Transcription: A Conversation with Jay Roszhart: Why Engaging Patients, Building Loyalty, and Doing It at Scale Is the Future of Healthcare



Greg Kefer: (00:07)
Welcome to Digital Conversations. I'm Greg Kefer. And today I'm joined by Jay Roszhart from Memorial Health System out of Springfield, Illinois. Jay, great to have you on the show today.

Jay Roszhart: (00:20)
Thanks Greg. Great to be here.

Greg Kefer: (00:21)
So Jay, maybe before we start, you can give the audience a little bit of background on what you do, and then we're going to talk about patient engagement.

Jay Roszhart: (00:30)
Sure. So my current role, I'm the President of the Ambulatory Group, Memorial Health System. That includes all of the primary care practices, specialty care practices, urgent cares, behavioral health, home health, hospice, durable medical equipment, et cetera. Everything that happens outside of the hospital is under my purview as the President of the Ambulatory Group. And my background, I've been with Memorial for 12 years now and I've progressed all the way from a fellow, an administrative fellow, after I got my graduate degree, up through the ranks and held increasingly progressive positions on the senior leadership and system leadership teams here. Came up mainly through the payer world actually, and managed care contracting and thinking about how we apply some of the population health and care management concepts throughout our health system. Outside of that, I was born and raised here in Springfield and actually began my career when I was only 17 as a phlebotomist drawing blood at the hospital that is part of the health system that I'm currently the president over. So it's been a long, long history here and I really have enjoyed my time and have enjoyed bringing some of the population health and care management concepts to Memorial.

Greg Kefer: (01:49)
Yeah. So I guess it's safe to say you're a career healthcare guy.

Jay Roszhart: (01:52)
I am a career healthcare guy, yes.

Greg Kefer: (01:55)
I've actually been reading quite a bit about you in the press lately. And you are also somewhat of a technology guy and you've been covered in a number of healthcare trades out there. I've seen you on some other podcasts and you know, you've got some opinions about patient engagement and technology, and I thought we would talk a bit about that. And then you've also got some ideas about vision and where you think the world should go and where you're taking Memorial Health. So maybe we could just start by the basics and you know, what is your take on patient engagement and the role of technology as we move forward? And maybe with an asterisk there, we'll talk about COVID implications as well.

Jay Roszhart: (02:37)
Yeah. So healthcare is, you know, something that happens to be a business, but it's ultimately about people, right? There is no healthcare unless you are engaging somebody else in the care that you're providing to them, whether it's focusing and engaging them around wellness care, whether it's engaging them on preventative services, engaging them when they are sick, or engaging them when they have a critical illness or a critical accident or a trauma, right? You don't get anything done unless you have a way to interact and interface with your patient. Traditionally, we, as healthcare providers have built a, you know, if you build it, they will come mentality and have relied on the very episodic one-to-one sort of interactions with our patients in order to build that engagement, and we have this whole concept around patient experience, and what experience they have while they're with us. Well, frankly, that's not enough. We've got to go beyond patient experience. We've got to go beyond the episodic, and we've got to go towards patient loyalty and engagement. And you're not going to get that in an episodic nature. You're not going to get that necessarily with just phone calls and outreach emails. The only way you're going to get that is if you can engage the patient over a period of time -- the formal relationship and a meaningful and lasting relationship. And that engagement is so critical because without an engaged patient, you ultimately are not going to get whatever outcome you're trying to get, whether it's fee for service medicine, and you're trying to drive care, gap closures and utilization of ancillary services, or value-based care. We are trying to drive really difficult changes in behaviors to reduce risks, to prevent bad outcomes, to prevent expense, to prevent all of those really bad things from occurring. So you have to have patient engagement and ultimately we also have to be much more economical about how we engage. And the only way to really do that at scale is going to be to leverage technology. A one-to-one engagement ratio is not sustainable for healthcare organizations who are financially struggling, especially after the COVID-19 pandemic.

Greg Kefer: (05:12)
Right. Right. It's funny because you said engagement a number of times in your statement there, and you know, the other thing that was going on well before COVID came along was this notion of consumerization of healthcare, right? You've got that overarching theme, you know, every CEO of hospitals is talking about that. And on the other side, just yesterday I read about Walmart -- they're opening up these health clinics at all their sites in the Southeast, and guess what, they just merged with an insurance provider too, now. And so as a hospital provider, you've got this threat coming off the left flank. And then you've got this desire to be more consumer-centric in the way you engage at scale. So how do you balance all of that and move forward?

Jay Roszhart: (05:58)
Yeah, well, there's absolutely no question that hospital-centric health systems are at risk of being commoditized in a value-based world, right? In a world where you're trying to drive down hospital utilization. And at the risk of sounding alarmist, I will tell you that hospital-based or hospital-centric health systems like us have to innovate and transform ourselves to be less hospital-centric and more about patient engagement and loyalty and more about interfacing with our community to keep people healthy. Because if we don't, somebody else is going to do it for us, whether it's the Walmarts of the world, the Blue Crosses of the world, the United's of the world, or the Apple Healths of the world, somebody is going to do it. And frankly, the best interest of the community, the best interest of the patient, it should be local. It really should. The best healthcare is local, but the consumer, the patient, isn't going to put up with local and archaic when there is non-local and tech-friendly and advanced available.

Greg Kefer: (07:17)
Right. Yeah. And it's funny because it's not like healthcare providers haven't invested in technology, right? I mean, a lot is being spent and has been spent digitizing health records and implementing apps and portals, et cetera. But that isn't enough for today's consumer wouldn't you say?

Jay Roszhart: (07:35)
Yeah. I would say that there has been a ton of technology being developed and deployed in terms of direct patient care technology, new DaVinci robots for how we do surgery or telehealth technology for how we turn an episodic visit more technology friendly or EHR electronic health records for digitizing the patient record and making it more accessible theoretically. But not as much effort necessarily has been spent on the idea of increasing technology around consumer-facing, engagement-facing, and engagement-centered approaches. And that's something that, again, I think is absolutely critical. You can have the best robot in the world, but if you can't engage the patient to let them know that they need this surgery, and by the way, they should get the surgery done at your place, that robot is going to sit there empty, not doing anything but costing you a lot of money.

Greg Kefer: (08:38)
Right. Do you think the technologists within hospital systems overestimate what consumers patients are willing to put up with? You know, we talk about this notion of friction and, asking somebody for example, to go to the iTunes store, download an app, remember that, getting in, setting it up, remembering another password to get into your own health record, and then learning how to use it is a tall order, right? And at the same time, you've got Apples and Amazons out there getting better and better and better at making frictionless experiences come to life. And that's the expectation. Do you feel like people sometimes overestimate what people are willing to put up with when it comes to engaging with technology?

Jay Roszhart: (09:23)
Absolutely. You know, it's the PITA factor and I think you can know what those letters stand for, right? And frankly, that PITA factor is going, you know, smaller and smaller and smaller in terms of what people are willing to put up with. It has got to be a really strong relationship to put up with something that is not necessarily, user-friendly, not easy, not something that is intuitive to them. And I think we absolutely overestimate that. And we also absolutely underestimate the amount of people who are willing to switch their healthcare loyalties or switch how they get their healthcare based on having an option that is much more user-friendly, is much more convenient, is much more accessible and frankly, is much more engaging. More people these days want to be involved in their own health than ever before. And we have to capitalize on that and connect with that and make it easy to do that. A once a year visit with your doctor is not going to do it.

Greg Kefer: (10:30)
Yep, I couldn't agree with you more. And you know, I don't think we need to talk a lot about this, but obviously this is no secret, but you know, with COVID, it's added urgency to this whole dimension. I've always felt that the healthcare systems move like snails, and technology innovators and the consumer side don't. Even big ones. And, COVID has added a sense of urgency with financial pressure that didn't exist before, right?

Jay Roszhart: (10:58)
Absolutely. It's definitely highlighted the artificial red tape and barriers that we extend for ourselves in the healthcare environment. That mostly comes with a lack of wanting to really change, right? A great example of this is the patient waiting room in a clinic. It is an asinine concept, right? Just a stupid concept that you are going to have somebody who comes and sits down in a chair for 30 minutes in a room, possibly with other sick people in that room, reading old magazines to go in and see their doctor for 10 minutes. Probably not get everything they really wanted to talk about talked about. Probably not being incredibly satisfied,... That's just absolutely silly, right? When I can now order from Walmart and drive up and they can put it in the back of my car and I don't even have to walk in. Somebody already picked it all for me, and there's no waiting and I'm good to go. Right? The concept of waiting is just one that is not an engagement- or patient-friendly or consumer-friendly concept. And really it's the artificial red tape that we've put ourselves through with COVID that's asked us to change. So, we're working with Lifelink Systems right now, it's a chatbot company, to basically do a virtual waiting room and completely change the concept of a waiting room. If I have my way, you know, a waiting room will be a very different place. It's much smaller, more like a hotel concierge service, where you are really engaging about different health techniques or different health items. And it's not there for you to wait for the doctor to be ready for you. It's there for you to experience and encourage your own health. And during this pandemic time, when we can't have that social interaction, when we can't have that occurring, the waiting room could be your car. It could be, hey, Dr. So-and-so is running about 30 minutes late, we apologize. You know, if you want to push back your arrival time and just let us know when you're in the parking lot, we'll make sure the doctor is ready for you. And press this button to tell us and you'll walk straight into the exam room.

Greg Kefer: (13:20)
Sure. Yep. Aside from missing out on finding out like, the latest discoveries of the pharaohs in the Egyptian desert when I read my National Geographic in the waiting room, it's such a terrible experience. And it it's funny because that one wasn't really talked about much before COVID right? The social distancing dimension of COVID brought that to the forefront, but you just nailed it. It's like, whoever had a big thumbs up for going and, you know, reading a magazine for 30, 40, 50 minutes at times? Not a great consumer experience. Now, technologically that system that you were describing, isn't an app, correct? I mean, that's, it's different.

Jay Roszhart: (14:02)
Yeah, it is different than an app. And I think that's really important. You know, we do have our own app here. That is something important for Memorial to have that app presence, but we also have to recognize not everybody's going to take the time to download an app, to sign into an app, and to do things differently through that app, especially if that's a different app from their portal app. And if that's a different app from their self-scheduling app, which is a different app from their EHR connection app, ... And they've got to manage 15 different apps for their health. You know, one thing every phone has, is the ability to text, unless you're one of those retro people that wants to go back to the old flip phone that doesn't necessarily have that ability. But every phone has that. And, being able to connect via text, or connect via a text that goes to a secure portal that is essentially one connection into a web space that's HIPAA-secure, don't have to download an app, don't have to do any of those things... Again, as simple, as easy as possible. And then the other thing that's simple and easy is having it be conversational so that, sort of what this is trying to do, what you're supposed to do, how you're supposed to interact, and you don't have to figure out a user interface, you don't have to figure out a website, and where to navigate. It's just asking you the questions that you need to know.

Greg Kefer: (15:27)
Right. Right. And are you telling me also, I don't have to fill out the same paper forms of my family medical history and what meds I'm on and every single time I go in, and that's all done in advance, right? I mean, I just think the whole idea of handing somebody a clipboard... I don't know if you write the way I do, but I wonder how that gets interpreted by whoever's re-keying it into the EMR system, because my Ss and 5s look just the same. I mean, I don't have good written capability. I gotta believe that's pretty common for data quality.

Jay Roszhart: (16:00)
Most people don't. And you know, the truth of the matter is those forms are legacy items that aren't always useful. And yes, there are some things that are regulatory-required or required because we have to collect it for billing, or required from a patient-centered medical home standpoint. But how do you make that process as easy, as seamless as possible, and make it so it's part of an experience to engage the customer and what they really want? So in that same thing, where we're collecting the billing insurance that we need to know, what if we're also asking you, what if somebody actually asked you, "Hey, you know, you got this visit coming up, what's most important to you about this visit? What concerns do you have? Are you worried about this, that or the other, you know, can you tell us how many minutes, how long would you like to spend with your physician today?" Or, "Hey, you know, if we have to give you unpleasant news, how would you like to receive that? If we're going to have to call you in a lab, would you like to do that through one of our drive-through labs? Or would you like to take a written script somewhere else?" What if, you know, somebody actually took the time to ask you these things that are about your preferences, not only to make that initial experience, that episodic experience better, but also then follows up on the back end to try and make it so it goes from an episodic experience into a loyal engagement relationship where I can then follow up and say, "Hey, you know, three days ago we had a visit, Greg and I asked you to start this medication. Did you go pick it up? Have you started it? Do you have any questions? If so, we'll forward that to your team and they can get you some answers today." And doing all of that at scale, in a way that makes the connection to the patient and the connection to the physician, much more possible at scale, but also much more friendly, much more engaging and much more able to be executed with the patient.

Greg Kefer: (18:10)
Right. I got to believe, just when you were rattling through those questions, you know, you do that for a couple of years, and you start slicing and dicing all that data... Holy moly! There's a beautiful insight dimension that you're tapping into that probably wouldn't be easy to get with a bunch of people on phones and emails.

Jay Roszhart: (18:30)
The truth of the matter is that that 35 year old male who comes to the physician once a year because there's health insurance requires them to get a physical every year in order to get a discount is a lot different person and probably wants a lot different from the physician than the 75 year old frail grandmother who's there with their grown children who just had a fall and is starting to show some signs of dementia. Much different desires about what they want out of those visits. And yet not a lot of people take the time to ask that ahead of time. Not a lot of people incorporate that in the pre-visit process that they use to address the patient.

Greg Kefer: (19:16)
Right. Yeah. And we, as you might imagine, talk all the time about conversational technology as something that is going to gradually replace,... to me, it's the beginning of Hal 2000 or C-3PO or whatever you want to call it, but you know, the idea that you don't have to download and use passwords and learn how to work through navigation, menu, trees, et cetera. And for something like healthcare, if you can solve the complexity riddle with something the way you describe it: Wow! So, okay, you've virtualized the waiting room, what else are you doing?

Jay Roszhart: (19:48)
Well, I mean, there's no real end to what we can innovate and improve on. And the long lasting implications from COVID-19 from the financial and the social perspectives, give us a ton of opportunity. So, for example, referrals --that's the next thing we're going to roll out, is referring a patient from a primary care office to a specialist or from a primary care office for an ancillary test or a CT or an MRI or something like that. Whether you are in a fee-for-service world, where you want to try to direct all those to your own, or in a value-based world where you're trying to direct it to the lowest cost, most appropriate setting and trying to control who gets what, when and how, again, it depends on patient engagement, right? And you've got to engage with the person, make sure they understand why they're going for this referral, and make sure they understand what their preferences are. Make sure they understand what options are from their insurance perspective. Heck, eventually make sure they understand, "Here's what your cost is going to be, from a price transparency. Hey, here's exactly the right directions to go. Here's what to bring with you. Are you concerned or worried? What do you want out of this visit with your CT technologist or your cardiologists that you're going to get? What are the top things you're concerned about?" You know the list of things that you can get in that conversational chatbot format is endless, but what's also endless is then the possibilities of what you can do with it, right? So what if then, and we're building this right now, we're using that input from the patient and the, you know, 200,000 referrals every year we send out from our primary care network to actually change the way in which our algorithm prioritizes care and prioritizes where referrals go, based upon the information that's coming back. And based upon things like we ask our patients, "Hey, how quickly were they able to see you? Was it a friendly experience? Did the physician meet your needs based on what we told them about this referral, did they address everything you wanted?" et cetera, et cetera. Well, you know, that is data the primary care doctor and health system wants to know in order to really manage that care, in order to manage that utilization. And frankly, it goes a long way towards driving engagement and loyalty of that patient towards your primary care physician, who ultimately is the one controlling that care and directing that care. So that referral idea is a huge idea. And it's one of many. The next one, just to throw out another one at you, is readmission prevention, right? You don't solve readmissions from inside a hospital. You can't, it's just not doable. But at the same time, it is not economical to assign a nurse, to talk to a patient every single day, multiple times a day for the first 7, 10, 20, 30 days after they're discharged from hospital to try and find that one moment when something might not be going right incorrect. Right? And there are so many things that might not be going right. They might not have understood their discharge instructions. They might not have understood their education that they were getting -- how to change this wound dressing. They might not have understood when to take this medication. They might not even have gotten it filled. But again, if you could automate a chatbot, if you could automate a conversation that can check in multiple times a day, "Hey, did you get your prescription? It was this. Do you know how to take it? Which of these three options tells you the right way to take it? You didn't click the right one. Let me clarify for you based on your discharge instructions, this is what you're supposed to do. Here's what the pill looks like. You have a wound, this is the type of wound you got this kind of wound dressing that you're supposed to do at home. We taught your spouse how to do this. Here's a video on exactly how to apply it. It's time to change your dressing. Have you done that yet?" All those sorts of things are available. And at any point, if something is not right, there's a way to get help a way to immediately alert somebody who can go and intervene hopefully before they even come back to the emergency room. Because if they get back to the emergency room, the likelihood is they're going to get readmitted.

Greg Kefer: (24:38)
Yeah. It's probably worth noting that a lot of what you're describing here, it doesn't sit on an island. It's stitched in to your EMR or your CRM and reading and writing patient data. In other words, it knows I'm Greg, and it knows I have diabetes and it knows I haven't been in six months. That's a very important part of this. So despite the fact that we were talking earlier that maybe a lot of money has been spent on a lot of technology that's not super patient-friendly, the fact is that's where the data sits. And absolutely you've got to make that experience personal for this really to work.

Jay Roszhart: (25:16)
For it to be effective, it has to be connected and have personalized data, and it's gotta be presented in a way that is consumable. And if you can't do those two things, you might not as well do it. So, you know, when I say consumable, I really mean it's gotta be smart. It's gotta be AI-driven. It's gotta be able to predict what they need and change as the conversation changes. And that's really difficult to do, but if it can be done well, you can very much so get all of that conversation that typically would take an army of nurses or an army of people to have, and reduce it so you don't need that same army of nurses just to have those conversations where everything's going well, but you can instead have that army of nurses focused on the conversations that aren't going well, and intervene where intervention is necessary.

Greg Kefer: (26:13)
Yeah, the scale. You made that point a few times, and that's obviously a very, very big part of this and it does have the potential to be the ultimate win-win where you're going to save money and get more happy patients and fend off the Apples and the Walmarts that are coming. Wow. That was a quick 30 minutes that we just rattled through there! I could go on, we are probably gonna have to have you back six more times because I have 19 other questions I still want to ask you. But, um, look, if you Google search "Jay Roszhart", R O S Z H A R T, there's a lot under news. You're gonna find a lot of articles out there about some of this. It has details. And I'd like to have you back again, maybe in a quarter, we'll check in with you.

Jay Roszhart: (26:53)
Happy to do it. Sounds great.

Greg Kefer: (26:55)
Okay. Thanks for coming on. Thanks for listening to Digital Conversations. If you liked our show, you can always subscribe on iTunes, and feel free to like retweet and share on your social networks. This and other episodes are available on iTunes, Spotify and LinkedIn.com. We'll be conversing again soon with a new episode. So long.