Predicting the Future of Value-Based Care

A critical requirement for effective value-based care is patient communication. Communicating with patients in an easy, accessible, and meaningful way can transform patient experiences.   

So, how can the healthcare industry get to a true value-based care model? According to John Lynn, healthcare could change the odds by taking a page from the Las Vegas Strip. John referenced Sunny Tara, the founder of CareCognitics, who built the original rewards and loyalty program in Las Vegas: 

“He can't change the odds. He can't change the fact that you're going to lose money, right? Like that's out of his control, but what can he do? He can change the experience you have and how you feel about your care and all of that. Well, the same is true in healthcare. We can't change the fact that you have a diagnosis of diabetes or that even that you're at risk of diabetes, but what we can do is change the experience for you.” - John Lynn, founder and chief editor of Healthcare IT Today

In this episode of The Connected Care Team, John Lynn, founder and chief editor of Healthcare IT Today, discusses what healthcare needs to achieve real value-based care, mergers and acquisitions, and the potential of AI.

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Transcript

Dr. O'Connor: With us today, we have John Lynn. He is the founder and chief editor of Healthcare IT Today, and the chief marketing officer of CareCognitics. Welcome to the show, John. 

John: Yeah, thanks for having me excited for the discussion.

Dr. O'Connor: Yeah. Yeah. I know. Really, really appreciate you joining us.

John: Yeah. Can you believe we made it to 2022? And, uh, you know, any predictions of 2022, I'm just going to ignore since, you know, the past two years haven’t, none of them have come true, right?

Dr. O'Connor: Well, have you, have you made any of your own for this year. 

John: You know, we have, you know, we've published a ton of them on Healthcare IT Today. But, uh, you know, the biggest one for me I look at is audio. Just the explosion of audio and how that's going to be. So whether it's, uh, something like ambient clinical voice for documentation, or whether it's voice access to information.

Or whether it's voice dictation or whether it's the patients using voice to be able to access care. I think voice is going to be a big thing in 2022.

Dr. O'Connor: Yeah, I've always found voice as a very natural way to, to practice medicine and, and record and document. And, when I was seeing patients, you know, we would record into a, uh, a Dictaphone or a tape recorder, and then that would be transcribed. And a lot of times I would do that right with the patient and it was a very natural way to interact, but we're really far from that today.

It's a lot of clicking and, and typing and the, the EMR in many ways has become a barrier. How do you transition from that? To what you're talking about? That getting us back to a natural way of using voice to, uh, to practice medicine?

John: Yeah. I mean, you bring up such an interesting history. The first EHR that I implemented in a doctor's office had specific fields and names of those fields. So you could still dictate. And so you'd say like field 1865 and then you dictate it, right? Because they were trying to facilitate that dictation mindset, but then it just disappeared.

It didn't really take up. And this whole, you know, kludgy, form-based, you know, template-based approach to documenting care, which hides the relevant information. And we know why this happened, it was because of billing, right? We needed to bill at these higher levels. And so we put all these normal values into a template and just makes the documentation really difficult to navigate and really difficult to do.

So to your question, how do we get there? I think it's the ambient clinical voice is the biggest hope I have. You know, really at the end of the day, a lot of people are saying, well, is that just virtual, remote, dictation with a scribe that's remote and in some ways, right now it is. So the question is, will it evolve enough that it is just talking and the AI documents what's needed, uses NLP to identify the relevant data, to be able to document the granular data that now regulation and reimbursement requires and achieve that dream goal, or is it just going to be glorified, virtual, remote scribes that are doing the work and provide that same experience, but don't scale the same way.

Uh, there's a lot of other companies working on more voice powered templates. I think that's an interesting angle because they believe the AI won't replace fully the doctors, uh, documentation. So, yeah, I mean, but the nice thing is there's hundreds of millions of dollars of investment in this area. And we're going to find out the answer. 

Dr. O'Connor: Yeah, it's certainly I, um, exciting space. And I would love to get back to being able to practice that way just because it has, you know, those templates and all that clicking, it has become such a barrier and it it's resulted in a poorer experience, I think for the patient and the providers as well. 

John: And one of the most exciting things about this change, if they're effective at doing it is for the patient. Because right now, what do we communicate with the patient? In many cases, very little. I've had the experience right where the doctor's sitting there pounding on the keyboard, not talking to me, not telling me what he's doing, what he's documenting, and that's just awful.

Well, if you’re voice dictating everything, that's there, the AI engine can actually abstract all that data and then communicate with the patient, the information that's relevant to the patient in a way that's relevant to them. And that's a beautiful change. If we can get there, right, where the information that was discussed in the thing is summarized in a useful document for the patient because the AI engine knows what's useful or not.

That would be an amazing evolution of this technology and would change the patient experience. Not just in the exam room, like you said, where the doctor is actually more focused on the patient, but also well beyond where we need to start communicating with patients outside of the doctor's office and sharing the information, ensuring compliance, you know, I think that's the future of value-based care and value-based care is going to require that, that communication with the patient.

Dr. O'Connor: Talk to me a little bit more about that. Cause you've seen, we've seen a lot of changes in the way patients are engaged. Um, and that was accelerated by Covid. Tell me a little bit more about what you're seeing in that area as far as changes in the ways that we've engaged patients. 

John: So there's so many layers to this, but first I would start off by saying, patients don't want to engage healthcare, right? Like this isn't Disneyland where we're like, I want to go to Disneyland. And you know how we know this is true is if you look at any of the unlimited primary care models, we don't abuse it.

Like, I don't want to go to my doctor because it's fun. And so you have to remember that, you know, like engagement from patients is something where they must have a need. And that's why we have this chief complaint driven healthcare system is because I'm not going to go talk to my doctor unless I have some need that's really driving it. 

It's not a fun experience to focus on my wellness and identify where I'm at risk for diabetes and how I need to do it. Right. But what has changed is when I do have a need, I'm going to make a different selection because the opportunities available to me through telehealth through secure text messaging with a doctor through direct primary care, through retail health, with Walmart and Dollar General of all places, having these options, quick care, convenient care.

Oh, yeah. And then there's my primary care doctor and the ED, right? Like there's all these plethora of options. And so now the patient with all of these options and more information is more empowered to choose where do they want to go and what type of care do they want to receive.

Dr. O'Connor: Do you think that patients are ready to engage digitally more in this way and communicate with their providers in these, these non-traditional ways and interact in non-traditional ways? 

John: Yeah. I mean, it's a tough question to abstract across all patients. So for example, I think there's two major categories of patients when we talk about this. And within those there's lots of sub categories, but the two categories I love to look at is the chronic patient that basically lives healthcare every day of the year.

Right. And knows their doctors knows their illness. Now there's some in denial and different things in that group. Right. But that's the chronic patient, which take up a huge portion of our healthcare industry in our, uh, you know, the costs associated with care. 

But then you also have the rest of the patients that only go to healthcare when they have a problem. And so they're very casual. I mean, I'm in that category, I call them the healthy patients, because for the most part, I just don't need to go see a doctor unless I break my leg, then I'll go see a doctor, right. Or something like that happens. And so I think first you have to divide into those two categories because communicating with someone who doesn't want to see the doctor is very different than someone who is actively proactively managing their chronic conditions and needs to, to be able to have a good, healthy life. 

So to go more specifically to your question, though, with chronic patients, they, they are largely engaged in their care. And so you can, they want to communicate with their doctor.

They want to have a relationship because they need to proactively manage their care to have a good life. And then the, the unhealthy are very different because they don't want to be communicated with, and this is where it's going to be a challenge when it comes to value-based care. They don't really want to hear from their doctor.

And so are they ready to communicate in that way? Probably not, unless you give them the right motivation. In fact, the biggest competition there is actually Netflix, right. Or Amazon, which create these amazing experiences that people love. And if their choices is hm do I want to binge another Netflix show or do I want to engage my doctor to improve my health, I think we know who wins every time. And so, you know, you have to really think about how do they want to engage. Now the exception is when they have a specific, you know, chief complaint that they need to work on, then they will engage. But now their expectation of how they engage is changing because of everything that they've experienced.

I mean, goodness. When you, when you realize the DMV has a better digital engagement with people than many in healthcare, you know, that's kind of a problem.

Dr. O'Connor: Yeah, that is a, uh, a bit of a a low bar, I think. Um, It seems like that in order for value based care to be effective, you really do have to have the patient as engaged as possible and part of that care team. How do we, how do we solve this problem?

We've been talking about value based care for a long time now. And there are some pockets of success. I think it, it will continue to be. pushed forward, but how do you, how do we make this successful with patients that don't necessarily want to engage?

John: Yeah. So let me pull some, some of my experience with CareCognitics and the work they're doing. Uh, the background of CareCognitics the founder, uh, created the original rewards program on the strip here in Vegas. To drive people to casinos. And there's some really interesting parallels between casinos and health care.

And I'm not talking about the risk and gambling side of things. I'm talking more about the experience and driving it there. Uh, you know, Sunny Tara, the founder of CareCognitics often describes that when he was building a rewards program and a loyalty program and the experience for those, uh, those customers.

He can't change the odds. He can't change the fact that you're going to lose money, right? Like that's out of his control, but what can he do? He can change the experience you have and how you feel about your care and all of that. Well, the same is true in healthcare. We can't change the fact that you have a diagnosis of diabetes or that even that you're at risk of diabetes, but what we can do is change the experience for you.

I mean, think about it. You know, if I were to pitch you and say, Hey, you're going to come and lose money in Vegas and you're going to, you're going to go home happy, everyone would be like, you're crazy. How is that even possible? And yet that's what happens because you create these amazing experiences, you know, you comp them a Celine Dion ticket, and so then they're like, oh, I had this great time. 

And you know, there's, there's some marketing there too, right around peak experience. If you follow Dan Heath’s book, you know, some, some elements there. Well, how do we apply that to healthcare? Right. People want to be healthy. They want wellness. They understand that kind of internally. I think we all appreciate that, but they're not going to just do it naturally because convenience, entertainment, et cetera, is going to drive us away from some of those things. So, you know, how do we take those experiences from the casino industry and say, wow, how could I take this experience in healthcare?

Which quite frankly is often miserable. Okay. I got long lines in the waiting room. Wait times I got to schedule two months out. I got to do all these things. You're like, this is not a recipe for high-quality engagement. Well, if you take the, those principles from the casino industry, even something as simple as when you're waiting, saying, Hey, you're fifth in line.

That changes your relationship with them and, and these small moments where you say, I actually care about you, and I'm going to tell you that you're fifth in line in the waiting room and that yeah, you do have time to run over and grab that Starbucks that changes the experience for the patient in the moment.

And in that one visit to the doctor. But it also begins that relationship of trust that between the patient and the, uh, the doctor or the practice or the health system, whoever's sending it. So that then in the future, when that health system, or that practice reaches out to the patient, the patient knows, hey, this organization respects me and they create great experiences.

So I'm going to listen to you going forward. So I think that's where I would start is how do you create a baseline relationship of trust with the patient where they know that you're going to be respectful of them and their time. And you're going to create a great experience for them. If you do that, then when you follow up with the Hey we're, we're kind of worried about you because you haven't done a wellness visit in, you know, a year and a half.

Why don't you come in, then there'll be like, oh yeah, I'm open to that because I know I'm going to have a great experience. Unfortunately, where most healthcare organizations are today. We're going to give you a really crappy experience. We're going to treat you like a commodity. And then we're going to, when we come to ask you to do something for your health, you're going to be like, wait, that doesn't jive, right.

That doesn't connect. And so I would start there.

Dr. O'Connor: Really enlightening. And I, and I think. A good model for some of these large providers to start to follow, to engage patients in that way and build some trust, communicate with them, you know, stay high touch. Um, I think it's something that's been missing for a long time and something that could help us quite a bit. 

You know, one of the things you've talked about in a couple of your answers so far is, is AI and, and analytics. Talk to me a little bit more about the potential there and what you see as, um, real and tangible, but coming relatively soon. A lot of what I see today that is marketed as AI, um, is, is usually not.

But we'd love to hear, about what you see coming. That's, that's tangible that may be usable here in the next, couple of years.

John: Yeah. So, you know, as, as good marketers and we have a healthcare marketing community called HITMC that, you know, I created, so I can include myself and these marketers, but we'd like to corrupt any term. Right. And I think that's, what's happened with the term AI and artificial intelligence.

Anything that's data-driven that will change whatever you're doing that's informed by data has kind of become AI, which is definitely, you know, a scientist would roll over in their bed saying that's not AI. But, you know, so using that broad definition of AI, uh, you know, that's any sort of use of analytics to improve processes, either automated or even informing it, you know, based on the understanding of the data to inform the doctor, there's, there's so many layers to it, but I think where we're going to see it first is in things like revenue cycle management. It's going to be things like chat bots that answer your website.

It's going to be informing the doctor of which messages are most important and need to be addressed now rather than waiting. I mean, we know the cognitive overload on doctors is challenging, and we also know that the messages that doctors are receiving partially thanks to COVID and partially thanks to these messaging opportunities being open because previously they weren’t.

The doctors are just inundated with message after message from patients, from other nurses, from administrative staff, et cetera. You know, I, I love where AI can take that and say, what's a priority and what's not. And helping them understand the priority of the messaging or, and, or the information I think we'll see it the same in the EHR where, you know, the AI is understanding which data might be relevant.

And if they're here for this certain chief complaint, then let's bubble up the lab results that are relevant to that chief complaint. I think we're going to see things like that. Um, the other way, I love to look at it is AI is going to replace the mundane stuff that we don't want to do. And so if I can do it repeatable and it's mundane and we all hate that repeatable, although I'm kind of, uh, I kinda like it to be honest, but it, most people hate the mundane and repeatable, like AI is going to automate that and it's going to make people's lives easier in that regard.

So that's the framework I like to think about is. Is it repeatable? Is it mundane? Are you tired of doing that thing over and over again? If that's the case, it's a good opportunity for AI to really solve that problem.

Dr. O'Connor: Yeah, I certainly see some potential in the mundane, but what you mentioned earlier, I think would be really powerful. Give me the information that is, is relevant to me and send it to the right provider on the right patient in real time. Like that to me is the gold standard of, of what we need, because there's, as you said, there's so much communication happening, right?

There's so many inputs, there's so much information in the EHR. I need to know what's important for me in the moment to help me take care of my patient. I think that would, would be an excellent use of, of AI as we move forward. 

John: Well, and it's really powerful for the patient as well, and that communication with the patient, because if we abstract and say, we're all value-based care and we have all these patients actually communicating with us. The only way to scale that is through some sort of technology and AI type of technology to filter all of those messages, to the ones that are relevant that are priority.

And then let's throw in all the sensor data that these patients are going to start collecting and start sharing with you. There's no way as humans that we could go through all that data, even if we wanted to. And so there's gonna have to be that AI layer in between the patient and the doctor that says, Hey, this is bubbling up from, you know, your ECG, Apple watch that you're wearing or whatever, you know, the, the Widing scale that has an ECG built in that's now collecting all that data. You know, the doctor can't go through that. But the AI engine can at scale and that's, I think the big difference. And then they can, you know, that the AI engine is not going to solve the problem. It probably isn't even going to tell the patient anything, but it's going to alert the doctor or the care manager who's over it and say, Hey, this is something worth looking at.

So to me, the only way to scale value-based care to the entire patient population is these AI like technologies.

Dr. O'Connor: I would love to hear there's been a lot of merger and acquisition activity, um, in, in healthcare IT. Comment on that and tell me what your, what your thoughts are there and any, any predictions for, uh, for 2020? 

John: Yeah. I mean, I, my prediction is it's going to keep going. The money's flowing and I don't see it stopping. Uh, it seems like it's an insatiable thing. If you say that you're in healthcare, you mentioned telehealth, you mentioned AI, you know, some of these things, it seems like people just want to throw money at you which, it's probably not fair to how hard it is to actually raise money. 

But I would say more from a prediction standpoint, my feeling is that some companies have raised too much money and I think that's going to be a problem. It's going to come back to bite them. Uh, investors are not going to get the returns that they need.

Now, what's nice for the patient is that value's going to be created. You know, if you raise a hundred million dollars, then you have to have the potential of billion multi-billion dollar exit. That's what the investors expect. And so, uh, you know, that's going to be a problem for some companies where they're just not able to scale it, and that could be a problem.

Uh, you know, some will be wildly successful and that's fine. That's actually the investment model. And what they expect is for most of them to lose their money and a few of them to give the returns that they really want. And so I think we're going to see some of that play out but because they've raised so much money, we're not going to see that for a couple of years actually.

But they're going to create value, and they're going to be bought on the cheap by some other people. And so at the end of the day, you know, the patients will benefit from all of this innovation, but I do worry about some of these companies that think that they're, you know, billion-dollar unicorns, when, you know, they probably aren't going to quite get there, right.

Because of how they're approaching it or whatnot. So that concerns me a, a little bit. Uh, you know, I think the other one that's, uh, interesting is there's a lot of new companies versus a lot of companies that have been around a half dozen years. That are now raising those same amounts. And I think those are two, two different categories.

Uh, the ones that have been around and, you know, have created the deep connections in healthcare because we know healthcare's sells slowly. You know, that's going to be a different animal. You know, someone who raises $50 million now that has been around for, you know, half dozen years. That's a different model than someone who's just raising $50 million and trying to go after healthcare.

And so that's going to be fun to see them battle it out and then I'd throw the ad. The last thing we'll see is we're going to see a lot of mergers and acquisitions. So combining these companies SPACs have kind of pushed this forward to some extent as well. So we'll see how that plays out, but there's been a lot of mergers and acquisitions where people are chasing market share.

And so, you know, we can watch for that this year as well.

Dr. O'Connor: Sounds good. Well. Uh, shaping up to be, uh, another exciting year and in healthcare IT, John, I really, really appreciate having you on the show, uh, with us today and hope you'll join us for another episode sometime in the future.

John: Yeah. Happy to be here and happy to join you anytime.