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Today on This Week Health.

I don't think that a lot of executives understand or can see how much incredible value and potential there is in case management to achieve some of the health system's biggest goals. Case managers are where the rubber hits the road for the health system in terms of interacting with their partners. And so understanding what they're up to, what their workflows look like and where we can support them turns out delivers a ton of value.

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 Newsday and today we are joined by Russell Graney, CEO for Aiden, and one of the Cedar Sinai accelerator companies. Russell, thank you and welcome to.

Thanks so much, bill, for having me.

It's a pleasure to be here.

I'm looking forward to the, looking forward to the conversation. We got some great stories to talk about. We're gonna talk about US Healthcare Spin. We're gonna talk about some of the things that Judy was quoted from her blog actually. So it's a pretty interesting story.

We're gonna talk about remote work, we'll talk about digital health and cloud and whatnot. But before we get there, this is the first time you're on the show. I'd like to hear a little bit. Aiden. And what's the problem you're solving for? He.

Sure. Yeah. About 12 years ago, my uncle was diagnosed with early onset Alzheimer's.

And what I learned kind of through his journey was that case managers were people at kind of the scariest moment in the healthcare journey, which was not. Usually the ambulance rushed to the hospital. But on the day of discharge from the hospital when suddenly your loved one's care is kind of back on you and case managers were there helping you set up the plan for what comes next.

And Aiden is in service to case managers. So we've spent the last decade working with some of the best health systems across the country. We're proud to say, and elbow to elbow with the case managers at their systems to build out one central home for case management. Basically do what they do all day, which is interact with the outside world of providers and payers to make sure that this patient's care plan can proceed on time without any delays.

Yeah.

Ucla, Ohio State Penn Medicine, St. Luke's Health out of Idaho it's definitely some good. What, what's the biggest challenge that case managers face? .

There's so many, but I think fundamentally the biggest challenge is that I don't think that a lot of executives understand or can see how much incredible value and potential there is in case management to achieve some of the health system's biggest goals from the financial around just pure capacity and length of stay and how much opportunity there is there.

All the way to kind of your broadest population health strategy, the way you're engaging with your community. Case managers are where the rubber hits the road for the health system in terms of interacting with their partners. And so understanding what they're up to, what their workflows look like and where we can support them turns out delivers a ton of value.

Ah, that's fantastic. We have a lot of different stories to talk about. We are not gonna do a story on ChatGPT It's so cliche at this point to do it, but, but I have to talk about it because Google came out with Bard yesterday and so the, the big news, and actually Google stock is down 6% today cuz Bard gave a whole bunch of bad answers on the On the, I'm serious.

That's exactly what it said. Of course, of course. Because these models have to be trained and they have to they have to be used in the real world in order to get better. And gosh, I mean, this stuff is so high on the hype cycle right now. It's, it's really kind of unbelievable.

Why do you think it is so high on the hype?

cycle

cause it's exciting. It's like, it's a brand new thing and I mean, have you used it yet? I have a bunch. It's it's pretty compelling. I don't know what your experience was, but I was working on a proposal with a physician that I work with.

We threw in some ideas, asked, Hey, spit out the one pager. It was pretty good. I mean, certainly depends on what you're putting in. but I don't know. My takeaway from ChatGPT versus Google kind of one insight that I do think is interesting is I was recently reading that ChatGPT is actually not even on their newest AI model.

It was actually an old model that they just put this together and got it to market. So I think it is exciting to think that, hey, if Google's putting out whatever they're putting out on their newest model maybe these guys are really ahead of the game and do have something exciting coming.

Yeah,

I think one of the things. Interesting to me is how much code it has consumed. Now it's written on code, but it's consumed code, and so I, I do some coding from time to time. I dropped some code in and said, Hey, can you correct this? I corrected it and it corrected it, like I just took the code, put it back over.

I, I had somebody over at my house last night and I told him that story. He said, oh, no, it's better than that. He goes, I had this code written in a different language, and I said, Hey, Can you turn this into C sharp code? And it did. And he said, no, no, no. Could you rename the variable something else based on this?

And it renamed the variables. It gave him the code back. He was just like, he goes, and I think that's the thing, that's why it's so high on the hype cycle. Cause we're looking at it going, oh my gosh, this is like, this is like all those movies we watched growing up as a kid where you're like interacting with it saying, oh no, no, no, that's not quite right.

Give me this. And the computer's actually giving you back things that are.

Yeah. No, I think it's, it's gonna be a game changer. And I think like anybody in technology should be thinking about how does this play a role in your company in the next five to 10 years? Cause otherwise, I think you'll, you'll be behind.

Well cool. You so healthcare IT news, digital health, 2023, cloud, human-centered design, and getting back to basics. So Marcus Perez, president Altara Digital. Offer some intriguing predictions for the year ahead. I'm curious, you, you picked this story, what, what really jumped out from this it's more of an interview, but what, what jumped out from this story to you?

Yeah, I mean, I just, the headline of it that I think Perez points to is that I think it was 63% of physicians report being burnt out. and just what a massive challenge that is to us. I think that that number is probably true across the clinical providers in a lot of different care settings. I know that nursing and case management are also similarly challenged.

So that's the headline. And I think they go on to discuss in the article a little bit about the role of technology and perhaps creating that burnout which is obviously not the goal. And I think kind of a classic discussion and conversation in healthcare is. Why aren't we building the right things?

Why are we so far behind in bringing technology in meaningful ways to to people who need it most? So I don't know. He talks about we just need instinctive, easy to use technology. And I think the question that it raised to me was like, well, why haven't we been able to do that yet?

Well, it, it's, when I came into healthcare, I had those same questions. Cause you come in from other industries finance manufacturing, other industries. You, you look at it and you go, well, look how hard can it be? And you've been in it for a while. I think one of the things that really shocked me was I asked for an application inventory and we ended up with I don't know, 800 applic.

Like 13 or 1400 instances of 800 applications and just, I mean, I had to step back and think about that. I'm like, I'm like just the complexity of that in, in and of itself, and, and now all of a sudden it's like, okay, you still have that complexity on the back end. That legacy is still there and we've reduced that somewhat.

We've been focused on that, but now, now people are saying, Hey, give us a digital experience. feels like Amazon or Google or easy to make an appointment and and I'm sitting there going on top of that legacy that's, that's hard to do. .

Absolutely. Honestly, I think that the, there is a path forward.

I think that we've gotten to the point of 800 applications because there is an idea that every part of healthcare is so specific and requires specialized. I agree, and I think that that's the wrong instincts to have. I, I think that it, it might be true. . But just the goal and kind of the attitude to come from when it comes to building technology and software solutions generally, I think is about, let's find whatever is common.

That's our first job. And I think the more you look at it at Keith, at least in the small world that we, that we live in we see case management team, they probably are working with five to 10 different vendors themselves. Just that one department. And if you look deeper, A lot of the same thing happening in just different ways.

And so, I dunno, I always look at the jobs to be done kind of category, I'm not sure, or the, the, the model. And I think that's a good one to bring into every kind of healthcare conversation, especially when you're talking technology, is to really figure out. Okay are, do we need help sending faxes or do we need help finding reservations faster.

How big can our ask be and what really is the job that needs to get done holistically? And I think challenging your technology partners to help you on those jobs is a place in a way that kind of gets us closer to really being in service to what the clinician's need is.

Yeah, and I, I think the other thing I'm, I'm always looking for is where, Insert a human being where a computer should do it, where they go, oh no, there's no, there's no bridge between here and here.

Therefore, we're gonna use the patient to be interoperability. The patient's gonna take the stuff from here to here, and you go, no, no, we, we've gotta be able to fix that. Oh, and we do it with the clinicians. And I think that's what leads to burnout. They're like, Seriously, I have to, I have to remember all these things and type all these things in, and the note has gotten so long, you can't possibly expect me to read all this stuff.

This is where technology should really shine. And instead we're, we're, we're not. We're not completing the workflow. And, and I like this idea of human-centered design and really going back and spending time with them to look at it and go, oh, no, we can smooth this out even more and even more as, as we move forward.

It's I, I think the other thing and is we're seeing a lot more platforms, people have said, all right, so the E H R is a platform. E r P is gonna be a platform. The service desk is gonna be a platform, some sort of data. Platform or analytics platform. These are becoming, we're, we're allowing less and less variability.

When people come in and go, no, no, we're gonna use a different analytics platform. It's like, no, no, no. We, this, we, we need to get to platforms so that when people ask us to be nimble on top and create these experiences for navigators or others, we can do it because it's all it's API enabled.

It's on top of platforms. It's it's modern architecture. Yeah.

I love, and platform thinking is fundamentally about the, what's the same about this? How do we make some common spaces to fit a lot of different work so that we can see it all in one place? I, I think that's a good, a good path forward.

If you haven't heard yet, we're doing webinars a little differently this year. We got your feedback. You wanted community generated topics, not vendor generat. You wanted great contributing panelists. Definitely not product focused, more focused on the challenges and the problems that we were facing in healthcare. We are only making these available live, so we are making them more dynamic in nature, and we're doing them on a fairly consistent time, . March 9th is gonna be the webinar, and we're gonna continue our leadership series. We're gonna be talking about the changing nature of work, and a lot of things have changed. The pandemic drove us to work out of our homes. What does that mean? What does it look like? How are we making decisions? Are we making data driven decisions on. How are we maintaining culture? How are we hiring? Are we hiring differently? Not only that, not only focusing on it and the roles there and the challenges there, but also on the challenges that our health systems are facing, the changing nature of work. As we move into working, hospital at home and some of these other care venues, what does that look like? Addressing the staffing challenges in the clinical side as well as the administrative side. We are looking forward to having that conversation. Love to have you join us March 9th. You can sign up on our website this week, health.com. Top right hand corner. The cool thing about that is you could put your question right in there, and I give those questions to the panelists ahead of time and we make sure we integrate that into the discussion. So sign up today, hope to see you there.

Becker's wrote a story US spends most on healthcare, but has worse outcomes. Six report findings. US has the lowest life expectancy at 77 years compared to 80 years. US has the highest rates of avoidable deaths from causes such as diabetes, hypertensive disease. In certain cancers, the US has the highest Covid 19 death rate among high income countries at 3000 deaths in every 1 million cases. Our fiscal assault, which includes gun violence is seven times higher in the US than in other high income countries. US infant and maternal deaths are more than triple the rate of most other high income countries. As you sort of read through the, I mean especially in an election year, we'll hear this pretty often these stats thrown out there besides commiserating on these stats or even questioning these stats is there a path forward?

I mean, I hope so. We all hope so. There's gotta be, there is a path forward. Cause here we are. I, I don't know. I think that the, the endemic nature of these statistics does point to things bigger than just covid and bigger than just like, the politics of the moment. And I don't know. I, I think that if you look at just the headline we're spending the most and getting the least output.

And That for me points to just, it's an inefficient marketplace. So while I think that in our popular imagination, we think of healthcare as a kind of a thriving part of the capitalist part of what we do. And, and a lot of people wanna protect that. I don't know that it really is that. And when you look at kind of the way that decisions are made and the size of health systems and the way things work, like I think that there's a lot of inefficiency in the marketplace and a lot.

of It's more, looks like a kind of a command economy, a control economy. And I think there is opportunity inevitably with so much of the internet and digital solutions that enables people to find more information on their own kind of breaks that down. Makes things more consumer friendly. But I do think that, yeah, it's like, it's a.

It's a big challenge for the healthcare ecosystem as a, as a whole.

Yeah. I, I could really nerd out on this just, it, it's economics and its healthcare and its technology. I think technology gives us some transparency into some of this stuff that we didn't have previously. From an economic standpoint, the, the challenge with healthcare is the, the elasticity of demand.

When you , when you have an acute situ, , they could literally charge you anything and you, you're gonna want to pay it, right? So you, you can't allow that. So you have to put some controls around that. And then you have the if you don't, if, if you don't have the ability to essentially incent innovation and those kinds of things.

So one of the things that happens in some of these other countries where they have essentially said, look, We're gonna focus on wellness, and we all know that's the path forward. We want everyone to be well. But the, the challenge with that there, there's a lot of challenges with that. One is people like to go to McDonald's and Burger King, and if you really wanted a healthy society, what you would do is you would turn all those buildings into something else.

Because you can't, you can't eat, keep eating McDonald's and Burger King and expect people to be healthy. And so when we talk about obesity rates in the United States, all you have to do is walk through a grocery store and see the incentives are, I mean, the, the temptations there are huge. The portions we give in the United States are bigger.

I mean, there's, there's cultural things that just exist that you have to address. From, from that perspective, not, not the least of which is fee for service and other things, but in terms of the innovation, if you go to some of these other countries that have said, look, here's what we're gonna do.

It's, it's government run in order to essentially qualify for the insurance or be covered or those kinds of things. You have. do these things. All that's well and good. The problem is they, they cap the rates that they're paying their physicians, they cap the rates, they're paying their nurses, they cap the rates on all that stuff, and then all of a sudden there's no incentive.

They're, I mean, we have the same problem in the United States though too. We we're running outta clinicians. There's no incentive to come up with innovations around new equipment and that kind of stuff. So this is not a, the, the reason this hasn't been solved is, , it's not an easy problem to solve.

It's cultural. It's economic, it's technology. It's I, there's just so many aspects of it and, and then it's political, right? If you lean one way or another, you're looking at it. And so, and, and the politics of it have created almost a, a situation where we can't even talk about some of these things, which I.

That's

true. I do think there is like there's room on the margin though, and that true that any major change requires policy in Congress and much bigger conversations. But on the margin and even just looking at what, what we're focused on is really A lot of healthcare services are really found on behalf of patients.

A lot of a lot of high spend healthcare needs actually coming out of a hospital stay, going into a rehab or getting home healthcare. A lot of these purchases, case managers are the ones kind of mitigating managing through, and so there is an opportunity to kind of, at the margin make sure that all of those decisions that patients are making.

Moving them towards the high quality partners ensuring that those high quality partners are getting rewarded with more referrals for having good outcomes. And there's a lot at the local level within the existing payment programs that exist. To just optimize like where people are going and what the incentives look like.

So that's a big part of my mission and why I love what we do is that I do think it's, it's healthcare and economics and technology altogether.

Yep. And I, and I, and I love that, and I think that's what we are doing is we're, we're looking at each one of the. The various practices within healthcare and all the different things that happen and you call it innovation at the margin and we're seeing it in imaging, we're seeing it in lab, we're seeing it in, we're seeing a lot of different innovations along the way.

But there's things that can only be done through policy, right? So when, when Biden gives his State of the Union, which he did last night, that'll tell people when we are recording this he talks about the cost of drugs and the cost of drugs, and especially some of these designer drugs and other things have gone, they're so high that that something has to be done about the, just the cost of those drugs otherwise, and that can only be done at a.

Likely at a government level, but maybe there's an innovation path through that as well. I'm not sure. Let's talk, let's talk work from home. I assume your company works from home. We

do. Yeah, we like had an office downtown. We're based in here in New York but midway through the pandemic said, let's go for it.

So there, there's a Wall Street Art Journal article that one company's trick to getting back 95,000 hours is canceling meetings. Do, do you find that meetings just naturally grow? Like they just kept, keep popping up? I mean, does, does Is one of the jobs as a CEO to look at this and say, Hey, do we need to have this many meetings?

I think like I'm lucky to have a culture of people who ask that question themselves. And we're all, we focus on being doers here. We're a pretty small team and we all like to be engaged in like, getting the work done with our hands on it. So I'll say that I hear the chorus primarily in response to a meeting that I have requested.

I'm usually the problem bill. But usually that's about. Creating that culture and reinforcing it. So if I'm looking for time from the team it's not going to be about something operational or something kind of like for the week. We're probably connecting about. , how are we doing, how are we doing on our health management principles and making sure that people are empowered to move on without needing consensus from everybody, but still getting input from the right domain experts.

Those kinds of lessons are kind of where I'm trying to bring the team together these days. Yeah,

I mean, I, I was so proud this week, one of my. One of my staff members sent me a note saying, Hey, I just attended these two meetings? Is there any way we could absorb these two meetings into one meeting?

And I'm like, and I was proud cause I'm sitting there going, no, that's, that's great cuz that's, that's the culture you're talking about. The other thing we implemented over here is no meeting Monday or Friday. So, , there's a need for workers to have uninterrupted time if you're a, if you're a strategy worker, to go through strategy if you're a programmer, to like really get immersed into solving different problems.

And if you keep context switching and splitting that up with, I worked on it for an hour meeting. I worked on it for two hours meeting. Just studies have shown that our, our brains do not contact, switch all that well. And so we. We've done that. Now my Tuesday, Wednesday, and Thursday are loaded with meetings and, and things, but there's

a, but I smile cause my team for like many years has had a joke that no meeting Wednesdays was introduced by someone like a couple of years ago.

And, I think that the engineering team does actually enable, no meeting Wednesdays, but it's like a joke for everybody who's got a client. Any sort of interaction. It's like, yeah, no meeting Wednesdays. So we would like to get there. I think that definitely depends on like the role. It's, it's kind of a joke at our company that we've been trying to get there.

Yep. Yeah, it's I mean, yeah, you've gotta align with your with your clients and, and. It works. It works for our organization. Does not work for all. I wanted to hit in the last couple minutes here I wanted to hit on let's see, Becker's again. Laura Deirdre pulled some business gems is what she called it from Judy, and she had a couple in here.

You read the article. I read the article. Pull one of Judy's gems out here and discuss it a little bit and I'll, I'll pull one out.

I think my my favorite one I had kind of like a one that I thought was very funny and one that I thought was spot on. I really like how she talks about no titles and how she, they're building a culture at Epic that is really just about what am I working on, what do I do?

I was kind of sharing that's like really jives with I think what I believe a company and a team should be about. We talk a lot about self-management and about being a domain expert or if you're, Just finding the domain expert. And that's kind of all you need to be able to make some decisions and make things happen.

So don't be limited by your title. And I thought that it was cool to see that alive and well, that an organization is as large and dominant

as epic. Yeah. I I like that one as well. And the next one you're gonna talk about is pain versus pleasure. It cracked me,

I don't wanna steal it from you.

I, I, I'm curious what your thoughts were on it. Well, no,

I'm curious your thought I. . It's interesting cuz she, she tells it through a story. She said we, we want to think that pleasure, essentially most people respond to pleasure is how they change. But most studies show that that's not accurate pain.

It usually is more powerful. And then she tells the story of where Carl. It's so funny cuz you just say Judy Carl, everyone knows who you're talking about in the industry, but Carl's the president of Epic and he needed a CIO to move faster on an epic implementation. And after multiple attempts at persuading him, Carl finally suggested the CIO get his resume in order.

She wrote that worked, worked. There's a couple things about that that jump out at me. One is I, I think. I mean, the studies I think are true that pain works. We've gotta be careful of how we think about that cuz we want, we want clinicians to change. We, we don't wanna make their, their lives painful in order to get them to adopt technology and those kinds of things.

I mean, I, I would assume that's, that, that's, that's a bad approach. The only other thing that sort of jumped out at me is Epic is the vendor. And Carl said to the cio, who is the client? Get your resume together. I, to me that was a, that's a pretty interesting story. I don't know if you can comment on that, but to me I'm like, that's maybe a little much, a little bit too much power. In the, the partner's hands rather than the client's hands.

Yeah, no, that was, I found it curious that there was such an openness to share that story, like the openness in and of itself was interesting. But yeah, I mean, that's no surprise and I think that you've gotta. in a lot of ways, being a good partner to your client is being bold and help and saying, Hey, this is kind of like the red line for us to be able to move forward and work together.

So I understand those moments, but that's a big one. I, the thing that made me chuckle was just like that, this whole idea of kind of, yeah. Building behavior change around pain and remembering earlier we were talking about the first article where 63% of physicians are burnt out and attributing it to their E M R and it's like, , we probably need to find some pleasure to, to stick into those UX loops.

That, that might, this might be a bigger problem here. We need to find some ways in. But both are certainly powerful. I think I think we do learn from the world of consumer that actually. Pleasure in. And I don't think like in the smallest version of the word in that little dopamine hit that is Instagram is pretty powerful for people.

And I think trying to figure out how to unleash that in the context of things like clinical and administrative care are

possible. Yeah, absolutely. Russell, I wanna thank you for coming on the show. If people want more information about your company, it's actually my Aiden, m y a i d i n.com.

They can get more information. Thanks again. It was great to catch up with you.

My pleasure. Thanks so much for having me. 📍 Take care.

And that is the news. If I were a CIO today, I would have every one of my team members listening to a show just like this one and trying to have conversations with them after the show about what they've learned and what we can apply at our health system. If you wanna sport this week, health, one of the ways you can do that is tell someone about our channels. We have two channels this week, health. And this week, health Newsroom, check them out today. You can find them wherever you listen to podcasts, and we are just about everywhere. You can find us on YouTube, apple, Google, overcast. You get the picture. And please subscribe to our webs at on our website this week, health.com as well. We wanna thank our Newsday partners, Cedar Sinai Accelerator, clear Sense CrowdStrike, digital Scientists, optimum Pure Storage. Sure. Test Tao Site and VMware, who invested in our mission to develop the next generation of health leaders. Thanks for listening. That's all for now.