Episode Transcript
[00:00:05] Speaker A: You float like a slow pen upon no hands look on no frame no shame Numb me up like can't focus Shake again which moment makes a man?
[00:00:17] Speaker B: Cause I'm hoping to just be welcome.
[00:00:19] Speaker C: I'm Dr. Robert Groves, your host for the Groves Connection Podcast.
The Groves Connection brings you intimate conversations with pundits, providers, patients, leaders and laypeople, all to help us understand a contradiction.
How can our healthcare system be both magnificent and yet so deeply flawed?
We're going inside Healthcare to talk candidly with those who know what they have to say. May delight, surprise, frustrate, or at times even anger you.
But I invite you to get curious and listen to the truth about health care and those who want to fix it.
[00:00:58] Speaker A: Maybe the answers have been there all along.
[00:01:01] Speaker C: We just need to make the connection.
Welcome to this special edition of the Groves Connection. I was recently interviewed at a virtual summit entitled Transform Better Health Care through math, which aired December 7th of this year.
[00:01:28] Speaker A: In my opinion, the most important topic
[00:01:30] Speaker C: discussed in this brief interview is the issue of cultural health. Cultural health is the cornerstone upon which the others must rest. I'll have more to say about this on a separate post, but for now, think about what makes a culture healthy, what communication strategies are most effective in bringing people together and creating a shared future? There are a loud few on the fringe that are driving our national dialogue with blame, contempt and defensiveness. But I believe that there is a vast moderate middle of people like you who still trust that we can and must do better. Perhaps, like warring couples, we've been stonewalling. Perhaps we feel overwhelmed by the toxic discourse in politics and social media. And so we've tuned out and shut down, decided not to engage at all. Well, I urge you to get back up, to get active, to speak up. We need you now more than ever. And what better season than this to espouse the principles of humility, compassion, and, yes, humility connection? You, in the moderate middle, are the treatment and the cure for our cultural illness.
Now back to the show.
A big thank you to Sanjeev Agrawal and the team at Leantas, as well as Becker's Healthcare for sponsoring the event and allowing me to reproduce the audio portion of that interview here. While the bulk of the summit was focused on specific strategies to streamline hospital operations, well worth a view in its own right, Sanjeev and I discuss the broader impact of the pandemic and lessons learned across the healthcare system. We touch on the differences between operational innovations versus clinical innovations, how the two overlap and create synergy. We also talk about the roots of the staffing shortage and where that may lead and how automation might help. We discuss healthcare equity, social determinants of health, trends in healthcare, as well as healthcare system literacy. This is the first of two special editions for the holidays.
[00:03:31] Speaker A: Let me know what you think.
[00:03:32] Speaker C: You can always reach me at rgroves g r o v e s robertgrovesmd.com let's end 2021 in this season of hope with a pledge to take back the moderate middle where we are curious and ready to learn where we move closer to the truth through respect and collaboration.
Now are you ready to connect?
[00:04:25] Speaker D: Hello and welcome to our next session at the Transform Better Healthcare Through Math Hospital Operations Virtual Summit Building Operational How Leaders Can Turn Pandemic Resource Management Lessons into Building Blocks for Future Success on behalf of Beckers Healthcare and leantas, thank you so much for joining us at this time. It is now my pleasure to introduce our moderator for today, Sanjeev Agrawal. Sanjeev serves as the President and Chief Operating Officer for Lean Toss and co author of the book Better healthcare through math.
Leantas works with over 110 health systems, including 40+ that have deployed the IQ tools across their 2,100 ORs with remarkable success.
Before Leantas, Sanju was Google's first head of product marketing and led three successful startups. CEO at Eloqua, which was acquired by Motorola, VP of products and Marketing at Telmi Networks, which was acquired by Microsoft and Founder and CEO at College Feed, which was acquired by After College. Sanjeev graduated with a BS and Ms. Degrees in electrical engineering and computer science from MIT. He started his career at McKinsey Co. And Cisco Systems. Before joining Google. Sanjeev has been named by Becker's Hospital Review as one of the top entrepreneurs innovating in healthcare. Sanjeev, I'll now turn it over to you to introduce our featured speaker for today.
[00:05:51] Speaker B: So in this session it's my pleasure to introduce Dr. Robert Groves.
Let me start with a brief bio of Dr. Groves. He is a trusted healthcare technology leader who has brought his unique style of energetic leadership to the world of health and care. In a career that has spanned four decades, he has led initiatives to use technology to improve care, whether by developing virtual care and tele ICU programs for some of the largest providers in the United States or leading corporate strategy for an innovative new pair, or advising some of the world's largest software brands on clinical engagement strategy. He's a published author, speaker, advisor and creator of the Groves Connection, a movement and podcast centered around changing healthcare to one that's more sustainable, inclusive, and beneficial for all. Dr. Groves currently serves as the Executive Vice President and Chief Medical Officer for Banner Aetna, a unique health insurance plan born out of a collaboration between the two healthcare leaders, where he oversees corporate strategy in the organization's physician leaders. He also serves as an Advisor to Microsoft CareCentra and the Health Management Academy. Dr. Groves is an honors graduate of the Center College of Kentucky, where he received a BS in chemistry and the Medical College of Georgia. He completed his medical training at UT Southwestern's Medical center and followed that up by fellowships at the University of Alabama Birmingham Medical center in both pulmonary diseases and critical care medicine. He is a Fellow of the American College of Chest Physicians and resides in Phoenix, Arizona with his wife, Elizabeth. Welcome, Dr. Groves. Thanks for being here.
[00:07:28] Speaker A: Thank you, Sanjeev. I'm delighted to be here and thank you for that kind introduction.
To clarify, I'm not the technology expert, but I know what I need and it's technology to get this work done. So I'm looking forward to the conversation.
[00:07:44] Speaker B: And, you know, I'm personally excited to get your perspective on a broad range of topics as both a clinical leader and a healthcare administrator. So what we'll do in this session is we'll discuss lessons learned from the pandemic, the opportunities for operational excellence to drive clinical gains, and how to accelerate transformation efforts. My first question, given your vantage point, you've had a front row seat to the pandemic and you've helped direct resources on staff during what's been a very challenging time for health systems. What would you say is the greatest lesson you've learned about healthcare operations in the last 18 months?
[00:08:17] Speaker A: Well, I think the lesson that almost anyone who looks at this has to take home is we're fragmented and that fragmentation really hurt us in terms of our ability to respond to the pandemic effectively. There's a silver lining there and that what we learned is that if we get some of the regulations and barriers out of the way, we can move very, very quickly to innovate. But again, the challenge we have is that it is such a complex and fragmented system to have any sort of organized approach across, quote, healthcare in America is incredibly challenging. And, you know, those deficiencies were laid bare by the pandemic and we're still dealing with them today.
[00:09:02] Speaker B: Yeah, you know, and that brings me to the rate and pace of change. What the pandemic did do is, to your point, in some areas, like telemedicine, we were able to be more agile. I've had friends tell me that we made more progress in a year than we'd made in 10 years before that, trying to get telemedicine in place. So is maintaining that fast pace, does it require some kind of an external shock like that, or do you think it can be done organically?
[00:09:27] Speaker A: Well, I think you nailed it when you said the external shock was a catalyst.
These are all approaches and, and strategies and technologies that have been in the works. It's, you know, health care change is glacially slow. There's good reason for that in many ways, and that the stakes are the highest in this industry, as high, if not higher, than almost any other people's lives are on the line. And so you don't want to make quick changes without understanding the consequences. But on the other hand, we saw that when we had aligned incentives, that is the pandemic, we were able to move pretty quickly in implementing technologies and adopting technologies very, very broadly. I think that maintaining the pace of that change is going to be difficult. We all have that tendency, you know, it's the nature of things, to regress to the mean, if you will. And you've seen that to some extent in the pullback and the pace of change. But I do think there's a role for leadership to keep the pressure on, to say, look, we've demonstrated now that these technologies and these approaches can be of value to increase access, to improve the ability for folks to get what they need, where they need it and when they need it.
Thank goodness the pandemic happened at a time when we could do that. If this had happened 10 years ago, I hesitate to think how much more dire the consequences might have been.
[00:10:50] Speaker B: Yeah. You know, and when we think about the healthcare system at large, you know, the United States, and we pride ourselves rightfully for being so far ahead of anybody when it comes to clinical change and clinical development, even the development of the vaccine, frankly, is just phenomenal at that speed.
[00:11:06] Speaker A: Amazing.
[00:11:06] Speaker B: And now even the distribution of this for all that, we might argue we've done a pretty darn good job. But then when we think operationally and how far we lag, why do you think that is and how do we change that? How do we align incentives to, say there are $2 trillion of assets in the ground that aren't being used very well?
[00:11:25] Speaker A: Yeah, that is a very interesting point. And I was speaking with one of your colleagues, Mohan, and he brought this to my attention in a way I hadn't thought about it before. I'd never made that separation and thought, well, clinically, we're very advanced, but operational we're not. And it's a good way of saying it's not the only way, obviously to parse it, but it's a great way of thinking about it. And part of it has to do with the fact that there are so many entrenched interests that are embedded in legacy systems. And the focus has been very much even by guys like me, on clinical care. How do we get this right? How do we move this forward? And those of us who might have the insight to be able to push this didn't have the level of awareness that was necessary to do it. And those who are in the trenches are just doing their job. Every day they're using the systems that they have.
Even though health care systems make a lot of money, they work on razor thin margins. And so choosing where to place your money, your investments, is always a challenging thing to do. And because it's healthcare, we often think about care. We don't think necessarily about the impact on care of streamlining operations. Now, obviously we do in smaller ways, but in a big way. The availability of prediction tools to help us determine demand in the future, to optimize the use of operating rooms so that there's not all this downtime with these incredibly expensive assets sitting idle. We could do a much better job of leveraging artificial intelligence and machine learning the way airlines do, to make sure that every single seat is filled on a flight, but that there are very few people who are left out. You know, sometimes they err on the side of overfilling flights, as I'm sure you've all been in that situation. But that gets back to the other point in, in healthcare, you don't want those margins quite so much, so you have to be much more precise. But the technology is there today for us to do a much better job of identifying demand and being able to respond to it proactively instead of reactively.
[00:13:38] Speaker B: It's really interesting you brought up two separate points, and I completely agree that they are kind of distinct and orthogonal. One is our way of doing things historically and sort of a culture and a. I'll use the term loosely, the sacred cows associated with the systems we use and the processes we use. And I'll give you two examples from my experience during the pandemic in working with systems. One is I have never seen so many, or block committees just get rid of blocks because that external shock basically said I can't be in this mode of. I've blocked out people from getting their surgeries done on the. Inpatient bedside is my second example. I have never seen systems move so quickly to say yes, just because I have 27 units doesn't mean I need 27 units. I need 20 and then I need a Covid unit. And so I will change configuration like I need to. So in some sense, the only possible silver lining I can think of operationally due to Covid are one is on the dimension of willingness to adapt to change as opposed to, I've always done it this way, so innovation from a process perspective. And the other, like you said, is technology, where the example I can think of is visibility into the backlog. If all our clinics are keeping backlog information on pieces of paper and a pencil, it's 20, 21. Are we really still keeping clinic backlog of surgical cases on pieces of paper? And more systems were willing to adopt that. So I thought I'd throw those two cents in from sort of a technology vendor provider side of things.
[00:15:08] Speaker A: Yeah, those are great examples. And it re emphasizes the point that what the pandemic did never underplay the suffering and challenges that many have faced during this pandemic. But what it did in healthcare is expose very plainly where we have challenges. And one of those challenges is clearly dead center in operations.
[00:15:31] Speaker B: Touch on something interesting that you mentioned a few minutes ago around the use of prediction and AI in operations, and I'll give you 1% perspective and I'd love your thoughts on this. The precision with which AI must work in. On the clinical side, frankly, operations has a bit of a hall pass because, you know, if you are not 100% sure that a certain medication or certain tool would help a patient, you still need a lot of clinical judgment where AI assisted human knowledge is required. On the operations side, honestly, you know, it's like, it's actually like running faster than the next guy in the African safari if you're being chased by an animal. Because honestly, at this point it feels like decision making is based on things like average block utilization, average wait times, and it's frankly not that hard to do a heck of a lot better than that. So do you see AI and such tools being adopted faster almost in the operations side?
[00:16:30] Speaker A: I think that we're going to see much faster adoption going forward. I mean, we've been using arithmetic when we need calculus, and I think that's been exposed now. And I think most systems are now open to the possibility that there's a better way to do things. I hope that that's the case and I do believe that it is. And frankly, in some ways it's much easier to focus on operations than it is on clinical care. And a byproduct of focusing on operations is clinical care gets better. Take it outside the hospital. What if physicians offices had this type of information management system in place and they could predict waiting times in the WA room? Nobody likes to wait in the waiting room for an hour to see a doctor for 10 minutes. It's almost arrogant to take that posture that it doesn't matter. So the experience of the patient, the mindset of the patient coming into the exam instead of being angry and not being able to focus on what the question was that they had that they've now forgotten because they can't get past the fact that they've been forced to wait for so long.
Some may even just get up and leave and say, I'll come back next month.
And all of those things add up to worse patient care. And so there's a beautiful symmetry here that if we streamline operations, then we are able to get to patients and give them what they need much more quickly and frankly, much more effectively when we're both in a mindset that allows that dialogue to take place.
[00:18:04] Speaker B: I love that. And if I may just build on it, one analogy I like to use is that if I'm a surgeon in any hospital in this country, why is it easier for me to book a table for four on OpenTable for dinner with my family than to find time in the OR if I don't have block, or if I if my block's filled over the next six weeks? And that's another example of where AI can predict who isn't going to use a block, get them to release it and let other people use it. So yeah, I completely agree with that.
[00:18:32] Speaker A: It also addresses issues of equity. Historically, blocktime has been a bit of an old boys network. And I use that term advisedly in that for the most part, historically healthcare was run by old white guys like me. And there was this sense that, well, this is an important surgeon, therefore he gets blocked time. If he doesn't use it all the time, that's okay, it's a perk. And those sorts of systems end up being perverted over the long run. It may have made sense at one time, it simply doesn't anymore. We ought to have a system that is fair and allocates resources to physicians, regardless of who they are and where they came from. If they are entitled to block time, then let's use a system that's much more fair to allocate that block time.
[00:19:22] Speaker B: Couldn't agree with you more. And that's honestly music to our ears as a provider that works with 150 health systems doing exactly that. The big fire now, as we all know, is around healthcare staffing, be it nursing, be it anesthesia, be it text. And obviously the pandemic has had a lot to do with that.
And so if you think back to 2019, we always knew we were going to hit a point where we had this shortage, but it wasn't that severe back then. Do you think this shortage is here to stay, or do we think in 22 or 23, if things die down from a Covid perspective, we might settle down to a more balanced workforce, but in general, it is a problem. And how do you see us working through rebuilding our workforce and making it more efficient and maybe doing more with less, in fact.
[00:20:12] Speaker A: Yeah. And I think the ultimate answer is we must get better at doing more with less. But there are some jobs, obviously, that you can't simply replace the bedside nurse, the bedside physician.
Those are areas where we're gonna have to have the staff. And we've got hospitals right here in Arizona who have the beds to manage this latest surge, but they don't have the staff. And it's an interesting phenomenon. We've had a reckoning, if will. I think we've seen a trend towards more individuation and more of a leaning towards freedom instead of collective.
And that's been going on for some time. And what the pandemic did was it. I think it forced us all to say, okay, what am I doing with my time? Where do I spend my time? And what does it all mean? You know, for some, they found themselves in roles that no longer gave them a sense of meaning. So we're going to have to provide a lot more than a paycheck going forward if we're going to correct this trend. It'll take a while for it to settle out, for people to find those roles that they feel comfortable in that more than anything else, fit with their mission. I think it was Dan Pink that said autonomy, mastery and purpose. And to the extent possible, when you give people that, then burnout goes away. People can work really, really hard if they believe in the mission and they believe that what they're doing is important. So we're going to put that on the side for a minute. But I think where automation comes in is really important too. When I think back to implementing the EICU at Banner Health, and this was back in 2005, one of the principles was, look what I want is an awake alert physician to manage the relationship at the bedside because that's how you influence behaviors and that's how you help people bring them along through the care journey. It's through relationship that happens. If I'm busy trying to remember every rote detail, then that's time I can't spend with families, that's time I can't spend with patients. And so what the EICU did was automate a lot of the rote stuff that we had to do every day so that I could spend my time actually doing what doctors are best at, recognizing those complex patterns, constructing a care plan and then bringing everybody on board so that we can implement.
So I think automation is going to play a big role going forward. Those things that are rote that human beings don't get delight from anyway, those are the kinds of things that we ought to start with. Let's get that stuff out of the way so that we can let our nurses get back to managing patients, managing the relationship.
[00:22:58] Speaker B: And again, if I may just build on that. If you look at other industries that have undergone transformation, if you think about how much has been automated in the self service check in process in airlines, the role of the airline scheduler has transformed from someone who always gave you a boarding pass or helped you check in your bags to one who's become a problem solver doing far more interesting things, dealing with, you know, if I don't have my, if I only have my passport, I want to change my flight is when I talk to a human being. And by the way, it's led to better traveler experience. So it's a win win. It's lower cost, it's a better traveler experience, or in this case would be a patient experience. And it's 24 by 7 as opposed to relying on a human being to do some of the more mundane tas.
[00:23:40] Speaker A: Absolutely. I think that's a great point and one that we ought to heed.
[00:23:45] Speaker B: You have so much experience across such a variety of topics, I don't think we'll be able to cover everything. But there are two other big areas I want to go to next. The first one is this whole consumer centric nature of change in healthcare where if I'm Amazon or I'm a Walmart and all kinds of emerging startups that are doing personalized medicine and providing different types of care.
They're putting a lot of pressure, I would imagine on health systems in general to embrace digital care and move to a different type of care. Obviously Covid has had something to do with it. General spending on health. It has had a lot to do with it. What kind of changes do health systems need to make to stay competitive and to embrace this new environment where there's pressure from all of these sources?
[00:24:30] Speaker A: You know the analogy that pops into my head as you're speaking about that is Walmart versus Amazon.
There was a time when Amazon, which began as an innovation purely online and books only, has slowly but surely encroached on every consumer business in America. And Amazon had designs on that same area and was for a while there eating Walmart's lunch. But Walmart responded. Walmart now has lots of programs that embrace automation. And Walmart's interesting in that they did it on the operations side first and now they're learning how to use those same tools to improve the consumer experience by making it easy to find things online, by making it easy to find a location, by making it easy to figure out what things cost. So it's analogous, although slightly in reverse. And I think that's what health systems need to do. They need to understand that this is not a trend that's going away because it just makes good sense. If I can create an environment where patients can be responsible for, they like that better. They want to check in online, they want to get that stuff out of the way before they arrive at the hospital or the clinic. So we need to take a page from Walmart's book and say, okay, this is the way the world is moving. How do we get out in front of this and what tools can we use and apply to make this happen? And it has to be focused on the consumer. It's no longer about physician convenience or we have a business big building you must come to for everything. We have to be able to meet consumers. And it's a tired term where they are, but literally where they want to be is at home most of the time, as most of us do. And so creating the opportunity to get services and to schedule services from the comfort of home is where it must go.
[00:26:26] Speaker B: And it's amazing how that's. We're starting to see Banner do some of this. We're starting to see many other forward thinking health systems move care closer to communities, move care to the home. Telemedicine. So absolutely thank you for that. The other big interface, the payer provider one. And you're one of the few healthcare leaders that I've worked with that has this very unique perspective on both because of the Banner Aetna partnership. What would your advice be to a health system and how to navigate that relationship as we go forward.
[00:26:57] Speaker A: Yeah, and as you might imagine, it can be a challenging relationship to form in the first place because historically insurers have been trying to get the lowest price for everything, while hospitals to, you know, keep their doors open, pay their staff and increase their razor thin margins, have wanted the highest price possible. So it's been a very adversarial relationship for years with the consumer sort of over on the side, you know, waiting for the battle to stop so they figure out what their co pay and their deductible is. The most important factor front is you've got to have a shared mission. Both entities have to be really committed to this from the top down. Because if that's not there, the barriers are just too great to get past the shared vision, the shared purpose. You know, I'm back to this theme of meaning and purpose. It's what makes us thrive as human beings. The Greeks had a term, eudaimonia. Well, you don't get eudaimonia without a personal mission and a personal vision of what the future.
And so you need to bring the leadership on both sides, find that common ground and a common mission, and then you start the hard work of working through the details. I would also say that I think connection as human beings is critically important. You know, on the Groves connection, one of my underlying premises is that if you look in healthcare, any sector, it's good people simply following the incentives. Now we have some bad apples like any industry does, but for the most part it's really good people. Whether it's an insurance company, company, a pharma, a payer or even a pbm. These are good people that are doing their job following the incentives. And so think about it in terms of the system in which these people are placed. Rather than, you know, he's an evil guy because he works for X or Y. That is a hurdle that is necessary to get past. Even in that simple relationship. We're not talking about the complexity of bringing in all the players now, just the payer and the delivery system. You've got to have a human connection, leader to leader, understand each other, value each other's opinions so that you can have an open dialogue and escape from what has become a culture of outrage and contempt that never got us anywhere. So common ground and human connection is the starting point.
[00:29:25] Speaker B: Thank you for that. You know, that leads me right into another big thorny problem that has to do with something you mentioned earlier, which is equity in access to care. So whether it's the insured versus the uninsured, whether it's surgeons with block or without block to have the ED be the only front facing door for patients that are underinsured or uninsured. How do we make progress on health equity and access?
[00:29:51] Speaker A: Yeah, and obviously it's a very thorny problem in this country. We have gotten to the point where we spend so much on health care that we have a hard time seeing how we could expand access to everyone.
But I would suggest that we must, that it's not optional. And there's a lot of debate about when you expand access, do you actually decrease cost? I don't think that's the right discussion to have. The right discussion to have is when you expand access, you streamline operations, you use knowledge management to deliver only evidence based care.
Then what happens? You know, there are a lot of things I don't know, but I can almost guarantee you that that's the sweet spot. It's not either we do this or we do that. The other thing that I want to say about that though is we have a tendency in this country, our healthcare system is optimized for rescue. We are phenomenal at rescuing you when you're diagnosed with cancer, at picking you up off the street after a motor vehicle accident and giving you the very best chance of walking out of the hospital alive. We are brilliant at rescue medicine. What we don't do well is the day to day management of health behaviors and chronic disease. And that's why it's important to expand access.
But we can't just expand access and continue to focus on rescue medicine. We have to expand access and understand the wisdom of getting in front of that curve. And from a cultural standpoint, a lot of the inequities that we see in healthcare are simply a reflection of a cultural sickness that we have today.
The polarization, the contempt, the blame, all of those things.
You know, we've become fragmented. We live in our own echo bubbles. You know, I was thinking the other day when I was growing up, there was plenty of debate. I mean, it was Vietnam era, there were protests, students got actually shot and killed on a college campus by, you know, troops. And so it wasn't that there were no problems. What it was though is we could have each side of the issue coming from a single source. There were three networks. They gave us the news, they gave us both sides of the news, but they, you know, we all had one source. Today we are so fragmented that the sources of our information are so disparate that we can't agree on a common reality. So if we're going to be a rescue system, yes, there are things we can do about equity. You see those happening increasingly. Social dollars are going to be paid for by health care because our fragmented social safety net we've demonstrated does not work. But if we want at the root of it, we need to start talking about not just physical health and behavioral health, but cultural health in this country.
[00:32:41] Speaker B: You know, we could literally spend an hour just on that topic. Because I would love to see a day where I walk into any fast food restaurant in this country and it's the salad that costs a buck and the burger that costs nine. I would love to see a day where sugar is taxed a lot more. And so it's such a deep statement that there is no money in prevention, there is only, only money in rescue. This is the first time I've heard that term and I love it because it seems on the spectrum of prevention, rescue and cure, neither bookend is actually part of the incentive system. It's the rescue part that's part of the incentive system.
I wish my insurance were based on how healthy I keep myself. And the other.
[00:33:26] Speaker A: I make great point and as I said before, I mean, it's the incentives that drive behavior.
It really is that simple. And we can apply that same logic, by the way, to consumers. There's no reason we can't reasonably incentivize consumers to do things that help them get better. And I think the next frontier as we get into knowledge management is going to be behavioral psychology. How do we help folks? How do we influence their behaviors towards health? And that gets us into the realm of psychographics and nudge theory and, and B.J. fogg has done some great work on how to form new habits. Those are things that we need to embrace and adopt as well if we're going to have a healthy culture and a healthy healthcare system that looks at the front end, that leads to rescue instead of just looking at the back end.
[00:34:20] Speaker B: Let's come back to something you mentioned earlier about innovation in healthcare and the many changes that are happening. It seems all at once in the healthcare system.
Meanwhile, the origins of the system are a highly regulated industry. It's easier for someone to start an airline than to necessarily start a hospital. It's also, for good reasons, led to a highly risk averse culture where there are standard ways of doing things and standard protocols people follow. Meanwhile, some of the world's smartest people end up becoming doctors and clinicians and obviously all the support staff have so much training. How do you get this system to embrace innovation and transformation. Given the roots and where it's coming
[00:35:04] Speaker A: from, I think some of it is healthcare policy literacy for the American public. I am fully convinced that if people actually knew how it works, they would not endorse it. Just a quick example. There's a medication that's a combination of two very basic meds that you can buy over the counter at, you know, cvs, Walgreens, take your pick, and you can buy it for 40 bucks a month. But there is a drug that has a patent on it now we can talk about patent reform some other time, but there's a drug that has a patent on it now that is a combination of these two that would only need take once a day. The question I want to ask you, is it worth upwards of, you know, fifteen hundred dollars for that little patent? That's what the insurance company is billed for that drug. To add insult to injury, a non profit is set up that will tell the patient, look, if you get this prescribed drug, not only is it prescribed, so you get to use it against your deductible, but we also have this little coupon and only if you're insured can you take advantage of this coupon, which eliminates, so it's free to the patient. So as a physician, if I'm sitting in front of the patient, the decision looks like, okay, I can prescribe this and it's going to be free to this guy who's living hand to mouth every month, month. Or I can tell him to go pick this up and take it and it's going to cost him 40 bucks. But behind the scenes, what the patient does not see is that that is what drives up premiums every single year. Paying that kind of money for that tiny little innovation that might be worth a few bucks. But I guarantee you, if you ask the American public, is that worth multiples of the over the counter options, I don't think they would agree with that. I think everybody would start getting real clear about what needs to happen. So regulation is sort of this generic term. The kind of regulation we need is the kind of regulation that prevents that sort of abuse of the system.
[00:37:09] Speaker B: Very interesting. It's as much about the culture and the transformation of process as it is about regulation. And making sure that the high leverage point regulations like the example you gave gave, actually allow more money to do other things in some ways.
[00:37:23] Speaker A: Yes, yes, tons of money to do other things. And you know, we also know that in Medicare Advantage because of the risk adjustment strategy, that there are lots and lots of dollars that are overspent on Medicare Advantage. We don't know how much exactly there are estimates out there.
And so it becomes almost like a game that's being played in coding and risk adjustment to get the highest dollar value. And so my assertion is that we need to move to a system that is essentially, as Robert Pearl has said, paid up front, capitated, you know, what you have to spend. And then automatically the focus immediately becomes how do we maximize our operational efficiency, how do we eliminate over treatment, how do we eliminate undertreatment? And get really good at streamlining this process? And we have examples of this. We know it work.
But it's a matter of getting from A to B. And it may take a groundswell of public knowledge about how this system really works to push our Congress towards enacting laws that will enable eudaimonia in healthcare.
[00:38:35] Speaker B: Let's move back to the banner Aetna relationship.
You obviously play a very significant role when you think about knowledge management, capacity management, asset utilization.
How do you define and measure success in the construct of this partnership?
[00:38:51] Speaker A: Yeah, I love the term knowledge management, by the way.
And just to frame this a little bit, if you go back to 1950, the world's knowledge doubled about every 50 years.
That same doubling now is measured in months.
So it is impossible for a practice that grew up essentially as a craft. I've got this knowledge, this specialized knowledge, because I've trained and had experience. And I'm going to craft for you an individual program that'll work perfectly well. No human being can do that anymore. We must have AI. We must have machine learning just to manage medical knowledge, to separate the wheat from the chaff, to know what the newest thing is and what the evidence says. That's an absolute necessity. One of the places where that shows up is a little surprising. And this may seem like a trivial area, but it is a point of contention. I guarantee you for every physician in the country, and frankly, for every health plan in the country. And that's prior authorization.
Nobody likes prior authorization. Nobody likes, mother, may I? But the problem is, and there are abuses on both sides of this, again, it's incentives that drive behavior. The problem is when I'm sitting down across from a patient and I think that that patient needs. Let's just take something simple, an mri, and I order the mri. The process then is somebody at the front desk fills out or enters online a form that says, Dr. Groves wants an MRI in this patient. And they try to remember all the things that the insurance company wants. And by the way every insurance company is different, and you know, this as an aside, raises the question, if it's evidence based practice, why is it different at every insurance company? I'll get back to that in a second. But the bott is that patient leaves not knowing that there's an issue. The doctor goes on about his day, not thinking about it. I ordered it, I assume that it will get done. And then a week later when the patient shows up, they say, well, I'm sorry, this hasn't been approved yet, or this has been denied. The patient is, you know, stunned. It's like, wait a minute, my doctor ordered it. What do you mean it's been denied? And in the sense is it's been denied by these bureaucrats that don't know what they're talking about, et cetera. And then you go through the whole process, the back and forth, the appeals, the amount of money spend on that is, it's insane. What if when the patient sat down across from the doc, we were able to use AI, machine learning, natural language processing, all of those tools that we have to look in the chart and say, hey doc, I know you want to get this CT scan, but based on this evidence that I can look at right there if I want to, we think this needs to be done first. And then you haven't damaged the relationship between, between the patient and the physician because the patient will leave either without that order because the doctor agrees and said, you know what, I think that's appropriate, or they're able to have the conversation in real time. And by the way, 80% of the time there is no barrier to prior authorization and it could be issued immediately so that the doctor knows and the patient knows the scan is scheduled, it's going to be done. So there are so many examples like that. That just happens to be one that irritates everyone. No matter side of the equation that they're on.
[00:42:16] Speaker B: And you know, you mentioned this. It's almost because it's at the nexus of the payer and the provider. This seems like a great example of where AIML applied across this junction could actually really help.
[00:42:29] Speaker A: Absolutely, yeah.
Another area where we're focusing this coming year is around the explanation of billing. And I gotta tell you, until I got on the insurance side, I still didn't understand what that was. I mean, you get it in the mail, right, says this is not a bill. My first response is, well, what the hell heck is it and why are you sending it to me? Because it's not accurate, it's not up to Date, it's a point in time. And you know you're going to get three more of them as bills come in and some of them get paid and some of them don't. And then there are errors. That whole process.
What if it were like a credit card and you say, here's what you've spent, here's what's covered, here's what's remaining in your deductible. And it was just clear. And so we're working on that. It's hard to do it across the complexity of the US System. And here's why. When you look at our insurance plan, we have a broad network and a performance network. The broad network is all comers. So they might go to any hospital, to any doctor, et cetera. We don't have connections to those docs because it's a fragmented system. We don't get that information. We don't get their bills. The patient does. And so we can do it. If you go to a banner facility and you see a banner doctor, we're creating that now so that it's a simplified, easy to read statement that regular people can understand instead of just insurance execs.
[00:43:54] Speaker B: Dr. Groves, I'm going to steal that line. If my, if my medical bill could be like my credit card bill. That's the kind of utopia that I think every American would love to see a future like that. I do believe we could spend another few hours talking about this since we only have five or seven minutes remaining. Let's let me take a few of the audience questions that when people signed up for Transform, they put in there saying, hey, let's. If we can get to this with Dr. Groves, we should. So in terms of future predictions and digital trends, which obviously are near and dear to my heart, you mentioned quite a few already, very specific examples like we just talked about, about AI assisting doctors and physicians in making the right choices for their patients and explaining them and getting them prior authorization authorized. You mentioned the bill being understandable. Are there other big things you're excited about in healthcare or either on the payer or the provider side from a digital trends perspective?
[00:44:49] Speaker A: Yeah. I think that we are going to see continued movement towards more services available at home. You know, there's lots of evidence of that. That's what patients want. They want to stay there as much as they can. They have learned over the past several years that hospitals, if you don't absolutely need them, can be very dangerous places to hang out. We've noticed during the surge that sometimes they're not even available. And so it makes sense for that trend to continue. And I think it will. And that means that we're going to have to have pretty streamlined operations on the back end of all those services. It means that we're going to have to have the kinds of technology that are reliable in the home so that patients can deliver information to their care teams. And I think we're going to see that trend continue and I think it's a good one. I think the other thing that we're seeing in no small part is embracing social determinants as a necessary part of a health system's issues. And you know, they're going to have to address it in some way. Now that's kind of an interesting problem because we have a social safety net. It's just too fragmented in and underfunded and understaffed to be effective. And the pandemic showed us that. And so we're seeing healthcare dollars now becoming social services dollars. We also need to make darn sure that we've got a streamlined way to monitor and operationalize that optimally allocate that across the system, because it's not an area that typically delivery systems have had expertise in. And that's when things can go wrong. So having operational excellence behind it so that you know exactly the right metrics to follow and that you can in real time assess where that money's going, whether it's effective or not, does it need to shift over here, et cetera. All of those things are going to be critically important going forward. It is my hope and I believe that we're going to get closer and closer to a true value based strategy for care, culminating I think, incapitation at some point of some form.
And that just demands highly efficient, streamlined operations. Don't waste money on operations that you don't have to put it into patient care.
[00:47:13] Speaker B: Again, very, very rich subject we could spend a lot more time on. Where we will end though is I would love to get some guidance from you. Having sat on both sides and at the junction of payers and providers. Both payers and providers probably have a thousand digital transformation or just transformation projects in general that they can, could do. And there's only so much staff and there's only so much money. What's the framework that you would recommend to prioritize these projects in terms of what to do first and how?
[00:47:40] Speaker A: Yeah, I think that because it's a win win, no matter what system you're operating under, what incentives you're operating under, it makes perfect sense to focus on streamlining operations as a priority. I don't mean that it would be the only priority, but as we mentioned, it improves patient care, it improves patient experience, and it frees up dollars to be spent on patient care rather than archaic systems that fail often and need lots and lots of people to check and double check and, you know, find the missing piece of paper that the schedule is written on. It's just insane that we're still doing that. So I think it is an area where it should be easy to control. Convince a hospital administrator that whether you're in fever service or capitation or in between, you will benefit from streamlining operations, as will your patients. So I think that's a key area going forward. I think the other area is behavioral psychology. We have really good predictive analytics now. And by the way, adding behavioral psychology into our predictive analytics engines, I.e. psychographics, improves our ability to predict demand and yield and supply. But it doesn't help for us to predict that somebody is going to get worse if they don't do X or Y. If we don't have the tools and strategies to help them do X and Y. This can get into a debate about undue influence, et cetera. But what I will tell you is when somebody joins Weight Watchers, it's not because they want everybody to leave them alone. It's because they want to lose weight and they want to join a culture that prompts them and influences them towards behaviors that allow them to accomplish their goals. That's what I'm talking about. You using it for positive intent. We call that a positive influence when we use it to influence people to do things that aren't in their interest. That's what I call manipulation. And that's not what I'm talking about.
[00:49:37] Speaker B: Dr. Groves, this has been an absolute pleasure. I have learned so much in this session from you. I look forward to welcoming you back at Transform. Thank you for doing this.
[00:49:46] Speaker A: Yes, thank you, Sanjeev. It's been a real pleasure. Thanks for the opportunity.
[00:49:53] Speaker C: You've been listening to the Groves Connection, your connection to the inside story on healthcare, featuring in depth interviews with those who know. You can find us on Apple Podcasts, Spotify and anywhere else you get your podcasts. If you like what you hear, give us a five star review to keep the connection going and hit the subscribe button to be sure you never miss a beat. The Groves Connection is Produced by by Dr. Robert Groves. Original music editing and creative direction provided by Alden Groves. Production support Content guidance courtesy of Janae Sharp and Elizabeth Barrett thank you for listening.
The professional ideas and opinions expressed in this podcast are mine and do not reflect those of any current or past employers. Thank you so much for listening and we hope you'll join us next time on the Groves Connection.
