and in the community setting that it's. Ultimately gonna offset costs. Right? And that's why we even see hospitals in investing in just down the street from my hometown or down the street from where I live right now. We had an urgent care open because one of the hospitals said, we need to get people out of our ERs.

Right? But it's costing them money to put an urgent care in the community. But that's something that they're gonna have a return on their investment. So I think if Kaiser continues to do forward thinking investments like that, yes we might see, some all the same factors as why hospitals aren't doing well.

But those are the kind of forward thinking outreach, tracking, getting a handle on your patient population. Those are the kind of things that are going to start saving people money and making people money in the future.

Yep. Absolutely.

if you have yet to hear, we are doing webinars differently. We got your feedback. You wanted us to focus on community generated topics, topics that were relevant to you in your role. We have gone out and gotten the best contributors that we possibly can. They are not product focused. They are only available live.

And we try to have them at a consistent time, the first Thursday of every month with some exceptions. And the next March happens to be that exception. March 2nd, I'm on vacation. So March 9th is going to be our next webinar, March 9th at one o'clock Eastern Time, and we're gonna do a leadership series on the changing nature of work.

We're gonna talk about a couple things. One is the remote distribution of health IT staff and what we have to do from a management standpoint in that regard. We're also gonna talk. The lack of staff specifically in the clinical areas and technicians and whatnot, and what the role healthcare and technology in particular is gonna play.

With regard to that. Love to have you sign up. Our first two webinars for done this year have been fantastic. Over 200 people signing up for each one of them, and we expect just spending for this one. This is a great conversation. Great panelists. We have Tricia Julian Baptist Health System out of Kentucky.

Will Weeder Peace Health and Andy Crowder with Atrium Health are going to join us for this discussion? And I've talked to each of them about this topic and I love their insights and look forward to sharing 'em with you. If you wanna sign up, hit our website, top right hand corner. We always have the next webinar listed.

Just go ahead and sign up, put your question in there and we'll incorporate it into the discussion. Look forward to seeing you then. πŸ“ β€Š

Well, we're a little late to this story, but I'll go ahead and we'll talk about it.

CVS Health acquires Oak Street Health for 10.6 billion. Let me set it up for you. With a definitive agreement in place, CVS Health is poised to acquire them, 10.6 billion. Oak Street Health is a multi-payer value-based primary care company focused on older adults with care model and technology platform.

It describes as scale. The organization said the acquisition would benefit patients long-term health by reducing care costs and improving outcomes, particularly with those underserved communities. More than 50% of Oak Street Health's patients have a housing, food, or isolation risk factor. They said Oak Street Health employs about 600 primary care providers and has 169 medical centers across 21.

its Signature Technology Solution is Canopy, which is integrated with the company's operations and utilized when determining the appropriate type and level of care. So again, CVS continues to push. Mm-hmm. , but they're not the only ones. Right? So CVS is pushing into the primary care space, Amazon. Is pushing into the primary care space.

Walgreens Walmart and then Optum obviously pushing into the primary care space and that seems to be the battlefield. That's, and the aha sort of signaled this, this week that hey, they've looked at the numbers and what they're recommending hospitals do is partner with one of those five players cuz they're not gonna be able to keep up from an experience standpoint and an omnichannel approach to care standpoint with the, with those five players. .

Yeah. Well, they're huge networks, right? So once the patient's in that network, they're gonna try to keep them in the network and that, that's keeping them out of the hospital's network.

Right? So a lot of our health services are provided in a primary care specialty care setting. And less and less are provided in an inpatient settings. And as they spokes continue to grow, they open outpatient clinics. and it's just kind of the catchment.

So by partnering with them, you get to be part of that catchment, right? But if they have their very robust networks, like they're continuing to grow, that's where the patients are gonna stay. So I think it's a good recommendation. But they think the interesting thing also with C V S Health is that, At the beginning of the article, as you were mentioning, they have identified these patients that have other factors besides health.

Now we talk about the social determinants of health. Yeah. Where incorporating, do you have some place to live? Do you have food insecurity? Do you have even a ride to your appointment? That can be a major barrier to care. So if CVS is really dedicated to understanding the non-medical needs of their patients, I think they'll find themselves, more successful in that.

Absolutely. I'm trying to figure out which,

which story I want to do next. So, there's a couple of smaller stories here. Henry Ford rehired 25% of nurses who left during the pandemic. So I think that's interesting. I think some of those nurses are returning, I think some of the health systems are looking at some of the policies they put in place.

Mm-hmm. and saying, you know what, we have other places we could have put these nurses. Without without essentially firing them or, or moving them off the payrolls. And so I think there's some flexibility in work arrangements and there's such an acute need for nurses. So I, they don't talk specifically about how they got all these nurses back, but, it's interesting if that challenge can be addressed.

And I think every health system right now has a plan of some sort. Through partnerships with colleges and universities through rehiring practices, through flexible work schedules. I think the work of a nurse it's gotten a lot of attention and I think it's going to get better as a result of, what we've seen over the last three or four years.

Yeah, well I think that goes .

With the old, you don't know what you got till it's gone. Right. Historically I don't remember, you remember that show, er, I was watching that the other day and one of the nurses says to the doctors, nurses are what makes this place operate. And it's true.

They're the backbone of a health system. And I think that during the pandemic, certainly a lot of people who worked at hospitals in general were perhaps dismissed because of vaccination situations or policies that the hospitals had in place at the time. And I think it's great for them to reexamine what the policies are, where nurses can be utilized.

I think that, I always said I wanted to be a nurse, cuz you could do a million different things. You could work in inpatient, you do outpatient, you work for an insurance company, you could work at Home Health. So, There's always gonna be a demand for nurses and the organizations that can be flexible and capitalize on what the nurses need and want are gonna do better.

Right. We don't need to treat people like, if you don't fit into this mold, you can't work here. Let's see what the other options are. It's better to have them than that.

Absolutely.

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There's another nurse story. Dartmouth Pilot's Nursing Hackathon, shark Tank for nurses. So the event described as Shark Tank for nurses was held January 26th, 27th.

Registered nurses, nurse practitioners, medical assistants, licensed nursing assistants, so forth. I mean, the list goes on. In an event, we're separated into five teams to learn about design thinking, artificial intelligence, among other topics. Each group then pitched their innovation to a panel of nurse.

The winning team developed a go-getter strap, which allows employees to transport two wheelchairs at the same time and expedite discharge process. The winners will undergo a six month mentorship program in which nursing innovation experts will help them bring the idea to life. I like these kinds of programs.

I just, yeah, it's just fun. Well,

yeah, and I think,

There's a lot of knowledge that, organizations have a hard time capitalizing on. I always said when I was in sales, if you wanna know what to do with this company, you should come talk to me, because I'm the one that's in the faces of the customers.

I'm the one that's hearing the, why they're happy and why they're unhappy. And for an organization to understand that the people on the ground, Have some of the best ideas cuz they're doing every single day. Would you have I ever thought that moving to wheelchairs at the same time? I didn't even know they did that ever.

Right. So, right. Who are the people that know that? The people who are actually doing it. So to make it into a competition like that is even more fun. But it just gives you a thoughts of how do you meaningfully engage your employees to solicit this type of innovation? And how do you have the internal.

Mechanisms to support innovation just on a daily basis. Somebody comes to you and says, I think we can make our organization better by doing this. Okay, then where does it go? So that's something to keep in mind cuz you know that's saving time, it's making people happier. It's small things that can make a huge difference.

Yeah. These people,

I

remember David Baker came to me with this idea of 60 back. He was gonna work with one of our hospitals. We had 16 hospitals and he was gonna work with the with the various staff. And when he met with the nurses, It was so easy to give them 60 back cuz it was just a matter of listening to 'em.

Yeah, yeah, absolutely. He's like, he's said, bill, here's their first five ideas. And I looked at it and I'm like, That's only gonna cost us like $4,000. Yeah, exactly. Yeah. He's like, he goes, yeah, I think we should do all of 'em. Like this week. I'm like, yeah, exactly,

exactly.

Yeah. But there's no mechanism within the organization to even ask the question, right?

Because I think people are afraid. So if you have an administrator, and this not only in healthcare, but just in general, if you ask your employees what could make their lives better, then they think, well, I can't ask 'em cuz what if they ask me to do it? Right? So, They don't wanna set the wrong expectation, but then you're also forfeiting potential, $4,000 ideas that can make people's lives better.

So I think there's, there's a balance in there and how do you solicit that? And also now they can have wheelchair races, like, remember those when we tied our likes together? You'd have two versus two now. So I think that would be another fun activity in the parking lot or something.

Yeah.

I like what

you're saying there just in terms of being able to respond, listening with an ability to respond, I think is one of the things. The other thing I'm hearing about and Sat, and Jane really ca captured it so well, and this is in a Forbes article, he said, the healthcare industry's biggest cultural challenge.

A name and it is toxic positivity , and so he defines toxic positivity. He says it results from a delusional idea that one should exclusively focus on what is going right rather than identify and troubleshoot underlying. Causes of a given problem. It's a somewhat understandable reaction to seemingly insurmountable obstacles, which perhaps explains toxic positivity's, ascendancy in the healthcare industry.

But the practice is bleeding into situations involving challenging but fully solvable problems. And it really causes us to flip blinders on. I'm gonna go into this whole article at another time. But the two things I've seen is one, that whole concept of don't ask because if they tell you something, you've gotta act on it.

And it's better to not have them ask and not respond than to essentially not know. Right. Right. It's be, it's better to not know

and I don't think, I don't deniability. Right. Like I

didn't hear anything about that. So why we don't need to do anything cuz I didn't hear anything about it. Right.

And I

don't think it is better not to know.

I think it is better to know cuz then you can classify things. Is this a critical, urgent problem? Is this a nice to have? Is it a wish or what? I mean you can know the things that are going on in people's heads and they're willing to tell you if you have the conversation and some of those things.

like I said, you can act on and within the week, spend a couple thousand bucks, which is disposable money in a lot of it budgets, right? And give nurses 60 minutes back in their week. Are you kidding me? That's a no

no. Now you're making money on that, right? ?

Yeah.

So that's one side of it. The second side of it is this positivity, and I find this all the. When you ask people about the situation and they say, oh, but you know, over the last 10 years we've made this much money and, and we, and we've served these people. We, they, they just, the bullet points just flow off of them of, of, this is the positivity.

And you're like, are you looking at these problems or are you trying to look at them through this positivity lens because. You're overwhelmed,

right? And

yeah, and I think, I also think, yes, is there and, and you'd ask any of my friends. I try, I personally try to have a good attitude about things, right?

So you can look at the bright side. There are situations where you can make a choice to say, you know what? This isn't really that bad because of X, Y, and Z. But I'm also New Englander. . And so I'm also a huge pessimist. I also call myself a realist, right? So if you're looking at the negative side of things that might not be negative, that might just be real.

And to your point, if something's real, then it should be addressed. We can talk about it. And yeah, all the problems aren't fixed, but just. Putting your rose colored glasses on during the workday is also not gonna solve all the problems either. So there gotta be a balance in there because Yes.

And nobody really likes all those people who are super positive. And then you think,

yeah, we don't like the people who are overly negative either, though. , that's

what I'm saying. Right. So it's gotta be something in the middle. You have to be a realist.

Yeah. I like the idea of being a realist. And, It's looking at the positive, Hey, we are still doing great things for the community. Yeah, most health systems have a really good brand in the community. They have helped people. People will say, oh, I was born there. My kids were born there. My parents received great care there.

Even my wife will talk about, my, my father. Died at that hospital. But man, he received such great care and they took such good care of him at the end. We have this strong connection with our community. We are really well positioned to be the trusted source for health and healthcare in our communities.

We have a lot of stuff to build on. The challenge is there's so much going on. We need focus. I hear this all the time from leaders. It's like during the pandemic, the thing they miss the most about the pandemic. I know it's hard to say that. The thing they miss the most about the pandemic is focus at, at a certain time.

They said, okay, shut off all the. noise We have to focus on the pandemic and we saw amazing things happen. Health systems did amazing things very quickly and they were able to identify that code red critical item, this is what we're gonna work on. And and now we're back to that, the age old day of, know, what am I gonna work on today?

There's

right.

There's 22 priorities and there's six strategy pillars and there's whatever. You're constantly being pulled in too many directions. Focus is required.

Exactly. Well, and also, you have a list of 30 things, let's just take it right. That's only a small portion of the initiatives within the hospital.

There's it projects, you have a whole list, you've been there. This is the thing of what we wanna do. So how do you go about evaluating those? So is Is this gonna improve patient care? Is this gonna lower cost? Is this gonna make us, our provider? Happier. How do we evaluate those projects and say, this is what we prioritize.

We're focused on the patients, we're focused on cost. And how do you pull that information out of these projects to help you make decisions on which of these third, you can't do 'em. All right, so what are the top five that you can focus on? It, back in the day we used to just say send us a po.

We never asked for any. Information on return on investment. It's just, we're just gonna do this thing, right? But now I think you have to be more, a little bit more strategic about how you're prioritizing them and seeing if there's a measurable outcome that can be achieved from these projects.

So hopefully people think about that because there is, there's just too much. So where are you gonna focus?

Absolutely. Well, Priscilla Time's Up. I know it went pretty fast. We got through a bunch of stories

though. I'm, I know we did. There's always something going on in healthcare. . There

there is.

Thanks. Thanks for coming on the show. It was great and I look forward to doing future shows with you. Sounds

great. It's great to meet you and I'll see you soon. I'm sure

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