HealthIMPACT Live Presents: Personalizing Digital Health Through Adaptive Patient-Focused Digital Front Doors
Original Published Date: November 11, 2021
YouTube Video: https://www.youtube.com/watch?v=UZfTgzobYHM
As the pandemic shifted the focus from in-person care to telehealth and virtual medicine, more patients have relied on virtual technologies to access both healthcare and their health data. Health systems and their providers are continuing to find ways to connect with patients to create digital front doors, through telehealth platforms and otherwise, and innovative companies are leveraging artificial intelligence and machine learning (AI/ML) to assist providers with scaling the clinical workflow, from inferring patient needs to rationalizing a plan of care. Health systems are using robotics and AI/ML technologies to assist in patient care, including the utilization of conversational AI to interview the patient as wells as recommending a care plan to the physician. Regulators are focused on patient-directed data sharing and the interoperability of electronic medical systems to promote care coordination, and health systems are partnering with digital health companies to transform the delivery of care.
Heather Deixler, Latham & Watkins, Moderator
Jason Wells, Chief Strategy, Consumer & Innovation Officer, Adventist Health
Matt Fisher, General Counsel, Carium
Leard Mita, AVP, Physician Contracts & Amb Finance Operations, NorthBay Healthcare
Mark Hanson, CEO, Decoded Health
Heather Deixler: Welcome to Health Impact, Fall. We're excited today to talk to you about Personalizing Digital Health Through Adaptive Patient-Focused Digital Front Doors, and I’m Council in the healthcare and life sciences group of Latham & Watkins in the Bay area offices.
And I generally advise companies operating in the healthcare industry on healthcare regulatory and data privacy and security matters now I’m going to introduce you to the rest of our panel here. So Matt, do you want to start by introducing yourself?
Matt Fisher: Hi everybody. So my name is Matt Fisher. I’m General Counsel at Carium. We're a virtual care platform company really focused on driving patient engagement and remote monitoring.
Heather Deixler: Great. Mark, how about you next.
Mark Hanson: Mark Hanson, I’m the CEO of Decoded Health. We are a clinical hyper-automation company. We are solving the problem of the labor shortage and healthcare, with respect to physicians and clinicians by automating clinical tasks.
Heather Deixler: Great. Leard?
Leard Mita: Hi my name is Leard Mita. Vice President of a Physician Contracts and Ambulatory Financial Operations for North Bay Health Care, which is a small nonprofit hospital system in Fairfield and Vacaville, California and my team and I are heavily involved in the provider relations and providers solutions.
In general, and many of those now include technology solutions both patient access our systems, as well as provider capacity, you know, through technology.
Heather Deixler: Great, and Jason.
Jason Wells: I am Jason Wells, and I serve as the Chief Strategy Consumer and Innovation Officer for Adventist Health. We are a 24-hour hospital system and hundreds of clinics up and down the West Coast in Hawaii.
And part of our 2030 strategy is to have 50% of our visits and care moments be virtual digital by 2030 and so big lift.
Heather Deixler: Great Thank you, Wells. I thought we would start today, and we have a lot of interesting things to discuss and topics to cover here.
But I thought we'd start just talking a little bit about some of the regulatory changes we've seen in this landscape.
You know sort of in the past year or so and I think you know sort of at a high level generally what we're seeing on the regulatory front is that there's a general relaxation of requirements.
You know, really to allow for the coordination of care and data sharing for those purposes.
And we're seeing what these agencies are calling a regulatory sprint and it's really a coordinated effort to you know remove barriers to innovation, to provide flexibility for coordinated cost-effective care.
You know we're seeing incentives to transition from volume-based outcomes-based care, you know and really at its crux.
You know outcomes-based care is about sharing information so providers can coordinate care to you know manage populations of patients.
You know cms calls it, a three-part aim better care for individuals, better health for populations, and lower cost.
And so on this, you know sort of healthcare regulatory stark anti-kickback side, we have no value-based arrangement rules, and you know those are applied to all payers and really are you know, providing greater flexibility with the more.
The greater assumption of financial risk, and then we have you know, on the HIPAA side there's been a regulatory emphasis on patient access to care and patient-directed.Data sharing and also you know, an emphasis on care coordination and so that providers understand that you know, sharing information for purposes of coordinating care is is permitted.
And then we also on the cms and oh and see side.
We also have the final rules on information blocking and interoperability, which again are sort of aimed at sharing information and ensuring that providers.
Are able to access information and patients are able to access their own information, you know from various formats so that they really can have a holistic vision of their health.And so I thought we'd start maybe by talking about you know we're talking about digital front doors today and kind of different innovative.
Technology technologies, you know to coordinate care and to solve problems in the.
You know throughout the healthcare ecosystem, I thought, maybe we start with you know digital front doors so maybe, mark you can talk a little bit about like How did we you know what were.
You know, when you started with your virtual front doors what problem, are you trying to solve.
Mark Hanson: yeah Thank you, I think it was a natural evolution and you know we see these kinds of moments in the history of healthcare that pull forward.
Maybe a decade of technology, adoption, and to a very small amount of time, we saw that with the high-tech Act and the adoption of electronic medical records.
I think co good pulled a lot of digital engagement technology into healthcare very quickly just out of necessity, at the beginning of coven.
People were very reticent, as everyone knows, to go to the to doctor, and doctor is needed to quickly find a way to engage with their patients virtually and digitally.
And, and the solution there was Telehealth and we saw Tele health as a technology people were using facetime for telehealth are using zoom for telehealth.
But it was very much a single point technology.
That wasn't really a workflow that was very efficient and so what we've seen with digital front doors is an amalgamation of different technologies that start to create a patient consumer experience.
That really is a digital first experience that enables omni channel care, ultimately, whether it's going to be a telehealth.
encounter or actually going to the correct line of service physically within the clinic or hospital.
So what we've seen is you know the quick adoption of telehealth but then also a fast follow too.
Many more technologies that that automate a lot of that that workflow that otherwise would have taken place in the clinic things like scheduling registration determination of benefits collection of co payment.
Everybody seems to do it slightly differently and there isn't really a single source solution, so you need to bring a lot of different technologies api's integrate them together.
To create an experience for your patients that not only works for the patients that want to want to have care at home.
You know either beginning their their encounter or their their their journey through the healthcare system, but also those patients that are returning home and extending the capabilities of the hospital to the home and to where that patient resides that takes a lot of technology to accomplish and that's what we're seeing hospitals really embraced very quickly as a virtual front door strategy.
With that it brings you know new problems, of course, you know, I have a friend who says that maybe virtual front door was like.
Adding the drive through to the Starbucks we've created convenience and we've also probably increased demand quite a bit because we've increased access and and we know that when we increase access and convenience demand increases as well but we haven't exactly enabled ourselves to make more coffee, and so we start to see the limitations of.
Our workflow in other areas, particularly on the on the clinical side.
Where now we've got bottlenecks, not at the front of the experience, but maybe midway and, at the end of the experience, where the physician nurse starts to become the rate limiting resource, with respect to providing care, and I think that's where the virtual front doors evolving is very much into creating efficiency, because Tele health is still a you know relatively high from its baseline prior to coded and now volumes are coming raging back to clinics and health centers so we've got to be able to to tackle that demand in an efficient way.
Heather Deixler: yeah and I know that I mean maybe Jason or laird I know that you have have a lot to add to this in terms of of what you're seeing kind of on the you know, once you get past the virtual front door how you're trying to solve for efficiencies there as well.
Jason Wells: yeah I put an exclamation point everything mark just shared he absolutely nailed it so are our volumes we've seen that the the pandemic accelerated the opportunity to go digital physician adoption went through the roof, because it was the only way to continue to see their patients, and so they they adopted things that may have taken years to to really motivated and kind of been that curve so.
What our challenge has been is that same thing, how do you provide a a touch free clinic experience how do we allow people to sign their consent.
You know, on their phone and and look at their health, history and see if anything's changed and be able to walk into that clinic experience right from their car skip the waiting room and go right in so you can imagine the operational challenges with one getting that right and is mark share there's no partner that that has the entire continuum of care digitally you know we we partner with about 12 different entities in that space through api's and it has to be seamless for the consumer, we haven't figured that out yet.
And you don't want the consumer to have to download seven different Apps and it's you know one thing Disney does so well it's this coordinated experience or marissa you've got the bond boy APP.
And you don't have to go to a different vendor to use your phone to get into your room it's it's all through Marriott but clearly Mary I didn't develop a lot of those technology so.
On the health system side, we have to make it seamless for the consumer.
You know I started using things like grub hub and Doordash for the first time, through the pandemic and.
You know when you're stuck at home you're willing to start downloading some different Apps and trying some things that may have taken years to try.
Healthcare consumers are now in that same mindset they're very comfortable in the digital space and they're like why haven't you guys caught up to the rest of the world.
And they're holding us accountable and there are frankly moving with their feet to health care providers that have figured this out and so it's essential for all of us that we get on this digital journey and do it quickly and do it well, frankly.
Matt Fisher: I guess i'll chime in there, because I agree with what you said Jason and market and what we've noticed that my company is we've seen.
That evolution of thinking occur over the past 12 to 18 months, where you're going to mark, as you said it started with using to throw something out there you don't have any tools to.
Actually connect with our patients that they can't come in to Okay, now that we have these things in place, we just threw them together they're not maybe fitting together, how can we evolve that.
And you know we've seen that working with some some of our customers, where you know, I think, maybe a first use case had been okay we're just going to do the remote monitoring, but then seeing how.
You can have drive engagement it evolved into that digital front door where you kind of have some of that throughput that you're talking about Jason of you know, we always constantly hear from systems and others like.
We don't want to keep adding Apps for our patients, we just want to make it easy for them, and when you can find something that you can scale off of where you have a solid base and can keep.
Putting additional components and not changing that end user interface we've seen a lot of power in a lot of sustained uptake with that.
Leard Mita: I agree with pretty much everything that's been said so far and that very well put.
You know the notes that I wrote down was we've kind of figured out we, this is what we need to solve for we've also sort of figured out what the technology is that needs to get their area there becomes a bit more challenging that, at least for me and my experience was.
The implementation integration and adoption right So how do we implement this the right way right thing Jason talked at length, you know about that.
And then, how do we make sure we integrate with our legacy ehr and other technology solutions that we have right and then, as it being adopted properly, not just by be.
You know by the patient, the consumer, but also by the staff by the providers and all that in the provider realm one of the things that I have to.
Always constantly in a way apologize to doctors is the burden that they have when it comes to.
The technology pieces they're constantly need to adapt and also the as far as documentation all of those it's an increasing burden it's placed on the providers and on the support staff.
And so I think technology to take those areas into account as well sure let's open up the front doors for the patient, but then, how does it flow downstream from there are there, areas where Ai can automate a lot of things like Jason said, where you go from your car to you know to to attend the exam room without having to anyone want the medical assistant or the provider comes in the room, they already have your medical history you've already answered the questions.
And I think those are huge pieces and and also alleviate the burden on the provider, so that they're not spending, you know five to 7pm every day, you know completing their notes, because there's just so much you know documentation and emails and inbox so they have to adapt in it so.
Jason Wells: i'll leave it as a great boy we an adventist health I know we have around eight. Over 800,000 care gaps left open right now mammograms colonoscopies you know annual wellness exams, and so you can imagine the amount of front desk back office staff, it would take two to one get someone to answer their cell phone to close those so. What exists out there to be able to appropriately in a in a safe and HIPPA compliant way reach out to those you know let's say 100,000 patients to say hey you haven't had your mammogram and four years.
Can you click here to schedule that and what can we do to to do that through Ai and make it seamless because.
We have a moral obligation to help people find the cancers that they have in their bodies, and if we aren't we're not living up to our mission.
And it's it's a serious challenge when when you can't get amazed, because you know you get how hard it is to get our ends and ma is right now, you you can't go hire more staff, so we have to have the technologies to help us close those gaps.
Mark Hanson: And I think.
Matt Fisher: This, I think, to your point it's.
You know it's also having the different kind of forms of communication to reach out because you know we've seen with some of the pop up some of the customers were helping there's a ball phone calls not going to do it, so we want. You know, but you know when they text somebody all of a sudden, they get an instant response and like we had one example where you know, a new customer sent out a text to a patient to get them enrolled in rpm.
And within five minutes of sending the text they already had exchanged text back and forth and had an appointment scheduled where the practice before that had been trying to call it was not getting any type of response so it's.
You know, being able to meet the patients exactly how they want to be met, so you know, some people do like the phone or maybe an email but text text in that type of form of communication is definitely growing and one in an area where I think it's not sufficiently utilized.
Heather Deixler: And I would just say in the text message I know we get a lot of questions on the legal side because it's something, you know as the sort of information is trying to be are you know communicated in different ways and text message you know you have things like the tcp a and there are certain.
Exceptions and that's tcp is is constantly evolving and it's very litigious so I know I mean, I have two questions right now about text messages and kind of the.
The you know guardrails on what can we put in the text message what you know what what constitutes consent for that text message and kind of you know just sort of those those kind of careful steps before you start a campaign, I think, are so important, and especially in the healthcare space where you know, for the most part you're trying to engage for healthcare purposes you're not you know it's not typically marketing but, but even that I think you have to be really careful because you know the difference between an informational and a marketing text is not always as clear as as you would think and and it is something that you know plaintiffs attorneys love to sort of latch on to so it's something that I know we get questions about all the time and it's constantly evolving there's new tcp a you know. Cases coming down.
Very there's you know, recently, and very often so it's something that we watch carefully and I think you know, the more that it becomes kind of.
Patient engagement and patient access and and you know more, the more that that's a focus, I think the more sort of you know, careful we want to be with respect to those communications. And I guess kind of on those lines, I think you know from from a regulatory perspective there's there's so many interesting things to talk about and think about when you're you know implementing these innovative technologies, and I think you know from a legal perspective there's kind of we're thinking about things like you know physician oversight when we're thinking about Ai and machine learning and we're thinking about scope of practice, you know.
What exactly you know, and I think really having that physician in the loop at all times and having that oversight and then you know we're always thinking about data issues. Both on the health care provider side you know the health system side and then also you know for our technology. Companies and clients, we want to think about you know, make sure that they have the data they need to train their algorithms.
You know, thinking about it in a hipaa contacts it's it gets increasingly complicated when you know you have Apps that patients are engaging with.
And you have a certain consent there, and you have your you know your terms of using your privacy policy and you want to make sure that that Is governing and that's very clear in your you know if you're for the technology on the technology side you want to make sure that that's clear in your agreements with the health care systems and.
You know, and then, of course, healthcare systems where we're thinking about hipaa and privacy and we want to make sure that you know we strike the right balance there as well.
Leard Mita: hey heather if I could add one more to your list that I kind of ran into was kind of service, where, how do you define side of service for virtual care, you know. Especially if the provider is not in the clinic they're doing it from somewhere else for movie can they do it remotely do they have to be in the clinic if they're going to do virtual care.And the patient, obviously, is not there, so it was an interesting thing we had to kind of ask questions about to like, how do we define side of service now for the purposes of you know provider enrollment with medicare and health plans and so forth, so. One more one more thing to your list.
Heather Deixler: yeah now great.
Matt Fisher: And i'll even add yet another one to it, which is something that will theoretically, and maybe early 2022 but the impact of all the waivers. As a result of the public health emergency that exists that came into play when Kobe was you know, a row is you know. I think we're probably all familiar with the fact that all those waivers greatly expanded the capabilities of what can be done through Tele health or you know or really kind of any of the various iterations that can come in, and I know, like a carry them we get questions from our customers have well, can I, you know. How many days Do I need to do for monitoring or you know how can you know who is eligible for it and you know there's still that interplay with the waivers and. People forget that they are that those have established almost that new reality and that a lot of it is still going to roll back when the public health emergency ends. You know, with all the fee schedule is coming out this first week in November I think that's providing hopefully a spur to Congress to kind of.
Keep that ball moving forward, because cms and hhs keep saying we're going as far as we can, without legislative change and.
I think that keeps getting lost because there are so many other things that are coming up from a policy perspective and i'm really fearful that we're going to come sometime in the first or second quarter of 2022 because the public health emergency is going to have to end at some point.
And overnight we're going to go back to a world that no one wants to come back into play.
Jason Wells: Mad I think that's brilliantly said, because that will be the challenge physicians and clinics have adopted this new reality and many are finding it more efficient their patients are absolutely loving it.
And we've got to be ready to roll back all the things that the PhD did that are not allowed moving forward, but when it's built into the core of your operations that's going to be the big challenge is there, like no I love doing as well you know when adventist health 82% of our peers or government payers.
You know you're we're going to follow the rules and it's going to be hard to take some of these tools away from physicians if we don't have some of the regulatory changes to support the efficiencies we found.
Heather Deixler: yeah I mean it's hopeful that you know sort of the focus on patient access to health care to information will sort of help move this forward even after you know the pandemic ends, but yeah it is something you know that we have to be really mindful of and watch really carefully. Well, I think i'm kind of thinking through sort of some of the challenges and ways in which we can kind of promote these technologies and maybe we can hear from you know.
Matt are layered or Jason on on how health systems can support both you know, on demand and asynchronous communications with patients without overburdening clinicians nerd maybe you want to start, I know you have some thoughts on that.
Leard Mita: yeah yeah I think that that is that is huge right, so you know I think mark said Jason mad, they said that look we opened up the doors now there's more patients, but you know how do we know we've already overburdened you know all of our processes all of our operations we've stressed them to the limits now because we've created new type of access, this is sort of like the Uber effect, you know not many people took cabs before.
Uber existed, all of a sudden, as soon as over existed everybody's is doing ride-share so it's the same thing here now that you provide this virtual care solution to.
Patients are going to use it, they can use it more than before, so it is by nature created more and more volume of work so.
You know one thing that we have i'll be very honest it's a patchwork right now its we've got.
A solution for this particular service here we've got another service line that has a different solution so.
We're we've tried in a lot of these kind of were grassroots they started from you know from from the teams that needed solutions right away on March, April 2020 to start seeing patients so.
Individual service lines reached out and figured out solutions, but now the question is how do we do it from the system level and do it good better we've got you know a lot of a lot of options now so.
I’ll give you an example we've got an urgent care partner, they are fantastic at doing the front and, especially, but the back end to when it comes to.
Care coordination after the visit you know of the patient, but even before from the time when the patient is is scheduling their appointment.
To the time that they're in the exam room, a lot of that can be done via their their mobile phone it's all not.
All the questions you're getting 2030 questions and, depending on what you're answering the algorithm last one more question.
One more question and, obviously, the physicians would would design the solution that they wrote all of the things that they need to know as physicians before a patient is in the exam room right, so what.
I’m going back to Jason’s point to where do you go from your car to the exam room right, so this particular, this is a launch right now in our in our urgent care platform, it is great we don't have this in our other services, how do we go about getting other services and another thing is.
This urgent care solution has a different ehr than the rest of our system.
So how do we go about integrating you know that all this documentation all these medical records now to our legacy legacy ehr so those have been sort of like some of the real experiences that are you know that i've noticed, you know in our organization and and that's one example other examples are creating telemedicine solutions for our hospital based positions, the hospitalist the doctors, the intensive this, how can we have more physicians when we have a surge on the Inpatient side, we need more doctors to help out.
How can we get more physicians without really you know, adding more bodies on the floor because number one we don't always have that option if we don't just have another doctor to come in.
And second it's very expensive, so you know that that's another area it's a little bit different from the front door side, but it does in other provider capacity area that we've kind of started going down that path of sprawl and finding solutions.
Jason Wells: yeah laird covered it well in the provider capacity, and so we we found a partner on the behavioral health side, and if you think about the traditional model of you know, patient might be with a psychiatrist psychologist lcs w 50 minutes once a week, they have the Tuesday at 3pm appointment.
We know and behavioral health that's not the best strategy because it may be Thursday, when they really actually need that support and end up in an er on FSo this partner has been incredibly successful with with a Bot Carla and Carla has regular conversations with all the patients in the panel.
And can escalate things, based on the feedback through Carla so it's a ou know leveraging scaling the small amount of clinicians that we have, but it is that 24 seven you know 365 connection and yes it's through a but it's a smart Bot, who can escalate things as necessary and then you have an on call team that kind of can step in and help out, and I think we're seeing a new breed of clinicians that are really enjoying.
Knowing that they can be scaled and their expertise can be scaled they can still have a life outside of work, but yet can truly lean in and instead of transactional relationships, I see you every Tuesday at 3pm it's an ongoing relationship that's developing, but yet it's scalable so it's it's exciting what's developing and and again heather from the regulatory side we.
Absolutely hope we can get the policies in place that that type of relationship can continued and be reimbursed for outside of the PhD.
Heather Deixler: yeah absolutely and do you see, are you seeing some physicians who are really sort of hesitant to to embrace this technology are there are there some who are kind of not comfortable with that or just see it as kind of more work for them.
Jason Wells: Absolutely, we have to help them realize that we're scaling their expertise and then helping everyone practice at the top of their license and so.
It may not be that that is the physician answering at two in the morning, but they know they have a trusted team member that they're overseeing that is answering and you know it's scaling their expertise so it's yeah you're exactly right we don't have 100% adoption, but there is a new breed of clinician that's coming out now that is very excited about this new with practice of medicine, no.
Mark Hanson: No, I.
Leard Mita: totally agree, you know what what Jason said there is that it takes a long time to get everyone on your medical group, you know, to adopt it and you know, so the new doctors, the new residents that we're seeing they're far more excited about this, in fact, the solution we have right now in the urgent cares was created by one of our own the medical director of already a fantastic. Emergency medicine physician who loves this stuff, and this is his creation, this is his he started a startup company and created this product so. What I would say that I found very useful is, if you have a strong position governance and decision culture to where the physicians are included in your decision making, they will, it is a more effective way to adopt these technologies, because it's coming from physician to physician, you know and they they are they're helping their peers, if you will, to jump on this new technology that's been.
Far more successful for us than just having an administrator or an IT expert that they're going to physician here's how this new technology, it works, so I found that that strong physician coltrane collaboration has been very, very useful.
Mark Hanson: I think, also there's a couple frameworks that are a bit helpful and looking at how you roll out and deploy these technologies, the first one is augment first automate. So when you look at your clinical workflow look at where the inefficiencies are and say to yourself, am I going to automate that function or am I going to augment the person that's performing that function. In order to get that that that workflow done and to the extent that you do automate.
I think it's critically important this has been a learning for us is that you can't take people's jobs away from them and expect them to still be there and not have a job to do so, you know very much you have when you're re contextualize somebody role it's very important that, to know that they're going to embrace the technology if they feel that they have a new job or new objective that might change because you're automating a task that they they previously performed.
So if you've got a registration clerk at your front desk and you've got an automated checking system. You really need to think about how you're going to read utilize that human resource in your front office, because otherwise you're you're a technology adoption might not go so well, because that clerk is not going to be incentivized to point people to the automated workflow that the second thing is that you know a lot of times we get down to particularly on the augment side.
You know not only what is the task, but what is the knowledge that's required to perform the task and ultimately.
You know, working at top of license you get to kind of ascending orders of complexity and the amount of knowledge that's required and ultimately it's going to be a clinical decision.
That that's made and that's that clinical knowledge that medical expertise is going to be the rate limiting resource and So how do we support physicians and I think a useful tool is look at the things that physicians utilize today that make them efficient that aren't necessarily. A great example is scribes alright so scribes do the documentation in some part for the physician, and we know that scribes.Human scribes I can increase productivity for physicians by 20% unfortunately we need kind of a step function and productivity. We looked at other things that that make physicians very efficient and it turned out that physicians that supervised medical residents can see two to three times the number of patients, because they had these trained medically trained extenders working on their behalf, collecting the API doing the. Clinical decision making and presenting to them not only the case but, but what they thought was appropriate plan of care for that patient.
Having gone through an interview the patient and looked at the patient's medical record. So we're seeing more and more clinically intelligent systems, try to scale the medical knowledge and augment the physician, so that they can no longer be the rate limiting step within the entirety of that patients clinical workflow.
Matt Fisher: embark, I like your discussion of are pointing out of trying to augment what the what each individual is doing you're bringing in new new forms of technology. You know, because Jason there, I agree, as you said, you have to have the condition buy in but you also have to make sure you're going to the right level of the clinician depending on what type of solution you're bringing in. Like I know when we're implementing with a lot of customers. You know we're kind of help helping supplement like the nurses or the ma is because, if there's a strong remote monitoring component to it so they're, the ones who are going to be the front line people. Seeing the data come back in so we make sure that they're attending the trainings and, frankly, like, I know, talking with our head of implementation, she actually what she likes she gives them homework. To make sure that they understand how to operate the system before it goes live so that way they can kind of work out those bugs and not be experiencing the real time get frustrated and want to throw out the solution because they think it's just a hindrance to what they're doing.
Leard Mita: And I agree with that matt that's that's a great point that i've spent a lot of time on the implementation side on the project management side and I. This I spent a lot of time in that particular piece on the training component good. It is it is challenging, it is not an easy piece it because it's going to take time to you're going to need the staff to take time off of their job and come into the training right so. And then you're going to have to be okay with repetition. This is not a one time you, it was taught once and that's it, this is continuous training and you have to be patient and you have to be okay that. Someone might need a bit more time, you know to to grasp and you need to identify your super users and your if superstars that are much better and they can teach to others so.
I wanted to add one comment, also about what mark mentioned about describing solutions, describing is also going virtual. Right now we're in the process of pretty much. Reviewing virtual Skype solutions because, even in person, describing it's so hard to get right now, our scribe partner at provide a provider, he is struggling to find personnel in our area in northern California, especially has been especially hard to find in person scribes right so in even that real even that that part of support our physicians is becoming is going virtual so.
Matt Fisher: yeah i'll throw in something a practical point on that which might be going a little bit of field, but even central Massachusetts where I am. You know their companies have trouble finding the scribes but you know there, I agree with you, as you said, virtual is happening, but for anyone who's reading those services make sure again as we're talking about get your clinicians involved because.
Jason Wells: You know.
Matt Fisher: i've heard about one service where it's going outside the country for describing to occur, which isn't necessarily bad, but then the turnaround time for the notes to come back to the clinicians interrupt their workflow because now they're having to wait 12 to 24 hours, if not more, in some instances, for to come back and all of a sudden, you had your clinicians not making the service that used to you know, as you said, with the in person, create these greater efficiencies now it's actually creating inefficiency.
Jason Wells: yeah Matt i'll share one on the on the physician challenge side, so one of our things we've been most excited to the pandemic is in California we've been the leader around hospital at home, so, as you know, the waivers allowed you know hospital without walls and so we've cared for over 800 patients on full acute status in the comfort of their own home in our age gap scores with that population are actually the best in the company, but on the change management, it has been a heavy lift with physicians because many of many of our 24 hospitals, the model is independent physicians are the hospitalist within our walls and so.
They will have to early discharge a patient to our hospital at home program and they personally lose those rv use. And so you know they've done the hard work, for the first let's say one day to day length of stay. What incentive do they have to move this patient at the hospital to create more capacity.
When they've really got this patient almost ready to go home and now they're ready for the hospital at home, but yet they're personally losing those rv use and so. Trying to show the value prop to the physician of hey this is really best for the patient let's get them out of the hospital let's get that patient out of the er up to the floor create more capacity. You know so it's it's a heavy lift to have the physicians on board with a lot of these changes and we do believe, especially in a place like California, where it's a million dollars a bed, we need to build 100 bed hospital it's $400 million, because the regulatory environment so.
Caring for patients, as appropriate, in their homes, is a strategy that it we're we're committed to, but that physician change management, we can't do this without physicians ultimately they direct care of where patients go.
Heather Deixler: And Jason I feel like that's the perfect argument for value based care and that's exactly what you know they're they're really having physicians by and you know for improved outcomes and and not thinking about you know the the volume, but really the value and note that sort of improves care reduce costs, but having you know physicians sharing those savings, I think, is is crucial, and the more we move to value based the more physicians will be on board.
Leard Mita: That, that is, that is, that a very strong and very big topic as well right that the physician incentives and you know I spent a lot of core part of my job is to do that and you know, to jason's point and challenges that same thing here we have that same challenge and we've started to.
Just shift position compensation away from productivity not completely but we're trying to make it to where productivity incentives are not a predominant piece of their compensation it's not easy, though it's not easy there's a lot of anytime that you try to attach a physician a contract or compensation, you have to have the trust there's got to be trust there's got to be transparency, it has to be slow, it cannot be fast it has there has to be buy in and and so you know it yeah I hear you I, and I feel your yeah the challenge there yeah.
Heather Deixler: yeah did you have something mountain on that.
Matt Fisher: yeah I think it's just kind of get additional angle to it, I agree, you know that and that kind of underscores the difficulty of trying to shift towards value based care, while still. Having your kind of most of your infrastructure built around fee for service, because you know there's very few i'm probably not aware of any system or provider group out there, that would be 100% value based care so you're always going to have some tensions. You know kind of along with that you know but yeah or I guess before to the next point no I agree shifting into a more kind of based compensation and then. You know, quality based incentive or quality based metrics for a component of compensation makes sense because it helps encourage to get in that direction, but at the same time, you know. We I think we also need to be honest about what the reality of value based care is too, because I think a few years ago is being sold that you're going to go to the conditions you're going to have more time with your patients but that hasn't actually that doesn't actually bear out because, as you go more into value. You want to increase your patient panels, so now you have a larger base of patients who are still looking to access, which I think then circles back around to what we were talking about what. You know the virtual care, the digital solutions of if you can drive efficiency probably drive interventions outside of the walls of an office, so you can keep people healthier than that's going to actually kind of free up the clinicians a practicing at the top of their license and seeing the patient to truly need to be coming in. As opposed to just trying to get people in because then that drives the rv use, you know, so I think you have a lot of circular arguments and circular logic there, but you know I think there is a reason you start to get those cells feeding loops because one piece really does keep feeding into the other and coming back around.
Heather Deixler: yeah. Absolutely, and maybe I know we only have a couple minutes left here, but I don't know if anyone wants to sort of ended on a high note kind of where you know we've talked about so many sort of interesting innovative solutions that that are here now and that we're using any anyone want to kind of chime in on what's next you know where you see this moving. Maybe Jason I know I know it adventist has a lot has a lot of a lot going on and a lot of interesting yeah.
Jason Wells: And so, when, obviously we have margin, when we keep people out of hospitals now out of clinics and keep them healthy and a true value space and so. That is something we have to be very good at, and I i'd say that would be our challenge for all health systems in the country is. We have to be experts and well being and as the reimbursement finally starts coming in with this shift. It will be sustainable frankly it hasn't been there hasn't been reimbursement, so people haven't moved into that but it's deep and dark.
Our roots in our history is a healthcare organization and so a lot of investment in that space and helping other health systems, create well-being solutions for the communities in which they operate so that's probably 25% of our focus and it's about 75% of our 2030 strategy.
Heather Deixler: awesome anyone else has anything I know we have maybe a minute left.
Mark Hanson: I think that the tools that physicians are going to be able to use too. Providing higher quality care to a larger number of patients and increasing their patient panel size, at the same time increasing access and engagement with their patients is going to be something we're going to see take effect over the next two to three years, I mean the data fabric alone that we have now for patients as interoperability and EHR brings together a more complete 360-degree view of the patient.
Combined with using artificial intelligence to tell us what in this data fabric is important for this particular patient at this particular time and then, how do we address that patient that's the intersectionality of infrastructure and artificial intelligence that I think is going to redefine how physicians perform work and the tools that they have at their disposal to do that.
Leard Mita: yeah I wanted to add that kind of the tipping point has happened, you know if before it was sort of more like a choice or all let's try this let's take our time it happened quickly it started in April March, April 2020 and that's it there's no going back now so now it's a matter of how do we go about doing this and how do we do it cost-effectively takes into account, you know patient care quality service quality financial viability physician services physician retention and all those areas, so those would be my thoughts yeah.
Matt Fisher: yeah and I think the one thing I'll just add on top of that is to remember to keep the patient at the Center to you know a lot of what we were talking about was for ways to help improve operations within the systems or within offices, but at the same time, everything that we do should also be baking patient lives easier. We don't want to be introducing something that creates friction and I know we're talking about doing things that you know some of the solutions we were talking about we're hitting on that point. You know, but that also I think means involving patients in the discussion, and not just making decisions that we think they're going to want, but asking the question and getting honest feedback so that way we're not unintentionally doing something that's going to make someone unhappy and not want to come into the system and seek the care that they need.
Heather Deixler: Well, thank you all, I think you know we've heard so many interesting stories and perspectives and I think you know.The virtual friends are just opening the door to so many different innovations and I think we're. You know, hopefully, the coven will be up behind us soon and we will continue to see innovation in our hospitals and health systems and it was great Thank you so much for all your time today, this was a great discussion.
Mark Hanson: Thank you