S1E18: Payer/Provider Model, HIEs, Agile (ft. Jason Joseph, Corewell Health)

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Joseph, Jason R.
But really, how does the business model work into the future? I mean health care right now is kind of in this interesting transitionary period trying to wrestle through these fee for service models, value based care and how is this going to wrestle out? I think at the end of the day when you think about it from a consumer perspective, Healthcare is kind of these things bundled together, right? How I get my coverage and how that manifests in terms of the care and the different services I get and the amount I pay and the copays and the services and the quality.

0:1:26.740 –> 0:2:0.250
Joseph, Jason R.
Are all really fundamentally intertwined, and so as we think about it from a corewell health perspective, we’re just moving towards kind of forward with that idea that that is the centerpiece, not the only part of our business certain we provide care to people on other health plans, insurance, et cetera. And we have people on our health plan that are seeking care elsewhere. But there’s also this kind of ability to do that a little bit better. We believe as we do it together in an integrated organization that’s kind of the future that we see coming together and.

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Joseph, Jason R.
And what we’re what we’re growing for.

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Jordan Cooper
So the Healthy Data Podcast audience is much like yourself. See CIO’s of large healthcare systems around the country, some of whom many of whom most of whom actually don’t have a priority health. They just represent a hospital and healthcare delivery system. There’s no payer involved at all. Some may be listening to this, and they’re intrigued. They say yes, I’ve been experiencing a transition away from fee for service. I have maybe an ACO. I understand value based care and risk sharing and and what I’d like to know is, you know, Jason, could you tell me what do you think I should be doing to move my organization?

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Jordan Cooper
In that directions that we’re not left behind.

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Joseph, Jason R.
Well, you know, I think value based care at its core is really about doing the right thing for the patient or member and looking at ways to actually increase the value, right. Thus the term. So better outcomes at a lower cost and what it really comes down to is who gets the share of that value. And I think the difference when you have that integrated system is you can kind of not worry so much about which side of the Ledger you’re counting those wins on, you can say let’s do the right thing and if that reduces our cost on the health plan side, but actually reduces our volume on the care delivery side which reduces revenue.

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Joseph, Jason R.
Well, if long as it’s the right thing to do and overall it reduces the total cost of care, we win and then it becomes more of an exercise about how do you make the interchange more efficient, how do you actually take the costs out of the system? It’s just a bit harder when you don’t have that and you have to be in that negotiation. So if you don’t have that other side, I think it’s really about getting a collaborative relationship and getting on the same page as a provider as a payer and saying, look, we’re all in the same game here, how do we come up with something that allows us to experiment a little bit?

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Joseph, Jason R.
And if we win by actually taking costs out of the system, how do we share in that win? That’s ultimately the goal and that benefits everybody all the way around.

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Jordan Cooper
So Jason, as Chief Digital and Information Officer for Spectrum Health, your previous position before the merger, you implemented an integrated clinical and revenue cycle system and you grew a Regional Health information exchange. Would you walk our listeners through an anecdote or two from these two experiences?

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Joseph, Jason R.
Yeah. You know, I’ve been in this business long enough, and many of us have to kind of go through the the transition from multiple nonintegrated, Emrs and clinical systems to kind of consolidating that. So we went on that journey and landed really on a singular instance of epic plus many combined third party systems as a spectrum authenticity. And as we’ve grown corewell health, that’s still our strategy. So as we as we grow, we’re doing that same strategy. We’re integrating that on that common. So it’s.

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Joseph, Jason R.
Really to me it’s a foundational requirement for innovation in the future, right? It’s not to say every situation is that same, but if you really do want to be able to scale innovation, you wanna be able to operate your organization consistently, especially in a value based world. It’s just become that much of a drag and that much harder to do it when you’ve got every change has to be made multiple times. So that’s the foundational strategy we went through that starting with our ambulatory outpatient facilities, grew really big and ambulatory or physician practice.

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Joseph, Jason R.
And that our broader hospitals on board as well and that was kind of our journey there terms of the HIE, this has been a kind of a passion in a focus for a while. It’s that connecting of all the parts of the healthcare system is biggest integrated systems are we are representative of 100% for sure. And so the HIE was really grown out of how do we get away from this which is like faxing each other like crazy and start to digitize that and that’s that health information change.

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Joseph, Jason R.
The exchange work which we were really pioneers on some of the technology that grew into our Regional Health information exchange and then ultimately our statewide health information exchange to kind of bridge those gaps in coverage that the large systems couldn’t do on their own between each other or with their kind of aligned providers and connected facilities by really kind of bridging what I call the last mile of healthcare and making sure that as much of that data is flowing as possible.

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Jordan Cooper
To some, the CIO’s of comparable health systems around the nation have had difficulty.

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Jordan Cooper
Finding a way of making an HIE financially viable, they found it to be more of a cost center than a revenue center. What what would you say to those individuals who maybe want to actualize the value of an HIE but are who are having a CFO battered down their door and say, you know, where’s the value here we’re providing value to these external entities and there’s data sharing and cyber security. So how do you respond to that?

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Joseph, Jason R.
I think the value of the HI was to be a prophet center of any sort, right? I mean one of the challenges is just editorial comment is healthcare can’t all be about every piece of it turning a profit or making a margin. Sometimes you do things because they’re necessary to make the whole system work. And to me, hi isn’t necessary part of making the whole system work and the beneficiaries of that really often are health plans who may be able to improve quality. There are certainly the patients and the Members and the communities that they serve to be able to have their information.

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Joseph, Jason R.
Flowing the health systems are a big part of that, and a lot of HIV’s are set up to be funded that way, but they’re not necessarily the ones who are.

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Joseph, Jason R.
But say the beneficiary of that. But they they’ve needed to fund it. So I look at the HIE infrastructure and I’ve been appreciative that are big vendors have stepped into this and made it easier for us to connect amongst themselves with kind of core capabilities of the HR, some of the regulations have actually moved us more in that direction. So I think that each IE frameworks are going to kind of have to adapt to say what is the gap and the problem we’re trying to solve, not being everything to everybody and having a high cost model to have to support it. I think that’s the.

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Joseph, Jason R.
Transition that many people are probably trying to go through right now.

0:8:0.420 –> 0:8:17.850
Jordan Cooper
To Jason on another topic, more operational, I kind of related but but more specific on the operations you’ve championed the implementation and adoption of agile methodology to enhance Spectrum health, project prioritization and execution. How have you measured the impact of agile?

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Joseph, Jason R.
You know, Agile is an interesting one. We’ve been on what I call an agile journey. Maybe for 10 years, although it wasn’t called that back in the day. It was really just called getting all the people in a room, fixing it, we call it fixed teams at the time, right where, you know, we have so many different priorities in healthcare, so many different ways of thinking about it. And usually we work really well in tickets. We work well as well in projects, but really more and more. We need to think about things as a value stream we’re delivering and we actually started this and kind of led this journey from our health plans perspective because there’s just more.

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Joseph, Jason R.
Software development lends itself well there. I will fully admit we are not to the point where I would start to say we are an expert in it, but I definitely think we’re on the leading edge of moving in this direction. And really what it is is it’s about us getting the ability to manage capacity and demand in a meaningful real time discussion with the people who are decision makers and the people who know best as to what can be done in that gap. We put all sorts of processes in the middle with different methodologies and we still have that in some areas, but boy.

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Joseph, Jason R.
When you can really shrink it down to that, I think the benefit and the measurability is A and it does become measurable, right? We have velocity metrics and we can trend those over time and see how we’re much more predictable and what we can deliver and we could make prioritization decisions on a two week notice timeframe which in other ways sometimes like oh, you got to think about that next year or this is really important. But we got to talk about it later. It just allows us to be more adaptable. And once you can get into that ongoing conversation, right, keeping a list of all the stuff you’re not doing just makes you Mac.

0:9:53.110 –> 0:10:3.910
Joseph, Jason R.
Looking at the things you are doing and staying focused on them really allows you to feel like you’re moving the needle and gets you more into that rhythm of getting the things done today that need to be done today. It’s just a healthier way to operate.

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Jordan Cooper
So under your leadership, Cornwell recently earned the highest marks of any health care organization in the country in the 2022 College of Healthcare Information Management Executives, which is chime Digital health. Most wired survey. What does this mean to you and what would you advise? CIOs appear institutions about how to go about following in your footsteps?

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Joseph, Jason R.
You know, I I appreciate CHIME putting this out and no offense to them, but we we never like go out and study for that test like this is something we do what’s necessary to advance our organization and do the best things for our communities, for our patients that are Members. And we have a very digitally focused strategy. And I think what’s happened is because of the combination of those two things and when you bring that together and say hey CHIME, how are we doing? We’ve fared very well in there and that’s been a focus for us on our inpatient world, but also very much on our outpatient our posted queue which is why the combined.

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Joseph, Jason R.
Combining of that really rose to the top and we’re very proud of that. I think that just really demonstrates the expertise in the focus and the investment of our teams and quite frankly our clinicians and leaders in advancing digital technologies with a purpose. But it’s not something we really walk around saying, oh, we’re going to do that next year. It doesn’t show up on our goals. It’s just something that we’re proud of. But the proof is in the pudding in what we deliver to our communities.

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Jordan Cooper
So many providers have been well, you find many providers now who may be retiring, who when they began their career in the 70s and 80s, didn’t interact with EHR’s too much. They had paper charts and they’ve seen the entire progression over the last four or five decades of from paper charts to electronic health records. And all the digital oriented strategy that we’ve been discussing, some providers have questioned the value.

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Jordan Cooper
Of electronic health records, they have said that it may have adversely impacted communication between patients and the providers in the exam room and it was more for research. I wonder what would you? How would you encapsulate the value that we’ve been seeing at or that you’ve been seeing as a health system over the last decade and 1/2 through your digital forward strategy?

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Joseph, Jason R.
You know this is a mixed bag because on one hand I think there are so many improvements that have been enabled, the speed to get a lab test done and results back like 20 years ago, that was a tube system and there was runners and there was, you know, today it’s real time and the patient has that information. The minute that lab test via automation comes out the back end, it’s amazing. So I think there’s so many innovations and advancements that that whole digital infrastructure has allowed for that are.

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Joseph, Jason R.
Really big improvements, but at the same time I have a lot of empathy for our clinicians in general, because the combination of I think two things. One is the increasing rigor required to get paid to do what we do in healthcare and the increasing regulations that are required to get it done has put burden on our clinicians to document more, to explain more. And I honestly when I look at much of that information that gets there, some of it is absolutely clinically valuable and relevant. And but it’s harder and harder to parse out how much of that is necessary.

0:13:20.160 –> 0:13:53.210
Joseph, Jason R.
For the clinical benefit versus how much is necessary for all the other supporting processes and that is an, I think a fault of the health systems, I think it’s the result of the game we’re playing in and I think it’s something we collectively do have to be very aware of and continuously pushing on because it’s a balance right when you’re running on razor thin margins and trying to produce high quality and meet all these requirements, that burden stacks up somewhere and that’s where I think we have to be very acutely aware, look for ways of leveraging AI and automation to improve it. But we also have to be realistic.

0:13:53.280 –> 0:14:24.160
Joseph, Jason R.
About how much of this burden can we put on health systems and on our clinicians in general, and what is the benefit versus the cost of doing so? And I think that’s what people are feeling it, I’m sure, generationally has a big difference because people just grew up with that expectation. But I certainly can’t look at 100% of it and say, yes, as a physician, as a clinician, as a nurse, everything you do is 100% about care. There are other things in there that have to do with the other things that are necessary, but it’s harder to understand. So I think we have.

0:14:26.910 –> 0:14:27.390
Jordan Cooper
Umm.

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Joseph, Jason R.
Opportunity as an industry, quite frankly, to make that better for everybody.

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Jordan Cooper
So Jason, we are approaching the end of this podcast. So I’d like to open it up to you to talk about. You’ve worked on myriad issues for medical devices, cyber security, emergency preparedness, digital platforms like an open up to you and talk about maybe one of the projects you’ve worked on that you’d like to highlight where any thoughts you’d like to convey to CIOs who are listening to this episode.

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Joseph, Jason R.
Well, you know it’s it’s hard to like pick something that you know I would focus on and highlight as a project per se I what I would say is that I think strategically one of the things that CIO should be really thinking about is complexity is the enemy of innovation and much of our organization, many of our organization have grown. It’s kind of like a hospital building. They’re like frank and buildings, right. They’re weird. They got weird corridors and the a level doesn’t match the B level and you’ve got these different things and our technology.

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Joseph, Jason R.
Ecosystem isn’t always that different, and so part of what we have to be like relentlessly doing is simplifying down that core, making sure that we’re not making decisions to trade off tech debt right to say we’re going to take on more and more tech debt because we want to do these things because those innovative things can’t scale. If you don’t have that ecosystem underneath of it. And so I’m really proud of like some of the things that we’ve done with AI and we’ve actually got some studies recently where we’ve taken our collection of data and actually allowed ourselves to grow.

0:15:57.470 –> 0:16:9.170
Joseph, Jason R.
So may competencies that are really proving our predictability of outcomes and improving patient experiences with AI and predictive algorithms. I think on the digital front we’ve.

0:16:9.850 –> 0:16:41.420
Joseph, Jason R.
You know, we’ve probably been a pioneer not only on just like the virtual digital health side of things, but also really connecting experiences and allowing people to automate as much as their care journey and self-serve their way through that as possible. All of this stuff is important, but I think as we move into the future more and more and more of the organizations that don’t think holistically about their ecosystem and how it all works together and finally increasingly difficult to innovate because so many of these things are dependent on each other, they can’t just be solved by point solutions with features and functions.

0:16:42.0 –> 0:16:52.480
Jordan Cooper
Jason, I’d like to thank you again for joining us. This has been Jason Joseph, Chief Digital and Information Officer of Corewell Health. So Jason, thank you very much for joining us on the podcast.

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Joseph, Jason R.
Thanks, Jordan. Appreciate the time.

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