This Week Health

June 17, 2022: Today we have a special treat. Jonathan Manis, Senior VP and CIO for CHRISTUS Health walks us through his Opening Keynote “Re-Design Healthcare” presented at the Texas HIMSS conference. In this episode, it becomes utterly apparent that the healthcare industry needs a mind-shift. We delve into mobility, connectivity, consumerism and an alteration  to “prediction and prevention” versus the “provision” of care to the sick and unwell. Healthcare can’t advance with a new approach until we stop using the old approach. How can we nix some of the complexity? Are customer experience expectations different across different countries? Healthcare consumers are stuck with what their insurance carriers’ want them to do. Will we ever break out of that model? How can we re-design healthcare?

Key Points:

  • In this digital hurricane world, healthcare is lagging way behind
  • Venture capitalists are not investing in the delivery of better healthcare. Venture capitalists are investing in better healthcare delivery.
  • I hate talking about innovation. We don't need innovation, we need adoption.
  • CHRISTUS Health
Transcript

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.

We're all looking for the same thing and that is that we really want that our everyday consumer experience in healthcare has gotta be the same as our everyday consumer experience in every other industry. I mean, we would not accept what we accept in healthcare in any other part of our life. And I think that's what we have to get our mind around and make that transition.

Thanks for joining us on This Week Health Keynote. 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 our Keynote show sponsors Sirius Healthcare, VMware, Transcarent, Press Ganey, Semperis and Veritas for choosing to invest in our mission to develop the next generation of health ???? leaders.

Alright, here we are for our keynote address today, we are talking with Jonathan Manis the CIO for Christus Health and always looking forward to these conversations. John loves to push the envelope in my thinking. And so I really appreciate that, John, welcome to the show.

Well, thank you very much for having me, sir. It's always a pleasure to speak with you and I just want to once again, how much I appreciate what you're doing for our industry and for our industry leaders and, and helping us to continue to push the envelope and on behalf of our patients and our consumers. So thank you for the work you're doing.

Well, I, I appreciate that my listeners have me starting off with the same question just to level set. And so they know where we're coming from, and that is tell us about your system. Tell us a little bit about Christus.

Oh, yeah, sure. I'm very proud to work here for Christus health where a Catholic health ministry. And we are actually located in four states as well as four countries. So we're here in Texas headquartered in Irving, the Dallas area of Texas, but we have facilities a broad range of facilities, about a hundred hospitals in total or in Texas, Louisiana. New Mexico and Arkansas. And then in addition, where not only in the United States, but we're also we've maintained facilities and hospitals and in Mexico, Chile, Colombia, and looking to expand our ministry into other Latin American countries.

Yeah. It's as fast. I mean, the last time you were on, we talked a little bit about that. How at the challenges of really understanding, cause each market. Is not like going from San Antonio to Dallas, each market is very distinct, very distinct set of rules and regulations, data, different EHR by design almost in those other countries. So a lot of complexity your environment, do you, do you strive to drive some of that complexity out?

Yeah, of course. I mean the key to a high quality and low cost is all about reducing variation that said we are hindered with as many hospitals as we have, like I said, close to a hundred, we're dealing with four countries.

So the laws, the regulations, the political system, The the social economic basis are all very different. the laws of chili are very different from the laws of the United States and Mexico and Columbia. So we've got everything from democracies to a socialist organizations or political systems in place that we have to, to navigate.

Very complex, but I also find it very attractive and frankly a real learning experience for myself. I've, I've really liked the international flavor that that we have here at crystal.

Yeah. It really is to state, but we're going to talk a lot today about customer experience and convenience and those kinds of things. Do you find that the target customer experience is different across countries or the expectations are different across countries.

No, I, I don't, I think for the most part in my mind we're all looking for the same thing and and that is that we want, we really want that our, our everyday consumer experience in healthcare.

has gotta be the same as our everyday consumer experience in every other industry. I mean, we, we would not accept what we accept in healthcare in any other part of our life. And I think that's what we have to get our mind around and make that transition. Many people call it transformation, but it's really understanding that that we really need to be a different kind of service delivery organization a different kind of service delivery industry and and, and not accept anything less than the experience we have in every other industry of our lives.

All right. So let's, let's go into this a little bit. You presented at the HIMSS, Texas regional conference, which was last month. So redesign healthcare think different or think differently was the title on the on the day.

I love your design on this deck. Do you do your own slides or do you have somebody help you out with the slides?

I actually had to do my own slides to tell you the truth. If I that's, how I learned my material and how my thought process works. I can make a theme and then carry that through my deck. So I do it all myself.

q It's it's it's fantastic. You definitely adhere to the. One point per slide each slide is about one thing. It sort of sets it up. and I love that. So the conversation really is about the need to change healthcare. what's the driver around the need to change.

I think frankly, the issue for us is it's really on top of what we've talked about previously bill and that's that the digital hurricane that's coming our way how every industry is actually in moving in that direction and, and healthcare is lagging. And I would tell you that we're lagging.

I primarily because there has been no need for us to change. And that is about to change dramatically for us. If you look at just the, just the U S population statistics already, 71, almost 72% of our population is made up of gen X-ers, millennials and gen Zs. And these people were born with a smartphone in their hand.

They have very different expectations. How they will access services, how they will interact with their community, how they will interact with our industry. And and if you take the greatest generation and the silent generation out of those populations, statistics, you're looking at. 80% of our population is gen X-ers, millennials and gen Z.

And again, they've been relatively healthy. They are just now starting to have interactions with the healthcare systems in terms of having their own children, maybe taking care of aging parents rolling off of their parents' insurance plans. Starting to have their first interactions with healthcare.

And they're basically saying, you've got to be kidding me. This is, this can't be the way that that, that we access services and healthcare. I would also tell you that I would also tell you that I just recently checked some statistics and that 54% of the world's population, the world's population, every man, woman, and child in the world is using a smartphone.

And that's just unbelievable to me. And. Doing on those smartphones is a hundred percent is accessing social media. And we've got to start realizing that that's the preferred method of accessing services in today's world.

Now I agree with you on most of these things, I'm going to take a little devil's advocate role on this, just to spark the conversation.

One of your slides that says healthcare is a retail industry that doesn't seem to know it's a retail industry. And I hear that, but on the flip side, when you get to my age and my wife's age, and you're caring for an elderly parent and whatnot, at some point you sort of throw up your hands and just.

I don't have choice. I there's like this very narrow path I can follow there's. I just don't have a lot of options in this thing. So it doesn't feel the same way that other retail industries feel like if I, if I want to buy a book from somewhere else, if I want to do some other digital transaction from somewhere else, it feels very I'm empowered as a consumer, but this, this doesn't feel that.

Well, I think, I think you're right in many ways. At the same time, I think there's an alternative way of looking at things. As you may know a statistic called share of care which is really for every dollar that a healthcare consumer. Spends how much of that goes to a, to a health system, for example, and the highest statistics is about 30% or 30 cents on the dollar.

That means you and I, as shoppers are spending 70 cents of that healthcare dollar somewhere else. And we're spending it in over the counter medications. We're spending it in pharmacy. We're spending it in walk-in clinics, maybe urgent care retail labs. Cosmetic surgery, DME, we're spending it wherever we want to.

So we want to shop, we want to, to access things and more and more we're finding that we're being disintermediated by those niche systems, those boutique systems that are doing one thing You remember you and I both remember when when a radial keratotomy for your eyes was done in hospital.

Now it's done at the mall for heaven sakes. You go to a, a spa to have a treatment and it could be dialysis for that treatment at the spa. I, I pass a place on my way to work back in California. That was a, a dental spa, literally. They had the Indian music playing and the water fountain running and A robe, an incense, kind of a, an environment where service mattered. You certainly got the clinical care, but they were focused on having a very high end retail experience, service experience for that consumer understanding that that's what they were really looking for. So I think that we do have an opportunity to take on more of that of a shopper mentality.

And I think you're going to see that more and more over, over time. the big fear for me. And I think it should be for our industry is those that were being cherry-picked. and I've said this many times in the past that places that used to be our bread and butter, those, those things that were low risk and high margin services are being taken away from health systems, cosmetic surgery, oncology, birthing centers, ophthalmology, and optics.

Walk-in clinics, retail, focus factories like the hip replacements home care, residential care primary care is now becoming more of a commercial boutique and health systems and healthcare systems are going to be left with those things that are high acuity, high risk, low margin services. And I'm talking about emergency services, complex surgeries.

Intensive care and end of life care things that are high risk, low margin, that people really the boutiques really don't want to do. And I think that's the risk for our industry.

???? ???? All right. We'll get back to our show in just a minute. I want to tell you about the podcasts that I am the most excited about right now that I am listening to, as often as I possibly can under that is the town hall show that we launched on the community channel this week health community, and an Arizona Tuesdays and Thursdays. What I've done is I have essentially recruited these great. Hosts who are coming in and they're tapping people in their networks and having conversations with them about the things that are frontline kind of stuff. So it's, it's technical, deep dives, it's hot button issues. It's tactical challenges. it's all the stuff that is happening right there. Where you live on a daily basis. We have some braid hosts on this show. We have Charles Boise. Who's a, data scientist, Craig Richard, bill Lee, Milligan Reed, Stephan, who are all CEOs. We have Jake Lancaster Brett Oliver, who are CMIOs. We have mark Weisman who is a former CMIO and host of the CML podcast. And now a CIO. At title health and we also have the incomparable sushi shade who is fantastic. And I'm really excited about the fact that she's tapping into her network and having some great conversations as well. I'd love for you to tune into these episodes. I am learning a ton myself. You can subscribe on our community channel this week health community. You can do that on iTunes, on Spotify. On Google on Stitcher, you name it, we're out there and you can subscribe there and start having a listen to yourself. All right, let's get back to our show. ???? ????

Sometimes on the today's show, I'll, I'll give some advice and that kind of stuff. And one of the things I talked about is having a point of view on the world that you live in. And I find a bunch of CIO's, don't have a point of view on things and you, you definitely have. This point of view really well. So I want to keep going further on this venture. Capitalists are not investing in the delivery of better healthcare venture capitalists are investing in better healthcare delivery.

We have a lot of competition. And that competition is coalescing around the experience. Isn't it it's really coalescing around how we, I mean, you talked about you talked about going into a place that that really focused in on your experience also delivered great care. But we're seeing the investments you do the investments, follow this, but we're also seeing the Transcarents to the world.

That's focused on experience. You're seeing Amazon is really focusing on experience, but you also have to, the payers are focusing in on experience because they're getting paid that first dollar. And because they're getting paid that first dollar, they're saying, all right, we already have this client, how are we going to orchestrate their healthcare in a way.

That keeps them coming back to us and they go, Hey, this is my, this is the person who is going to help me to navigate this Byzantine architecture that I have to, because from time to time, I don't just need a radiology. I need, I need something serious. And I still want somebody who's going to help me with that experience from one end to the other.

All the way through the bill that I get and explain that to me, but all the way from the beginning where they say, okay, we're going to set up this, special appointment and what. The investment.

I could talk about this. I could talk about this for the rest of our time.

I think you're right on top of the challenge and the opportunity, and it makes really no sense for me to talk about the future of healthcare until we can talk about providing a modern consumer centric healthcare experience, which we cannot do today. If you look at where all the venture capitalists are dumping their money into healthcare And I would tell you that if you track digital health funding through venture capitalists, through like rock health, for example the largest influx of venture capital on record has been invested in digital health. And what are they pumping their money into? Now, these are smart people who are making big bets on they're successful people.

They're smart people. They're making big bets and they're expecting a payback. They're dumping their money into smartphone apps. They're dumping their money into, and I'll give them these to you. In order smartphone apps has the. Piece of their investment dollar self service has the second biggest piece.

Third is virtual and remote health. Fourth would be a health and wellness. Fifth would be wearable devices. Six would be ingestible devices. Seventh would be data and analytics and eighth would be implantable devices. Nowhere on that list. Do you have. Hospitals and clinics. They don't want to invest in bricks and mortar.

And yet that's what we find is most comfortable for us as a, as an industry. They are trying to help keep people healthy and well and keep them out of healthcare. That's what, what they're doing. And when they have to have an interaction with, with with a health system, they're finding people to invest in that will make.

A better experience, a better healthcare delivery, not necessarily better health, but a better healthcare delivery experience. So I think there's a very big difference. I talked to some of those venture capitalists in a, in Silicon valley. And one of the very first things that they always ask about is. If you, when they're thinking about an investment is they, they always say, what, how do you, how do you measure success?

And if they start talking about admissions and discharges and ed visits and length of stay or staffing ratio, Those venture capitalists will walk out of the room. Those things are not what they consider success metrics. And I think that's where we have to, as an industry, think about what do we define success?

How do we define success differently? Going forward? Our entire model is built around the convenience of the supplier of services, not the consumer of services. And that's what it's got to ship. That's what transformation is really all about in our industry.

Right? So you and I are going to redesign. Before I get there, David Feinberg was just on the just on the show and he w obviously he's at Cerner now, but he used to be the actually, I guess, I guess he's at Oracle as of today.

used to be the CEO at Geisinger. And he said he would like to transform the the waiting room and all that rep represents. And one of the things he says it represents is a design around the clinic. The entire process is we have a holding queue and we line people up and we say your time doesn't really matter.

Your experience really doesn't matter. What we need to optimize is our, our workflow on the other side of it. It was an interesting conversation to talk through through that with him, but it requires us to start thinking differently. So let's start let's. The rock health list is pretty interesting to me.

ince Gosh, I had to be before:

And the concept is a portal is a window into another system that you're gathering this information. It wasn't designed what we have today is more, Hey we're going to give you a glimpse into your medical record and some other things but. Modern apps today, modern phone apps and digital apps are really about facilitating the facilitating the experience, decreasing the complexity of interacting with that organization, providing them relevant information for their health and those kinds of things.

So what does the app look like? And what does the modern app look like that a health system could put together that can get them on a path to maybe being consumer centric.

So again I wish we had more time cause I could really talk about this all day. I mean our industry talks a lot about innovation and I'm a. I may be in the minority. I hate talking about innovation. We don't need innovation, we need adoption. And if you want, if all you have to do is look at any other industry, retail service industry, hospitality, you name it, and you can see exactly what we need to do. Let me give you a quick example.

One of, one of the most innovative advanced digital companies, there are. Is Domino's pizza for heaven sakes. They have not only can you order a pizza on your smartphone, computer tablet or, or or TV set for that matter, you can have the, the app on your watch, you get the tracker how and where your pizza is in the delivery process.

They have an ability now for you to look at. your iPhone look at their app and with zero clicks access your normal pizza order, they will deliver it to you via drone used to have to be at, you had to have an address that they would deliver it to. Now, all you need is a smartphone.

They'll find you on the beach on a trail On the park, they will find you with that delivery drone and drop your pizza right to you. They understand that people want absolute convenience. They want absolute access. They want an immediacy of service and their entire model is built around it. What can we take from that?

And bring it into our industry. I drive, I told you this story before I drive past a Chili's restaurant on my way home from work. And it always pops up on my GPS and says two for one margaritas it's happy hour, come in and have a margarita yet. I cannot drive by a clinic. And it says, Hey John, have you had your flu shot today?

We don't think that way instead. We think about. you talked about the delivery model being built around the convenience of the supplier. We have reserved parking for physicians and we're debating whether or not to have valet parking for patients for heaven sakes. That's not an innovation.

Valet parking has been around for golf clubs and hotels and restaurants. A hundred years. And yet hospitals just in the last 10 years have started valley parking for, for sick people. It makes no sense to me why we adopt these things from service industries and retail industries. And hospitality industries.

So slowly, we've got to be more embracive of those kinds of things that already exist. A pizza tracker. We should be able to track our, our lab results. We should be able to help people find an appointment quickly. We should be able to deliver their medications to them easily. We should not have portal or e-health or virtual.

Or telehealth, we just need to have access to health services. It's not about a portal or an app. It's about how can people immediately access our services in order to get what they need, convenience trumps everything else, brand and everything. So we've got to figure that out really quick or we're in trouble.

So in order to do that, One of the things that happens is the, you have the, the convenience you want to create, but in order to do that, you have to address the complexity that sits behind me behind the the curtain, if you will, the digital curtain and the complexity that exists is, Hey, we want to do appointment scheduling.

And then as a CIO, you have to have a million conversations before you can get a common set of schedules and a common way of putting that out there because. Quite frankly, there's just a lot of different opinions about things. And so there's it just, just to do that basic, Hey, I wanna, I wanna schedule something or I want to do I wanna do the referral to a to a specialist and I want that information to flow pretty easily and whatnot.

That still requires a lot of work on the, on the back end to make that work. And then my favorite is. Is when people say, Hey, why can't you tell me how much something's gonna cost? I'm like, not only can we not tell the patient what something's going to cost. The CFO can't tell me what something's going to cost.

And that the reason is because we don't do cost-based accounting in, in healthcare, at least not. Well, we don't do cost-based accounting. So when you go to create some of these things and you go, okay, here's what I'd like to do. I'd like to do a schedule, an appointment, tell them what we think it's going to cost and have the bill sort of match that and create all those experiences.

When you talk about dominoes, they designed the entire backend to support that front. And so it does take intentionality. And intentionality on, on, on behalf of the system to, to to want that it can't just be the CIO saying, Hey here's what we can do. It really has to be the entire system saying, we want to go in this. I would think.

You're exactly right. And I think that's, that's been my thesis all along, which is the transformation of our industry does not take it's not required digital. We can talk about that. It doesn't require innovation. We can talk about that. What it requires is leadership. Someone does say this true leaders to say, look here, let's start with the patient experience that the consumer experience, patient experience that we want, then let's work backwards and everything else needs to work backwards from there.

And let's tear down those walls and those obstacles and those incumbents that prevent us providing that exceptional consumer experience. That is really the key to our success longterm. If we don't do. Then we're doomed as an industry. that's the truth of the matter, because there are others out there who are working to do that.

If you look, and you mentioned this earlier, that you're going to see this emergence of brokers people who, as you said, you want to, you want to shop you want to do what's most convenient for you. You want to go where it's cheapest for you. Afford your care. And that's really what places like Amazon or eBay or Netflix or someone else really wants to step in.

They want to provide a better customer experience because we don't do that very well. We don't, we've had a hard time even thinking of people who use our services as consumers or customers, they want to make it easy for an individual to manage their own health and wellness, because we all want to do.

And then they really want to be the new front door for for health and wellness services. And then they want to create that customer relationship and then competitively broker for services. So the analogy I like to use. And you and I had talked about maybe in a, in a previous conversation in person where you used to have to call United and Delta and American airlines and Alaska airlines to figure out their routes and their prices and a number of stops. Now I just go to Expedia. Expedia doesn't have any airplanes. What they have is a relationship with me that they know what I like and allow me to see what's available and pick what's best for me and insurance companies and and health brokers. And maybe even at some point, the government will step in and say, look.

We're going to manage your health end-to-end, but those providers of services are going to be like they're, they're going to be commodities that you can access. You can go to Baylor, Scott and white for your colonoscopy. You can go to Texas health for your colonoscopy. You can go to Methodist or Parkland for your colonoscopy.

Whichever one offers the best time. Travel and costs that meets your needs, but we'll have your health record and we'll tell you how we can see trends and issues. They're not any one of them individually, but rather us trust us, just like Amazon does today. Amazon doesn't have products. They broker for products and we love Amazon.

The brokers, the insurance companies want us to do just that kind of thing. They want to step in and broker for services, and then they will handle the coordination of care and the longitudinal record. I think that's going to be a real threat to our disintermediation discussion that we talked about earlier.

Let's talk about the digital healthcare paradigm. You have a slide in this deck, you talked about the digital healthcare paradigm, and I like some of the things that you touch on personalized virtual self-service and location agnostic. by the way, I like also like the way you described in that last answer, how health care could be delivered anywhere, but if you were the trusted relationship. With me as the consumer and as the. As the patient then potentially I'm going to you because you're doing the right diagnostics on the data that you're receiving from these other health systems, your coordinating my care, you're saying, Hey bill, have you gotten your flu shot this year? You're the one I have an ongoing digital relationship with.

I may only see my doctor once a year or twice a year at my age, twice a year. But you have an ongoing relationship with me that essentially helps me to navigate Not navigate healthcare, navigate my health. That's really, the outcome is what I want.

That's the whole, that's the whole thing. It's like your stockbroker bill. You don't need to have a relationship with every one of those stocks or your automobile. You don't need all you need is someone to take care of it and manage the longitudinal. Your health longitudinally to do that. What they need is your health record. They don't need to be the same system. They just need your health record so that they can curate and coordinate your care across your lifetime. And it's in the best interest of your insurance company to do that potentially cause they can help direct you to the right care at the right cost at the right level of convenience for you.

And I think that's where this is going. We're a very mobile. Society and we want personalized service. We want it to be location agnostic. We want it to be remote and virtual. Those are the things that we want as consumers. What we don't know that we want is someone back behind the scenes coordinating all of that care.

If you're going to a health system for that, this is why we resist digital transformation in healthcare, because digital does not care. When or where, or how you access services, but our healthcare systems do, I don't want you accessing any services outside of my health system. And our entire footprint is about territorialism and it's designed to put heads in beds and that's where.

The challenge is we want to drive volume to facilities. And that's a different objective than a person who's trying to manage their care and have their care coordinated, no matter when they are or where they are or how they exist in our, in our world today,

the problem. Really the payment model. I read an article where they said during COVID, there was a. A significant number. I forget what the number was. It might have been half a million or so unnecessary surgeries that happen. And when you think about it during COVID, we were trying to protect people. We were worried about these things and the reason the unnecessary surgeries happen is because the payment model, right.

If people aren't coming in, in a fee for service model, we have factories essentially that are, that are idle. I remember talking to Dr. Klasko about this. And he said people will follow the payment model and people will follow their compensation every time. So even though we paint this picture of, this is what the consumer was.

We have a payment model that incense incense, a new campus. I'm always surprised when I see the, what we're building another campus, we're building a new hospital, we're building more hospitals and that kind of stuff. And I, I think aren't there enough hospitals in Dallas. Aren't there enough hospitals in, in Houston at this point?

Or are we maybe, maybe as the suburbs grow, we need to put some more campuses out there and, and whatnot. But it just, it surprises me that we're seeing. It's still doing that when the. The focus of those campuses really is on specialty care. It's really on high acuity care and those kinds of things. And the goal really should be to keep people out of those.

Yeah. So I think you're on top of another important issue. There's the three components. Define them are with regard to health and wellness are there's the prediction, there's the prevention. And then there's the provision, right? So what we are in the business with, with general health care in our society is today is in the business of the provision of sick care.

You get sick, you get diabetes, you have a heart attack. You come to us and we take care of you because there's no financial incentive for us to predict or prevent those diseases. So we really need to shift that cost model so that we are incentive and rewarded for predicting your, your bad episode preventing that.

And in the very least or the very worst case. Providing you with services when you twist your ankle or when you have a heart attack or some chest pain and you get very low cost, very low complexity of care, and you can handle those things with self-service with apps with at home. With the internet of things, as you move up, that cost access you're going to see maybe even start to see some, some chronic disease management, some assisted or monitored weights, those kinds of things.

So you get a little more cost, a little more higher level complexity of care. And then. Further up now you're into the diabetic range and the chronic disease range where you're coached or you're managed. You're both either physically on occasion and virtually on, on more of an occasion. And then lastly, that provision of care where the costs are, the highest, the level of complexity on the excess accesses, that is the furthest out.

And that's where you need expert and specialty care. That's where you need to be in a hospital or in a clinic. And I think what we have to shift is a way from being. The sick care provider, unless that's how we want to define ourselves and become more of the wellness provider focused on the prediction and prevention, because frankly, what that's, what consumers want.

There's a, there's an old, saw in a business. that says Give the customer, what they want. The number one thing that our customers want is to not be our customers. Nobody wants to be a patient, so we've got to help them with that. And that means keeping them out of our facilities, not putting more and more heads in beds. That's not the, that can't be the way we get paid and be successful. Long-term.

You have redesign in 10 easy steps. I love the, I mean that if you wrote a blog article with that title, it would I put healthcare in there redesign healthcare in 10 easy steps. that thing would get a ton of hits.

So let's, walk through some of those actually, if you want to start us on number one, that's that would be great.

Yeah. So I kinda did this at the end of my of my keynote for the hymns group. Cause I figured I wrote this the night before the presentation, as a matter of fact.

And it was, it was I figured they were going to ask me, what are we going to do about this, John now you've defined the problem. You've kind of laid it out for us. What would you do? And I, I would tell you what I would do. Number one is I would help leadership and healthcare today to understand that nobody wants to be. Nobody wants to be our customers. People want to be happy and healthy and live a good, long, healthy life. So let's start there. We're starting with what the desired state is and working backwards.

but if you start there and you the only thing I, don't like the way you said it is. Nobody wants to be our customers. That's what we need to transition. If you were my partner in this. I'd I'd want interactions with, I w I'd welcome your text messages that says, Hey bill, we see that you you got this image over here. That image was funneled through our AI or a radiologist, took a look at the information and everything looks good. Or I don't know. I, that's a, that's a bad example because there's a cost. Yes.

And bill, I think you're exactly right. And I think the keyword here is patient. If you want to be, I think lots of people would like to be our partner in health and wellness, but nobody wants to be a patient. Nobody wants to be in a hospital.

No one likes to have to go to a clinic to get care. They want to be happy and healthy and well. So if you want to define them as our partners in health or as our consumers, if you want to be a partner in health t we want to partner with you to keep you happy, healthy, and well.

I think that's the key. I think you're exactly right, but nobody really wants to be a patient. Nobody is happy about being a patient. That's so true.

I agree. Number two is interesting as well. alignment.

I, I think we've got to, we've got to do something about the payment reform. You've touched on this. We've got to incentivize providers and physicians and clinicians for the health and wealth. Of their, of their cohort, not just getting them paid and incentive and rewarded for providing sick care. Yes. That's a necessary component of what needs to be done, but let's have an equal measure of, of, of success and value placed on keeping people out of facilities on the health and wellness of individuals. That's I think important.

So I I've seen a lot of systems recently, not recently. I mean, over, over the last. Decade start to become payers and providers. And there's part of me that really likes that because they are incentive to keep me well. Yeah. I liked that model and I've also seen some creative partnerships between payers and providers, where they sort of co-manage population.

And again, aligning that, that incentive to keep people. Healthy. So I think there's models here that don't require that people are always like, well, yeah, absolutely. It's going to Medicare for all. And I'm like, all right, well, there's, there's like 50 things you could do between here and Medicare for all. I'm not saying Medicare for all is bad. I'm just saying there's a lot of other ways to to go about.

I agree with you completely. There are models that could be that we could build a system around. We could build a delivery model around that would incentivize all of those who are involved with it. Specifically the physicians and clinicians and nursing staff for the health and wellness of a cohort of individuals. That's what they want. Allow them to take care of themselves. Allow them to be healthy and live good, long happy lives. And then on those occasions, when something requires a clinical intervention an unpreventable disease maybe a trauma, maybe a pregnancy, whatever it might be, then let's be sure that they're compensated appropriately for that care of that illness.

But the real value here has to be on health and wellness, not the provision of clinical services after somebody's sick. That doesn't that's. I think that's upside down.

I love number three, use all available data to help predict and prevent disease. We have a lot of data now.

We have a tremendous amount of data. And every other industry uses our data to predict what we want to prevent, what what they don't want to have happen. our cars, we, if it's having a, starting to have a problem, they can bring it into the shop and get it repaired before it causes a disease or causes a breakdown. So we have the data we have to use.

To predict and prevent disease so that we can maintain that health and wellness of people, not just wait until they break down or have a sickness and then provide them with the care that we get compensated for. That's again, upside down.

Well, now we have a lot of devices When I used to talk about this, doctors used to save all that apple device. Doesn't give me good information. Although I've talked to some people at the aphid thing on the apple device is exceptional and really helps them. But with that being said, we have other devices that we're putting into the home. Now we're collecting all that information. Are we at a point now where we're thinking through a model where that information comes up, it goes through.

Some sort of algorithms and whatnot, it then gets from data, adapt to information down to insights, and the physician can act on it without the physician taking on the cognitive load of, of trying to go through all that, that information that exists.

It's available. Do we do it? I think as an industry, the answer is no. I mean they're, they're again, I, I pull from every other industry. My air conditioner and my home has a sensor on it that tells when the filter needs replacement. And then at my doorstep, a filter shows. And I swapped the filter. I don't even have to think about it anymore.

They have the sensor, that's sending it to them and letting them know that it needs to be done. There's all kinds of technologies available. We don't have to be innovative. We just need to adopt those technologies that are available and allow us to continue to provide. Health and wellness until such time as they need to provide sick care, which inevitably is going to come.

But I think you're on top of the other thing, which is, is we need to help people keep themselves healthy well and safe. And that was my number four. We need to encourage self care and self service. There's a whole list of, diagnostic tests that are available in home. Things you can do at the, pharmacy now you can from Cola guard to smartphone apps that we'll look and see if your eyes are having problems. There are, there are internet of things, issues that tell you how many times you're flushing the toilet in the middle of the night that you might have a kidney problem.

I mean, there are all kinds of self service availability. The applications and technologies that will allow people to take better care of monitoring and caring for themselves connected scales, for example, I mean, there's just all kinds of things that are available.

Yep. Number five was embrace a new hybrid delivery model, personalized location, agnostic, virtual self-service we hear this all the time our tele-health initiative. And at the end of the day we don't have an ATM initiative and whatnot. We would just do banking. And in this case, it's it's care. And we really have a lot of different modalities for delivering that care. And at the end of the day, it's, it's just it's looking at each type of requests that we're getting and aligning the right delivery of care for that location, agnostic virtual, in some cases self-service or bot driven and, but at the end of the day, we want to know that that is on the other end of that, all that, all those algorithms, all that technology.

It's a health system that has thought through. And at some point it's going through someone's hands. That has empathy that has that essentially is a human being that can look at something and identify if a mistake's been made by the algorithm, or they don't know something about me, or they don't know that whatever.

And we're looking for, for that partner on the other side, who who has thought through and built that, that whole structure.

I agree with you a hundred percent. I think I have been a constructive critic of a. Of telehealth and virtual health only because I feel like we bolted it on to an old chassis rather than design a whole new type of delivery model with an emphasis on virtualizing the patient experience rather than just bolting it on.

And I think that's. You know that in our industry, in technology used to be called garbage in garbage out. And I think people have been dissatisfied because ultimately it's not yet realized its full potential and it won't until we, we really embrace a new way of doing telehealth and virtual health that said it all comes back to freeing up.

Our clinicians, our physicians, our highly valued and highly trained practitioners of clinical services to provide more empathetic sympathetic and personalized care. All of these things that can be done by a computer should be done by a computer. And you're going to see that later in my list we don't need people to be doing some of these things.

Let's let the machines do the things. that Machines are designed to do freeing up people, to be people and to have a real personalized interaction with another human being that will allow them to feel that that spiritual empathy, that personal empathy for the care that we're providing. I think that's, we've added too much Without redefining what the model looks like. And it's, I think it's hurt us in that regard.

All right. We got five more. We got support collaborative disruption. What is that about?

Yeah, I'll tell you, I, I think there are all kinds of organizations and people out there that are. That want to help us for all the right reasons.

And our industry has been stiff armed them for, far too long. I always use analogy that on Halloween where the house with the lights off in the sprinklers on, right. we don't want anybody here cause healthcare is different. Well, no, we're not. There's there's people who want to help us with great ideas. Energy and enthusiasm, and we need to throw up in the doors and open the shutter and embrace that those ideas and see if it might help us. We do we do hackathons and, and and innovation slams that allow people to come up with some brilliant ideas that we in the industry never even thought of before.

And as a result, we've come up with new apps and new ideas and new designs on things that, that are really improving the customer service experience for our consumers and, and really would never have come from inside of healthcare. We're just too insulated.

Your next one is a good grounded principle and the reason I like it is a lot of times I hear organizations talk about, well, we need to do this digital thing, or we need to do this disruptive thing, or we need to do this. And at the end of the day, there are table stakes. And when you put digital on top of a bad back end, it doesn't make things better.

And so this one is understand that high quality care. At low cost services are expected and assumed. I go to that high quality care one, if you can't deliver high quality care as a health system, no reason to digitize it. There's no reason to automate it. There's no reason to whatever, until you sort of get to the bottom of all right, what, what's it going to take for us to deliver high quality care? There are table stakes associated with this.

Absolutely. I mean it, you and I both in the course of our careers, We have differentiator ourselves. Our systems have differentiated themselves in terms of we are the highest quality we get the most stars we are the best at these things as ranked by, and the truth of the matter is.

Everybody assumes that we assume doctors know what they're doing. We assume we're going to get great clinical quality care. We assume that our services are going to be low cost. What we really want is an exceptional customer or consumer experience. And that is that is something that has never really been a differentiator in our. In our industry and going forward, I think it's going to be it's the whole game that the consumer experience is how you will succeed or fail in healthcare going forward, the rest table stakes.

Yeah. Yeah. And that's your number eight consumer experience. We see glimpses every now and then. John. I mean, there's, there's part of me.

That's optimistic because I'll see a glimpse here and there and I'll go, Hey, that's a, that's a pretty good experience. I like what they're doing. I like how they're reaching out. I like how they're integrating the devices in the home. I like how they are helping those who are caring for their elderly patients by giving them things straight through their set-top box.

So we see glimpses of it. So there there's reason for hope, but it does require. Connecting it all up.

I think also it requires bill a different mindset. I mean, I, I I've said anecdotally or humorous in presentations previously, the number one thing we could do a clinical episode is made or broken at the point of registration.

If you just incented the registrars. To, to provide a wonderful consumer experience. Like you might get at a Nordstrom, meet people at the door, welcomed them, ask them if you can get them some water, some coffee, set them down, explain what's going on so that they get graded on their consumer experience.

And there's some incentive tied to that. You would change the complexion of an episode of care completely. Unfortunately in this industry, the registration process is, if you've ever been through one, it's typically terrible. And people are confused and people are pers the perception is it wasn't a good experience.

So why don't we change that it's really simple to do, and it could change everything in, in what you perceive to be your experience with.

Yeah. I, I remember going to the, one of the clinics in my health system and to get registered, they handed me some paper and then they handed me another, another thing with paper, and then they hit the newspaper. I remember going back to the head of the medical group and. Are you kidding me? I mean, not only that I know all the information was already in there, so I was, I was giving them all this information. I'm going, oh man, this, this, this makes me sad. But sometimes that's what it takes. It takes us going through the system to go.

Yeah, I don't know what kind of car you drive. I happen to drive an older Cadillac, but if you go to the Cadillac dealer, you make an appointment and there's a service advisor who meets you as you pull in. Well-dressed well-spoken and one of the nicest people and, and you leave no matter what's wrong with your car, what they're going to charge you, you leave feeling like you were. You were, you were taking great care of and I think that why can't we take that to our registrars? Why can't we just simply make a change like that and see what that might do for the perception of care.

People just want to feel good. They don't want to feel like they're dumb or insulted or someone was rude to them, or they're confused. And all of those things are how people characterize a healthcare registration process. Let's change that metric. That's all I'm saying.

All right, we're done in the last two, we've got only a couple minutes left. I'll give number nine and I want to hit number 10 when services are required to understand that convenience trumps brand and everything else provide easy and immediate access when and where. And how it's most convenient for the consumer. And we've hit on that a bunch. I like your number 10, automate everything that can be automated. What are you getting at there?

I think both of them are very important and that's why I included them. I think convenience trumps everything. No matter who you are, where you are, if you can make it convenient and That's how every innovative company in any industry in the world is I described for you Dominic's pizza.

What they have done is make it so convenient to get a Domino's pizza that I don't really think about getting one anywhere else that. What's the important nugget there. Convenience trumps everything. If I'm, if I have to go out of my way to get something, I would rather not. So how can we make it more convenient?

That's that's critically important and it has to be convenient for the consumer of services, not the supplier of services and automate everything. I think that this is I'm a technical person. Available and emergent in tools and technologies in our industry and outside of our industry, that will help us do everything we need to do.

Smartphone, apps, mobility, connectivity, data, artificial intelligence, virtual, augmented realities. We've got drones and robots. Every one of those things should be brought to bear. To help us decrease our costs, eliminate the friction in our, in our service offerings, address our labor shortages, certainly reduce response time and make our services more convenient and improve the service that we provide to our consumers.

I think all of those tools and technologies exist, we don't have to be innovative. We have to be a welcoming and adoptive of those things. And once we do, and we leveraged. We can reduce our labor costs. We can reduce the provision of care costs. We can improve our quality. And I think we're going to get a much better experience for our consumers.

Fantastic. John, always great to catch up with you always great to have you on the show and I really appreciate you sharing your, expertise with the.

Bill. I appreciate you taking your time to speak with me and given me an opportunity to maybe describe some of the things that I see coming. I've often said that the future of healthcare is not in front of us. It's coming up behind us, it's in your children and my children. And they have a very different perception of how they will be served. And I think it's incumbent upon us to prepare that future for them. So I appreciate you doing your part to help us do.

Thanks, John. I look forward to catching up with you again soon.

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