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January 30, 2023: Charles Boicey, Chief Innovation Officer at Clearsense joins Bill for the news. What are the big takeaways from the 2023 J.P.Morgan Conference? What are the impacts of Ascension Health’s $2.5B economic recovery plan? Will it really alleviate operational challenges and staffing pressures? What does OpenAI’s GPT-3 mean for healthcare? Finally, we talk about health equity and SDoH and how these might shift and grow in 2023. Despite the economic strain on companies, how can we continue to move forward?

Key Points:

  • The continuation of the shift from inpatient to outpatient
  • What does the down economy shift to the ambulatory care settings and the home mean from a technology perspective? 
  • 5G is going to be the marker that enables us to do things out of the home that we couldn't do before
  • Clearsense

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.

With the advent of artificial humans moving away from the IVR to actual intelligent assistance and whatnot. I think that's a huge step forward. Organizations that are utilizing that technology can have call centers operating twenty four seven with digital humans taking the place of humans.

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.

all right. It's News Day, and today we are joined by Charles Boicey with Clearsense. Charles, welcome back to the show and Happy New Year, by the way.

Hey, bill, good to be here and happy New Year to you and everyone.

It, it wasn't really a happy new year for you. I mean, you're just getting over being Oh yeah.

Fairly sick.

Yeah, COVID times too. Upper respiratory this time and initial vaccine plus four boosters. So I think we're years off before we've got this thing figured out.

I saw an article that there was in August of last year, there was more deaths of vaccinated people than unvaccinated. Not making the case for vaccines or or not vaccines, but I am making the case for I'm not sure the vaccines protect us as much as, as we once thought. So we need to practice caution as we're, I don't know, going into large public places and that kind of stuff. That's, that's my only thought.

Yeah, I totally agree, and I think we'll know more in the next five

to 10 years.

Yeah. JP Morgan is in full force this week and it seems like everyone's just walking around and shaking hands like nothing's going on. So, Yeah. So I don't think it's gonna impact our schedule all that much.

All right, so this is our first time talking in the year. Here's what I'm gonna do I'm gonna go over to the Becker's site, look at some things. Well, actually let's start with JP Morgan. Here's what's coming out of JP Morgan. And I, I did not get to go this year, but I will be doing a review show with some people who were there.

But I imagine this is a common refrain. So, JP Morgan, 23, Ascension Health Details, a 2.5 billion economic recovery plan to rebound from financial and operational headwinds. All right, so if you're wondering what the financial headwinds are, Ascension Health closed 2022 with a 1.8 billion loss, and they started the year, their first quarter closed, and they posted.

Wasn't that good. Let's see. 239 million negative operating margin. yeah, so the, the new year hasn't kicked off any better than the, the old year for Ascension, and they put together a significant plan.

To try to address some things. So they're targeting billions in opportunities. The initiatives they're looking at are to stabilize labor costs, specifically contract labor, labor, also investing in ambulatory care, ancillary services to drive higher patient volumes as more care shifts from inpatient to outpatient settings.

And then it goes on and talks about some other things. So that's the general. I think it's gonna be the general mood at JP Morgan. Now I only have this one report, but just conversations we've had and other releases we have seen. Let me ask you this, are we, I mean, this shift from inpatient to outpatient has been well underway for many years.

Do you think it's gonna accelerate in the next I don't know, 24? 36 months.

I do. And as bill, I do a, a bit of work in the UK with the nhs. And they've already started that. They've made the realization that in the home is preferable over the hospital from a cost perspective.

But what they're learning is from a employment perspective especially on the nursing side. The patient care assistance and so forth they prefer to work in patient's home. Been in the hospital. So there, there is some attractiveness to that model from just a a staffing perspective.

And currently that's you talked about operational costs and whatnot. We've got two hospitals in New York City right now, the nurses are out on strike and whatnot. So yes, so taking care of this. This, this issue from an operational perspective and staffing, I think that even from a US perspective, it will be attractive to do your shift in, in a home or multiple homes.

We're seeing from a nursing perspective more home health. Nursing folks and whatnot.

Yeah. So just so people don't hear us wrong, high acuity care will still happen in, in the hospitals, and that's what the campus is designed for and those kind of things.

If I were a health system today, I would not be investing any more money in buildings unless it's upkeep of those buildings, which I would absolutely do, but I would not be building new buildings per se. ambulatory centers, but even those ambulatory centers, I wouldn't be building those buildings.

I'd be leasing the space because this, the how care is being delivered is like transforming right before our eyes. And I think the other thing is I think. One of the things that is being discussed in probably many boardrooms right now is how do we, how, how do we get outside the four walls? Now, we've been talking about this also for many years, but I think it, it becomes the, the health system of the future will have more health being delivered by people on the road, in homes, in ambulatory centers, just outside the campus.

Inside the campus. So I mean, I think one of the metrics I would look at if I were, were an investor and I were investing in bonds or something to that effect with health systems is what percentage of their workers are working on the campus and what percentage of their workers deliver their care off the campus.

And those that have figured out that percentage starting to shift and they're figuring out the, the reimbursement and the other things that happen that have changed. I, I think, are gonna be successful. But people didn't tune in to hear us talk about that. They're, they're tuning in to hear us talk about the technology implications of that.

So we have a down economy shift from the ambulatory care settings and the home. What does that mean from a technology perspective?

Bill, if you look at Phillips and others, they are actually pursuing that pursuing that market. Their devices and future roadmaps are reflective of even a higher acuity being delivered within the home.

As far as monitoring whatnot. If you look at GE and Phillips and. Manufacturers of diagnostic equipment same thing geared towards the home. And it's all a result of the ability from a a 5G perspective. If you wanna talk tech where healthcare can be given transmissions can be given a higher priority than normal traffic and whatnot.

And this all goes to edge computing and the ability to perform. Within the home and, and do what's the requisite deliver the requisite care with the tech technology enablement. So yeah, I, I see a little bit of higher acuity care delivered than most people would think that at some point in time in the future, technology enabled.

Yeah, I, I think that's absolutely true. I mean, one of the things is the winners here are those that have shifted their business model. To capitate is the wrong word. Managed managed contracts. You tell we're in a new year. I have to, like, relearn all the things that I know.

Cuz my head's still foggy on this stuff, but so we are gonna have more of what we've, we've thought for years value-based care. How do we keep people healthy? How do we keep 'em out of the hospital and. One of the ways to get paid for that is to get paid as the insurance provider and as the full, full risk care provider for that.

Now you can do that through partnership or you can do that through to going that alone and, and going into the community obviously a, a much greater lift in order to do that. Either way, you end up with a, a whole host of technology shift. That are going to happen. And when we're talking about, I, we used to talk about 5G and I remember CIOs would come on and say we're doing 5G into our hospital.

And I sort of scratched my head, like, I, I don't, I don't understand that like it did, it made I already have a incredibly fast network within my. Health system that's highly secure and all this other stuff. I don't really need 5G within my campus. But I agree with you. I think 5G is gonna be one of those things that, you know, one of those, those markers that enables us to do things out of the home that we couldn't do before.

And so I think those 5G partnerships are, are going to be important. I think the partnerships with companies that can go into the home and teach us how to go into the home effectively. And the, the companies that have really good solutions around age tech and around care at home and higher acuity care at home, and the people that have figured out the devices and maintaining those devices, monitoring those devices are, are going to be winners.

And then I think the call center becomes, The absolute lifeblood of the organization. And I say that because what we did set up, we, we were doing pilots back in 2012 care at home, and it started with a with a cohort of about a hundred people and they just lit up the, the call center that we set up for 'em.

And it's one of the reasons it wasn't making money early on is because the. What we found is people were just calling in cuz they were lonely cuz they wanted to talk to somebody. And so anyway, so I, I say that to say the call center's gonna be your lifeblood. You have to think through the use cases around that.

And you have to get really smart in that call center to direct people to have the right information and direct people where they need to be directed. And you and I have talked to call center before. What are some ways people should be thinking about their call?

there's a a few things of note with the advent of artificial humans moving away from the IVR to actual intelligent assistance and whatnot.

I think that's a huge step forward. Organizations that are utilizing that technology can have call centers operating twenty four seven with digital humans taking the place of humans just for information for way finding and not so much initial triage, but you know, taking care of a lot of the things that most of the agents in the call center normally take care of.

And then the adequate you handoffs can be made as a result, especially. From a knowledge perspective, information, if you're calling in on information let's say dementia or DI diabetes et cetera those types of technologies can bring, bring information back to know, the patient, patient, family, citizens, et cetera, and make the requisite handoffs when required.

Charles did we talk about Chat-GPT 3 Or actually the, the newest iteration, which I think they're calling 3.5. No, I don't

believe so, bill. But we can hit that one now.

Yeah. it seems to have taken a huge leap forward. And I say that because I, I now find myself, it's an open tab on my browser here, and I find myself hitting it up. it's a new way of searching. It's a new way of asking questions of the internet and getting some pretty interesting responses. interesting in a, like cogent and things I can actually use and I'm wondering if this starts to become what we can expect from agents, digital agents I guess people would call 'em chat bots, but digital agents that become the smart front end for our call center that can direct people.

Yeah, especially if you have the requisite knowledge base behind it. And that's extremely doable. And there's vendors out there that are utilizing these technologies. And bill I'm a professor at Stony Brook University. I'm trying to figure out how I'm gonna counteract my students using this technology for producing papers and answering test questions and things of that sort. So yeah, you've seen the good and the bad from this and it's just getting better and better. So it's gonna be interesting to see this as it progresses. But again, think about this 24 7, the ability to ask a question and get a response.

I saw different examples of how people were using it in healthcare order sets you just asking about order sets. I'll tell you one of the things. What was interesting, I had a problem with our website and I don't think I'm giving anything away here.

It's a WordPress website. And having a problem with some of the code in one of the plugins. And so I went over to the chat G P T, and I said, Hey, here's the code. What's wrong with it? And it said here's what's wrong with it. I just copied and pasted it over and it fixed it. And I was like, yeah.

Wow. And we keep hiring new people into the team and I wanna bring them up to speed on, on some of the marketing trends and that kind of stuff. And we have some people that we listen to and that kind of stuff. But I thought, hey, chat, G P T three. I'm gonna ask you a series of questions on marketing and let's see what you respond with.

And I ended up creating a 15 page document over the holidays by the way, took me about, I don't know, 25 minutes, 20 minutes. I would ask it a question tell me about product marketing, what's the distinction between product marketing and other things of marketing? And it would just answer the question, and I'm reading this.

Yeah, I'm gonna give this, I'm gonna give this to the staff. This is a great very high level. And actually it's not only high level stuff cuz I just talked about the programming. You can take it as deep as you want if you know how to interact mm-hmm. with it and ask the right questions.

Bill, I always go back to people can make mistakes and be forgiven machines get one shot at it.

Yeah. And it, it does make mistakes and yeah,

we're, we're not quite there yet where we're forgiving machines.

Yeah, I agree. 📍 📍 In 2023 we are celebrating five years at This Week Health, and we are working to give back and we will be partnering this year with Alex's Lemonade stand all year long. As you know, having a child with cancer is one of the most painful and difficult situations a family can face. At Alex's Lemonade Stand Foundation, they understand the personal side of the diagnosis, the resources needed and the impact that funded research can have for better treatments and more cures. Today, Alex's Lemonade Stand is one of the leading funders of pediatric cancer research in the US and Canada, funding more than a thousand research projects and providing programs to families affected by childhood cancer. You can get more information about them at So how are we going to partner? The leadership team and myself personally, we have put some money aside to really fund the start of this. But what we're looking for is partners, right? So we're gonna ask our partner our partners, our sponsors to be a part of this. We're gonna ask you to be a part of this. And some of the ways that you can help contribute is we're gonna have drives throughout the year. We're gonna have follower drives, followers of the show, followers of our LinkedIn channel, Twitter channel, YouTube channel, you name it. We're gonna have these drives. And as part of those drives, we're gonna ask people to be a part of putting donations towards Alex's Lemonade Stand. There should be many opportunities this year, so keep an eye out all year long to see how you can support Alex's lemonade stand. You can find more information out on our website You can also check out Alex's Lemonade Stand again at A L E X S And if you go to our website their logos gonna be on our homepage on the top right hand corner. We're celebrating our five year anniversary, and we want to continue to give back to the community. So we welcome you to be a part of it and looking forward to seeing what we can do this year.

📍 📍 Alright, there's an article here. We can hit it and it's a predictions article. Let's see. Ted Quinn, CEO Founder Activate Care says, continued economic instability will put more Americans at risk for social determinants of health creating even more strain on the system. Chairman at SW says Equity and access. We can expect to see more programs implemented that bridge, the equity gaps in chronic care management, obesity, diabetes, preventative care among other areas.

Chief Medical Officer Qualtrics. Financial health must be recognized as inseparable from health from 2020 to 22 to 22. Consumers were more likely to receive care they needed, but cost concerns have become more common. Better coverage options will broaden mental health access for all. Reimbursement plans will be based on social determinants and risk stratified.

Let's see. Some of the other things people are saying, outcomes and account. Will be more critical. Regulatory changes and continued private equity investment. All right. So we're hearing some of the stuff people are saying. I don't think it's amazing to say that this is going to be a challenging year.

We know that economically, we know that. I'm, I'm gonna start with our, my first prediction. I, I, I'd like for you to chime in with your prediction, So this year's gonna be challenged financially. I don't disagree that social determinants of health would deteriorate. As this moves forward, people will put off care.

Quite frankly, people will put off buying eggs because they're getting so expensive. And so whenever that happens in an economy, we know that there's a downturn because people. In healthcare because people will defer care. So that's going to continue. I think you're gonna see two things as a result of this economy.

One is significant consolidation, not amongst the healthcare providers, but significant consolidation amongst the. The the digital health investments that are out there, you'll see these start to come together. They could just be flat out tech and asset buys. But there's gonna be a whole bunch that are more willing to sell now than they were before.

And we're already seeing some of those announcements. Mm-hmm. at JP Morgan. So, thats Absolutely. Going to continue. And if I thought about it, the the primary impact on healthcare providers is gonna be significant reductions in staff. And so I'd love to give you the, pick me up here.

But I think healthcare will be impacted from a staffing level and it can't be at the nursing side because we're seeing the strikes right now. We're seeing the burnout right now. It, we, it can't be on that side until we implement some technology that's going to improve that. Now I don't think technology should be impacted that.

Great. . Because if you impact technology, invariably it will, it will impact the overall health of the health system, but it will impact the health IT teams across the board. So I, I would expect cuts. We saw some cuts at the end of the year. We will see those continue through this year as part of plans to get in front of the financial conditions.

So those are just off the top of my head. Two predictions. I have more, but I'd love to hear from you. What do.

you got

Sure. And I agree. Bill, with that, I think that. We say 2023, I think it's gonna extend into 2024. Unfortunately. I think it may be a 12-18 month horizon there.

And then from a healthcare IT or technology, you know how many startups there are out there, you know how many that have been you know Going around for year, two years, three years. And I do agree that you're gonna see a many acquisitions in the consolidation of those various technologies so that they can be delivered in a single ecosystem or single platform.

I, if you will ROI. If you're a healthcare technologist, you better be able to produce some type of roi. Cost reduction before we used to try for six to 12 months, you better be able to do that within 90 days or just a little bit after, and you better be able to demonstratively show that during the sales cycle.

You mentioned the issues around staffing and so forth those definitely aren't going away. But they're gonna be looking at other departments to cut from. And that's gonna have a significant impact.

It's just gonna be tough. There's gonna be a lot of healthcare authorizations that just say, Hey basically we're done. We're ready to be acquired and you gonna continue to see that m a but it's gonna be a little bit more targeted. Bill, one thing we didn't talk about the predominance of Consumer health health technology at CES this year.

C s was in conjunction with JP Morgan. And I don't know if you were looking at it, but the number of technologies that are coming out that will allow us to take care of ourselves. Or at least have a little bit more participation. Participation may per, per chance alleviate some of the burden, if not all.

The other from prediction perspective, I think that absolute realization you talk about equity and equity and care as well as financial equity. We'll get, the more understanding around. We are all N of ones. You and I could be type two diabetics as a category, but we're very different physiologically.

We're very different cognitively, and financially all the rest of that. And that care has to be auto-tuned if you will for us as individuals. So I think you'll see. In the next 12 months or so better understanding of that. And then from a financial perspective, being able to target that will have improved outcomes and whatnot.

Cause I treat every diabetic as the same. I'm gonna have some excellent outcomes. I'm gonna have some, not so much, and then in the middle

and whatnot. 📍 📍 All right. We're doing webinars a little different this year. As we have told. You got a lot of feedback from the community about what works, what doesn't work. We talked to our advisors, our cio, CMO advisors, and they said, Hey, Community generated topics, great contributors, not product focused. They want the questions ahead of time so that they can incorporate them into their answers. And they want a forum that is honest and open. And what we decided was once and done. If you're at the webinar, you get to hear the content. If not, it's not on demand. You don't get to download it later. We're gonna do it on a consistent date and time, and our next one coming. Is February 2nd. It is priorities for 2023, and this one is around academic medical center. So we have some great leaders who are gonna come in and discuss the priorities for 2023. We're gonna continue to just bring great content, community generated topics and keep the discussion going. If you have feedback, love to hear. And if there is any questions you have, go ahead and fill out the registration form and you have a space there to give us your questions ahead of time. We wanna make sure that we cover the topics that are of interest to you. website, top right hand corner. Sign up today. Love to see you there. 📍 let me give you a couple more of mine real quick. By the way. I. With what you're saying, I think the the battle for primary care is gonna continue.

CVS is going after it in a heavy way as well as some of the other players. So that's gonna continue. There's gonna be a battle for doctors. And that's going to again, exacerbate the financial challenges if the health systems haven't really taken on that. If I think about this whole concept of healthcare consumer experience, The healthcare consumer experience is gonna get better and worse.

Let me tell you how it's gonna get worse. It's gonna get worse in that we are gonna go to our health system and the the weights are gonna be longer. The amount of time it takes to get an appointment's gonna be longer because as I said earlier, I think health systems are gonna do. In certain areas and they have to be cost conscious.

And we're in, we're in this flux right now, into a new way of delivering and receiving care. So that's one of the things that's happening. I, I think it's gonna be better in, in what you said, CES and other things. There's gonna be more options for health to keep us healthy to, to, and, and we're gonna be able to engage with those ourselves.

I. That I saw a telenutrition company was just bought by, I think Memorial Hermann, and that's, that's smart thinking if you can keep people healthy. But again, I, I think that the consumer experience will take a hit and I think it will, the health experience will get a, a little better.

The I think health it. Yeah, that the, the projects that are regulatory have to be done. The projects that are improvement projects, the optimization projects and that kind of stuff. Those are going to go slower. The projects that will change how we deliver something will start to accelerate.

So I think AI falls into that category. I think the call center falls into that category. I think chatbots fall into that category. I think RPA falls into that. . Anything where we can automate something that used to be done by a human, I think computer vision falls in that ca. There's just a whole host of projects that I think are going to all of a sudden bu bubble up to the top because it's like, Hey, look, we used to have 30,000 people at our health system and we now have 26, and we need help to fill that.

Yeah. And Bill the underlying technology for all of that is the ability for these healthcare organizations to have all of their data in a trusted environment that they can consume for various methodologies whether it be for ai, whether it be for care delivery and so forth.

And I think those healthcare organizations that are able to do that over the next 18 months. And many of these healthcares have 1200 systems in place. And from a data perspective, taking it from those systems all the way to a point where it's actually trusted and consumable is a feat.

But if that's accomplished, They're working in the here and now. They're not working retrospectively and they know what's gonna occur in the next several weeks and whatnot. So I think that's gonna be a, a big component of 23 is getting our data assets

in order.

That's, that's why you and I, that's how we first met and that's, Yeah we were essentially in 20 12, 20 13, that's what we were working on. So that was probably the right timeframe to be working on that. By the way, if you're just getting started now it's gonna be a challenge by the way. I think the application rationalization projects are gonna accelerate as well.

If we can turn off not just, not just fewer applications and simplify the, the environment, but if we could actually turn them off and turn off the licensing and all that stuff, I think that will acceler. Yeah, absolutely Bill.

But the other the other advantage of that if done properly with the right technologies, all of that data is available for building out machine learning, AI products and so forth, and understanding the population throwing 40 years worth of data or 20 or 30 years worth of data into a pdf.

It doesn't make it usable. It does not.

And we've all done it in healthcare, haven't we?

Yeah, yeah. We have. If you're able to accomplish the retrievability for clinicians and others, but at the same time retain that data for secondary use and so forth, you've really accomplished something.

Well, Charles, I'm glad that Clear Sense is a sponsor again for this. Because it means you and I get to have more of these conversations and we still are planning. And so I'm gonna, I'm gonna put it out there for everybody so that we can be held accountable. We still are planning for you and I to do our first virtual, virtual reality interview.

So both of us in virtual reality doing the interview. And my understanding is that we will see something from Apple this year, potentially in the next couple months from Apple in terms of their first foray into virtual reality.

looking forward to hanging out on the beach with you. With a, a couple of Coronas talking about healthcare


Yeah, I, I think what we're gonna do is we're gonna, we're gonna demonstrate some of this stuff. There's some interesting learning modules and that kind of stuff that we can, we can demonstrate. I don't know. Hey, we're, we're not there yet, but we both have headsets.

We've talked about it a little bit. I think we can pull it off. The thing I don't like is my avatar looks goofy, so I, I, the whole avatar thing, and I, and I want it to have like the, this week health logo on the shirt and stuff. Yeah. I don't have enough ability to make it look like.

my avatar looks like Brad Pit, so I'm not


well, I could, I could gone in that direction. We'll, we'll see what happens. Charles, thanks again for your time. Really appreciate the conversation.

All thanks Bill, and looking forward to working with you in 2023. 📍

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