This Week Health

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January 17, 2022: Chris Logan, Senior Vice President and Chief Security Officer at Censinet joins Bill for the news. Transcarent, a digital health platform for self-insured employers, closed a $200 million series C funding round with players like Northwell, Intermountain & Rush. Will telemedicine evolve to a dynamic and preferred experience or have we cut and pasted the traditional doctor’s office experience into the computer screen and left it at that? Plus highlights from the JP Morgan Conference. Moderna’s earnings were excellent. Sinovac went from slightly in the red in 2020 to 5.1 billion net income in 2021. Ascension is ready to take more risk when it comes to value-based payment models. And Intermountain Healthcare touted its acquisition-fueled shift away from fee-for-service care.

Key Points:

00:00:00 - Intro

00:11:15 - Transcarent is going to change the experience employees have with their employer benefits

00:15:10 - We assume everybody understands how to navigate healthcare but they don't

00:21:30 - A health system should become a partner in health care as opposed to a partner in sick care

00:26:45 - How do we really transform what telemedicine looks like?




Newsday - #JPMHC22 Themes, Telehealth 2.0, and the Labor Crisis with Chris Logan

Season 2, Episode 11: Transcript - January 17, 2022

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

Bill Russell: [00:00:00] Today on This Week in Health IT.

Chris Logan: Nine times out of 10 ransomware starts with a human being. Are they training their people? Are they segmenting out the environments? What's running in their platform? I wish this would continue to get pushed by the feds and become reality so that people know exactly how their operating environments are running. That way we can identify a breach quickly. Isolate it and move on.

Bill Russell: It's Newsday. My name is Bill Russell. I'm a former CIO [00:00:30] for a 16 hospital system and creator of This Week in Health IT. A channel dedicated to keeping health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, MEDITECH and Cedars-Sinai Accelerator, who are our Newsday show sponsors for investing in our mission to develop the next generation of health leaders.

And just a few years, This Week in Health IT has grown from a podcast into a media channel hosting, all sorts of health IT content. Here's what you can expect from us in 2022 and [00:01:00] where to find all of your favorite shows. Our this week in health It podcast has been rebranded as this week health conference Here you're going to find our shows solution showcase and keynote This channel aims to bring the conference to you year round hear from industry leaders without expanding your resources time or travel Our today in health It podcast has become this week health newsroom It will air our today in health It shows every weekday but you'll also want to find our Newsday show [00:01:30] over there as well This channel is dedicated to industry trends and commentary from different voices in health IT This week health academy is a new show for us And what we have out there is a show called insights Insights is a highlight reel from all of our content over the last four years It centers each episode around a specific healthcare topic as explained by an industry leader. This channel is a resource for health IT staff new to their role or looking to take the [00:02:00] next step in their careers. I'm personally very excited about the last podcast we're launching. It's called This Week Health Community. And it's about just that. Voices from our community. It's hosting a new show Town Hall. Here we've invited several guests hosts to come on and have conversations in all their areas of expertise. This will take our conversations out of high-level hypotheticals and into tactical challenges that you may be experiencing in your role Make sure to follow us on social media this [00:02:30]week in HIT on Twitter and subscribe to our email list thisweek to never miss a moment of any of these great shows.

It's Newsday. And I'm excited for this week's conversation. We're going to talk a little bit about telemedicine 2.0, and I think a great article. We're going to talk a little JP Morgan. L ittle bit of investment and some other things that have happened.

We'll probably talk some cybersecurity because today we are joined by Chris Logan, formerly with VMware now with[00:03:00] Censinet. SVP and Chief Security Officer for Censinet. Chris, welcome back to the show.

Chris Logan: Bill, always a pleasure to join you, my friend.

Bill Russell: You've been on Newsday once and our conversation was so good that we're going to kick off the year with another conversation. So I'm looking forward to it, but since we have you on and people are last week was Drex and we started with security.

I just want to touch on this security thing. I have a bunch of CEOs that I work with that have been hit by various issues.

And [00:03:30] one of them is this Kronos cloud. I don't know if it's a breach or what it is, but essentially Kronos is down. A certain aspect of Kronos cloud is down. It's impacting a fair number of health systems across the country. Do we have to start worrying about our cloud systems being taken offline for 30 or 40 days? And what can we do about that?

Chris Logan: You should have been worrying about.

Bill Russell: Oh man, you're right. I probably should have been.

Chris Logan: So, so bill, I'll say this and I'm [00:04:00] not saying this loosely, cloud is just an extension of your operations. It's not a destination. If that's a magical place that everybody goes to, it's an extension of your operations. Every organization that's using a cloud-based provider should be pressing that provider on what their security controls are.

Bill Russell: What can I do? I mean to a certain extent, I move stuff to Kronos big company. My guess is their sales pitch, when they come in is, oh, look, we're in the cloud or. But we can do [00:04:30]multi-cloud we can move this around.

We can do these things. And then they're hit by a ransomware attack, where they get in and they kill you from the inside and they're as vulnerable as anybody else. Well, who knew what was I supposed to do? I mean push them is one thing, but what am I asking them?

Chris Logan: You're asking them all the same questions that you're trying to answer yourself. In your operating environment, your data center, what are you doing to prevent these bad things from happening. Now, I don't have a silver bullet answer for this [00:05:00] because there are so many variables that are involved, but right out of the gate, nine times out of 10 ransomware starts with a human being.

Are they training their people? Is somebody clicking on a link in an email that's causing serious disaster across that operating environment? Are they segmenting out the environments? Here's my favorite one, because this spins off of the whole log for J issue. Do they have a defined software bill of materials? What's running in their platform?

I wish I wish this would continue to get pushed by the feds and become [00:05:30] reality so that people know exactly how their operating environments are running. That way we can identify a breach quickly. Isolate it and move on. Breaches become five minute incidents when we start to do things like understand the entire operating environment and then put some fancy AI controls in place in machine learning to actually react to things that shouldn't be taking place.

I've said this for for two decades now. The biggest detractor of security is variability. How do we get the variability out of this? I'm listening to [00:06:00] systems. There's a lot of noise. That's exactly what it is. Noise. If I know exactly what should be talking to whom what should be running, what should be connecting, where data should be flowing.

Now I know exactly how the system works and I'm removing that variability because anytime something strange from that standard? I have a problem and I have to go address it. I have to look at it better yet. Now that I have that baseline, I can have the machines go look at it for me. We, we got a lot of work to do in this space and I'll tell you nobody should rest [00:06:30] easy just because you are using a cloud-based provider, it's just an extension of your operations. Treat them no different.

Bill Russell: I will say this. I love my staff where I was CIO for a health system. But they always felt like I was pushing them too hard. Hey, no, no we need to know the things you're just asking for. We need to know what systems talked to which. What defines normal traffic on our network? What defines the normal flow of data across our network?

And they'd look at me like, oh my gosh, that's a lot of work. But I pushed them really hard. And now [00:07:00] it's really the events of the day that are pushing us. And that's what happens when we don't get ahead of this stuff. Then the events of the day are pushing us and that now dictates our agenda.

And that's why we have to stay ahead of this stuff. And not only what's going on today but what goes on to the future. Let me ask you one more security question. Then we're going to go into a bunch of other things. And that is, rumor out there on some of these breaches is that these organizations are paying the ransom.

Now, I don't know if that's the case or not, but let's [00:07:30] assume they are. Doesn't that create a more challenging environment for the rest of us? First of all, they're funding them. And second of all, they're being emboldened. They're like, Hey, there's there's money in them there hills. I'm going to pack up my family and really camping in healthcare and camp in this space. Especially, I mean, I've heard two stories of two different cloud vendors that were ransomed and they paid the ransom.

Chris Logan: If that's true. And again, speculation, we hear things on the wire, you're creating a gold [00:08:00] rush. You know what that's going to cause disparity. For those of us that don't have the means to participate in said gold rush. It's bad behavior. At the end of the day, nobody should be paying the ransom. I understand, there's a lot of, again, variability in that how quickly can I get my data back? First off. dO you even know you're getting your data back?

Is it not corrupted? Are you getting a subset of portion of it? Again, it goes back to that and I hate to beat on this soap box and that security best practice, do you have an immutable copy someplace [00:08:30] else that's not connected anywhere? Something just as simple as that, people don't want to invest the time, energy and effort into it because it's tough.

It's not easy to do. You know what else is not easy to do? Not have your system that provides payroll for 35 days. I would rather take the 35 days to figure out that problem and solve it before it becomes a problem. Right? So bad behavior is never going to change how the bad guys act. Keep paying 'em, they're going to keep coming back to the well. So you're just creating a whole nightmare for the rest [00:09:00] of us.

Bill Russell: All right. Little foretaste of what we're going to be talking about. I'm meeting with Glen Tullman tomorrow. Going to do a half hour conversation, but Transcarent is at it again. This is from Becker's and it's Northwell, Intermountain and Rush invest in digital health platform for self-insured. Let me give you a couple of excerpts here. So Transcarent, a digital health platform for self-insured employers founded by former Livongo CEO, Glen Tullman closed a $200 million series C funding round on January 11th. In full [00:09:30] disclosure. Transcarent is a sponsor of the show. Northwell Health, Salt Lake City based Intermountain healthcare in Chicago based Rush University medical center also participated in the funding round.

Transcarent provided healthcare services, including urgent care medications, personalized behavioral health symptom, evaluation, and support experts, second opinions and specialty care. And here's the quote, the million dollar quote from Michael Dowling, CEO of Northwell. Northwell Health has [00:10:00] long been committed to doing our part to drive health reform in our region. It's why we launched Northwell Direct, which is an employer program that they were doing to deliver high quality employer health services, tied to new payment models. Today, we are proud to be partnering with and investing in Transcarent as a way to accelerate our efforts on a national level.

The new investments bring Transcarent's total funding to 298 million raised, since its founding [00:10:30] in 2020. Essentially they've raised $300 million, it feels like a year. It might, it might be a little more than that, but it's not much more than that. So 300 million I think this is interesting to me.

And I think it's interesting because Glen Tullman has a way of identifying the gaps that exist within health care. He went straight to the employers and he said, what's the problems you face. And then he got an earful. It's like, oh my gosh. Every time we turn [00:11:00] around, our costs are going up and there's no transparency.

We send our people to these care networks. They get horrible care. The digital experience is bad. And we're working with an insurance provider and the, again, the experience is bad. People can't figure out what's covered. What's not covered.

He raised the money and he's wading into that. And he's saying, look, we're going to change the experience that employees have with their employer benefits. And it would seem that the investors, [00:11:30] including health systems, Northwell, Intermountain, and Rush.

These are some solid partners. And my guess is the only reason he doesn't have other partners is because he tried to raise money so fast. And some of these other health systems cannot move that fast on an investment like this. But I think we'll see some other names sort of tag along here in the next three to six months who said I didn't get in that round, but we'd like to be a part of this.

This is a I dunno, I mean, what's been your [00:12:00] experience as you go to the benefits meetings and those kinds of things. I mean, generally I've sat in a couple of those and even at health systems, I've sat in a couple of those where the employees are like our health benefits stink and we're the healthcare provider. It's like, why, why is this? Why is my experience so bad?

Chris Logan: I've seen it from a couple of different angles. From being with the health system, trying to figure out what our costs were per employee for healthcare coverage, right. To now being with a smaller company and actually [00:12:30] be a larger part of the conversation about what benefits packages we're going to bring forward for employees.

This is awesome. And this is why I'm saying this. This is going to create more competition in a very bloated space. That's going to change behaviors. And why I love this model is because, I'll just use myself as a perfect example. How many health visits did I have this last year? I went and saw my primary care for my annual. How much I pay per month just for me [00:13:00] alone?

Not even my family, in benefit costs. It far outweighs what it would've cost me out of pocket just to go see my primary care. Now I understand, some things happen. I may need emergency services. I may be on a drug that I have to take every month. There's there's issues there. Right? But put the cost of healthcare, put the drive for healthcare services back to the individual.

Give me choice and flexibility. That's what they're doing. They're putting it back in the [00:13:30]hand of the individual. Where this benefit the employers now is that I don't have to pay these exorbitant fees for, I don't even know what my employees are getting. I don't know who's taking advantage of these services.

I'm putting the power back in their hands. More importantly, we're shifting the dynamic of what people actually want. Most of the employers that we have in our own employees that we have in our organization. I call them digital natives. They grew up with technology. They want care a specific way. You know what they don't [00:14:00] want to be told they have to go to very specific PCP on a very specific day and a very specific time and show up physically. They want to take advantage of the technology in their hands.

Bill Russell: And to be honest with you, Chris, it's the stuff we don't see. One of the things that this team at Transcarent is going after is medication pricing. And they, they struck a deal with Walmart. And when we get involved in these very connected organizations, Cigna has a PBM and Aetna has a PBM and they all have their own [00:14:30] PBMs. And you look at the pricing. If you really look at the pricing closely and you're like, okay, they're barely making money here, but they're making an exorbitant amount of money here and all this other stuff.

And what Glen sort of stepping in there and that team is, I hate saying Glen it's the team is stepping in there and doing is they're looking at that saying, look, we're going to partner with Walmart. It's the first of many partnerships that is going to drive down the cost of medications. They may partner with Amazon, which is a large pharmacy.

Now they may partner with CVS and others as [00:15:00] they move forward and essentially say, look, we're going to manage this process for you. And we will find the lowest cost medications. Now there's applications out there that do that for us now, but it's so funny, cause we assume everybody understands how to navigate healthcare and they don't.

And that's what this is. This is a, an experienced company. They're saying, look, you can get us on the phone within 60 seconds. We'll answer your questions. We'll help you to find the doctor at the lowest cost with the highest outcomes. We'll find [00:15:30] you your medications after the fact. We'll find a, your rehab, your durable goods.

So they're going to step in there and say I understand how hard this is for you, your family to navigate care. We know care and we're going to, we're going to plow through this junk that exists within care and make it a better experience. And when you talk to Glenn and he'll say we are a healthcare experience company. That's very interesting.

Chris Logan: Yeah, I like i ta lot actually.

Bill Russell: All right. I want to talk this next story [00:16:00] with you. John Nosta wrote this and in fairness, let's see. What does he say halfway through this thing? This article is sponsored by AT&T business however it doesn't necessarily represent at and T businesses positions or strategies.

And to be honest with you, I don't think it does at all. I just think that's one of their sponsors. And he talks about the urgent need for telemedicine 2.0. And I love, I love the setup and I love where he goes. First he talks about Steve jobs once observed the early days of TV. We're nothing more than a radio show with a TV camera added in the background.[00:16:30]

There was nothing new. In fact, it might've even made the magic of radio less compelling as you could see behind the curtain of your imagination. Television was new and powerful medium but for many, it was just a simple evolution of the old radio. He goes on to talk to the internet the same way. And if you around in the early days of the internet, and I was in some of these conversations, I have the gray hair to prove it where people were like, Hey, we've got to get our brochure up online.

And so that's how people sort of looked at the internet [00:17:00] until this whole idea of user experience and automation, digital transactions really changed the way we, we look at these things and then he goes on to talk about telemedicine and he says, we might be looking at the exact same thing.

We might be able to make a similar comparison to the state of telemedicine today. The news contrary to many sensationalized headlines of robust adoption seem to indicate a rapid increase with telemedicine visits that was not sustained early data and [00:17:30] anecdotal accounts. In most instances have shown that visits have fallen off and in some cases returned almost a baseline.

My guess is that today's telemedicine was born out of the necessity of COVID-19, which it was, and not out of our desire. The result is no surprise and is less an expression of digital transformation and more of yesterday's radio show with the volume tuned up. So he lays that foundation. I'm going to give you a little bit more of this article because I think, I think it's a, I love [00:18:00] the setup for this.

He goes on to say, will telemedicine evolve to a dynamic and preferred experience or have we cut and pasted the traditional office experience into the computer screen and left it at that? The talking head clinician is hardly a robust application of technology's capabilities to telemedicine. Our challenge is do much more than transfer an office visit to a Zoom call. Available technologies combined with our user education can transform this experience into something [00:18:30] that is enjoyable and provides a valuable clinical experience for both the patient and clinician. This is a dramatic contrast in today's perspective that positions telemedicine as an event of convenience versus a tool of medical excellence. Does that resonate with you? That telemedicine we've just sort of taken the office visit and put it on a screen?

Chris Logan: That's it. So I'm going to go back. We created a telepresence way back in the day so that we could [00:19:00] staff an urgent care center with mid-levels and have the attending on a screen to be able to finalize the diagnoses. That was 15 years ago.

Bill Russell: I think I know where you're going with this. Go ahead.

Chris Logan: What have we done today? Nothing. It's the same exact thing. I get necessity. I understand. COVID. My hopes was that we would have evolved from that telepresence that we're in for medical services. It's a much more of that [00:19:30] digital user experience. Right. And I can't, the expectation now of that patient is something different. It's not that office visit. We haven't changed now. There's companies out there that are doing some pretty slick stuff, but I don't need to sit down and talk to my physician over Zoom to understand that I'm sick. What's helpful. Take other digital assets and bring it into that conversation.

And maybe I don't even need a conversation. I have so much technology at my fingertips. My Apple watch does EKGs for crying out loud. How come that's [00:20:00] not incorporate into that digital experience for improving healthcare? That's what telemedicine should be. Not what we have today, which is basically the radio show, just being broadcast.

Bill Russell: Yeah. And that's, that's what he goes on to say that the opportunities are here for telemedicine to become an ongoing and continuous engagement where clinicians can leverage technology to advance care, not just provide a bland substitute for the office visit. Wow. There's a lot in that sentence. We talked about this back in 2011.

Presented the [00:20:30] strategy that our team and in collaboration with clinicians and others came up with to the board. And we talked about, we've got to reach outside the four walls of this health system. I mean, that's the obvious one. And the thing we said is we, we see a person on average one time a year, your story, we see them one time a year.

What if we could develop an ongoing relationship with somebody where we are touching them in many different ways. We're touching them digitally. We're touching them with [00:21:00] messaging. We're touching them with the suggestions. We're talking to them when they're in the aisle of the grocery store, because the decisions we make in the grocery store will dictate where we loo like a month from now. In a lot of cases or as we're looking at a menu or those kinds of things. How do we take one visit a year, one touch point a year. And my thing was, how do we take one touch point a year and turned it into a hundred or a thousand? And that is, that's the promise of digital. Where it's integrated into our lifestyle. It's integrated into [00:21:30] how we interact on our health. And then the health system could become a partner in health as opposed to a partner in sick care. When I'm sick, I call my doctor or when I absolutely have to get my annual visit, I call my doctor now, clearly there's people on all sorts of that continuum.

There's there's children, there's chronic conditions. There's people of advanced age, but we're talking our stories. I mean, I saw a doctor maybe [00:22:00] twice last year, if I thought about. And one of those was in the ED. That, that really doesn't work.

Let me go on to what he talks about. And so this is the money paragraph, I think, in this article. By the way, the article the urgent need for telemedicine 2.0. It's on his medium account. So you could look it up there. The future of telemedicine must leverage the tools of user engagement that are already in our consumer toolboxes.

Our challenge, isn't just to repurpose a clinical history and physician exam but to reinvent the exchange of information in the [00:22:30] techno human construct. Even our natural conversations can be optimized with technology and artificial intelligence to offer something that is not just human life, but actually Uber human and establishes a new potential that makes a simple video chat with a doctor, feel a bit more yesterday.

And I think what I'm picturing as I read that article is, if I talked to somebody once a year and I see them again next year, think about that conversation. I mean, [00:23:00] how dynamic is that conversation? But if I have your EKG from your watch. Your Apple rings for your exercise and your ongoing, just all those data points that by the way physicians told me, I don't want in the medical record, it's too much noise.

And I understand that. It is an awful, we have to figure out a way to take the noise and turn it into valuable information. But at the end of the day, if I had those thousand interactions with that person, the next time I talked to them, I [00:23:30] could be looking at a history of their exercise and say, hey, look, you exercised great in January and February. It seems like you pick it up again in July and all.

And you don't do it again until January, February next year. Let's talk about what it's going to take for you to have a more balanced and healthy lifestyle throughout the year. Maybe your goals are too big in January for your exercise regimen and maybe we can reduce those to, Hey, let's, let's just get you moving two days a week.

And maybe two days a week at the [00:24:00] gym is all you need. But we're sick care. We're not well care, We're not health of the person. And that's the transformation in mindset. I think that needs to happen at the health system level in order for them to weight in now, granted a ton of digital health companies are thinking this way and trying to enter that space. But I'd like to see healthcare companies see themselves as the partner in health for their communities and establish many more digital touch points. I'll [00:24:30] give you the last word on this article here.

Chris Logan: So healthcare was supposed to become preventive right. Again so we go back to this idea of sick care. Nobody's moved away from that because the incentive structures haven't changed from that. I don't know we're going to dive into this concept of fee for service and changing payment models because of what's coming out of JP Morgan. But nobody's incentivized as fact to preventative medicine. So we do have the tools and capability today to change this experience for the individual patient and [00:25:00] the caregiver so they can make better informed decisions to prevent bad things from happening. We want to remove the cost. We have the data right at our fingertips. All these digital health companies that are coming out today are doing substantial work to provide the foundation for just that. We just can't get out of our own ways for some reason. Why? Because it doesn't make sense monetarily to do it. Somebody has got to change that model. It has to be, it has to be pushed forward. And I'll talk to you about the tools. I love this idea of tele and this idea of [00:25:30] meta and changing how we work in general too cause labor shortages is a huge issue. How do we change and address that?

We're now starting to dabble with Oculus quest in my organization. And this is no plug for them to have joint meetings, to whiteboard with each other, because it's a new way to do work that technology is readily available for us, and it may spark some innovation and ideas that we didn't have before. We need to take that same model and put it into direct care and make it much more preventative.

I love this idea that I don't have to have a dialogue [00:26:00] with my physician just one time a year. It can be the thousand touchpoints because if my watch or my treadmill now is sending data and he goes, Chris, why didn't you work out between March and April? What's going on? That's the point of question right there. Isn't that what we're trying to solve for in science and medicine anyways. The why. Why aren't you working out? What is going on in your personal life? Were you sick? Did you have a cold? What were your symptoms? Should I order you a lab test now that can be done directly at your [00:26:30] home. Maybe spit into this tube so we can understand a little bit more about what's going on and then start to dive into why you may be feeling the way that you feel. There's so many different avenues we could take, and we're just not doing it yet because we're just stuck. We're stuck in this rut and we need to change it.

Bill Russell: Yeah. I'd like to see CEO's lead here. Lead the conversation into a different direction of how do we really transform what telemedicine looks like? And I think it is increasing the number of touch points, figuring out how to make sense of that data, increasing the [00:27:00] communication options that we have getting more personalized with the consumer. Obviously the more touch points you have, the more information you're going to have on that person, the more relevant you're going to be in their life.

Perhaps we can get better at things like med ahderance. Keeping people out of the ED. Getting them to the right point of care. Those are just some of the things off the top of my head. All right. I love the JP Morgan conference. I wish I could attend every session, but all day Monday, all day Tuesday, all I did was sit in the nonprofit track.

Not [00:27:30] that it's boring. It is from where I sit, it sets up the rest of the year. I get to hear what the intentions are. First of all, what happened last year. And then I got to hear what the intentions are of the health system and of the leaders who are leading those health systems. We're going to hit three different articles that are going to cover the other 600 presentations that I wasn't able to attend.

But before we get there, generally here are some themes from the health system part of the presentation, from the part that I attended [00:28:00] and then we'll get to the articles. Number one, there's a labor crisis and the labor crisis, especially a clinical labor crisis at this point. This specific variant, the Omicron variant is putting healthcare workers on the sidelines at a time where we need more healthcare workers. And so what you're seeing right now, what we heard is significant shortages, some delays in care, some surgeries being deferred as well to [00:28:30] later times in the year. Now the good news is Omicron not as potent as previous. And so for the vaccinated, it essentially is a cold to a bad cold.

And for the unvaccinated, I mean, it's a viral infection and can impact them a lot of different ways. But at the end of the day, this is impacting staff. So we heard a lot of questions, a lot of conversations around staffing. How are you addressing this? And I heard CEOs for the first time, really in my mind, talk about labor supply. chain

Building a [00:29:00] labor supply chain. I heard of different organizations going national in terms of their recruiting efforts to pull people. And incredible partnerships, new partnerships. They're training, new people. They are new residency type programs. So a lot of creativity being pushed this way.

And you're in the cybersecurity space. We talked about the clinical shortage here and they did talk about that. But I'm talking to CIOs who are saying, look there's areas within IT that are very acute. I mean, it's really hard to get good staff [00:29:30] in certain areas. Do you think some of these things apply? I would assume some of these things that apply to what we're doing from an IT staffing standpoint.

Chris Logan: Yeah. We've had a shortage in IT securities since the jump. We've never had enough supply to meet the demand and we're seeing the demand curve spike so rapidly. And now, again, I'm just specifically talking about IT security here across all industries at that it's not just healthcare.

There's such a deep shortage of qualified individuals to help [00:30:00] solve these problems. Jump back to the nursing issue and the physician issue, right? The clincians. Wern't we talking about this 20 years ago? A decreasing shortage of available talent for these fields? Why didn't anybody listen back then? Well, now we're now we're paying the Piper, so to speak for not addressing this issue 20 years ago, when we were predicting that shortage add in this bad pandemic.

Now the people who are qualified and work in their sideline because they have to be to recover. We knew [00:30:30] this was coming and I'm not pointing fingers. I'm not jabbing anybody, but this is that classic case of yeah that, that may be a future issue and we don't need to address it right now. No, you needed to address it 20 years ago because we just don't have that labor supply chain right now to solve for this problem that we're faced with today.

Bill Russell: Yeah. I coach CIOs as part of my business and I was talking to a CIO the other day about this. And we were just sort of spitballing on ideas of how to address this clinical [00:31:00] supply shortage. And there's a handful of things that are low-hanging fruit. There's some clinical automation out there. There's some clinical AI you can apply to it. There's obviously some user experience, clinical user experience things. Nuance has some great tools that make people more efficient in how they interact. There's ambient clinical listening and other things.

So we were just talking about different things. And he said the challenge with all these things is we're just getting started today. To your point. We're just getting started today. He goes, so we're not going to see any [00:31:30] benefits to this for another three years. Right. And that always opens up the conversation to me to say, all right, what's it going to take for us to have more foresight? To look at something and say, look, we know this problem is coming.

I always, every year I try to anticipate what's going to be my problem three years from now, and maybe that's too hard and maybe it's just, what's going to be my problem next year and make sure I set aside about 15 to 20% of my time this year to prepare for next year's problems.

[00:32:00] And I'll give you, I give you a couple of examples. I've gotten actually pretty good at, patting myself on the back. I've gotten pretty good at this. And I still do this in the business I do today. I looked what's going to be my problem in year from now. But when we were coming up with the vaccine, everyone was worried about how are we going to schedule people for the vaccine? I'm like, that's not the problem. That's not the problem. That's not the problem. And they were like, yeah, what do you mean? That's not the problem. It's going to be hard to get it. And scheduling was a mess early on. And I'm like, look, you have a line of people.

That's about 50% of the population that if you told them, in [00:32:30] Florida, if you told them all the vaccines being shipped to Orlando, you have to get there for the vaccine. They were going to drive there and they were going to get the vaccine. Right. So we had 50% of the people. I'm like, that's not the problem.

The problem, which is going to manifest itself nine to 12 months from now is going to be, we're going to get the 50% and no one's going to be in line. That's the problem we need to solve today. And and I had people saying we'll cross that bridge when we get there. W when we got to that bridge, we had screwed it up so bad with our communication that those people had dug their heels in [00:33:00] and they said over my dead body am I getting vaccinated. And we're like, oh, look at those idiots. Now I look at us and say, we had no foresight. Our communication was awful. We shamed people. And then we said, why didn't you get a vaccine? Well, it's like looking at my kids and saying, you're stupid.

Why don't you go to college? And they're like, I'm not listening to you. Whatever. So, I mean, that's, that's just one example, but this is another one of those that as you say we knew 20 years ago but we didn't even have to have 20 years of foresight. All we [00:33:30] had to say is, hey, we just entered a pandemic.

Most pandemics lasts for two or three years. At some point we're going to have a vaccine mandate and we're going to lose five to 10% of our clinical staff. And it didn't take that much foresight. It just, it took us stepping out of the urgent for an hour. Maybe having a few conversations with our peers and say, Hey, do you think we're going to face a clinical shortage?

I'm thinking about these issues and I, I think, I think we might have a very [00:34:00] acute clinical staffing shortage towards the middle, to the end of this pandemic. What do you think? I think this is playing hindsight and hindsight's 2020. I think most people would have said if given the time to step back and think they would've said, yeah, I think you might have something we're going to have a problem.

Chris Logan: I agree with you. We get so caught up in the tactical. And I was listening to a great podcast. Jacque Wilks. Very smart guy when it comes to leadership. Extreme ownership for these types of issues. We're so focused on the tactical day to day. How [00:34:30] do we get our job done now, that we never think about what that means for the strategic.

The most important element of that is just take that step back. What you have going on right now. It's not going away. Right. We may solve for it, but what's going to be that further outcome. So if you took that step back and started to think, what's the next thing that's going to manifest itself based upon what's happening now, we could've come up with a better answer, but like you said, Nobody does that because we're so caught up in what's the issue of today and that's across every industry, right?

[00:35:00] Every vertical that you can think of that labor is going to be that issue that we're going to be dealing with for awhile. I'll take it back to security. Why are we so bad at responding to breaches? Because we're so focused on what's happening right now. And so thinking, how could we have prevented this?

What do we need to do to move forward, to prevent this from happening in the future? We're thinking about it too late in the game after it's already affected us. So just take that deep breath. Push away from the table for just a hot five minutes and go, what's next? What do I need to focus on my 15% [00:35:30] of the time, this year to prevent something from happening next year?

I can't look out three years because everything's moving way too fast. And again, there's way too much variability with certain outcomes, but I can have an impact and effect on what's manifesting today to impact tomorrow. And that's what people need to stop and think for a hot minute. Is that not be so drawn into what the problem of the day is? What's going to manifest from the problem that day for tomorrow.

Bill Russell: I'll tell you, Chris says security is a good one because people are going to say, Bill show show us you're good at this. [00:36:00] And if it's just not rocket science. Right. So I remember when and I've told this story a couple of times now, Deloitte brought a former NSA person into my office and she said to me look, you have to assume they're in your network.

And that changed how I thought about cybersecurity moving forward. And it's the same kind of thing. So sit down right now and say to yourself, assume you're not going to be able to get a hundred percent education across the board. And every email attack that comes in at least 3% of your organization's going to click on it.

Okay. [00:36:30] No matter how good you get, at least 3% are going to click on it. Okay. That's one aspect. Do you gotta make sure you take care of that? The second is we have to look at the commonalities of the nature of cybersecurity attacks at this point and say what is the way that we protect against them?

And you talked about the immutable record and you talked about recovery and I think that's part of it. I think the other part of it is we need to detect within seconds of abnormal activity and be able to go through because there's a bunch of abnormal activity on your network every second of the day.

And you have to be able to [00:37:00] call through that very quickly and identify what's going on. And so I'm a huge fan of real-time monitoring of the movement of data. Real-time monitoring of access, real-time monitoring of where things are coming from. But even if you put those real-time tools into play, You also have to support that with processes that call through that information.

And the only machines are going to be able to do this right. Call through that information very rapidly determine the, the positives from the false positives and then have procedures in place that [00:37:30]lock that stuff down very quickly. We've gotta be able to identify the traffic that we don't want to have happen within that first minute and be able to shut that down within, within 60 minutes. And then get better at that and turn it into 45 minutes, turn it into 30 minutes.

Cause you know, if, if they only have free reign on your network for 60 minutes, they're going to be able to do a lot less than what we're currently running, which they're on our networks for three to six months. And so that kind of thing. And again, it's not rocket science, just make some [00:38:00]assumptions.

I believe I'm never going to be able to educate a hundred percent. Somebody is going to click on an email and some of those emails, it might be me clicking on that email. They're sophisticated. And then the other thing, I would say on a cyber security. This is the low hanging fruit.

They're still not doing really highly sophisticated attacks yet. Maybe, maybe they're getting there, but the really sophisticated attacks I think are right on the horizon. So that's why I really want to have the ability to identify that, that, that activity on my network and the traffic on my [00:38:30] network that just doesn't belong there.

And figure out a way to stop it in its tracks, because when we get more sophisticated, it's going to be harder to detect what they're doing. It's going to be harder. But at some point they got, they have to actual trait, they have to escalate privileges. They have to do something that should trigger something in our on our systems to say, yeah, I say that doesn't look right. Chris should not have that level of rights on my network.

Chris Logan: You know what you just did right there, by the way. And I know we're going on the [00:39:00] sidebar. Well, we were just talking about with all those touch points for healthcare delivery and preventative medicine. So if I'm real time monitoring you and I see sleep patterns starting to get worse, I now know I need to call you and figure out what the hell is going on. Oh, how these worlds collide.

Bill Russell: Well, I'll tell you, so getting back to some of these. There was a big conversation around Medicare advantage cause Umana CEO said some goofy things last week and to identify why their Medicare advantage enrollments was I think less than [00:39:30] half of what it should be.

And then every single organization that could spell Medicare advantage had to get up there and answer the question of what's your enrollment. And Cigna's Medicare advantage enrollment is down as well. So there was a big discussion around that. ProMedica who presented in the nonprofit track is selling their Medicaid business to Anthem.

There was a ton of questions around that is something worth taking a look at as well. Bunch of things around the pandemic. My gosh, some of these numbers were just staggering. Do you see the numbers on[00:40:00] what the pharmaceutical companies made during this thing?

Chris Logan: Significant.

Bill Russell: Yeah. So you had a bunch of companies present. The Moderna earnings were great. Let's see. While all the COVID-19 vaccine manufacturers have had an astounding financial success, a global customer base will do that. The numbers are jaw dropping. Sinovac went from a net income slightly in the red in the first half of 2020 to 5.1 billion and net income in the first half of [00:40:30]2021.

Moderna generated sales of 17.5 billion. In 2021 that's unaudited. It's generally accepted that COVID will not go away and these vaccine manufacturers will continue to produce boosters. We can all expect to be receiving over the long haul. So those numbers were kind of staggering, but I want to close with this conversation that you have alluded to on several occasions.

So interesting contrasts was made between [00:41:00] Ascension and Intermountain. Okay. So Intermountain came out and said, look for the first time in our history, over 50% of our of our care that was delivered is value based care. And we are going to continue to grow in a value based care way because the incentives that are created in fee for service are perverse in the words of Bert Zimmerli who is the CFO of Intermountain who has been presenting forever. Every one I've ever been at, he has been the presenter. [00:41:30] And then you had to essentially get up there and say essentially 97% of the. Revenue is fee for service. They don't expect that in the next three years to go blow 90%, even though is directionally where they would like to go.

They cited some challenges along the way with with partners, with pay payers and the partnerships, and just some of the challenge challenges with getting to from fee [00:42:00] for service to value based care. And people, news articles made the comparison as that social media had a good time with the comparison as well.

Why can't Intermountain do this? Why can't Ascension do this? What are your thoughts as you hear that? I have a couple thoughts on this, but as you hear that, what are your, what are your thoughts on that?

Chris Logan: Well, I think Intermountain's M&A strategy is very specific. I think they're targeting very specific geographies that are within their original reach.[00:42:30]

They're not growing beyond the walls of their geographic region at a breakneck pace, which allows them to simplify their operations across those different care settings, across those different states that they're operating in, adding different componentry in as well is solving some of those problems where they can start to focus on a different pay model and take advantage of those incentives. Cause they're doing it very well. As you look at what SCL will bring to the table with Intermountain. They have different operating models. So [00:43:00] that's taking advantage of their bread and butter from SCL and folding it into the strong operations and the inner workings of Intermountain that has shown success time and time again.

So it's a great recipe for success in what they're doing. They're not going outside their playbook. They're improving on the skillset that they have. You know what they're doing to akin to a basketball reference, they're shooting free throws all day long until they sink 95% of them. And then they go to the next thing, that's a [00:43:30] smart way to operate their business.

So I think they can have nothing but success with that model as they add the right pieces of the puzzle to create that great team effort, to take advantage of those incentives.

Bill Russell: These are two very different organizations. Intermountain runs at about 10.8% operating margins tend to 12, let's say percent operating margins, which is indicative of a very, very well-run company.

Ascension on a good year is lucky if they hit 3%. Okay. So [00:44:00] not that they're a poorly run company and differently running. Right. So Ascension again, 20 billion, Intermountain, maybe 10 or 11, 12 billion. I don't, I'm not sure what the number is. Ascension has an investment arm. They are very much in the arms race of becoming a provider to providers.

Right. So they have, they have supply chain services, they have call center services. They have AR. But I mean, th they, they can do all kinds of services for, and quite frankly, it [00:44:30] goes beyond that they have technology services and other things they have investment funds. And that whole capability that they have as well that they're doing.

So they're, they're very much in that space. When you look at their footprint, I know they, they tout that we're number one or two in a majority of the markets we serve, but. The challenge with value-based care is you need to have a complete continuum of care in order to do value-based care well. And that means you have to [00:45:00] have market essential reality in those markets and have the money to invest in building out the partnerships and everything else that is around that. Take that in contrast to Intermountain. Intermountain is fairly contiguous in terms of their geographic area that they serve.

Whereas when you look at an Ascension map and it literally goes from the east coast to pretty far, pretty far into the Midwest, if not, what would be considered the west and you go, all right, even if they're number one in, let's say [00:45:30] Boise, Idaho. They're number one in that market, or even number two in that market. They have to determine how much are we going to invest in the partners, the entire care continuum around that so that we can start taking on value based care contracts because value-based care contracts essentially is all of the things it's health, it's everything, right?

So you're trying to keep people out of the hospital. You're trying to keep them healthy. It also requires a good plan medical plan insurance. Right. And [00:46:00] so Intermountain has select health Ascension has played around in the in the exchanges, but doesn't really have that, that kind of national plan that comes alongside of this thing.

They're two very different organizations with different strategies. In fact, if I were Ascension this will get quoted. If anyone listens to this, this will be quoted. If I were Ascension, I would be much more aggressive in selling off because I would ask the question, is this population better served with us running the hospital or is it better served with [00:46:30] someone else in this market running the hospital?

And I think the answer to that, and I know at least 30% of their markets is going to be even though we have essentiality, even though we're one or two in this market. This market would be better served. If somebody else ran this hospital And that takes a lot of courage as a leadership team.

It's difficult to ask that question and it's takes a lot of honesty to say, are we really good operators of a hospital in this rural location or this [00:47:00] remote location to our core operations and I could see them selling off 30 to 50% of their hospitals and their care delivery organization, and essentially doubling down on becoming a provider to providers and really growing that out.

But instead, I think what they're doing is they're doubling down on fee for service they're growing they're ambulatory centers. They're growing all the things that are related to fee for service they're [00:47:30] investing in. So I don't, I'm not sure I like their strategy right now. I like I, I'm not sure I like their strategy right now.

So but Intermountain, I'm a huge fan of what they're doing, but very different market and the other. Intermountain is a very healthy population. I mean, when you look at the markets that they serve, they're fairly healthy. It's one thing, I said this on social media it's one thing and I'll take it a different market from both of them at this point.

It's one thing to be Temple University and do a fee for service [00:48:00] model, which is in the middle of one of the unhealthiest parts of Philadelphia. And it's another thing to do it in mainline Philadelphia, right? Where it's generally a fluent, educated access to care and all these other things.

And you sit there and you sort of look at it and go if you start with a healthy population, it's easy, it's a lot easier to take on risks for that population than it is to take on risk for a population that's generally unhealthy. Wow. Did I, I just pontificated. I'm sorry about that.

Chris Logan: I like it though.

Bill Russell: Chris, it's always a pleasure [00:48:30] to have you on the show. We'll have to do it again as we move through the year. Just love having the conversations with you. Thanks again for coming on the show.

Chris Logan: Yeah, I appreciate you having me Bill. Have a great day, man.

Bill Russell: What a great discussion. If you know someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to the show is conference level value. Every week of the year, they can subscribe on our website this week, or wherever you listen to podcasts, apple, Google, overcast, Spotify, [00:49:00] Stitcher, you name it. We're out there. Go ahead. Subscribe today, send a note to someone and have them subscribe as well. We want to thank our new state sponsors who are investing in our mission to develop a next generation of health leaders. Those are CrowdStrike, Proofpoint Clearsense Meditech and Cedars-Sinai accelerator. Thanks for listening. That's all for now.


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