You can do price transparency for compliance or for the consumer. Chad Brisendine from St. Luke's University Health Network joins us to discuss an approach that benefits the consumer. Hope you enjoy.
Bill Russell: 00:00 Welcome to this week in health it influence where we discuss the influence of technology on health with people who are making it happen. My name is Bill Russell, recovering healthcare CIO and creator of this week in health. It is set a podcast and videos dedicated to developing the next generation of Health It leaders. This podcast is brought to you by health lyrics, Need a health it executive coach. Let's talk visit health lyrics.com to Schedule your free consultation. Today we're joined by Chad Brisendine, CIO of Saint Lukes University health network and one of my favorite young CEO's morning chat. And welcome to the a fucking to the show.
Chad Brisendine: 00:45 Good Morning Bill. Thanks again for having me.
Bill Russell: 00:47 I'm going to keep you in that class of younger CIO. Since every time I go to one of these chime events now it seems like people are in their late fifties, early sixties. Scos and you're, you're not in that category yet. I don't think. No, just to my 40th birthday. Congratulations. Uh, what I'm excited for our conversation. So today, uh, you have a hard stop. Uh, so we're gonna we're just going to jump right into it. Our two main topics today or price transparency is something which I think Saint Luke's has done a really good job on and a on consumer engagement. So, uh, let's, let's just jump into a price transparency. Cause I heard you give a talk at the, uh, at the HIMSS event and it was, it was pretty exciting as the direction you guys were going. Um, so every, every health systems handling price transparency, a little, just a little different. Uh, why don't you give us some background on what your team did and how they approached it?
Chad Brisendine: 01:44 Yeah, so a little bit of background, I think, uh, first I would say, um, our CEO's vision has always been to have low, low cost, high quality, easy access, um, access from a, you know, consumer access standpoint as far as services, service, availability, location, quality. Obviously that means a lot of things, but we have a very defined all of the program and mechanisms and then, uh, obviously cost. And one of the things we've always felt is, is that we do have a cost advantage, um, in our market, uh, and and beyond from what we consider costs. And I know that's a hairy subject, whatever you talk about in health care. Um, but for me it's all about the consumer's costs and the consumers out of pocket. That's the vantage and viewpoints, um, that I really take in that we really take. So when we're doing that work back in 2013, 2014, we were doing a lot of research around what transparency and what cost transparency of price transparency was.
Chad Brisendine: 02:43 And we really weren't able to find a lot people had some organizations and where I came at before, I'm also had their prices online, um, which was basically their, you know, their fee schedule on there. Just kind of what happened with the government regulation said put it on there, everybody put it on there and nobody can understand it. So I'm, in about 2015, we decided to build out a prototype of a, what we call price checker and basically we put online prices available. But what's unique about that price transparency is, is that it's a bundled price. It's meant to be for people that have high, have high deductible plans and have um, you know, a cash, cash price and included in that is a, as a bundling of services and it's a cash price and you don't get a bill and it also counts towards your insurance. So if you have a $5,000 out of pocket in the service costs you 4,000 and you still have a thousand left to meet your deductible. So I'll pause there cause there's a lot to it, but um, you know, that's, that's what it's meant for us. It's about being able to provide certain consumers and segments of consumers a fully bundled price.
Bill Russell: 03:51 Yeah, I would go back to that, but it really is true that what we've seen is sort of a compliance approach to this as opposed to a consumer approach to it and the compliance approaches. All right, let's go to the chargemaster. Let's print these things out. Let's put it into a spreadsheet. Let's go ahead and put it out on the website. And then when you download, those things should take a look at and you can't figure anything out. I mean, you've looked at the charge master, I've looked at a charge master. It's really hard to navigate. Um, your consumer approach is much more, um, it's, it's mobile, it's to, you have a mobile platform that they're able to go in there. They're able to see their price before, um, before they're even able to get in there. And actually in some cases, because it's bundled in whatnot, you, you will offer, if I understood what you were saying before pretty correctly, you're actually offering a discount for, um, for paying up front for some of those fees.
Chad Brisendine: 04:41 That's, that's correct. So actually we have two versions of it now. Um, we've partnered with the Code Development Company and I've included some additional price or, or billing transparency tools within that as well. But basically we can, you can do an estimation now. So if you have, you can go in there and look at your blue price and you can look at what we call the price checker price lock price, which basically gives you the discounted price that we have. So you can go with either or based on your insurance types. So that's available now as well.
Bill Russell: 05:14 And that's where, I mean it makes sense to really target the uh, the high deductible plans because you know, people with low deductible plans aren't really consumers as much of health care but, but those people that are price sensitive, uh, these kinds of tools make a lot of sense. And that's, are you thinking of moving it, making it more broad than that or you can continue to focus in on that market.
Chad Brisendine: 05:37 Uh, so our market has been primarily focused on, you know, high and high deductible plans I'd say, cause they're the most ones that call to action. We have all the other transparency tools, like I said, the estimated out of pocket estimate or all that stuff coupled in all of this because it's for the folks that have commercial insurance. So the way we look at it as if you have a secondary commercial insurance, we have a set of products and capabilities to make that transparent for you. And then for the high deductible plans we have that as well. More, I think we're unique and different as in the high deductible plan. I think a lot of people have put price estimation for commercial insurance folks out there on their web or mobile or whatever they've done. But we're, we're unique is this bundled high deductible. So for example, it includes your anesthesia costs, your or costs for your surgical procedure and your pre and post, you know, 90 days that those physician visits that you have.
Chad Brisendine: 06:28 So what we've done uniquely is partnered with our physicians in the community and said, here's the rate we're going to take on all these things for it. Saint Luke's will take the full amount from the consumer and then through our kind of B two B transactions will pay the physicians do the collections and all that stuff. But the patient at the end never gets a bill. So we've kind of taken that, you know, kind of all the transactional issues that people have with in a high deductible plan and being able to, cause the price problem is, is if you come to us and say, Hey, I want to get a knee surgery. You said, what's the price of that? Well, I can tell you how much the OR time costs. Well, no, that's not what we want. We want to be able to fly from, you know, La to New York all in one trip. And I don't want to have to go, uh, this person for my luggage, this person from my airplane tickets, this person for the food that's delivered on me. I want it all in a bundled thing. So we've created a B, two B relationship with our physicians. Uh, and, and the, the BDC relationship is the consumer to Saint Lukes.
Bill Russell: 07:24 Yeah. So talk about the project. So they're, there obviously is a, uh, there's a technology component to it. Talk A, talk a little bit about that. Then talk about the business side of it because there obviously was a lot to bring that network together. Get the pricing if there's an awful lot of work there as well.
Chad Brisendine: 07:37 This work is because obviously the business, the business side of that, which I give, uh, our COO and our, um, one of our, uh, uh, project directors, a lot of credit for doing a lot of the legwork on how we're going to actually make this into like a business business model. Uh, and I think the unique thing that they were able to do is a, he did a lot of consumer research. So just calling out there and asking people what do people really want and what do they need and what were they check on and how would they do things. So some voice of the customer or cried, not, not as sexy as maybe marketing would do, but, but low scale that I'm actually, our project director had, um, their family members had talked to all their family members and then their had their family members and then we checked other hospitals and called and everything.
Chad Brisendine: 08:18 So pretty good. I think idea of what consumers really wanted and needed out of this was the first approach. Um, finding out what they needed was a bundled price. Um, so being able to develop that, run a price, it was literally working with certain procedures. So we started with a very simpler procedures to start out with. Now I think we have a couple of hundred out there, but I think we started out with like 10, um, CPT codes that were out there. And then we begin and then certain physicians that we only worked with to start out and then move again modeling it. We also created a contact center specifically for this. So being able to set up the context center, he can go to check to see how many customers were getting us. So all that kind of components of what it would take to run a true, you know, customer contact center with, with being able to handle contract management, uh, and being able to handle, you know, the consumer is asking questions and how do I handle all that. So I'd say that was a lot of heavy lifting of trying to get physicians on board with taking a certain rate for these patients. Um, cause this isn't like 40% of your commercial business is going away with these rates. It's a, at least in our market today, it's a percentage of our business that we're willing to have a negotiated discount for. And it was getting the physicians I think onboard with that conceptually. So I think that's really where a lot of the heavy lifting room. Um, so that's a business op set.
Bill Russell: 09:34 Yeah. So what about the technology side? So you like to partner, um, did you do something off the shelf and then partner with that company in terms of customizing it for you guys or did you build something out?
Chad Brisendine: 09:46 Uh, originally, um, the, the real quick prototype was just literally the webpage. And as it got traction and we got more and more views, we determined we can either build this thing in full scale out front and back end or we can really partner with somebody. And we were already doing a lot of work on um, transparency with the estimation, uh, bill pay, et cetera with a vendor partner. Uh, and we decided to co develop with them. So they took the product, you know, built it within their platform. And now I think we're on version three of that release that's out there. So they have that product in the market generally available as of probably about six or nine months ago. Um,
Bill Russell: 10:26 awesome. So transitioning a little bit cause we're going to transition into consumer engagement. So how did you, how'd you make the community aware of the program? I mean, was it billboards and ads and the traditional things? I mean, how did you, how'd you get adoption?
Chad Brisendine: 10:43 I think, uh, there's a number of different ways. One, it was, um, there's a business coalition that meets here cause a lot of this is, you know, us informing the business leaders because a lot of This is like, right. Certain businesses have decided to go with the high deductible for their employees. And so there was a lot of the local business bureaus and stuff like that that our team did education and communication on. Um, it would literally patient stories. So we got, we've gotten the new several times because people heard about these stories. So a lot of word of mouth. Um, obviously digital, we didn't do any billboards or anything like that, but a lot of digital marketing, Facebook, linkedin, et cetera with patient stories. We've had a lot of really great patient stories of people coming from other more, you know, our market and you've been here, um, your familys from here so, you know, our market's kind of kind of nuts nestled north of Philly about an hour and we're to the west of New York about an hour and a half. We actually got patients from the, both of those demographics to come to us because no one could really find this thing. So a lot of those stories where we had travelers that literally came to us just because they couldn't get a price anywhere, needing to know what the total price is going to be for procedure and ended up paying cash, cash for our business. So a of that and you know, digital marketing around that.
Bill Russell: 11:56 Yeah. So, uh, the last time you were on the show, which was a pretty, uh, pretty listened to a podcast you talked about the development of a, a consumer engagement tool, uh, built, built on top of the epic Kpis, uh, with a really small development team and an external partner. Um, I think that was about, it was closer to a year ago that We had that conversation. Can you give us an update on that? I mean, you had just rolled out a handful of, of applications on top of it. Here we are a year later with, you know, where, where, where are you at?
Chad Brisendine: 12:28 Uh, I looked the other day we're at 143,000 unique logins for the month and I'm on average seven times that someone's revisiting. Um,
Bill Russell: 12:39 well what do, what are you offering that people keep, uh, are, are logging in and keep coming back?
Chad Brisendine: 12:45 I mean, I think a lot of it is core, uh, what's inside the, um, epic system. You know, a lot of the high transactions or what's inside the medical record that people touch most of the time, right? I mean you're, you're a new patient a few times, but once you're a new patient in your, in the system, you're constantly, you know, go and tell all your different tests. So what we're trying to do right now is look to optimize those different journeys within that piece. Um, but right now we're continuing to try to expand our scheduling, our scheduling capability, uh, that we have in there. Um, we are, um, in the next release we're continuing to bridge. We had, um, a white label, a video visit platform in there who are continuing to bring capabilities from that white label into our a mobile web experience.
Chad Brisendine: 13:30 So that's continuing to enhance that. We just had our 4,000, um, uh, consumer video visit. We'd have more than that in total about 4,000 unique video visits. We just did that this week inside of there. So, um, I would say that the highest transaction is going to be a results and stuff like that just because you have so many of them that are pumping out that people are looking at. Um, but what we're, what we're trying to optimize too is you know, registration, scheduling and trying to ease all the pain of the high transaction areas. Um, and that's where that's our next set of releases is focusing on reds and schedge and how do we continue to optimize that. Our last feature that we rolled out that you feel like is really cool, um, is the not feeling well component. I don't know if we talked about that or had that deployed at that point.
Chad Brisendine: 14:17 Um, but that is basically low acuity triage a is the best way to look in that. So when I'm on my mobile after or whatever, I can look and see and it does it by the time of day it does it by what services are available at what time in and also does it have by what? Um, what's available now. So on my app I can see three, three care settings, uh, which we're trying to position them to. One would be, you know, what appointments has a new patient or an existing patient or available for my primary care for my favorite physician, cause I can click them a favor physician on my app within the next 24 48 hours, which urgent cares because we have a lot of convenient, urgent care's really close to you and it's all done by location proximity, what urgent cares are available for you.
Chad Brisendine: 15:04 And you can click into those ahead of time or skip the wait is what we call it. Uh, and then also the video visits. So we tee up different things for you based on the time of day, based on the location, etc. So it's kind of hypersensitive to I'm not feeling well and how do I get care now? Uh, but it gives me multiple options for that care now. So we're going to continue to advance that capability. Uh, it's still new. We're probably two months into the release of that, so we have more optimization. But the whole thought is get you, get you in, give you multiple options for that based on your preference as a consumer.
Bill Russell: 15:38 Yeah. So you're, so you're baking on top of the epic Api, uh, your largest competitor in your market is, is on epic as well. I mean, what, what advantage does this give you? A, it sounds like you're layering an awful lot of technologies on top of this to really take the friction out of the environment and improve the consumer experience. Um, what benefits are, do you think you're getting at this point?
Chad Brisendine: 16:05 Um, well I think that there's, you know, kind of, there's maybe three worlds to view this and if you want to, there's the view of I'm going to build all my consumers stuff, um, all on my own. You know what I mean? And everything's going to be custom built and it's going to be 100% that way. And if you're a CIO, you do that to have, you know, high, high competitive advantage, high differentiation advantage, right? Um, so that you can build anything you want for your consumer. Then there's the middle of the ground, that's where I call us, where you leverage all the capabilities that you can from a third party without building them. And then you build what you need to, to give you a quick competitive differentiation and advantage. That's the model I think we've landed on. And then you have the model of your epic only.
Chad Brisendine: 16:49 So, you know, there's choice I guess in the matter of what architecture is. People want to pick. My view of the world is we get to leverage all the best capabilities of epic for epic. And, and I love epic. I mean they, they're a tremendous development company. They, they pump out a lot of amazing stuff, but they don't have everything right and they're never going to have everything. And so how do we fill the gaps in? Um, there's a lot of the capabilities I just mentioned to you are not things that we have in epic, but I'm leveraging a lot of what we have behind epic to push that to you as a consumer. So we're, I can a button's going to be from epic from the back end, but a button may be from another third party vendor that we leverage in the ecosystem. So I know that's a lot of words. Um,
Bill Russell: 17:28 I, I love how you framed that up to be honest with you. I mean, it's because I have seen the fully custom shops. I've seen the people building on top of Kpis and then I've seen the people just roll out, hey, here's, here's my chart and away we go. And Oh, and you run into this. I mean, you'll develop something and an epic, we'll put it on their roadmap and you'll have it in two years. Um, and that's just, that's part of the challenge of building on top of it is yeah, sometimes you're gonna, you're gonna you're going to develop some stuff today to go to the market that's going to be replaced in two years. But that's just the nature of the business.
Chad Brisendine: 18:01 That is the nature of the business. I think we, we do it on the internal word a lot because we pulled by a third party. Epic's not ready. We'll buy third party APP internally. Epic's not ready. You know, they, they don't have the capability. Um, there's many spots where they still don't have the capability. We have a third party and we buy a third party as soon as we can move it into epic cause it makes sense and it meets all the requirements. We move in an epic and there's no difference on that on the consumer. The only difference on our consumer is the front Ux Ui that you'll always see will always be ours.
Bill Russell: 18:29 Yeah. That's interesting. So what's the biggest surprise? So you're, you're, you know, over a year into a year and a half, two years into developing on top. What's the negative and positive that you've experienced?
Chad Brisendine: 18:41 I don't think there's a lot of lessons learned on all this. I think the, um, the understanding the true journeys of these consumers from end to end, like you think, you know, in the end is until you start going down and then you look at end to end is different. Um, and I would just say, you know, it's the journey mapping is the customer. It's a hard work. You know, it's all that different components. Figuring out what should we really do next. The prioritization of that. Um, and then the technical architecture, I think it's very complex. Um, I think, um, there's certain vendors, as I mentioned, my EMR vendor does a great job at it to be honest, or one of the best ones to provide an Sdk and API and all that. Even though everybody knocks them for that, they have been the best out of all of our partners from that perspective.
Chad Brisendine: 19:25 Even though you would think you would get something better out of Silicon Valley related to an sdk or an API. But everyone wants to do, you know, the easy way out on this. They want to go html five and they want to push out a mobile and a web to mobile rendered, which is they call it interactive. I call it slow. Um, you know, so I think, you know, there's all different ways to deliver these things. Um, and at the end I think it's just all about, you know, what, what do you want for your consumers? And my perspective is we want the, um, best experience possible. Um, I wouldn't say I have that today. I would say those are our longterm goal is to have the best consumer experience possible. And I don't consider it a small project. I consider it a journey. You know, something we're building over.
Bill Russell: 20:12 I want to thank you for the time you gave me. I know you, you came from a meeting. I know you're going to a meeting, so I want to honor your time here and I just appreciate this, uh, this quick visit. Hopefully we can touch base a little later in the year when the, uh, schedule slows down a little bit. Thanks a lot, Bill. Sure. This show is a production of this week in health it for more great content. Check out the website and thisweekinhealthit.com or the youtube channel at thisweekinhealthit.com/video. Thanks for listening.