Transcription: A Conversation with Jeff Johnson, VP Innovation and Digital Business at Banner Health



Greg Kefer: (00:08)
Welcome to Digital Conversations. I'm Greg Kefer. And today, I have the pleasure of welcoming Jeff Johnson, Vice President of Digital Business and Innovation at Banner Health, to the show. Jeff, welcome, and it's great to have you on today.

Jeff Johnson: (00:23)
Thank you, Greg. Happy to be here.

Greg Kefer: (00:24)
So, Jeff, I guess before we start, maybe you can just level set our audience with Banner. I imagine most people are aware of who that is, but what is Banner Health? And describe your role down there.

Jeff Johnson: (00:36)
Yeah. Banner Health is a not-for-profit hospital system. We're actually an integrated delivery network. We've got medical groups as well as hospitals, and we even have our own insurance products. So we really operate as a full spectrum integrated network. We're based in Phoenix, Arizona, and we operate in six states and we provide everything from urgent care, to imaging, to world-class cancer center or cancer care with our partnership with MD Anderson, and just about everything in between.

Greg Kefer: (01:07)
Great. And specifically, what do you spend your days and nights worrying about or doing as a digital business innovation leader down there?

Jeff Johnson: (01:13)
Yeah, well, I probably tend to worry about everything. It's just my nature, but, you know, my role is really to look at our opportunities, to use digital in a way to change the business and to grow the business. And so a lot of that really focuses on how do we present healthcare services to our customers in a new way, a way that's really centered on their experience and their expectations, and what really brings value to them in the way they want to receive healthcare and interact with healthcare providers like Banner.

Greg Kefer: (01:46)
Right. You know, as we were chatting before we turned the record button on here, it occurred to me at least that it was just about a year ago that, you know, we're recording this in March of 2021, that this thing called COVID started going crazy. And it really hit me when NBA games suddenly were being canceled minutes before tip off and, fast forward a year later, maybe we're on the other side of the curve, but, you know, that was pretty much a watershed moment for healthcare. How did that go for you and for Banner? How has the past year been, just overall for you?

Jeff Johnson: (02:17)
Well, I think, you know, we've all just had our lives, completely reframed, it seems like, in this past year. And you know, something that we talk about in, uh, in Banner and that I talk about with my teams a lot is that, you know, this is a once in a career, once in a lifetime opportunity, if you're in healthcare to have been part of this and to have an opportunity, to make a contribution to how our whole industry would respond to a pandemic like this. And at Banner, it's just been remarkable. You know, I just continue to see what heroes our clinical workers and our frontline operators are. I mean, we've always known they're heroic individuals, who on any given day go into potentially very risky situations, and put their patients first. But, you know, to hear the stories of what's been done at Banner and other systems where you've got, you know, healthcare workers doing 275 consecutive days without a break, is just amazing. And so, you know, Banner did really, really well because of the strength and the character of the folks that we have at Banner on those front lines. You know, in my world, we've certainly tried to see the opportunities to make a contribution and how we can use a lot of innovation and a lot of digital solutions to respond to this, and take what are challenges and turn them into opportunities. So, lots of things that we've done on the digital front, and the innovation front, that I think will take us through COVID and certainly into the future.

Greg Kefer: (03:50)
Yeah. I hear that all over the place. You're so right, it's just a pandemic moment, if there's such a term where it really forced systems all over the world to reimagine how they deliver services, whether it was because of the surging demand that came, or social distancing and how to see people for services unrelated to COVID. So we hear a lot about virtual visits, which in way it's like a zoom call with your doctor, but it goes much more beyond that, right? It's not just tele-visits, but there's a whole array of digital that was brought forward because of this. Is that a fair statement?

Jeff Johnson: (04:26)
Absolutely. The industry was on a pretty good trajectory to really buckle down on better digital customer experiences, and COVID has just, you know, lit a fire under that. Um, and you're right. I think that it's a lot more than tele-health or just a video consult. In fact, if you look at the numbers in the industry for video consults, they really spiked last spring. And then they've kind of leveled off a little bit. They've come down and leveled off. And so that's not the only part of the future. There's a lot more. And certainly, you know, patients want to come in and they want to be seen face to face. They want to have that type of relationship with their caregivers and with their physicians. So, one thing that you mentioned, is this virtualization of the visit, or the waiting room. Our marketing team did some really phenomenal research with our customers. And one thing that they found was that people were nervous to come in. They were afraid. They didn't know if they would be going into a situation where potentially they would be around other patients and they would be in contact with someone that had COVID. And so we had to look for ways to say, how do we raise that comfort level, where our customers felt safe coming back into the clinic to see their doctors because they needed to do that. And so we created this solution that we called the virtual waiting room, and it turned out to be a really big success, both in terms of our patients feeling confident and safe with it, but then also just feeling like, well, this is the way it should have always been. Like, why was I ever coming in and sitting in this chair, and touching a clipboard, and touching a pen, and filling out a piece of paper?

Greg Kefer: (06:02)
Right. Now, how does that work? I imagine it's mobile. If I had to go see my dermatologist for say a rash, at a high level, how does a virtual waiting room work?

Jeff Johnson: (06:11)
Yeah, let me back up a little bit and talk about waiting rooms because you know, we've used the term waiting room just so casually. And if you think about it, it's, if you're in the service business, having a function called a waiting room, just doesn't sound very good. And it's one of those things that I hope future generations will look back and go, "They used to have these things in healthcare called a waiting room..." And we'll laugh about that and go, yeah, it wasn't that crazy, but you know, you think about it from a little more practical standpoint, a large system like Banner or any other hospital system. You know, we own a fair amount of expensive real estate that is dedicated to the waiting room. And it's something that our customers don't value. You know, nobody wants that. So there's a huge opportunity just to extract that cost out of the system and deliver a better experience.

But to answer your question, what we did with the virtual waiting room was when an appointment was made and they could book that online, we would send out a text message that would say, "Hey, we're glad you're coming in for this visit. It's really important prior to your visit, we'd like you to engage with this little chatbot, to fill out some of the pre-visit forms." And so they could complete those forms just on their phone using the Lifelink chatbot. And then when they would arrive at our facility, rather than coming in and checking in, they could just wait in their cars. They would text us and let us know, "Hey, I'm here in your parking lot." We would say, "Great. We'll let you know if your exam room is open, we'll bring you in." And then we would text them back and they would come in and rather than touching a clipboard, or sitting in a chair or going to a front desk, we'd just escort them right back into the exam room to meet with their care provider.

Greg Kefer: (07:56)
Yeah. What a concept, right. I mean, as you were going through that, I felt like, gosh, I'm getting ready to, you know, go to the airport and do TSA-pre to get on my flight, and why would I wait in that long line over there to go the other way? And you're using a mobile device, which is the way to reach the masses. So, wow. What a cool concept. It's amazing to me because I feel like, you know, when you're dealing with a pandemic, which is just so staggeringly, huge, you've got to think about how we interact with people, which is always a challenge. And if you look at mobile phone penetration, these days, there's like 270 million adults with mobile smartphones in the U S which is like 81% of them. So if you're going to go out and engage the masses, that sounds like the right platform to do it, right?

Jeff Johnson: (08:39)
Yeah. Yeah. Everybody's on their phone. And, you know, you had mentioned kind of that TSA sort of experience, and that's what we're getting to. We're connecting a couple of dots here that came out of the COVID work. So in addition to the virtual waiting room, you know, we also are a large supplier of the vaccine at this point. And so we run some big pods where we see thousands of folks come in to get their vaccinations from us. And we did something very similar. We piggybacked off that virtual waiting room concept where you had the pre-visit forms just on your phone. But then we were able to also attach a QR code. Once we got all that pre vaccination paperwork, and some of it was our own forms that we needed, but some of it was like the CDC attestation and those kinds of things.

And we put all of that in the phone. And then when we had all that successfully entered into our system, we would just send back our customer a QR code. And so the way it would work at these vaccination centers is that you would drive in your car and you would pull up to this attendant, and you would just open your window and show your phone with the QR code. They had a little wand and they could scan it. And it puts that information right into our EHR that says, yeah, you are in fact ready to go. And they just move you on up to the station to get the shot in the arm. So we're starting to connect these things together, to your point. It should be just like, just in time getting on an airplane. And I arrive, I'm ready to go, I scan my phone, and I walk on.

Greg Kefer: (10:08)
That's brilliant. It's interesting because obviously consumer habits are changing all over the place, healthcare being one. But you know, when you go to a restaurant these days, they don't give you a menu anymore. There's a QR code taped to the table and you'll have your phone over it and up pops the website with the menu on it. And I'm thinking about this too, that, two years ago, sure, there were a lot of people that knew how to use QR codes, but now everybody knows how to use them. And the masses are being reoriented into how these smartphone devices can really help them with a lot of bureaucracies out there in their lives, right? Where there's functionality on that phone, like a camera that can read QR codes, and chat that can be pretty effective in helping you do away with things like waiting rooms that were never that great to begin with.

Jeff Johnson: (10:56)
Right. That was a big step. When the camera could just recognize that it was looking at a QR code and use it. We used to have like a QR code reader app or something like that. And it was just cumbersome. We're using that all over the place, whether it's a QR code or just a short code. Another example that we've just started implementing is what we call Text the CEO. Another one of these anachronistic things... So, you know, you go into a hospital and they have little suggestion box things on the wall where you can fill out a card to talk about your experience or to give a compliment, Or to give a suggestion, or even a complaint. And so we've now started that in our hospital rooms, just a little code where they can just text short code and they can start filling out a little message that gets texted directly to that hospital CEO. So we're starting to put these kinds of interactions, just all over the experience, whether it's on your phone, and you're at home getting ready to come in, or you're actually in one of these facilities and you would need to order a meal, or you need to text and CEO. We've been connecting with our consumers and their phones all over the place in these really easy touchpoints.

Greg Kefer: (12:01)
It's cool too, because a lot of the stuff here that you're describing, isn't about, oh, I've got another vaccination app that you've got to go iTunes and download and set up an account and passwords. So it really addresses the big challenge, which is friction, right? People don't adopt technology because there's no technology to adopt. It's just, it's been too hard. And go and fire your camera up and hover it over a QR code, or respond to just a text you get, are examples of making it really easy for people to get into the technology. So you don't have to set up accounts and remember passwords because there's just too many of them out there.

Jeff Johnson: (12:34)
Yeah, that's right. There's definitely a place for an authenticated, personalized experience inside of an app or a portal, but that boundary between that and just these other kinds of digital touchpoints, is just getting really, really blurred, which is good. So that it's as easy as you described. And we certainly look for those kinds of opportunities first and foremost, to engage our customers

Greg Kefer: (12:56)
Right. I've read a lot about you in the press,... You're a very well known name out there in the media circles, talking about innovation at Banner. And one of the things I also read about you, which was somewhat unique, I haven't seen it anywhere else. And this really started before COVID, which was you identified the emergency department as an opportunity to address patient satisfaction, patient experience. And I think that's pretty interesting. I'm curious how that went with the surge that ERs had. Maybe there was some added benefit to that, or it shined a big, bright light that we've got to do more there. Can you talk a little bit about that?

Jeff Johnson: (13:35)
Yeah. You're referring to what we've kind of always called the ED chatbot. And this really was one of our first real digital innovations when I came to Banner three years ago. And it's actually kind of been a precedent for a lot of the things that I've already described, like the virtual waiting room, and even the vaccination experience, because we really learned that there's this easy, conversational way to engage with our customers. So the way the ED chatbot works, and as you mentioned, we had a patient experience dissatisfier in our EDs, and it was basically people would come into some of our EDs and they didn't feel like they were getting communicated with well enough. And sometimes they felt a little bit like, "Hey, I'm just sitting here waiting. And I don't know what's going on." And in the worst case, they would feel a little bit abandoned.

And so, you know, they would walk up to the desk and say, "Hey, what's going on? And how much longer is it going to be?" Or something, even as simple as, "Hey, I need to go down to the hall and get a drink. Can I do that?" Or "Am I going to lose my place in line?" And we took all that feedback and we created this ED chatbot with our partner Lifelink. And it's basically this little companion that lives in the ED with you. And when you register, it starts talking to you and telling you what's going on. It gives you some basic information about what to expect and the ED, and yes, you can go down and get a drink and you won't lose your place... But what's really powerful about it is that it's integrated directly into our EHR. So it's giving you smart updates as well.

So if the labs have been ordered, it tells you that those labs have been ordered, and it tells you how long it typically takes for a lab to get back, to get resulted in how long it will be before your physician will likely be able to see those and get back to you. We did that for images as well. So you're getting this digital companion that's not replacing the communication from the ED, it's just augmenting the communication. You may be getting your physician or other staff in there, and the customers love it. They just feel like they're not forgotten. They feel like they're the center of this, which they should be. And it's just had remarkable results in terms of the patients' satisfaction, but also staff, feeling like they've been given an extra helping hand to manage the flow in the ED.

Greg Kefer: (15:48)
Right? Yeah. You touch on a really interesting concept there, which is that integration to the system of record the EHR, or maybe a CRM, or something where, like a conversational digital assistant chatbot is much more effective if it knows your name is Jeff. And it knows that this is your lab, or it knows you have an appointment coming up. I mean, that's where you really begin to see the smartness of this technology come to bear and it's not going to happen in a vacuum because all of that data does sit in an EMR. Right?

Jeff Johnson: (16:19)
That's right. And, you know, that's where I think we really made some big strides in not just being satisfied with this being kind of a lightweight front end, but really connecting down there because that's where I really see all of these digital interactions going, they're going to be hyper-personalized. So that kind of connection into what we know about you, and how we can use that knowledge to give you a better experiences is going to be critical.

Greg Kefer: (16:44)
Yeah. And it also gives you a degree of scale and the ability to run loyalty programs with your patients without having to reach out personally, you know, expensively each and every time, which begins to sound a lot like what Walmart does, you know? Where you try to consumerize the experience. You read a lot about that too.

Jeff Johnson: (17:03)
Yeah, I think that's right. And I think where I'd like to see us go with this too, is to really apply those behavioral economic principles to helping our customers take the next best step, to stay healthy and do the right thing. And that's all premised on having a really good understanding of who they are, and what their health objectives are. So connecting it to that EHR where some of that data will be in certainly other places as well will be key to that. And then I see our digital interactions and our digital products just getting really, really smart, and really personalized and really increasing their value to the customer.

Greg Kefer: (17:41)
Yeah. So it's interesting. We've touched on a lot of things here on one hand, we've had this pandemic that's forced radical change. As in like doing away with the waiting room, potentially you've got digital assistants that are allowing patients to really utilize the power of their smartphones, more intensely in the scope of getting their care. You see the government, you know, CMS, that's willing to reimburse more for virtual, which might expand because they see the benefits. So if we kind of look past COVID, and you've had this watershed moment this year, this once in a career year... Things are gonna change going forward. And I'm curious how you see the next two, three years as COVID kind of hopefully fades away into history books. Yet now there's this kind of new path of innovation in healthcare to really make it better for everybody. More cost-effective. Where do you see it going? What's your view if you look forward a couple of years?

Jeff Johnson: (18:36)
Yeah. I hate questions like that, Greg. Because in two years I'll listen to this and I'll sound so stupid. So I never try to predict the future, but I would say this, we still have a lot of work to do on the transactional level of just connecting better with our customers digitally. And so you're going to see a lot of just really rapid development of every single form being digitized or replaced or eliminated if it's not necessary, really making the whole transactional part of healthcare much easier than it is today. Getting to just-in-time care. Like we've talked about making inputs for information, not these big static forms of everybody fills out all 20 fields, but we know who you are, and we only need one piece of information from you today before we can get you ready for your visit. So we'll see a lot of those really transactional things made simpler and easier through digital.

Jeff Johnson: (19:33)
And then as I mentioned, I think the opportunity to lay on top of that is...starting to get into a lot of the AI and the machine learning opportunities. Once you've got those connections with your customers and you've got the data sets behind them to just continually make those interactions much smarter. And the focus really being on how are we helping that customer through that digital connectivity, do what they need to do or provide them what we need to provide them, to make the decisions and the steps in their lives that will keep them healthy, like they want to be. And that's what our customers want. We get all this really good input when we sit down and we see how is digital impacting other parts of your life and how would healthcare do it better. But it really comes down to, you know, people want to be healthy and they want their families to be healthy. And so I think we just keep our eye on that, of how we can use this new way to connect to our customers, to help them reach those goals.

Greg Kefer: (20:28)
Yeah. As I mentioned before, I think there's a really big opportunity because so many people are using mobile and what we're talking about here, isn't just for the millennials, for example, you mean we've got middle-aged people, even seniors that are getting more comfortable with this technology. So the chances of getting it to stick are much higher maybe than it was 18 months ago.

Jeff Johnson: (20:46)
Absolutely. And you know, you bring up different age groups and we had done a health risk assessment on a chatbot for our Medicare patients. It's a funny story because prior to coming in for their annual wellness visit that Medicare patients do, we would talk to them on the phone and we mail them out this health risk assessment and say, "Please fill this out and bring it into your doctor for your visit." And then we'd go to the clinics and talk to the doctors and say, "How often do you see that form completed? When the patients come in with it?" And they said, "What form?" It was never getting completed! It's this onerous task to fill this thing out. And so we converted it into a mobile experience where they're just using a little conversational bot and it doesn't feel like you're filling out a form.

You're just answering some questions in a natural kind of conversational way. And we immediately went from about a 0% pre-visit form completion to over a 50% pre-visit form completion. And that's critical data that drives a really effective appointment with that patient because that physician and the care team has had a chance to really see what the issues and the changes may have been. And then from a value-based care standpoint, it helps us sharpen the pencil, if you will, a little bit around our RAF scoring and things like that, because we have much better information about our patients and their needs.

Greg Kefer: (22:05)
Yeah. And it's with the supposed low tech seniors, right? I mean, everybody says, "Oh, you know, my grandmother could never figure this out!" It sounds like that's not exactly a true statement anymore.

Jeff Johnson: (22:16)
Oh, not at all. Seniors are huge adopters of digital. The most interesting stat in that work was I think that we had like a 25% adoption rate for the 85 plus year olds.

Greg Kefer: (22:28)

Jeff Johnson: (22:28)
That's believable, it just seems a little surprising, but everybody's using their phones.

Greg Kefer: (22:34)
Yeah. It is. I mean, I'll tell you that these things,... if you just look at the stats, it's, you know, 80% penetration. People spend sometimes five hours a day on these things. All you have to do is go back to the airport and look at the waiting area there and everyone's on their phone. These devices are where people are spending their time. And so the more that healthcare such as yourself can adopt those platforms, I think that the sky's the limit and maybe COVID, despite the horror of COVID, has kind of advanced that. And that's one of the silver linings that's going to come out of this whole thing.

Jeff Johnson: (23:04)
Yeah, you're right on the phone. In fact, you know, thinking back to that ED chatbot experience, when we first started kind of kicking ideas around of how were we going to solve this problem of people feeling that they hadn't been communicated with well enough in the emergency rooms, you know, people were talking about, well, "What if we had big boards on the wall?" And, you know, we could post things, but there's some privacy issues around that, obviously. But we also just said, "Well, let's sit down and let's watch people in the ED and where are their eyes?" Their eyes are not on TVs on the wall. Their eyes are in their hands on their phone. So that's where the messaging, that's where the connection happens. Because that's where their attention is.

Greg Kefer: (23:45)
Yeah, get them where they're spending their time. That's the trick, right? Well, Jeff, hey, this has been great. Thank you so much for sharing your thoughts here and joining us. And I know you don't like to predict the future. So maybe we'll circle back in several months and we'll see how much of this is coming true when COVID is behind us, and we're kind of moving into healthcare innovation tech 2.0.

Jeff Johnson: (24:06)
Absolutely. I'd love to do that and thank you for the opportunity to talk today. It's been a real pleasure.

Greg Kefer: (24:12)
Thank you so much. This has been Digital Conversations. 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.