1 00:00:05,155 --> 00:00:07,205 - This is the Becker's Healthcare Podcast, created 2 00:00:07,205 --> 00:00:08,365 by the team of Becker's Healthcare, 3 00:00:08,485 --> 00:00:10,245 a multimedia company devoted to the people 4 00:00:10,265 --> 00:00:11,565 who power us healthcare. 5 00:00:11,835 --> 00:00:14,645 Four new 15 minute episodes are released daily containing 6 00:00:14,845 --> 00:00:16,605 industry news analysis and thought leadership. 7 00:00:16,605 --> 00:00:19,485 From powerful healthcare decision makers Support our show 8 00:00:19,625 --> 00:00:22,445 by leaving it a five star rating and review on Apple Podcast 9 00:00:22,665 --> 00:00:23,925 or other platforms you use. 10 00:00:24,075 --> 00:00:25,885 It's a chance to tell us what you like about the show 11 00:00:25,945 --> 00:00:27,165 and act on your feedback. 12 00:00:27,165 --> 00:00:29,125 Thanks for listening. Now here's the episode. 13 00:00:30,635 --> 00:00:31,725 - This is Chanel Bunger 14 00:00:31,725 --> 00:00:32,925 with the Becker's Healthcare Podcast. 15 00:00:33,265 --> 00:00:36,285 In today, I am recording at the eighth annual Becker's 16 00:00:36,285 --> 00:00:40,045 Health, it Digital Health and RCM conference in Chicago. 17 00:00:40,725 --> 00:00:44,045 I am sitting down with Ethan Booker from MedStar Health. 18 00:00:44,335 --> 00:00:45,885 Ethan, thank you so much for joining me. 19 00:00:45,985 --> 00:00:47,805 Can you take a moment and please introduce yourself 20 00:00:47,805 --> 00:00:49,565 and tell us a a little bit about your background? 21 00:00:49,835 --> 00:00:51,125 - Sure, Chanel, thanks for having me. 22 00:00:51,225 --> 00:00:52,645 So I'm the Chief Medical Officer 23 00:00:52,785 --> 00:00:54,085 for Telehealth for MedStar Health. 24 00:00:54,625 --> 00:00:56,805 Uh, a role I've been in for a few years now 25 00:00:57,025 --> 00:00:58,965 and a role that was new, uh, not a role 26 00:00:58,965 --> 00:01:00,605 that existed a couple of years ago 27 00:01:00,805 --> 00:01:03,965 'cause who needed ACMO for telehealth, uh, in 2019? 28 00:01:04,505 --> 00:01:07,365 Um, so, uh, I uh, sort of evolved into 29 00:01:07,365 --> 00:01:10,005 that role from an innovation perspective, uh, 30 00:01:10,005 --> 00:01:12,885 and still sit within MedStar's Institute for Innovation, uh, 31 00:01:12,885 --> 00:01:14,965 where I have a responsibility not only 32 00:01:15,065 --> 00:01:17,685 for maintaining the processes where we, uh, 33 00:01:17,685 --> 00:01:20,245 deliver telehealth, um, including vendor relationships 34 00:01:20,265 --> 00:01:23,205 and that kind of thing, but also thinking about what's next 35 00:01:23,225 --> 00:01:25,725 and what's after that, uh, with an innovation lens. 36 00:01:26,065 --> 00:01:27,445 Uh, I'm an emergency physician. 37 00:01:27,625 --> 00:01:30,565 Uh, I have, I took my, my first job out 38 00:01:30,565 --> 00:01:33,565 of residency in 2005 in the middle of Washington DC 39 00:01:33,565 --> 00:01:35,405 and I still work in that emergency department. 40 00:01:35,785 --> 00:01:39,405 Uh, and the person who hired me, uh, in 2005 is still kind 41 00:01:39,405 --> 00:01:40,485 of, sort of my boss 42 00:01:40,485 --> 00:01:43,845 because the founding executive of the MedStar Institute 43 00:01:43,845 --> 00:01:45,445 for Innovation, where I still am was that 44 00:01:45,635 --> 00:01:48,325 that department chair who hired me, uh, back then. 45 00:01:49,075 --> 00:01:51,485 - Perfect. And what is your growth strategy 46 00:01:51,505 --> 00:01:52,805 for the next year or two? 47 00:01:53,665 --> 00:01:56,155 - Well, I think we, you know, there's, there's sort 48 00:01:56,155 --> 00:01:58,355 of a lot in the question of what our growth strategy is. 49 00:01:58,595 --> 00:02:01,035 'cause there's the sort of growth strategy of MedStar Health 50 00:02:01,095 --> 00:02:02,355 as a whole, uh, 51 00:02:02,365 --> 00:02:05,435 which is aligned across an enormous amount of activities. 52 00:02:05,775 --> 00:02:07,835 Uh, and then there's the growth strategy of, of say, 53 00:02:07,925 --> 00:02:11,355 innovation, uh, which has a number of threads. 54 00:02:11,515 --> 00:02:13,675 And then with the area of responsibility that I have, 55 00:02:13,675 --> 00:02:16,475 which is telehealth, um, certainly for the time being 56 00:02:16,775 --> 00:02:18,595 and what, what strategies we have there. 57 00:02:18,595 --> 00:02:20,795 Fortunately, those three things are interdigitated 58 00:02:20,795 --> 00:02:23,035 because the overall strategies 59 00:02:23,035 --> 00:02:25,115 of MedStar health include improving access 60 00:02:25,115 --> 00:02:26,355 and experience for our patients. 61 00:02:26,415 --> 00:02:28,755 And we think, we think the digital journey 62 00:02:28,815 --> 00:02:31,995 and telehealth obviously dovetail neatly with the need 63 00:02:31,995 --> 00:02:33,035 to improve access. 64 00:02:33,535 --> 00:02:35,675 Um, telehealth also gives us opportunities for 65 00:02:35,855 --> 00:02:38,835 or for efficiency in our workforce, which, 66 00:02:38,855 --> 00:02:42,275 if deployed correctly can mean financial stability, uh, 67 00:02:42,275 --> 00:02:43,995 but also improvement of the experience 68 00:02:44,015 --> 00:02:45,595 of work for that workforce. 69 00:02:46,175 --> 00:02:48,275 Uh, which is really an critical part of making sure 70 00:02:48,475 --> 00:02:51,715 that we're successful, is that we find and hire 71 00:02:52,335 --> 00:02:54,835 and, uh, provide the environment for 72 00:02:54,895 --> 00:02:56,195 and keep the best talent. 73 00:02:56,655 --> 00:02:58,475 Um, and so those are the, the things 74 00:02:58,475 --> 00:03:00,325 that we think are key to that strategy. 75 00:03:00,865 --> 00:03:02,685 Um, but the access components 76 00:03:02,785 --> 00:03:06,325 of them probably are big drivers of a lot of that, right? 77 00:03:06,345 --> 00:03:08,485 And, and that access needs to be comprehensive, 78 00:03:09,145 --> 00:03:11,125 not just about sort of smoothing the process 79 00:03:11,795 --> 00:03:14,045 from which patients looking for a particular type 80 00:03:14,045 --> 00:03:16,845 of appointment can schedule that appointment and get to it. 81 00:03:16,865 --> 00:03:19,365 But also really a comprehensive thought about 82 00:03:19,365 --> 00:03:20,525 access throughout the journey. 83 00:03:20,525 --> 00:03:23,325 Meaning how do you, if you're in one 84 00:03:23,325 --> 00:03:26,525 of our smaller hospitals, access the resources 85 00:03:26,525 --> 00:03:29,125 of a place like Georgetown that has, you know, 86 00:03:29,125 --> 00:03:31,845 world-class liver transplant specialists to be able 87 00:03:31,845 --> 00:03:33,205 to deliver the consultative care 88 00:03:33,205 --> 00:03:36,405 that a patient might need out in southern Maryland where 89 00:03:36,635 --> 00:03:38,725 that expert is not physically available. 90 00:03:38,945 --> 00:03:42,085 And so access for us is not just about the appointment, 91 00:03:42,085 --> 00:03:45,445 but it's also about really the access to the totality of 92 00:03:45,445 --> 00:03:47,285 what services are available to a patient. 93 00:03:48,065 --> 00:03:49,645 You know, obviously that access strategy, 94 00:03:49,665 --> 00:03:52,285 if it's gonna be digitized like that comes with a lot 95 00:03:52,305 --> 00:03:54,685 of process change, um, 96 00:03:55,105 --> 00:03:58,165 and understanding how our technology is gonna support that, 97 00:03:58,545 --> 00:04:00,485 um, and, and maintain the stability 98 00:04:00,905 --> 00:04:02,605 and reliability that we need it to have. 99 00:04:03,345 --> 00:04:05,365 - Got it. Thank you so much for walking us through that 100 00:04:05,585 --> 00:04:06,965 and moving forward. 101 00:04:07,145 --> 00:04:08,645 Can you tell us about the most exciting 102 00:04:08,665 --> 00:04:10,245 and impactful initiative 103 00:04:10,345 --> 00:04:11,925 or project that you are working on right now? 104 00:04:12,795 --> 00:04:14,485 - Yeah, I think there are a couple of really interesting 105 00:04:14,485 --> 00:04:16,845 projects and initiatives that we have going on right now, 106 00:04:17,385 --> 00:04:19,485 um, that are really down that thread that I talked about, 107 00:04:19,485 --> 00:04:22,765 about, about access, um, and improving the experience. 108 00:04:22,945 --> 00:04:25,565 So one of the models, um, that we've been helpful 109 00:04:25,915 --> 00:04:27,645 with from the MedStar Institute for Innovation 110 00:04:27,645 --> 00:04:30,005 and kind of implementing within our medical group is 111 00:04:30,005 --> 00:04:31,685 something called the connected care model. 112 00:04:32,105 --> 00:04:34,565 Uh, obviously connected care is a term of art, um, 113 00:04:34,635 --> 00:04:36,045 that means, means something, 114 00:04:36,045 --> 00:04:38,885 but the way that we've deployed this particular model is 115 00:04:39,225 --> 00:04:42,605 rather than asking our primary care doctors to kind 116 00:04:42,605 --> 00:04:44,325 of work harder at access 117 00:04:44,785 --> 00:04:47,725 or even really to adopt a whole bunch of new tools, um, 118 00:04:47,815 --> 00:04:50,485 we've actually broadened workforce 119 00:04:50,745 --> 00:04:52,725 and we have a group of nurse practitioners 120 00:04:52,725 --> 00:04:56,205 and MAs who work exclusively remotely to manage some 121 00:04:56,205 --> 00:04:58,445 of the aspects about primary care specifically 122 00:04:58,445 --> 00:04:59,485 that we think we can improve. 123 00:05:00,145 --> 00:05:01,965 So, um, what these nurse practitioners 124 00:05:01,965 --> 00:05:03,885 and MAs do is they actually provide same day 125 00:05:03,885 --> 00:05:06,765 and next day access via telehealth appointments for patients 126 00:05:06,765 --> 00:05:08,525 that are coming into those practices. 127 00:05:08,945 --> 00:05:10,645 One of the things we heard from both doctors 128 00:05:10,905 --> 00:05:14,685 and patients was, I can't get in to see my doctor as quickly 129 00:05:14,745 --> 00:05:15,845 as I would like to be seen. 130 00:05:16,225 --> 00:05:17,925 Um, and so to try to address that problem, 131 00:05:18,025 --> 00:05:19,485 we opened up telehealth appointments, 132 00:05:19,945 --> 00:05:22,885 but there's not access in the native way in in doing that. 133 00:05:22,885 --> 00:05:24,965 And so we really needed to create new capacity. 134 00:05:25,705 --> 00:05:27,845 Um, another part of the kind 135 00:05:27,845 --> 00:05:31,325 of primary care experience right now, which can be um, 136 00:05:31,325 --> 00:05:32,765 really frustrating on both patient 137 00:05:33,025 --> 00:05:36,485 and provider side is the asynchronous interactions 138 00:05:36,485 --> 00:05:38,925 that patients want through portal messaging. 139 00:05:39,305 --> 00:05:41,685 Um, and that really are kind of difficult 140 00:05:41,685 --> 00:05:42,885 to manage for a host of reasons. 141 00:05:42,915 --> 00:05:46,285 Some of that is actually the technology could be better, um, 142 00:05:46,465 --> 00:05:48,045 in terms of how it is that we engage 143 00:05:48,045 --> 00:05:49,365 with patients asynchronously, 144 00:05:49,545 --> 00:05:52,845 but also just the sheer volume right in in my health system. 145 00:05:53,345 --> 00:05:56,525 Uh, in the calendar year, uh, 2022, 146 00:05:56,525 --> 00:05:59,645 there were were 280,000 messages from patients 147 00:05:59,645 --> 00:06:01,645 to their primary care doctors around medical needs. 148 00:06:01,905 --> 00:06:04,205 Oh. Um, which is, you know, an enormous number. 149 00:06:04,705 --> 00:06:07,565 Um, and then there's maybe half a million requests 150 00:06:07,625 --> 00:06:08,845 for medication management 151 00:06:08,845 --> 00:06:10,765 and medication refills, renewals, that kind of thing. 152 00:06:10,985 --> 00:06:14,325 So that volume of work, which we knew needed to be done 153 00:06:14,385 --> 00:06:15,725 to meet the access needs, 154 00:06:16,065 --> 00:06:17,285 but really wasn't the work that 155 00:06:17,285 --> 00:06:19,285 that our primary care doctors had the capacity 156 00:06:19,285 --> 00:06:21,205 to do was shifted to the group 157 00:06:21,205 --> 00:06:22,365 that we're talking about here. 158 00:06:23,025 --> 00:06:28,005 So that, that work shifting is not just about sort 159 00:06:28,005 --> 00:06:30,725 of making that suffering to a different workforce, 160 00:06:30,905 --> 00:06:32,645 but also to an opportunity 161 00:06:32,645 --> 00:06:34,605 to centralize it and standardize it. 162 00:06:34,905 --> 00:06:37,045 Um, which allowed us to insert some automation. 163 00:06:37,145 --> 00:06:39,325 So for instance, the prescription refill process 164 00:06:39,905 --> 00:06:43,845 is now semi-automated that allows that group of providers 165 00:06:43,945 --> 00:06:46,045 to get through the requests 166 00:06:46,065 --> 00:06:48,765 for refills about five times faster, 167 00:06:49,265 --> 00:06:51,925 and with a considerably larger percentage of them 168 00:06:52,585 --> 00:06:55,085 really scraping through the medical record effectively 169 00:06:55,105 --> 00:06:57,885 to look for quality and safety issues that might cause them 170 00:06:57,885 --> 00:06:59,365 to change the prescribing practice. 171 00:06:59,785 --> 00:07:01,965 And so that workforce and workflow 172 00:07:02,025 --> 00:07:03,365 and technology innovation 173 00:07:03,385 --> 00:07:06,765 of connected care now has 15 nurse practitioners 174 00:07:06,765 --> 00:07:10,805 and MAs in payers supporting our approximately 350 175 00:07:10,885 --> 00:07:12,125 primary care providers. 176 00:07:12,555 --> 00:07:15,365 They spend about half of their time in revenue generating 177 00:07:15,365 --> 00:07:19,085 activities like, uh, fee for service telehealth appointments 178 00:07:19,385 --> 00:07:20,525 and about half of their time. 179 00:07:20,585 --> 00:07:22,885 And some of these things that create real value 180 00:07:23,145 --> 00:07:25,885 but may not necessarily drive forward at the finances. 181 00:07:26,265 --> 00:07:28,285 But by configuring them this way, 182 00:07:28,965 --> 00:07:31,325 a nurse practitioner workforce that's working remotely, 183 00:07:31,735 --> 00:07:33,485 we're actually able to generate the revenue 184 00:07:33,675 --> 00:07:35,525 that makes the whole thing stay in the black 185 00:07:35,825 --> 00:07:38,525 and solve these important issues that create access 186 00:07:38,545 --> 00:07:41,085 for patients, create a better pa patient experience, 187 00:07:41,545 --> 00:07:44,565 and also take about two hours of work per day 188 00:07:44,705 --> 00:07:45,925 and prescription refills 189 00:07:46,185 --> 00:07:47,845 and portal message management off 190 00:07:47,845 --> 00:07:49,085 of the primary care doctors. 191 00:07:49,465 --> 00:07:51,485 And so that innovation's been really downhill 192 00:07:51,825 --> 00:07:53,085 for those primary care doctors. 193 00:07:53,275 --> 00:07:57,085 When they say, say we're gonna have a new program, they say, 194 00:07:57,225 --> 00:07:58,845 oh no, not another new program. 195 00:07:59,465 --> 00:08:02,205 Uh, and we say, this program is gonna just take all 196 00:08:02,205 --> 00:08:04,805 of those prescriptions that, that are keeping you, um, 197 00:08:04,805 --> 00:08:06,285 working between 8:00 PM 198 00:08:06,305 --> 00:08:08,245 and 10:00 PM We're just gonna take those. 199 00:08:08,705 --> 00:08:11,565 And, and so the answer is great . Yeah, happy to. 200 00:08:11,625 --> 00:08:13,525 And I, I think that's a good example 201 00:08:13,625 --> 00:08:15,805 of not just inserting new innovation 202 00:08:15,825 --> 00:08:17,725 and kind of aligning our strategy, 203 00:08:17,865 --> 00:08:19,685 but being really thoughtful about what it is 204 00:08:19,685 --> 00:08:23,085 that would allow us to, to overcome any barriers to, 205 00:08:23,225 --> 00:08:24,525 to putting that in place. 206 00:08:24,525 --> 00:08:28,325 Because again, that innovation energy was downhill 207 00:08:28,785 --> 00:08:31,565 as opposed to having to overcome some hurdle to get 208 00:08:31,565 --> 00:08:33,085 to some promise new frontier. 209 00:08:33,905 --> 00:08:35,485 - Got it. Well, Dr. Booker, 210 00:08:35,485 --> 00:08:37,765 this has been an enjoyable conversation, but 211 00:08:37,765 --> 00:08:39,445 before I let you go, I have one more question. 212 00:08:39,755 --> 00:08:42,165 What is the most important thing healthcare executives 213 00:08:42,165 --> 00:08:43,845 should do now to make sure 214 00:08:43,845 --> 00:08:46,285 that their organizations are successful in the future? 215 00:08:47,235 --> 00:08:49,215 - You know, I think that there are, there are 216 00:08:49,355 --> 00:08:52,495 so many competing priorities now for our health systems 217 00:08:52,595 --> 00:08:53,735 as we think about what's, 218 00:08:53,755 --> 00:08:55,820 what's gonna happen in the next, next three to five years. 219 00:08:56,305 --> 00:08:58,725 Um, but when I look at our organization now, 220 00:08:58,885 --> 00:09:01,565 I have an expectation that our, our organization three 221 00:09:01,565 --> 00:09:04,365 to five years from now is gonna have some of the very same 222 00:09:04,975 --> 00:09:07,765 areas of importance that it has historically had. 223 00:09:08,055 --> 00:09:09,525 Healthcare is a 224 00:09:10,435 --> 00:09:13,165 primarily about your labor workforce, right? 225 00:09:13,305 --> 00:09:16,885 And so the expense of labor where we put our dollars 226 00:09:17,065 --> 00:09:19,165 as a health system is primarily into our people. 227 00:09:19,625 --> 00:09:21,205 And I think that's still gonna be the case. 228 00:09:21,425 --> 00:09:23,845 And so much of what we talk about in innovation 229 00:09:24,545 --> 00:09:28,325 is about technology, about automation, about ai, about 230 00:09:28,345 --> 00:09:30,045 how we can sort of do more with less. 231 00:09:30,345 --> 00:09:31,885 And all of that is absolutely true. 232 00:09:31,985 --> 00:09:33,925 And I think there's an opportunity for us 233 00:09:33,945 --> 00:09:37,325 to use these automations, ai, all these kinds of things 234 00:09:37,355 --> 00:09:41,125 that allow patients to navigate their care better, allow us 235 00:09:41,125 --> 00:09:42,965 to manage our workforce more effectively. 236 00:09:43,465 --> 00:09:45,645 Um, but what that means is that those things 237 00:09:45,645 --> 00:09:47,325 that are replaced by automation, there's things 238 00:09:47,325 --> 00:09:50,885 that are replaced by ai, there's still gonna be an output 239 00:09:50,885 --> 00:09:53,485 that's gonna require humans to do that hard work. 240 00:09:53,545 --> 00:09:54,885 And the work that they're gonna need 241 00:09:54,885 --> 00:09:58,845 to do is actually gonna be no longer the easiest of things. 242 00:09:59,205 --> 00:10:00,885 'cause the idea is to automate that out. 243 00:10:01,305 --> 00:10:04,365 And so what I think is likely to happen is that, 244 00:10:04,365 --> 00:10:06,325 that we're gonna need to have the best talent 245 00:10:06,945 --> 00:10:10,445 and as we migrate our healthcare system into a more 246 00:10:10,445 --> 00:10:12,685 automated, uh, a more intelligent, 247 00:10:13,245 --> 00:10:15,525 a more seamless digital experience for patients 248 00:10:15,525 --> 00:10:16,765 that can navigate it themselves 249 00:10:16,785 --> 00:10:19,605 and don't need a lot of the labor that's currently doing it, 250 00:10:19,625 --> 00:10:22,245 the labor that is engaged is gonna have 251 00:10:22,245 --> 00:10:24,445 to be really well supported, really well trained. 252 00:10:24,985 --> 00:10:28,005 Um, and we're probably gonna have to pay them more 253 00:10:28,145 --> 00:10:29,845 as we think about what that workforce is. 254 00:10:29,985 --> 00:10:33,965 And so I think the, this challenge of today is workforce, 255 00:10:34,195 --> 00:10:35,365 it's nursing shortages. 256 00:10:35,675 --> 00:10:38,085 It's um, having enough psychiatrists, 257 00:10:38,115 --> 00:10:40,165 it's having enough behavioral care specialists. 258 00:10:40,585 --> 00:10:42,805 The challenge of tomorrow is still workforce. 259 00:10:43,085 --> 00:10:45,285 I think the challenges are slightly different 260 00:10:45,625 --> 00:10:46,725 and how we think about them, 261 00:10:46,985 --> 00:10:48,205 but I still think it's about people. 262 00:10:48,665 --> 00:10:50,165 - Got it. That makes a lot of sense. 263 00:10:50,425 --> 00:10:52,285 And Dr. Booker, I wanna thank you once again 264 00:10:52,285 --> 00:10:54,405 for joining me today on the Becker's Healthcare Podcast. 265 00:10:54,755 --> 00:10:56,445 This was an insightful conversation. 266 00:10:56,645 --> 00:10:57,725 I appreciate it. Thank you. 267 00:10:57,725 --> 00:11:02,045 - Thanks a lot. - It's so important 268 00:11:02,045 --> 00:11:04,845 for leaders at the top of organizations to keep learning, 269 00:11:04,995 --> 00:11:06,645 stay sharp, grow their networks, 270 00:11:07,075 --> 00:11:09,525 help our audience better do this in a more simplified, 271 00:11:09,525 --> 00:11:11,205 personalized, and meaningful way. 272 00:11:11,765 --> 00:11:14,245 Becker's Healthcare has launched my bhc, 273 00:11:14,715 --> 00:11:16,725 it's your trusted Becker's healthcare experience 274 00:11:16,725 --> 00:11:18,445 and more with content, connections, 275 00:11:18,445 --> 00:11:19,805 events and learning opportunities. 276 00:11:20,515 --> 00:11:21,685 Join the community free 277 00:11:21,685 --> 00:11:26,605 of charge@www.my dot becker's hospital review.com 278 00:11:26,705 --> 00:11:27,525 and we'll see you there.