Sarah Richardson joins me to discuss opioids and Apple. Both enjoy bi-partisan support and make meaningful progress over the course of this past week.

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Bill Russell:                   00:09                Welcome to this week in health it where we discussed the news information and emerging thought leaders from across the healthcare industry. This is episode number 36. Today we talk apple and opioids more specifically, legislation to fight their proliferation opioids, not apple. Uh, this, uh, this podcast is brought to you by health lyrics. Health systems are moving to the cloud to gain agility, efficiency, and new capabilities. Work with a trusted partner that has been moving health system to the cloud since 2010. Visit Health Eric’s icon to schedule your free consultation. My name is Bill Russell. We’re covering healthcare cio, writer, advisor with the previously mentioned health lyrics. Before I get to our guests, I want to make everyone aware of our great resource for your it team, since we can help it as a youtube channel with great insights from industry influencers like our guest today, short segments, complete episodes, all curated for easy access. Uh, every week we add another seven or eight videos to the collection. And it’s now up a well over 300 videos a at this moment. So check it out today and this week, health [inaudible] dot com slash video and share it with your colleagues. Today’s guest is a returning host from episode 12. Wow. It, it’s really been. It’s been a long time. And, and, and the host of the hymn. SoCal podcast. Today we’re joined by Sarah Richardson of healthcare partners at Davita medical group. Good morning, Sarah. Welcome to the show

Sarah Richardson:         01:30                bill. Thanks for having me back.

Bill Russell:                   01:32                Wow. You’re like a professional. You have such a great podcast with the so cal hymns podcasts and buy great podcast. I mean great gas, great topics. Uh, you know, what do you think the best thing is about, about doing a podcast from your perspective?

Sarah Richardson:         01:47                Oh Gosh. Yeah. It’s funny. It started out as a sort of pet project for us at SoCal him to see how we could expand our educational footprint of topics that are relevant in the industry. What we found out was that there is a ton of content out there and so many people who are willing to share that information with others. And so what we love about it is that it forces us to go and say, hey, we need to be talking about these topics and, or may not be topics where we’re the subject matter expert clearly. So in order to thoughtfully do that interview, you have to a go cole the talent to have come, come, come at the conversation, then you have to do your research before they show up. And so what most people don’t know is that we record those in bulk.

Sarah Richardson:         02:23                So we’ll sit at of Saturday aside and work with like four or five hours worth of shows. So those, like those days leading up to that day, I feel like I’m, I feel like I’m a college student cramming for an exam because every topics pretty, pretty intense. And then having to go and create all these different questions, et cetera. But I’m fortunate enough to have the contacts that I can reach out to colleagues and I know that it’s going to be a great show because no one’s going to try to trip anybody up on a podcast all about sharing of ideas and information. So it’s just been a great journey.

Bill Russell:                   02:51                Yeah, absolutely. Sometimes people are nervous about coming on this podcast and I’m like, look, my job is to, is to bring out the best in you. It’s not to stump you with a question.

Sarah Richardson:         03:00                Yeah. I give him the questions ahead of time. I let them send me their questions, etc. The whole point is to have a great conversation about a cool topic that all of us need to know about in today’s that hit world.

Bill Russell:                   03:10                Yeah. So you guys have covered a loT of great side of cybersecurity innovation, uh, cloud computing. Uh, what are, what are some, who are some of your guests and what are some of the things you’ve talked about?

Sarah Richardson:         03:18                Oh, absolutely. So we’ve had sajida men talk about artificial intelligence. We just did this month is september episode that comes out today, is Dr. Anthony chain a, another level of ai being interviewed by Alan Young. so it’s great allen’s our first guest podcast or from a host perspective and he’s on our board as well, which is very cool. and we’ve had everything from people talking about leadership traits. So in the next, like the next four months, you’re going to hear from bricks to ford about relentless prioritization and governance. You’re going to hear from tom stafford about 10 leadership principles. Um, they’re going to, we had a conversation with it’s Finland is really about how they host medicine and their thoughts around r and d and we chose Finland because it’s working in europe is going to be over the next three years. And so we’ve created that partnership within lynda as well.

Sarah Richardson:         04:04                So those are the types of topics that are coming up. And then I’ve got a whole slew of people that are reaching out to. And if I’m on my favorites, is that we’re going to have senator ed hernandez on the show, a recording with us in october to talk about his state hit agenda and really how we can continue to be huge advocates because uh, on the side I took on this year and the vp of advocacy for so cal hymns and just the importance of how we can affect legislation. And you see that in the opioid epidemic with what time is doing and other leaders in the industry.

Bill Russell:                   04:35                Yeah. So you’re, you’re heading off to Washington soon for that, uh, for that get together. is that, is that right?

Sarah Richardson:         04:40                It is. It’s the first, uh, annual time a policy summit. It’s October 3rd through the fifth. It’s on capital hill’s mdc. what’s really good about that though, is that years ago the hymns chapters used to go to dc and do like the national hit week, which is October 8th through the twelfth this year. And now we do about two years ago, it switched over to state levels. Now You need to like state hit days. We do ourS in may in California. So there’s that gap of how do you get your hit advocates onto capitol hill. We’ll time is stepping in and doing that work in terms of it’s so active with policy. Anyway, cletus earl’s been waiting for time for a bit this last year that, um, it’s really cool that we’re going to be able to start to have a reciprocal way to get to Washington and be heard and really combine our state and our local efforts.

Bill Russell:                   05:25                Wow, that’s awesome. So the last time we checked in with you, again, it’s been 20 some odd weeks. It was optum, a healthcare partners medical group all coming together. What’s the update on that? How’s that going?

Sarah Richardson:         05:39                It’s going well and we are, we’re still anticipated to close in 2018, so it’s still in process and we’re hopeful that it happens this year. I think anybody that’s and threw it knows that an acquisition of this magnitude takes time and we’re just in that final checks and balances and making sure everything’s way that it’s supposed to be in. Of course the ftc makes the final decision and so we’re hopeful that it happens this year. That’s where all of our time and energy has been spent is what we call day one readiness. And when you spent probably the last two and a half to three years combining all of your hit and your resources into a shared service like we did with the devita umbrella, which was phenomenally, we’re just about done creating a singular it organization for all of devita inclusive of kidney care. And they go, hey, by the way, uh, you’re being sold and now you need to undo all the work that you did over the last two and a half years. So that’s really been the last few months in my life, is making sure that we are an independent medical group again, ready for day one once the transaction finally closes.

Bill Russell:                   06:35                It’s amazing. So one of the things we like to do with our guests is just, we just talked about a bunch of things that you’re doing, but you know, what are some of the things that you’re working on that you’re excited about right now?

Sarah Richardson:         06:47                I would say for work continues to be to build that independent team. So, you know, what’s wonderful about the whole health care partners footprint in southern California is that it’s always been a series of acquisitions. And really select acquisitions to become the leading independent medical group in so cal and being able to do that again, just basically able to say, hey, we’re now we’re going to go back to being a medical group owned by a medical group organization essentially. But when you really bring your teams through that journey, it’s watching them be able to say, okay, we did all this work and then we need to essentially undo the work of undoing something. We’re building something a little bit different and stronger than before. And so I’ve been excited about the fact that our teams have just been heads down getting the work done, looking forward to the continued future like they have always done, quite most pressing was in a, um, in a recent town hall with the team and there’s just $10, change their strife.

Sarah Richardson:         07:37                And one of our manager said, hey guys, I’ve been with the organization 25 years and that means I’ve been acquired seven times throughout the journey of healthcare partners. So this is just one more step in that journey. And she’s touched a pillar on our team. And everyone was like, oh right, we can do this again. And so I feel like it’s the ability for the team to focUs on being able to become part of something even bigger than what they were and realize that their future is very much in front of them and that they have control over that

Bill Russell:                   08:06                m and a. And she, she took the role of the acquiring entity and I took the role of the cio of the being acquired entity and we just talked about the different things. and one of the things I made it a point is that, you know, in being the acquired entity, a lot of times that opens up a whole set of new opportunities for the organization. and so people sometimes get skiddish and want to jump ship. But in reality it could be the best thing to happen to your career to be acquired by another entity.

Sarah Richardson:         08:35                Especially one that’s like the end of the day. It’s, it’s a fortune six company. And I’m like, guys, there’s going to be more, more opportunities than you’ve ever even considered in, in your life before. And, and it helps to. I think that if people like me and others have are totally set where we’re like, we’re looking forward to it, we’re ready to go. We’re not even even exhibiting any kind of concern only because, hey, I have done this before, but more importantly we’re on the right trajectory. And so when your, when your leaders are comfortable and are excited about what’s coming in, I think it helps the team similar a little better too.

Bill Russell:                   09:08                Fantastic. Alright, so on the, on the show we do two things to do in the news and sound bites in the news. We each pick a story and discuss and we’ve got a lot to talk about this week. And then the soundbite sections. I just asked you a series of questions that I have shared with you earlier, not too much earlier. I’m going to give you the first story, so, uh, go ahead and share your story and give us a little background.

Sarah Richardson:         09:32                Yeah, absolutely. So more and more involved in advocacy relevance thing is there are, there are four key things that really have the time advocacy teams are focusing on a national level of cyber security interoperability, a opioid epidemic and telemedicine and all very relevant and what’s probably the most pressing in some cases is the opioid epidemic because in our, you know, we don’t necessarily hear about it as much. We hear about the things that we can do to do like ecs and help our physicians get in front of that. But you know, I personally haven’t been affected by anybody with opioids, but I know it’s, it’s very prevalent. I mean 70,000 people a year are dying from opioid overdoses, overdoses, and it’s not like the people you would expect it. I’m surprised I don’t know anybody and I’m grateful that I haven’t. and so when you think about things that you can advocate for, uh, the senate was actually voting this week on a bill that you can get fentanyl, which is 50 times stronger than heroin, a mail order through China for the us postal service and a sentence voting on a bill to ask the eu has ps to have to register these packages that are coming in.

Sarah Richardson:         10:33                It’s something that fedex and dhl and ups already do so you can get in front of the fact that you can mail order some of the strongest opioids out there in the world. And to figure out a way to get in front of that more than just, you know, through the hit efforts. And so I’m grateful that we have such a visibility into it at a national level. I feel like it’s something that’s not partisan. You know, whether it doesn’t matter what your politics are, it’s a problem. And you see people coming together at a time when they’ve been more divided than ever on helping people overcome an addiction and creating policy that allows for that to potentially be a true statement.

Bill Russell:                   11:12                I also noticed that in the bill it has a, it accelerates the research, uh, to develop nonaddictive, painkillers and alternatives to opioids, which is, you know, I guess they call it really the silver bullet if she can get a nonaddictive a painkiller. So that’s a great step as well. All right, so that’s a regulatory step that’s being taken and we appreciate that. Um, it’s interesting when I had a, uh, an while they’re on the show, uh, the ceo from wellpepper, which was a digital startup, she just got us how h caps is a potential driver for over prescribing. So h caps scores, you know, of how was your pain managed and, and she shared the story, you know, so when someone’s tried opioids after total joint replacement, uh, surgery, uh, they’re, they’re typically prescribed a large number because you can only prescribe them in person.

Bill Russell:                   12:04                And so if they’re having joint replacement, they can’t get back into the, to the, they struggled to get back in to, to get the prescription refilled. So they, so they over prescribed. And so two things happen. Either they take them all or it ends up in a medicine cabinet for a high school kid or, or, or younger to take. And um, and, you know, and she actually shared a, a patient story. They were doing some, some research and one of the patient stories, you know, a good patient said, well, I took all the opioids and they said, well, you know, what was it because of your pain? And the answer was nO, it wasn’t because of my pain is because my doctor prescribed it to me. I assumed that was supposed to take it. So, you know, the, the legislation is one aspect of it, but there’s still a, there’s still a policy challenge, uh, in, in the unintended consequences of the age cap measure. Uh, and in some other things. But one of the things I wanted to talk to you about is a, so we’re going to be the ones in the room, uh, and we’re going to be asked the role technology can play in addressing this crisis. What do you think are Some of the things that you’re seeing out there from a technology perspective or from technology partners that may help in addressing this challenge? Do you think?

Sarah Richardson:         13:19                That’s an excellent question, bill, because you think about the fact that, um, that first met the med adherence or med adherence isn’t about taking your opioids. Med adherence is about making sure you’re taking your status and other things that were being measured on. So you think about the reconciliation process when a patient leaves the hospital or even the post acute setting, what that followup looks like and what kind of education materials we can give to them, whether it’s a patient portal or another sms push technology or messenger service that allows us to be able to say, here’s the education behind your opioidS and here’s what you should do. If you don’t need all of them, like, here’s how you can get rid of them or if you do need them, here’s how we can call you and pitch you really in the care management plan that helps to manage your pain or manage the issue that’s at hand.

Sarah Richardson:         14:03                Um, but there’s a few things that are in flight, there’s the overdose protection and patient safety act that allows us to manage opioid records, but they don’t necessarily get shared because of hipaa. So how do you create opportunity for drug treatment or diagnoses that are out there on the ehr is to be interoperable to share those specific details because you get this blob of data and a ccda, you’re not going to go look to see, hey, bill got sent and all for this at one point. Um, so there’s interoperability, there’s the ability to share the drug history records. Um, telehealth to me continues to be a space where if you can, so you think at fairbanks federally qualified health centers aren’t allowed to bill for telemedicine right now. And a lot of the people in the us that have an addiction to may go to those for care. And if there’s not a way for that, a provider or for that patient to be able to have access to either maybe a behavioral health advocate or someone who can help them manage that care more effectively in a setting of where they are, then we’re going to continue to put ourselves at risk at some of our most vulnerable population. So using the tools we already have. I’m just making them very specific to something that’s been identified as a very worthy cause.

Bill Russell:                   15:21                Aspect of education here I think is really key. Sometimes recording those conversations that the physicians have at the end where they’re giving the care plan and the care instructions, recording those and putting those into a portal so that they can be watched later. I know that with my, my family, I’d like to see what the doctor actually said because I’m not in the room. And they’re like, well I don’t know what she said. She said this and this. And I’m like, oh man, you know, so how do we know what’s right? So recording those things is interesting. I think one of the more interesting things I’ve seen in my career was I saw a design agency that worked with a hospital in chicago and they took their discharged documents and they did a, I think like a 90 day program with them and design thinking and really redid the discharge and they, they gave.

Bill Russell:                   16:09                I wish I had a copy, but they gave me a copy of it. Uh, in fact I know who to reach out to. I’m going to reach out and get it because it, it’s phenomenal that they took this really complex, you know, five page thing that they handed somebody and they made it into a front and back color. Coordinated a really interesting pictures. And I just looked at it and I’m like, and they said, you know, fifth grade reading level. And I looked at him like, yeah, it’s pictures. It’s very clear What I was supposed to do and I think it was for asthma and it’s very clear, you know, when I’m supposed to just take my inhaler, it’s very clear what I’m supposed to go to an emergency room and that kind of that kind of thing. Maybe not falling within technology, but the whole idea of bringing design thinking into the organization is something that it really can facilitate and help.

Sarah Richardson:         16:59                oh, absolutely. When you think about when your patient, if a patient has a preScription for an opioid in your face numbers, like we don’t want you to become a statistic. Seventy 2000 people who are dying from this as an addiction and here’s what we’re going to do to make sure that you only take this as long as you absolutely need it. Yeah.

Bill Russell:                   17:19                Well that’s great. I’ll let you have the last word. Is there anything else you want to say on that story before we get to, you know, the flashiest story of the. Of the week?

Sarah Richardson:         17:26                Yeah. Would you share with those that are listening and our peers is that if you’re not aware of what’s going on both in congress and across the board with opioid epidemic becomes familiar with it because if it hasn’t happened to you a little that you know about it very well may and you want to know what resources are available to help someone who may be suffering from something like this.

Bill Russell:                   17:46                Yeah. And it’s great to see him taking a lead in and it’s great to just plug right into that, uh, for, for those of us who are connected with chime and looking forward to looking forward to having you on the show. Let’s see. It’s been 24 episodes so the next time we’ll have you on as sometime in the spring and hopefully we’ll hear more about what you’re doing in that role with, uh, with advocacy. It shoulD, it should be interesting. So I feel kind of, I feel kind of wimpy here. I took the, I took the eAsy story, but I think it’s something we should talk about. It’s already getting a play in the physician community and some other things. So apple unveils a watch series for with fda approved ecg so you could find the story anywhere. I’m actually looking at the healthcare it news story and you know, the, the big thing is right there in the title fda approved ecg on the apple watch, which one of the big reveals.

Bill Russell:                   18:39                And that’s uh, you know, and that’s pretty exciting to have that on your, on your, um, risks and you can just touch the digital crown, you can get the ecg done. Uh, and, but I thought the more interesting one to me was the fAll prevention work that they had done. And so the fall, fall prevention is when it detects a fall. They, uh, you know, they can tell if you slipped, if you fell forward because the actions are pretty standard and, and the watch would sort of track that. And uh, so if you, if you fall it, uh, will initiate an sos call and you could or it’ll pull it up. So all you have to do is hit a button and you can actually call somebody. So the, the famous I’ve, I’ve fallen and I can’t get up in the apple watch will, will function, is that, uh, the second thing is if you fall and are immobile and don’t move for 60 seconds, it will actually make that emergency call, that emergency contact for you.

Bill Russell:                   19:41                And uh, I, I would assume given your gps and those kinds of, those kinds of settings. So the apple watch is really becoming a, a, a, a medical device. I mean it clearly, I meAn it’s fda approved and they are continuing to push in this direction. Uh, so I guess let’s start here. So where does this fit in the strategY? Are we, uh, let’s see. Are we issuing an apple watch to all patients have a certain acuity in the hospitals so that they fall in the hospital? We find, you know, we, we know if they are home care, it’s probably a better case. Should I buy one for my, my parents and, and my father in law who are in their eighties so I can have peace of mind and sent me up as the emergency contact. So if they fall, you know, uh, you know, and they, they live at my, my father in law lives on his own, so he falls. That would be, it would be great for my, my wife to get a phone call and, and be able to help them in that time. So where does it fit, where does it fit in the overall it strategy and, and really health system strategy do you think saw when I saw

Sarah Richardson:         20:48                that they don’t fail the ability to, do you know, the ekg or the elevated heart rate? What I love about it is I think if we sometimes discount that are baby boomers and our seniors and here’s a thousand people every day in the state of California, aging into medicare eligibility. and so thAt means that whole population is very tech savvy. I literally. So I share a plan with my mom. She’s almost 76 a data plan. I had to go unlimited data. So a woman who didn’t want a smartphone and now she’s like, I mean literally I like, I like I have a teenager for all the right reasons. I had to go an unlimited data plan because my mom is online so much on her smart phone. Just like, wow, these ads will use a lot of data. I’m like, yes they do. Um, so part of that, what I think is great about what apple is doing is that they have slowly integrated themselves into a population that was historically seen as being maybe a scared of technology or not as much of an adopter.

Sarah Richardson:         21:42                And now it’s not a big deal. I could give my mother and apple watch and I’d probably think goodness already have unlimited data. It’s one of those things that it would be one more thing in her technical ecosystem and she has alexa and she helps her out with all kinds of different things that she’s looking to do. So I remember last year at hims, the day beforehand is always had the big time conference and one of our first speakers talked about the fact that hospitals, systems that are early adopters of taking high risk patients, like somebody who has chf, endorsee, opd, pretty common combo of being a high likelihood for readmission. Sending that patient home with an iwatch to look for elevated heart rate and to look for just different anomalies that may be occurring to provide that intervention ahead of time and call them and potentially prevent them from having to go to the er and be able to get in front of those types of things.

Sarah Richardson:         22:31                We are at the precipice of this and it’ll be some of the larger health systems. Maybe take this on initially, but it’s the beginning of being able to say if I’m wearing an iwatch and it starts to track my body temperature in for two or three days, it had a fluctuation and body temperature and the fluctuation in my heart rates I wasn’t anticipating or I wasn’t even paying attention to. That’s actually the sign of like a pending infection. Then my watch is going to tell me ahead of time that even I may have something going on. Um, so it’s right now it’s maybe high risk patients that are at risk of being readmitted, but at the end of the day it’s going to be people that are in their forties like me, who maybe have something going on that we weren’t even aware of because it’s not happening in a very acute level.

Bill Russell:                   23:10                Last week, talked about the role of incentives and how 80 percent of their patients now beth Israel deaconess are at risk so they’re not at risk health, but the health system has taken risk, uh, in terms of the contract to manage that patient. So they’re only getting a fixed amount of money to manage those, uh, those patients. And that really changes the paradigm. So, you know, giving somebody a $300 watch to go home with a might make sense if you, if you have a risk based contract and you need to monitor things. If we’re still in a fee for service model, you’re maybe not looking at these kinds of alternative models. But if, if it matters to you what’s happening at the home, not I understand it matters to everybody from an altruistic standpoint, but if it matters from a financial standpoint, then you’re saying, hey, this $200, $300 investment makes sense to manage to make sure that we’re monitoring this person on a 24 basis so that they don’t become a, you know, to a higher acuity and hire a level of need. So you guys have a fair amount of at risk population that you manage. Do you see this as you, I know you said the, we’re at the precipice, but do you see like an apple watch strategy or, or a device strategy, uh, in the home that cio should be thinking about that, you know, that patient centered medical home as has been a topic for awhile. But where do you, how do you see that playing out?

Sarah Richardson:         24:47                No, it’s already there. so we have a lot of disease management and high risk program management with our care managers because we are, we’re risks. We do take almost full delegation from 14 health plans for all of our patient populations. And So we’re already in that boat and we do it for things like copt and diabetes and chf. We have programs where we have a disease managers and if we know that you’re discharged into a high risk program, we have europe, we have the ivr, we have a phone call you every two or three days and based on your responses we know to have someone do an intervention, et cetera. So then we started adding technology for. We send people home with a home monitoring kit for 30 days for cfed and make sure that they’re doing well and if they show improvement then obviously be discharged from the, from the kit and we still monitor them, et cetera.

Sarah Richardson:         25:30                You continue to continue to add the things that make sense for your population. And so most places are already doing things like that. Home monitoring is not new. It’s a matter of, to your point, are we altruistic about it or we just delegated for it, like I’m lucky in that where you are delegated for it, but we’ve been delegated for so long that that is part of who we are. Maybe an altruistic mission, but it’s also the right thing to do. I’m grateful to work for a healthcare organization that does the right thing perhaps based on some of our modeling, but it’s wonderful to know that we are 100 percent responsible for the care coordination that patient. And so adding technology to help them be healthier is really one of the funnest parts of my job.

Bill Russell:                   26:09                Yeah. And I think we’re seeing more and more systems a go at risk and I think that a more interesting story for me from this year was from the jp morgan conference was intermountain saying we’ve, we’ve selected a zip code of a population that has very poor health outcomes and we’re going at risk with medicaid for that population. So intermountain’s doing a whole lot of work to try to figure out how to bring the level of that whole population out. And literally, and we had mark probes on the, on the show and you was saying, you know, literally from this side of the street to this side of the street, someone could live an extra five years and that’s just doesn’t make any sense. And so they’re waiting into social determinants there waiting into technology. They’re waiting into, uh, you know, making sure that, uh, I mean not in, not in salt lake, but making sure that they have air conditioning, making sure they have access to people.

Bill Russell:                   27:05                And so that’s, I think we all agree that that’s the future. The future of medicine is a more continuous, more where the healthcare provider acts as the, uh, the, the expert that, uh, is, is calling through that information and proactively reaching out and managing the population in that community. So this, I think the apple watch is, is interesting. I think it’s just like you said, it’s on the precipice. So I’m looking forward to a fair number of pilots and integrations with this in the health system. But what do you say to, you know, so one of the tweets from this morning was, what about all the false false positives, you know, who’s going to pay for the false positives on the, on the falls and that kind of stuff. And that was from a physician and um, you know, that’s, that’s going to be kind of the push back. I think we get on this kind of technology, I’ll give you the last word on this as well if you’d like.

Sarah Richardson:         28:08                One thing I love about apple as it creates conversation and the conversation that it drives allows them to think about what to put into their next release, so their next thing they’re going to be doing to connect people to take better care or help take better care of patients and what I love about and everyone doesn’t big apple Fan so it’s like fine. I’m always, it’s evangelist of apple. What I love is that they are taking the very best of what technology has to offer and incorporating it into things that we are already comfortable with. So you see them introduce the product and then all the benefits that it can have. So it becomes ubiquitous with of how we do every day. So it’s not a surprise. The next thing is going to be the ability to connect directly with your physician and do your video visit from your watch, et cetera. So you know, kudos to apple for creating a both solutions and controversy around doing the right thing.

Bill Russell:                   28:58                Yeah, that’s awesome. Uh, yeah, I’m, I’m really excited about this. So this, we’ll transition to a sound bites now. So during this section I asked toss out about five questions, one to three minute answers, you know, if you go longer, I don’t stop you. It’s more of a guideline than a rule. Uh, and if you want you can throw questions back at me. I can’t guarantee the answers because I have not prepared any answers to these questions, but we can, uh, we can see what happens. So first question, your, your, uh, your system is a leader in coordinated care value based care. What foundational technologies enable healthcare partners to excel in this area?

Sarah Richardson:         29:33                We are amazingly talented at population health. We built our own platform, you know, 20 years ago before it was even before I was even a thing. Healthcare partners was doing it. Um, that’s heavy though. That’s about utilization management, care management, disease management, an incredibly robust warehouse with very deep analytics reporting capabilities on top of it. And I think one of our favorite things is that we grow. We’ve grown up running our own gap lists and creating Your own metrics, the blessing and the curses, all of that is it now that most of this stuff is mainstream, these tools and technologies, it’s us adapting all of our processes into what’s off the shelf. So we are at the phase where we can now retire our homegrown stuff, go mainstream, and then you just, all of that talent that we have in house to build tools that don’t exist in the marketplace today that we need. So we’ve always been at the front end of a lot of the things that you’re seeing the off the shelf today. Um, but we’ve always done it with just really deep analytics and probably have an incredible understanding of what it takes to maintain a healthy population.

Bill Russell:                   30:40                That segues into the second question, which is, uh, you know, analytics is so foundational to everything we do in care and especially value based care. So give us an idea of how a new measure or meTric goes from idea to operational daShboard in your organization. How does the idea get off the ground, get approved, assigned resources built? And then operationalized.

Sarah Richardson:         31:04                So let’s start with, we’re not unique in that we use steering committees and to help drive what needs to go into the tool sets that we utilize. So obviously you’re gonna get the regulatory compliance things that you handed out. Hey, there’s new heatest measures. Hey, there’s new p for p, hey, there’s new starters and those are things we need to be thinking about that all those into basically our think tank, this one steering committee, we figure out what pieces need to go into what we call the physician intervention or the physician information portal, which creates our patient intervention reports. Like this is the things yoU need to be talking to your patients about, et cetera. It’s always this think tank of ideas and sharing what’s coming. So we’re fortunate, we’ve got people who sit on apg, we’ve got people that are connected with all of our health plans, we’ve just, we’re kind of all over the state and we bring that information back into our organization and be like, hey, this is the requirement, but then how are we going to do more than just need that?

Sarah Richardson:         31:54                So we are not in the business of checking a box and meeting and requirement for like, here’s what, here’s why it exists, here’s what we need to be doing and here’s what that looks like in our organization. So our goal is always to create what we think are the exceeding or the metrics that go along with that. And there’s a lot of creativity that goes into that. So that’s why so many of the things that we built, anybody who’s been a part of a healthcare organization for a long time knows that what I call the, um, the sort of organizational architecture of how your systems are built. It looks like we call it spaghetti diagram and it literally looks like that. It’s very, it’s a beautiful diagram, but I’ll tell you, it’s like a board game. There’s so many pieces and connections and parts and things that have to work well. Um, that now we’ve also learned that not only is it important to bring an idea in how we’re going to build design, test and implement, maintain, et cetera, do we buy versus build? Who’s going to manage it? What is the reporting functionality look like? How are we going to use the data? How do we refine it? It’s also how are we documenting this so that we aren’t creating a monster For ourselves? We almost have to think about the internal interoperability as we build for the future.

Bill Russell:                   32:57                It’s interesting to me to the second person I’ve asked that question too, and I’m going to keep asking it because each organization has a different flavor for how analytics gets operationalized within their organization. And some have a very distributed governance model. Obviously the, the, the regulatory ones are easy and the business wants. Some of the business ones are pretty easy. You know, you have to do certain things for, uh, the payment models that use, that impact your physician. So you have to do certain things from a regulatory standpoint. But then there’s a whole host of ways that analytics bubbles up that I find fascinating to look at the differences of how organizations function.

Sarah Richardson:         33:40                We’re always getting better at it because we have so many spaces that can do analytics. So you give people access to your warehouse with reporting and just know what that means.

Bill Russell:                   33:50                Yeah. And that’s, that’s the golden ticket right there that we’ve, we’ve often talked about when you can get analytics for your health system to be google or ask, you know, ask siri or ask alexa how many, how many of this or how many of that. And you just get the response back. In fact, that’s what my ceo asked me for us, I want it to be like google. I want to ask about our health system or our population anD I want, I want it to give me answers back, like, who I’m like, I don’t, I understand what you’re asking for you, you want the ease, ease of finding the information. But google doesn’t come back with generally doesn’t come back with a speciFic answer. They come back with, hey, here’s 100. And then you as a person have to go through and go, I think it’s this lake or this lake. So, uh, the most cost effective care. Obviously it’s preventative homebase and we just talked about this with the apple announcement, but I wanted to walk through some other technologies with you to get your thoughts on how they, um, how that will be applied to build healthy communities. Let’s start with the easiest and most prevalent today at least. And that’s telehealth. So, uh, how is that going to be utilized in home based care? Are we at the beginning? Are we starting to see this mature?

Sarah Richardson:         35:06                We’re at the beginning. You certainly see a mature where people have a level of comfort with the technology. So again, how many people have, you know, alexa or the google device in their home and they’re already using it to do intEraction will now you have the video components available on not being able to just go and speak with your doctor or healthcare provider if you need it. Um, and so it just becomes, again, that ubiquity of healthcare is as easy for me as making a reservation or ordering flowers or doing anything else. And so it just becomes part of the whole ecosystem. So it’s, it’s out there. It’s available because more prevalent once you know that you can easily connect to your healthcare provider, your health, your agency through that technology.

Bill Russell:                   35:43                Yeah, so access is going to be a lot easier with telehealth. What about iot and sensors

Sarah Richardson:         35:49                if you want to wear them. So here’s the other piece, like the apple watch is great if you were an apple watch, so if you’re going to have sensors or wearables be part of how we manage a healthcare. I personally don’t wear an apple watch and mine’s more about fashion than anything else and I’m totally honest about that. I mean I’m the first one to tell you I don’t want to wear the same watch as everybody else. I already care at the same boat as everybody else and I changed my band doesn’t do it for me kind of thing. So it’s a matter of how pervasive that people want to be in that space. People may think I’m crazy. I’d rather have a chip in my neck then have to wear a watch because I don’t remember the chip on my neck and someone’s like, oh, that’s too. That’s too invasive. I’m like, you’re already carrying, you’re already carrying your chips every day. Everywhere you go, it’s a matter of where you put it,

Bill Russell:                   36:32                right. There’s also passive sensors as well, right? So you can put them in a pillow, you put them in a bed, you can put them in a pill. Um, so do you think, uh, you think we’re just going to see more and more sensors start to surround the patient community community

Sarah Richardson:         36:49                will. And again, I’m hopeful that it’s still the patient’s choice as far as the value that the invasive feeling that it may have with it. So there’s a bit of that big brother feeling when you have too many sensors are too many things around you. So helpful that we still allow it to be the choice of the patient before we assume that’s what they’re gonna want.

Bill Russell:                   37:10                Absolutely. So, you know, this is an interesting one. I’m getting more and more conversations with, with people because people like to talk to me about emerging technology. So this is one of those that’s on the edge right now, but that’s chatbots and natural conversation with technology. Um, uh, you know, do, do you see this, are you starting to experiment with it? Are you starting to see, uh, other technology partners come in and talk to you about chatbots and natural language interaction?

Sarah Richardson:         37:43                I have been, what I love is there’s the innovation lab at cedars sinai and some of the recent groups that have come through with them. Are those really playing in this space and taking again, alexa type technology and utilizing it for inpatient setting so that you can use that device to say, you know, let’s just say it’s alexa, hey alexa, I’m cold or I need to use the restroom or I’m hungry. And then that, that command is able to go and direct that request to the appropriate level of individual in the hospital. So a patient technician can bring you the blanket whereas the nurse practitioner maybe needs to come and give you a dosage of your medication. Um, so there’s this really cool to know that we’re already integrating into that, into that space, but you can have the, you know, there’s the chat bots that run on rules and the ones that only do the things that you tell it to do, I think where we’re headed is the ones that are really based on machine learning and use artificial intelligence to truly learn the language.

Sarah Richardson:         38:39                And so you can have a conversation with that, that chat bot you can even, uh, I was so cool. We were at an event last week in chicago and rest friends. I was like, here’s the chat bot dog. He’s like, I want this dog and I couldn’t get when they’re sold out for all this period of time, but it literally, like if you’re gone for like three or four days, this chat bot dog already knows to be mad at you for two days because you left it alone. It learns, you know, how to be happy to see you in these different things. So we’re absoLutely on our way there a while today, chat bots aren’t used as prevalently for medicine. Um, I think the number one use case going forward is that because we do a lot with seniors is that seniors get depressed because they get lonely and you think about the chat bot that can be conversational and really becomes that seniors friend and is managing their care and everything else about them. We’re going to See longevity in seniors. Do you do the ability for a chat bot to, to become a friend

Bill Russell:                   39:38                because of the nature of machine learning because of the nature of healthcare, because you cannot make a mistake and machine learning learns through iteration just over time. It gets smarter and smarter and smarter. But the problem is we can’t have like, hey, it’s 95 percent accurate in making any kind of medical a deduction. So I think this is going to be slower adoption. I think you will see it in call centers for hospitals and scheduling and those kinds of things. and I’m looking forward to just seeing that slowly moved from the business side over into the, uh, into the clinical side. Last thing, gamification of health has always fascinated me. You know, when we could get kids interested in health earlier, when we can get, um, you know, people competing with each other to be healthier. How do, how do you see this plAying out in our. Are you seeing this? Are you having some conversations around gamification?

Sarah Richardson:         40:34                A few years ago, jane mcconico was one of the keynotes at tIme talking about using it to help patients learn about how to combat cancer and to give them like a bed and they’re winning the video game. They know that they can beat that disease as well and you’re starting to see it come into back office operations too because processing claims isn’t the most exciting job everyday. But if you can make it a game and win that daily, total, etc. Then it helps engage your teammates. So the gamification piece, to me, I think about it. I don’t have kids, but I hear about kids like being obsessed with this game called fortnite. Imagine if you can take that, that things that kids are learning in fortnight and teach them how to eat healthy. Hey, by the way, time to get up and go exercise or go run around and play outside for 30 minutes, etc.

Sarah Richardson:         41:13                So the fact that we have this current generation, so I mean their whole life revolves around just the technology of making healthcare again, is just the natural progression of something that you’d want to do. And I’m hopeful that that’s where, you know, parents and provIders are starting to spend more time is how do you make healthy choices. Smart, because I spend all my outside growing up. I grew up outside growing up as a kid. I noted it gets in front of their devices and I’m thinking, oh my gosh, let’s make part of that, you know, a game as far as getting your steps in at whatever age you need to get into. So it gamification for healthcare. It’s just a matter of how we integrate that into kids today more than anybody.

Bill Russell:                   41:49                Yeah. So you have a distributed staff and we’ve talked about the talent shortage and challenges in that perspective. So you mentioned that you know, you hire people really for the right skill wherever they’re at. So what are some of the ways to affect the, that you effectively manage a distributed or promote it staff?

Sarah Richardson:         42:11                What we’re doing right now? So you and I are doing a video chat, um, you know, obviously in person is best at video, second phone I say as always third. So using that video connection and being able to actually see somebody and half the fun is the fact that they may be at home when you have a beautiful backdrop and I havE a wall today because I’m going to one of our remote offices, but I’m especially on fridays once one friday a montH I’ll get to work from home and I tell people beware because you’re going to see me in, in with no makeup and the hair’s in a ponytail and I’ve got my cup of coffee and my cat might do a drive by. But you know, what’s really cool about those types of interactions with people is that they get to see you for who you are.

Sarah Richardson:         42:48                And the most important, whether it’s video conference or not, the most important aspect to any relationship with any teammate is a personal connection. I start every single meeting with an icebreaker, some of and some of them are profound, like, hey, if you could be one person in the past, who would it be? And some of them are like, hey, what’s in the trunk of your car? And then we create these fun stories around all of those. So getting to know them personally is the most important thing that you could ever do. And the reason I do things like icebreakers and fun facts is that teammates who have worked together for 20 years, they’ll find out things about each other they never knew before, like, I don’t know about you. And those are those personal connections like you care last night that the bangles one for a teammate who likes the bangles, whether you care or not, but you know that that happened and you say, hey, great game last night is that drug, um, extend the length of your one on ones and you and you have an agenda to talk through.

Sarah Richardson:         43:36                I’m a big agenda person. If you will give me grief for like, oh, I always have to have an agenda when they come to with you. Well, of course you do because what happens is last time we met, what are your roadblocks are the basic things that you want, but they’re owning and driving that conversation and it’s very realistic and it’s important in person a personal. Um, and then I would say that culture trumps everything in organization. So what culture are you creating for teammates, whether they’re remote or otherwise is creating a place that they want to come to everyday even if what they come to is a video screen. So I would say that the biggest tenants create an amazing culture. Get to know them personally, um, and be transparent and focused. So right now I’m not looking, the phone’s not ringing, but looking at other things. You have to be dedicated to that time you spend with them and not be distracted by anything else that’s going on.

Bill Russell:                   44:23                Fantastic answer. I really loved the, uh, the icebreaker questions. That becOmes one of those things that, you know, it might, people might gloss over in the answer, but I, I agree with you knowing that somebody is a bengals fan, somebody, um, you know, into skiing somebody to whatever, somebody who loves the olympics, that’s all great stuff and even as simple as you come to, you know, hey, we’re, we’re buying each other gifts for christmas or whatever. Those guests become more personal because you know them. and I think people who, that’s one of the things that people miss when you walk into somebody’s office, you can tell a lot about them, like your office and your star wars gear, which people don’t see right now because you’re not in an office. But the first time I walked in I’m like, oh, that’s, you know, that’s that.

Bill Russell:                   45:11                And you got a $49, uh, uh, you just, when you walk into someone’s office you can just tell a lot about them and that doesn’t happen remotely. And so you have to, you have to generate it. You have to figure out a way to get it out. That’s awesome. Uh, so we’ve talked about people need to own their own career and this is another one of those questions I’d like to revisit often with different people from different perspectives. What are a couple of ways you have seen that done effectively? People really owning their own career over the years.

Sarah Richardson:         45:44                The number one thing is to you. You have to own it. Then you have to be able to, even if you don’t know, like, hey, I’m going to be this when I grow up. The, I call it curiosity and continuous learning. I remember one time when someone said to me at the college was always gonna go to happen. My mom always used to say, the reason you’re going to college is because no one can ever take that away from you. Once you have a degree, it’s yours. and then it was like, hey, you probably should get your masters degree because you’re going to need it to get promoted in the future. And that was a good choice, but I did it. It wasn’t like it was a one on done. You have to constantly be curious about what’s around you. Join him. Joined time, I recently just joined the southern California society for information management.

Sarah Richardson:         46:22                It’s a bunch of ceos and art and health care because I need to know what’s happening outside of my world too because otherwise you get so myopic and to like, hey, been in an organization for x amount of years and I know how to do this one thing. Knowing how to do that one thing well is great and you’ve got to be able to know what’s happening out in the world around you and so there’s a level of comfort. I had a colleague once asked me, how do I know when it’s time to move on or how do I know what I need to be doing? Something different like when it’s easy, when you weren’t almost terrified about the fact that you have all these deliverables that you’ve actually maybe don’t know how to do all of them. You should almost always have a level of discomfort in your role because it means you’re challenging yourself and as soon as it’s not a little bit scary, every morning when you wake up, it is time to learn to do something new. Doesn’t mean you go like find a new job and I mean go learn about data science, go get a certification, go take a class at ucla extension, like constantly challenge yourself to do something that you don’t know how to do.

Bill Russell:                   47:18                Yeah, that’s, that’s great advice. I’m sarah, as always. I love having you on the show. Thank you for coming. Um, you know, what’s the best people, the way for people to follow. You?

Sarah Richardson:         47:31                Follow me on linkedin. I love linkedin. I’m Sarah Richardson. It’s, there’s probably, I think there’s a lot of sense in the world, but when I been leadership banner behind it at concierge leader for twitter or I just tell people, just email me. I’m [email protected], but also sarah concierge leadership.com and just for that final plug, I am looking for a subject matter expert to talk about chatbots on the southern California hymns podcast and if it’s, if it is a vendor, the rules of engagement or that you can’t sell your product on the podcast, you just have to build to talk about what it means from an industry perspective. So anyone out there who’s a part of our world, bill, who is really in the chat bot space, give me a call, let me know. I would love to have them on as a guest and a you are going to be coming up as guests on the podcast too, so he did give me the date and organize it, but a semi fun to have you and you get to pick your topic because you pretty much covered all of them.

Bill Russell:                   48:30                Yeah, and I’m looking forward to that. That’ll be great. It’d be great to work on a saturday with you in your. You have a really cool studio, so I’m looking forward to getting a part of that. You can follow me on twitter at the patient cio health erik’s website, a writing and don’t forget the show’s on twitter as well this week and hit and check out the website this week at [inaudible] dot com and catch the videos on the youtube channel that we talked about this week in health it.com/video and please come back every friday for more news, information and commentary from them

New Speaker:               49:04                industry. That’s all. For now.

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