March 12, 2021: Dr. Karen Murphy, Chief Innovation Officer at Geisinger recently gave a talk at the HIMSS Accelerate Health Series on the four lessons healthcare systems learned going through the pandemic. Flexibility, boosting digital tools, using more data and reforming healthcare payment models. These lessons were learnt at lightning speed. Can health systems sustain this pace? What can leaders do to enhance the long-term wellness of their staff? How will we expand our use of data to drive a higher level of care? How far can we take remote patient monitoring? What strategies will health systems be focusing on in 2021 and beyond?
How COVID-19 will Influence Digital Strategy Post-Pandemic with Dr. Karen Murphy
Episode 376: Transcript – March 12, 2021
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
[00:00:00] Bill Russell: [00:00:00] Thanks for joining us on This Week in Health IT influence. My name is Bill Russell, former healthcare CIO for 16 hospital system and creator of This Week in Health IT, a channel dedicated to keeping health IT staff current and engaged.
[00:00:17]Today, we’re joined by Dr. Karen Murphy. She’s a registered nurse, but she is also the EVP and Chief Innovation Officer for Geisinger Health. And she recently spoke at the HIMSS Accelerated Health Series [00:00:30] conference. She was a keynote speaker and she discussed the lessons learned as we move through the pandemic. And we’re going to cover those four lessons that she shared at that panel discussion. And we’re going to break them down in more detail. A great conversation.
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[00:00:59]Last [00:01:00] week I keyed you in on something that’s unfolding here at This Week in Health IT. We started off with our influencer podcast a little over three years ago, but since then we’ve been able to introduce Newsday and Solution Showcases and last year, We expanded even further with our daily COVID-19 series.
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[00:01:54] All right. Today, we are going to take a look at how the pandemic has and will influence digital [00:02:00] strategy, post pandemic. And we have as our guest today, Dr. Karen Murphy, who is the EVP chief innovation officer for Geisinger. Welcome to the show, Karen.
[00:02:11] Karen Murphy: [00:02:11] Good morning Bill. And thank you very much for having me.
[00:02:13] Bill Russell: [00:02:13] Yeah. I’m looking forward to this conversation, although we are we’re recording on a day where there’s probably a fair amount of snow outside, although that picture behind you doesn’t reflect it. Is did, were, did you guys get dumped on a yesterday?
[00:02:27] Karen Murphy: [00:02:27] I live in the Northeast part of Pennsylvania [00:02:30] and I have two feet.
[00:02:31] Bill Russell: [00:02:31] Two feet. Wow. I talked to my parents they’re in Bethlehem, Pennsylvania, and they were saying that you know, it would normally feel like a snow day, but since COVID, it’s like every day, we’re sort of stuck inside. Well, thanks for doing this. Let’s just start off. You’re you’re new to the show. Tell us a little bit about Geisinger and your role at Geisinger.
[00:02:56] Karen Murphy: [00:02:56] Sure. Well, thanks Bill. So Geisinger is an [00:03:00] integrated delivery network. That means we have a health plan clinical enterprise. Also a medical college we’re located in several counties throughout Pennsylvania. The building you see behind me is our major center, major academic medical center.
[00:03:18] And then we have several smaller rural hospitals scattered in our rural communities. And then finally we have two fairly large platforms in a more [00:03:30] urban Northeastern, Pennsylvania.
[00:03:33] Bill Russell: [00:03:33] Yeah. So tell us a little bit about the Chief Innovation Officer role at at Geisinger.
[00:03:40] Karen Murphy: [00:03:40] So the Chief Innovation Officer role is to lead the Steele Institute for health innovation, and we define innovation as a fundamentally different approach to solving a problem that has quantifiable outcomes. So if it’s not a problem, we don’t work on it because we all know that we have plenty of [00:04:00] problems in healthcare, right? So we concentrate our efforts in solving really big problems.
[00:04:08] And I always say it’s the hardest job I ever had because what we’re trying to do is make a meaningful difference in cost or quality. And as you well know, that is very challenging. So we have in the Steel Institute we housed the data Informatica shop or for [00:04:30] the entire enterprise. We also have a unit that addresses innovative approaches to population health and social determinants.
[00:04:39] We have a care delivery team that is looking at new care models. And we also have artificial intelligence. We have a digital strategy transformation office where we’re leveraging digital strategy to accelerate transformation. And we also [00:05:00] have an intelligent automation hub where we’re building chatbots that has become increasingly important during COVID.
[00:05:07] And then finally we have a unit called the nudge unit. We have a scientist behavioral scientist that really study how we could nudge providers and patients into better decision-making.
[00:05:24] Bill Russell: [00:05:24] Yeah, I’ve, we’ve had that conversation on the show before just the, in until you can get me to [00:05:30] stop going to McDonald’s it’s hard to really influence my care. And as a health system, it’s that behavioral science and the nudges integrated into digital tools that’s going to make that difference isn’t it?
[00:05:45] Karen Murphy: [00:05:45] We hope.
[00:05:46] Bill Russell: [00:05:46] Absolutely. So you gave a talk recently at the HIMSS Accelerate Health Series, it was virtual and online. So but you discussed the lessons, healthcare systems learn going through the pandemic. [00:06:00] Give us a little glimpse into what some of those lessons were that you discussed in the in the talk.
[00:06:08] Karen Murphy: [00:06:08] So from the very beginning Bill, we have tried to look at the silver linings of this very challenging, both professionally and personally. I think everyone has really had a very, obviously difficult times since last night, but we’ve tried to study from the very beginning.
[00:06:26] What are the lessons that are coming out and how do we carry [00:06:30] forward. And not go back to where we were before. So if you think about last March, we, if like March 1st, if you ever said to me, we can transform the healthcare delivery system in a matter of hours and days, I would have said that’s impossible. But we did. And we really demonstrated that we’re a lot more flexible than we thought we were. And [00:07:00] quite frankly, a lot more resilient. So that’s one lesson. I think another lesson is we used to talk about innovation in periods of months, years. We have been innovating since last March in hours and days.
[00:07:15] That’s our time. That’s our time. Right? I think the other lesson that we’ve learned is the importance of data to drive decision-making and the advantages that predictive [00:07:30] analytics. And also other types of digital strategies have really enhanced our response and our ability to respond.
[00:07:40] And then finally, I think it’s crystal clear that the fee for service system that we’re all living under is abysmal. So if you think back what we did in March, we did all the right things to protect our patients, our communities, and our workers. We stopped our elective [00:08:00] procedures. We’ve amped up our care in the home. We encourage community. We provided public health services for our communities and really it was financially devastating. That should not be the case. It should be that we’re always incentivized to do the right thing and that doing the right thing does not does not result in financial peril.
[00:08:28] So we’re [00:08:30] really always have been, but have really increased our advocacy to say, we’ve got to move this payment system to value and become fixated on cost and quality and net on the number of types of services that we’ve rendered.
[00:08:47] Bill Russell: [00:08:47] Wow. So those are great four great lessons, or as you said earlier, silver linings to the pandemic.
[00:08:58] And so those four things, [00:09:00] flexibility, really the innovation around digital tools and the use of innovative tools, using the data much more effectively and healthcare payment models. I want to break those four down a little bit and go through each one. You know in the opening months, in the March timeframe, we really absolutely moved at a speed I’ve never seen healthcare move before. And we moved in that way, almost adopting agile methods, agile [00:09:30] methodologies in terms of, you know, just move. Move fast and adjust. And people were meeting on a daily basis, even an hourly basis in some cases and adjusting what they were doing.
[00:09:42] What strategies do you think healthcare leaders will take to make that a part of the cultural DNA of the organization moving forward?
[00:09:52] Karen Murphy: [00:09:52] So I think it’s been very clear to us that a part of our success was the focus. [00:10:00] So everyone was aligned. Everyone knew our goal was to protect our patients, our communities, our employees. And I think strategically as we move forward, we have to take those lessons of focus and be very clear in our communication that this is what we’re trying to achieve. Because I think the clarity of the message and the focus of the organization really allowed us [00:10:30] to to improve. And to continue to serve the needs that of our patients and our providers as well.
[00:10:40] Bill Russell: [00:10:40] Yes, safety of our employees and of our communities was was paramount and that drove everything work from home, telehealth, remote, remote patient strategy. It was really fascinating to watch. I’m wondering though, if the expectations have [00:11:00] changed? The expectations of leaders and the expectations of board members, that healthcare should be able to,we’ve demonstrated it, you know, do you think they’re going to expect us to move at this pace post pandemic?
[00:11:14] Karen Murphy: [00:11:14] I, you know, I think we’re all going to have to temper. And really the valuate are there moves that we can make that we can make quicker? Can we lighten up the decision-making process? [00:11:30] I don’t think the expectations, this pace that we’re at now, 24 7and now we’re into the vaccine program.
[00:11:39] Yeah, you know, I don’t think it’s sustainable. But I do think the expectations should be really evaluated if we were talking about innovation, for example, there’s no reason to do a one-year timeline, right? We were always going for perfection [00:12:00] in design. I think we have learned to iterate and it’s okay for it not to be perfect to start. And I think we’ll have to compress where we’re able to do so.
[00:12:13] The danger of adopting that universally of course, is that you create chaos because the reason we were able to move so quickly this time is because again, very clear, focused, very clear mission and [00:12:30] really put all the parts together to achieve what we did.
[00:12:34] But I definitely think that there is going to be not only from boards, but I think the public. Will become a demand from us, which they should a much faster response rate and a much tighter communication a much tighter communication.
[00:12:54] Bill Russell: [00:12:54] So it’s a little off topic, but not too much off topic. [00:13:00] The burden that the pandemic has put on our staff, we’re talking about moving faster and, you know, it’s kinda neat on the technology side to say, Oh, look, we’re going to act like Silicon Valley and we’re going to do these things.
[00:13:10] But I mean, since March of last year, they’re spending a significant burden on the clinical staff to expect them to just, you know, move out of pandemic and continue to move at the pace we’re talking aboutt’s is probably going to take its toll. Is that something that you guys are keeping an eye on it? And [00:13:30] what are you thinking about with regard to, you know, just the long-term wellness of your staff?
[00:13:36] Karen Murphy: [00:13:36] So we’re really focused on that for focused on burnout, because I think it’s only natural given the intensity, the sheer intensity that people have been working. I mean, even the frontline workers. Even my team who has been building a lot of these digital tools have been working for months and months, seven days a week [00:14:00] and really trying to respond to the needs of the system.
[00:14:03] So we, I think there’s going to be, you know, there are some things that are going to come out post pandemic that we’re going to have to really work on. And I really think there will be, I hate to say the word PTSD so strongly. But I think there is going to be an adjustment that we’re going to have to make and really a focus on wellness, [00:14:30] mental health, particularly for our frontline workers. And for all that have been working so hard in this game.
[00:14:38] Bill Russell: [00:14:38] Yeah I agree. No human can work at this pace and there’s even some aspects of working at home and being isolated that I think we’re going to look at in retrospect and maybe change the way we’re doing things. But this is, you know, what safety has driven us to have. We’re going to do the right thing and we’ll figure some of [00:15:00] this stuff out as we go I guess.
[00:15:02] I, you know, the second thing you talked about was digital tools and the innovation around those digital tools. I’d love to hear your thoughts on the use of digital tools, but more specifically how they extend care outside the four walls of the health system and really give choice back to the patient. In what specific areas do you think that telehealth and other tools are going to be used outside the health system [00:15:30] following the pandemic?
[00:15:31] Karen Murphy: [00:15:31] So that’s a great question. So if we look at the lessons of the pandemic and what digital did for us, we have, part of the transformation that we were able to make such as keeping in contact with our patients, particularly those with chronic diseases. We were able to do that through virtual health and remote monitoring.
[00:15:50] I think after the pandemic we are going to have to really think about. Where’s the value and identify where the value [00:16:00] is. I think my past experience as a policymaker, you just can’t go to policymakers and say, we just want to be paid on parody fee for service for everything. I think we really have to demonstrate in the post pandemic world where does virtual health sit? Where does it produce the greatest outcomes? Where does it lower the total cost of care? And I think we have to study that because it’s not based on a percentage to say, Oh, you know, [00:16:30] overall 20% of our visits are virtual. I think we have to stay, instead we have found in these use cases that we can really impact outcome and cost going forward.
[00:16:45] So I think remote patient monitoring, we don’t, we can’t monitor every patient. Because we shouldn’t monitor every patient just because we can. We have to figure out what type of remote monitoring transforms [00:17:00] care and delivers higher outcomes. So I think that will be I know it’s something we’re already working on. It’s a post pandemic exercise. I think the other thing that we have figured out is the importance of connecting and knowing our patients very well. So if you I always joke and say, retailers were reaching out to me during the pandemic asking me how I was more than healthcare because they know their [00:17:30] customers and they’re in constant contact with their customers. We have to transform that consumer experience to the patient experience. We have to be available to them. We have to know what their needs are and we have to provide them with a much simpler way than picking up the phone. And get bounced around to 20 phone lines before they actually get the answer.
[00:17:54] So we’re working on digital strategy in three ways or three focus [00:18:00] areas. The first is in the care delivery model. We’re creating a new model of chronic disease management leveraging our case managers with remote monitoring patient reported outcomes that artificial intelligence. We are working in the consumer area of making the journey easier easier to create better health.
[00:18:24] And then we’re also leveraging digital. How do we bring down the total cost of care. What [00:18:30] digital tools are they are, they’re both in business processes and clinical clinical area to say, if we can replace digit, if we can replace some of our roles within the healthcare system. Using digital technology, then we will be able to achieve a lower cost of care.
[00:18:51] Bill Russell: [00:18:51] Is your lens maybe a little different because you’re looking at it because the Geisinger has a health plan as well. Is your [00:19:00] lens a little different because you have a health plan or are you predominantly looking at it through the provider lens?
[00:19:05] Karen Murphy: [00:19:05] So I would say we look through both because all of our payment is met from the guys in our health plan. So I, you know, I think if you take it from a provider perspective, all providers want to be in as great a contact with their patients as they possibly can. I think the areas of moving care to home we certainly can do in a much more [00:19:30] advantageous way because we have the health plan. So we pay ourselves based on a value-based payment.
[00:19:37] So it’s easier for us to do that. But I think when you’re talking about digital, I think it’s excuse me. I think it’s industry wide, I don’t think it’s a provider or health plan. I think all parts of the system have to really look at leveraging digital technology. Okay.
[00:19:54] Bill Russell: [00:19:54] So let’s talk telehealth a little bit. So telehealth. And, you know, obviously in [00:20:00] the behavioral health and mental health space has really demonstrated a significant amount of value during the pandemic. And I think there’s low hanging fruit that we’ve known for years. The follow-up visits and some of those things are obvious. Are there other areas in telehealth that we really saw had excelled during the pandemic?
[00:20:20] Karen Murphy: [00:20:20] You know, it’s really been across the board. I was talking to a neurosurgeon. Last week, you know, you would think a surgical specialist has to have all visits in [00:20:30] person and he was describing how he was able to enhance access and see more patients by leveraging virtual care. So I think, and I go back to my earlier comments of really identifying the value proposition.
[00:20:45] You mentioned behavioral health. We had the lowest cancellation rates that we’ve ever seen in behavioral health. Now that could be because of the needs brought on by the pandemic but it’s also, it’s easier for [00:21:00] patients. More convenient, so they tend to keep their appointments. But I think that, I think there is use cases in almost every specialty that we’ll be able to render us a higher yield, a greater value that will improve access. And that’s one of the things that we’re really focusing on also is how do we leverage virtual technology that will allow us to actually see more [00:21:30] patients and serve more patients in a timely manner.
[00:21:34] Bill Russell: [00:21:34] So remote patient monitoring is another thing that you mentioned. How far do you think we’re going to be able to take that? I mean what level of acuity are we going to do in the home? And what kind of things do you think will be, I don’t know, maybe common in five years that we don’t see today.
[00:21:51] Karen Murphy: [00:21:51] Assuming we’re going to move to value based payment, right? So we have to have value based payment to move to the home. But I think we have discovered, and we have [00:22:00] our guys and our home program that’s around for about three years. And we have discovered that a very high intensity of services can be rendered in the home. So I think if we move to value we will move. We will move more patients home and prevent those hospitalizations.
[00:22:20] You know, we’re administering IV fluid at home, we’re monitoring congestive heart failure at home, that five years ago would have had a five day stay [00:22:30] in the hospital, with very good outcomes. I think again, always in mind, always keeping in mind the total cost of care. I think we have to identify what the value proposition is for remote patient monitoring.
[00:22:44] Just because we can do something doesn’t mean we should. Again, so I think we have to figure out where does it produce the greatest value. And I think the other piece that we can’t lose sight of is patient engagement. And [00:23:00] that is, you know, a 49 year old hypertensive doesn’t really want to call every day to tell them they have high blood pressure.
[00:23:07] You know, they may want to know once a week to send in a blood pressure reading. Whereas the 70 year old with uncontrolled hypertension understands that the consequences could be very grave and they may need a heavier touch with monitoring. So I think we have to figure out the right way to engage patients [00:23:30] in this valuable tool.
[00:23:32] And we have to figure out and design programs according to what the patients are telling us. Like, you know, a lot of times in healthcare we make the mistake of we’re all knowing. And in our innovation lab, we insist that we have patients engaged as we designed so that we don’t believe our own stuff.
[00:23:56] Bill Russell: [00:23:56] Yeah. So the third area, [00:24:00] which is always an interesting area to talk about is the use of data in healthcare and healthcare delivery. And, you know, you noted that the use of data expanded during the pandemic, what have you seen and how has that played out?
[00:24:16] Karen Murphy: [00:24:16] So it’s been tremendously valuable to us internally with operations. So during the first wave, you know, we started out by just reporting the number of positive cases that we that we were saying, then [00:24:30] we pivoted to, we realized. That we saw a pattern and we’re able to predict of the cases that we saw, what is that going to do to hospital capacity? And of course in the spring it was easier because we had all of our clinics shutdown.
[00:24:48] We had redeployed population we canceled elective surgery but that has a cost also. And I mean, a human toll. And that if [00:25:00] patients need open heart surgery, they need open heart surgery. If they need their knee done because they can’t walk, they need their knee done. So we approached the second wave a little bit differently and that was to rely on the data, to predict what we were going to see over the next couple of weeks and really dial down and dial up our elective procedures without canceling them completely based on bed capacity.
[00:25:27] So that has been a tremendously [00:25:30] important. The other piece of studying the data that has been really important is in the area of employee infections. So we were able to hone in by monitoring employee COVID infections. We were able to do contact tracing and really identify behaviors. That we wouldn’t have thought of had we not be monitoring the data behaviors that we needed to really adjust.
[00:25:57] So that would be longer that [00:26:00] degree of communication while people were communicating the virus. Well people were at work. So the data shop was tremendously beneficial for us to learn trending to be able to adjust to capacity. To be able to monitor PPE and really be able to share with the community what we were seeing and really be able to affect a ability based on data. Get that [00:26:30] public service messaging out.
[00:26:32] Bill Russell: [00:26:32] Where there any external data sources that you guys were taking a look at that were maybe informing some of the models you were developing?
[00:26:40] Karen Murphy: [00:26:40] Sure. So we stayed heavily aligned with the Pennsylvania Department of Health, which had very good data analytics. On infection rates because in some of our communities in Danville, the hospital that I’m sitting behind were the sole provider, but in many other communities, there were different testing sites.
[00:26:58] There were [00:27:00] other hospitals. So to really understand community spread, it was necessary to combine those data sources, to understand what potentially was coming down the road.
[00:27:12] Bill Russell: [00:27:12] Interesting. So you know, the last thing is payment models. Payment models is huge and you have served in policy roles within the state of Pennsylvania and whatnot. So it’s an interesting topic to discuss with you. At the JP Morgan conference I [00:27:30] listened to CFOs and CEOs get up there. And they laid out their financials and it didn’t take like an MBA to look at these financials and go what happened between March and May. And the answer to that was the elective procedures went away and in some cases, you know, New York and in other markets the beds were filled with COVID patients but in a majority of the markets, they were not filled with COVID pace patients.
[00:27:57] And there was a significant sort of [00:28:00] body blow to the financials for a lot of health systems. You know, how do you think that’s going to shape strategies going into next year for health systems and maybe even the debate that is going to go on around fee for service value based care and I don’t know, maybe changes to the affordable care act and, and just providing more coverage. Where do you think, how do you think that’s going to [00:28:30] impact that conversation?
[00:28:32] Karen Murphy: [00:28:32] So my hope is that it accelerates it. You know, we’ve kind of there’s a couple of very strong studies right now that are happening. One is in the state of Maryland, which the state of Maryland is a little bit different because it has hospital rates setting, but the state of Maryland has been on a global budget for hospital payment since 2013 and has [00:29:00] produced pretty significant. Say a savings to the public payer. And the reason that is, is because they’re not dependent on what they do.
[00:29:09] They’re dependent on the value that they create. In Pennsylvania, when I was Secretary of Health, we worked with CMS on developing the first national payment model for new payment model for rural hospitals which was a global budget. A multi-payer global budget and actually [00:29:30] based off of the Maryland model.
[00:29:32] And I was on a call a couple of weeks ago with a hospital, a rural hospital that said, had they not had the global budget during the pandemic. Is they most likely would have been closed because to your point they didn’t have a hospital for COVID patients, but they had an empty hospital. But they received a global payment, a fixed payment, sustainable payment that’s predictable throughout the whole year that allows them to transform [00:30:00] into something that’s meaningful and sustainable. So I think if policy makers want to lower the total cost of care and really take care out of the higher payment areas and want to encourage virtual care.
[00:30:19] A higher level of acuity outside of loss at the hospital. We’re going to have to accelerate to value much faster by all payers, not just by public payers. [00:30:30] So I’m hoping it accelerates the conversation.
[00:30:33] Bill Russell: [00:30:33] Do you think the leadership for this is going to come from the state level or the federal level? I mean, during the. Obama administration. We had a bundled payments and I would assume that that’s going to come back again under the Biden administration. But what you just described is what Maryland did and what Pennsylvania did do you think we’ll see from the state level?
[00:30:54] Karen Murphy: [00:30:54] Yeah, it really has to come from both. And it really has to be principles that are [00:31:00] brought in by all payers. So we live in that world now, right? Every hospital lives in a piece of value. And a piece of fee for surface, and we’ve got to get those reconciled. And I think, Medicare is a leader in our markets and the state has control over Medicaid and they also have some regulatory authority over insurance companies through their insurance commissions.
[00:31:28] So I think for [00:31:30] policymakers, it’s a federal and state, it’s not one or the other. I think it’s both. And I think also it’s commercial insurers that have to take a look, the chassies are built on fee for service. So the transformation to value is just going to have to accelerate.
[00:31:52] I mean, I think payers are going to have to say five years stake in the ground, [00:32:00] we’re moving to value. So that by year 2026, you know, we’re paying on a value based payment.
[00:32:08] Bill Russell: [00:32:08] Yeah. You know, it’s interesting because, we talk about the financial chassis and the models and that kind of stuff, but really it boils down to, one is being paid to take care of the sec. And the other is to keep people well, I mean, at the end of the day.
[00:32:25] Karen Murphy: [00:32:25] That’s right. And to keep people, even though they are sick, not to [00:32:30] have them in the highest level of service just because they’re sick. There are, we can treat illness outside of the four hospital walls.
[00:32:40] Bill Russell: [00:32:40] Yeah, absolutely. Well, this is, you know, I appreciate your insights and your experience going through the pandemic. And I really want to thank you for taking the time to come on here and share it with us.
[00:32:52] Karen Murphy: [00:32:52] Thank you. It’s been my pleasure Bill.
[00:32:55]Bill Russell: [00:32:55] What a great discussion. If you know someone that might benefit from our channel, from these [00:33:00] kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to this show. It’s conference level value every week. They can subscribe on our website thisweekhealth.com or they can go wherever you listen to podcasts, Apple, Google, Overcast, which is what I use, Spotify, Stitcher. You name it. We’re out there. They can find us. Go ahead. Subscribe today. Send a note to someone and have them subscribe as well. We want to thank our channel sponsors who are [00:33:30] investing in our mission to develop the next generation of health IT leaders. Those are VMware, Hill-Rom, StarBridge Advisers, Aruba and McAfee. Thanks for listening. That’s all for now.