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- This is Chanel Bunger
with the Becker's Healthcare Podcast.
In today, I am recording at the eighth annual Becker's
Health, it Digital Health and RCM conference in Chicago.
I am sitting down with Ethan Booker from MedStar Health.
Ethan, thank you so much for joining me.
Can you take a moment and please introduce yourself
and tell us a a little bit about your background?
- Sure, Chanel, thanks for having me.
So I'm the Chief Medical Officer
for Telehealth for MedStar Health.
Uh, a role I've been in for a few years now
and a role that was new, uh, not a role
that existed a couple of years ago
'cause who needed ACMO for telehealth, uh, in 2019?
Um, so, uh, I uh, sort of evolved into
that role from an innovation perspective, uh,
and still sit within MedStar's Institute for Innovation, uh,
where I have a responsibility not only
for maintaining the processes where we, uh,
deliver telehealth, um, including vendor relationships
and that kind of thing, but also thinking about what's next
and what's after that, uh, with an innovation lens.
Uh, I'm an emergency physician.
Uh, I have, I took my, my first job out
of residency in 2005 in the middle of Washington DC
and I still work in that emergency department.
Uh, and the person who hired me, uh, in 2005 is still kind
of, sort of my boss
because the founding executive of the MedStar Institute
for Innovation, where I still am was that
that department chair who hired me, uh, back then.
- Perfect. And what is your growth strategy
for the next year or two?
- Well, I think we, you know, there's, there's sort
of a lot in the question of what our growth strategy is.
'cause there's the sort of growth strategy of MedStar Health
as a whole, uh,
which is aligned across an enormous amount of activities.
Uh, and then there's the growth strategy of, of say,
innovation, uh, which has a number of threads.
And then with the area of responsibility that I have,
which is telehealth, um, certainly for the time being
and what, what strategies we have there.
Fortunately, those three things are interdigitated
because the overall strategies
of MedStar health include improving access
and experience for our patients.
And we think, we think the digital journey
and telehealth obviously dovetail neatly with the need
to improve access.
Um, telehealth also gives us opportunities for
or for efficiency in our workforce, which,
if deployed correctly can mean financial stability, uh,
but also improvement of the experience
of work for that workforce.
Uh, which is really an critical part of making sure
that we're successful, is that we find and hire
and, uh, provide the environment for
and keep the best talent.
Um, and so those are the, the things
that we think are key to that strategy.
Um, but the access components
of them probably are big drivers of a lot of that, right?
And, and that access needs to be comprehensive,
not just about sort of smoothing the process
from which patients looking for a particular type
of appointment can schedule that appointment and get to it.
But also really a comprehensive thought about
access throughout the journey.
Meaning how do you, if you're in one
of our smaller hospitals, access the resources
of a place like Georgetown that has, you know,
world-class liver transplant specialists to be able
to deliver the consultative care
that a patient might need out in southern Maryland where
that expert is not physically available.
And so access for us is not just about the appointment,
but it's also about really the access to the totality of
what services are available to a patient.
You know, obviously that access strategy,
if it's gonna be digitized like that comes with a lot
of process change, um,
and understanding how our technology is gonna support that,
um, and, and maintain the stability
and reliability that we need it to have.
- Got it. Thank you so much for walking us through that
and moving forward.
Can you tell us about the most exciting
and impactful initiative
or project that you are working on right now?
- Yeah, I think there are a couple of really interesting
projects and initiatives that we have going on right now,
um, that are really down that thread that I talked about,
about, about access, um, and improving the experience.
So one of the models, um, that we've been helpful
with from the MedStar Institute for Innovation
and kind of implementing within our medical group is
something called the connected care model.
Uh, obviously connected care is a term of art, um,
that means, means something,
but the way that we've deployed this particular model is
rather than asking our primary care doctors to kind
of work harder at access
or even really to adopt a whole bunch of new tools, um,
we've actually broadened workforce
and we have a group of nurse practitioners
and MAs who work exclusively remotely to manage some
of the aspects about primary care specifically
that we think we can improve.
So, um, what these nurse practitioners
and MAs do is they actually provide same day
and next day access via telehealth appointments for patients
that are coming into those practices.
One of the things we heard from both doctors
and patients was, I can't get in to see my doctor as quickly
as I would like to be seen.
Um, and so to try to address that problem,
we opened up telehealth appointments,
but there's not access in the native way in in doing that.
And so we really needed to create new capacity.
Um, another part of the kind
of primary care experience right now, which can be um,
really frustrating on both patient
and provider side is the asynchronous interactions
that patients want through portal messaging.
Um, and that really are kind of difficult
to manage for a host of reasons.
Some of that is actually the technology could be better, um,
in terms of how it is that we engage
with patients asynchronously,
but also just the sheer volume right in in my health system.
Uh, in the calendar year, uh, 2022,
there were were 280,000 messages from patients
to their primary care doctors around medical needs.
Oh. Um, which is, you know, an enormous number.
Um, and then there's maybe half a million requests
for medication management
and medication refills, renewals, that kind of thing.
So that volume of work, which we knew needed to be done
to meet the access needs,
but really wasn't the work that
that our primary care doctors had the capacity
to do was shifted to the group
that we're talking about here.
So that, that work shifting is not just about sort
of making that suffering to a different workforce,
but also to an opportunity
to centralize it and standardize it.
Um, which allowed us to insert some automation.
So for instance, the prescription refill process
is now semi-automated that allows that group of providers
to get through the requests
for refills about five times faster,
and with a considerably larger percentage of them
really scraping through the medical record effectively
to look for quality and safety issues that might cause them
to change the prescribing practice.
And so that workforce and workflow
and technology innovation
of connected care now has 15 nurse practitioners
and MAs in payers supporting our approximately 350
primary care providers.
They spend about half of their time in revenue generating
activities like, uh, fee for service telehealth appointments
and about half of their time.
And some of these things that create real value
but may not necessarily drive forward at the finances.
But by configuring them this way,
a nurse practitioner workforce that's working remotely,
we're actually able to generate the revenue
that makes the whole thing stay in the black
and solve these important issues that create access
for patients, create a better pa patient experience,
and also take about two hours of work per day
and prescription refills
and portal message management off
of the primary care doctors.
And so that innovation's been really downhill
for those primary care doctors.
When they say, say we're gonna have a new program, they say,
oh no, not another new program.
Uh, and we say, this program is gonna just take all
of those prescriptions that, that are keeping you, um,
working between 8:00 PM
and 10:00 PM We're just gonna take those.
And, and so the answer is great . Yeah, happy to.
And I, I think that's a good example
of not just inserting new innovation
and kind of aligning our strategy,
but being really thoughtful about what it is
that would allow us to, to overcome any barriers to,
to putting that in place.
Because again, that innovation energy was downhill
as opposed to having to overcome some hurdle to get
to some promise new frontier.
- Got it. Well, Dr. Booker,
this has been an enjoyable conversation, but
before I let you go, I have one more question.
What is the most important thing healthcare executives
should do now to make sure
that their organizations are successful in the future?
- You know, I think that there are, there are
so many competing priorities now for our health systems
as we think about what's,
what's gonna happen in the next, next three to five years.
Um, but when I look at our organization now,
I have an expectation that our, our organization three
to five years from now is gonna have some of the very same
areas of importance that it has historically had.
Healthcare is a
primarily about your labor workforce, right?
And so the expense of labor where we put our dollars
as a health system is primarily into our people.
And I think that's still gonna be the case.
And so much of what we talk about in innovation
is about technology, about automation, about ai, about
how we can sort of do more with less.
And all of that is absolutely true.
And I think there's an opportunity for us
to use these automations, ai, all these kinds of things
that allow patients to navigate their care better, allow us
to manage our workforce more effectively.
Um, but what that means is that those things
that are replaced by automation, there's things
that are replaced by ai, there's still gonna be an output
that's gonna require humans to do that hard work.
And the work that they're gonna need
to do is actually gonna be no longer the easiest of things.
'cause the idea is to automate that out.
And so what I think is likely to happen is that,
that we're gonna need to have the best talent
and as we migrate our healthcare system into a more
automated, uh, a more intelligent,
a more seamless digital experience for patients
that can navigate it themselves
and don't need a lot of the labor that's currently doing it,
the labor that is engaged is gonna have
to be really well supported, really well trained.
Um, and we're probably gonna have to pay them more
as we think about what that workforce is.
And so I think the, this challenge of today is workforce,
it's nursing shortages.
It's um, having enough psychiatrists,
it's having enough behavioral care specialists.
The challenge of tomorrow is still workforce.
I think the challenges are slightly different
and how we think about them,
but I still think it's about people.
- Got it. That makes a lot of sense.
And Dr. Booker, I wanna thank you once again
for joining me today on the Becker's Healthcare Podcast.
This was an insightful conversation.
I appreciate it. Thank you.
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