Tuesday News Day - This Week in Health IT
April 20, 2020

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April 21, 2020: Welcome back to another Tuesday Newsday! This week we are covering a few stories reflecting on the current pandemic and these include perspectives from some leading CIOs in the space with insight that you are not going to want to miss. The first piece we we look at was published by AHIP and features a study by Wakely around the potential financial costs of the COVID-19 crisis. These range from around $50 billion to $550 billion, so the range is still wide and one might say the findings are not very clear as of yet. Then we turn to an article on the problems many are experiencing with their health insurance currently. At this point many of the population have lost their coverage and this shows no signs of slowing down; this is a crisis on top of a crisis and obviously could not come at a worse time for those affected. The last article we look at comes from Beckers and focusses on perspectives from several top health systems CIOs, where they were asked to share lessons and advice borne from this time of crisis. A number of these CIOs have been guests on the show and Bill shares a bunch of helpful insight that is featured in the article, so make sure to stay tuned for that part of the episode! 

Key Points From This Episode:

  • The predicted costs of COVID-19 to the healthcare sector; a study by Wakely.
  • Intersecting issues of the pandemic and health insurance — who will lose their coverage?
  • Anger over the way financial aid is being dispersed to hospital during the crisis.
  • How these financial concerns affect everyone in the healthcare technology space. 
  • The message that health leaders should be taking from this pandemic: strategies come from the business!
  • Beckers’ survey on top health CIOs and their priorities and advice amid the crisis. 
  • The integration of IT with the rest of a healthcare organization.  
  • Great responses from carriers for the necessary increases in bandwidth for healthcare.
  • The inspiring and creative uses of technology we have seen across the board.
  • Areas in healthcare that should receive a renewed emphasis; efficiency, interoperability and more.
  • Amazing feats in communication and other success stories from this crisis.

News Day: Cost of Covid – Business of Healthcare – Learnings Thus Far

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News Day: Cost of Covid – Business of Healthcare – Learnings Thus Far

Episode 230: Transcript – April 21, 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.

[0:00:04.5] BR: Welcome to This Week in Health IT, it’s Tuesday news day where we look at the news which will impact health IT. Today we’re going to take a look at, well, we’re going to take a look at the financials of healthcare, real quick, because it’s important and then we’re going to take a look at what 6 CIOs said were their top priorities and key advice during COVID-19. These are 6 CIOs that we did not talk to on the show so I thought I’d take a look at what they were saying online and in the news. 

My name is Bill Russell, healthcare CIO coach and creator of This week in Health IT a set of podcasts, videos and collaboration events dedicated to developing the next generation of health leaders. Are you ready for this? We’re going to do something a little different next week for this show. We are going to go live at noon Eastern, 9 AM Pacific, we will be live on our YouTube channel with myself, Drex DeFord, Sue Schade and David Muntz with StarBridge Advisors to discuss the new normal for health IT. With you supplying the questions with a live chat during the whole thing. I’m so excited to do this and I hope you will join us. Mark your calendar. Noon eastern, nine AM pacific time on April 28th. We’re going to do our news day show live. 

There you go. This episode and every episode since we started the COVID-19 series have been sponsored by Sirius Healthcare. They have really reached out to me and to see how we might partner during this time and that is how we’ve been able to support producing so many daily shows over the last couple of weeks. Special thanks to Sirius for supporting the show’s efforts during the crisis. It’s Tuesday news day, and here is what we have in terms of news.


[0:01:45.2] BR: We have a couple of stories. AHIP, COVID-19 Study Could Cost Healthcare 556 Billion Dollars Over Two Years. Intersecting US Epidemics, COVID-19 and Lack of Health Insurance. Furor Erupts — Billions Going to Hospitals Based on Medicare Billings, Not COVID-19, these are three stories and then the last one I already discussed that we’re going to take a look at is Beckers’s story which has some quotes from some different CIOs, want to take a look at those.


American Health Insurance Plans, AHIP. Released a study that COVID-19 could cost healthcare 556 billion dollars over two years and let me read some of this for you. “To get a more complete picture of what COVID-19 costs could be, AHIP retained Wakely a consulting group to explore the potential cost implications of COVID-19 testing and treatment to US health insurance providers for 2020 and 2021. Weekly estimated that the cost to the healthcare systems for COVID-19 could range from 56 billion to 556 billion dollars over the next two years.” 


I love when they do that with the headline. “It could cost 556 billion.” Of course the range they give is 56 to 556 which is a wildly huge range by the way and it shows some of the challenges with doing these studies right in the midst of the crisis. “The risk and impact of COVID-19 are unprecedented and we are learning more about its true impacts every day. Actual outcomes will differ depending on the things like number of Americans who become infected but are asymptomatic, the impact of intervention such as social distancing and the availability of testing.”


Hospital cost could exceed Wakely’s estimates. If average, intensive care stays are longer, more expensive or require more services than estimated in these models.” In other words, I’m sorry, I’m highlighting this because it’s a very real thing, there will be significant costs but I’m readying this study, this is having been a consultant for many years. I’m reading this and sort of giggling because it’s the quintessential, “You asked me you do a study, I did a study but hey, the range is really broad and it could be even broader if some things change.”


Wakely’s findings are based on the data and information available on March 28th which gives you an indication of why they’re struggling as we know, the numbers have been changing pretty dramatically through the course of this pandemic. As a COVID-19 national emergency continues to evolve, AHIP and Wakely will revisit these findings and provide updates as needed. The report considers the impact of COVID-19 to commercial Medicare advantage and Medicaid managed care plans, assuming a 200% infection rate among the study populations the report estimates that more than 50 million Americans will become infected with at least 5.5 million requiring hospitalization, of which 1.3 million will require intensive care. for each person admitted into intensive care, cost on average could exceed $30,000. Please see the full report.” 


And they have a link to the floor report. They also go in to talk about out of pocket costs, so what about out of pocket costs? The report also considers the potential out of pocket costs consumers could experience for COVID-19 care. “Wakely estimates enrollee cost sharing would on average be approximately 14 to 18% of annual allowed costs on average across lines of business model and would range from 10 billion to 78 billion. This figure does not take into account announcements made by health insurance providers that they are waving out of pocket costs for COVID-19.” 


Which is a pretty significant number of them that have waved those costs by the way. Be interesting to see how that comes out. That’s the first of a financial picture that I’m trying to paint here, so here’s the next one. Intersecting US Epidemics. COVID-19 and Lack of Health Insurance from the Annals of Internal Medicine. April 7th article. “A report published in the Annals of Internal Medicine estimates that more than seven million Americans could lose their employer sponsored health insurance during the COVID-19 pandemic. More than 1.5 million Americans have already lost their health insurance and 5.7 million are projected to lose their coverage by the end of June.”


All right. That’s the second thing, right? We have significant cost to the health systems, we have a whole bunch of Americans getting closer to 20% unemployment, that are going to be without health insurance, employee sponsored health insurance. Finally, for those who are saying well, you know, the government is going to throw money at health systems because they wouldn’t – couldn’t possibly not support them during this time. And they did, right?


There was 30 billion dollars in the original cares act and here’s what happened, Furor Erupts, Billions Going to Hospitals Based on Medicare Billings, Not COVID-19. They quoted an executive – well, they have a whole thing about an executive in Florida and it says, “Executives at beleaguered systems are blasting the government’s decision to take a one size fits all approach to distributing the first 30 billion dollars and emergency grants.” 


[0:07:06.8] BR: “HHS confirmed Friday that it will give hospitals and doctors money according to their historical share of revenue from Medicare programs for seniors. Not according to their coronavirus burden. This method is woefully insufficient to address the financial challenges facing hospitals at this time, especially those located in hot spot areas such as New York City region. Kenneth Rasky, CEO of the Greater New York Hospital Association said in a memo to association members.” 


“States such as Minnesota, Nebraska, Montana, which the pandemic has touched relatively lightly are getting more than 300,000 per reported COVID-19 case in the 30 billion dollars, according to the Kaiser Health News. On the other hand, New York, the worst hit state would receive only about $12,000 per case. Florida is getting $132,000 per case, Kaiser Health News, relied on the state breakdown provided to the house ways and means committee by HHS along with the COVID-19 cases tabulated by the New York Times. 


All right. A lot of stuff around financials. Why am I talking about financials, this is called This Week in Health IT. Well, you know what? The reality is the financial picture has changed for every health system. Now, more than ever, it is important for CIOs and other IT leaders to understand the impact and start to consider the ramifications. We’ve just been asked to summit this huge mountain and you know, in response to the coronavirus, right? We stood up telehealth, we stood up work from home, we’ve done a lot of just amazing things and we should stop at the top of that mountain, put our arms around each other, take it — well, six feet apart, take some pictures and enjoy the view but we’re going to have to come down from that summit and that’s what I started to talk about starting last week.


[0:09:02.0] BR: You know, we need to try to figure out the new normal for each health system, right? We’re going to be returning. If I can use that mountain analogy, we started from a base camp, we went from the top of the mountain but we’re going to be returning to a different base camp than the one we started out from.


Trying to figure out what the new normal is for your health system. What base camp are you going to be returning to? Most health systems will be – they’re generally conservative organizations coming out of this but there are going to be other that are going to have the opportunity to be aggressive, right? It is widely considered to be truth that large health systems will weather the storm better than smaller health systems and I’m not sure that’s really true. Large health systems have more resources. That is absolutely true and some smaller systems don’t have enough resources and they’re going to really struggle but you know, large systems also have more liabilities. The operative word there is the word more. They’re bigger and less nimble.


I was with a company that went through Chapter 11 and one of the mantras I got really tired of hearing, coming out of this was ‘cash is king’. Well, in coming out of this, access to capital is going to be the king coming out of this crisis. Strong business leaders will understand that this crisis opened up a rare opportunity in the market.


[0:10:22.9] BR: You know, you get to place bets coming out of this if you have the capital to DoIT and while a bunch of emphasis over the past couple of years has been on internal efficiency, I believe that MNA activity and consolidation is going to be really the new order of the day coming out of this. You know, what is the message to health IT? Strategies come from the business. The business environment changed dramatically, understand the business environment and its impact on your health IT strategy. We’re coming down to a different base camp, start to evaluate, how your system is thinking about the new norm and the new environment that we are walking into. Just something to consider as we come out of this. 


All right. You know, not everybody came on  this show per se. Some of them actually didn’t have time and so what they did is they responded to some emails. A lot of these articles that get written, as a CIO, I used to receive some of these request, they’d say hey, we’re going to do an article. Can you answer these three questions and it’s a lot easier to sit down at your desk and just answer these three questions and you send them back and voila, you have an article.


[0:11:41.9] BR: I think that’s the case here. I’d be surprised if it wasn’t the case here. This is a Becker’s story and it’s called The Difference Makers During This Surge. Six CIO’s on Top Priorities and Key Advice Amid COVID-19. A couple of people are quoted here, none of them have been on the show. Nope. Let’s see. No, actually, two of them have been on the show but not during the COVID crisis. BJ Moore has been on the show, CIO of Providence and Tom Barnett, CIO for University of Rochester Medical Center has been on the show. So I am going to touch on some of these, I think they did a good job answering these questions. 


So three top priorities during COVID-19. “Enhancing,” so this is Jeffrey Sturman, CIO from Memorial Healthcare System in Hollywood, Florida. Top three priorities, “Enhancing and rapidly pushing out or existing telehealth capabilities.” We have heard that over and over again and that is true. Helping to coordinate consistent and constant communication with our patients and consumers via any and all technology means.” 


“That includes websites, text, emails, bots, telephone and even manually while also helping the facilities communication to our internal healthcare staff through video conferencing and all other traditional means.” I love that, I think that has a lot of great insight in that early on we were sort of looking at this but I was hitting websites early on that were way behind the curve. I mean we should have had things on our websites early on. 


We should have been redesigning them, this is going to be something we consider as we come out of this is do we have the ties between marketing and IT and even some clinical information? Do we all have those ties together so that we can produce the websites and the texts and emails that are going to go out and stand up the bots that we need. A great observation by Jeffrey Sturman there and then he had, “Designing automated screenings, scheduling and results notifications process for our local, regional and state representatives in testing of COVID-19.” 


The thing I hope comes out of this, by the way, is we just stood up these things for COVID-19 that we have struggled to stand up for I don’t know, a decade, you know, quite frankly. Getting those test results back in a timely fashion to our patients. This should be something that we had done a long time ago. So those are three of his top priorities. His key advice, we need to all remain extremely flexible in these uncertain times and we are used to running projects across our diverse settings. 


[0:14:20.7] Our IT teams are often times helpful in coordinating and facilitating major initiatives and we are certainly in the midst of major activities in dealing with COVID-19 and IT can help to keep things in controlled, finally we are all in this together. The thing I like about this statements, the key advice statements is it talks about the integration of IT. If your IT team is technically integrated with the other parts of the organization with marketing, with the leadership team. 


With the clinical side, we’re generally tied in pretty well with the clinical side because we are doing some of the EHR projects. But we need to be tied in with all aspects of the business and he really highlights this. BJ Moore, we are starting to see, BJ Moore, vice-president EVP CIO of Providence, “We are starting to see the benefits of our progress that we have made standardizing our systems and tools, moving to the cloud and simplifying the environment. Having most locations on the same instance of Epic for example, has been critical in helping us drive rapid response to changing these having Office 365 and Teams rolled out. The majority of our caregivers have also made a big difference in our ability to maintain productivity.” 


“This together with improvements in network capacity and VPN are allowing us to enable work from home for a broad range of clinical users.” I thought it was interesting. A couple of the CIOs came on and did talk about the fact that even though they may not have predicted the level of bandwidth they needed, the carriers really stepped up in this case. It was a phone call or two expedited contracts and things were turned up in days that it would normally take weeks or even months and kudos to the carriers out there who recognized the situation that we are in. They prioritized the bandwidth to the health systems during the crisis. 


[0:16:11.5] You know BJ really focuses in and if you spend any time with him you know he’s a big platforms guy, cloud platforms, platform tools as well, Office 365, Teams. We have seen Teams use pretty effectively in this crisis as well and not only four managing projects and managing your work from home teams but also we have seen it for clinical rounding and some other things but people are being really creative with this. 


I think Teams is going to be one of the big winners out of this. I think Microsoft is going to be one of the big winners out of this, if there are winners. I mean clearly this is a pandemic, there are people dying and those kinds of things but I think we are going to have new learnings out of this. We are going to be stronger out of this. And one of the things is that we are experimenting and learning how to use some of the tools that we had in our arsenal for years. 


And we recognize the need for that in the crisis and sometimes you only recognize it in a crisis and bring it to bear. So some great stuff from BJ, his key advice, “Important to have a strong leaders engaged across the board driving varying attempts in coordination in this kind of situation. It is very easy to have many well-intentioned efforts at odds with each other, which can result in a waste of time and resources. It’s important to have well-functioning command and controlled structures to manage the response also having to enable business processes and roles that are traditionally performed at the office setting versus home has to write valuable insights for our advice strategies. For example, using laptops instead of desktops and so forth.” Again, great insights. Appreciate BJ talking about those things. 


[0:17:59.1] Laishy Williams-Carlson, CIO of Bon Secours, Mercy Health out of Cincinnati. “Our top three priorities to support clinical operations include rapid changes to our Epic instances to build COVID-19 dashboards.” And we have talked a fair amount about that on the show and a lot of great work has been done there. “Build,” let’s see, “There’s was the to build COVID-19 dashboards and registries, build and configure repurposed inpatient care units and support changes in accessing records.” 


Number two, “Deployment of technologies supporting a new purchase to care such as workstations on wheels located for isolation rooms and rapid expansion of virtual visits.” I am not going to touch on virtual visits. We have touched on that a couple of times but the organizations that have a single instance of the EHR regardless of what that is, I am not a proponent of one versus another but if you have a single instance of your EHR across your health system, I think you have a huge advantage going into this crisis and I think it is going to be one of the things that gets evaluated. If you are a system that is trying to do a multi EHR strategy and you had not progressed far enough along in terms of your ability to have those integrated and the data sharing, the ability to do screens across multiple things. Across multiple instances. I think you recognized the significant weakness of that strategy. 


You either need to sure up your ability to do that or you need to adopt a single EHR strategy across the board. And then the other thing I think we saw is creative uses of technology. You know we saw cameras taking temperatures of people. We saw iPads in rooms. We limited the number of times that people have exposure to COVID patients. A lot of really cool thoughts on that. So Laishy’s key advice, the biggest need for technology resources and budget to support caregivers is additional mobile devices and new configurations to support constant innovation and new use cases.


[0:20:06.6] “The partnership of clinical informatics and IT has never been more essential to assure we meet caregivers’ needs. I would like to commend many of our vendors who have stepped up to say what do you need and have partnered with us to get the equipment and assist us in building out solutions.” 


Zafar Chaudry, Doctor, Senior Vice-President, CIO of Sales at Children’s, “My priorities include maintaining a stable and resilient remote working platform technology. The mental health of my employees, keeping clinicians — clinical services supported so that they can continue to take care of patients in pivoting.” Key advice, “COVID-19 is going to have a long term effect on how healthcare organizations look at their costs, how they shift delivery of care away from the medical centers and how they pivot to virtual moving forward. Healthcare systems must re-evaluate all aspects of how the deliver care and makes sustainable plans to put cost improvement programs into place throughout all clinical and non-clinical areas. Healthcare systems should plan to reduce back office cost including IT, human resources and revenue cycle also.” 


I think it is interesting that is one of the reasons I focus on those three financial stories. I think Dr. Chaudry appropriately points out that the new norm is going to be one where we put a renewed emphasis on efficiency and renewed emphasis on interoperability. And renewed emphasis on financial management and cost reductions I think are going to be a par for the course. 


And then Tom Barnett, University of Rochester Medical Center, “Our top priorities tended to shift very quickly once COVID-19 takes center stage, as a result the teams shift the priorities to those that immediately supported the health system including scaling up our ability to support work from home scenarios, expanding telemedicine, provide connection with our patients.” 


[0:22:07.3] “And focusing on our expenses both operating and capital to assist the organization through these challenging time. I’m extremely proud of how great IT leadership team, our great IT leadership team that is staying synchronized with our operational leadership.” The other thing I will point out just from doing so many of these show over the last 30, I think we have done 35 or 36 of these shows and talk to different CIOs. 


It is amazing the things we have been able to stand up in the last 60 days in terms of communication. We have created this cadence, this rhythm of communication that I don’t think we had or at least we didn’t have it as often and a lot of times we ended up with a miscommunication or gaps in our communication because we didn’t have that stood up and it will be interesting to see if we can maintain those communication rhythms, those communication cycles or the cadence of communication and the clarity that has come out of this. 


Now I realize part of the clarity is because on the focus of COVID-19, but perhaps from this we will have experienced what focus feels like for the health system and we can take it forward with us. So I wanted to touch on that story, some great wisdom, some great insights from those leaders. 




[0:23:26.7] BR: That is all for this week. Special thanks to our sponsors, VMware, StarBridge Advisors, Galen Healthcare, Health Lyrics, Pro Talent Advisors and Sirius Healthcare for choosing to invest in developing the next generation of health leaders. The show is a production of This Week in Health IT. For more great content, you can check out the website at thisweekhealth.com or our YouTube channel as well. If you want to support the show, the best way to do that is to share with a peer. 


Send an email or let them know, however you do it that you get value out of this show and that will really help significantly. We’re going to be back again for more episodes through the entire remainder of this week and don’t forget, live next week. In fact, I didn’t give you the URL, it is thisweekinhealthit.com/live. That’s right, it’s that simple or thisweekhealth.com/live. They both go to the same place.  Thanks for listening. That is all for now.



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