Transcription: A Post-COVID Prescription for Healthcare Systems: One That’s Predicated on Massive Digital Engagement Scale that Builds Patient Trust and Delivers Outcomes



Greg Kefer: (00:07)
Welcome to Digital Conversations. I'm Greg Kefer, and back in the studio with me about a year since last time is Jay Roszhart, President of Ambulatory at Memorial Health. Jay, good to have you back on the show.

Jay Roszhart: (00:21)
Thanks Greg. Good to be back. It's been a long year, but we've definitely learned a lot about ourselves over the last year's timeframe.

Greg Kefer: (00:30)
Yeah. Gosh, I know. I cannot believe when I look back was literally last fall and we were talking all about COVID and vaccines were sort of in development, health systems were trying to figure out how to get reopened. Again, the vaccines came online, you had to deliver millions of shots, we thought we had it all under control, and along comes Delta. Now we're in boosterland. Whoa, right? That's a lot for a year!

Jay Roszhart: (00:55)
Yes, it is. It is an absolute lot for a year. And uh, I joke around and I've actually got a coffee mug on my desk that has the pivot scene from Friends where they're trying to move a couch up and Ross keeps yelling, pivot, pivot, pivot! And it just won't pivot because it seems like every environmental change that comes along, we're having to do another pivot. Yeah. We're having to look at and learn a whole new system and a whole new responsibility as we try to, manage this pandemic and more importantly, manage ongoing health and ongoing healthcare for our community.

Greg Kefer: (01:34)
Yeah. So before we get into it, Memorial Health is a new name. I mean, that's changed. So maybe you can talk real quickly about the new brand of your organization before we get into COVID and technology.

Jay Roszhart: (01:44)
Absolutely. So we learned a lot about ourselves over the pandemic throughout two years here of a very, very challenging time. One thing we learned is that if we wanna be successful as an organization, we've got to be ruthless in terms of how we integrate and optimize our system. The workforce challenges we face, the labor challenges we face, really the cost challenges we face as an industry, necessitate us being optimized, working as a system, being able to be flexible and being able to share resources. But not only that, it also necessitates that we have similar systems from an IT standpoint, so that as we build things like technology-enabled solutions, chat bots, others, we've gotta have a tech platform that works at every location. So recognizing this necessity to have this integrated optimized system and really taking a hard look at our mission, our vision, our values, our whole strategic plan, as the pandemic starts to wane a little bit, we decided to rebrand, drop the word "System" for the Memorial Health name, so it's now Memorial Health. Every one of our hospitals are the city name and then Memorial Hospital. Our ambulatory brand is Memorial Care, everywhere you go. And we've got a new mission, It's to not just improve health anymore, but to improve lives and build stronger communities through better health. And so that's key. It's critical. It's what we're all about. And to do it, we've gotta be great partners with our community. We've gotta partner with the right payers. We've gotta partner with the right physicians and we've gotta partner with the right companies, technology firms, and others that can help us innovate a path forward and move forward in a way that allows us to face the challenges of tomorrow. You know, the workforce challenge, the technology challenge, the outcome challenge, the loyalty challenge, the engagement challenge, all of those things are crucial to our success.

Greg Kefer: (03:59)
Yep. You hit on a lot of themes. And if you kind of look at the context of the pivots that have happened over the past year, year and a half that you've had to deal with, what's your state of the union right now? How's it going in Springfield, Illinois? You know, I know that Delta whacked you guys relatively hard. I saw Missouri in headlines when Delta was doing its thing a few months ago. How's it going right now?

Jay Roszhart: (04:23)
Oh, it's going pretty well. We have seen a slow down in terms of COVID transmission. Delta hit us real hard over the last year to the point where we were at max capacity and on bypass in other things. And many of our hospitals' ICUs overflowing, all of that, just like many organizations throughout the country. And it's compounded with this double pandemic mass exodus of staff and the really difficult defined workforce and nursing shortage. But we're on a downhill hill slide. Where we're at right now is trying to get more and more of our community vaccinated, trying to get boosters in arms, trying to get kids vaccinated. Being a more rural part of the state, we have, you know, quite a few people that aren't so sure about the vaccine and we understand that. But it's actually a very good analogy to why building local trusted relationships are so important because people can get online now. They can listen to just about anything on YouTube or on Facebook or anything else and hear anything they want to hear. They've gotta have that local trusted connection that they can rely upon in order to understand all the information that's being put out there. And that's the only way we're gonna get more and more shots in arms and get past some of this. But, you know, speaking to the technology piece of this, why do people turn to Facebook and YouTube and the social medias and the web and everything else rather than talk to their doctor about it? It's easier. We have to make talking to your doctor as easy as going to Google.

Greg Kefer: (06:10)

Jay Roszhart: (06:11)
And we gotta make engaging and building loyalty with a local trusted resource, as easy as getting on Facebook.

Greg Kefer: (06:21)
Yeah. When I was listening to our show from last year, which by the way, was so great...I encourage all of our listeners to check that out after you listen to this. But there were two quotes that I wrote down, that you said at the time, one was, "Tthere was no healthcare, unless you are engaging somebody else in the care you were providing to them." And another one related was "You don't get anything done unless you have a way to interact and interface with patients." Now, of course, no one would disagree with that. But when you talk about what we've been through for the last year and a half — worker shortages, technology... Can you comment on that, maybe past tense and bring it to today?

Jay Roszhart: (06:59)
Yeah, absolutely. So we saw this. There is no healthcare, unless you have a way to engage the patient and you have people or technology or other things to engage the patient. So we had to build things. We had to work with chatbots. We had to do a number of different services over the last year to expand the ways in which we can engage with the population that has a huge amount of demand, whether it's demand for information, demand for care, or otherwise. And while we've been able to do that at some of what I'll call the low hanging fruit over the last year, we've been challenged at some of the more complicated areas. We have a real challenge in nursing, just like most of the country does in terms of nursing shortages. We've got a big challenge within our own primary care areas in terms of getting MAs and LPNs and others to support the primary care doctors. It's a huge challenge that we've gotta face and you've gotta have the technology, you've gotta have the foresight to think about how you can automate, you can control, you can standardize some of that engagement so that the people you do have can do the more complicated things that only really humans can do, people can do. They can spend their time patient facing, working with the patient, and not chasing some of these phone calls, and some of these other ways in which we've historically engaged our population.

Greg Kefer: (08:35)
Yeah. And historically, you break up a good point there because, and, and I'm not gonna say that you guys have done this, maybe you have, but historically, a lot of technology over the past 20, 30 years, was designed to kind of offload work. So the patients have to do it. You know, if you think about a portal or an app, you know, I heard a CIO on a web conference the other day, of a very large system, and he said, yeah, we have this untapped resource to do all the work. It's our patients. And I thought to myself, well, that's not really what patients want or need, you know, they're not looking to take on all that complexity because there's a worker shortage going on in healthcare. And if you think about the tools that have been provided to them, that's precisely what they're designed to do. It's, you've gotta figure out how to schedule an appointment and do all your own paperwork instead of having someone do it for you. And, you know, I don't think that that's the right way. You know, when you think of technology, that's designed to engage people, make them happy, generate loyalty, the technology has to do the work. You know, the workers have to be the software. How do, how do you respond to that?

Jay Roszhart: (09:38)
Oh, I think that's dead on. I mean, the best example I have of that is if you've ever been caught in one of those God-awful phone trees where they don't even let you press buttons anymore, you have to speak into it. And you just keep screaming into the phone "customer service!", because you want to talk to a human, right? Because they don't have enough people to actually have humans talk to everybody that calls. That's the difference between what I'll call stupid AI -- not very smart, not very user-friendly, offloading onto the customer, some of the work. Versus true smart AI, true smart chatbot. It's the difference between passively asking your patients to do something and actively engaging them in a way that it doesn't feel like you're asking them to do something as much as you're having a conversation, staying in touch and care about them and want to work with them as a partner in their care or in the service that you're delivering.

Greg Kefer: (10:41)
Yeah. We talk often here, on Digital Conversations, a show about automating that engagement cycle, this notion of friction and the other thing that a lot of, I think IT designers, not just in healthcare, but everywhere, overlook is friction. What it's gonna take to make an experience easy and satisfying for an average person. And that means no, you're not gonna make them download an app or remember a password or have to figure out a crazy menu tree to get to the place they want to go. And you know, one of the reasons conversational AI makes a ton of sense is it's using language, the language that we all know. You're basically using words to interact with machines, which is a kind of a step forward in technology innovation. How do you see that in your view of making this whole engagement experience next level?

Jay Roszhart: (11:34)
Yeah. You know, there's a thousand things that our care teams do every day, a thousand times a day, right there, there's so many conversations that really are standardized. They really are the same 85, 95% of the time. And the key is automating that in a way that feels still like a human connection. It still feels like somebody is there and caring about it. And in a way that as soon as something is needed, that's maybe a little bit outside of that, 85, 90% of the time of what, you know, you can immediately get help, immediately get a real person involved, a real human involved, et cetera. So going forward the stressors on healthcare right now related to workforce shortage, we can do all we want to build pipeline, we can do all we want to grow the next generation of healthcare workers, but the demographics don't lie. They're gonna have so many more baby boomers that need care. So many more generations that need care, older generations that need care. And frankly, not enough in the workforce to care for. Nobody's projecting a surplus of providers or healthcare workers. Everybody's projecting a deficit. The only solution to that is to figure out how to work smarter, to figure out how to do more with what we have, because if we don't, it's going to impact people's lives. It's gonna impact people's ability to be cared for. But more importantly, if we do it badly, we are not going to get the outcomes that we need to get in order to truly make a difference in those lives. Frustration kills more things quicker than anything else, right? If you make a conversation incredibly frustrating by making it difficult, to proceed, difficult to get what you want, difficult to understand, or just plain time-consuming and annoying, it's not going to help you get the outcome that you ultimately want to achieve.

Greg Kefer: (13:57)
Yep. For sure. So you were on this journey before COVID happened. You, I think had digital conversation Nirvana back in 2019, before COVID even existed. Now COVID hits, a lot of your peers around the world are suddenly under the same stresses you are that they've gotta virtualize. You know, we saw a lot of telehealth and things kind of ramp up. One of the things that I've observed is that COVID took a lot of the slowness out of innovation timelines, because hospitals had to innovate fast to get back opened. Do you feel like the urgency has risen because of what we have and are currently going through as it relates to COVID to get digital?

Jay Roszhart: (14:41)
Absolutely. The truth of the matter is, is the care demands aren't slowing down. You know, we had extremely high care demands during COVID. We still have extremely high care demands and they're only gonna go up, whereas our ability to care for, and to meet those demands is more challenged now than it ever has been. So I'll give you a very simple example along with Lifelink we deployed a results chatbot that went out, told the patient what their results were of their test, it could have been a COVID test, a strep test, a lab test, et cetera, had them acknowledge the results depending on what the result was, worked with the patient through a number of next steps that were programmed and protocolized by our physicians and our clinical teams. And through a two month period, essentially we did somewhere in the neighborhood of 70,000 of these conversations. And we probably saved in the neighborhood of 10 to 15 FTE's worth of time in spending on the phone, just having these standard conversations with patients about what their test results were. That's the kind of FTE that is usually a nurse or a tech or somebody that is otherwise caring for patients. So we can redirect, refocus on the work that technology can't help us with. On the work that is still about the human touch and the human experience. And frankly, you know, what, if we didn't do it eventually, that patient would be so frustrated with not being able to get their results. They go to a provider, whether it's local or national or some larger tech company who can get them, those results that they want, and that test that they want quicker, easier, and using some sort of technology platform that makes it automated and given the information. This way, we're able to do it. We're able to do it in a way that stays local. It stays connected to the source of truth, which is the local EMR. And it gives them an experience that is pleasurable. That same chatbot about getting your experience? Over 96% of the people who engaged with it rated it as a very positive engagement and completed the full thing. It's an amazing, piece of functionality that we want to continue to explore, continue to build out, and apply to a number of different other areas. But it's just one where we have tens of hundreds of ideas of what to do next.

Greg Kefer: (17:26)
And to be clear, that's not a, like a text you get that we all have gotten. It says, dear customer X, your labs are ready, or your test results are ready, click here to get 'em. It's not that, right?

Jay Roszhart: (17:40)
It's not that. It's actually a HIPAA-secure text-based message that comes in, and says, I need to know that you're the right person, give me the last four of your social, for example, or something along those lines. And it says, here's your test results. Here's what to do. And your doctor has looked at these, this is what we think you should do next. You know, how are you feeling right now? Let's understand, are you getting better? Are you getting worse? It looks like your doctor put in this prescription for you, have you picked it up yet? All of these things that are personalized individualized to you, but automated in a way that, you know, it doesn't have to be a nurse relaying this from the medical record to you, to the patient, over the phone. But at the same time, as soon as that patient says something or asks something, or does something that the software's maybe not quite ready to answer, we can get that human involved. We can get that nurse involved. We can get that doctor back involved and engaged.

Greg Kefer: (18:43)
Cool. That's super cool. What a great example, because yeah, you're right. I mean, 70,000 tests, 15 FTE, and how long the time compression, right? You can do it almost instantly versus how many months of call center hours that you're gonna have to take. Going back to the past podcast, one of the other kind of topics that we got into that I was just fascinated with and just thought was such a spot on direct hit was this whole notion of loyalty. Building loyalty with your patient population. Healthcare loves to hold up retail and, and banking, and travel of service industries as examples of what they want to emulate technologically. And if you think of loyalty, you know, that's what these guys are really good at. Walmart is great at making sure people don't go to Target, for example, through awards and communications, et cetera. And, you know, you kind of made the statement that, we need to find a way to move beyond episodic to loyalty and engagement, kind of to move into that next thing, which is not a monthly email, but something much more engaging, more custom, more personalized. And I guess, where are you on that vision? Where are you on that mission? Has anything changed since COVID?

Jay Roszhart: (19:55)
Well, I think the one thing that has changed again is our mission statement, right? We're not just talking about wanting to improve the healthcare of the people and communities we serve. Now it's about improving lives. It's about building stronger communities through better health. So right there in order to improve a life in order to engage a life, you've gotta understand that life. You've gotta understand all of the 80% of things outside of just how their care is delivered on an episodic basis that actually drives their health. And so the next phase of healthcare here moves beyond, how is your experience with us today, to building relationships and building loyalty over time. And we are actively working through that. We know technology will play a role in that, but more important, we know that people will want to build loyalty and build relationships with those who are genuinely interested and genuinely care about helping them live a healthy life. Right? So how do you build that loyalty? You build the conversations, you build the outreach, you build the various mechanisms to show that you genuinely care to show that you understand what they're going through to help remind them of certain things that they can do to check in on them. When you learn of a loved one of theirs, or a pet of theirs passing away, you know, various ways that you can show you really do care, and that you can use to help identify where you can intervene in all of those social determinants of health and all of those other environmental factors beyond just the episodic. So that when they do come to you for that episodic care, not only can they have a great experience, but in the end they'll have great health. And that will build a stronger life for them. And it'll build a stronger community for all of us.

Greg Kefer: (22:08)
Yeah. And it seems like the place to start that would be an ambulatory channel, right? Like through that network of people that maybe aren't super sick and coming in every week, but just coming every now and then -- the episodic users of healthcare, right?

Jay Roszhart: (22:22)
Absolutely. I mean the best place to start it. If you think about where you want, the best relationship, is that primary care doctor, who's managing a panel of patients. You don't want that primary care doctor to think about them as a panel of patients. And you don't want the patients to think, I'm just one member of a panel of this primary care doctor's, you know, 2000. You want this more to be like, they're my family doctor, it's my, you know, family doctor. They understand me, they understand my family. I understand them. I have a great relationship with them and I trust them. Therefore, going back to our COVID example, if I read something about the COVID vaccine that I don't understand, I've got a great trusting person that is a physician, and I've got an easy way to access them and an easy way to talk to them. And I've got an easy way to discuss what I should do about getting vaccinated or having my child get vaccinated. That's a perfect example of how you have to build those trusting relationships. And those trusting relationships will build the loyalty that you want.

Greg Kefer: (23:35)
Yeah. And to me, it's that territory that a lot of the Walmarts and CVSs and the One Medicals are coming in that they're trying to wiggle into that part of the pie. And of course they don't have the trust dimension that you're talking about with the family doctor that you've used for X number of years. Yet again, if the experience is really lousy, you know, the odds of them checking one medical out because they didn't get an appointment for weeks or had a lousy experience goes up. And I think that's a, that's a big one to pay attention to.

Jay Roszhart: (24:05)
That's it. I mean, trust is earned, it's not given. And anybody has the chance to earn it once you are able to get in front of that patient, get in front of that individual and build it up. And so the fundamental underlying thing here is you still have to be easy to access. Now, once you've earned that trust, you can make a few mistakes here and there. You can have your service delivery, maybe fall off a little bit, but before you earn that trust, you've gotta have the service delivery really nailed. You've gotta have the way in which you get in the access, the convenience, all of those things really nailed if you wanna win that episodic visit in the first place.

Greg Kefer: (24:56)
Yep. And if you think about, digital armies, you know, massive conversational horsepower under an umbrella of 96% satisfaction, that's one way to do it, right?

Jay Roszhart: (25:06)
That's absolutely one way to do it. Great way to do it.

Greg Kefer: (25:08)
Yeah. Okay, Jay. Well, Hey, this has been great. I'm not gonna wait another year to get you back on the show because I could go on for six hours talking to you, but, thanks so much for coming on the show today.

Jay Roszhart: (25:18)
I appreciate it. Thanks for having me.

Greg Kefer: (25:20)
Okay. 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!