Newsday – Hiring a CMO, Price transparency and 2021 Health Tech Predictions
February 1, 2021

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February 1, 2021: Dr. Sanaz Cordes, Chief Healthcare Advisor at World Wide Technology joins Bill for the news today. What is the number one thing she learned being an entrepreneur? What advice does she give to health tech startups? What’s the next frontier for remote patient monitoring? How do we scale teletherapy? What do we learn by putting up quick solutions that may not be sustainable? Plus the 4 different types of CMO roles and how to hire them, AI, machine learning and 2021 predictions. Is this the year that social determinants efforts will shift from aspirational to operational? And will the federal health emergency funding last another 10 months?

Key Points:

  • Who knew that the EHR implementation and meaningful use would drive so many physicians into the technology world? [00:02:52]
  • Your ultimate guide to hiring doctors into digital health [00:08:35] 
  • Price transparency was unheard of five years ago [00:19:10] 
  • Consumers will be in the driver’s seat in 2021 [00:27:27] 
  • 2021 will be a pivotal year for machine learning and artificial intelligence [00:32:00] 
  • Alternative treatments for ADHD, substance abuse, mental health and insomnia [00:44:15] 
  • There’s going to be a return to bundle payments [00:45:40] 
  • World Wide Technology


Newsday – Hiring a CMO, Price transparency and 2021 Health Tech Predictions

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Newsday – Hiring a CMO, Price transparency and 2021 Health Tech Predictions

Episode 359: Transcript – February 1, 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] Welcome to This Week in Health IT. It’s Newsday today. We have a new sponsor. We have a new co-host. We have a lot of new things. We’re going to talk about the transition for a CMO to go into health tech. We’re going to talk well, actually, we’re going to break down some predictions, make some predictions of our own.

[00:00:22] And we’re going to talk about the transparency rules. So we’ve got a lot to talk about today. Looking forward to it. My name is Bill Russell, former healthcare CIO for a [00:00:30] 16 hospital system and creator of this week and health it a channel dedicated to developing the next generation of health IT leaders.

[00:00:37] If you want to be a part of our mission to become a show sponsor, you can do that. Just send an email to [email protected] Today we have a new show sponsor and I’m excited and they join our existing show sponsors. We have Worldwide Technology and platinum partner, Intel, Health lyrics and Sirius Health care.

[00:00:57] They are our Newsday show sponsors, and we really [00:01:00] appreciate them investing in our mission to develop the next generation health leaders. The , quick note, we launched a new podcast Today in Health IT. We do one story every weekday morning, check it out. You can subscribe wherever you listen to podcasts.

[00:01:13] All right, let’s get to our new guest hosts. Dr. Sanaz Cordes who is the chief healthcare advisor for worldwide technologies. Prior to that, she has led digital health therapy. She was a part of health venture chief operations and commercial [00:01:30] officer. And is that a pediatrician by training?

[00:01:33] Good morning Sanaz. And welcome to the show. I was so close to saying your name right every time. Sorry about that. 

[00:01:38] Sanaz Cordes, MD: [00:01:38] Got it right. 2 out of 3. Good morning. Thanks for having me. 

[00:01:42] Bill Russell: [00:01:42] I’m looking forward to this conversation. You have a phenomenal background and I’m looking forward to not only having this conversation with you, but introducing you to the community.

[00:01:52] And , you started as a pediatric pediatrician. How, how did you get the technology background? How’d you get into [00:02:00] technology? 

[00:02:01] Sanaz Cordes, MD: [00:02:01] Yeah. So I started out as a pediatrician, pediatric hospitalist with Providence health many years ago practice for a few years yeah. With them. And, , the EHR happened to be quiet, honest with you.

[00:02:15] And I started to see all my colleagues, , very talented physicians start to experience dissatisfaction, , all the extra cooking, , two hours a day. Of extra clicking. And so I thought there’s just gotta be a better way, right? Like you don’t build an iPhone and never put any [00:02:30] apps on it.

[00:02:30] So I kind of went on a quest for my, my own passion, , driving that, to see what was out there. And so that led me on a 15 year pretty , windy career path that brought me here. But yeah, I went in search of, , applications that could actually make workflow better and automate some, some work off of physician’s plates. And that’s how I landed there. 

[00:02:52] Bill Russell: [00:02:52] And who knew that the EHR implementation and meaningful use would drive so many physicians into the technology world, but [00:03:00] it is a great transition. So not only did that cause a lot of physicians stop there, but you then took the leap and went into the startup world.

[00:03:10] What, , how did you, how did you decide to do that? And what’d you learn as an entrepreneur? 

[00:03:15] Sanaz Cordes, MD: [00:03:15] Yeah. So after I did about six or seven years and in larger organizations,  content and, and CPO, we companies back at the time, , back in the day I realized that, , for technology vendors that are building software [00:03:30] solutions, that.

[00:03:30] , sometimes in these larger, larger organizations, things just aren’t moving fast enough. Right. And so with health tech and healthcare needing things happening, , yesterday, because that industry, we have slow enough as it is, I was really drawn to that startup space. And I was really fortunate in my first role to be pulled into some incubator work and yeah.

[00:03:48] Some venture dollars that were set aside by Hearst health care. That was one of my first employers. And yeah, that’s when I met, , three guys in a garage that were PhD dropouts at university of Wisconsin. And, , [00:04:00] after looking at about 30, 40 different companies, it was amazing, , what they were doing at the time with workflow automation.

[00:04:06] And so that’s, , I got the bug and that was helped mint in Madison, Wisconsin led by Jonathan Barron. And yeah, I was with them for a few years and then stayed on and did a couple more startups in Madison. And the most recent was a CEO of a teletherapy company therapy.

[00:04:24] So yeah, it’s been it’s been a great ride, , and you learn something new every day and it’s great to also look back [00:04:30] to see we’ve actually moved the needle, , for folks like me that were crazy enough to, to make that leap. So it’s rewarding. 

[00:04:35] Bill Russell: [00:04:35] Yeah, it’s true. I w what’s the, what’s the number one thing you learned at being an entrepreneur?

[00:04:42]Sanaz Cordes, MD: [00:04:42] What there’s always a way there just has to be. Right. I mean, there’s times you just think there’s no way through this wall. And , the founder actually at CEO at the dot gum therapy taught me like, , who moved my cheese? Like you just, you got to get to the other side and get your cheese.

[00:04:57] Right. And so I always hear that her mantra I’m in [00:05:00] my head, but it’s true. I mean, the highs are high and there. Ecstatic. And they’re wonderful when you get, , that venture capital money wired in after a year and a half journey, but the lows are low, ? And so you just have to keep remembering that. There’s just, there’s gotta be a way. 

[00:05:14] Bill Russell: [00:05:14] Yeah. You don’t even get to ask the question who is my cheese. It doesn’t matter who moved your sheets. You still have to find the cheese. So keep looking right. 

[00:05:20] Sanaz Cordes, MD: [00:05:20] That’s right,. 

[00:05:22] Oh man. So you’re 

[00:05:23] Bill Russell: [00:05:23] now helping organizations through worldwide technology and , where do you find yourself spending your time, these days? What [00:05:30] kind of challenges are health systems focused in on. 

[00:05:33] Sanaz Cordes, MD: [00:05:33] So, yeah, I had the unique opportunity to join worldwide the day, the world shut down with COVID. So last March 26th is when I joined. And, , it was a really crazy time to come into a company like worldwide with such a large footprint and, , healthcare provider, payer side, as well as life science and doing it all remotely.

[00:05:51] And yeah. Doing it where, , your customers are also in a, in a, in a frenzy. So it was a steep learning curve for all of us. [00:06:00] So it’s, it’s been interesting, , my time, the first three to four months, probably like a lot of other, , guests on your show were spent with stop the bleeding, , how do we get tents up?

[00:06:09] How do we get infrastructure put in place for.  The army Corps of engineers to do, , COVID treatments and how do we quickly put up virtual care solutions? We had one organization that called us on a Wednesday and we had them up and running on video for visits by the following Tuesday, , across a thousand different sites.

[00:06:30] [00:06:29] So there was a lot of that, , the first three, four months. And then I was just amazed, , talk about. Moving quickly moving slowly in healthcare, , people moving so, so quickly. And now probably like other folks that you speak to, , it’s, it’s kind of moving in a, in a different direction.

[00:06:45] We realized that a lot of these things are here to stay. So yeah, we’re working with folks. How do we scale teletherapy? What do we learn by putting up the quick solutions that may not be. Stainable what’s the next frontier, , [00:07:00] remote patient monitoring. How do we make that meaningful? A lot of work around AI machine learning.

[00:07:05] I think our organizations especially also in life science have seen the importance of having that structure in place and being able to really drive meaningful use out of their data. And so I’d say yeah, those three categories. And then I think what we’re going to see more of, we do a lot of work with our.

[00:07:21] Application services and AI team with revenue cycle, , and I think when everything’s kind of, everyone can catch their breath, , that [00:07:30] there’s a lot of things to fix that got, , broken there, obviously with, with the financial impact. So we’re starting to see a lot of people kind of planning for that as well, and for the, for this year.

[00:07:42] Bill Russell: [00:07:42] So there’s a few things going on. Well, and that’s, , we’re, we’re doing the CIO interviews and that’s, that’s what I’m asking. One of the questions I ask every one of them is what are your priorities? And it’s interesting that they break it down into two categories. It’s like the priority to get through the pandemic.

[00:07:56] And then the priority to really sustain [00:08:00] the digital games. Cause one of the silver linings from this has really been the digital transformation that we had been pushing for the better part of a decade or more seems to have really accelerated over the last nine, nine or 10 months. 

[00:08:15] Sanaz Cordes, MD: [00:08:15] A hundred percent yup. Things that were on a roadmap, , that were like on a six to 18 month roadmap happened within six to eight weeks now. And it’s amazing to kind of watch that that happened. And I think they’re amazing, , they’re surprising themselves [00:08:30] that they can do that. So it’s, it’s pretty phenomenal. 

[00:08:33] Bill Russell: [00:08:33] Yeah. It should be interesting. All right. So the first we’re going to get to the news. So the news first story was tailor made for you. It is your ultimate guide to hiring doctors into digital health. And Chrissy Farr has moved from from reporting to investing, but she still produces content. And this is a really good one.

[00:08:49] She breaks down the jump from being in medical practice to becoming a COO for a health tech startup. So this is in your wheelhouse, I assume. It is. 

[00:08:59] Sanaz Cordes, MD: [00:08:59] Yeah, I’ve [00:09:00] actually, , when we chatted about this online, I I’ve actually given talks about this to like developer conferences for folks building apps for like all scripts and things like that.

[00:09:10] So yeah. I got to check a lot of chance to chat about this today. 

[00:09:13] Bill Russell: [00:09:13] Well, it’s a, it’s a great, it’s an SEO piece, actually. It’s search engine optimization piece. If you now search for become a health tech CMO, I’m sure this piece is going to rank really high because it answers so many questions. Like, , the types of [00:09:30] different roles and where do you recruit CMOs and, , do you continue to practice or not?

[00:09:35] Right. It answers a bunch of the core questions. So let’s just march through some of these. I thought her first distinction was pretty interesting in that the roles and this wasn’t, she, it was just people she interviewed, they, they talked about the different types of CMO roles that exist. You can have a COO of product, and these are probably one of the more rare, but these are the people who are actually physicians who are leading the product development, roadmap and cycle, and those kinds of things.

[00:10:00] [00:10:00] Then you have the COO of sales and they say, and I agree with this, a majority of the physicians to get hired into these. Organizations end up in seat one, a flying around the country, acting as the spokesman for that product. And I don’t think a lot of physicians know that they’re signing up for that when they sign up for it.

[00:10:19] But that’s, that is one of the roles that ends up happening a CMO clinical operations, the person who bakes it into the clinical workflow and make sure that it’s, , it functions well. And then the [00:10:30] the last one is COO optics and we’ve seen this from time to time. It’s when you hire. The physician really to be the person you roll out at the conferences and they, they write papers and those kinds of things, it’s about, , how it’s about making your product synonymous with , high high minded, clinical studies and those kinds of things.

[00:10:52] So it’s, it’s, it’s connecting you with those two things. How have you seen this? I mean, I I’ve seen all four of those. How have you seen the [00:11:00] COO role in health tech and, , does it fall in these four categories? Have you seen any others? 

[00:11:06] Sanaz Cordes, MD: [00:11:06] Yeah, no, I think this is, this was a great article. I actually kind of, I kind of disagree with a few few of the categorizations from Christine as hopefully, , she, she won’t be listening to this, but yeah.

[00:11:18] , in my experience, I think that the sales COO is the hardest role to find. I mean, in the 18 years that I’ve been doing this, I think I can count on. [00:11:30] Less less than the five fingers on one hand. How many physicians I’ve met that can really get in there and do that sales position. And I think it’s fundamentally the DNA that is required to, to draw someone into, , eight years of university and four years of residency.

[00:11:46] And , if you many years of practice, I mean, that’s a very different DNA than someone who. , it is as a Hunter and gatherer and someone that can actually ultimately, , drive something to [00:12:00] help close. So that’s really I mean, across the board, that’s been what I’ve seen and when physicians are broadened into that sales side of the organization, it, it’s what you’re describing, where I think it’s more of a clinical subject matter perhaps.

[00:12:14] Right. And I think that expert, and I think that that works but a, , I, I think, , we’re trained to be like lone wolves, right? Like it’s not a team sport really to be a physician despite how much movement we’ve had towards,  [00:12:30] patient centered care and people working in collaboration, that’s still solid.

[00:12:34] But at the end of the day at three o’clock in the morning, the diagnosis is still yours to make over the phone or in the ER. And so I just think that it’s been a real struggle. I think for a lot of my colleagues, who’ve tried to make that jump to then, , kind of. What that and say, the center of everything I’m doing is this perspective customer or this customer.

[00:12:51] And I’m going to actually, , listen and I’m going to take in input and , I’m going to be comfortable being disagreed with and and [00:13:00] being rejected, , and having to divorce that my face. And it’s just, it’s just different DNA. So that, that has been my, my observation, 

[00:13:08] Bill Russell: [00:13:08] Put your CEO hat on. And you’re you’re hiring. So, , you’re, you’re gonna hire a sales manager, you’re gonna hire sales organization. You’re gonna put them out there. You finally got your series B and you’re ready to really scale up. But , if you start putting those people out in the field, they’re going to get hammered in those meetings.

[00:13:24] They’re going to sit across from physicians and clinical leaders. And they’re going to say, you don’t understand the EMR or whatever. [00:13:30] So you have to put somebody in a room who, who has the credibility. You can say, Hey, I’ve been in your shoes. Let me tell you how this works. Let me tell you why it’s not able to.

[00:13:39] So you’re not really putting them out there to sell you, just, you really want the sales organization to sell and the sales manager to manage that sales organization to the numbers and get the meetings and that kind of stuff. And you, you really, you really want them in that room to. To be that subject matter expert.

[00:13:57] But I think I agree with you in this [00:14:00] respect. I see a lot of them burn out because they, they, they sit there after a while and they, they, , during their 50th meeting of the week and they’re going, what have I done? I mean, this is, this is not what I signed up for. 

[00:14:12] Sanaz Cordes, MD: [00:14:12] Yeah, and I think it’s so personal too, because when you’ve practiced, I mean, I’ll use health Finch as an example for myself.

[00:14:18] Right. , when I practiced, I did refills all night, , and in the evenings, like that’s what I had to do. And that was our product, , automated refills. And so I had my methodology, I had my, what I think about. Refills what my emotions [00:14:30] are about, about that workflow and my experiences. And so I think as a physician coming in sometimes, and then a sales role, you really need to understand that like your experience, isn’t what that potential customer’s experiences and, and, and holding back that urge to say, you’re doing it wrong, , or like that, that’s not how .

[00:14:48] And I think because when you’re doing, when you’re. Sales. You’re not necessarily the user of the product that you’re selling. Right. When you’re, when you’re a sales individual, that’s not a physician. And so that’s sort of where I’ve seen a little bit of challenge, but. [00:15:00] All that said, I think it’s all about setting expectations and really making sure.

[00:15:04] And that’s one thing where startups, particularly who has time, right. To even, to create a lot of these processes, but I think the more, yeah, you set expectations and let them know, like, to your point, , your job is to sh. To be the expert and to just to be able to relate and, and offer that credibility.

[00:15:20] I think it helps, but it’s hard. It’s hard to find those individuals that are comfortable, , doing, doing that type of role. So, , the other challenge too, is a lot of startups sort of [00:15:30] build the product first and then bring in the clinical folks. And so I think getting someone in early that’s that.

[00:15:36] Physician product expert is just, it’s so important. , I always say there’s like two types of founders. There’s the clinician founder. And then there’s the, , a tech founder and without, I mean, individually, there’s a lot of challenges with them. So getting those folks in sooner is, is, is huge.

[00:15:54] Bill Russell: [00:15:54] No, it’s it. I’ve watched the sales as a startup. I have watched the [00:16:00] sales cycle on this thing. And, and the, the old adage is really true. 80% of your sales are just going to be , word of mouth, essentially. It’s going to be me talking to another health system and saying, Hey, we’ve got this challenge.

[00:16:11] They’re going to say, I use this saying, call this person. That’s a, that’s a majority. And then your, your team has the lead comes from that. And then they go on from there, either that, or your team comes in and then I make the three or five phone calls I’m going to make anyway. And identify the other health systems that are using it.

[00:16:27] But the catch 22 is if you’re a startup, [00:16:30] you have to decide, how am I going to get that reference client? And what a lot of people do is they sell ownership to get that reference client. Right? So you. You end up with , money from Providence money from a Cedars-Sinai accelerator or a Mayo or a Jefferson and that kind of stuff.

[00:16:47] And then you have to grow each one of those halves has their like network of health systems that are looking to them on how, how do we innovate? And so you get a built in little sales thing, but then the next hurdle that you have to [00:17:00] go over is you get, you sort of sell into that whole little swath of organizations, and then you have to break out of that.

[00:17:07] And sometimes these health systems are in competition. So, , as, as accelerators or investors and that kind of stuff, sometimes you see them cross cross, but other times it’s like, nah, we, we have this solution and we’re going to use it because we’re a part of UPMC and, , and and this is what they’re doing. There’s so many barriers to cross. 

[00:17:29] Sanaz Cordes, MD: [00:17:29] There is, [00:17:30] and, , I think really about qualification. So, , my, my whole spiel that I usually going bring into an organization is really setting that engine. And China, I mean, just like health tech itself, automating previously manual workflow. So it can go.

[00:17:45] Smoother better, faster. So as much as you can do that qualification, there’s so many tools out there now, , that you can use to research. And so even knowing that, okay, I’m selling a solution, that’s going to work better in a centralized organization, like a centralized call center type [00:18:00] organization because of the way that product works.

[00:18:02] And then really tying to hone in on finding those. First eliminates a lot of pain, a lot of like duplication of efforts and, and just futile efforts, honestly. And to your point, , landing in a third meeting only to find out that, well, that’s just not going to fit because they’re doing it this way, or they’re already using this product because of the way they’re doing it.

[00:18:20] And so it sounds simple. And you would think, , people probably say, well, everyone qualifies, but. They really don’t, , be able to qualify against, , [00:18:30] these particular things saves a lot of headache as well. 

[00:18:33] Bill Russell: [00:18:33] Absolutely. A great article. She goes on to talk about the cultural challenges and some other things. The it’s it’s out on sub stack, you can probably just search for it by title the ultimate guide to hiring doctors into digital health. All right, you’re going to tee up. Let’s see. What are you going to do? If you’re going to see a price transparency, look forward to this conversation. What do you got?

[00:18:54] Sanaz Cordes, MD: [00:18:54] That’s been near and dear to my heart. We’ve worked with several clients on that pretty deeply [00:19:00] for, for some building, , from the ground up. So it’s an interesting, I mean, I’ve been following that for, I guess, almost a year now. And I think, , it’s really the first chance we’ve had to, , as a nation, try to bring some of those transparency unheard of right. Five years ago, like consumers knowing the prices of their don’t, you just go to whatever your insurance, , tells you to do. So I love that. I think it has the potential to really disrupt things, but of course, like anything that comes from the government , [00:19:30] it doesn’t necessarily go through an outcomes review or an outcomes focused discussion and it gets put in place. And there’s a lot of arbitrary deadlines and things that have to be met without not a lot of focus. And I kind of think about the, , the hit act, right? Like in 2011, the EHR happening so quickly with all this like industry motivation to do this and get stimulus money. And now look where we are with like an interoperability mess, right.

[00:19:55] It’s like 18 years later and maybe we should have thought. It through better when we did that. So [00:20:00] of course there’s downstream consequences, but yeah, no, I think I think it’s, it’s interesting. What we’re seeing, , at worldwide is there are the large organizations where you would look to them and say, they have the luxury of having.

[00:20:14] Staff, , having engineers and resources that can build this because there’s some pretty complex requirements of, , machine readable files. And, , it has to be able to pull this information from multiple applications within your EHR and PR  PM systems. [00:20:30] So you would think, , these large organizations, they have the staff, they’re going to be quicker to do it.

[00:20:34] And what we’ve actually seen is a lot of these large organizations are on multiple instances of BHRS multiple applications for their rev cycle. And so we’re actually helping organizations like that because it’s so much more complex. Those are the ones where you have to build it from the ground up.

[00:20:51] You can’t just use Epic’s price, transparency module, right. Cause you’ve got 18 different instances. So that’s the, , there’s that group. [00:21:00] And then of course the smaller health systems. Don’t have the resources to do it. And and then the ones in the middle that are on one instance of Epic, they’re winning.

[00:21:09] Like I’m seeing where, , I’m going to websites just to do due diligence and the ones that are able to just plug in the Epic modules and customize it or are doing great. But Yeah. I mean, it’s January 30th and we haven’t really seen it being standardized across the board. And I’m kind of concerned of health systems are going to make this deadline.

[00:21:30] [00:21:29] Bill Russell: [00:21:29] Yeah. So help me to understand, is this a dynamic price list or is this something where you could go in and do the research, plug the numbers into a spreadsheet, make it into a machine-readable file and put it out there. 

[00:21:42] Sanaz Cordes, MD: [00:21:42] Yeah, it’s it’s it’s dynamic. I mean, you have to be able to, based on that consumers, health plan, be able to access this information.

[00:21:53] So you’re pulling information from your contracts. Applications up to your negotiated rates with your [00:22:00] payers. You’re pulling information from your charge master, which for a lot of these organizations, there’s a lot of cleanup and work that has to be done there. And then being able to, , display that in a consumer friendly, which is actually like, I think the wording  in the transparency rule format. So it’s. Pretty complicated on the backend, as far as the data sources, unless you’re going to unify a single instance of a lot of these different applications already. 

[00:22:26] Bill Russell: [00:22:26] Yeah. So the, the article goes on and talks about a [00:22:30] handful of things. One is , the, the challenge with this is clarity. They don’t tell you, it’s like, just put it out on your website. Okay. Where do I have to put it on my website? I’d like to be able to hit the 15 websites in this state of certain hospitals pull that information, but I have to find it on those websites. It’s not readily available. And then, , as you noted earlier it has to be in a in a patient friendly format and that’s really [00:23:00] not something that’s really well-defined either.

[00:23:02] And so you end up with some people actually publishing a sheet that you can download and take a look at other people are using their price a tool, an actual tool that you put in some information and it pops some information out. And so there’s a lot, a lot of different ways to do this. I, from where, from where I said that the federal government is doing the press transparency makes perfect sense.

[00:23:25] If you’re trying to drive down costs. Transparency is one of the ways that you drive down [00:23:30] costs. You give me options of where to go and give me transparency. I get that. I understand why the American hospital association is actually fighting this a little bit. I assume they’re finding it because it’s not as clear as it could be and they have to , essentially put their pricing out there.

[00:23:47] I mean, we, we don’t go to Walmart and say, , show us all your negotiated prices. I mean, there’s no other industry w do this in. 

[00:23:55] Sanaz Cordes, MD: [00:23:55] Yeah. I mean, there’s been first amendment challenge arguments around this whole thing. [00:24:00] I think in my opinion, and I’m just now I, nobody, but I think that, , we probably are going to move the needle more if the next rollout of this is upheld, which is an up in the air right now.

[00:24:11] But hving payers do this. Right. Because I think like, if you live in a mid-size to small community and there’s only like one health system and maybe another one an hour away, I mean, it’s great to see like what the pricing has been. Yeah. Do you really have that much control over what you can do with that? Right. I mean, it is. What is your insurance cover? Who’s [00:24:30] negotiated and this where you gonna go? I think it’s, I think it’s good. Just holistically that it’s putting pressure on. Hospitals to examine. Why is a colonoscopy I’m going to make up this number, like $5,000 here and like $33,000 here.

[00:24:44] Right. So that’s good. But I think it’ll be valuable to the consumer is when payers are forced to do that. And I think originally that was supposed to happen like by 20, 23, because then you can really see like, huh, I have Aetna and it’s like $18,000 for this procedure. But look over [00:25:00] here, , a local state run payer it’s $4,000.

[00:25:05] And I think then we’re really creating competition in the marketplace. And I think that in my opinion, that’s, that’s really where we’re also going to see probably more value from this type of transparency. 

[00:25:16] Bill Russell: [00:25:16] Yeah. Well, to a certain extent you get some of that transparency with this, because if they’re showing them negotiated rates to see some of it. But I agree with you that the next round will be more interesting, but then in the story they have, some of that comparison [00:25:30] to high volume radiology code ranged from $90 to 2030 $3. And there’s another Oh, a wound care. Certain wound care was $505 for care first, but $4,138 for Cigna.

[00:25:49] And yeah. And that’s the kind of stuff you only see that through transparency and, , here’s the other thing from a, from again, a startup standpoint, I think there’s a whole bunch of data companies [00:26:00] right now chomping at the bit to get at this information, put it into a tool and, , put it out on the apps to put it out on the Apple app store and say, okay, we now have information, go in and look at these shoppable services.

[00:26:13] And , much, much like a good RX and not going to snuff, you can shop those services. So it’s just a matter of getting everybody to put it out there. 

[00:26:21] Sanaz Cordes, MD: [00:26:21] Yeah, no, I agree. And I think that I I’ve actually read a lot of articles around, , the value of it. And then if [00:26:30] you fold in these, , cause with the payers, that’ll be beyond the shot.

[00:26:33] Like it’s like they’re going to be asked by bank, , by whatever year it’s that held all of their codes  the charges for it. So, yes, I mean, I’m reading that startups are salivating at the opportunity to then, curate this information and do all sorts of all sorts of things with it. So it’ll be interesting to see. 

[00:26:52] Bill Russell: [00:26:52] All right. Well, we’re, here’s what we’re going to do. We have some predictions here. We have a Fierce Healthcare article with seven predictions for healthcare, [00:27:00] and I’m going to go through them and you, and I will just go back and forth a little bit on each one. And then you have, you have a couple of predictions. I have a couple of predictions, so I thought, I thought we’d close out the show with some of our predictions for 2021. Does that work for you? 

[00:27:14] Sanaz Cordes, MD: [00:27:14] Yeah, that’s great. 

[00:27:15] Bill Russell: [00:27:15] All right. So Firece Healthcare, the story title is seven predictions of what lies ahead for health tech in 2021. It’s Heather land who was actually written in December, as you would imagine.

[00:27:27] Let’s start with the first one. Consumers will be in the [00:27:30] driver’s seat in 2021. My thought on that is, I think that’s more aspirational than, than practical. I, , options have increased obviously, and we have a new, I mean, let’s say it this way, the patient’s experience has gotten a lot better.

[00:27:48] There are, there are more options, but to say we’re in the driver’s seat to say consumers are in the driver’s seat, I think is, is, is probably more aspirational than, than, than practical. What [00:28:00] are your thoughts on that one? 

[00:28:01] Sanaz Cordes, MD: [00:28:01] Yeah, I tend to agree with you, I think though that it has been ,we’ve actually seen where, where patients are now actually voting with their feet. I mean, we we’ve had talked to a couple of health systems that said, boy, we were so under-prepared, , you know what we consider the patient engagement tool at our organization is our portal, right? Like our EHR portal that’s, , like written, The code for me, who knows when? So as consumers, it’s like three in the morning, do I [00:28:30] have COVID, I want to be able to go and do some sort of,  triage, like a digital triage or boy, my telemedicine experience was so bad, , I had to open three different apps and then it didn’t work and then I couldn’t get,  and we’ve heard them say and we’re losing.

[00:28:45] Patients like the health system down the road, especially in like cities it has a much better kind of retail like experience. So it’s the first time I’m sort of hearing that. And I think, , consumers are feeling more empowered to say this isn’t good enough. [00:29:00] Like I want the Wayfair experience or, , the whatever apps they like to use.

[00:29:04] So yeah, I think it’ll fall somewhere in the middle of that where, , That they’re going to feel more empowered because of what they’ve experienced with those unprecedented does surge for need, need for care during the pandemic. 

[00:29:16] Bill Russell: [00:29:16] The word portal sort of says it all, doesn’t it it’s sorta like having an AOL email address anyway.

[00:29:22] Sanaz Cordes, MD: [00:29:22] Yeah. And also Bill, I think being able to go to the big box offerings now, like, okay, I can’t get what I [00:29:30] need for my health system. I’m just going to go to CVS or go to the hub or go to X, Y, and Z. That didn’t, that wasn’t as much of an option even a year ago as it is going to be and continue to be as we go forward.

[00:29:42] Bill Russell: [00:29:42] Yeah. And the number of tests that CVS, well that’s, I think their number seven prediction, but we’ll get to that, but I think CVS probably did more tests than any health system in the country. Just because of their just because of their scope. And my guess is when all of a sudden done, they will probably do more vaccinations than any health system in the country.

[00:30:00] [00:30:00] That’s my number two virtual care services will expand, but there will be risks. What’s your, what’s your take on 2021 for virtual care. 

[00:30:09] Sanaz Cordes, MD: [00:30:09] Yeah. I’m always kind of following this and looking at what CMS is doing here and there with these regulations. I do think that it’s, , I mean, I’m not the first one to think of this, but I do think it’s it’s here to stay.

[00:30:22] Right. I mean, I think there’s going to be a rollback on certain things. Like, for example, like we made physical therapy, virtual care aloud for the first time ever [00:30:30] in an emergency, is that going to continue? Like, who knows, like some of those things might reverse, but I think that the, the surge numbers, like where were we like close to 50% at some point of usage of virtual care. And now we’re predicting somewhere with like between 20 and 30. I think that’s still a lot more than like five, right? Like where we were before. So I think, , I know actually, like every organization I talk to, there are no plans to pull back on their virtual care solutions.

[00:30:58] It’s just about how do we tighten them up, [00:31:00] align them, , unify them and scale them, moving forward. 

[00:31:04] Bill Russell: [00:31:04] Yeah. Virtual care will, 30% is a, let’s just say a, an appropriate correction. We sort of threw everything at, at tele-health and some of those things weren’t row well suited, but during a pandemic, that’s what you do.

[00:31:18] So it comes back 20 to 30 that’s those are, those are decent gains. We should, we should cement those gains and call that a day and then start building off of that, start going to home care and [00:31:30] other kinds of things. So I, I think that’s, that’s , I mean, that’s. That’s almost a no, no kidding.

[00:31:35] Kind of prediction. Virtual care services will expand. , we’re still in a public health emergency. Of course, they’re going to continue to expand. And this, the next one, I’m not even gonna ask you to comment on, because it’s also a no kidding cash will continue to flow into digital health. And  it is flowing and it is continuing to slow. Livongo has made, made it , made sure that the money will continue to slow into it. [00:32:00] 2021 will be a pivotal year for machine learning and artificial intelligence. Okay. What do you, what do you think about that pivotal? In what way? 

[00:32:10] Sanaz Cordes, MD: [00:32:10] Yeah, I kinda chuckled at that one because I’m almost been doing this for two decades. Like how long have we been hearing? Like it’s the year of AI and machine learning? I mean, I remember going to HIMSS many, many years ago and so, , I don’t mean to be cynical, but I mean, it, it it’s always been top of mind. I think, , what’s interesting now is that it’s. I don’t want to [00:32:30] say like commoditize, maybe democratize where health systems themselves, as we talked to them are saying, Oh, we’ve, we’ve hired data scientists.

[00:32:38] Like we’ve hired, PhD data scientists that are helping us build this and that for, , social determinants of health or, , and you didn’t hear that like three or four years ago. So I think that To that point then? Yes. Obviously the prediction is accurate that if anything, just the inequities that we’ve seen in our inability to capture that information, I mean, 80% of that is like narrative [00:33:00] information.

[00:33:00] Non-structured in an EHR, right? Like how do we even know someone’s social situation? And then more importantly, how do we, , reach out to them? So I think, yeah, I think it’s just more it’s. More widely, widely accepted. Now that there’s a role for it in health systems and then in life science and pharma, my gosh, trying to crank out a vaccine right in three to four months.

[00:33:23] If you don’t have a strong AI machine learning play in your R and D acceleration, if you don’t have high-performance computing [00:33:30] infrastructure to support it, then you’re behind the times. And we saw how that played out with organizations that, that kind of won that race. 

[00:33:38] Bill Russell: [00:33:38] Yeah, I would say the in addition to that, I would say the, the other area we’ll see, this is RPA robotic process automation. We’ll see back office systems. We’ll see more IT systems, security, machine learning and AI being layered in. So I think it is going to be a year that it sees significant growth in those areas and [00:34:00] the clinical side. It just has to move at the pace of safety. Right. So you just have to be. It’s almost like introducing a new drug.

[00:34:09] You can’t just introduce new algorithms and say, Hey let’s launch this and do that. In the clinical setting, it will remain, it will continue to go slow and the research and the research and development area, it can go fast and the administrative side, it can go fast. So we’ll see what happens.

[00:34:25] I’m not gonna ask you to comment on this one. The shift to cloud will ramp up. [00:34:30] Cloud has been ramping for a while, so it’s going to continue in that direction. And number six, Walmart will redesign healthcare. And so will Amazon and alphabet. I think they’re all three of those are going to do it a little differently.

[00:34:42] I think Walmart is already scaling up. Well, I mean, they’re already rolling out their their larger clinics. They used to just pop them into a store. And now they’re actually building larger facilities in the parking lots. Those are pretty integrated type facilities. I mean, they’ve done all, they [00:35:00] have behavioral health, they have imaging, they have you name it. It’s a it’s a pretty well thought out model to build those out. And now there’s only maybe five or six of them in the country right now, but yeah, that’ll scale out. Amazon’s doing Amazon health of their employees and we’ll see where that goes. And then alphabet is really their partnership with Mayo is really fascinating to me.

[00:35:24] And I think they’re going to continue to. Be the player that you take, this health data to [00:35:30] you anonymize it and you generate insights from, so each one of those are going to make different contributions to redesigning healthcare. What are your thoughts on that? 

[00:35:40] Sanaz Cordes, MD: [00:35:40] No, I, I absolutely agree. And I think, if we touch on Walmart, I mean just how much they’ve already invested in scaling how many clinics we know they’re rolling out in the next two quarters.

[00:35:50] I mean, it’s working. I mean, I think about myself. Like I have a, I go to a very well-known national health system for my, for my care. I have. [00:36:00] Had times where I’ve called like three or four times within two hours. And I can’t even get a human to answer. I’m waiting through layers and layers of just people and barriers.

[00:36:12] And wouldn’t it just be great to walk over to Walmart and get my care. I mean, it would, and I think that their health systems, we touched on this earlier, but are going to see some competition there. And I think it’s a, the consumers are going to accept this. , quite readily as they start to experience this new kind of retail [00:36:30] experience of care, where you’re not on hold and you’re not being forced to wait and be told things when you really want to be able to give, be given a choice and have it be done on your time and your convenience.

[00:36:41] Bill Russell: [00:36:41] Yeah. And that, that gets pretty close to one of my, one of my predictions. So I won’t go there. Social determinants after the last one, social determinants efforts.will shift from aspirational to operational. I hope that’s the case. We did an interview with the Intermountain and the United way and the stuff they’re doing in Utah is fantastic.

[00:36:58] But you also [00:37:00] hear when you talk to them, the complexity, the partnerships, the it takes institutional. Will I, again, I just think it’s, it’s aspirational. I’m, I’m hopeful that that will happen. But given that a lot of health systems. Took a I mean, when we did, when we did the, the elective surgeries and we took those out for three months, that, that set hospitals back a little bit. And [00:37:30] so I think this is aspirational for 21. Hopefully we’ll pick up the pace again in 2022. We’ll see.

[00:37:36] Sanaz Cordes, MD: [00:37:36] Yeah. Oh, I was just going to say, I agree. I mean, I went to my second startup I had, we worked with about three dozen different startups, sort of help them launch whatever it was, product commercial sales. And I had the fortune of working with a company called Pieces Technology. I think they go by pieces now and they’ve been working on this for over a decade.

[00:37:56] And when you look at how complex it was, , they really [00:38:00] kind of pioneered working with local community organizations. They’re all on different technology platforms, right? They’re all using different CRMs and things like that. So they had to overcome that. And the health system, UT Southwestern Parkland Health system at the time they had to invest the dollars like to your point and that they recognize the value of that, the ROI of that, of the reduction of readmissions and identifying people proactively to treat them differently upon discharge. They were very forward-thinking. [00:38:30] And I think to your point, it hasn’t been widely accepted and now the dollars may not even be there, but I think it put it on the map.

[00:38:37] And I think that with organizations looking at the forward-thinking ones that. Knew this was coming almost a decade ago. I am hopeful that we are going to see a uptake on this maybe for the first time as a health has the health care, , a company in a country of how we’re delivering healthcare.

[00:38:56] Bill Russell: [00:38:56] Fantastic. So  it’s pretty easy to sit here and [00:39:00] poke holes in other people’s predictions. Let’s throw some of our, so I’ll let you go first. What’s a prediction that you have for 2021. 

[00:39:08] Sanaz Cordes, MD: [00:39:08] Yeah. I mean, I don’t think I’m the first to predict this. I think we touched on it. But I think there’s going to be a lot of well expansion of how we already think of remote patient monitoring, but also some disruption and innovation on how we think of, , remote patient monitoring.

[00:39:22] I think before the pandemic, , there was some focus on chronic disease populations, right? I mean, they over-utilize [00:39:30] healthcare resources disproportionately to the. Percentage of what they represent and the patient population. So, , diabetics and going home with glucometers or congestive heart failure, patients with scales and things like that.

[00:39:41] But even then it was a very, very small percentage of health systems that were doing it. And so absolutely, I think that’s going to scale, as we’ve seen, what’s happened to our family. We have 50% increase in mortality for heart failure patients during the pandemic. Couldn’t come in. So  how realizing yeah, [00:40:00] boy, we should do a better job taking care at home, but I’ve been really excited about the work we’re doing with organizations around even acute care, remote monitoring.

[00:40:08] Right. So, I mean, COVID obviously triggered that let’s send people home from the ed with a pulse oximeter and, and collect that data data, , passively and then react to it. But just seeing it in general, , pregnancy, what if we sent everyone at high risk for,  preeclampsia during pregnancy home with, , blood pressure cuffs and things like that to [00:40:30] prevent what if even an urgent cares or ed is when people have three hour waits, putting them on some sort of data collecting, , a device where we’re able to track and send the appropriate notification. So there’s a lot of that going on and, , we’re actually kind of working on some of those first time solutions in those spaces. So I think that I predict that’s really gonna take off as well.

[00:40:55] Bill Russell: [00:40:55] Yeah. And I think one of the enablers for that, and not to comment on yours [00:41:00] predict one of the enablers for that is going to be, I think the digital divide last year became really apparent. And the , the fact that we sent these kids home to study from home and they didn’t have broadband, they didn’t have computers.

[00:41:12] There were people that tried to get into tele-health and whatnot. Complete the call. So I think one of the first things you’re going to see is an infrastructure project out of this administration. And part of that will be to address this this broadband and this digital divide that exists.

[00:41:30] [00:41:30] And I think healthcare is going to be at the center of that conversation. And, and that’s gonna, that’s going to give us a even broader foundation to deliver what you were just talking about, this remote patient monitoring, remote acute services and those kinds of things. So that’ll be interesting. All right. Sorry about that. 

[00:41:48] Sanaz Cordes, MD: [00:41:48] I agree. 100%. 

[00:41:51] Bill Russell: [00:41:51] My prediction on this one is that the federal health emergency is going to continue through the end of this year. I don’t think we should anticipate any change [00:42:00] to, to that status. And what that means is that the tele-health funding will remain in place through the end of the year.

[00:42:06] The state’s moves at this point are mostly for show until the emergency is lifted. And what that means is with tele-health funding in place, really at parody through most of 20, 21 health systems are going to have the opportunity and the opportunity is to to build out their capability  and with that Bible funding stream [00:42:30] already in place.

[00:42:30] So now the design, whatever you do around telehealth and those kind of things, but design is going to have to take into account that the. The funding won’t always be at parody. It will, it will change based on research. That’ll be done this year based on the data that was collected over the, over the pandemic, obviously you’ll see. And behavioral health services. I think that will continue to be slighted at parody moving forward, other things, they’re going to look at what the ethicacy, what the, what the , [00:43:00] the amount of usage and the quality and the outcomes and determine what what level is going to be funded at.

[00:43:07] But the good news is you have a year, you have a year to build this out, to really cement those gains and to build out a program and with funding for a year. There’s a, there’s an opportunity to build it with an eye towards, okay. Maybe in a year from now, we have to find our own funding source for this.

[00:43:25] And it could come in the form of lowering the cost of delivering services making [00:43:30] come in, improves efficiency or even an outcomes or it can be, as you were talking about earlier, the ability to draw more people into your health system because you’re offering those services and others aren’t.

[00:43:40] So that’s sort of my prediction for the year. The unfortunately the federal health emergency will continue while the funding source for tele-health and health systems. We’ll have a really now about an 11 months runway to really cement the gains in tele-health. How [00:44:00] about you? What’s the next one?

[00:44:05] Sanaz Cordes, MD: [00:44:05] I hope it happens maybe more than it’s a prediction. I was really, as a pediatrician, I’ve always sort of followed alternative treatments for things like ADHD. It’s amazing how much of that we see as pediatricians, right? I mean, you only hear about the cases where they’re hyperactive ayou put them on Ritalin, they’re disruptive, but it is so much more common than we know and it’s sometimes the more [00:44:30] subtle cases where it’s an attention, having trouble kind of focusing on things that you need to focus quietly. So you may not be as disruptive and some people don’t notice. So I’ve always been really fascinated and hopeful that there’s other solutions. And so I think with digital therapeutics, for the first time we’ve seen, , FDA approved digital therapeutics that are software based.

[00:44:52] And when we look at Achille I believe is the one that did the one for a software for [00:45:00] ADHD and like proven efficacy at the level of therapy or even medication. I think that that’s really exciting for me as a health tech person to see us doing that for the first time.

[00:45:13] So things like substance abuse and mental health. Challenges around insomnia even like with I think therapeutics. So I’m really excited to see more of that happening. And I’ve known over the years, just chatting with entrepreneurs from idea stage to, okay, we’ve received, , series a funding, and we want to get this [00:45:30] done, that pivotal acceptance that the FDA happening this year. I’d love to see that market explode. 

[00:45:36] Bill Russell: [00:45:36] Fantastic. Mike, my last prediction and then we’ll we’ll close up is Yeah, there’s going to be a return to bundle payments and that an emphasis on bundled payments. This is not rocket science, because this is what we saw during the Obama administration. I think we’ll see return to that in the Biden administration.

[00:45:53] And the reason I look at this as a CIO is because orchestrating the continuum of care becomes critical and [00:46:00] it’s really from diagnosis until recovery. And in some cases, the patients are moving in and out of your health system, into. Different caravan use that aren’t controlled by the health system.

[00:46:10] So but the, the main entity is responsible for controlling quality and costs across that continuum. Regardless of if, if you are the hospital or or if you have the, the, the, the recovery and the rehab, or you don’t, you have to still control it from one end to the other. [00:46:30] So we’re going to need technology to orchestrate the experience.

[00:46:33] Manage measure, the quality moves the data around the ecosystem is going to be critical and likely moves people into lower cost venues as quickly as possible. So there’s just something to keep an eye on. When those bundled payments come back, we are going to be really tasked with making sure that the data moves across that entire continuum.

[00:46:54] We track it well, and. We can deliver at a high quality level. So [00:47:00] that’s, that’s so if people want to comment on our predictions, feel free to do that online. We would love to get your feedback. Sanaz thank you for thank you for joining me today. This has been a wonderful conversation. 

[00:47:14] Sanaz Cordes, MD: [00:47:14] Yeah. Thanks for having me very much. 

[00:47:17] Bill Russell: [00:47:17] We’ll have to do it again. That’s all for this week. If  someone that might benefit from our channel, please forward them a note. They can subscribe on our website this or wherever you listen to podcasts. Apple, Google overcast, Spotify, Stitcher. We’re everywhere. We [00:47:30] want to thank our channel sponsors who are investing in our vision to develop the next generation of health IT leaders. VMware, Hill-Rom and StarBridge Advisers. Thanks for listening. That’s all for now.

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