Health Care and Customer Digital Experience


Bill Russell / San Banerjee

San Banerjee Texas Health Resources This Week in Health IT

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January 10, 2020: Companies like Amazon, Walmart, and Best Buy are currently entering the health care provision space across the US offering technologically cutting edge solutions, particularly where customer experience is concerned. This raises questions for health care providers who have been in the game for longer and may not be technologically integrated enough to be able to provide customers with as much of a seamless experience. Our guest on the show today is San Banerjee, VP of Digital Experience at Texas Health Resources, and he is here to speak about the steps he has taken to merge THR with the virtual sphere. San’s method begins by considering consumer needs and then moves on to assess provider capacity. He speaks about the role that focus groups have played in sparking new systems at THR, such as a text-based ED service which has been a huge success. We get into the different industry champions that have come on board to prioritize customer UI, as well as consider some of the other barriers that still exist, with reimbursement featuring strongly. San shares more about other major wins for the industry in the two years since he has occupied his position, and sketches out the horizon for new technologies he is still looking at implementing. Join us for this engaging head to head covering the competitive updates happening in US healthcare today.

Key Points From This Episode:

  • A short summary of San’s role as VP of Digital Experience at Texas Health Resources.
  • Perspectives on new healthcare models based on customer UI found in retail.
  • A consideration of UI based on consumer needs, provider capacity, and consumer care.
  • Major customer concerns at THR: connectivity, cost transparency, service expectations, etc.
  • Whether health care can match the innovative UI created by Amazon Care.
  • The fact that industry champions are all on board with prioritizing customer experience.
  • Successes San has orchestrated in the last two years: a text-based ED service, and more.
  • How the text ED service came about through focus groups.
  • Barriers to the adoption of virtual care, with a major one being state reimbursement.
  • Logistics and standards around reimbursement practices for telemedicine and Medicaid.
  • New technologies that THR is looking at adding to their stack such as a CRM system.
  • Questions of how to gather customer data and the best technologies to use in doing so.

Health Care and Customer Digital Experience with San Banerjee

Episode 173 : Transcript –  January 10, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[0:00:04.6] BR: Welcome to this week in Health IT Influence where we discuss the influence of technology on health with the people who are making it happen. Today, San Banerjee the VP of digital experience for Texas Health Resources joins us. My name is Bill Russel, healthcare CIO coach and creator of This Week in Health IT, a set of podcast videos and collaboration events designed to develop the next generation of health leaders. 

This episode is sponsored by Health Lyrics. I coach health leaders on all things health IT. Coaching was instrumental in my success and it is the focus of my work at Health Lyrics. I’ve coached CEO’s of health systems, CEO’s of startups, CIO’s, CTO’s and, you know, if you want to elevate your game in 2020, visit to schedule your free conversation.

Today’s recording is not the best. I was in the process of moving studios and my microphone was already packed so I did a straight up laptop recording. I sound a little tinny. The good news is San sounds great and his words are the most important on this podcast and on this show. Here’s the show, hope you enjoy.


[0:01:04.8] BR: Today I’m excited to be joined by San Banerjee from Texas Health Resources. He’s the VP of Digital Experience. Good morning San and welcome to the show.


[0:01:14.7] SB: Good morning. Glad to be in the show here.


[0:01:17.5] BR: This is actually the second time we’ve met, you were on a panel discussion that I moderated at the Scottsdale Institute on this very topic and there was a pretty interesting group of people, we had a CEO, we had digital officers, we had innovation officers, and we had you as an experience officer, so it was a pretty interesting cross section of people and we’re going to dive in to some of the same topics but before we get going, give us some idea of what the VP of digital experience, what does that role do for THR?


[0:01:53.7] SB: The short summary, I think, the role is all about ensuring that we have a connected experience for our consumers that cross our physical channels which is our access forums and the digital challenge that we have. It’s basically creating this seamless experience across all the access points that we have today. That is all about. And, also, driving digital health, which is one of our key focus areas for the system.


[0:02:16.7] BR: Is the focus more the consumer or is it focused internally on the internal consumer of technologies as well?


[0:02:23.2] SB: It is primarily focused on consumers, yeah.


[0:02:28.2] BR: Interesting. This is actually a great time to have this conversation because we had multiple announcers this week, we had Amazon Care was announced and they’re going direct to consumer, we have – obviously CVS Aetna continue to do what they do but we had Walmart open up 10,000 square foot clinics now instead of that little carve out 1,500 foot deal that they had in the Walmart store, they’re now at 10,000 foot clinics and then we had – this is the one that really got me. Best Buy announced their healthcare company and they expect to provide services into the home for 5,000 people.


To help people age in place and they’re going to use their expertise in retail in the geek squad and actually getting out to the home and technology, to set up a way for people to actually age in place and connect in with their health system, and so people are asking this question San, and this is probably where we can start.


Is healthcare going to be able to play in those thing’s bases, to make it easier – and in this is what they’re doing, they’re just making it easier for the consumer with let’s call them intentional experience design around different healthcare experiences. I mean, what are your thoughts as you hear those announcements and what can we do as health systems.


[0:03:46.1] SB: I think fundamentally, the whole model is shipped in, right? If you look at from a consumer perspective, the expectations are changing. They expect a similar kind of experience from healthcare systems, what they had found in retail services and financial services and other industries, right?


Fundamentally, there’s a huge ship. I think – my point of view is that there will be some kind of aggregation that will happen in the industry in saying, “Well, these are all the services coming out, whoever can do the best intentional aggregation in service with consumer, they will win at the end.” It’s not about creating point solutions, it’s about aggregating in service of the consumer and I think we’ll have to be very intentional that the models are changing.


We have to be smart enough to really figure out who has really the best service in a particular space, bring them along as partners and create a holistic service an experience for our consumers. That’s the path in my mind moving forward.


[0:04:41.2] BR: Yeah, is that hard to do? I mean, because one of the things about healthcare is it’s so broad. It reaches in so many different directions, you have ambulatory and acute and you have – and then you have the different specialties and why not – where do you start? Where do you step back and serve and try to orchestrate experiences for the consumer? 


[0:05:00.3] SB: I think the best place in my mind to start is from a consumer needs perspective, right? Because there are – knowing that the way the healthcare organized today, there are a lot of gaps in the consumer need perspective, right? We’ll have to start there. Consumer needs will drive a lot of the things that we have to connect, right?


To your point, it is hard, you know? All of this, all the different services that are coming up, the way we organized ourselves these last several years, it’s difficult to really, kind of get out of that and start bringing new partners in there but I think the easiest way or the most logical place to start is from a consumer need perspective, and also looking at what is the provider aspect? What is the aspect where the people that provide the service can be brought in to understand when the consumer needs look like?


For a health system, the two places to really start is with consumer, leading with consumer, and also understanding what provider is – from a provider perspective, what we have, and how do we connect all that. At the end of the day, from a service fulfillment perspective, somebody has to do the hardest of the hardest jobs, which is providing care, right? 


There can be a lot of layers that will be created on top of all that. Providing care is still the most important thing health system really can take, okay? There are maybe a way to connect with better and different way but to your question, I think starting from consumer need, understanding where the provider capacity is all about and what the provider is trying to do in this space will help connect the dots on that.


[0:06:31.1] BR: One of the things – so Texas Health Resources has done a good job of actually aggregating your consumers and having a conversation with them. What are you hearing from the consumers when you sit down with them or when you do focus groups or when you do the other methods that you listen to the consumers, what are you hearing from them that they want from a health system?


[0:06:51.2] SB: I think there are a couple of things that comes out, right? One is, they still think about the way they connect with the health system, right? It is still hard. Though we can talk about seamless experience but it is still hard for them. Repeatedly, we’re hearing that the entry, barriers of entry is still there. It’s very hard to schedule things. It may look mundane but being able to schedule things correctly, being able to connect with somebody, connect them in the right time is still a big issue. There’s a need that consumers are talking to us all the time. 


Second is cost transparency. It is about, what is the cost they’re going to pay when they come in. It is big on top of their mind. 


The third is the ability to understand, in advance, before they come and interact with us, what they can expect, right? There is a huge amount of question around, “I’m going to come for this, what do we expect as a service?” Right? Those are some of the top things that we are hearing.


We also are hearing about the ability to be in the system and be within the same premises and being able to do multiple things, right? It is all going beyond the point of interaction is a need that consumers have. Being able to meet their needs in their schedules, able to meet their needs in their timelines is something that we are hearing all the time from consumers.


[0:08:08.2] BR: It’s interesting, those same things that you’re talking about, those are the things that we’re hearing. When you look at the Amazon Care announcement this week, I went on to their website to look at what the offering is. They are only offering in the state of Washington so you don’t have to worry in Texas for competing with this just yet but it’s interesting, it’s all around that friction.


It’s reducing the friction so you can get a same day, tele-health appointment with a physician and have a conversation, you can text a clinician of some kind, you know, nurse practitioner all the way to the doctor and have a conversation. You can have meds even prescribed over the tele-health visit and it’s Amazon so they use PillPack and they can actually deliver it. When you look at that experience, what they do is, which is interesting and easier, I think, than a health system is – 


They just took one experience, they packaged it up real nice, and then they took the offering out and they’re just piloting it in the state of Washington but that’s how they’re doing it. Are we able to do the same thing in healthcare? Are we able to just take one experience and say, “All right, they’re asking for this. Let’s do this in this one area and get it out there and get feedback.” 


[0:09:21.0] SB: Well, I think it is possible and it is something that is not – it’s not something that we cannot do but at the end of the day, if you look at Amazon Care model, the one that you explained, it is family for the employees, right? It is a one-pair self-funded employee plan where there is no questions of reimbursement and things like that. I think the biggest thing that we have to figure out, you know, our health system, is really creating those experiences where we have a way to do this in Epic and EMR and the way the team works, right? 


I think, when I look at the whole spectrum here, experience can be packaged but experience has to play with our box of whatever old box we have which is with the EMR, the documentation [inaudible 0:11:00.0] that we have, the way we – our billing and reimbursement is set up, the rules and policies that are set up. I think those things have to be figured out to really create those experiences that are meaningful to consumers.


I think we as a system have started figuring that out, we are hiring [inaudible 0:11:13.0] out for us so that we can create all that. It’s a possible – it’s a very possible game.


[0:10:26.5] BR: I’m going to come back and ask you about when you guys have had, or areas where you’ve been able to move the needle forward but let’s start with this question. Who are the key champions within the health system that you have to work, or not have to work with, but you choose to work with that see the vision for a consumer experience, they’re excited about a vision for consumer experience, and they help you?


I think people think, “Hey, we hired a chief experience officer, we’re done here,” but really, you’re a convener, you bring a lot of different people and groups together in order to solve the problem. Who are the key champions internally?


[0:11:04.4] SB: Great question. I think the way we have done it a little bit different. We have for last couple of years, two years, we had been very deliberate in terms of creating the mind share across the company, in terms of why consumer experience is important, right? That mind share was grown over the last two years and then we had to reorganize ourselves in a way the new business is going to implement.


If you talk to me today about the key champions, all the business unit leaders are leaders who are supporting this initiative to really ensure that we [inaudible 0:12:30.0] We do not have a question saying ‘why?’ we have a question saying, ‘what?’ and, ‘how?’ The ‘why?’ part has been tackled in a very different way. 


I think that’s one of the best practice in my mind saying – you have to stop, spend that time to create that mind share, before you can start figuring out how the wallet share is going to happen and how do you execute that. Today, I think all the hospital presidents, all the channel leaders and all the business industry leaders, they are pretty much in the same place in terms of why consumer experience is important, why should we be driving this, and how they can support. We do not have the challenge here so we are in a different place than most of that systems.


[0:12:18.5] BR: Yeah, that’s fantastic. Let’s go to when, how long have you been there now?


[0:12:23.7] SB: Two years.


[0:12:25.5] BR: Two years. We expect huge wins out of you in two years now, it’s health care, it doesn’t move that fast, takes a little while to get your feet under you but what wins have you guys seen over those two years, what have you been able to do around this experience? 


[0:12:37.8] SB: Yeah, a couple of wins that we had, number one, we had created some service which is text based service, SMS based service for people that are come into our EDs and then get released out over our EDs to really get them support so that we can reduce readmissions, and know exactly who to bring in front of our EDs. All the ED population, the people that come to our doors, we have been able to come on and serve.


That has been a great service for us that we have created as a part of this effort. The second is, we are tracking pretty good on the virtual care side, we are kind of releasing our virtual care for our primary care and our hospitals. That has all happened in last two years. We want to go more deeper into the virtual care within hospitals as well to really create the interpreted virtual strategy for us that we want to connect together. That has been in big success for us. 


The third is really ensuring that we understand what different kind of services we need to tackle chronic conditions, right? For example, heart and vascular chronic conditions, COPD, CHR. We are talking and releasing our certain services for them for those patient by more patient monitoring and other things to really kind of tackle those kind of chronic conditions.


All happened within the last two years.


[0:14:02.2] BR: Wow, you’ve got a lot going on. It was interesting, when you started with ED visits and texting, at the Health 2.0 conference we heard a lot of people talking about texting as an extremely powerful platform because almost everyone is connected in some way to an SMS platform, you are able to text. They know how to use it, they do it with their grandkids so we have been able to whatever – they can answer questions that way and interact.


And it is actually interesting to hear some of the digital startups talking about how it is really a more powerful platform to connect with the user community than an app is per say because it is an app that is already on the phone that they know how to use and you guys, that is one of the things that you tapped into early on was this is a platform that we can help to reduce readmissions and whatnot. How did that come about? Did the idea spring out from the ED or was it just conversations? How did that idea sort of germinate at Texas Health? 


[0:15:02.2] SB: Great question. I think it all came from consumer inputs. So we interviewed a lot of people that were in our ED’s and they went back home. They are a part of our forum panels and some of the people basically said it would be good to kind of get help after you have been discharged from ED. We have needs to talk to somebody on [inaudible 0:15:19.9] basis. It came up as a need, right? 


So, what we see is when people with chronic conditions comes to our ED and they get discharged out after, and then to stay here, they typically need to talk to somebody to ensure they are being – they don’t have a company ED and they can do their self-care that is needed at home. So it basically came back from a focus group, to be honest, and that idea came up, we did the love and care of that idea for some time and then really took it very seriously, saying we need to do something on this. 


We gathered a set of emergency traditions on a texting platform in a short way and then created the service and I would tell you this service has been one of the most successful services for us in huge NPS, right? Net promoters produce close to over 90% because people love the service and our volumes are increasing every week as we speak. 




[0:16:18.6] BR: We’ll get back to our show in just a minute. As you know Health Catalyst is a new sponsor for our show and a company I am really excited to talk about. In the digital age, cloud computing is an essential part of an effective healthcare and precision medicine strategy and we’ve talked about it many times on the podcast but healthcare organizations themselves are still facing huge challenges in migrating to the cloud. 


Currently, only 8% of AHR data needed for precision medicine and population to health is being effectively captured and used. That is 8%. One of the things I like about Health Catalyst is that they are committed to making health care more effective through freely sharing what they have learned over the years. They published a free eBook on how to accelerate the use of data in the delivery of healthcare and precision medicine. 


You can get that eBook by visiting and you know, this is a great opportunity to learn how a data platform brings health care organizations the benefits of a more flexible computing infrastructure in the cloud. I want to give a special thanks to Health Catalyst for investing in our show and more specifically, for investing and developing the next generation of health leaders. Now back to our show.




[0:17:32.5] BR: So you know, here is what he hear that is holding digital back, regulatory, we hear payment, you know, how are physicians going to be able to get paid, just payment in general, wallet share, things you were referring to. Technology, you know, legacy environments, and siloed environments. These are some of the things that hold it back, and culture.


Those are probably the four big ones when I do these podcast and talk to different people, that they say, “Hey, here are the things that are challenging for us.” Does that list resonate with you in terms of the challenges to really push this forward as fast as, say, you would push forward a retail company, and which of those do you feel like we can get our arms around and really start to make a difference around? 


[0:18:17.2] SB: Yeah, I think the list is a good list and I think the list is a newest of lists across the country to be honest, right? Everybody has the same problems. The one thing that I did not see mentioned is about people look at virtual and digital to be ‘and/or’ with whatever we do. It has to be an ‘and.’ Digital is not an ‘or,’ it is an ‘and.’ It is a part of the business, it is part of the critical path. So it is very important to think about digital to be an enabler for the business in the way we do business, right? 


And one of the things that people hear me again and again often is saying digital is not an ‘or,’ it is an ‘and.’ I think out of all the four things that you talked about, I think the reimbursement and adoption are the two big ones that we face just because the policies are not well in place in a few things, like for example look at Medicare. Medicare does certain things from a digital perspective but their reimbursement is different and it is kind of changing over a period of time. 


Like there are new links coming up first January 2020, which is different than what we have today. How much it appears they have a different approach in terms of how they approved virtual things, right? It is not a standard set of rules. So I think the reimbursement is a big one that we are trying to tackle. One of the things that we are doing proactively at this point is to look at our bare contracts and figuring out how can we be intentional about negotiating those things in the contract itself, so that it is not left to anybody’s judgment, right? 


And we are doing that and also we keeping a very close eye on CMS because CMS is opening up their doors in terms of virtual and indoor patient monitoring and they are paying for that to be honest, but it is not an at par reimbursement. There is a difference between reimbursing and there is a difference with the reimbursing at par, right? So there is an at par reimbursement situation here saying virtual is not getting reimbursed at par. 


And we are talking to the state here, we also have people that talk to CMS all the time and we are figuring out how do we ensure that they have for reimbursement happens so that we can put and ship the kind of people that really need to get into the virtual care as a part of our care continuing.


[0:20:29.3] BR: So we might solve that gap through Medicaid, is another way that we could – that I guess is why you are talking to the state, but can you help me understand that a little bit? I mean, if you can go into it a little bit more or we can head in a different direction. So there is different levels of reimbursement, is that what I hear you saying? 


[0:20:47.4] SB: Yes, so the way it typically works is the way Medicare reimbursement happens, especially, let us say, let us talk about tele-medicine in general. These two have a rule for something called HPSA, which basically means if you have a healthcare provider shortage area in remote places then they use to reimburse all of that tele-medicine efforts. So HPSA came off the charter in July of 2019, right? It is no longer a requirement now. 


You can do tele-medicine in the city as well. Now, the second turn of the problem is that it is all about ensuring that the tele-medicine visit is as equal to an in-office visit, right? That is what is called ‘at par’ so today, tele-medicine visits are not at par with the in-office visits and there are some of the relations that are coming up in the 1st of January of 2020 when they could be made similar. 


Now the way it happens in our world, there are different levels of reimbursement, like you have EM levels, like one to five, which are levels of reimbursement. Tele-medicine is falling up in one and two instead of five. So what happens is as long as there are regulations to make that as a five, if it is a five visit, then that will become to make it at par. So we are keeping a close eye to CMS and CMS is already considering this to really make certain visits at five, which is at the level five from an EM an import standpoint, that will make things a lot better. 


On the Medicaid side, on the State side, there are different ones as well. You need to have a state licenses for anybody practicing, which is typically the case, but they also have regulations, which they are lifting up right now because the CMS and other federal agencies are coming pretty heavy and high on virtual medicine. 


[0:22:37.4] BR: Since we’re having – I guess an argument can be made that digital should cost less than – it should maybe not be as on par with an office visit because you don’t need an office for starters at rent and all of that stuff, but you still need a digital infrastructure, which is expensive, and IT and the equipment and all of that other stuff to sustain that up. So I guess that is the argument for why it is at par. Well the show is This Week in Health IT. 


So what kind of IT infrastructures is required to get this right and really support a seamless consumer experience across the entire journey? 


[0:23:11.7] SB: That is a great question. So we are rebuilding and relooking at the whole IT stack that we have today because the IT stack that we have today is to service our present or the past, it has serviced our past. So we are looking at a new set of technologies that we can add to our stack or build something new so that we can service the consumer needs that we have. 


I will give you some examples. We are looking at completely brand new CRM system which can act across providers, our businesses as well as our consumers. So we are trying to build a whole CRM stack. We are also looking at the way we collect preferences from the consumers. It has to be in a central place so that we can act on them. We are looking at an open API-based structure so that we can connect with any external ecosystem that we need to. These are new muscle which we never had, and this is –


If you have to really think about it, is a parallel stack that is getting built at this point of time and at some point, will fall back whatever from our past has to come in that stack. That is the path we are on. 


[0:24:19.5] BR: And you really can’t wait for the EHR to say, “Hey we are going to let you,” – let’s take something crazy like food, “and I am willing to give you a listing. I am going to keep track and give you a listing of all the food I eat.” Well, from a health standpoint, that is extremely valuable information, but if we wait for EHR to bring all of that data in that is not going to happen, but, and I am using this an odd example, but essentially, if you have your own stack that sits around the EHR, you can then iterate on that stack and create a place for that food information or whatever the information. 


Again, interesting and silly example but if people are willing to give you that kind of information from their digital tools, from their lifestyle, where they are going for fast food and that kind of stuff, we know that that significantly contributes to health and health outcomes, but the technology today, we don’t have an easy spot to go, “Well that is all where that data goes,” and that is what you are doing. You are building an ecosystem around the existing environment that you have just for healthcare at THR. That is what it sounds like. 


[0:25:24.9] SB: Yeah, absolutely right and I think the key question here is where does the golden source of record really lie? The existing business model is all about putting our golden source of recording Epic, right? That is where EHR used to play in the – where you have a lot of user defined information today. The way you kind of talked about social determinants of health then there are a lot of community partners that can provide us all of that. 


So we are trying to figure out saying there is a world beyond an EHR and how do we bring all of this data together so that we can create a single source, a golden source of information from where this experience can improve because – and it is about aligning those plans with Epic, which is our partner in this case and we have been talking and ensuring that we know exactly what the plans looks like there and aligning our talks there as well. So it is a journey. 


[0:26:17.6] BR: It absolutely is and actually an exciting conversation. I am looking forward to seeing where you guys go. Do you guys partner with other health systems or do like slaughterhouse systems partner with you to get access to your findings and the things you are doing?


[0:26:32.0] SB: Yeah, we do not partner actively today but we are talking to certain health systems right now. There is a health system similar to our size in the same state and there are a couple of other health systems that are not in our state that we are talking to at this point. There are certain things that we can package and it can be meaningful for those health systems and we are looking at an opportunity for us to share and a potential revenue stream down the line as well. 


[0:27:01.1] BR: Fantastic. San thank you for coming on the show. I really enjoyed our time together. Is there a way for people to follow you or do you post? Can they follow you on LinkedIn? What is the best way for people to follow you? 


[0:27:13.7] SB: So I have a LinkedIn page, which is San Banerjee is the LinkedIn page and anybody can follow me there. I typically write blogs that comes out once every month and people can follow there as well. Those are the two ways and I also have a Twitter handle @sanbanerjee and people can follow there as well. 




[0:27:30.7] BR: I really want to thank San for taking the time to join us this week. I really appreciate his insights and his experience and wisdom in the digital space. Special thanks to our channel sponsors, VMware and Health Lyrics for choosing to invest in developing the next generation of health leaders. Please come back every Friday for more great interviews with influencers, and don’t forget, every Tuesday we take a look at the news, which is impacting health IT. 


The show is a production of This Week in Health IT. For more great content, you can check out the website at or the YouTube channel. One of the things that you could do that would really help us out, if you find this show valuable, if you could share it with a peer, someone in the industry, just shoot them an email and say, “Hey I just listened to this show and I think you will get something out of it.” That helps us immensely. 


Thanks for listening. That is all for now.