CareDelivey_J.D. Whitlock: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Manav Sevak:
Welcome to the Memora Health Care Delivery podcast. Through conversations with industry leaders and innovators, we uncover ways to simplify how patients and care teams navigate complex care delivery.
Manav Sevak:
Hey everybody! This is Manav here from Memora Health, founder and the CEO. Very excited to have J.D. Whitlock on, from Dayton Children’s today. J.D., if you want to introduce yourself, feel free to.
J.D. Whitlock:
Sure thing, thanks for having me on. So I am CIO at Dayton Children’s, been here a little under five years and in healthcare over 25 years, about 20 of that on the IT side, started out military healthcare, doing accountable care before it was cool, and so I’m always looking at how can we actually execute accountable care on the private sector side and Dayton Children’s we have our, about 50% of our patients are on Medicaid, and we’ve got them in an accountable care arrangements. And so, you know what does that look like going forward? How do we transition our care models and our analytics and our IT support to better enable accountable care, so that’s the short version.
Manav Sevak:
That’s great, and what’s kind of the story like, how did, what’s the journey that takes somebody from actually being in the military, to part of the military healthcare system, to Dayton specifically? Like, what drew you to Dayton Children’s?
J.D. Whitlock:
Sure, so I was, what got me in Dayton was the US Air Force. There was a Wright-Patterson Air Force Base here, which is the headquarters of the Air Force Materiel Command and the Air Force Research Lab, and there’s actually an incredible amount of innovation that’s going on here tied to the Air Force Research Lab, and a lot of super smart people working on incredible things. And there’s also the, it’s a military unit called the Human Performance Wing, where the Air Force is trying to figure out how do we do better in healthcare and sort of human performance generally, innovation around that as part of the Air Force Research lab, so it’s an exciting community to be a part of. I’m privileged to be on the board of a small company called Ascend Innovations, which is owned by the local health systems, and part of what Ascend Innovations tries to do is take some great ideas that come out of both the Air Force Research lab and the local healthcare community, and what does that look like for commercializing some of these good ideas. And they have, over time, built up some good expertise on the data science side. And so, it’s just, it’s a, for a small city, it’s not, obviously, not a big city, but it’s sort of punches above its weight in terms of what’s going on here in science technology, and healthcare. So fun community to be a part of.
Manav Sevak:
That’s awesome, and I, you know, maybe like seven, eight years ago, I had a chance to visit Dayton and go to like the Air Force Museum and all, and it’s a cool town. So you’ve had a chance to see healthcare from a bunch of different lenses, and obviously, like operating inside of a military healthcare system versus operating inside a children’s hospital versus operating inside of a larger system like Mercy that you were at before, looks dramatically different. Having been in all of those different types of just care delivery organizations, what are some of the biggest changes that you’ve seen in care delivery as a whole, or just all care delivery organizations or healthcare as an industry go through over the last call it, five, seven, ten years? Any big takeaways or themes that you’ve seen?
J.D. Whitlock:
Let’s see, big takeaways and themes. So what’s exciting to me is with, the progress with interoperability and the EHR app stores. So with, so I’m, we’re Epic, so I’m familiar with the Epic app, Orchard. I know there’s equivalent on the Cerner side, and some of the other large EHRs also have app stores. What’s transformational about that is, it used to be, if you, if there is a small, innovative company that was going to do something better for your patients, you were really rolling the dice with, you would get to the point of contracting with a company and then you would find out later that the amount of effort required for the interfacing was twice as big as whatever you paid for the licensure for the software, and then you would burn, and it would take you in a year to get something implemented. And so with the EHR app stores, it’s, that’s gotten a lot better. And in Epic World recently, it’s now an app market and it actually tells you, or is this a, what stage of maturity is this app in. So you can have some assurance that if you like what you see in a demo, that you will actually be able to relatively quickly implement that and integrate that into your clinical workflow. So that is still all maturing, but if you’re asking me some of the bigger things that’s changed in the last few years, I would say that’s one of the biggest things. Now, that’s been helped by some of the government regulations pushing forward for interoperability to eliminate information blocking. So the combination of that and all the venture capital going into a lot of digital health has enabled some great innovation. Doesn’t mean that it’s easy, it just means that it’s more feasible than it has been in the past.
Manav Sevak:
Yep, yep, … And do you feel as if, I would love your perspective on like, do you feel as if things like the app market and for Cerner, the App Gallery, and Code program and all of that have, at least on your side of the table, made it easier to be able to find and vet tools? So when you have a specific, let’s say, competency that you need filled, or you’re looking for a certain set of vendors, do you feel like you’re going to the app market to actually search for vendors, or do you feel as if it’s much more of a, after the fact, after you may have found a vendor, checking to see if they’ve been through that process to make sure that they can integrate?
J.D. Whitlock:
It’s absolutely both of those situations. So if I’m talking to a vendor today, one of, maybe not the first question, the first question is, does the demo look good? Do we want this thing, right? But at the end of the demo, if that’s something that we’re excited about, then one of the first questions is, are you on the app Orchard? Where are you on the app Orchard? Have other Epic customers already implemented you successfully on the app Orchard, and is that a, give us some kind of guarantee that that integration effort is going to be easier. I have also searched on the app Orchard for particular functionality. In other cases, we know we want something, and so I’m searching on the app market for vendors that do a particular thing. So yes, that’s absolutely worked both ways.
Manav Sevak:
That’s great, and maybe, what happens in the case that you don’t find a particular functionality on there? Like, let’s say there’s a set of tools that you are looking to invest in, but you don’t find it on there. How have you thought a little bit around that, plus a little bit around consolidation? Just because I know one thing that we hear from a lot of health systems is that there’s so much momentum right now around new tools that are starting to appear around making the process for delivering care easier. So you’ll see cases where inside of organizations, pockets of physicians that have adopted their own tools, right? And then you’ll have some enterprisewide decisions that have been made, and then you’ll have a different pocket of executives that may be looking at a different set of tools, but some of that functionality may already exist. So I’d love your perspective on how do you kind of bring all of that together, right? Is, is the app market, or, like the best way that you’re kind of calling out which tools you should and should not invest in long-term? How are you centralizing what the enterprise-wide approach is?
J.D. Whitlock:
Yes, we are definitely centralizing. So one of, blessing and the curse of being in a smaller health system, and we’re on the smaller end of Epic customers, is that we don’t have money to toss around. So we can only spend our pennies on things that we’re reasonably certain are going to be a smart move from an ROI perspective. Now, sometimes that ROI is soft ROI, not hard ROI, we know it’s better for our patients, we know it’s better for patient experience, we know it’s better for our own staff’s experience. We may still invest in these things, but we don’t have the problem of being this humongous health system with 50 hospitals where you have people trying to do things in different states in different ways. So the downside is we don’t have a whole lot of money to toss at innovation, the good thing is we generally have our governance in place, so we’re not trying to go three different directions at once.
Manav Sevak:
100%, and maybe related to that, what are the big things that you’re spending time on? What are your big priorities or big maybe digital areas and just IT areas that you’re investing right now?
J.D. Whitlock:
Sure, so everybody’s talking about the digital front door, appropriately, right? Because everybody knows they got this good experience when they go to their bank. Why can’t they have the same experience when they go to their healthcare provider? I would say we’re doing an okay job there. We did a nice job getting open scheduling on our website. You go to Dayton website, you get your scale, you can schedule yourself an appointment with one of our pediatric specialists, and we will figure out the referral part later. And I know a lot of health systems had difficulty doing that, we implemented that pretty well. However, we are, we have a ways to go in some of the, some areas that I know other health systems are a little ahead of us in terms of AI-assisted chatbots on the website and in a call center to get you efficiently to the right help, or including some triage in some cases, which really accountable care organizations should be doing triage, right, get you to the right level of care. So and making sure that you are, when you are searching for a provider, you are leveraging all the best technology in terms of what exactly, I’m looking for a provider that does this exact thing, that performs this exact procedure, that takes this insurance, that’s in this area, you know, really, and then technology can support all that, right? But some of these things are not things that our EHR does, you do need to bolt on some digital front door tools, and so I’d say we’re about halfway in our journey there, we can do a little better there. And let’s see, some other things, everyone’s talking about remote patient monitoring. It’s another area where the technology is not the limiting factor, it’s who’s going to buy the hardware for the remote patient monitoring. And oftentimes, and particularly in pediatrics, or asthma and diabetes are big, but we have as many rescue inhalers and spirometers and glucometers as we do payers, so the payers decide which model to buy. And so we have a, too many of those, and it’s sort of difficult to get all that integrated when you, when each payer has different hardware. It’s interesting when you see people, when you read about people being successful with that, when you dig down, a lot of times it’s a research study, they got some, they got a grant to buy some hardware for. So the technology is there with remote monitoring and Bluetooth, talking to your phone, talking to some awesome SAS app someplace that integrates with the EHR. But getting that deployed at scale for all your patients, so your provider staff just has one platform to look at, that is very challenging.
Manav Sevak:
Yep, yep, 100%, and maybe related to that, so one of the themes that I think we’ve taken away is that investing in things like digital front door, investing in things like remote monitoring, are all part of this broader theme of healthcare becoming more and more asynchronous and becoming more and more longitudinal and making it so that there’s just much more digitally enabled processes across the board that support that trend. And I think one of the big things that, one of the big reasons why healthcare is becoming more asynchronous or more longitudinal is because of value-based care initiatives that have started to be introduced, right, and because of the concept of accountable care. That being said, for all the discussion that happens around accountable care, in reality, the large majority of care that’s delivered is still in fee-for-service structures. So what is your perspective having specifically spent a lot of time around that, on why you think the adoption and just kind of roll out of accountable care and value-based care initiatives has been low?
J.D. Whitlock:
Yes, so that is a great question, and I think the answer is complex and multifactorial. One of the things is that health systems need to, even in a shared savings agreement, which when we talk about value-based care, most of the time we’re still talking about shared savings, right? And what that means is if you are successfully reducing acute care utilization and keeping patients healthier and out of the hospital and out of the emergency department, well, that’s good. That’s good for the patient, obviously. But you’re typically, in the ACOs that are that our health system sponsored, our hospital, ultimately hospital system sponsored, you’re not actually making money doing that. You’re losing less money on the patients that are not coming to your hospital in your emergency department, right? And so that is a little bit difficult for the health systems, and particularly in difficult financial times, as we see, if you, if you’re paying attention to the trade press, it’s one story after another of the health systems that’s bleeding money today. It is challenging to do, when you’re, even in a value-based care environment, doing the right thing for patients and investing in new technology and new operational processes, it’s the right thing for the patient, is ultimately still a money-losing thing. It takes a lot of enlightened leadership to go after some of those things. So we are still doing some of those things at Dayton Children’s, and I’m proud that we’re doing those things, but it is occasionally difficult to justify, hey, let’s go invest in this brand new thing that may or may not reduce acute care utilization down the road, right? Those are tough decisions to make in hard financial times.
Manav Sevak:
Do you think that the core technology infrastructure that’s needed for us to effectively implement and benchmark value-based contracts exists in health systems?
J.D. Whitlock:
So answering that question is a little complicated because I, so I’ve got experience in the adult system. My previous gig with Mercy Health and Urban School for Mercy Health was right about the time the Medicare shared savings started back in 2011, 2012. So I saw that from the ground up. I know that’s a, it’s a delicate balance for the policymakers at CMS and TMI to get things right, where they appropriately incentivize large health systems to do the right thing and value-based care and at the same time, actually save the taxpayers’ dollars, right? So is, once again, it’s a, technology is not the limiting factor. I would say, ten years ago, that technology was sometimes a limiting factor, right, but with the evolution of population health platforms within the major EHR vendors and the evolution of interoperability to where we are today, where if you have a really good chronic care, chronic disease management application, you now can go to your providers and say, give me my data out of my health record to put it into whatever platform, whatever, your Apple health, or whatever your preferred platform is and your preferred application is, that the interoperability technology is there today. So I think there’s a lot of opportunity there. I just think it’s, I think it’s well, it’s the old turning the aircraft carrier analogy, right? Just takes a while to get things going.
Manav Sevak:
That’s really helpful. So, just the last question I have for you is, you’ve been in healthcare for quite some time and you’ve seen it from a lot of different angles, what gets you most excited for the next ten years, and sort of where we are right now and the amount of focus that there is on technology development in healthcare?
J.D. Whitlock:
Sure, so I think that, building upon everything we just talked about with the, where we are now within our operability, which is really a good place, and the evolution of value-based care models, I think that some of this is just so complicated, it takes a little while to percolate through, and I think that there’s, I see a lot of good ideas coming. I participate and I do some consulting on the side, I do some mentoring of startups. I do, we’re members of a, Dayton Children’s members of Kids X, which is a pediatric digital health accelerator. There’s a lot of great, great tools coming down the road, a lot of good venture capital investments. So I’m hopeful that in the next few years we will see a lot of these things that will be easier to implement than they have been in the past. Now they still need to make economic sense. Sometimes vendors ask for prices for things that are, just don’t make sense from an accountable care perspective. So it still needs to make sense from an ROI perspective, but I am hopeful that a lot of these tools are going to be commercializable and implementable where in the past they have, they have not been. So that’s what’s hopeful, from my perspective.
Manav Sevak:
That’s awesome, cool. Well, J.D., thank you so much for coming on, and really appreciate the perspective, especially around some of the work that you’ve done in accountable care and, just your outlook on sort of where we’re headed. So appreciate all the time that you spent with me and hopefully, we’ll chat again soon.
J.D. Whitlock:
Absolutely, it’s my pleasure. Nice to meet you, Manav.
Manav Sevak:
Thanks for listening to the Memora Health Care Delivery podcast. For more ideas on simplifying complex care for care teams and patients, visit MemoraHealth.com.
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