Kathryn Teng on Unlocking the puzzle of population

Transcript 

Harry Glorikian: Hello, I’m Harry Glorikian. And this is Moneyball Medicine. The show where we meet executives, entrepreneurs, physicians, and scientists using the power of data to reinvent healthcare from machine learning to genomics, to personalized medicine. We look at the biggest trends in patient care and healthcare management. 

And we talk to people behind the trends to find out where data is making the biggest difference. 

My next guest has said, relying on specialty care is just too expensive. Many studies over the years have shown that primary care is the key to changing the healthcare cost trajectory. The realization is bringing new attention to how primary care operates and new initiatives to redesign it. Her team is collecting and analyzing market research about patients in the region they serve, information from focus groups and surveys, but also a lot of data about how their own patients use services. Dr. Katherine A Teng is the division chief for general internal medicine and community medicine. She joined Metro health in spring of 2015. She is also the physician director for the adult health and wellness service line. 

She practises general internal medicine with a focus on preventative care and chronic disease management.  As Division chief, she is responsible for the recruitment and retention of general internal medicine providers across the Metro health system. In her role as service line director, she oversees the operations of more than 200 providers in the fields of family medicine, internal medicine, geriatrics, medicine pediatrics, behavioral health, hospital, medicine, and dentistry in 21 practice locations across Cuyahoga County prior to joining MetroHealth medical center. Dr. Teng practiced general medicine in Massachusetts general hospital, and then served on the staff of Cleveland clinic, leading their efforts in personalized healthcare. 

She completed her MBA at CWRU Weatherhead school of management in 2014. Dr. Teng is a clinician educator focused on training, internal medicine residents in the ambulatory setting and committed to building a pipeline for future generations of primary healthcare providers. She is also an associate professor at Case medical school and teaches and mentors, students, residents, and junior faculty. 

Dr. Teng, welcome to the show.  

Kathryn Teng: Thank you so much. Thanks for having me.  

Harry Glorikian: That, that was a mouthful. I don’t know. I don’t know. Do you have time to do anything? Because I, it seems like there’s- wow 21 locations, 200 providers. Um, you know, you must need therapy yourself after all that, uh, after all that interaction 

Kathryn Teng: Seriously. Right? Um, no, actually it’s a lot of fun. Um, the nice thing about this job is that it really sort of integrates and coordinates all of our primary care or primary care like services across the organization. Um, I think the thought with hospital medicine is that, there’s you know, there’s a continuum of a patient from the time of discharge handoff to the primary care providers and behavioral health is really par and dentistry is really part of primary care services. 

So many of our patients have mental health comorbid conditions and how they cope with their overall health is very much related to how we manage their behavioral health. Um, so it all kind of goes together, even though it seems fairly disparate,  

Harry Glorikian: It’s been awhile since we’ve, we we’ve really, you know, talked and, and, you know, Can you tell me and the listeners about what you’ve been working on since talking to you for the Moneyball Medicine book? 

Kathryn Teng: Yeah,  absolutely. Um, so I think the, the part of the job that you described, um, the management piece, I think is, you know, there are, there’s fun in that. Um, but the real joy in this job, um, is, uh, around our implementation of population health initiatives, and really trying to achieve the vision of population health, which is how do we provide the right care for the right patients, for the right team members and in the right modality. 

Um, so I think, uh, for anyone who kind of follows this sort of concept of population health, the tenants of population health are in this quadruple aim. So that’s sort of the framework that we use. And the quadruple aim, um, is, uh, consists of these four arms, um, access to care. That’s one, uh, two is patient experience. Three is provider and caregiver experience. And the fourth is obviously lower costs and making sure that whatever systems you put in place are financially sustainable. So, um, as we kind of use that framework, um, uh, one of the first things I did when I came to this organization was to start um, collecting data and it’s actually been amazing to me, um, that for many years we really didn’t use data and, you know, it was all sort of anecdotal, um, decisions that were being made around these, um, around this quadruple aim. 

And so part of what I set out to do was to create some data points to help us really make some decisions around these four quadrants. Um, so for example, with access to care um, the challenge that we have, um, not just at Metro health, but across the country is that we have a shortage of primary care providers and we have a shortage of behavioral health providers. 

Um, so part of the question is, you know, how do we figure out, how do we define how much work one person should be doing? How do we ultimately use other members of the team and how do we use technology to provide better access to care? So, um, one of my first projects was to collect data around panel size.  And you would think, well, that should be pretty easy. Right? How many patients are attributed to a specific primary care provider? You can pull that on the computer, you would think not {inaudible} they’ll be right, because what does it mean to be attributed? Like if I saw a patient, um, three years ago and I’m listed in the primary care, the PCP field. But since then, the patient has seen, um, some specialists gone to the {inaudible} a couple times, but hasn’t seen me, is that really my patient? Am I responsible for that person? You know, so it really kind of launched us on this path of trying to really define, what do we mean by a panel and, and who’s responsible for that panel of patients?

Um, and that’s really where we’re moving with reimbursement models in the United States. I think that currently the way we’re paid to do deliver healthcare is volume based and we get paid for doing stuff. Um, the first is in the future, we’re going to be paid instead of {inaudible} for outcomes or for making sure that a population of patients is taken care of and it’s not using  {inaudible}, not utilizing too many resources. So it’s a very different way of thinking about things.  

Harry Glorikian: Yeah, no, I, I, I was just talking to, um, you know, Dr. Carter about this it’s, you know, all of this technology shift, all of these things that we’re changing is because of a shift in payment systems. And without it, I’m not sure we would’ve seen the shift or it wouldn’t have happened to the degree that it’s been happening. 

Kathryn Teng: Yeah, I would agree with that. I think that it would have been slower for sure. Um, I think the shortage and the access issues are driving would, you know, would have driven it initially. Um, but the change in reimbursement is definitely pushing us to change a lot faster.  

Harry Glorikian: Can you give the listeners some examples of, of maybe let’s let’s uh, if you can sort of look at it from both angles. So from, from the operational side of, of the institution, where have you guys implemented data analytics or machine learning or AI or any one of the combination of things, or maybe even something really simple and seen, uh, a significant improvement in some key metric or, or, or operational process that you’ve had. 

And then another one, if you could think about it from a patient impact, uh, perspective, so one sort of internal operations and the other one’s sort of, how does it impact the user?

 Kathryn Teng: From an operational standpoint, I think, um, the most impactful, um, process that we set into place is something that we call draft day. 

So this takes into account, the panel size calculations that we were finally able to calculate, you know, accurate panel sizes. Um, And then we took other data points, including things like third next available appointment, slot, uh, template utilization rate no-show rates. We sort of look at these, this overall picture of access and we put together a scoring system so that we could best determine at each of our 21 locations what does overall access look like for primary care? 

And based on that information, we have a session that we call draft day where we say to our leadership. Based on this data and based on market research data, in terms of where we know growth is at these sites, we need to hire X number of providers in the next year. 

So this is completely different from how recruitment was done in the past. In the past, what happened was, if a provider left the provider was replaced, maybe, um, and then if a chair got a wind of somebody, if some great candidates they wanted to come in, they would just make up a position and put them in. 

And so you would end up with a situation in which, in some places you were overstaffed and in other places you were understaffed and you know, there just wasn’t a whole lot of, um, thought put behind where people were being deployed and, and, and you know, how that was going to meet the access need for that site. 

So I think this has been a really great process for us. Um, it has also helped us streamline the process operationally of how do you get positions approved? Because when we’ve included our finance team in this process, they’ve, you know, they’ve had these aha moments where they’re like, oh, now we understand why you’re asking us to approve this position. 

Now we understand why we need to hire more people for this location. And so it’s really kind of gotten the entire organization, um, to start thinking around this, these data points and to start thinking about how this data affects recruitment and deployment and access for the system. So that’s been really great for us operationally. 

Um, in terms of patients. So, I think there are a couple examples, um, and this is not really novel to Metro health. Um, I think, um, data, it has been revolutionary, I think for patients in a couple of ways, um, we have been doing public reporting of experience score. So that’s the second tenant of the quadruple aim, um, uh, public reporting of our patient experience, scores and comments about providers. 

And we also have made our notes open uh, completely open to our patients so they can see everything that we write about them and their plans. And it actually has been very, very well received. First of all, what we find is that patients, um, very rarely contact us about the notes that we write, um, and the ones who do read their notes, find it to be very helpful to reiterate the plan. 

And so, um, the next step obviously is to collect some data around um, compliance or outcomes, um, instead of {inaudible} from patients from the, these sorts of initiatives, there is one other, um, uh, project I will mention, which is around machine learning. Um, so we are using machine learning analytics to predict um, whether a patient is going to no show for a pay for an appointment. And if the, if the risk is, let’s say, um, higher than 90% based on this machine, predictive analytics, uh, program, then we overbook the, um, patient, um, on that provider’s template. So, um, you know, so that has, I think been received, um, with very mixed reviews from the patient and the provider standpoint, the patients have actually been very upset. 

Um, you would think that they would be less upset as a whole because they might have better access because a slot just opened up. But when they arrive for the appointment, they get very upset to find that they’re being in a double booked slot. And the provider is splitting their time potentially between two patients or it’s going to be late because they got double booked. From a provider standpoint it has also been received very poorly because the accuracy rate of these predictions at this point is maybe 60% at best. And so I think this is a really important concept to think about that um, even with some of the analytic tools that we have to date, they’re only as good as the data that’s going in.

 And at some point, you know, somebody smart has to interpret the data and make sure it makes sense. Um, you know, part of the challenge that we’ve had with this is that, you know, the concept of predicting for overbooks is a great idea, but when it doesn’t work, um, it requires a whole system of people to actually manage that. 

So to manage the patient dissatisfaction, to manage the fact that templates are screwed up and a private provider, can’t be in two places at once, to manage expectations. And so that has been very much a struggle for us.  

Harry Glorikian: So, but let’s, let’s just step back from that for a moment. Right? So it, I, I understand that there’s always, you know, coming from the corporate world, nothing works exactly the way you think it’s gonna work when you implement it.

Kathryn Teng: Right

Harry Glorikian: For the most part, you’re always tweaking things to, to improve it. And it’s only as good as, like you said, the data that you put in, but, you know, could you sort of flip that and say, if I think that this is a patient that has a higher probability of no show. Do we put in a program where we’re calling that patient or, um, provide a service to pick them up and make sure that they get there or something else that, that as opposed to sort of the double booking, in other words, the data is the data, but

Kathryn Teng: Yeah

Harry Glorikian: Is there a way to mitigate the downsides in a different way

Kathryn Teng: Yeah

Harry Glorikian: Then you might be implementing? 

Kathryn Teng: Absolutely. And, and I this is, this is ,a, this is a really good point. And so, um, I think this is where we are today, which is that we are, um, feeling that. And I think there’s been a lot of actually published literature around this concept of how do you improve no show rates and, um, in the literature, actually, the only way to improve no-show rates is to offer a same-day appointment. 

So there are, um, systems of access that, that scheduling systems that we could go to, like open access or advanced access that would help with no show rates in particular. Um, I do think the other piece of this, which is, which is a lot of the population health line is moving towards team-based care models. And by that, I mean, not only, um, opening up appointments for patients, with other members of the care team who can help manage their, their problems, like the nurses, like the clinical pharmacist, like the behavioral health providers, but it also means opening them up for visits telephonically. 

Um, we actually also use a digital, uh, like an app it’s called, we call it Dr. Go. And, um, it is available for any patients on our health plan, um, 24/7 access to a doctor, um, by phone. Um, and so that actually is a great population health, um, uh, initiative, because it helps us to funnel the more complex people who need to be seen face to face to the providers. 

You know, to be seen in the clinic and, and actually funnel the less acute people to, you know, these telephonic visits or the, uh, team members who can see less acute patients or to the, um, portals, these digital technologies in, in which they can get their needs taken care of right away and not have to come into the clinic. 

Harry Glorikian: So how do you see the, this, these analytic approaches that you have impacting? Cost. And I guess there’s two ways to look at cost {inaudible} there’s costs that affects your PNL and then there’s cost to the system or the patient um, and I think those are two very distinct metrics. 

Kathryn Teng: So I think, um, the way I will just say that the way organizations like ours, who are moving towards population health models are funding um, Uh,  or hoping to fund um, a lot of these efforts is through value based contracts and, uh, downstream revenue. So it’s a combination of both value-based care, um, bundled payments, um, you know, they, they do pay significant amounts of money, um, for, um, care that is probably better for the patients. Um, and with better health outcomes, hopefully they’re spending less money. 

Um, in a volume-based world, downstream revenue is still a big deal. Um, we do want to funnel the right patients to the right specialist. And I think if we create models in which we, um, allow the primary care providers to work, maybe telephonically or remotely with a specialist to manage most of the issues that a patient is having and send only the really complicated or new issues that a patient’s having to the specialist. It actually allows a specialist to bill at a higher level and work at the top of their skill sets more. Right now what’s happening with our specialists is that their schedules are being clogged with these quick follow-up visits of people who really don’t need to be seeing the specialists. They really can be managed by the PCP, by the primary care provider. And so when we did sort of a financial performer or a financial analysis of these sorts of team-based care approaches, it actually did look positive, um, for the system. Um, in terms of whether patients are going to have to pay more out of pocket, um, it is certainly possible. 

I think payers, they will have to be assigned to push the payer, um, community to, um, to either subsidize or pay for this for the patients. Um, do I think that there are patients who would be willing to pay a nominal amount to have uh, 24/7 access to a doc, I think there are. So I, you know, um, I think there’s a lot of potential. 

Harry Glorikian: So, I mean, I always, you know, after, after writing the book and interacting with this, this system for quite some time, I always feel that the, if you were self-insured, there’s almost more of an impetus to experiment with these new capabilities as opposed to third-party insurer because it seems like every time that you make an improvement, somebody else benefits for the most part. 

Kathryn Teng: Right,  right. It’s a tough situation. I think, um, payers are coming along though. I mean, I think at the end of the day, they do want better health outcomes and they want it for less cost. And so, um, I’ve seen many of them, um, do, first of all, care coordination is just a basic function, uh, for our patients, which is very helpful. 

Um, they are running registries as well to help make sure that the patients are complying with, you know, um, evidence-based care. Um, that’s very important. Um, I think that, um, I think, and some of them, I believe are offering incentives for patients. Um, uh, if they comply with, you know, their mammograms or whatever preventive care that they’re supposed to be doing. 

So I think the payers are coming along, um, I guess the question is what’s going to be the big impetus for change. Um,  

Harry Glorikian: Well there’s not too many – I mean, you know, we’re running out of standalone payers. I mean, that’s one thing that seems like it’s changing. So, um, I feel like everybody’s seeing the writing on the wall and just being a middleman may not, may not be the best place to be in the end and being you know, part of the system might be, uh, a better place for all of them to gravitate to.  

Kathryn Teng: Yeah. Yeah, absolutely. I mean, I think they have a lot to gain in the end because I think that moving towards this population health sort of model does, uh, improve costs, um, improves their defenses and, and, uh, and hopefully has better outcomes for the patient.

Harry Glorikian: So population health. I mean, I keep thinking, you know, whenever I think of population health and managing patients, I’m, I can’t help, but think that there’s a incredible need for analytics, um, and, uh, digital technologies. 

And, you know, it’s funny because in the last say 5 or 10 years, the digital technologies are at a completely different level than I think most people appreciate, but where do you see the digital technologies playing a role in, in what you’re doing? Um, and, and I think of digital as everything from a wearable to, you know, can you put in a system that helps you, uh, look at radiology scans and help you make a better decision? Right? So it, it sort of plays the gamut across.  

Kathryn Teng: Yeah, I think again, in a, in a value-based world, if we’re getting reimbursed in a value-based world, all of those technologies become very critical because it’s all about how do you get number one, get the right data, number two, get it to the right person to interpret it and let the patient know what to do. 

Um, and again, that does not have to be a doctor, right? It can be a nurse, it can be somebody else on the care team to do all of that. And at the end of the day, what we’re trying to do is save people from having to come in for face-to-face visits, because who wants to come in for a face-to-face during business hours and miss work or school to go see your doctor, right? 

You only want to do that. If you are really sick and you really need to be seen. All the other things that can be done outside the office really needs to happen outside the office. Um, that is how we’re going to address the provider shortage. That’s how we’re going to get better patient experience and compliance and, um, engagement with the healthcare system. 

So I think all of those digital technologies are going to be critical. Um, we also see it on a provider, you know, um on a provider level in terms of engagement with other specialists being able to consult or get answers. I mean, sometimes we, as primary care providers just need a quick answer from a specialist. 

Like, should I put the person on this med or not? Should I wait for you to see them or not? You know, just something really quick. And if we can facilitate that with other means, um, and potentially get reimbursed right for that sort of care, um, that’s going to be critical. And I think that’s where the reimbursement piece is really important because unfortunately, in order to drive behavior change from everyone, we do need the reimbursement models to catch up. 

Harry Glorikian: Yeah. It’s uh, I always, I used to tell all the CEOs that, you know, I used to work with on strategy is if you don’t change the way somebody gets paid, you can’t change their behavior. Um, it’s sort of tied together. Uh, unfortunately, But you’re sort of on that bleeding edge of primary care and, and everything that’s going on there. 

How do you see business models being impacted by the value-based shift? The, um, use of digital technologies. Um, if you’re looking, you know, out on the competitive landscape, you know, there’s, you know, what is Walmart doing? What is Amazon doing? What is, you know, CVS doing? There’s a lot of things where I think the coming into the ivory tower is not always going to be where everything is going to happen. 

So how do you see business models being affected, uh, by these shifts? Cause you’re on the front lines. You, you have to be thinking about this daily. 

Kathryn Teng: So. You know, tough question to ask, right? Cause it’s hard to sort of predict the future of where everything is going. Um,  

Harry Glorikian: I’m furiously taking notes by the way, just because I want to know.  

Kathryn Teng: Yeah. Unfortunately I don’t have a clear answer to that. I think everyone. Look businesses, this, this is still capitalism, right? 

So, so people are still looking to develop technologies, products, things that are going to solutions that are going to improve, that we can use, right. Improve the way we deliver care or, or whatever else. Um, the, the question is going to always be how disruptive is that technology, right. And how expensive is it? 

Um, and how does it, you know, where is it in the in the, in the, in the continuum of change, I guess, you know, because change is slow in many organisations and across our country. Um, and so, um, you, you know, so I think there just are so many factors. Um, I know that there have been many sort of think tanks put together. 

In fact, I’m going to one later this week to kind of help companies think about, well, what’s the next solution we should work on. What’s the next, you know, um, you know, collection of data that you need, uh, for your practice? Um, I think that’s all great because we do need really great, um, data collection tools, data, analytic tools, um, the issue is going to be the cost because healthcare organisations can’t really afford to pay for a lot of these, um, sorts of tools and whatnot. 

And we also can’t necessarily afford to build everything ourselves. So, um, you know, I’m not sure where this is going to go. I think eventually, um, we’re going to have to come together as a unified country. I guess I’m just going to say, I’m going to say, to save our healthcare system, right. I mean, not to get into politics, but like where are we going with our healthcare system and what do we want as baseline healthcare for our population? And then what’s an add on,

Harry Glorikian: Yeah, yeah

Kathryn Teng: {inaudible}

Harry Glorikian: No, it’s very it’s it’s no, no, no. I understand. And, and, you know, it’s interesting because I I do think technology and monitoring and early warning systems are, you know, can be very helpful. I mean, if, of course, if the patient is compliant and you know, all the other things that you and I could sort of add on to that statement, but, you know, I mean, I see it, like, I step on my scale. 

You know, I can see the trend line if it’s moving in the wrong direction, I should sort of course correct. Um, I I’m, you know, I may be one of those people that sort of tries to look at that and there’s a lot of people that don’t care, but I think as we were moving in that direction of, of these technologies being part of a patient’s life, uh, I’m not going to say governing it, but, but interacting with the patient more, it, it sort of, you can keep them on it. 

But I was look at, you know, how do you think about implementation, but then if I’m an entrepreneur and sort of an out of the box thinker, how do I come up. How do I think of a Uber implementation of an existing technology that is, changes the way the system or changes where care can be provided? If that makes sense. 

Kathryn Teng: Yeah. Yeah. And I think there’s more of an opportunity for entrepreneurs to work with clinicians, obviously, and patients, and maybe even with payers, because, you know, at some point we got to get the, we got to get the payer folks involved. Um, you know, if we want to use these technologies.  

Harry Glorikian: Right. Right. Well, I think there’s an opportunity for self pay also. 

Um, or as you said in, in bundled payment, you know, it may be who viewed as sort of offer it as part of the package because it ends up saving, ends up making the whole package more profitable. 

Kathryn Teng: Correct?   Absolutely. Absolutely. There’s a lot of opportunity. And, and I think, um, and I think patients want it, at least the patients who are educated and, and very motivated really want, um, to participate in this way. 

Um, you know, um, I think the other piece of it is that we have a huge segment of the population that just, um, you know, the social determinants piece that they’re just, they’re not in a place where they can easily engage with these sorts of technologies, um, or, um, maybe not willing to do so. And so I think, you know, part of what we have to think about because, because at the end of the day, We are going to be as a country with our health. 

We’re going to be as- just  like a football team, you’re only as strong as your weakest player. So that’s how we are going to be as a health system or as a country in terms of health outcomes. If we don’t take care of the people who have mental illness and social determinants, you know, that, that, that prevent them from getting the care that they need. 

Then we are not able to rise as a whole. So, um, a lot of this is how do we get those technologies to those folks? Or how do we, how do we engage them or get them to a point in which they can actually start thinking about their health?  

Harry Glorikian: Well, I’ve, I, you know, I’ve, I’ve been in and around this area for a while. 

I, you know, and I’ve always thought that there is a way to be more six Sigma and therefore get to a, a good outcome, but it not cost what it does today. And I think over the last five years, we’ve seen really interesting movements in that direction, in different areas. And we’ve barely scratched the surface of optimizing the system. 

Kathryn Teng: Yeah

Harry Glorikian: I mean, you, you, you, you know, you have a lot of experience in that just in your day to day. Like how do we staff. I mean, it’s funny. Cause when I was listening to you at the beginning, you sounded like Walmart, Amazon, you know, any one of these companies that, you know, if, if, if I didn’t introduce you as, as Dr. Teng, it would have been like, I could have been talking to anybody from any corporate environment that’s optimizing their system.

Kathryn Teng:  Yeah, yeah. Absolutely  

Harry Glorikian:  It’s brand new to healthcare. Relatively speaking.

Kathryn Teng: Isn’t it funny, I, I do feel like healthcare has lagged behind, but we are, I think we are catching up and there are a lot of lessons that we’ve learned from other industries. 

Um, I think there’s a lot more we can learn as well. And, and, and a lot of that is around change management too. I think we have had very disparate groups of people working in healthcare.

Um, maybe not aligned with the same goals, not marching towards you know, the same outcomes. And so I think the more we can get everybody on track and, um, and that requires obviously data and technology is a huge piece of this, but it is also, um, it also requires a visionary leadership. 

Right. And, and, and other components coming together at the same time. Um, yeah. And I think, um, in terms of, um, uh, these, uh, technologies, um, there’s just so much opportunity, um, out there, uh, to, to create, um, and to pilot and test, um, these sorts of technologies.

 I think, you know, if we’re, if we’re going to rely on a payer mark or excuse me, a self-pay sort of model upfront, um, I find at least that most consumers. There are some who are sort of early adopters, but most consumers want to sort of know, well, you know, what am I getting for my money? Is this truly going to work? And so I think there’s a lot of opportunity for us to figure out how to best, um, study quote unquote, if you will, some of these technologies and educate people about what they’re getting and what they’re not getting. 

Harry Glorikian: Well, it’s no different than what we saw in, you know, many other industries, right. In the, uh, 70’s and 80’s of, you know, Six Sigma, you know, it’s all, you know, the Japanese are beating us on, on the car front, well, we’ve got-

Kathryn Teng: Yeah

Harry Glorikian:  To produce better, you know, so we, you need to start to measure everything and then optimize to produce a better product.

Kathryn Teng: Yeah

Harry Glorikian:  Um, and you know, you can’t blame the healthcare. We have a wonderful payment system pay me for everything I do. What, what, uh, how fantastic is that? 

Kathryn Teng: Right

Harry Glorikian: I mean, I would loved the job like that. Right. Um, But now you’re being, you know, you’re changing the whole thing and saying, well, no, I’m going to pay you for outcomes. 

We’ll wait, how am I supposed to give you a good outcome? I don’t have a way of measuring and then improving and optimizing, right? So

Kathryn Teng: Right

Harry Glorikian: You almost have to wait for all the measurement systems to go into place

Kathryn Teng: Yeah,

Harry Glorikian: Before you can figure out how to optimize and unfortunately, you know, the EMR I’m, I’m a total EMR, I’m not going to say basher, but I just it’s an accounting system, right. It was, it was never designed for optimized patient outcome. And so. Until that gets completely retooled. I think you guys are getting the short end of the stick, frankly.  

Kathryn Teng: Yeah, yeah. That, that is, that is a huge challenge for us. I mean, I don’t get me wrong. 

I, I like having an EHR as opposed to having paper charts. I mean, certainly 

Harry Glorikian: Right, right. Well, okay

Kathryn Teng: Right, right It’s all relative. Right. But, uh, no, I would totally agree. I mean, the systems are set up, um, for billing and, and, and other, but, but not necessarily for true communication for true coordination of care. Um, we have made some progress. I think in being able to pull, um, at least quality data points, RVU data points for our providers, we have a dashboard that we have within epic, um, that people can see in real time and really sort of track their productivity, track their quality outcomes and whatnot. And we’ve redesigned our comp plans that people are getting compensated um, both for our views and for what we call non production metrics, uh, or quality and patient experience scores, which they can see on this dashboard. Um, so that’s been a huge amount of progress. Um, I think the other, I think the other interesting thing, just shifting gears a little bit, you know, in this industry is going to be around, um, space and real estate, if you will, because I think, you know, a lot of our hospitals and our buildings are aging and I have noticed that, you know, in the last 10, 20 years, as people have built new buildings and clinics and whatnot, they have been taking to account this concept of population health and team-based care and building sort of teams spaces. 

But I think when I think to 30 years from now, hopefully 30 years from now, I think we are going to have very little hospital clinic base in like building infrastructure, because I think, and I hope that most of the care is going to occur in the communities or in people’s homes or on their apps or somewhere else, you know? And so it’s a kind of an interesting concept that we’re all investing money in our buildings and infrastructure. And yet, we have to, as we do that, make sure that they can be multipurpose for something else because we may actually not need all that space in the future. 

Harry Glorikian: Oh yeah, no, no. I I’m. You know, as an investor, you know, in this space, I’m, I’m constantly looking at things that completely change the business model and don’t rely on the ivory tower. I mean, I’m looking at both. I look at the gamut, but I’m, I’m always challenging myself of how to look at this differently. 

How to think about it differently. How can it be implemented in a-? I may end up in the same place, but going through that mental framework to challenge myself is I think how you see how care will-co- could change as time goes on. Uh, assuming Washington DC doesn’t blow up the whole system. So that’s that’s um,

Kathryn Teng: Alright. 

So, well, Thank you so much for, uh, spending the time with me today and talking to, uh, to myself and, and, and helping our listeners understand what you’re working on. And I mean, I look forward to staying in touch and, and, uh, working together in the future on, on future podcasts and maybe a next book

Kathryn Teng: Perfect. Do you have a, do you have a topic yet? 

Harry Glorikian: Uh, I’m I’m I’m, I’m working on one now and, and, uh, uh, of course in my spare time, but, um, it’s, uh, you know, it, it, it is along the lines of Moneyball medicine, but it’s, uh, I, I think there’s a profound change that’s coming that is very difficult for people to sort of anticipate. And that’s one of the Uh, topics or views. Um, I’m going to start, um, I’ve actually already got sort of half a chapter done, so sort of slowly moving in that direction.  

Kathryn Teng: Oh, that’s awesome. Well, it’s been a pleasure, Harry, always nice to chat with you and have a good conversation. I hope, I gave you some good material.  

 

Harry Glorikian: Thank you so much. All right, you’re welcome. 

Have a great day. You too. Take care. Thanks. And that’s it for this. If you enjoyed Moneyball medicine, please head over to iTunes, to subscribe, rate, and leave a review. It is greatly appreciated. Hope you join us next time until then.