- Becker Healthcare Podcast made for the people
who power US healthcare.
I'm Molly Gamble. Becker is thrilled today
to spend some time with Dr.
Ashish Barad, chief Digital Information Officer
with Allegheny Health Network.
Dr. Barad, thanks so much
for being our guest on the podcast today.
How are you? And where does the podcast find you?
- Thanks for having me, Molly.
I am excited to be on the podcast, and I am doing well.
I am in the city of Bridges, so Pittsburgh, Pennsylvania,
um, has a lot of bridges.
And being that I'm from Texas, um, it's a,
it's a new venture, but it's a fantastic town.
- Yeah. Well, for listeners who could use a,
a refresh on Allegheny Health Network
and based in Pittsburgh,
can you share a few other key facts about the system
and organization for our listeners just to get reacquainted?
- Yeah, happy to. So, yeah, Allegheny Health Network,
as you said, based outta Pittsburgh, Pennsylvania,
and Western Pennsylvania,
and is a 14 hospital system, about 2,500 beds,
uh, 22,000 employees and about 3000, uh, physicians, uh,
and other providers.
And, um, we serve around 29 counties here, uh,
in some portions of New York, Ohio, West Virginia,
about 5 billion in annual revenue.
Um, and we are owned by Highmark Health, uh, which is, um,
obviously a very large insurance company.
Uh, I believe it's the fourth,
the fifth largest Blue Cross Blue Shield, uh, in the US
and serves, uh, roughly five states,
but also has national members.
So it's just a, a unique aspect of
what makes a HNA bit different.
- Mm-Hmm. , you mentioned coming up from Texas.
I, I should let listeners know,
congratulations on passing the one year mark in your role
as CDIO.
You've been with Allegheny Health Network,
but you took on a new role, expanded to include the CIO hat
to your CDO role in January of 2023.
What have been the biggest lessons you've learned in this
time, in this past year,
ways you've grown throughout this past
year? What comes to mind?
- Yeah, I appreciate the question.
So thank you for the, for the congrats.
It's, it's been, um, really nice to, uh, kind
of own the quote unquote the, the full tech stack.
And I think, you know, to, as far as the lessons learned,
I think a few, you know, I came from a very,
very large health system in Texas,
and, um, I'm sure everybody liked each other
and everybody was good friends,
but you could only imagine
that the Chief Digital officer's roadmap may not always
align with the CMIO's roadmap, may not always align
with the CIO's roadmap and many others.
So, um, the fact that I wear all those hats, so, um,
I'm in charge of the informatics shop as well with Epic, um,
and the data shop as well as virtual help.
So I do, uh, wear a lot of hats, um,
depending on the meeting I go to,
probably from 30 minutes to 30 minutes.
But all of that really allows us to have one roadmap
that's very succinct
and has a kind of clear trajectory, vision, you know,
roadmap to it.
So that, that has really been, um, very helpful,
uh, to really be able to create impact.
And I guess that's the other point that I'll, uh,
answer your question with, which is, you know,
lessons learned in this role,
not just at a Allegheny Health Network,
but just in the industry, is, you know,
it's not just about disrupting healthcare.
I know we talk a lot about disrupting healthcare,
and trust me, I'm, I'm a big believer on the fact
that it needs to be disrupted, um, on some accounts.
But, you know, I see a lot of disruptors.
I don't always see a lot of factors.
And what I mean, it's just, it's
sometimes it is about the impact.
And I think we need to be very clear, um, about
what impact we're trying to achieve.
You know, many people will say, be very clear about
what problem you're trying to solve.
And I think we say it a lot,
but, um, I think many, many times, uh, we,
we get over our skis at times trying
to disrupt the process without really understanding
what impact we're trying to achieve.
So that's probably been one
of the biggest lessons in the last couple of years here.
Um, and trying to focus the team
and focus everybody's efforts on the impact.
- Mm-Hmm. . And then, I mean, I appreciate
that a lot because I remember, uh, probably
around 10 years ago, the slogan, oh, it was, what was it?
Something fast, fail fast.
This is gonna come more easily to you. Oh, yeah. I,
- Right.
I mean, I, the fail fast. Uh, I mean, I don't know.
You know, I mean, I, we, uh, so I,
before this for the listeners, you know,
I spent 11 years at Baylor Scott
and y um, so again, the the larger health system that I, um,
that I alluded to earlier, and gosh, I learned so much.
I called it my, um, you know, second fellowship.
Um, so I am a pediatric gastroenterologist.
I still practice, but it,
it was such a fabulous learning experience,
and we had a product team and experience team
and a design team, and, um, you know, it was just, um,
a very different experience.
So part of that is we did, you know, bring a lot
of traits from Amazon and Google and Best Buy
and other retail aspects.
And we talked a lot about within the product world
of failing fast, um, and lessons learned there.
And especially, you know, ones that I lead here is
that I think what often we don't realize
or think about, especially if you're,
if you didn't grow up in healthcare, is that, you know,
if you look, if you think back at the, the origins
of healthcare and the history of, of everything we've done,
including the EMR, it, it has been a bit up through the lens
of safety first, right?
I mean, even the, the Hippocratic Oath
that I took in medical school do no harm, um, that,
that inherently is saying, first think about safety, right?
Do no harm. So the, and,
and there's nothing wrong with that.
Absolutely nothing wrong with that. We should absolutely
think about that, especially in the age
of ai as we look at that.
That all being said though, fail fast
is conceptually at odds, you know, with
that concept of safety first.
So right, as a doc,
and I wanna bring in a new med, especially in pediatrics,
and I want to give, you know, some experimental medication
to a child for let's say Crohns disease.
I'm not going to just experiment and fail fast
and think about, you know, deal with it,
and I'll learn, I'll iterative, we'll be agile, uh,
and, and we'll sprint, you know, to figure out really,
you know, what the process is.
That's not gonna happen in medical care.
If I'm in the ICU, I want it to be tried and true,
and I want a lot of random, uh, controlled trials and,
and peer studies, and I want my, you know, professors
who mentored me to say, yes, I've done this 10 times
and it works, or it doesn't work, or, try this.
It's just inherent in our culture, in our training
that we really take a long time
before it actually hits bedside medicine.
So I think to, to your point, you know, inside
what we're trying to do with innovation now and digital
and virtual and AI and what have you, it is this mentality
of fail fast is, is really, uh, to many degrees,
just very culturally abrasive, um, to kind of the,
the core of, of how we're trained.
And so I think, you know, that doesn't mean
that it doesn't apply.
That doesn't mean we can't do those things.
But I think in my position, um, I'm well poised, I believe,
just as a practicing physician that's, you know,
I was section chief of a department.
I was a leader in a children's hospital for 16 years.
So I am, you know, I, I know the front lines.
I know operations, I know clinic, clinical medicine enough
to be able to know, you know,
what's really gonna fly inside that model.
What are you allowed to touch, if you will, and fast at,
and what's kind of sacred ground, if you will.
And you need to really be more thoughtful and careful
before you start disrupting, uh, certain models.
- Mm-Hmm. the slogan
or motto I butchered, there was
that from Mark Zuckerberg, the internal motto at Facebook
for early 2000 tens that move fast
and break things, which I think Facebook arguably very much
has broken a lot of things.
Um, but it, it talk about ideologically at odds.
I think that is one slogan, like you said,
culturally abrasive is a good term for it.
- Yeah, no, I, and, and,
and listen, I am that guy that wants to break things truly
and really, you know, re-engineer it
and rebuild it to be, you know,
whether it be consumer centric
or provide higher quality care
and decrease the burden on caregivers.
And we can go on and on, uh,
because I think there's some fundamental things
that we do need to kind of break, if you will, and,
and put them back together.
Um, so it is, it's just, it's a, it's, it, I, I, I often,
um, I I feel like Dr.
Je, Mr. Hyde sometimes, right?
Where I'm on one on one side of it, I'm talking about
how we're gonna break things, and then with the docs, I need
to make sure that I'm thoughtful, careful, responsible,
ethical, um, and pushing them at the right pace Mm-Hmm.
to be able within their comfort zone.
- Well talk a little bit about your vision, if you will.
Uh, you mentioned you are a physician,
you also are leading technology and digital efforts.
What's the vision you're working toward at a HN,
at a A HN right now?
Can you spell it out for us in a bit more detail
so we can envision it with you?
- Yeah, sure. Um, well, I think that, you know,
as I described the system,
it's very important context now as we talk about vision.
Um, you know,
what worked in Texas is not necessarily gonna work
in Western Pennsylvania.
And I, I do think, you know, um, healthcare is local
and the dynamics, the state laws, the, the policies, um,
as well as just the demographics, the payer mix population,
is it growing, is it not growing?
You know, all those things are really relevant.
So, you know, I'm sure Molly, as you talked to a lot
of different, um, chief digital officer, strategy officers,
what have you, um, there's, it, it, it's,
it's gonna be inherently different based on
what system they're at, what state they're at, uh,
they're they're in, and,
and what's the population that they're taking care of,
and what that, what does digital mean to them?
So, so having said that, being that, uh,
we have a very large, uh, payer that owns us, um,
and an enterprise, uh, that comes with that, with a, with a,
actually with many more companies besides Highmark, Inc.
Uh, in a diversified business model,
including an IT company, um, a dental company
and others, is we really look at a much broader ecosystem
and, and how Allegheny Health Network really fits into
that broader ecosystem.
So we, we talk often about Allegheny Health Network being a,
uh, pacesetter or a living laboratory, um, if you will,
within the broader Highmark, uh, strategy.
And that strategy is called Living Health.
Um, and the, the Highmark Health Living
Strategy, oh, sorry, excuse me.
Living Health Strategy, um, really focuses,
and I'll just be very kind of overly simplistic about it,
is, um, is really creating, um, personalized, proactive, uh,
simplified, um, experiences.
And these experiences, um, really lead to more engagement,
um, by, in, in, in Highmark Health terms, you know,
the member or the patient.
And if they're more engaged in their health, um,
and then, you know, that can lead to better outcomes.
Um, you know, as assuming we're, we're helping orchestrate
and navigate them to the right, uh, solutions, programs,
benefits, and those improved outcomes, um,
make healthcare more affordable.
Right? Which is important to us all
as we know we're not on that, uh, trajectory.
So, as I, I outline that, uh, being
that it's the Highmark Health, um, living health strategy
to say Allegheny Health Network plays a very,
very important role, um, in, in seeing how we actually, um,
make that actionable, make that really, truly, uh, come
to life inside of a, you know,
relatively large health system that is not also closed.
Um, half our claims are through Highmark Health,
and that means half our claims are
through governmental business and other commercial payers.
And so to be, um, doing that, um, inside
of an open system is, is really complex.
It's really tough. So building a strategy that, um,
really works, uh, in both worlds.
And, and so we are, uh, as of this year fully at risk, uh,
in a value-based care arrangement with all lines
of business, um, with Highmark Health, uh,
but we are also living in the fee for service world, um,
with, um, our other books of business, many of them,
not all of them, but many of them.
So, to, to then, that poses the issue for me
as you asked me about the vision.
It's how do you operate in both worlds at the same time
and really create these wonderful experiences for all people
that touch us and, um, and,
and our health system in many different ways.
Um, home virtual, um, physical assets, um, and digital
and, and still really, um, you know,
create those wonderful experiences, um, that lead
to engagement and better outcomes.
Um, it, it, it that's, you know, it's tough.
That's the, that's the vision, if you will.
Um, so, you know, within that, right, we're,
we're really thinking about orchestration of care.
That's kind of the, the key word that I'll use is,
is really, you know, being with people.
And I, I always envision a world where I know, we'll,
we built, we will be building
to especially generative AI now, in which, um,
we should know you need us before, you know, you need us.
And really, if you just simply said, you know, what is it
that you really want healthcare to get
to is, is I think we're there.
We have the data, we have a lot of the tools to be able
to do that, but we haven't really done that yet, right?
So I wanna build a role in which, you know,
before you know, that you need to engage with us, um,
you know, we have enough data, information, trust,
that's a big word there, um, to
where we can then help orchestrate
and navigate your healthcare journey
before you know, you need us.
And I think, um, as we really build that role
and are able to do that,
and I think a system like ours with the provider
and a payer, uh, really in a blended way, um, is,
is gonna have the, the data and the intelligence
and the engagement capabilities, uh, to perhaps
actually achieve that, to improve outcomes.
So that's, that's the vision. Mm-Hmm.
- , I mean, that's a pretty big vision.
And just to clarify when you say that,
how do you operate in both worlds at the same time?
You're talking about the fee for service
and the at at-risk models.
- That's right. That's right.
- Yeah. I, I mean, I remember the,
the phrase about like having one leg
and one foot on the dock, one on the boat.
It's been put to you so many more times,
but it's still very much true today, uh, as it was about 10,
15 years ago, it sounds like.
- Yeah, I haven't heard that,
but it certainly feels like that many days.
So, uh, yeah, that, that, that hits home.
Um, and, you know, I think that, uh, again, you know,
I'll put my physician hat on,
and it's important to say physicians don't
inherently treat patients different based on the
insurance card that they carry.
Um, when you walk into an emergency room,
when you walk into an office, when you walk in
and you do a video visit, the provider, the care team,
it's not just physicians, but nurses, the care team,
the whole EVS, it, they're not gonna look at that batch.
They're not gonna look at inside that, you know, section
of Epic and the storyboard to say, you know,
which insurance are you?
So as we solve for that, it's important that, you know,
we treat people as people, um,
and, um, so the, the solutions, the programs, the digital,
the, even the, the, you know, the physical, um, uh, programs
that we have, um, really be need to be able to solve, uh,
for all of our people that we serve.
Um, and so the challenge is, and,
and they're there is how do you find, uh, ways to do that
where you really don't have to go to the care teams
and say, I need you to look at
what bags they're wearing today.
Are they, are they at risk or are they paper service?
So it's a cha it's a tough challenge.
And some across the country, we've talked to a lot
of other health systems, some are going down that path
and saying, we're gonna really, you know, do this kind
of divergent model where we're gonna have care teams
that only take care of that risk,
and we're gonna have care teams that only take care of fee
for service and nothing wrong.
I just think that inherently we're trying to, um,
really create a world in which, um, we're just proactive
and preventative in the right way for all patients.
Um, but we do need to be thoughtful about how that, um,
you know, fiscally, um, uh, falls out.
- Ashish Barad, chief Digital Information Officer
with Allegheny Health Network, I wanna thank you again
for being my guest fan on the podcast.
Any closing thoughts you'd like
to leave our listeners with as we wind down?
- Oh, gosh. Um, I, um, would just say that,
um, I would encourage all, I, I did not in any way, um,
meant to mean to discourage any
of the disruptors that are out there.
I think that we need it in healthcare.
I encourage, uh, others to get into this and help us.
I think the future is partnership,
and we absolutely need outside thinkers
and other, uh, ecosystem partners that come in
and help us disrupt ourselves.
Um, and so, uh, I look forward to that role.
And, um, and Molly, thanks again
for having me on the Becker's podcast.
- Thanks for being our guest.