: [00:00:01] 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: [00:00:18] Outcomes rocket listeners welcome back once again to the outcomes rocket where we chat with today’s most successful and inspiring healthcare leaders. I invite you to go to outcomesrocket.health to check out today’s podcast and any other feature podcast where you can also leave a rating and review. We love hearing from our listeners because today and as usual we have an amazing guest today. His name is Dr. Richard Chang. He’s a chief medical information officer at Kencore health and he’s also an interventionist cardiologist at John Muir health. He’s in San Francisco and he’s got a really rich history of innovating and providing solutions within the cardiology space. And so we had a pleasure of connecting and it was Santa Clara for the Health 2.0 event. And so I wanted to have him on our podcast so Dr. Chang welcome.
Richard Chang: [00:01:10] Thank you, Saul. Appreciate the opportunity.
Saul Marquez: [00:01:12] Absolutely. You guys are doing some pretty cool stuff before diving into anything else. I was pretty intrigued by the work that you guys are doing at Kencore health. Maybe you could offer the audience a little bit about what you guys are doing there. And then we can dive into to the questions.
Richard Chang: [00:01:27] Sure well Saul you know as a practicing cardiologist we often recognize the challenges and difficulties of managing our patients and you know one of the largest segment of the patient population that’s burdening the healthcare system or patients with congestive heart failure of heart failure that one diagnosis is the single most costly healthcare expense to Medicare on an annual basis. It’s huge cost. Medicare 40 billion dollars a year just to care for patients with congestive heart failure. And so there’s not enough cardiologist to manage all these patients especially as the baby boomers enter the Medicare age. It’s just impossible to keep up. And so you know why not use technology and innovative ideas to more efficiently and perhaps more effectively manage and care for these patients. And so that’s what we’re trying to formulate at and Kencore health. We’re using artificial intelligence home monitoring remote bio sensors that we can all integrate into a system of essentially trying to gather more information for the physicians in an efficient manner where it’s filtered and presented in an effective way that the physician can respond quickly transmit instructions digitally through a secure encrypted Hippo compliant fashion and delivery of healthcare which I think is changing you know with telemedicine. We have the ability to videoconference as we are doing now and communicate effectively and without any confusion. I mean the old dynamics of Haitians calling the office waiting for a phone call back and medical assistance. You are consistently leaving voicemail messages in this ongoing phone tag. Health care is really something I think is going to change. And that’s what we’re doing. And courthouse were utilizing the digital biosensors the ability to track patients heart rate their vital signs or cannibal cardiac monitors that aid is also able to be there seamlessly and organized and most importantly we have designed a avatar on our cloud that functions really as a digital personal assistant. And so it has the ability to track patients schedule their scheduled medications their schedule doctor’s appointments their schedules laboratory examinations that are required. And oftentimes you have elderly patients who have a difficulty just managing all of the aspects of their health care. And it’s amazing to me that some of our patients who are taking a dozen medications. Yeah. And that challenge alone. So I think for patients who are complex medical chronic conditions the ability to facilitate to remind them we do also even have a prompt that allows us to tag a family member or tag a health care provider that is intricately involved in the patient’s care to be able to be alerted when these aspects are not followed. That’s what we’re trying to do it Kencore health, the ability to innovate the way that we care for patients and obviously we did recognize it. The latest statements from Medicare for 2018 does allow for some reimbursement structure for digital health.
Saul Marquez: [00:05:04] That’s really interesting I did about that yeah and it seems like it may be that bridge that helped you guys take that technology that you’re putting together and actually make it to the point where it’s actually something you could get paid for.
Richard Chang: [00:05:16] Yes I think the cost benefits of of a digital platform will be utilized more often in closed structures where there’s managed care. The transition from volume to value based care. There’s a push for accountable care organizations and I think the the main concept of targeting value is important. But I do think that what most in the healthcare industry have to recognize that the volume is not going away all human volume is only going up. So how do we manage that increased volume more and provide the added value. And I think the answer there is utilizing innovative digital technology and the ability to facilitate increased interactions more seamlessly rather than the traditional office visits.
Saul Marquez: [00:06:08] Yes. And you’re highlighting some really great point here Richard. Just taking it down this path. What would you say is one of the main things that healthcare leaders need to be thinking about today.
Richard Chang: [00:06:18] I think the number one as a practicing physician for me the number one factor is how do we effectively deploy the healthcare. Everybody’s talking about the efficiencies and the systems and the protocols and people are talking about metrics and you know I think metrics are really utilized. We spend more time acquiring the data or the metrics than actually delivering the health care. And I mean that’s the number one priority that we should focus on. Sometimes the added cost really results in a superior outcome it’s impossible or naïve I think to think that we can deliver a higher quality product at a discounted cost. It’s just not going to happen. Everybody acknowledges that there are tradeoffs and in nations that have socialized healthcare you know in our country in the United States where we have the highest health care spending per capita we still have the most advanced technology the greatest medical care for multiple medical conditions. So there is some cost related to having superior outcomes and treatment strategies that are developed in our country.
Saul Marquez: [00:07:33] And Dr. Chang what would you say at this point right. You know you’re going to have to layer in some cost and and get some benefit. What would you say to this point an outcome that can cause health has helped an organization or practice achieve to improve outcomes.
Richard Chang: [00:07:48] So for us you know we’re a small startup so we began in a small remote outpatient part of your center and that heart failure center had been contracted with the local hospital because of their inability to have it outcomes. They did not have the infrastructure or the physician support or availability really because they’re in a remote area and we were able to employ our platform to essentially digitize the care of the patients. And it allowed for a medical assistant and a nurse midlevel to monitor five times as many patients with out patients having to constantly come to the doctors office which was challenging for some because of distance transportation issues. Now for those patients in our population with lower economic facilities just making to the doctor’s office regrettably is a financial challenge. Yes you know you have some patients who lack transportation and their ability to follow up and be compliant is extremely difficult. And so for us to employ our digital platform allow those individuals be able to communicate actively the changes in their conditions were able to effectively send instructions and a digital platform that did not even require the use of the phone. It didn’t have to even have a landline. So we use a Wi-Fi enabled access through our system and so we can do video conferencing if needed as well as sending text instructions so that it’s all digitized and they don’t even have to write it down it shows up and pops up with all their instructions. So we were able to efficiently maximize the ability to monitor patients and the Schmit we were able to show that almost 80 percent of those patients had increases in their quality of life of life in terms of their depression their dignity level we assess all of our patients on a form initially with a Minnesota living with heart. Kushnir which has endured ordeal of life measure assessment that’s used in most art dealer publications and we were able to show that use of our digital platform after three months improve their quality of life measures by more than 20 percent in a that without much more than increasing patience connectivity while decreasing the burden of messaging to the providers and the positions. So you know we pride a little bit of a filtered through the use of our artificial intelligence programming that interacts with action on the cloud.
Saul Marquez: [00:10:39] Yeah that’s really interesting Richard and as we drive through this there’s no doubt you mentioned earlier that volume is going up. It’s happening right. Got the silver tsunami as they like it are the aging baby boomers retiring they’re needing care. So the quadruple aim comes into mind where we’re providing lower cost technology improving outcomes but so important as well as the is the aspect of the quality of life of the provider and being able to help all these people that are coming in just pouring into their office. And what are you going to do to help manage them better. And what are you going to do to improve your quality of life as a physician. Can you speak to that part of it as well.
Richard Chang: [00:11:22] Yes thanks. That’s very important point. Saul I think that most technology or digital health companies really cater to the patients. Their background is usually Taq and corporate America which is very focused on customers. Yes and of course in healthcare I think a lot of times the physician is neglected as being one of those customers totally. And so our platform actually has facilitated all of these interactions and we have a provider dial or navigator platform which the assistant or the nurses utilize and for the physician there is a nice digital summary of patients complaint is vital signs as answers to some questions. Is medication profile. His latest laboratory results. All of that is summarized in a digital format or the position and the final step in terms of acknowledging the instructions that should be conveyed to the patient is embedded as a suggestion that our AI formulates and so of course as we have more interactions that would improve we’re triggering or our AI to actually automatically send a recommended therapeutic change. Of course you know there will be some legal constraints but I think we will ultimately get to that point. The summary that’s digitalized the physician just has to acknowledge can authorize or he can modify it and then send the digital instructions that alerts summary for the position is already document. He doesn’t have to type a single word and then just Czarnik digitally sign. And this summary alert embeds into the electronic health record. So.
Saul Marquez: [00:13:12] Yeah. And you know that’s so cool because a lot of physicians out of the 15 minutes that you get with the patient you spend half of it in EMR.
Richard Chang: [00:13:20] It’s more than that time myself. And how is it I use a dictation is a dictation microphone. And I would say that quite frankly a 15 minute visit or utilize maybe five minutes to examine the issue and then I utilize 10 minutes documenting everything I’ve discussed with the patient or my findings on the exam. So I would say two thirds of my visit with the patient is struggling with the documentation criteria and clicking the right buttons on the EMR too just to justify the metrics. Right and so by using this digital platform I think a lot of the documentation acquirements we designed so that its hold in automatically and placed in a format where the physician really just does the last step which is the most important. Using your knowledge to make the recommendations treatment. And the only thing that would be required on the physicians part is usually sign off on that summary and the rest of it is added. So I think as a practicing physician I formulated it that way. We also designed a dashboard of Haitian compliance. There is a huge drive in the healthcare for physicians that’s based on pay for performance. And I think those pay for performance metrics are often sometimes causing physicians to either game the system. They make cherry pick more compliant patients. There is some gaming of the system in terms of their abilities to try and increase their performance. Yes so they are not penalize and I think that negatively impacts those in lower socio economic status is you’re less likely to take on patients who have a lack of resources and may have worse outcomes for which as a physician you’d be penalized. Yes and I think that having a patient dashboard that we’ve built into our platform digitized the ability to gather that information. We would be able to designate this patient does not have a car. This patient has low income and there will be factors that you can utilize to say why is this patient not doing as well as the other patient who has a personal driver has a caretaker 24 hours a day. And I think those are important aspects that we have to look at. And also for those patients who have all those resources and have a core compliance with their medications their diet the recommended exercise programs perhaps they should be rated. So we have that built into our platform to say this is a patient with core patient compliance and maybe that’s why it correlates to their core outcomes and if they do have all those resources and are not doing their part maybe they should pay a higher premium for their or their insurance. If we penalize rather or habits why not a physician who gets blamed for the poor outcomes. You Know.
Saul Marquez: [00:16:28] I totally get that man and it’s interesting right because within the platform it sounds like you guys also integrated a social determinants of health screening of sorts where you could factor in these things that may be a result of these factors that leads to decreased outcomes. And at the same time.
Richard Chang: [00:16:46] Yes we’ve had questions gender based questions ask it going out to eat dinner at a restaurant assess which restaurant you know to gather some of their behavioral patterns and their exercise patterns. And I think those are aspects of patient’s health that other platforms are trying to achieve in an app based module. But in terms of physicians ability to have access to that summarized information I think is better facilitated through our platform because of the integration with care delivery and instructions of the professional delivery of health care rather than a consumer based product.
Saul Marquez: [00:17:31] Yeah. Dr. Chang I got a question for you then. So today it just going I mean it’s almost all the way there but the days of a physician hanging up their shingle I’m practicing on their own are pretty much gone. So now you’ve got a lot of physicians as part of large systems that have processes and systems in place and contracts with large vendors. How do you go about sharing and spreading the great things that you guys are doing an already established systems or do you go a different route.
Richard Chang: [00:18:00] Yes so I think you highlight a very very important point. That is the biggest obstacle. People do not like change.
Saul Marquez: [00:18:07] Yes.
Richard Chang: [00:18:07] And especially large organizations who feel they have an established structure in place. No one likes to be told that they’re not doing the best job right. And so I think we’re just trying to highlight that utilization of our platform can really fuel and make their existing structure better. We’re really trying to incentivize hospital systems to take a look at our platform to experience the efficiencies the patient satisfaction the patient engagement and importantly also the physician satisfaction in essence decision engagement on our platform. From what we’ve done in our small pilots we’ve had extremely good feedback. We have physicians who are calling their friends and other organizations and saying when when are we going to get an offer that say nice you know. And so I think from a physician standpoint we do have physician champions who are cardiologists who are essentially banging on the doors in the C suite and saying we need something we need to get and you know certainly the payment structure is not established yet. So our biggest hurdle is due to the hospital revenue cycle being as we all know it will slow. So the greatest challenge in smaller organizations that are more agile and the administrative structure is very streamlined. We see that we have tremendous success in establishing our platform and then having a little more challenges in the larger organizations with a more. Extensive structure seeking things approved. So I think the biggest test for us will come since our platform is so new we’re acquiring all the data literally on a daily basis. And I would anticipate in about three or four months we would have a large organization be able to sign on after they use the data from our small sites where we have one or two hospital organizations utilize.
Saul Marquez: [00:20:11] Well that’s really exciting you know and if you’re a hospital executive looking to start targeting your efforts in failure clinics that you’re managing. It’s important to think about all the options and I started out rocket as a way to make a bridge between those creating some amazing solutions like Dr. Chang and his team and the people implementing solutions. And so my hope is that this conversation resonates with somebody out there and that you check them out because I really do believe that that the solution that they’re putting together here is instrumental and could be really awesome as far as the quadruple aim and the things that you guys are after so you know at the end here we’ll have a place where Dr. Chang could share the best place to get in touch with him and maybe a connections made and we find a synergy.
Richard Chang: [00:21:01] Thank you Saul appreciate that. I think Ken cornhole we have innovated and bring together technology AI traditional healthcare and seamlessly integrated them together to allow for a slightly more tech Ishant way of healthcare delivery. So if anyone’s interested they can just go to our website can Kencorhealth.com. K E N C O R health dot com. And we have a contact tab then we’re happy to engage anyone who has interest this issue and champions patients as well as hospital administrators. We’ve interacted with all aspects even relatives of patients have contacted us after seeing our platform and I think that is something that we’re excited about.
Saul Marquez: [00:21:54] And it’s beginning to resonate in indefinitely. It really made an impact on me when I was at the conference just learning more about what you guys did. So really thrilled that you were able to make the time right now in this part of the podcast. Dr. Chang it’s a lightning round. I got four questions for you. It’s that 101 of Dr. Chang and improving outcome right for questions lightning round style. And then we finish up the syllabus with a book that you recommend to the listeners. The first question is what is the best way to improve healthcare outcomes.
Richard Chang: [00:22:23] Best way to improve healthcare outcomes is to have a healthy lifestyle.
Saul Marquez: [00:22:28] What is the biggest mistake or pitfalls to avoid.
Richard Chang: [00:22:31] Being the greatest pitfall to avoid is becoming complacent with what you’ve done so far.
Saul Marquez: [00:22:39] Love it. How to stay relevant as an organization. Despite constant change.
Richard Chang: [00:22:43] Keep learning that is the most important.
Saul Marquez: [00:22:46] And finally what is one area that should drive everything else in your organization.
Richard Chang: [00:22:51] Patient care patient care should be the priority that drives everyone and motivates everyone to better than they are currently.
Saul Marquez: [00:22:59] Awesome. That’s great. And finally what book would you recommend Dr. Chang for the listeners to read.
Richard Chang: [00:23:05] Well I think that nowadays there isn’t a single book I would actually recommend that patients get on the Internet and search any health topics on their disease condition. That improvement in health literacy actually corresponds to better outcomes better age. And that’s why I would not recommend a single book. I would recommend that you continue to educate yourself on the Internet on your medical condition.
Saul Marquez: [00:23:35] I mean that’s a great tip. So listeners all the pearls that Dr. Chang has dropped on us today they’re all available at outcomesrocket.health/Chang that C H A N G. You’ll be able to find all the show notes links to the things that we’ve talked about including his company Dr. Chang this has been fun. Before we conclude I love if you could just share a closing thought with the listeners and then we can say goodbye.
Richard Chang: [00:24:00] Well first of all thank you Saul much. Thanks to outcomes rockets. It’s a pleasure for me to represent Kencor health`. My final thoughts I would say is that the most important thing that we do every day is taking care of mom and dad brothers and sisters and the health care delivery is about caring for each other and irrespective of what your your background is what you do what you have bailable to you as healthcare providers. We’re always looking to achieve better care for your family. And I think that’s what we’re focused on it can help health. Thank you so much Saul.
Saul Marquez: [00:24:39] Hey it’s been a pleasure and looking forward to seeing how you guys develop.
Richard Chang: [00:24:43] Thank you very much Saul. Really appreciate.
: [00:24:48] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at wwww.outcomesrocket.health for the show notes, resources, inspiration and so much more.
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