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(INTRO)   It's not just about doing the work faster. It's actually improving the quality of the note and of the data using Ambient. And I think in a value based world, that's going to be tremendous.

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health.

Where we are dedicated to transforming healthcare, one connection at a time. Our town hall show is designed to bring insights from practitioners and leaders. on the front lines of healthcare. Today's episode is sponsored by ARMIS, First Health Advisory, Meditech, Optimum Health IT, and uPerform. Alright, let's jump right into today's episode.

  Welcome to the This Week Health Community Town Hall Conversation. I'm Reid Stephan, CIO at St. Luke's Health System in Boise, Idaho. And I'm joined today by Dr. Ashis Barad, Chief Digital and Information Officer at Allegheny Health Network, and Joey Seliski Director of Operations and Strategy for Digital Health at Allegheny Health Network.

Ashis and Joey, welcome and thanks for making the time.

So let's take a minute and just to introduce you and AHN to our listeners. I'll have you both take a couple of minutes to share a bit about your career background, how you ended up at AHN.

Joey, we'll start with you. And then, Ashis, you can also take a minute and share a bit about AHN for listeners who may not be familiar. So, Joey, please.

Sure. So as you mentioned, Reid, Director of Digital Health Strategy and Operations at AHN. Really focusing on where we're going with our technology platforms currently and in the next one to ten years.

As well. So what problems are we seeing with our executives and leaders that we can maybe solve with technology through that? Background about myself, I came from EPIC, the medical record company. You all may have heard of that before. But was there for seven years, all different roles from that perspective, from implementation to more executive consulting at the end.

And I got really excited by what Ashis and the digital health team are doing at AHN and joined the team back in November. little bit about me personally, I love the golf, love to cook Thai and Indian cuisine, as well as love to volunteer. I love to volunteer with a group called Camp Kesem.

They're an org for patients who have cancer and their kids and letting them have a summer camp throughout the summer, so I love to do that when I can as well.

Yeah, what a rewarding activity to be involved in. Thank you. Ashis.

yeah, I got Joey over with the Indian cuisine.

You know, and ripped him away from Judy there at Epic. So That's my only one up I'll ever have on duty, absolutely. So, thanks for having me, Reid. So, Ashis Barad, let me start with the org, since you heard the intro. I'll put them in the middle of the org. So, Allegheny Health Network, you mentioned, for those listeners that don't know it, is a 14 hospital system in western Pennsylvania.

Certainly Pittsburgh is kind of the home site, but we do actually have a couple of portions of New York, Ohio, West Virginia as part of that. And it's about 2, 500 beds, let's see, you know, 22, 000 kind of employees, about 6, 000 nurses. So, those are kind of the numbers. And I think it's important because it'll be a big part of our conversations to talk about the fact that Allegheny Health Network is wholly owned by Highmark Health.

And Highmark Health is a 27 billion company with the fourth largest Blue Cross Blue Shield in the country with around 6 million members. And so, it's a wild story that we can probably talk about another time of how AHN got put together about 10 years ago. We just celebrated 10 years of a system, of a network.

And obviously we you know, have UPMC here in town. And so. It's a very interesting town the two systems here in place that both have payer and provider, but we look at everything very much so through a payer provider lens, and that is that is absolutely a big reason why I'm here. So then to get, me, then I'll say, again I have been here now two years, so this month was two years in.

The prior 11 years were at Baylor Scott White, a large health system with the Bayer in Texas, and there is really where I kind of grew up into the technology space and digital and virtual health. I started there as a full time pediatric gastroenterologist. I became section chief of BDGI group department, you know, children's hospital, procedural suite operator.

So operator, clinician, leader, medical leader. So this was definitely a left turn in life and big part of my why is just I'm a physician first, a technologist second. So technology to me is How do we use technology to really augment, enable the care that we provide our people? And so I'm very people, patient, consumer, member, whatever we want to call it, centric in everything I do, and, clinician, of course, as well.

And so really being purpose built about how we use technology to really enhance all those things.

So you said something I want to ask a question around. You said consumer, member, patient, whatever. is there A term that you prefer to use and if so, why?

Yeah, I'll take a stab, Joey. what I'll say, is there is no great term.

I think we haven't found the right term. I think everybody's going to resonate with that is my guess, because I think we're throwing a lot of terms. We understand that patient has a connotation of sick care. To some degree, and then there's member on the insurance side. We use that term a lot too. Customer also kind of sometimes feels like non representative, but we do use customer a lot internally at the company, because we do think of things as, right, for the insurance side, they have employers as customers.

It's not just the members, right? so we are very, customer kind of obsessed, if you will, for like an Amazon term. It's the best term right now is probably a two worder, which is whole person. So, right now, that's kind of the way we're thinking about it is, it's a person, right, and it's a whole person, and a whole person to imply that there's more to a person than just anything even health related.

that didn't take on social terms of health and, drivers and other aspects of who they are. So, that's, the kind of term at this moment that I'd probably say.

Okay, that helps. Joey, question for you, and kind of leading up to this, we'd had conversations around digital health, which is this ubiquitous term, it might even be polarizing or charged.

I heard something the other day, and the person described digital health like an empty briefcase. That everyone is carrying it around, but nobody knows exactly what's inside of it. So with that really kind of positive TF how would you define digital health?

Yeah so I mean, I think simply our definition of digital health is meeting the patients where they're at and having them be 24 7 connected to their care and also providing our clinicians with joint practice and re humanizing the healthcare interactions that they may have taken away through technology now and artificial intelligence.

So I think that's really simply our definition we go to. I think from a TACFOL perspective, Dave. You know, we can't ignore the fact that EMRs came in over the past 10 years and are a large part of the digital health environment within our ecosystem. It's a huge part of that through the patient portal and how our clinicians work day to day.

So we need to factor that in. But can't be our only answer from our opinion and view of digital health. It's a complementary and it feeds the whole ecosystem. So there's sort of three pillars that we look at when we think about digital health that forms our team and our strategy for sort of where we're going.

And we sort of view it in pyramid perspective. The base of that is the system of record or infrastructure. So how well are you connected to all the data that you're receiving in your environment and making sure that that is being collected intelligently. If you do that well, you can then build your artificial intelligence and your insights for layer two.

So the system of insights, which is where our reporting comes into play, language processes, our machine learning, and our AI. And then if you do all that well, you get your top layer of the pyramid, which is our engagement. So that's where all the tools end. If you have the right data, and you have the right insights built on that, you can really engage with your patients, clinicians, and in our case, members even, from a Highmark Health perspective, to make a collected ecosystem.

Again, if you only focus on the top part, the engagement, which might be a product or solution, but you don't have the right data at the base layer, then it's not going to work well. So I think we really view it in that holistic pyramid perspective to make sure we're doing it in the right way.

so everything you said makes sense, but as you mentioned, the temptation is to go right to the engagement layer, because like that's the fun part. That's where you can actually start to. conversations of the benefits or the value, but to your point, without those underlying layers of the infrastructure and the insight, you then end up with, what I would think of as digital theater where you have a lot of activity, but it's not really maximizing value.

So Ashis, what are ways that you found effective at avoiding that trapping digital health theater, and really driving pragmatic value add initiatives.

Yeah, no it's a great question that we sit on a lot, and it's a tough world. I mean, I don't think anybody's quite figured out the exact answer to your question, right?

I mean, I think it'd be foolish to say, yeah, we got that figured out, and there's the ROI happening. Always right away as soon as we put anything out there. Right. You know, I'll give you a quick example right now with, I love ambient listening, right? I mean, with a bridge and ambience and Dax and Suki and Nala and everybody else, and you're looking at it like the rest of the industry, right?

As we're having a town hall interview, I'm sure you're looking at it and others are looking at it and thinking, okay, what do we do? But you look at that and then we look at, oh my gosh, this is going to really humanize healthcare to what Joey talked about and allow somebody to swivel that chair around and talk to, talk to their patient, and guess I'm a clinician, so I totally get it, right?

Like joy in practice and burnout pajama time and everything else, but then right on the back end of that is It's costly. Like it's not zero dollars, right? So anything above that is then how are we building out the business case? How are we going to our CFO, and then saying hey, this is absolutely going to yield What exactly right now?

Some may say well then ask everybody to see three more patients a day. It doesn't feel good Right to then go to our docs and say hey, I'm gonna give you joy and practice by making you do more volume, right? And So that's just an example and we can talk through, you know, that at a later time of like how we're thinking about that.

We do have some thoughts, a lot of thoughts about how we're going to go build that out in a way that's not adding burden to our doctors and nurses and everybody else with the ambient. But I think it's a good point because there might be something that's just. Oh my gosh, this is wonderful.

This is great. We love it. everybody's going to adopt it. But then you don't have necessarily the business case behind it to then run that forward unless you're just sitting on a bunch of money, which most of us aren't anymore in the hospital system side, or maybe ever. On the other side of it, there's a rollout of stuff that makes a lot of financial and business sense.

But, right, you're just adding more burden to the front lines and saying, do more, or we're going to automate something, but you might have to do three more clicks. Right, and then there's no adoption. can be true, and we're in the same struggle as anybody else to think about how do we think about those things.

So, to answer your question, I think that it's really important to do all those things at the same time. And what I mean to say with it is, look, you do need to have those real talks with your C suite leaders, and say, look it's going to take us some time in the basement until we really get a lot of those shiny tools out there that everybody wants to see.

At the same time, it doesn't mean we can't do any shiny tools right now, early on and quickly, so it gets some people hungry and seeing that they're seeing some value. We're doing that with like virtual nursing, right? And some other use cases we're also doing on the rev cycle. And so the other part of it is I think everybody's kind of realizing, look, the clinical side and touching the care delivery side is going to be a little tougher.

It's going to get a lot more. We've got to get a lot more buying and change management and adoption. So there's a bunch of stuff we can do, right? The digital side with supply chain, with rev cycle, another backend kind of administrative work that doesn't require necessarily as much change management, from doctors and nurses.

So we're spending a whole lot of time there to realize real hard ROI and value there too.

Yeah, I think that's well said, and I love the idea of the pyramid framework. You need to have that kind of scaffolding, but it's not always linear to your point, and so there has to be the flexibility and the openness to understand that you may look at some things just initially from the engagement layer just to generate some excitement or some learnings that can help maybe shape the other layers as well.

So I think that was That was well said. Joey, question for you. Is there an example of an initiative that you have been involved with at AHN that kind of pragmatically demonstrates what you described around the definition of digital health? Anything that you've done or that's happening right now that would just give some real world context to that?

Yeah, so again, going back to, my framework I said to start Reid we're collecting information, you know, about patient preferences for how they respond to how they receive their bills, you know, for example through a platform and when and how do they engage with that platform?

What time of day and how do they pay their bill? How do they want to receive that payment message through an SMS or some, you Patients may say, I actually prefer paper as my way that I want to be notified because I just don't respond to my phone, but potentially. So we have that sort of base infrastructure of how the patient wants to engage.

We can then really engage that well. So we have that baseline of their preferences. We know how, when they want to be reached out to. And then that engagement step happens through that respective platform or customer preference or patient preference. To make that maybe payment or engagement with our health system.

So that's sort of one example through an end to end for how you think about that patient preference. I'll call that the base layer to then make sure that engagement tool is really outreaching to them when and where they need it and in the way that they need it as well.

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I've heard you both really talk about the human.

There was the concept of whole human. There was the idea that as we design or as we think about digital health, it's really with that human at the center. So let's talk about ambience just for a minute. I'm glad that it was brought up. Because don't know, a CIO that's not piloting or exploring or using it, and it feels like it's kind of fast approaching this space where it's almost a commodity, like it's just expected you'll have that kind of capability, and it was kind of touched on, but we're going through the same thing, you know, as we try and figure out how we calculate ROI and as Our pilot showing free up some clinician time.

The temptation is to then want to fill that void. But what we've done is step back and say, well, wait a minute. Let's not just fill that capacity with the same work and the same way we've done things in the past. Let's take a minute. And figure out what's the best use of that time that the clinician has now back in their day.

But then trying to balance that with the cost of it. And at the end of the day, we have margins to meet in trying to find that ROI. Maybe just either one of you or both of you share more about how you're approaching that or thinking about it. Because I think that's a challenge we're all trying to find our way through.

I'll take a first stab at that one, Reid, and then Ashis, feel free to add on. So I mean, I think to your point with this type of technology it's actually taking even the next step. So it's one, you know, helping with better note quality and accuracy to start which is perfect and needed, but now while we're also moving into more diagnosis accuracy based on that conversation and I feel like that along with also improving like Ashis hit on the revenue cycle downstream is going to generate that value.

To your point, without needing to add. additional volume in that capacity. So now we're having more, I'll call it, accurate coding, potentially more,, diagnosis that maybe wasn't captured correctly, but now for the generative AI and the conversation that clinician can know, okay, this is actually what that is based on our generative AI models and improving that process as well, too, from a value based care perspective and a fee for service model.

Yeah, I'll add to it just briefly, and you know, so Joey touched exactly how, you know, we're sitting down with the leaders of these companies we're asking a lot of questions about what they're doing in the rev cycle space that's where I think it's gonna shine so then both can be true.

It's giving joy in practice and it's getting you better margins, if you will, you know. So then the CFO and the CMO can all nod their heads, saying this is great which is where we want to go. Joe, we based care, you know, we are a risk model contract with our Highmark payer.

We're not a closed system. we have half our claims roughly through Highmark and half our claims are outside of Highmark. So it's a very unique environment, which, you know, even though we're own paid payers, very different from Kaiser model, let's say in which we had to kind of live in both worlds.

So we have absolutely both worlds. one foot in fee for service and one foot from value based care, like risk, you know, real risk. And so That's a tough role to live in because, right, is it volume or is it value, right? And sometimes there's tough place to know how to go about that.

I think something like Ambient is a great tool that works in both, right? If it allows you to see more volume and you're just on the hamster wheel and you want to do that, I mean, listen, some providers are going to say on their own, I will see more. We know that. And so, right, and that's great. Good, good, good, good.

But, there's also this world of I spent more time, I talked about social determinants of health. It's documented in the note. And, know, and there's transportation issues. And, listen, I think we all know also that people don't always identify those issues on a, you know, Questionnaire before the appointment, or when a medical assistant says, do you feel safe in the home?

It's the shame. There's a lot of reasons why people just don't say those things, but they often do talk about it in some capacity during the visit with their doctor, with their clinician, right? And so, but that may not then be. Document it back in, you know, to the sections and the structured areas that we want it to be documented.

So I also think about where Ambient is going to go from that perspective to really actually capture. It's not just about doing the work faster. It's actually improving the quality of the note and of the data using Ambient. And I think in a value based world, that's going to be tremendous.

think to add on to that really quick too, Ashis and Reid, I love your point, Ashis.

I think when we go back to your digital health framework like that, this is one where we're starting at the very top to point. But now think about, from these conversations, additional data that can now be structured to Ashis's point in the medical record that previously couldn't be or potentially, you know, that conversation, utilizing that to make more structured reporting, AI based on that, again, information we previously couldn't capture.

Completely agree and goes back to that view of that, how we're thinking about digital.

Yeah, as you were both describing that, I think what I'm hearing is the great advice of, you know, you come into it from the standpoint of the AI scribe for the ambient listening capability, but really thinking about it as a platform.

And that should guide the questions you're asking of your vendor. Understanding the roadmap. I mean, the AI scribe is certainly an important part of it, but there's many other problems that it can help solve. Rev cycle operations, closing care gaps social determinants, all the things that were described.

that resonates with me, and I think that's the way we should think about ambient listening and those solutions, is from a platform perspective. And then the ROI, I think, maybe not easy, but you just then start to look at it more holistically, and you then create the space then for, It's not just a pure cost for an AI scribe, it's the cost of a platform that can do a lot of things for you.

I, so you think about it, go further. And I do, and I enjoy sitting down with those C-suite leaders and, they're getting it. they're thinking this way, which is great because look, during the visit, I may say, I wanna get labs in four weeks, and I want to get to repeat.

I'm a gastroenterologist, right? A pediatric gastroenterologist. So I might say six weeks, I wanna get an ultrasound, and I wanna see you back in eight months. All right. Now, how many of those things actually happen in those time frames or ever? Yeah. Not much. But Ambient heard that, picked it up. Now you start tying it into your system of records, in the intelligence, right? And then you add that to your CRM platform. And now, like, right, Ambient can just auto nudge at the right time to say, hey, your labs were due. Dr. Bharat said that the last visit. It's probably time to go get them. Your ultrasound is due. Your follow up is due. So care retention and following through with care plans.

Well, so that's how it's done. 100 percent with you on platform thinking for it.

And to Joey's point, then you layer that with what you know about your human, and you know, do they want to get a text for that reminder, or a call? Or do they want something in the mail? Like, you can really personalize this in a way that I think drives higher engagement, with the goal of, you know, Taking care of the whole human.

So I think it's beautiful and it's just an exciting time to have technology come and really, I think, have the ability to deliver on the value that sometimes the promise value outpaces the realized benefit that's delivered. And it feels like we're at an inflection point where maybe we can start to get that more balanced, which is exciting.

Okay last question for both of you as we conclude crystal ball, and you can go in whatever order you want. One future prediction as you look into your crystal ball around digital health.

I'll start. So I think we hit a lot on your ambient clinical intelligent read and generative AI, so I think the concept of ambient brain really, you know, five years from now, keyboard's not being a thing in exam rooms.

I don't know if that'll be the case, but imagine, it's coming with your phone and just setting it down, having the conversation. And then for us, being associated with Highmark Health, imagine a world where we know that patient's a member and we can suggest a program at that time for the clinician on the phone.

Hey, you should talk to them about this. Because we know that information about them from their medical record and their insurance information to suggest that. So I think that ambient brain, I'm going to call it, is going to be the big thing of the future in the outpatient setting and inpatient.

Hey Reed, so say two things, if sorry, but one is on the.

Clinical side, I'll give you the both sides of the story on the clinical side. There's a good paper in JAMA about the productivity paradox of healthcare it. And I think about that paper a lot and I think about what that is and with the EMR and everything else.

And the point of all that is to say that. I think crystal ball is that we are going to see a substantial productivity improvement in our workforce. The negative aspect of that that I worry about is a lot of times when you see productivity improvement, you free up all that time. There's a consumer expectation that's being unmet today.

And just like the in basket, Is you turn something on and it's flooded now because they needed us. They just didn't have a mechanism to engage us. And I worry that to some degree, and maybe this is a good problem. I don't know. That time. Instead of us saying, oh my gosh, everybody got 40 percent time back, 50 percent of their day back, right, because of ambient and AI and this and this and this.

Will it just be filled with other stuff? Because I think we're not meeting consumer person, whole person expectations today. And I think that that time will be just gobbled up with that. But that's not necessarily a bad thing. Because then maybe the happy quotient goes up. All the way around with that, but I worry if there's a thought of, yeah, productivity and we're going to get more RVUs, and we're going to get more things out of the doc, I don't know if that's necessarily happening.

The second prediction I have is on the person perspective, the consumer, the person, the patient, which is we talk about this term patient empowerment. I think we're in the infancy of it, and I think that right now that usually means shared decision making in the office or health literacy or education.

And I think we're generating AI. And with five, six, seven, right? As we, I'm thinking 10 years, whatever timeframe is, everybody's going to have a doctor. You know, when the iPod came out, it was like, you got a thousand songs in your pocket, right? That was the slogan. And I think it's going to be, you have a doctor in your pocket.

and they're going to engage with generative AI in a way to say, Hey, it's already happening, right? It's already happening. There's no Google searches. It's chat GPT or whatever told me that I might have this. That is going to accelerate through the roof and it's not going to be always wrong. And it might not actually be bad.

So I think that doctors are going to be more guides and sherpas to some degree in the future model. And this paternalistic of you come to me for all the decision making and I tell you what I think it is, is going to be different. Yeah. And so the other part is that the people that are going to succeed in that role, the physician traits, are going to be human trust, empathy, right?

And compassion. And I think there's a whole new training that's going to happen that we're going to have to really go back and develop those skills and, really say, those are the skills that differentiate us from AI.

Okay great. We'll have to have a part two and unpack some of those items, but this was great conversation.

Ashis, Joey, thank you for your time, great insights, best of luck in your continued journey at Allegheny Health Network, and thank you for all you're doing.

Appreciate the time.  📍

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