September 19, 2022: Melissa Morris, CEO of Lantum joins Bill for the news today. The trend of "quiet quitting" has recently gained traction on social media, referring to a phenomenon in which workers reduce their enthusiasm at work and stick to the minimum expectations of their role. What does 'quiet quitting' look like at hospitals? Some healthcare experts say the Amazon Care shutdown is a strategic play and not a failure. What happens when telehealth expansion is put under the microscope? How does it address concerns about access, quality of care, equity and program integrity?
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I think killing projects is a really good thing. And I think that that attitude is something I would say tech companies are a lot better at. They're just much more agile and able to kind of ruthlessly chop something off it's not working and then take the learnings and take it either to a new place or not bother with it at all.
It's Newsday. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst who are our Newsday show sponsors for investing in our mission to develop the next generation of health 📍 leaders.
All right. It's Newsday. And today we are gonna talk about a lot of fun things. We're gonna talk about quiet, quitting. We're gonna talk about the telehealth expansion and maybe a little bit of Amazon care conversation as well. Today we're joined by Melissa Morris, CEO of Lantum Melissa. Welcome to the show.
Hi, thank you for having me.
I'm looking forward to the conversation. This is the first time we're meeting, literally. You are in London. Give us a little idea of what LAN does and what your role.
Yeah, so, yeah, so I'm the CEO and founder of Lantum and we're a workforce management platform for healthcare organizations to better connect with and engage with their workforce.
So specifically it's a scheduling tool but it's a, we call it connected scheduling. So it really kind of connects with not only your full-time staff. But also any kind of moonlighters or float pool that you need to ensure to fill any shift gaps that you've got.
So you, you started in Europe and you're doing work in the states these days.
That's right. Yeah. Started in started in London. We've now got 3000 plus clients in London that we work with across primary care and across hospitals. And then we launched in the us with Cedar Sinai as our first hospital that we work with. So we've got a small office based in LA and we're just expanding out in the us right now.
Cool. Do you spend much time in LA?
Yes. Luckily I, I do get to spend quite a lot time.
Lucki. Luckily I I used to live in Huntington beach and I would go up to Cedar Sinai from time to time. That is not a commute. I wish on anyone. People are like, well, how long is it? I'm like 45 minutes to three hours. It did just depends. Depends on when you do.
Anybody in LA talks about the traffic as much as British people talk about the weather.
Yes, absolutely. Alright, so we're gonna hit some interesting stories. we'll start with the quiet, quitting story. And this is one of those that's starting to impact healthcare.
So here it is quiet, quitting. This is from Becker's hospital review and it says the title is what does quiet quitting look like at hospitals? So the trend of quiet quitting has recently gained traction on social media, referring to a phenomenon in which workers. it encourages workers to reduce their enthusiasm at work and stick to the minimum expectations of the role.
Some professionals, including gen Z workers have embraced the concept as an increased form of work life balance, and others. See it as a lesser version of actually quitting regardless of how the individual interprets the idea, the concept is not new among us workforce or in healthcare. According to jeremy Sadlier executive director of American society for healthcare, human resources administration. Let me ask you this. and I'm gonna go through more of the story, but he talks about the fact that this isn't a new phenomenon. But it feels like it is pandemic induced somewhat.
Like we've really pushed this workforce to the break and they're like, is this really worth it? It feels like. And I don't, maybe I'm missing that. What's your feeling on this whole idea of quiet, quitting?
Yeah. So I think the pandemic definitely has a lot to do with it. So I think the first thing we saw after the pandemic was this whole great resignation people were quitting, their roles not just in healthcare, but healthcare was particularly affected.
People just leaving in their droves or reducing their commitments. I think essentially the same thing. So anybody that's kind of winding down their enthusiasm or. Working less hard. I think a lot of that is because people feel like, yeah, they've been pushed to the limit and they feel like mentally, they deserve some downtime and they've kind of built up a mental tally in they're kind of thinking, well I've worked so hard.
During the last two years, I think it's time I deserve some downtime. I think the other thing is that the great resignation piece is kind of tailed off a little bit because I think the cost of living crisis and all of that kind. People's fear of actually not being able to meet their daily commitments.
There just aren't in as many jobs around as there were during the great resignation, when that was all kind of gaining a lot of traction. I think that people now are okay instead of quitting, this is another way of quitting or reducing my commitment, doing the very bare minimum. So I think it's sort of a combination of the pandemic, but I think also just what's going on in the economy. Well, people are afraid if they quit, they won't get another job. So instead they're just doing less.
I have a couple theories around this one is you just go back to mega trends. This is a demographic shift we saw coming for a while. Right? So the baby boom generation in the us I'm talking specifically, but probably it applies to Europe.
I mean the baby boom generation moves through the, the cycle. They move out of the workforce. So we're gonna have less workers. To support more people in healthcare that means more sick people, more aging people, or more people utilizing the system and less workers to actually do that. The other thing I noted before on the show is we have a transfer of wealth going on in this country, which is unprecedented.
So as the baby boom generation moves out and they die, they could potentially leave even, even a worker that was like a steel worker. We'll die with a house and something else and pass that onto a kids. And it's, it's not a small amount of money. A house could be 200 to half million dollars.
And so we have this, this transfer of wealth. Plus when you look at the pandemic statistics, A majority of the people who died were in that baby boom generation, they were the elderly who had amassed them well. So they're passing the wealth on, I think that led to the initial round or partially led to the initial round of the great resignation of people going, Hey, I could take a year off potentially.
I could take two years off. And they were a little burn out and they're like, let's just see where it goes, but I think you're right. I think. The inflation, the cost of living has sort of scared people back into the workforce, but they're coming back in with a different mindset altogether. Let me give you little bit more from this story.
So in healthcare, this phenomenon has only grown and April Gallup poll found that 34% of us employees were actively engaged at. work In 2021 compared to only 32% this year, healthcare professionals saw the largest step in engagement with their engagement scores dropping nine point year over year. Any lack of engagement on the part of staff ultimately impacts patient care, teamwork, safety, and throughput, all of which impact the financial health of organization and the patient experience is incredibly important for leaders to focus on engagement, growth opportunities, and to recognize and reward work. We all have employees. How do we keep this from happening? And how do we maintain engaged employees?
So I think there's a few things. I think there's a question of why is healthcare more affected? So I think one is the pandemic really tired to help people in healthcare out like big time.
I think the other thing is healthcare is less flexible. So a lot of other organizations have been able to adapt, so for example, at Lantum we've allowed people to. work flexibly So if they wanna work from home three days a week and they're in the office two days, then they can be if they want to, some people actually in our workforce have moved abroad and they're able to work from abroad and still deliver their, like, Role to the full capacity in healthcare.
That's not possible. You often have to be physically in the organization. And there really isn't as much flexibility in terms of the hours you work. So I think that lack of flexibility is what made this affect healthcare more. I think Another thing is like, when you just think about what really does engage people, people really just need three things.
It's autonomy, mastery, and purpose in their role. And I think in healthcare, I think you can get to mastery there's a sort of quite a, a clear progression to progress through your career and purpose. I think no one ever disputes the people who work in healthcare have a purpose, but I think autonomy is really lacking.
And I think there is a high degree of control and supervision. In healthcare. And I think that's what kind of makes people lose a lot of enthusiasm when they just kind of almost switch off and just do what they're told or they take the shifts that they're told to take. And I think this combined with all the other factors is what's really meaning that healthcare is being more affected than other industries.
Yeah. It's by the way, I agree with, I agree with everything you said. I mean we have created an interesting workforce situation, not only across all industries, but within healthcare, you have people that are remote people that do have flexibility, and then you have those that do not, they have to still come into the facility and deliver care and sit behind a desk or whatever they happen to do. And I think within that, we have to look at the culture that we're creating. I think this is the exit question on this one. So I feel like this is sort of like a snow globe. We had the pandemic, we shook it up and all the snow is flying around on the snow globe.
But I'm not sure it's gonna go back to where it was. So we've created so many things have changed. Within healthcare. I think a lot of the player we're gonna get into Amazon care and we're gonna get into some of the other players. the world of healthcare is changing. I mean, it's, it is. And it isn't right. I mean, the, payment models, not changing all that rapidly things in healthcare don't change all that rapidly, but the pandemic has shook things up so much I mean, I'm, I'm talking to CIOs all the time and different healthcare leaders. The number of organizations doing reductions right now is pretty significant.
So we have that dynamic here happening as well. Has the world of healthcare changed and we just, I mean, we know that it's changed, but has it changed in a way that's not going back to the way it was and we just haven't recognized it yet?
I think so. And I think it's happening. Like starting with the workforce. So this whole topic is really interesting, cuz I think that what's making the healthcare system change. Is the workforce and it's almost like we're kind of going to this almost new world order where the workers are gonna have almost more control than ever before, because they're a lot of them voting with their feet.
And you're seeing this huge trend just like massive reduction in the workforce that can deliver care. Many of them winding down as we were just discussing, and I think that that's gonna have to force. Like change because beforehand the workers were not actually, they didn't have as much power as they had before. So I think that's really, what's gonna kind of create the tides of change in my view.
So this, this might be the change that we saw in the industrial revolution, where the workers finally have a, a say as health healthcare leadership teams. I would assume it's gonna be really important to, to create those connections and to be discussing with that workforce, what the future looks like. And yeah. Maybe healthcare doesn't look the same and we create a new norm coming out of this.
Yeah. And I think the other kind of thing that obviously we've seen a big shift is just like patients being able to access healthcare really cheaply. So obviously we've seen a lot of these. Tech companies that will obviously talk about later that have come providing telehealth and like remote ways of being able to access healthcare much, much more cheaply than ever before primary care in general.
Isn't a, a part of the market that people have entered into in a big way, because there's not as much money there that the margins are thinner. But because now. There's been a big shift in the adoption of technology and also how cheap it is now to create technology. We've seen that now patients can access that front door much easier.
And I think that's gonna see a big shift as well as in what we see then flow down to the acutes. So I think that's another kind of. Big shift as well. And I guess kind of joining those two things together would be really interesting to see Amazon's obviously making progressively greater, greater entry into this space are they gonna actually crack this workforce problem and treat the workers in the way that they want to be treated, like giving them more flexibility and then will those workers then move more towards primary care and reduce their commitments in the hospital sector. I dunno. I think that might be quite an interesting thing to, to navigate into look at. Cause I think whoever can essentially kind of own that workforce piece or crack that workforce piece will be basically in a very, very good position to, to, win in the market. 📍
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I was gonna go to the telehealth report next and then go to Amazon. But since you brought it up, I'll go to the Amazon story. So we have fierce healthcare, did a story. What's next for Amazon healthcare strategy. Amazon care may be done, but that's not the end of the Amazon's bold healthcare ambitions industries insiders say Amazon they're gonna shutter Amazon care. The general consensus is that it wasn't going to scale. And with the acquisition of OneMedical OneMedical has already scaled and has a couple things that that Amazon didn't have. So one medical has 8,000 employees. Company operates 188 clinics in 29.
Markets also has 760 7,000 members. OneMedical represents a more mature advanced primary care model compared to that what Amazon had built. And with that deal, Amazon also gains footprint into Medicare space to serve patients 65 and older with one Medical's IRA. Health line of business. So and then they go out and they talk to some some industry Watchers who say essentially you could look at this and say Amazon care failed.
Haven failed the JP Morgan Berkshire Amazon partnership. And some speculated that Amazon was gonna pull back. We knew that Amazon wasn't gonna pull back. They just made some major hires with industry insiders that we knew that they were just reformulating their strategy. So that's obviously where they're going.
And I'm trying to think if there's anything else I wanna point out from this story. One of the things that they say, they believe that Amazon is moving away from the employer, healthcare space and more to the direct to consumer opportunities. they're just repositioning themselves to go after that market.
When you heard this story, what was your first reaction to shuttering Amazon care after expanding it to 50 states and getting the licenses and doing all those things signing up some major players, Peloton, and Wholefoods and others.
So I, I didn't at all think that this was a failure actually. I think firstly, we can't speculate what Amazon decided that success looked like. I, I mean, hindsight is obviously easier, but it looks to me like. Getting into 50 states, but only with a handful of employers. I think they only had half a dozen employers tells me that they essentially just wanna learn about every single state, how the licensing works. And essentially use it as a, as a way to just learn how the market works, because they haven't actually tried to scale this in a big way, because they've only got half a dozen employers, but they tried to get spread across every single state. So I think to me, it seems like they wanted to. Do this as a learning exercise rather than as a scaling exercise.
I think the other thing to note is that the timing of the announcement's very interesting because they actually haven't completed that deal fully with that's.
That's an important thing to note, isn't it?
Yeah. And I think that obviously they're shutting one thing down, but they wanted to announce one medical at the same time almost to tell shareholders in the market that they are.
Planning or winding down. In fact they wanna scale up, but they've still got these capabilities that they've built in house, through these interesting partnerships with Haven. and yeah, so I think I think in general, I think it would be easy to look at it and deduce, oh, they failed, but I just think actually there's a lot of things pointing at the fact that this is just a step in their journey.
And I think that they've actually, I think it's all planned. So yeah, for me, I don't, I wouldn't say it's a failure. I think the other thing is that you need to think about how Amazon works. So Amazon generally their whole. Their whole thing is the experience for a consumer and how that consumer essentially interacts with all of Amazon's different products, how cross sell and upsell happens. Obviously they own pill pack. I think they buy that in 2018 or 2019 around then. And so it's sort of in order for that to really get the synergies that they want to, they need to. Have some creative destruction cut some of these things which are almost siloed and actually just put it back into a completely new customer experience.
I think also killing projects is is a really good thing. And I think the markets should think this is a good thing. I remember once I. Went on a tour of Google X. And they were saying that they've got this culture of killing projects and essentially they encourage people and incentivize people to kill projects with pride rather than getting too attached to it because you worked on it or because there's this sum cost that you've put into it to make it work.
And I think that actually that attitude is something I would say tech companies are a lot better at, they're just much more agile and able to kind of ruthlessly chop Something off it's not working and then take the learnings and, and take it either to a new place or not bother with it at all. So I think that yes, maybe it seems cutting this project or shutting something down might be interpreted as a bad thing, but my bet is on the fact that this is actually all planned and all just part of the journey of kind of them carefully learning the capabilities and a kind of lowish risk and then scaling through acquisition.
So let me ask you a business strategy question here. So I'm gonna compare Microsoft and Amazon. Because Amazon appears to be in healthcare. They set themselves up as a competitor to healthcare providers. And so they have other services, right? They have Amazon web services, they have some logistics services as well that you could purchase.
They have some data services as well that you could purchase. If you're a health system, you're looking at all those things and. Yeah, I mean, should I really partner with them? They could be my next competitor. Everything I read is they're my next competitor. On the flip side, you have Microsoft.
Microsoft has no healthcare ambitions other than to serve healthcare. And that's clear we have office 365, we have Azure, you can do epic and Azure. You can do all sorts of things. And so they sort of, they play that, that we serve healthcare as we serve other industries. And quite frankly, we serve all of healthcare.
We could serve competitors in healthcare just fine. Is Amazon hurting some of their other business? By not going all in on healthcare and just sort of playing on the periphery and saying, Hey we are going to get into healthcare at some point or is it just is it just the reality that they have to live with, which is at a market cap that they're at, they have to play in this 4 trillion space in order to drive additional market cap. Mean, they can't ignore. Healthcare
no, I think it's, I think it's a really good question. I think like on the competitive side, I definitely know that some of the large healthcare providers are, are wary of Amazon and they are concerned to partner with them because they don't trust them essentially.
And they can see that Amazon is trying to make a play into the market. It looks really like Amazon is really just. Trying to make a play into primary care. I think the barriers to entry are lower there. They can serve people at scale they can kind of do a lot of their kind of consumer marketing.
That's worked in other parts of Amazon. I think there's synergies there where they can kind of capture the audience. Obviously then the link with pill pack. I mean, the other thing and I guess, so I think that if you're a primary care provider, I would say you'd be more nervous than if you were an acute provider. I don't know. I can't really see how they would get into hospital.
Yeah, I don't, I don't see 'em getting into hospitals either, but that fight at the primary care space is fascinating to me as, as a primary care physician. I think you're in the cat bird seat right now, United healthcare is buying up those practices.
You have health systems buying up those practices. you have private equity buying up those practices and rolling up. I mean, at this point, you're just sitting there going all right, I'm just waiting for the phone call, waiting for somebody to knock on my door because for, for whatever reason, this whole primary care. Is the battleground right now? Because I think the premise is if we control that's the entry point into healthcare, and if we control that entry point, we can pill pack's been rebranded, Amazon pharmacy. We can lead people to Amazon pharmacy. We can lead people. To our CVS doing the same thing, essentially at this point we could lead people to our stores.
We can lead people to, I mean, they're, they're leading the healthcare buying decisions. It would, it would appear. Yeah.
Well, yeah. I mean, it's the front door of healthcare, isn't it? So it's like everybody goes through there before they go anywhere else. And I think you can just remove, I think, removing the barriers to entry for the patient as well means that not only have they already got this captive audience of people coming in, they can grow it as well, because there are a lot of people that are not actually using primary care as they could. So there's a whole piece around that market can be grown. Yeah, I agree. Like it's that whole thing of waiting for the phone call. I mean, it's been right for consolidation for a very long time, but I think the technology has not been there to make it economically viable for anybody to make a big play into that market. Whereas I think now the cost of care delivery have got come down so much, particularly like through the pandemic that I think now that's why it's kind of restarting to accelerate.
But yeah, I mean, consolidation has been on the cards for a long time and I think, yeah, we'll start to see that pick up a.
All right. Last story, telehealth expansion under the microscope by HHS office of inspector general. So OIG and we talked about this when the pandemic was going on and they put these allowances in place where CMS and others were going to pay for telehealth services and it spiked, it spiked significantly over the first Let's say year of the pandemic.
And the thing I was saying back then is we are gonna have so much data to finally look at to see if, I mean, because we've been, we, we were just playing around with it. It was like 2%, 1%, 3% and some health systems. And then all of a sudden it spiked. And so here's, here's a little excerpt. CMS is evaluating the continuation of telehealth services that were temporarily added during the COVID 19 emergency Medicare beneficiaries used 114 million telehealth services from March, 2020 through February, 2021.
It's important to note that was the peak. So this amounts to 88 times more telehealth services compared to a year prior to the pandemic, when beneficiaries used 1.3 million telehealth services over half of these telehealth services. 60.1 million in total were used by beneficiaries enrolled in Medicare fee for service in total, Medicare paid out 5.1 billion for these services, 76 times more than what it paid for telehealth in the prior year.
Again, it's important to know March 20, 20 to February, 2021 was the peak. And if you measure February or March, 2021 to February, 2022, I think you're gonna see. That that line is gonna go way up and then come back to higher than it was before, but a little lower some of their findings now I'll, I'll come back over to you.
Beneficiaries in urban areas were more likely than those in rural areas to use telehealth. Which I guess, I don't know. That's interesting. Just shared demographics, maybe numbers, dually eligible, Hispanic, younger, and female beneficiaries were also more likely than others to use telehealth. Almost one fifth of beneficiaries used certain audio, only telehealth services.
Vast majority of those beneficiaries used them. Exclusively older beneficiaries were more likely to use certain audio only services. And what they're looking at right now. To inform how lawmakers look at this policymakers, look at this around the concepts of access, quality of care, cost, and program integrity.
Can we afford to keep doing this? So those are the four things they're looking at. I don't know what the question is here other than I guess they're looking at the numbers during that peak time and saying, Hey, we can't afford to keep doing this, but. Things like mental health were accessed significantly.
We see that the access could be different across different demographics and those kind of things. But we now have a ton of data. Where do you think this is gonna go?
So I guess this is an interesting one, isn't it? So I think Kind of the way that the article was worded implies. And I'm not sure if I read it exactly as it's supposed to be interpreted, but kind of implies that oh, this seems like a massive spend.
So should we look at cutting this? And I think it's really strange to look at this just in isolation and decide, oh, it's, this is too much money. We should cut it because what I'd really wanna know is as a whole, you. What has been the spend, has this replaced more costly face to face appointments, for example, has this reduced more acute attendances, has it managed to reduce average length of stay?
Can you discharge patients faster? Because you can give them better remote care. So I think there's a lot. I don't think you can really just look at this number and say, oh, this is massive. And then actually decide, oh, we're spending too much. Cause I think the, what we really need to know, and it's interesting about the data point.
Cause yeah, there is a lot of data, but there is not enough data on a. Longevity point of view. So we do not know yet if the increasing people's access to telehealth is actually gonna prolong someone's life or is it going to actually prevent disease or is it going to particularly in the mental health piece, like if.
People are able to access mental health more easily through telehealth. Is that gonna prevent other things later down the line? So I think, yes, there's a lot of data cuz there's more people using it, but I don't think we know yet what the knock on impacts are and if long term it's gonna save money.
So. I think it's just quite an interesting one and it kind of, I don't know how Medicare basically look at their budgets, but I can assume that it's slightly similar to how the NHS looks at their budgets, which is they look at a line item on the PNL and decide it's too much and then just decide to cut it.
And they don't necessarily always think. Through the longer term the longer term implications. And a lot of that is because they're tied up with, with politics so much in the same way Medicare, Medicaid, again, heavily politicized. Therefore you often do tend to think short term rather than long term, because of just the nature of the way that the politics works.
So I don't know, like if I've interpreted it correctly, but it does just seem a little bit shortsighted just to look at one line item and decide that it's too cost.
Yeah, I, I agree with you. I mean, but the thing we have to keep in mind, NHS and CMS fee for service and national health services completely different models. And one of the things that they're looking at, and I know that because of another story we covered a while back they're trying to figure out how effective these things were. And the problem is in the fee for service model, what you have is significant entities, large entities, trying to figure out, okay.
Is there another opportunity for revenue here? And we already talked about cuts that they're doing. And so they're sitting there going well. They don't want it to decrease their office visits or their visits to the hospital or those kind of things, because that's what funds the model. Unfortunately, we're still a sick care system, not a healthcare system in the us.
So so CMS sort of looks back out of one eye and says, yeah, I see the benefits and we're gonna fund those things. But these things, it seems like you guys are. Trying to get more of more fees for doing the same services and it's not necessarily moving the needle. I, this is a, this is gonna be a tough one, but I agree with you more data.
And tell the story through the data. Don't just I mean the politics of it, the person who shouts the loudest is not the best way to make these decisions.
Yeah, I guess the other thing I thought was quite interesting was like, it talks about, I knew, I think picked up on this around like the urban areas. Having the highest take up. And I don't know if they were cuz I mean, what we've seen, we partner with telehealth providers over here in the UK. And what we've noticed is it's the rural populations that generally use it more on a kind of per capita basis, not looking at absolute numbers, but it's more valuable to people who can't.
Get to the doctor very easily. So I was just wondering, I didn't know what you thought about that piece, where it was sort of talking about it is popular in urban areas.
Yeah, that, that was my thought too. It has to just be sheer numbers. Yeah. I mean, I mean, New York itself, if, a percentage of that population does does telehealth, then it's gonna be more than probably all of urban areas across the us, just because you probably haven't been to South Dakota, but there's large. swaths of land in between. And I, I imagine it's being used. In fact, I know it's being used pretty extensively in some of those areas, but just the num the volume, the numbers of people is, is a lot lower.
Yeah, I think that probably is right. Cause that didn't really make much sense to me based on what I've seen here,
Melissa, it has been fantastic to discuss the news with you. I really appreciate the time. If people wanna know more information about LAN where can they go?
Well, they can go to www.lantum LANTUM com
Fantastic, Melissa again, thank you for your time. Really appreciate it.
Thank you. Really great to talk 📍 to you.
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