Leveraging A.I. enabled technologies to transform healthcare
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Predicting Healthcare Costs and Improving Quality of Care with Chris DeRienzo was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2019.
Welcome to the Outcomes Rocket podcast, where we inspire collaborative thinking, improved outcomes, and business success, with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez.
Saul Marquez:
Welcome back to the podcast. Everybody, today I have a guest that you guys have met before, the outstanding Doctor Chris DeRienzo. He’s a Chief Medical Officer at Cardinal Analytx. As the Chief Medical Officer there, he leads the company’s clinical enterprise, helping connect world class data science to better care sooner for patients, employees, and plan members across the nation. He’s been recognized by modern healthcare in 2018 as one of 15 “Up and Comers” under 40 and Becker’s as one of healthcare’s “Rising Stars.” Chris has published and presented internationally on leveraging analytics to drive continuous improvement, implementing data science and healthcare, and the intersection of humanity and technology. He’s also the author of Tiny Medicine: One Doctor’s Biggest Lessons from His Smallest Patients. Prior to joining Cardinal, he served as… and one thing that I that I do want to clarify here, Cardinal not Cardinal Health, it is Cardinal Analytx. Prior to that, he served as Chief Quality Officer for Mission Health, which if you guys haven’t had a chance to listen to that interview, type in mission health in the search bar at outcomesrock.health, you’ll hear that amazing interview where we talked about value based care, among other things. Mission Health is a 2 billion dollar integrated delivery system in Asheville, North Carolina. There he practice both pediatrics and neonatology. He completed is M.D. and Master’s in Public Policy and Postgraduate Medical Training at Duke University. He is still a practicing neonatologist in the Mission Children’s NICU Follow Up Clinic and volunteer as a member of the Mercy Health Board Quality Committee and the YMCA Blue Ridge Assembly Board of Directors. Nationally, DeRienzo was the fourth medical student elected and re-elected to serve on the AMA Board of Trustees and appointed by the North Carolina Secretary of Health and Human Services in 2018 to serve on the Medical Care Advisory Committee. So as you can see in here, Chris is very involved clinically as well as in business now, and I’m really excited to dive in to his new track at Cardinal Analytx and to hear the latest in his thoughts and work. So, Chris, just want to extend a very warm welcome to you.
Chris DeRienzo:
As always Saul. Thank you for such incredible introduction. It’s a pleasure to be back on your show.
Saul Marquez:
Yeah, it’s. I’m glad you’re here. And now you’re on the industry side. So just to kick it off, I’d like to hear why you took the switch and how things are gone.
Chris DeRienzo:
You’ve got it. So I had a tremendous team at Mission and really enjoyed my role in the role I served there. Most recently, I covered a quality patient safety, patient experience, a pop health and analytics. And one of the things I was most excited about were the things that we were beginning to do, admission that cross the intersection there of a population health. So our value based care and our risk based contracting that we covered a little bit in our last time on the podcast and some of the real emerging data science trends and specifically in machine learning. Within the mission team, I was fortunate to work with a couple of really bright data scientists and they were beginning to show what we could do to drive pop health outcomes by leveraging newer technologies that are A.I. enabled. And so several months ago I got a tap on the shoulder from the folks at Cardinal who said, “hey, you know this, if this is really something you’re passionate about, why don’t you consider joining us and getting to do that, not just for the million people of western North Carolina, but for the 350 million people nationwide.” And so that’s really what sparked the interest. And we’ll talk a little bit about the Cardinal team and what we do. And I think once you hear that, the switch will become clear.
Saul Marquez:
Now, that’s really, really great Chris, and you know, I applaud you for the switch. It’s not easy to go from a provider working as a caregiver to industry. But you saw the bigger picture, so to speak, and I applaud you for that. So, Chris, what would you say now that you’re working on? The work that you’re working is a hot topic that needs to be on health leaders agenda. And how is your organization Cardinal Analytx, tackling it?
Chris DeRienzo:
Yeah. As always Saul, it’s a great question. I think one of the major challenges facing health tourism industry today is grappling with this intersection of technology and humanity, and especially as our data science development pathways offer new A.I. enabled tools, I think it’ll be really important for us to ensure that we’re pointing those tools at the right things. So, you know, defining the right core purpose and then ensuring that as we implement those tools, what we do with them is really driving a better care for patients, better outcomes and truly better workflows for our clinicians. And so when I think about it, do we really know today what the ideal state of an A.I. enabled health plan or an A.I. enabled population health manager looks like. I think that is a challenge that the industry is really going to grapple with.
Saul Marquez:
That’s a… it’s a great point, Chris. And so as we think about some examples, maybe something that you’ve done early on with Cardinal Analytx, maybe you could share with us something that you guys have used A.I. for to improve the way that things happen, outcomes, and business processes. It’d be good to hear that from you.
Chris DeRienzo:
So Cardinal really isn’t A.I. first company. The company was born out of Stanford’s incubator about four years ago when Dr. Ernie Milstein, who’s a famous professor from Stanford, has been working in the public health space for decades. Noted that when you look at folks within a population who become high cost, each year, about 60% of them are totally new. So about half of people who are high cost and therefore high acuity patients,drop outs, or revert to the mean each year. And he asked the question of one of his partners there at Stanford, “Hey, is this something we could predict?” And so Dr. Nigam Shah is one of the country’s machine learning experts said, “you know, I bet we can.” So four years ago, they trained a model on international data set and sure enough, approved that we could predict who are going to bloom in costs next year. So you moved from the bottom 90% into that top decile in costs. So that was sort of the notice of the company’s genesis. Now, four years later, with many, many iterations, there are 21 million lives spending seven years with a plane’s history that have been ingested into kind of the machine, led by Brian Maples, who was the company’s first hire as our Chief Data Scientist. The way that Cardinal is using machine learning is pointing a massively powerful engine at driving better care sooner for, as we noted, patients, health plan members, and employees nationwide. When you think Saul about what is the power of machine learning? What can we do? As the biggest utilizations of A.I. enabled software today have really been using massive labeled data sets to dramatically improve workflows and sort of match kind of right place, right time, right thing. Like you’ve got A.I. in your pocket. Many times A.I. powers Siri to tell you what she thinks you’re going to want to see next. Or if you’re you’re identifying pictures on anywhere on the Internet. That is the power of machine learning using a label data set. Within healthcare, we have tons of label data sets, but we just haven’t put them to use in ways that could improve patient outcomes. And that is exactly what we’re doing here at Cardinal.
Saul Marquez:
Well, it’s fascinating, Chris. And, you know, I think a lot of folks take a look at this topic of A.I. and healthcare and in particular, the predictive models and stripping away variability to improve outcomes. So the thought goes into what data are you pulling and how are you pulling it? Where are you pulling it from to get these analytics? Because if you could prevent these high cost patients from having these continual issues, how do you do it?
Chris DeRienzo:
Exactly right. Today, we predominantly use a combination of medical claims, prescription drug claims, lab results, and then other data that different clients may have access to. So perhaps socioeconomic data or other sources. And with each new client, we learn about interesting new data set. And the idea Saul was if we can look at multiple years worth of claims history and then say, “Okay, there’s a high likelihood that’s Chris, 38 year old male with these various conditions who’s had these kinds of encounters lives in this area. He has a really high probability of blooming next year.” Moving from low cost now to high cost, the question then is, “Okay is there anything we can do to prevent that?” And the answer is yes, that, you know, sometimes that blooming cost is driven by someone who’s heading down a surgical pathway. And perhaps, you know, they have not gone through the right process to see if that surgery is really needed or if it is needed, I hope they really connected with the provider and their space is going to be at both the highest quality and most cost effective. Or perhaps it’s someone who’s kind of fallen through the cracks of the city’s healthcare delivery system. Maybe they don’t have solid primary care. They’ve connected with a couple of specialists or they’ve in the 80’s for these ambulatory care sensitive conditions. And really what they need is better care coordination. So we’ve got a ton of examples now of folks after one of our clients who we’ve caught kind of in this state and through some some pretty basic sort of simple care management interventions, we’ve been able to connect them into the right pathways that have captured them from falling off the cliff and then both improved their health outcome as well as reduced cost for the health plan.
Saul Marquez:
I think that’s brilliant. And are you guys mainly working with insurance plans? Providers? A little bit of both?
Chris DeRienzo:
Our approach is really relevant to anyone who is in the role of managing a population’s health and cost. Imagine health plans have been for the folks most attracted initially to the different offerings that we have since they’ve been in that space for a long time, that we are working with a large integrated plan provider and they’ll be a public announcement on that’s in the very near future. And then the employer space. Employers who are large enough to really be able to think holistically about the health of their workforce. Those are folks who had worked with us as well.
Saul Marquez:
Fascinating. Yeah. Because at the end of the day, folks, we really have to look at this from the perspective of the payer and the population model, the impact that these things are… these these technologies that Chris, Dr. DeRienzo and his team are using, are definitely making a difference for outcomes and costs. Two of the things that need to be solved for. So as you all have been working on this, Chris, what would you say a setback or a lesson that you guys learned along the process of the programs you’ve been implementing?
Chris DeRienzo:
Yeah, I think that any time in healthcare we try to integrate new technology into workflows. There’s going to be challenges with implementation. I remember the very first time I tried to bring machine learning into a program admission. It was an objectively better model, way better predictive capacity than the tool that the team was using previously. But that took several months to really be able to integrate into the workflow in a way that the team could now use. And so I think as we’ve worked with early clients, it’s clear that there are definitely a new universe of opportunities that A.I. enable technologies are offering. And so we’ve become very focused on helping ensure that we’re connecting with a health plan or a provider or employers different lever arm so that we maximally support the humans who are at the other end of connecting those predictions to action. And that really is where our focus as a company is, yes, the different machine learning models can predict off cost. And what that cost really means, though, is a person’s life who’s getting sicker, which is leading them to need to engage in more high cost care. And so if we can prevent a person from getting sicker, then it’s the person who’s gotten better care sooner. As a result, they’re experiencing lower healthcare costs. And that leads to a more sustainable healthcare model overall.
Saul Marquez:
Now, that’s really fascinating. So now that you guys have been cranking, so Cardinal AnalytX has been in business for how long again Chris?
Chris DeRienzo:
Four years. Yes.
Saul Marquez:
For years?
Chris DeRienzo:
We spun out of Stanford, started four years ago. Like I said, the first hire was a really bright data scientist. And we’re now I lose track depending on the day where I need a 25 or 26 employees, but scaling rapidly, bringing on almost one new person every week to really keep pace with the market demand that we’re seeing.
Saul Marquez:
Amazing. Amazing. And so now you guys have scaled to a larger size. You’re continuing to grow. In the history of the work that you guys have done, what’s one of the proudest moments?
Chris DeRienzo:
That’s a really good question. You know, and when I think about what we can do at a population level, it’s really impressive. The delta that we can demonstrate across multi-million lives within a population is dramatic. But I think some of the proudest moments that I’ve had are when we get down to these individual patients stories, because that makes it real. You know, I’ve thought about population health as a health system executive. I thought about it as a doctor. And working on big populations is rewarding given the end that you can impact. But I think drawing that back to individual people is also really important. So I remember working through this one story. It was a woman in her 50’s. I think she had significant cardiac risk to the tobacco users. She had some underlying behavioral health challenges, a number of pain issues. It was on multiple opiates. She had engaged in something like 20 plus different outpatient visits and had a year one cost that was significant. There was over eleven thousand dollars. And so as a partner, we predicted, “hey, this is someone who looks like she is going to bloom in year two” and said the three drivers that we’re seeing out that are there’s cardiac combined with tobacco risk and then behavioral health combined with this pain, plus opiates. And then this is a personal assault. Who would never have hit a plan, you know, high cost claim world or providers, high needs population said she was not totally well, but she was not so sick that she would have gotten kind of the high touch bespoke care management. But we found her and the plan care management side engaged and they linked her again to sort of not brain surgery sort of things that they found really high quality behavioral counseling for her. They found her a tobacco cessation program that worked and she now most of the way through her year two at less than 50% of the cost, less than 50% utilization in terms of outpatient visits. But more importantly, she now has continued. Pain and diagnosis of depression, but is not on opiates. She’s gotten off of these highly addictive and highly expensive medications, and despite her existence cardiac risk, she’s now no longer using tobacco. So she’s markedly improved her future risk profile. But I have seen a person like that and I know that. But for our partnership with that clients, she would very likely have continued to fall through the cracks. That makes me really proud of what we get to do.
Saul Marquez:
That’s really big. Chris. And you know, one of the things that I’ve noticed is as more physicians like yourself join industry to help make things better. I see the dots being connected in a way that really will help us continue to improve the care pathways and the overall results. I mean, you mentioned something really, really important is that, yeah, you know what? As we take cost out of the system, we’re actually improving lives. So as the dollars that we spend go down, health goes up, it’s inversely related. And we need more folks like you, Dr. DeRienzo in the business.
Chris DeRienzo:
I appreciate that Saul. One of the things I like most about my new job is I get the clinical side and I can work on that all day. I have no clue how to program in Python or R I get to work with these ridiculously brilliant people who when we drive a problem, they say, “I don’t have a model of it.” And then they go to work on their giant Mac books, whatever. And then sometime later they come out, they say, “look, here’s what we’re now able to do with this prediction.” And then I get to say, “well, here’s what we can do with that to change someone’s life.” I think as a doctor of the health system side, the folks who worked in industry who I was most excited to partner with, you really got the problems that we were trying to solve and we’re there as partners to help us solve them. And there are many ways, I think, to be able to do that in a revenue sustainable manner and ultimately drive total cost down just in part because of the way that today with limited resources, we’re not focusing on folks, I think, who can sometimes most benefit from engagement, you know, finding someone like this, this woman and I’ve got tons of examples like her who are about to deflect. Yeah, they’re about to fall off… off that cliff. Their health is about to get worse. Their cost is going to rise dramatically. If we can keep that from happening over and over and over and over again. Think about the deflection in the overall health of the country to the positive and the total cost to the negative. So if that’s not something as a doctor, I could get excited about that, but I’m not sure why I went into medicine in the first place.
Saul Marquez:
I love it Chris. And you know, one of the things that that just kind of a side note, I’ve had the privilege of speaking with several other successful physicians like yourself that have taken a turn in the industry. And I notice really kind of two characteristics. One is a strong passion and desire to help. And then the second thing is the desire to scale beyond what you could do on your own or at an institution. And joining industry definitely helps provide that scalability because like you said, right. Going from 2 million patients to three hundred and fifty million potentially. It’s a big thing. And I congratulate you for that. What would you say is an exciting project you’re working on?
Chris DeRienzo:
One of the most exciting things about working at a company at this stage is the speed of growth and the pace in which we can drive change. And so the the three offerings that we have out there right now on cost bloom on kind of matching folks who have preference sensitive conditions with bright spots providers using Arnie’s Research’s language and then on risk assessment adjustment. Those are kind of the three things we get to do today. But working with Brian and the data science team means that by the end of the year, even by the end of the quarter, they’ll be entirely new things that we’re getting to bring to market. And so some of the most exciting work kind of in our skunkworks I can’t really talk about yet. But if you keep an eye on Cardinal over the course of the year, I think you’ll see some really exciting connections that that we’ll be able to make that that have not yet been able to see made in the market.
Saul Marquez:
Fascinating. So do you get people confusing you with Cardinal Health a lot or no? Is it pretty clear?
Chris DeRienzo:
You know? I think the spelling of our name kind of helps distinguish That. The cardinal analytx with the X and the fact that Cardinal Healthcare there are big in a significant industry player, but there I think been historically more on a different side of the road.
Saul Marquez:
That’s true. Yeah they’re very different, but it’s worth distinguishing here for the listeners, right? I mean, these guys are innovating in a big way, using A.I. and data science to help population health, decrease costs, improve outcomes, while on the other side, it’s distribution pharma, very different as a Doctor DeRienzo’s point. So here we’ve gotten to the lightning round. So I got a couple questions for you, Chris, followed by a book. Obviously, aside from your book, which is Tiny Medicine: One Doctors Biggest Lesson from His Smallest Patients, a recommendation that you’d make there and listeners just to know if you go to the show notes, you’ll be able to find a link to Dr. Chris DeRienzo’s book as well as our entire transcript. Then short notes, just go to outcomesrocket.health and in the search bar type in cardinal analytx with an X and you’ll find it there. But Chris, are you ready for a lightning round?
Chris DeRienzo:
Hey I have gone through this once before. I am now welcome at this time Saul.
Saul Marquez:
You’re a veteran. All right. What’s the best way to improve healthcare outcomes?
Chris DeRienzo:
You know, I answered this one for you already know an answer at the same way to continuously get better. The best way to improve healthcare outcomes is focus on always getting better.
Saul Marquez:
What’s the biggest mistake or pitfall to avoid?
Chris DeRienzo:
I think that sometimes folks see a new technology or a new approach and either out of fear or out of fear of the unknown or fear of change that can initially be challenged by that. And that’s a normal human instinct. And totally understandable. But I think it would be a mistake to fall victim, to only feeling that fear without offering yourself the opportunity to see what different might look like. Because any of the major transformational changes in healthcare in any industry have really needed someone to take that next step and say, “I really can envision a future that is both different and better.”
Saul Marquez:
How do you stay relevant as an organization despite constant change?
Chris DeRienzo:
Constant change is what keeps us relevant. And I think that in a world that is exceptionally dynamic in healthcare, it’s not just about being on trend, but about continuing to focus every day on what tools do I need? How do I need to equip my teams to be better tomorrow than they are today?
Saul Marquez:
What’s an area of focus that drives everything in your work there at Cardinal?
Chris DeRienzo:
At Cardinal that’s a simple answer. It’s better care sooner, which means that we get to serve people. So plan members, patients, employees, all across the nation and we get to serve the people who are trying to support them so that the care managers, the care coordinators, folks in doctors offices, in employee health locations, they are doing their very best to try to serve their people. And as a result, we get to serve them.
Saul Marquez:
So, Chris, since last time we were together, I started asking two new ones. These are more…
Chris DeRienzo:
Alright.
Saul Marquez:
Surprise! For the listeners to get to know the guest a little bit better. So on a personal note, what is your number one health habit?
Chris DeRienzo:
I’m a bit of a movement junkie.
Saul Marquez:
Okay, tell me more.
Chris DeRienzo:
I’m good friends with Eric, Eric Langshur and Nate Klemp. They’re the authors of Start Here, which is a book with the New York Times bestseller a few years ago. They drove the beginning of a company called Life XT. And I’ve done some work with them over time. I really believe in their mission. And within their construct,they’ve got sort of these nine, nine different components of driving personal well-being. So meditation. There’s there’s a core group on that gratitude, there is one there for me. I find that movement everyday really helps keep me grounded. And so I’m a triathlete. I took that up when running, boxed my knees. And I’ve realized that if I woman bike and ran, then I could do all three without being injured all the time. So I got to make sure I get movement every day.
Saul Marquez:
Love it. Love it Chris. And what is your number one success habit?
Chris DeRienzo:
My number one success habit? Oh, gosh. I’m not sure how to answer that one, but it reminds me of a passage from Colin Powell’s book. One of my favorite books. It worked for me and he was talking about how he came home one day in his brand spanking new general dress uniform, looking all spiffy. And he walked into his house and one of his kids looked up and said, “Mom, G.I. Joe is home.” And then his point, obviously was having family who keeps you grounded is a wonderful gift that I think for me, I would say the same thing, that I’m fortunate to have three great kids and I’m married to a wonderful woman. And I think much of my ability to succeed professionally is how rewarding my life is personally.
Saul Marquez:
That’s awesome. Chris, thanks for sharing that. And yeah, it’s a good reminder to all of us, you know, but the why of what we do. Remember it. Keep it front and center. And so obviously you wrote a book. So aside from Tiny Medicine, which book would you recommend to the listeners?
Chris DeRienzo:
Yeah, I certainly would recommend that one, it’s coming out on June 11 by the time your podcast is up. Amazon preorder should be live, but a book that I read recently that I really enjoyed that was Educated by Tara Westover. I read it on a recommendation from Troy, who is one of the CBS executives. And man, it was a really powerful message. My wife and I actually got to read it together, which is rare as she likes to read books and in hardback form. And I do most of my reading the audible on planes and…
Saul Marquez:
Me too.
Chris DeRienzo:
Prevalent all around the world. So we sort of contemporaneously read it together and just it was a really powerful, really powerful story.
Saul Marquez:
Great recommendation, Chris. Definitely put that one on your list, listeners. And again, a reminder to go to outcomesrocket.health in the search bar, type in cardinal analytx with an X and you’ll be able to find our conversation and links to Dr. DeRienzo’s recommendations there. Before we conclude Chris, I’d love if you could just share a parting message with the listeners and then the best place where they could learn more about you and what you’re doing.
Chris DeRienzo:
You bet. So, as always Saul, I’m really appreciative of folks like you who are willing to bring, you know, members from all across healthcare, folks from the provider side, in industry, and plans, and employers. Really, what I find is you bring together folks who are pushing the edge and really trying to drive change. And healthcare is an industry that is ripe for a disruption in a number of ways. And I think that in reflecting on both of the times I’ve gotten to join you, kind of one of the core messages, to me I think, is if as a doctor, clinicians are constantly focusing on not only “how do I treat the patient in front of me today? But how do I make this system better to treat patients, including me all across the country, better and better and better and better.” Then it’ll lead to the kind of change that we need in healthcare. The industries that reach our size have gotten disrupted effectively every century since the founding of our nation. And since disruption is coming to our work in healthcare, it gives me a great degree of comfort that folks like the people you have on your podcast are helping drive it, because I think that means we’ll be pointing it in the right direction. To get in touch with me, you can reach out to me on LinkedIn. Our website is also live, just Google Cardinal Analytx and you’ll see it there.
Saul Marquez:
Outstanding, Chris. Listen, this has been a pleasure. Once again, super excited with this new turn in your career and this exciting company that you’ve become a part of. And I’m definitely looking forward to staying in touch and maybe a year from now getting you back on to hear the progress.
Chris DeRienzo:
That sounds great Saul, I could be your first three peat.
Saul Marquez:
You would be. You would be. I would love the opportunity, Chris. Thanks again.
Chris DeRienzo:
You bet. Take care.
Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration, and so much more.
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