SCT_Spotlight_Jane Sarasohn-Kahn(2) (1).mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Speaker1:
Welcome to the Smartcare team Spotlight presented by Care I the Smart Care facility platform company and leader in AI and ambient intelligence for health care. Join Molly McCarthy, former CMO of Microsoft as she interviews the brightest minds in health care about the transformational promise of AI and ambient intelligence for care teams.
Speaker2:
Too often, technology makes caregivers lives harder, not easier. It's time for smart technology to empower care with a more human touch. Hello, I'm Molly McCarthy. And today we are joined by Jane Sarasohn con on the smart care team spotlight. It's great to hear you and see you, Jane. Welcome.
Speaker3:
Thank you. And I'm delighted to see you, too, Molly.
Speaker2:
I just wanted to give our listeners an overview of your amazing background. I met Jane in Philadelphia at an American nursing informatics conference. I heard her speak many years ago. She's got an amazing background. She's a health economist, advisor and trend Weaver to organizations focused on the intersection of health, technology and people. Jane founded Think Health after working with health care consultancies in the US and Europe. Her clients span the health care ecosystem, tech, pharma and life sciences providers, plans, retail, financial services and consumer goods. She founded one of my favorite blogs, Health Populi Blog, in 2007 and has been the sole writer of nearly 3000 posts in her independent voice. And they're fun and interesting to read. So just a little plug. Jane advises on strategy via environmental analysis scenario and strategic planning, market research and health policy analysis. She sits on several advisory boards and is a frequent speaker and contributor to many publications frequently quoted as an expert in her field. I could go on and on. I also just want to mention I'm the recipient of two of the books that she's written. I think one came out prior to Covid and then one maybe during Covid. But Jane, thank you so much for taking time out of your busy schedule to be with us today.
Speaker3:
So delighted to be with you, Molly, especially to talk about what smart care teams are all about and how they can be enabled through technology.
Speaker2:
Well, great. It's been a while since we've chatted, but we actually spoke earlier this year, talked about our outlook for the tech sector, specifically in health care. Just wanted to get your thoughts now that we're more than halfway through the year, what are your thoughts on where, where we've been and where we're going? And I also want to make sure we give our audience a really broad perspective because of your health, economic background. So any thoughts?
Speaker3:
So I guess with that ask will follow the money where health care is and health care delivery and at the center of health care delivery, which I think is very relevant to what you're talking about in this podcast, which is health systems and hospitals who took a hard hit in Covid, both in terms of what happened with the workforce burnout for nurses and physicians and other frontline workers in hospitals. So the human capital of the hospital got hit hard and then Capital Capital got hit hard. Finance revenue, the fiscal part of capital got hit hard. And so that's what I've been tracking with respect to hospitals. Ability to invest in digital transformation entered the pandemic period 2019 into 2020. Really thinking about digital transformation. That's what our conferences were all about. The next generation of the Internet and health care, the cloud computing and the beginning of virtual care and then Covid accelerated virtual care as part of digital health. But broadly speaking, hospitals have not financially recovered the way they had their balance sheet looking before the pandemic. Why I say this I base this on wonderful, important, horizontal, longitudinal research done by Kaufman Hall. Kaufman Hall has published since the beginning of the pandemic. The National Hospital Flash Report, which they publish freely on their website.
Speaker3:
It's a great resource. They also do one for physicians. I'm not going to talk about that one today, but physicians, too, have had challenges fiscally. But if we're going to look at the hospital sector and finance and the ability to invest in this digital transformation, it's been tough because of supply costs. Again, nursing and supply. Lies, not just PPE, but other supplies. And the cost of some medicines in the hospital have really skyrocketed as well. So on the supply and cost side of the hospital, it's been tough. And then on the demand side, patients have not returned in the numbers that I would have anticipated. When you and I spoke earlier this year, I thought there'd be a short a short term, month to month to month increase, little by little that the concept of medical distancing, people distancing themselves from the hospital would have abated and gotten better. But in fact, we look at inpatient volumes, which are recovering pretty well. And I say that relative to pre-pandemic, it's the outpatient volumes where the margins are typically for health systems that have not recovered universally with every health system. So you've got a gap between health systems that are doing fairly well and those that are not. And the most recent data from Coppenhall just came out a couple of days ago.
Speaker3:
They published these at the end of every month. So I have fresh data from July. Again, it's retrospective one month showing margins declined in the last month, which was surprising to me because they were just starting to turn around and see a little black ink. Now they're below the line again. So I'm concerned because we're coming up against the fall, the flu season, RSV, maybe a tripledemic, maybe not. Depends who you listen to. The ability for hospitals to take a look at investing in. We'll just say digital health broadly and digital transformation has been challenging. Let me add a little Sentinel event to that that just came across my email in the last couple of days. Just in terms of scheduling, we're recording this on the 31st of August. For those of you who might want to look up this story, that is that one of the credit rating agencies, Fitch Ratings, had downgraded the hospital system, which I wasn't that familiar with. The regional West Medical Center had its bonds downgraded to B, b, B minus from B plus because of some revenue challenges they had and cost challenges. But Fitch called out something that will interest you and the listeners but really freak me out a little bit.
Speaker3:
They called out the fact that the Cerner implementation of the SRX was costing more than the hospital had anticipated and eating into the revenues, lowering margins for the entire enterprise when EHR implementation costs thereof hit the bond rating. We don't see that kind of granularity spoken in these documents from Standard and Poor's or Fitch or any of the other bond rating agencies. I call that out because the work that I do, I'm always having to look around the corner and forecasting. I'm going to be watching this now from other rating agencies to see are we actually seeing the big iron implementations, the EHR implementations, eating into other hospitals, fiscal health. That's, I think, a warning to watch. A signal. We want to know if that's noise or just a signal. It's something to watch for in terms of what you and I talked about six months ago, I'm less optimistic than I was in terms of the overall profile on digital transformation. But that doesn't mean we're not going to digitally transform. I think a lot of this is a challenge with definitions of what we mean by digital health. Now I'll stop there and you can dive into an aspect of that if you'd like.
Speaker2:
I think that's important because it's like when any term comes out within health care, will virtual health What do you mean by that? Virtual nursing even? Are you talking about robots? No, we're talking about perhaps having a licensed nurse in a different physical area that's supporting a unit or a number of caregivers. I guess to that point, I'm thinking back to some of the areas that we talked about earlier in the year in terms of remote patient monitoring could be in the hospital, could be outside of the hospital and just care model changes in general. And your thoughts, too, if that's impacting you said fewer hospital patient days. Et cetera. That might be. I know there's a big shift looking at how can we especially with nursing. I'm just looking at an article from McKinsey. It says Nurse time could be saved through care model changes and innovations. It says current time spent on activities that could be optimized with technology. I think it says 42% then current time spent on activities that could be delegated 24% and really looking to reduce that might not necessarily. Impact the bottom line right away, but really pushing our practitioners to the top of their license as well as hopefully better patient outcomes and perhaps even less time on implementations or administrative tasks. I'd love to hear your thoughts just on what you've seen in terms of care model changes within the hospital. If you've noticed that or in what you've been reading or seeing and talking with clients, I know you're an advisor to so many.
Speaker3:
I think it starts with strategy. What businesses is the health system? One of the recommendations from Kaufman Hall in this month's report slash report, I agree with and it's something that I've been talking to all the stakeholders that I talked to, whether it's pharma or hospitals, health plans or technology companies, both consumer facing and the bigger iron B2B technology, hospital supply, med tech. That is the shift to lower cost settings because we know hospitals mean to take on value. We talk about value based payment, whatever guise that is. It's got many different flavors from bundled payments to population health. Et cetera. Many hospitals taking on innovation programs, initiatives with Medicare and Medicare Advantage. Et cetera. And some very creative Medicaid programs. We have props to the governors who have expanded Medicaid and are trying to cover the care for their health citizens in their states. Several states are doing some cool things with hospital to home and food as medicine. Et cetera. So if we look at these institutions who want to deliver care outside of the expensive bed walls and can do, that's then where we kick in this flywheel of let's empower nurse teams, smart care teams with dietitians, nutritionists, physical therapists, and importantly, mental health providers on the primary care team.
Speaker3:
On that smart care team that you talk about. It's all those people working together. How do we do that with remote monitoring, with looking at data that capture what we can call the social determinants of health or the drivers of health or the health risks, depending where you stand on the terminology. But it's getting data from other things besides the claim, whether it's the prescription drug claim or the hospital and health care claim, it's getting data from sleep. You know what I always talk about? Sex, drugs, rock roll, sleep, emotions, health, job security, financial security. We can start to corral that in a smart way, which we can start to do. Then we can manage the whole patient. That's when we empower nurses to operate their full license. They are complemented by lots of other providers as appropriate. On that smart team. We have the technology deployed, aspired with good design that nurses inform and that patients inform. We need to have patient opinion leaders to inform this and not that the opinion leaders need to be digital natives who understand, because that's not the point. It's who do we really need to serve and serve is Mrs. Jones, who wants to just get on the floor and play with her grandkids after the hip operation.
Speaker3:
That's her end point for the orthopedic surgeon. It's the nail and the screw worked really well. Thank you very much. Orthopedic surgical supply company. But what does Mrs. Jones think? One of my favorite articles from Jama and I'm sure in one of our discussions I've brought this up was from maybe 2018. It's not new, but it was titled Value based Payments require valuing what matters to patients. So yes, value to the hospital, value to the payer. But as the patient is increasingly the payer, she needs to be part of the input into this user centered design world. To your point, absolutely. We can see people, clinicians like you, my favorite chief nursing officer persona, that's you operating to your full license. Then burnout goes down, delight goes up, outcomes go up because everybody's on the same page and is a team with the patient and her family. So I think that's when that's that flywheel. It's a virtuous cycle. Once you kick that in. We see a lot of success with this at Intermountain Health, which was early to hospital to home, and they put together infrastructure for that, as others have too.
Speaker2:
I think that's so important in thinking about new care models and care at home and. Acute care hospital at home. One of the things that really needs to happen within the four walls of the hospital is teaching and education. Right now. One of the greatest joys, I think, as a nurse is educating, at least for me, in terms of prepping that patient for what's going to happen in the hospital as well as any type of procedure. And then really what's going to happen when they go home and are they and their family prepared? And one area that I've seen really pick up specific to virtual nursing and thinking about that smart care team is ensuring that teaching period with the patient really starts. If you look at it and discharge transfer form the ADT form for facilities. I remember this even back in the day when I was handwriting patient. Teaching is on that form right from the start, and I think that's one of the areas that has really been impacted by by other administrative tasks. One of the things that we've seen through smart care teams and this is anecdotal, I don't necessarily have any published data, but just the patient teaching where you have that virtual nurse coming into the room and working alongside could be a newer nurse and really educating that family, making sure that education, time and preparation for hospital at home, for example, or follow up is uninterrupted with that patient, with that family, ensuring that prep and education happen prior to discharge. So that's one of the areas I think we're seeing. The other kind of along those lines really is better teaching and education, improved patient safety and satisfaction. Ultimately, I think if you ask any nurse or clinician who's working at the bedside, they want to ensure their patient is well cared for and optimal outcomes, Those.
Speaker3:
Outcomes real hard ROI. On the issue of patients feeling respected and communicated with in the moment in the exam room or at discharge. But at that moment of truth, where we want to impart education, wisdom, bolster literacy, not just how to take the medicine, but when to take it with food without. Et cetera. Judith Hibbard, one of the mother's godmothers of patient activation patient engagement years ago, did some amazing research in Oregon with one of the big health plans, found that patients who were managing diabetes. This was a very specific population, but she she could get the data to show this. Patients who were in the exam room with the doctor getting instructions for measuring H1C and taking anti glucose medication if they felt respected. And that was the word they used in the research in the moment. Right. They come back in a few months. Their blood sugar was more controlled and they were more adherent to the medication. This is all everything normalized, all the data managed. There's an ROI on respect in the moment If we educate and I think this is true for everybody, clinicians as well. If we have this protocol on our checklist to educate people and spend the time in doing the education with patients and their families, again, you bolster the outcome and obviously it'll be fewer days in hospital, fewer trips into the E.R. That's real saving and outcomes improved for quality of life so Mrs. Jones can get on with her life. I think that kind of putting that in the new kind of protocol is super important and again, bolsters the value of the encounter across all the stakeholders.
Speaker2:
I think at the beginning I said, I'm just going to read this again. It's time for smart technology to empower care with a more human touch. Having worked in tech for so long, tech to me should be working in the background, providing that informed decision making to that clinician so that they have the information at his or her fingertips, allowing them to maintain and foster that relationship with the patient throughout that stay or in the home. And so my next question and I know we're got a couple more questions here. One area that we've touched upon is obviously smart care teams. What's your gut response? If I were to say, you know, Jane, what's the cost of doing nothing in health care right now? What maintaining the status quo versus looking at these different solutions to really help? Foster clinicians as well as improve patient outcomes.
Speaker3:
If we do nothing, we're going to end up in that negative margin space. We're going to lose clinicians, we're going to lose the human capital, the nursing capital. I just pulled out in anticipation of talking to you data from the advisory board. They asked nurse leaders, This is from early in August, Health system, nursing leaders concerns in 2023. And what's number one? More than half the people, half the nurses polled said the market shortage of qualified candidates. Our sisters and brothers aren't there coming up through the pipeline. So this impacts everybody. This impacts every patient, every provider, every hospital, every health system, and really health plans and the profitability of plans because nursing is where it's at. This is where rubber hits the road and caregiving physicians work to do at the highest of their license. And so the heck do nurses. That's why I'm so passionate about collaborating with Stanziale on the nurse hack for health, because nurses are at the front line and they see what's going on and they're incredibly innovative because they spot the problems and they hack their way to solutions. So this issue of do nothing means, okay, you're not going to be relevant anymore. People want care increasingly in this omnichannel environment. And don't forget, half the people in America are still commercially insured and employers are providing that insurance. So employers providing insurance have demands on quality and access. This omnichannel world is real. Providing care in hospital, in the community, at home, at employers on the go and again virtual and through apps and self care, DIY ING all of this together. That's really the end game for now. You know the 135 years out and so that's where this all has to go. Many providers have started to lay this foundation. We have many examples we can point to, but those that don't start to build that infrastructure and again, educating the providers, nurses, physicians, the allied health professionals and come along with patients because patients minds are already there. I want care this way.
Speaker2:
I don't think we have time here today, but just even the next generation of caregivers who are already in the workforce. I forget what I read recently. How many generations are in the workforce right now? Five, maybe.
Speaker3:
Yeah, up to five, depending on the company.
Speaker2:
You have that generation coming in who's very tech savvy and used to. They're going to gravitate towards those opportunities that have tech as part of the solution and platform, quite frankly, in my opinion. So anyway, one last question here, and I know I could talk to you all day, but because if you think about the listeners of this podcast, perhaps seniors, their care teams, healthcare executives, if you could reach out and just give one. Practical piece of advice today to one of them. What would it be?
Speaker3:
Embrace virtual care and develop a strategy where you're empowering your clinicians to operate in that new environment, rewarding them to be innovative and meet the patient where he and she are. To your point about younger people in the workforce, older people really got digital in the pandemic using Zoom and teams and FaceTime with grandchildren reading to them. Now the they're on that journey to being digital immigrants, not digital natives. This is normal. Now that digital divide is closing, closing, closing through demographic aging, of course, but also because older people actually have learned to cotton on to this stuff and they register for Part D Medicare drug lists on there and they're engaged and they vote. I've learned a lot about older people and younger people in the pandemic. I think we need to meet people where they are now. And I think the future is this omnichannel thing which we're doing in retail and in banking, and it's also the reality for health care. Now, financially, it has to be the reality because we have to find lower cost places to do things that are safe and clean. Hygienic people like that idea. I think that's my one piece of advice. Sit still. You know, you don't have to do the unified field theory of everything at once, but figure out how do we meet all these touch points, keeping the person, the patient, the caregiver at the center right, and then lots of clinician involvement And what that looks like partnering with patient as a co-designer.
Speaker2:
Yeah, love that. Partnering with the patient as a co designer, Jane said it first, so I just want to say thank you, Jane. I really appreciate connecting with you today and look forward to future discussions. And just want to say thanks for listening and you can join us on future episodes of the Smart Care Team Spotlight. We look forward to seeing you there. Thanks, Jane.
Speaker3:
Thanks, Molly.
Speaker1:
Thanks for listening to the Smart Care team. Spotlight for Best Practices in AI and Ambient Intelligence and ways your organization can help lead the era of smart care teams. Visit us at virtual nursing.com and for information on the leading Smart Care facility platform, visit care.i.
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