#JoinTheConversation with Dr. John Showalter and Leigh Williams
This #JoinTheConversation series is brought to you by our partner Experian Health and the episodes were broadcast live in Experian Health’s booth (#3503) at the The HIMSS17 Annual Conference and Exhibition. The interviews were recorded and published to the media player on this page. Please read more about why more than 60% of U.S. hospitals count on Experian Health.
Dr. John Showalter, CHIO Propel Health (Now Chief Product Officer for JVION)
Leigh Williams, Administrator, Business Systems for UVA Health System
Joe Lavelle 00:31 All right, I’m Joe Lavelle and I’m so excited to be bringing you “Join The Conversation” with my co-host Todd Eury from Experian Health Booth here at HIMSS17. Todd, let’s give a quick shout out to our sponsor Experian Health today, what a great partner.
Todd Eury 00:44 This has been an absolute incredible Experian Health experience. And I’m excited to be a part of it. The healthcare provider industry leader, revenue cycle management, identity management, patient engagement and care management. I can’t think of a better partner to be bolted up to against the podcasting with here at HIMSS 2017.
Joe Lavelle 01:07 Todd put your seatbelt on. You are about to be introduced to my absolute favorite guests of all time. I think we’ve done every HIMSS for the last three years at least. Leigh Williams and Dr. John Showalter. Leigh is the Administrator, Business Systems for UVA Health System and Dr. Showalter is the Chief Health Information Officer for Propel Health IT. Guys, welcome to the show! Thanks so much for making the time.
Dr. John Showalter 01:31 Thanks for having us.
Joe Lavelle 01:32 All right. I’ll get this started. You guys got a new book, I was just fortunate enough to get your autographs on my copy. What can you tell us about the new book, Mastering Physician Engagement: A Practical Guide to Achieving Shared Outcomes?
Dr. John Showalter 01:46 The book is a compilation of over five years of experience that Leigh and I have had really getting physicians to adopt things that they weren’t necessarily excited to adopt, whether it was working with the electronic health record or jumping on board with ICD-10. Those lessons are compiled and distilled into the book, and put into a framework that people can actually take action off of and improve their organizations.
Leigh Williams 02:11 I’ve been really struck by how this resonates with so many people. So we’ve done a few events this week where we were talking about the book and from folks that are coming from the other side of the planet to people that are right here in Florida talking about what a challenge it is to get physicians to want to participate to actively engage in IT, revenue cycle, population health, any of those initiatives that they see as not direct patient care. Just a timely topic for us because in order to move healthcare forward to transform, we need our physicians to be right there along with us doing that work together, and this talks about the tactics and the methodologies for approaching physicians to make that a successful partnership. So, fun to be talking with all of us that are struggling with it and perhaps finding some ways to get for it.
Todd Eury 02:58 The worst thing that can happen to a patient base is the status quo, and if there isn’t innovation in medicine, innovation in healthcare IT and technology, then patients are going to suffer. So when I think of this particular book, why this time? Why did you pick this time to come out with a book like this?
Dr. John Showalter 03:19 I think it’s because physician’s engagement never been more important, getting physicians to accept the change that is coming, except that changes going to continue to come and be part of the conversations. I’m actually just reading, somebody wrote about the quadruple aim. And it’s the triple aim of better healthcare, better health at lower cost, with the addition of and the satisfaction of the frontline clinicians. And they’ve really been left out of this conversation and I think one of the reasons they been left out of the conversation is that no one really has a clear path for how bring them into the conversation and work with them.
Leigh Williams 03:53 I agree and the pace at which were trying to do initiatives within our healthcare systems these days is frantic. There are so many IT initiatives going on, the healthcare providers all feel like they’re under a lot of pressure with changing reimbursement methodologies and now with uncertainty with what’s going to happen with the Affordable Care Act. It just creates this pressure cooker for them and we experience sometimes where they can be either frustrated or resistant to getting involved. So I think to face the challenges that are here and now, it is absolutely core to the all of the products that we have going on in healthcare.
Joe Lavelle 04:28 Outstanding. I’m hoping you’ll scoop us, I know you have the next four or five books conceptualized. What’s the next book that you’re going to write about, what it’s going to be about?
Leigh Williams 04:38 Too soon Joe, too soon.
Todd Eury 04:41 Spoiler alert, spoiler alert.
Joe Lavelle 04:42 Three more years.
Leigh Williams 04:43 What we’ve been talking about actually and it’s part of the response to the book is that people then think about how do you engage health IT professionals, and revenue cycle professionals in healthcare transformation. So sort of the inverse of that discussion. Another group that would be interesting to look at are simply executives or leaders within the healthcare organization, how do you get them engage when you know that you need to drive your business forward in a certain area, how do you get their attention to be able to fund? So if you look at the development of analytics programs within healthcare organizations that takes CFO, CEO level support for the process, how do you give them engage to understand the technology and be able to select that as their strategy? So some of those around looking at other categories of folks within the health system to think deeply about how they work and then apply some of the same types of tactics to that.
Dr. John Showalter 05:53 I definitely think that is the direction that we’ve discuss. We have discussed it from a presentation perspective, not so much from our book perspective at the moment. But a big part of the book is dedicated to the psychology of physicians and how physicians become more physician-like over their career, and how to tackle that. What is embedded in there though is an acknowledgement that the various stakeholders in healthcare fall into very different psychologies and trying to get them all on the same page when they approach problems differently, when they think very much differently about the same solution is a great deal of challenge. and we’ve had very open discussions when we were on projects together about how do we talk to who? Who do we talk to? When do we bring them together? How do we bring them together? When do we talk to them separately and what is the messaging to each of those? And I think that’s been one of the secrets to Leigh and I success, and would definitely be fotter for another book.
Todd Eury 06:31 So you remember the transition between 1999 and 2000 and the Y2K scare, and what that was like for our industry and nothing happened. So the world didn’t blow up, so the transition from ICD-9 to ICD-10 was another scare and you both provided such great insight to ICD-10 and advice to the audience and to the healthcare industry at large, what are revenue cycle teams busy with now that the that scare is kind of passed us or has it?
Leigh Williams 07:03 I think the scare has passed. I think that it’s become just simply operationalized at this point, and a big shout out to all those medical coders who really learn the new set and did an awesome job transitioning to version 10 for ICD-10. They really have it at this point. We need to keep focusing on physician documentation and making sure we’re getting the clarity and the chart and the recorded language around the treatment plans, and the illnesses and injuries, so they can do their jobs. So I think largely we are over that hump.
And to answer the question about what we’re talking about in the future, so we had a Revenue Cycle Solution Summit here at the beginning of the week on Sunday, and we were talking about process redesign, so applying leans, six sigma, concepts to workflows and healthcare. We were talking about the patient financial experience so one thing that I had recommended was be a patient in your own healthcare system and see what it’s like to receive those bills. If you get more than one for a stay, that’s not where the industry is headed or even is at right now. Some organizations are doing a very nice job with single statement, making it very clear to understand what the patient responsibility is.
And our HIMSS Revenue Cycle Improvement Task Force has also, we have here at the show information about what that patient financial experience of the future could look like with good collaboration and partnership between funding sources like banks, payers, and other healthcare providers who were giving their value into the system, and how does a patient deal with all of the information. So there’s a ton of focus on price transparency, good information to the patient and overall treating the financial experience as important as we do with the clinical experience, and thinking of it as its own thing that needs to be addressed as opposed to just that’s the bill. Anybody who’s ever gotten a bill knows what I’m talking about that there’s room for improvement there to make it better for us. And that helps with the health of our patients, because there’s nothing like getting a stressful bill at the end of a surgery, etc that can actually harm your relationship with the organization.
Joe Lavelle 09:05 Absolutely. Leigh we’ve talked in December about a couple of things, the duplicate medical record problem, the need for a National Patient ID, was there any progress on either of those or discussions about either those at the Revenue Cycle Solutions Summit?
Leigh Williams 09:18 We did not discuss the ID. I think that that is something that everybody would like to do and I know there’s some really good work that a AHIMA is championing and others that are, I think WEDI is working on that, there are other work groups that are looking at patient ID. And I think CHIME also has celebrated that as a topic that is very timely and needs to be dealt with. It’s difficult to figure out how to make that happen, and I think that that’s why standards are necessary, they’re also difficult. But absolutely in terms of if you blow it up and think of it as patient safety and how the data needs to be collected, governed, all of the data stewardship around the electronic health record that absolutely is a topic.
So I think we were freezing it perhaps differently, but it is the same thing where you’re focused on patient safety, reducing any kind of duplication in medical record, making sure that you’ve got the right patient with the right treatment at the right time with this little waste and error that you can possibly have, that absolutely is a topic that is high of mide.
Dr. John Showalter 10:20 And I think we’re at a point with technology where that discussion the next five years might become moot because there’s a lot of legislative confusion, discussion about the national patient identifiers. But what we really need is a trusted patient identifier whether that’s an assigned number or whether it is an algorithm that can look at all the information just put in and matched up. And I think we’re getting to the point where there are new technologies emerging. Actually I was just talking to someone about tackling the problem of actually making sure that someone that’s doing fitness activities for a discount from their insurance companies actually the person doing it, because you could give your Fitbit to your kid.
And there’s a new sole that you put in your shoe and the impact on that sole is identifying as a fingerprint, so it has to be you walking to get credit for it. So there are new emerging technologies that might offer a new space, but the patient matching understanding from algorithmic prospective is light years ahead of where it was 3 years ago. And I think we’re going to solve a large portion of the problem, just through the technology and the algorithms.
Joe Lavelle 11:28 Yeah, to your point Dr. Showalter our last interview was NCPDP, and they’re doing something with our sponsors here, Experian Health, and they’ve got a solution. And it could be a national solution, there’s lots of politics around that.
Todd Eury 11:42 Patient identifier.
Joe Lavelle 11:43 So the CHIME National Patient ID Challenge, they are looking for a national solution. So I think the technology, well we all know the technology could be there, it’s just now overcoming the political hurdles and getting patient safe and just getting over the politics of it all.
Todd Eury 11:58 So as that Fitbit is generating data, as that foot pad is generating data, as the collection of data is taking place, it’s generating all of this stuff the analytics of what is healthcare. So I have a question for Dr. Showalter first, but then Leigh I want to hear it from you too. So what are some ways that you are specifically using data analytics at your health system to improve patient care?
John Showalter 12:25 The internet of things is still a long way from the internet of knowledge, and it’s a really a long way from internet of clinical knowledge. But pieces are falling in place and I think we’re going to see really, really big games in the next five years or I think it’s going to be kind of transformational. The thing that is in place today that we’re beginning to get some benefit from really is the geospatial analytics. The knowledge about a person’s neighborhood what that means for their environment, what that means for their health, what that means for their incomes, and what that does for predicting what’s going to come out. Pointing that information in is way more important than a credit scores as far as predictions. It’s hugely important for clinical care and there are data sets out there that are unreal that have been collected for non-clinical reasons.
So the political campaigns collect all kinds of data, actually talking with a vendor that has 150,000 data points for census block and there are 11 million census blocks, so they have over a trillion data points and it includes things like would you use an app if recommended by your physician? So you can actually go census block by census block and figure out, which group of patients is likely to respond to a home monitoring system based upon apps. And we’re not really using that information anywhere across healthcare and it’s there, and our patients need us to figure out how to make it beneficial.
Joe Lavelle 13:45 We have to start paying you for promoting our prior interviews, because two interviews ago we had Mandi Bishop from Aloha Health (now Lifely Insights), there so solely focused on social determinants to health. They’ve created all this data or they gathered all this data, and there now helping organizations to figure out just what you said, how to incorporate that data and how to make meaningful decisions with it, and in meaningful suggestion with it. So I think you’re right, I think we’re on the doorstep. There’s companies that want to tackle that problem, they’ve just got to figure out how to get engaged with payers and providers to make it happen.
Todd Eury 14:17 There was an article in Healthcare IT Magazine about the future home and how the future home which would be driven by public assistance would be a smart home. So the carpet, the frigerator door, the commode, will all have sensors that would be able to collect data to report back to who is actually paying the bill, how healthy these patients were, but of course it sounded scary, big brother to me. But regardless the thought of that especially if you build an incubator for study would be so interesting and it plays right into what everyone is talking about here.
Joe Lavelle 14:52 Absolutely. Leigh I want to give you a chance to answer the question about analytics. How are you guys using analytics to improve patient care?
Leigh Williams 15:00 So the University of Virginia Health System has a stated mission of being the safest place to give and receive care. Much of our analytics work is around predicting readmissions risk, predicting sepsis, predicting harm events within our healthcare system, and we even look at predictions around which types of caregiving may be dangerous or more risky for our caregivers. So it’s not only about patient safety, but also about our team member’s safety. So we’ve got a vibrant analytics group that really does some nice work around figuring out where can we reduce harm and bring both improved health and lower costs to our organization.
So very focused on identifying problems that we have or what is the problem statement, what are we trying to fix and then aiming the data at those questions like who is at high risk for readmission and then putting the resources very strategically towards those patient populations.
Joe Lavelle 15:58 So three four years ago we were talking about analytics. People are really doing it today. What’s going to make the difference of the ones that are good at it and the ones that are just struggling through?
Dr. John Showalter 16:16 So I think in 5 years, it’s not going to be the math anymore. The edge for the next five years is going to be who’s got the best math? who really can have the best solutions? In 5 years were going to be staring at a whole bunch of people that have the area under a curve over a .9 which is as good as you can get in realistic in a real life situation. We’re working with partners now that are delivering that level of accuracy, but I think that that accuracy level is going to spread and there’s going to be more competitors right now.
What’s really going to make the difference is: can you get it embedded? Can you get it adopted, and how do you work with the clinicians to get impact to the patients or how do you work with a revenue cycle to get impact to the patients and the business? It’s all going to be about who can drive outcomes because the math is going to catch up, people are going to get it figured out.
Joe Lavelle 16:56 Very interesting.
Todd Eury 16:58 So Joe just got done saying about how data analytics was the big buzz word four or five years ago, but now it’s leverage. Now, it’s actually making sense. It’s not a buzzword anymore, it’s palatable and we know it’s happening. So if you look in this crystal ball, Joe brings one every year to the HIMSS conference and you look into it and you see the biggest innovations in revenue cycle in the next two to three years Leigh, what’s that look like?
Leigh Williams 17:23 Wow! So we did talk about some game changing technologies at our conference, so I’ll share some of the wisdom that is coming out of that group. Analytics is part of it, really moving into cognitive science and being able to, I like John’s phrase of saying, solve the mystery. So rather than doing the work where I just talked about aiming the data at a specific problem and getting a specific answer, starting to take in a whole context of data and information that we’ve now spent years accumulating and figuring out infrastructures and how do we work with it and getting the math done, and start asking more complex discussions around how do we help in the context of revenue cycle, it is around, how do we help patients understand their responsibility and create processes that enable healthcare systems to connect with their patients to handle those responsibilities, pay their bills in a timely fashion in a way that encourages their engagement with the health system. So not in just sort of a transactional way, but really in keeping it as a partnership on both their healthcare and their financial care.
So that’s a very open field right now that I think has a ton of possibility with it and that in itself is going to lead us to improve processes around workflows, and using the application suites better, and making better use of patient engagement. The technology’s there to be able to work differently and I think we do it all in this concept of engaging the patient in their financial experience with the healthcare system.
Joe Lavelle 18:50 Perfect. Dr. Showalter?
Dr. John Showalter 18:51 I think we’re going to see, I don’t know whether or not you want to call it an innovation or a resurgence of patients inviting the clinicians back into their home. If you go back a hundred years, a hundred plus years. It was all about the clinician and the doctor at that time, with his little white bag coming to your house and doing whatever he could for you whether he had medicine or not. And we went through this transition where we kicked the physician out of our houses and they went to hospitals, and they went to clinics and what we’re realizing is that it does not really help us stay well. And I think we’re going to invite them back into our homes. It’ll be virtual, it’ll be with monitors, but it’s going to be about inviting the clinicians back into the patient’s life. And what I find kind of interesting is I think revenue cycle is going to drive a lot of that, because of payment reform and the win win of that occurring. But I also think the physicians are going to get a lot more satisfaction out of those interactions than what we’ve been having over the last decade.
Todd Eury 19:51 Go telehealth.
Joe Lavelle 19:54 All right. But you’ve got to have the workflow to make it work. You can’t just plug it in.
Leigh Williams 19:58 Correct.
Joe Lavelle 19:59 All right guys, as we wrap it up here. Leigh I’ll ask you this, where can people go to learn more about your new book and get your book Mastering Physician Engagement?
Leigh Williams 20:08 You can easily find it on our best friend Amazon, so Mastering Physician Engagement is the title. And CRC Press is the publisher for our book and they have a nice website as well. It’s easy to search and find the title, and they’ve got some information. Both places share a little bit of an exert with you, so those would be the best.
Joe Lavelle 20:28 If someone would like an autographed copy, what other shows are you guys going to this year?
Dr. John Showalter 20:34 Oh, that’s a good question because I don’t know if we have it all planned out yet. The next one I will be doing a presentation at the summit for the Texas Association of Community Health Care Systems. I think we’re going to North Carolina in May.
Leigh Williams 20:50 That’s the North Carolina state chapter event, we’ll be there. And then there are several events that we do with HIMSS Media, so there’s Big Data and Population Health, there’s the Cloud Computing Forum and the Revenue Cycle Solutions Summit. So we are participating in those throughout the year as well, and then other applications specific healthcare user groups.
Joe Lavelle 21:09 Very good. All right guys. It’s always a pleasure, thanks so much for sharing your wisdom with us today.
Todd Eury 21:13 Thank you.
Leigh Williams 21:14 Thank you for having us.
Dr. John Showalter 21:15 Thanks for having us.
Joe Lavelle 21:16 It’s our pleasure for sure. That wraps this live broadcast from HIMSS, again we want to shout out a quick thanks to your sponsor Experian Health. On behalf of our guests Leigh Williams, Dr. John Showalter and my co-host Todd Eury, I’m Joe Lavelle and we hope you stay tuned for more Intrepid Healthcare’s “Join The Conversation” coverage live from Orlando.
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