Through the Eyes of a Health Executive

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Through the Eyes of a Health Executive

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A recap of Sutter Health’s CXO-themed Health Influencers panel with a few healthcare comics that are all too real

One of the most enjoyable panels at this year’s HTFIC2017 at Stanford’s School of Medicine was “CXO Perspectives”. It is not totally un-rare to witness an industry panel full of speakers who want to fill their segments with plugs for their company and marketed buzzword soup alone. This was not one of those panels.

Sponsored by Sutter Health, and facilitated by Sutter’s own Sameer Badlani, a CHIO, VP and interim Chief Data Officer (…I mean, what else does he do?), we in the audience got to witness a panel with a casual tone, illuminating the struggles the CXOs face in innovation and the healthcare industry as a whole. This panel teetered to the far side of casual and real talking, which allowed us in the audience to soak in the experiences of some great veterans who’ve been around the healthcare block.

Sutter’s panel Health Technology Forum’s Common Good Conference at Stanford dove directly into the problems facing some of the world’s best CXOs in health and into the strategies they use to craft better futures in their respective fields.


SutterHealth.org

The CXO Perspectives Panel

Sameer Badlani is a CHIO and VP at Sutter Health. He was the moderator for this event. He opened up on a refreshingly organic and casual note.

“I’m moderating in a very informal way. We got on a phone call, figured: ‘What would be the four things we wanted to talk about?’ And then we’ll see how that goes… Hopefully you guys will ask us some interesting questions and we will give some dumb answers, but we’ll keep it light.”

The casual tone of the panel was a big part of what made it so memorable. It was simple and to the point, allowing us as audience members to relate with these health titans and to take a journey into the world of a CXO.


First, here’s some brief background information on the fantastic speakers that made up this panel:

Ben Rosner was the first to introduce himself. Ben is the CMIO of Health Loop, a “patient engagement and outcomes platform” based out of San Francisco. Health Loop provides (in Ben’s words) “patient physician connectivity in between visits.”

Arun Villivalam is a “family physician by training” and Advisor and CMIO at Core Mobile. “Core Mobile is focused on improving efficiencies and outcomes and the patient experience in the operating room space, so a lot of the work we do is in service centers and in hospital settings.”

David Pating is a Psychiatrist and Chief of Addiction Medicine at Kaiser in San Francisco. David comes from the health policy sphere. As he puts it: “I’ve been involved nationally and statewide with National Quality Forum, Vice Chair of the Mental Health Services Act, overseeing evaluation of our $2–3 billion mental health system. I’m a health commissioner for San Francisco City and County.”

Sameer Badlani is a Physician-by-background and Internist, with a fellowship training in informatics. “I joined Sutter Health about a year and a half ago as Vice President and [CHIO] for the entire company. We’re about 26 hospitals, $12 billion in revenue, mostly from Northern California. We have one psych facility in the Hawaii Islands, nobody knows why, but nobody wants to get rid of it, everybody wants to do a site visit there, and I’m also Interim Chief Data Officer of the Company. So that’s me in a nutshell.”


Next, we jump into the first question, posed by Sameer:

What are the critical issues facing your organization?

David starts out with a concept: for every system, there’s a gap.

He explains that a national level and at a statewide level, we’re looking at value-driven healthcare which means collecting enough data to be able to compile various numerators and denominators into metrics. But the problem is, is that the quality of data throughout most systems is very rough. There’s gaps in the data. There are duplicate sets of data. There are datasets that don’t communicate through various APIs. And so at the state level, we have large amounts of data.

The state and the feds pay organizations in the counties dollars, and the counties give the state data, but whether that data means anything, or whether it does anything, is not really quite clear.

They do this to answer “very simple questions” like: “How many people have high blood pressure in Palo Alto? How many people are able to see their doctors on an annual basis in Menlo Park? Very simple questions, but we can’t answer them at a statewide level.”

“The Counties say ‘if we had better data records, namely Electronic Medical Records, we’d be able to solve the problem’”. The problem beyond that, though, is that in California alone, there are around 4 different systems used for EMRs.

Another problem aptly put by Pating is explained via the “flea of the dog” metaphor. For the flea, you have the obvious problems like cancer and diabetes, but all the way in the back you have the “turd” that is mental health. Seriously. Pretty spot on description of our healthcare system’s focus on mental health.

He explains that if you want to really move mental health forward, you have to look away from simply moving healthcare as it is onto a mobile platform. You should instead look for something that is more like one step forward, figuring out “what mental health would look like in two generations”. He explains “we need to find clear pathways in which mobile health not only supplements the gaps, but fills and becomes the standard by which we want to raise even traditional care too.”

Arun reiterates that as a primary care Doc, David’s point on mental health rang so true. One main problem he notices in organizations, where “problem can be stated simply, but the solution is very difficult”, is “how to create technology in a way that’s intuitive and seamless.” If a technology creates more steps, it actually creates problems rather than offering help in solving those problems.

He references a book called “The Science of Everyday Things”, written by Donald Norman. In it, Norman says “if you design it correctly, if you create a workflow or a process that is right, then people don’t even really think about using it.”

There are very few things in healthcare that really do that. This is the secret, Villivellam explains, that is lacking in much of the healthcare tools that are out there.

via Callum Willcox

Rosner follows up on the main point Arun made, which he sees as a common issue anywhere you go: the Sutters, the Kaisers, etc. A need for seamless workflow processes.

“It’s really about ‘Change Management’”, Rosner describes. “Care teams and providers are extremely busy in what they do already, and so asking them to do anything additional or anything different is really tough.” Because of this, creating something that is seamless or operates in the background is really a key to getting their engagement.

Rosner has found through HealthLoop that consumer engagement is actually very easy to get, because it can act as sort of a consumer experiment. “What’s really tough,” says Rosner, is “engaging care teams and providers”.

Universally, healthcare professionals and patients alike can agree that they want the best outcome for patients. This is a problem simply put, but of course, the solution to achieving this is fairly difficult. Rosner maintains clearly, “providing high quality care at low cost is an immutable issue.”

Another issue that Rosner brings up is based on a philosophy he follows: “outcomes are the new incomes”. What he means by this is that software is going from a service-based pricing model to an outcomes-based pricing model. And this is for the better.

via governance international

Then a question from the audience, from Sarah Ellen O’Farrell, a Behavioral Strategist for Hill+Knowlton strategies:

How have you all fit behavioral sciences into your strategies for change management?

Sameer jumps in. Sarah has this great UK/Irish accent (her company is based in the UK) and Sameer jokes that no matter how hard he tries, his answer in an Indian accent can’t sound nearly as intelligent due to the old addage that things somehow seem to sound smarter when said in a UK accent.

He talks about an identity crisis. He explains that the Feds expect organizations like Sutter to be a “value-based organization”, but hearing that term, organizations are at about 20% value-based, while the rest of the models are still fee-for-service.

There’s a famous example of Johns Hopkins jumping to a value-based model, but “they lost $15 million before they realized something wrong”. In a fee for service model, if you switch to value-based “you will go out of business”. As Sameer puts it eloquently “even the saints don’t do miracles”. This is a driving point. How can we expect companies to continue performing against the bottom line while also switching to a model more akin to value for all?

Sameer’s Challenge: what does the market value and how will you stay in business? Sutter health is trying to understand what the community wants. How do organizations avoid friction with digital solutions without having to create a complete end-to-end solution? He brings up an example that governments have used to get people to pay taxes. They will send postcards to people who haven’t paid, saying something like, “in your geographical area, 86% of people have already paid their taxes”. This helps, because it gives people perspectives on just how behind they are, and facilitates more timely action. Effective peer pressure (my words, not Sameer’s).

via hipaacartoons.com

While these clips gave us only a glimpse, this panel was refreshing in its ability to get right to the point.

We found that devices and healthcare programs need to be implemented in a way that doctors can uniformly agree on. We found that Healthcare programs need to possibly be able to be implemented with pre-existing programs, so as not to ask for too much change. We found that it’s not quite so easy to just flip a large organization’s model from service-based to value-based.

Moving forward, these ideas give us a good idea of what needs to happen for all of the parts of healthcare to work better with one another. It seems, though, like therein lies the first step:

Lets get all parts of healthcare to start working together.


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