Anthony Guerra: Good afternoon, and welcome to “Balancing Standardization & Innovation in the Digital Patient Engagement Space,” a healthsystemCIO production sponsored by Artera. Just a little housekeeping before we get started, my name is Anthony Guerra, I’m the Founder/Editor-in-Chief at healthsystemCIO and I’ll be your moderator today. We’re looking forward to your participation – you can send in questions or comments at any time in the Q&A box and we’ll take them later in the program. Just how you see how we’re going to spend our time today, we’re first going to go about 30-40 minutes on the main panel featuring Sara Vaezy, EVP, Chief Strategy & Digital Officer with Providence, Pamela Landis, SVP, Digital Engagement at Hackensack Meridian Health, and Guillaume de Zwirek, CEO with Artera. And then we’ll have our Q&A. So let’s jump right in. Sara, can you give us an overview of your organization and your role?
Sara Vaezy: Great to be here, Anthony, thank you so much. Looking forward to today’s conversation. As you noted, I serve as the Chief Strategy Officer and the Chief Digital Officer at Providence. Providence is a Catholic, not-for-profit healthcare system based in the Western United States. We cover 51 hospitals and over a thousand ambulatory sites. We care for about 5 million patients every year. And in my role, I’m responsible for corporate strategy, digital marketing, virtual care and kind of underpinning all of that is innovation. So we do a lot of work in innovation to support our patients and our clinicians, driving care, model transformation and digital experience and transformation for our communities.
Pamela Landis: Hi, thanks for having us, Anthony. I’m Pam Landis. I’m the Senior Vice President of Digital Engagement here at Hackensack Meridian Health. Hackensack Meridian Health is a health system in New Jersey, basically in the 8 counties, that kind of run from Northern New Jersey down all, and hugs the border all the way down to the south – we stop short of Atlantic City. So there are 18 hospitals in our network, and 500 other care locations. We service the biggest population here in New Jersey, and we’re the biggest integrated delivery network here.
My role is a lot like Sarah’s in that I oversee digital marketing, what we call digital acquisition. How do we acquire those patients? And then we move those patients into our digital activation program, the websites, the mobile apps, MyChart, patient texting, online appointment scheduling. We also have our access center where we do all of our scheduling for all our physician practices and hospitals, and finally, our virtual care component, how we keep people to stay with us once we’ve activated them, give them access to our great doctors and nurses, and then we want them to stay with us. And so we do that through virtual care, video visits, hospital at home, remote, patient, monitoring. Those kinds of strategies are there.
Guillaume de Zwirek: I guess I get to represent the vendor side. I’ve known Sara and Pam for a while. So I’m among two greats, and I’m sure you’ll have a lot of insights today. I founded Artera almost a decade ago. We’re coming up on the anniversary next April, and we build software that patients interact with – we started with communications because when you think about it, I started this company as a patient. And when you think about the experience with the health system, you have the brand, but you also have the phenomenal physicians and NPs that you interact with on a day to day basis. And that’s for most people. That’s the connection that keeps them at your hospital. So we started with communication which we believe is the glue of the entire patient journey. We’ve since expanded into offering solutions and scheduling and intake and other categories that are part of the patient journey. Thanks for having us.
Anthony Guerra: Alright. Very good. Thank you. All right. So we’re going to start with you, Sara. How do you approach the balance between standardizing technology across your organization and implementing innovative solutions to enhance patient engagement? How do you manage competing demands between departmental needs for innovative solutions and the organization’s need for consistency across the tech stack? So wherever you want to jump in there.
Sara Vaezy: You know, I actually think that the question of standardization versus innovation is a little bit of a red herring. And what we’re really trying to do in a way, I mean if you fundamentally break it down into what health systems need to do and what other industries who’ve gone through digital transformations have done, is bring their sort of suppliers – In our case, our clinicians – like that Gui talked about right? Like you really want like, that’s the best thing about the system is the care that’s delivered by our clinicians, and bring them closer to those people who need it, our patients or our consumers, and take all the crap out of the middle, right? And when you — and so with that end goal in mind, right like, bring your supply and your demand closer together. You do whatever it takes to do that right. And so standardization versus innovation works in service to that goal. And often when you think about when you think about bringing supply and demand together, you don’t want to just do it the same way. Everybody else is doing it right. You don’t want to have the same stuff everybody else has. You really need to innovate. You really need to have a differentiated experience. If you want to be around. If you want your patients to come to you versus go elsewhere. And so I think when you, when you think about it that way, it’s the goal of whether you know, in very kind of crude terms, new customer acquisition and retention.
That does not need to have sort of standardization, or I would say, sort of tech stack. Rationalization doesn’t mean a whole lot. In that case, differentiation really matters, and experience for the patient really matters as well as, like not burdening the clinician. So that’s how we think about it. For stuff where differentiation doesn’t matter as much, that’s okay where you know, tech stack rationalization or consistency across the tech stack. That’s okay. But you need to really like from our perspective, you really need to invest in differentiation. And so that’s where we focus our innovative efforts is on that front.
Anthony Guerra: All right. Very good, Pam. Your thoughts?
Pamela Landis: You know, I’m going to echo a little bit of what Sarah said. And the reason is, I think she nailed it in that people have relationships with doctors – it’s very intimate. And so we are basically trying to say, what is the technology that can enable and strengthen that relationship? And so it doesn’t have to be. You know the big EMR company does this or that, whatever it takes to strengthen that relationship that is easy for both the patient and the clinician to manage, that’s what we’re always gonna sign on. So when I like, look at, you know, how do you standardize? And when do you go with the implementing innovative solutions? I always think about, you know in the end, what’s gonna make it easier for patients and our clinicians to have a better relationship with each other.
And one of the things that I think is really important to keep in mind, I don’t want to look like everybody else in our market. We’re in a competitive market in New Jersey and in New York, we compete with our New York City health systems – they’re all very good. They have great clinicians, great systems, and there’s a lot of really great healthcare. So where I’m going to differentiate on is when I’m going to make it easier to access and manage that care – that’s how we do that. And that’s the stuff that I really have to, you know, that I work on focusing the team here and our leaders on. That’s how you compete. You don’t compete by looking like everybody else.
Anthony Guerra: All right, very interesting. Gui, I want to hear your thoughts.
Guillaume de Zwirek: Hard to refute anything you’ve all said. The thing that comes to mind for me, 2 things come to mind. The first is, you know, I’m sure you’re all familiar with the iron triangle – you can really only compete on 3 things. Cost, quality and speed. Cost is out of the picture in healthcare, because that’s prenegotiated right, like no one is choosing your – I mean not nobody, but very few patients – are choosing your sites of care because of cost.
For the most part it is Medicare, Medicaid, it’s commercial. They’re assuming it’s covered, and they have a copay, and it’s so convoluted and confusing. So you’ve got quality, and you’ve got speed right? And I think we’re anchoring around those two things. Speed is like access. Right? How do we free up physician schedules? How we create more capacity? How do we make it easy for patients to get into the healthcare system. And then quality is all the other things that we’re talking about. When it comes to standardization and innovation, the thing that we see, that I’ve seen over the last decade, both as a consumer and as an operator of a business, is bundling and unbundling. I think it’s synonymous with standardization and innovation. Let’s use a consumer example: cable. 10 years ago, everything was bundled right? You bought a cable channel, everything was included, it was mediocre, there were a lot of ads, you couldn’t watch the channel when you wanted to, and then we had massive, massive investment around the Covid time in play kind of digital streaming channels, Netflix, Roku, Hulu, Disney. I could go on and on and on, and it’s interesting to me because I think over the last 2 years, we’ve seen the shift back to bundling. Think about Youtube, TV. Think about Disney plus Hulu plus Espn. And I think we’re saying the same thing. I don’t think that’s unique to the consumer side. We’re seeing the same thing in healthcare. We’re seeing the same thing in many, many other industries. I think this is a global phenomenon, and it’s this constant yin yang of bundle, unbundle standardized, innovate. I think everything at some point has to reach equilibrium, and as a vendor and as a consumer, it feels like we’re starting to steer back towards that bundling or standardization route. So that’d be my only other observation.
Anthony Guerra: Yeah, well, it’s a good point, and we’ve seen it in this industry. 20 years ago, it was very best of breed approach on the application side, and then we saw the huge pendulum shift towards a package deal, which is a big reason for Epic’s success, and don’t know. I don’t know where we are now you’re seeing in some areas you’re seeing bundling which would sort of be the enterprise approach, But I don’t know, Gui, any more thoughts? I mean it definitely, You definitely see the pendulum over the decades.
Guillaume de Zwirek: So the thing I’d say is that extremes are never good, right? And in general, in life you eat too much of a certain type of food, It’s going to be bad, even if it’s a healthy food, so extremes are politics. You name it right. Everything. Extremes generally are not a stable long term solution. So I think the equilibrium is the best. I think, Sara, Pam, you both hinted to some of this like, how do you, as executives at hospitals, think about that equilibrium? What should be standardized? What should be, you know, single platform? And where are the opportunities to differentiate, to drive value to your consumers, to balance that supply-demand scale like, I think that is, that is the crux of the question. What is the right balance? I’m not sure. As a whole healthcare has found that equilibrium. I think we were. We were there. We’ve been there at parts of the last 20 years, but I think more recently, I’m concerned that we’re moving away from that equilibrium in general. I think you are two leaders who have found a way to kind of keep. Keep steady and manage it well, but I’m not sure the whole industry has.
Anthony Guerra: And you’re seeing it move right now towards more of a bundled approach, and that’s where you see the pendulum.
Guillaume de Zwirek: I actually have a thesis here, and I’m curious what the other panelists think. I think it’s tied to the cost of capital. I think the higher interest rates are, the more finance the more CEOs come in and go, ‘I need bottom line. I need Ebitda.’ And the easiest way to get Ebitda is to cut costs, and the easiest way to cut costs is to get leverage with fewer vendors and get them to do more. Now the problem with Ebitda-first thinking is that you’re ignoring the top line. Okay? Great. Save a couple 100 grand, great, save a couple million dollars, but what are the long-term ramifications of that decision? And those decisions don’t show up today. The 200 grand, the 500 grand show up today. But the 20% reduction in your inbound acquisition flow, that shows up 6 months from now, a year from now. And, by the way, it’s really hard to point fingers a year from now, because everyone’s going to go, ‘Well, no, that wasn’t me. There’s 20 other things that we changed,’ right? So this is the conundrum I think that we’re in right now, and no one’s going to feel the pain in the fire for another 6 months. When things start looking a little bit different and fingers start getting pointed.
Sara Vaezy: I agree completely. I think it’s you know, it’s cost of capital, it’s also just pure cash flow. A lot of you know, a lot of systems are still, and we’re in markets where there’s a lot of downward pressure in general. And so the overall economics are driving a lot of the a lot of the decision making. And to Gui’s point, he’s absolutely right, like we’re not going to see it right away, we’ll see the consequences of sort of a consolidation of the tech stack and getting a platform to do a little bit of everything, but nothing super well – you will see the consequences of that in 6 months to a year, and then let’s say you don’t. Let’s say you don’t go that route and say we’re still going to differentiate, and we’re still going to have an experience and access experience, personalization experience, communication experience that’s differentiated. Attribution is very difficult. And so, unless you have a mechanism where you’ve instrumented your overall stack to be able to measure attribution and say, this is the clear reason why the cause, not just like some sort of correlated thing, but the actual cause for ROI, and being able to sort of track it all the way through.
It’s very difficult to kind of stay the course. And so, I just, I agree. But I do think that over time it will become more and more important. The one potential sort of wrinkle in all of that is that one of the reasons why a lot of health systems started to invest in differentiated experiences was because there was there were outside disruptors coming in right? like the retailers were coming in, we thought, you know. Oh, you know, we’re going to see Walgreens and Walmart, and all these disruptors kind of fundamentally changing our business, and we’ve kind of seen what has happened there, which is that they have not been successful. And so they’ve sort of retracted as well. And so there’s this potential like, we might be a little bit too arrogant, and say, Oh, you know, everything is going to be fine, no one’s going to manage to do that. But that’s also risky. Right?
Guillaume de Zwirek: Sorry, you know. The next risky thing is that the FTC. We’re gonna have a new FTC chair, and you know, they’ve been focusing on big tech hospitals. You know, we’re focused a decade before. So I mean, there are real, you know, the competition might just be from across the street now, instead of, you know, create market power in specific regions, which is really what we’ve seen over the last 10,15 years. So there’s – it’s a difficult balancing act.
Pamela Landis: Here’s what I would say, too. I am. I’m kind of I’ve been doing this a long time. I’m kind of tired of sacrificing the patient need and experience for making it easy for us to check a box in our tech stack. Oh, yes, we offer that. It’s not. It’s not consumer grade. It’s not as good as we want it to be, but we have it – at the patient expense. We don’t say that around a radiology system. We don’t say that around a cardiovascular information system, we actually do want the best there. And we do you know, make sure that it meets all the clinical and business requirements. So I think we have to get to a place understanding what these outside pressures are, and basically saying that I don’t believe we, as an industry, have cracked the nut that the tools that we are putting out there – we’re starting to – there are places that they’re doing that like Providence, they’re starting to really do that saying we’re going to make a differentiated experience to make it easier to access, understand and manage care, because right now we’re just providing people access to read about the care they just received. That’s it. If you’re in-patient, we’ll send you your notes. If you go to your doctor’s office, we’ll publish your notes, and here are your labs. But we’re not telling you ‘What do you got to do next? What’s the care plan? How can I help you?’ And those are the things that I think we have to get to. And we have to start to really say that the patient’s needs and requirements are important. They’re just as important, and they will help us grow enough so that our business and our finances can improve, also. I don’t think it’s an either, or that you either do standardization or you do innovation. I think it’s and-and I think you have to do both.
Guillaume de Zwirek: So, Pam, Sara..How can folks like me, right, on the vendor side, technology builders help you make those cases internally, right? Because at the end of the day, the CFO is gonna make you find the cash flow, right? Not going down anytime soon, right, like that is going to be a challenge. And the truth is that when you bundle software you can sell it for cheaper, you got more efficiencies. So it’s very, very hard to compete on cost when you know you are an external company, right? That hasn’t been entrenched in the market for 30 years and has a hundred products, right? So how can we help you make those business cases? How do we find that cash flow? Because I have the same problem internally right, like our investors want cash flow, too. So I’m going, do we really need Slack? Right? Can we just use Google chat? It’s way worse, what is that gonna cost, efficiencies? How can we help? How can we help you make those cases and make sure we’re not shooting ourselves in the foot, you know, 6 months from now, 2 years from now.
Pamela Landis: So I think that, I’ll say this because we use your product at Artera, we actually are making that case. The fact of the matter is, we are able to prove out by using these technologies to communicate with people. We are closing care gaps – boom, qualities right there. And 2, we’re actually growing our patient rates, reducing no shows, and also in closing those care gaps, we’re appealing to them by showing that we are getting more people scheduled for annual wellness, visits, mammograph colorectal screenings and lung cancer screens and doing that.
Actually we have been able to track that through and show the bottom line and show the marketing lift. We show that as a lift – this is what we would have gotten if we did nothing, and now we did this, and here’s the lift, but also we’ve personalized it, and we’ve pulled out, and we’ve shown you know, women who had a who had not scheduled their mammography, we got them in after a simple tax, and something was found, and they were treated early, and they’re better. I mean don’t discount the power of the story of the individual patient that you’ve helped make better. That still appeals to our CFOs and our other leaders in our C-suite, but we actually have to show every single time the value of that how it improved care and grew our patient base.
Guillaume de Zwirek: So the patient story matters at the end of the day. Everyone’s in this. Most people in this industry are in this for the mission to see how much better and how much and more impactful that is, and telling that story to the whole C-suite is helpful. That’s great. Sorry about you. Sorry, Anthony. I’m stealing your job.
Anthony Guerra: No, no, I’m good. Go ahead. I’m listening.
Sara Vaezy: I totally agree with Pam. The patient story matters. She also referenced, you know, like, have the basically the your product instrumented in a way that can measure and quantify attribution, and that’s really critical because it helps us tell the top line storyin a way that, you know, like a lot of folks, a lot of companies say that they’re going to do, They’re going to drive growth. But do they actually? And often we don’t see that growth when we engage with companies, and so having the data-driven sort of quantified view of that is really helpful. And so the product instrumentation to drive and measure attribution is really critical.
The other piece is, you know, we’re increasingly, I think, in healthcare technology sort of fighting this never ending battle of open ecosystem and interoperability. And the more that we can do that the better, because we can actually consolidate the gains associated with an unbundled environment. We’ve never really been able to do that that well, because we’ve had difficulty with data exchange with APIs between our different tech stacks, and so everything sort of operates in silos, and that prevents us from consolidating the gains of the technologies that we’re putting in in many ways right? And so we don’t get the ultimate benefit. And I think that’s 1 of the key ways that without compromising so much on some of the just pure tech stack consolidation, we can actually get a case for having some best of breed, as long as the best of breed talks to other parts of our environment, right? And so I think that’s also a really helpful potential action that folks can take with, you know, in the absence of a really robust, though, of course, we’re making progress. But a really robust, standards-based interoperability environment, we’re getting there. But there’s still a lot of work to be done.
Guillaume de Zwirek: It feels like we need to pledge, like an interrupt pledge. Because the problem is interopt as a word, everyone shares data, but then you get hit by 10 X increases in API fees, you’re wiped out with a single decision – we need to pledge for like free API, Also, I’ll be the 1st person to sign pledge seriously, because, like I am such a believer like, if you can make best agreed, work well together, and integrate well together into workflows, which you can, if folks are willing to open their systems – even when they compete. And some companies have done this very, very well outside healthcare.
Pamela Landis: I often use the analogy of the banks. The banks figured out a way, you know, when they built the ATM. They figured out a way how to exchange that data – you can put your card in any ATM, and it’s going to access your dollars, your balance, or whatever. They decided this is our common set of extension. We’re going to agree, because in the end they put the customer first. And so we’ve got a certain customer, and this is going to help all of us if we do that. And I do think that in our industry, we need to get to that point where I agree with you, I think that these APIs and we’ve got to stop, we have to get to this point where we’re okay with a walled garden of mediocrity around some of the big tech players, and really start to articulate the fact that the fact that I go on my phone and that my cable company digital experience – my cable company – is better than my health system companies, that to me, that means that we have to really start to hold our tech partners also accountable, too. And we do that, too, by talking to them. And, you know, contractually and really saying, these are the expectations we have of you too.
Guillaume de Zwirek: Yeah, and yet the pressure still is ‘CFO wants cash flow, you can do those things for cheaper, They’re not going to be as good, you know, like there’s the Ying and the Yang, right? There in lies the problem.
Sara Vaezy: But if you could say, look like, yes, this may cost more, but we can actually measure better performance. And that essentially, what you’re doing is a cash generator as opposed to a cost center – then that’s you know, no CFO is going to turn that down, they just want the evidence for it, and we don’t have that evidence. Historically, we have not had it.
Guillaume de Zwirek: Do you think, in this kind of changing tides of more bundling or standardization, that CFOs would go at risk on that? because that’s another way, I think a lot of entrepreneurs would be open to navigate this model, which is, I get it. This will cost you this much. We don’t make money if we charge that much, but I’ll tell you what we’ll do it for that price, and we’ll go at risk on the gains. Here’s how we’re going to measure gains – that hasn’t worked, I think, for a lot of entrepreneurs over the last decade, but maybe we’re hitting that turning point where risk is back in fashion, right? Because of just the changing economics.
Sara Vaezy: I think it is. I think it’s coming back in fashion because the economics are changing and what historically folks have just wanted is reliability around budget. But the truth is like reliability around budget doesn’t exist from a macro environmental perspective anymore, either. And so there’s more tolerance for uncertainty and going at risk. If there is a, you know, if the total Ebitda impact is at least to some extent predictable, then you may say, Okay, the cost could go up, but also your top line would go up right? And so, therefore we’re willing to make the investment.
Anthony Guerra: Wow! A lot of stuff there. Really, really great conversation. So a lot of people I talk to are the CIO types, and they might be on the other side of this conversation, right? And they would be more on the standardization side, even though they want to be very innovative. But they would have sort of the other side. You mentioned the CFO, but I wonder if we could lump some of the CIOs in with that and the other side of the conversation? and I’ve actually heard the formula of, If it’s going to give, If staying in suite is going to give you 80% of what you’re looking for, then take the deal because there are savings on the other side. But it sounds like what Sarah, what you and Pam are saying is, that’s not a great deal, because that 20% is going to be where you differentiate and where you make a difference for the patient where you become special. So if you keep forcing me to compromise and take the 80, I can’t do much innovation. I’m not going to be able to do the things and move the needle. Does that make sense, Sara?
Sara Vaezy: It makes sense to me, and I don’t think that we have any platform out there that gets us 80% of the way there. By the way, 80 is not bad. We’re being asked to compromise like 30%. And with real consequences. I’ll give you one example. There is no concept today of a large platform, a large electronic medical record company out there doing true federated identification for the patient. And what I mean by that is, we know you as a patient, and we can connect you to 3rd parties through an identification mechanism that’s like open-id certified and exchange information in a permission-based way that allows for a connecting of dots between your clinical record and then other parties that have some sort of role within your overall health – that does not exist today, and that is not the last 20%. That is the average person out there, any patient, any of us, the average person interacts with 5 different healthcare companies every year. And so if you’re only if you’re being forced into one health system or one electronic medical record and then have another account somewhere else, and another account else you, as a patient, and going back to Pam’s like the patient, is what matters, right? You are having an extremely fragmented experience. And so we are being asked as health systems, like, we’re being forced not to take 80%, we’re being forced to take 20 to 30%. And so that’s just one example. There’s all sorts of other ones as well. But I would say that if we could get closer to 80, that’d be all right. That would be all right.
Guillaume de Zwirek: Sara, you know this because you’re an operator. Pam, you know this because you’re an operator. The CIOs are the purveyors of a garden that needs to stay water and stay, manage, manage cyber risks right? And you know it’s interesting managing those 2 voices, right? Because the operator gets it, and they know it. And the CIO is like, Yeah, but there’s a garden here, and like, I need to install some drip lines for this thing, and like I need to bring in the weed whacker, and like I got to put security guards around it so that the foxes don’t come eat the plants. I don’t know how I came up with this, but you get the idea right then. That balance is like the operator gets it. These carrots taste better. They’re better. They’ll be healthier. They’re going to help us, you know. Get to more farmers markets. And I’m really continuing with this analogy.
Anthony Guerra: I like it, keep going.
Guillaume de Zwirek: And I think that’s the challenge, I do. And frankly, Anthony, the reason I didn’t say CIO is, I didn’t want to alienate 100% of your audience. But it is the CIO and the CFO, right? And I get it. I really do get it. In times of cash constraint, right? Finance, and IT, those are like very, very easy places to find bottom line savings. The problem is you can railroad a lot of operators who are driving business growth without even realizing it, right? So keep going back to the same point. But I resonate so much, Sara.
Pamela Landis: Here’s what I would say. You do not cut your way to financial stability. You have to do. You can trim, but you have to grow your way, and the way to grow your way is to differentiate yourself, and to take care of your customers, and honestly, as difficult as the days ahead of us are going to be, I also believe, and I know this to be true, My experience is CIOs and CFOs and CEOs, they want to innovate, they want better, they know that they’ve got to do better. And so we’ve got to find ways to make it easy for them to sign up for these ideas that we have around improving that experience. You know the CIOs, they want to be seen as innovative and they should be, and they are our partners in this. And we’ve got to show them by doing this, you’re going to get Xyz. You’re going to have a partnership. It’s going to open up this. It’s going to create new patients for us. It’s going to make sure that we retain the patients that we have today by creating an easier and better experience. And that’s the way you do it, because, you know, they actually do want to do the right thing. They’re under pressure. And so we, it’s our job to show them how it can be done.
Anthony Guerra: So Gui had asked you guys, how do you, how can I help you make the case? And then you have to make a case. And I think what’s really interesting. We talk about making the case, and the individual patient story was mentioned as a compelling way to make the case. You’re also gonna have to use some numbers. And I know we talk about hard ROI versus soft ROI. But you’re talking about, especially with the CFO, you’re talking about numbers oriented people. So you want to convince someone who’s numbers oriented, you need to bring in numbers. So let’s talk about how to make the case and how to speak a language. And, Sara, I think it’s really important. You know, I talked about them making the argument that you know you live with 80%. Well, you’re saying it’s 30%. So that’s also part of making the case is explaining, It’s not the 80%. You may think it is. We’re at 30. And here’s why let me list it out for you. So it’s a whole complete picture of making the sale, so to speak. I’d like you guys to talk a little bit more about that in terms of giving your colleagues, who are in similar positions some ideas for how to make the case.
Sara Vaezy: You know, I’ll give a couple of examples, and one is on the just pure access front, like we actually go pretty deep right when we’re making the case one on the access front, for instance, like when it comes to appointment scheduling, we actually show that the goal would be one click scheduling right? Like, go from Google to one-click scheduling. And that is the way that you get the most conversion with electronic medical records today and their ability to book. It takes at least, you know, 5 clicks, perhaps more. And so we actually show if you’re going, If you’re taking 5 to 7 clicks, there’s a 30% drop off every single time right? like it just reduces your conversion, and we can show what the delta is between what we could accomplish via another solution as compared to our electronic record, and we can quantify it. And we can say, this is how much more incremental conversion you can expect and what we’ve seen based on the data. That’s 1 example.
Another example is to say, look like within the context of care gap closure, if it’s not personalized. And if it’s not personalized in terms of like sort of the next best action to take at a specific time that is relevant to you as a patient versus if it’s buried somewhere in your patient portal, this is the delta in the conversion, and how many folks would actually go through that process of pulling down a dropdown menu and searching around and figuring out like, do they? Or don’t they need to go get their immunization or their mammogram, or their colon cancer screening, or whatever the case may be, versus, if it shows up right in their face with a text or in their health system app? We can show the Delta in conversion to Pam’s Point, around Care Gap closure, they can show that patients will get more of those care gaps closed, you know, just like that, data is available. And we can, we can make that case and then take it, you know, kind of if you say, Okay, then if you scale it out. This is what the total impact would be versus the cost. And those are the ways that we’ve done it. And we actually like, even on our marketing efforts, now we are able to show at Prov that based on knowing our users and doing targeted outbound marketing efforts around specific efforts like for specific services, we’re generating a return on marketing investment of attributed incremental of a billion dollars a year. And so we can actually show that, we can demonstrate it. And now our marketing efforts are seen as a cash-generating effort versus a cost center.
Pamela Landis: Yeah. So I think I’m going to Riff a little bit on it. We’re doing the same thing, too, here at Hackensack Meridian Health, and we’re getting more selective of how we’re doing our outreach to people and making sure it’s targeted. One of the things that we learned is we did a lot of research over the summer here in our marketing. And this was really enlightening for us. People didn’t want to hear from health systems, they wanted to hear from their doctors. So now our messaging is coming out from the doctors. So Dr. Smith noticed that you haven’t had your mammogram in the last 18 months. Here’s a link to go right to that to schedule that right there online for you. Here’s the thing that I have said consistently to people in our network – We’ll do these text campaigns. We’ll close these care gaps. But you must have online scheduling enabled. We must enable that because people are going to get a text so they can click to call. Nope, you guys stay in the same form factor, you gotta. And say, and they’re like, Oh, well, that means we’re going to have to standardize and centralize our processes. Well, yes, that does. And that standardization and centralization actually does make sense in the scheduling. When we take over practices and take the scheduling out of the practices and into our patient access center – we just did this for an orthopedics practice this summer, we increased the schedule utilization 50%because we went through. We looked at their visit types. We built decision trees. We redid all of their templates. But that’s how you do. It is to make. That’s where you get the real value around centralization and standardization is in this, the tools that you have, we’re not leveraging. We’re not doing as much as we can in the tools we have today. And so we’re forcing patients to kind of maneuver through all of our oh, well, in this practice they do it this way, and in this doctor’s office, they do it that way. No, no, we’ve got to use those big tools to standardize there, and then put the patient into that experience.
Guillaume de Zwirek: You both brought up amazing points. You know, Sara, around, it’s not really 80%. 30%, I think clicks are a great example of that from a feature functionality standpoint. Yeah, maybe 80% of the features are there. But it’s 5 clicks instead of one. There might be a 60% drop off in forms, right? And that is fundamentally the story we need to sell. I think the point, I think the interesting anecdote I would bring is that I think it would, both of you ladies do this right, but I don’t think every hospital executive does. This is a partnership both ways. I think so often when we think about solving problems, it’s here’s my Rfp respond, check the boxes. And as an entrepreneur, we can’t help you as much if we’re not fully transparent with each other. What are you trying to solve for who else are you considering? Right? Okay, what is your EMR offering? What are they charging? Let’s open up the book, right? And we can be very honest and forthcoming about like, okay, look, we can’t do it at that price. Right? Let’s talk about how we would build a case, for why our solution makes sense. Here are the pros and cons of different solutions. I think I find that maybe 50% of the people I interact with really, really lean into that approach. And we’ll open up and be transparent. And the truth is especially, I’ll say, with founder entrepreneurs, we’re in this for the same reason as you all to make patient lives better. It’s not about the money it’s about, like, you know. For example, I started this company because I was a patient. I was not trying to solve a problem that I fixed. That is the most important thing. If there’s a difference between solving that problem for your patients and making no money and not solving it, I will solve it and make no money right as long as we can pay our bills, and you know, pay the aws fees right? And I think that’s rare, and I think more of that is helpful because we can help each other, and we can get to the right solution. Sometimes the right solution might not be a partnership with a specific company, it might be with somebody else, and like, I think there are more people than folks would think who are willing to make those suggestions and point you in the right direction, because at the end of the day, for me at least, and I think for many folks like me, it is about the patient. It is about the experience it is about making the whole system just run better.
Anthony Guerra: So, okay, let me ask you this. We have the upfront cost of solving, we’re talking about people evaluating these things and saying, I want this product. Okay, it’s outside of the stack. But I want this product because it’s better. It’s going to help me be innovative. Upfront costs are one thing, sort of the cost of the software. We did touch on the idea of interoperability. Sara mentioned the idea that it’s getting better, right? We’re moving, maybe in the right direction. But how would you, what would you say to a CIO who said, ‘That’s really where I have my sticking point is the ongoing interoperability issues.’ I mean, where do you think we are? You think we’re getting in a better position with APIs and fire to where that’s becoming less of an issue? And what would you want from a government or industry standpoint of standards, bodies? Are you happy where things are going? Because obviously the more this is plug and play the better it is for a service like yours, the easier it is for CIOs to say, yes,
Guillaume de Zwirek: Yeah, I think this has been a challenge, at least on the vendor side, it’s been a challenge. And I think there’s ptsd here for everybody in the industry, right? Like, you know, there were massive price increases over the last year, kind of invisible, not invisible, I mean, they were very visible to folks like us, and Sara, Pam, in some cases you have some experience, some of your other vendors tend to, you know, probably 20,30, 40 times increases on API fees, they make solutions untenable. So when we started the company 9 years ago, and we were signing on to marketplaces for APIs for all the various EMRs, and paid a lot of attention to the contracts, and there were clauses like we can remove you from the marketplace at any time without any notice, and we push back very, very hard on those contracts. That’s not fair to our customers. In some cases we got 6 month notices, on some cases we asked for pricing guarantees, In many cases we didn’t get them, and for the source systems where we didn’t get the concessions we needed to feel like we could build long-term sustainable software, we focused on standards that we knew were never going to cost money, HL7, and fire. So there’s a huge onus for me on expanding some of those interoperability rules.
As I mentioned earlier, I am happy to pledge and sign up as a vendor myself, to make our APIs free and accessible and open today, because I think that’s the best way we take the industry forward, including our private APIs, right? As long as we have enough demand for those, and can cover the cost to open up private APIs with the right security mechanisms, Absolutely. I know many, many people just like me who would pledge that. I do think we need to expand HL7, fire. They’re limited. There’s so much we can’t do. Pam talked a lot about scheduling, there are a lot of scheduling APIs we don’t have access to. The way we’ve worked around that is, we try to build the relationships with the EMRs, we’re very transparent about those with our customers and with our vendor partners. We’re advocating for new APIs being released. I’ll name one name because I think it’s helpful. I actually really like the stance that Oracle has taken here. They’ve been very API-first. I know they face a lot of challenges, but they’ve been public about being API-first. I am a partner of theirs, right? I benefit from the partnership that I have with them…them opening up their APIs might not be good for me, but I actually think it’s the right thing for the industry, and I’d like to see more of that candidly across the entire kind of universe of EMR Companies.
Pamela Landis: I also think that that openness, encourages competition and improves products and improves what we end up delivering to our patients. When we build those walls and moats around places, that is a limit to innovation. And I think that that’s- but I do believe that we are making some steps, you know, in the right directions with Techfa and some other things. However, what the next administration is going to do in the direction that they’re going to take at HHS and ONC, I honestly, I do not have that crystal ball. I think it’s going to take the leadership of health systems across the country to make a demand and say, this is our data. This is, these are our patients. This is, we are paying for this service. And this is what we have to collectively do as an industry to make a difference in people’s lives. We cannot say to the tech companies, Oh, it’s okay. Yeah. We’ll sign your agreements. We have to be able to start pushing back on this.
Guillaume de Zwirek: Pam, you triggered a thought in me – one thing that we actually invested in this year, specifically for interopt reasons, is direct integrations into the databases. Right? If you can like. If you can go a layer below the Emr to the database, the snowflake layer we can. We build all the security permissions? It might not be as real time. But you can get those things to the minute. It’s a little bit more technical work upfront. But if you can build a direct database data connection layer, it opens up a universe of possibilities.
Anthony Guerra: Sarah, you want to jump in there?
Sara Vaezy: No, I think both Pam and Gui covered it. I do actually one thing that Pam said is, I think, critical, which is health systems need to put like have the sort of fire in the belly to collectively make those demands on the systems that we are utilizing as infrastructure for medical records and the transactional systems and all that are that are utilizing our data and and then charging us for its access.
Anthony Guerra: All right, very good. We only have a few more minutes here. I do want to get to this, because I think it’s kind of an interesting question. Vendor roadmaps, if you are looking at something outside your normal tech stack, outside your EMRs offerings, and you’re looking at an organization like Artera, you’re going to want to know, well, you’re gonna want to know from both, you’re going to want to know from the core vendor for their particular product in this area, what’s your roadmap? versus the vendor that’s outside of that family, say, what’s your roadmap as you’re trying to evaluate which way to go. Does this come into play in some of your decisions and discussions? Sara?
Sara Vaezy: To a degree, but you know, we’ve been trained to not trust roadmaps because typically the roadmaps that we get from our large partners do not play out in the way that we are told they will play out. So we’ve been trained to sort of ignore them to some extent. But one thing that Gui said earlier does help like I find roadmaps useful when we’re in a co-development type of conversation like being transparent about what problems are we trying to solve, how do we actually factor that into a roadmap of a company that it’s not just like one-directional like them telling us, but rather we’re formulating it together. I do find that useful. And if that kind of relationship with a Solution Company exists, then then it is I think it’s productive and would help inform our decision-making.
Pamela Landis: Yeah, I do. I want to see the roadmap, because I want to see the thinking of the leadership at that vendor partner, and I want to be able to have some influence on it. I’ve actually seen some vendor partners where I’m like, oh, well, there’s a pivot going on in the company, and it’s been like, actually a clue for me to think, okay, maybe this like this partnership doesn’t last. It’s not going to do what I needed to do, going forward in the next few years. But what I really am starting to think is, I’m more interested in the partnership like with Sara said the partnership. So, for instance. how many of us are really tired of hearing these. And I’m going to be a little bit pejorative Silicon Valley companies coming in. And they’re gonna disrupt healthcare. And they’re gonna fix healthcare. They’re gonna fix it all, and they they don’t work with anybody in healthcare, and they’ve never delivered one. You know. They’ve never seen a patient. They’ve talked so they talk to doctors, and they’ve been a patient, but they’ve never actually built a system for this, but they figured out they’ve got a lot of funding, and one of them was you know, a couple of them are out of business because they were trying to, you know, disrupt from outside in. I’m really more interested in having a partnership where people are going to partner with vendor companies who are going to help us disrupt from inside out, who are going to sit side by side with us, learn our problems, learn our needs, understand what we are going through and what we’re trying to solve and help us figure out creative ways to address those needs. That’s what I would like to see more of in the tech industry partner with us to solve from with inside out.
Anthony Guerra: All right. You know what we want to go with a lightning round of final thoughts here, we’ve obviously got people who are innovative, innovative folks want to change healthcare, want to deliver what’s best for the patient. But, as we said, the key here is going to be making the case to some of those who also are going to have a lot of say over whether or not these solutions that we want are purchased and engaged with, and the idea is making the case and getting them on board. And I think a good point was made that they want to be innovative, but they’re working within certain parameters. Right? They get their job. They’ve got certain requirements. So I want to help you help me help you. So Gui wants to help you, and they want you to convince them everybody wants to be convinced. So let’s get a final round of making the case, Pamela. I’m going to start with you.
Pamela Landis: So I think what I do is I show them how this is going to help them grow the business, and that this is actually going to bring in revenue. That’s the 1st thing, and then, you know, bring them in. Bring in the data. But then I actually bring in the story, and a lot of times I am not above, like, you know, talking to board members and having them voice their experiences, and how it could be improved, and some other folks. But also just we do a lot of research, a lot of focus groups. And we listen to our patients and like, let them have their voice and say, this is the problem we need to solve today.
Anthony Guerra: Awesome, Sara, your final thought.
Sara Vaezy: Pam said it. We have to paint the picture of how what we’re going do helps grow the business and helps you know, again consolidate the gains of the work that we’ve already done. Everybody’s doing a lot of good work, but it needs to be brought together to drive growth holistically across the business, and that’s the way to do it.
Anthony Guerra: Gui? We’re gonna give you the last word.
Guillaume de Zwirek: It’s hard to follow these two. But, as you all said, I think a few new thoughts for me is remembering that we’re all human and appealing to the mission right, like fundamentally, I think, the case for value. It’s so easy to debate value, but to make it very clear, and maybe be willing to sacrifice financials, right, and go at risk on financials, so that you know, cost is a non-issue, and if folks don’t agree on value, then you have a different problem. Fundamentally. And then I think the 3rd thing is more of a plea than anything which is, I really think, most people on the vendor side, they share the same fundamental mission, alignment, that every single healthcare executive. Does you know who’s sitting at a big hospital or something today? So open your world right. Let them be part of the solution, and that is the best way that we’re going to get to the best outcomes. And this isn’t going to be the case. You know. There are always bad apples, right in every, in every crop. But I think when you open your universe or vendor partners, and are transparent about solving the problem together, they will partner with you, and get to the right solution, even if it isn’t their solution.
Anthony Guerra: Perfect. Wonderful event today. Regarding continuing education, you can use the final slide in this deck. You’ll get an email when the on demand recording of this event is ready for viewing. If you want to work with us, you can reach out to Nancy Wilcox from our team, go to our website to register for upcoming panels. By the way, I will say, I got an email during this event from a CIO friend of mine at a health system, said this was one of the best events she’s heard this year. So well done, folks, thank you to our panel, Sarah Vaezy, Pamela Landis, and Gui de Zwirek, Artera for sponsoring, and you for attending, and with that everybody have a wonderful day.
