Empowering individual patients and consumers and health using digital tools
Episode 85
: [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: [00:00:20] Outcomes Rocket listeners. Welcome back once again to the outcomes rocket where we chat with today’s most successful and inspiring healthcare leaders. I really want to thank you for tuning in once again and I invite you to go to outcomesrocket.health/reviews where you could go to Apple podcasts and give us a rating and review on what you thought about today’s episode. And so really again just want to say thanks. I have an amazing guest for you to listen today. Her name is Lygeia Ricciardi. She is a digital health expert president of Clear Voice consulting. She works to empower individual patients and consumers and health using digital tools. She does a lot to help her clients who share in this goal as well to successfully navigate the quickly changing digital health business and policy landscape and position themselves for success within it. I want to open up the microphone to Lygeia to just fill in any of the gaps in that introduction and welcome you to the podcast Lygeia.
Lygeia Ricciardi: [00:01:22] Thank you so much, Saul. It is a pleasure to be here and I’m excited to be joining you.
Saul Marquez: [00:01:27] It is so exciting to have you on all the way from D.C. Lygeia. You’re in a really hot spot there with a lot things going on but what is it that made you decide to get into health care to begin with.
Lygeia Ricciardi: [00:01:39] You know interestingly Saul, I started out getting into technology and saying technology is the biggest force. I think that’s really changing the landscape. My first job out of college when I was an undergrad was reading business case studies for a Harvard Business School. And so we were looking at business history like what are the big themes. And so of course the question came up what are the big themes now and technology. Hands down seemed to be redoing everything not just about business but about society. So I got really interested in how information technology can not just make things more efficient say but how it can fundamentally change social structures and hierarchies and things like that. And I saw that early on in both education learning and also in healthcare. So I got really interested in that subject went back to grad school there weren’t any courses in how is technology going to totally change healthcare. So I had a sort of like put the pieces together and make it up you know working with people who I thought were inspiring whether at the MIT Media Lab or the Kennedy School of Government as well as the education school and just trying to string together ideas about like how are we going to use this technology to fundamentally change. Well in this case healthcare. And at its essence the answer to that for me came down to empowerment and empowerment of what’s been called the most underutilized resource in healthcare which is patients patients and families are more motivated than anybody else to have positive health outcomes and their actions make a huge impact on what actually happens in terms of wellbeing and health generally as well as even in acute settings. So the question is how do you take healthcare and really leverage technology to help patients be more engaged and effective.
Saul Marquez: [00:03:32] That’s really interesting you sort of were ahead of your time idea you wanted to somehow put technology and health care together and fast forward to today. You’re very much at the center of how do we engage patients better and so on that question how do we engage patients better. What would you give the leaders in healthcare today if it was like a number one thing they should keep in mind to do this.
Lygeia Ricciardi: [00:03:56] Yeah. So what a really basic thing. And I think many people who know me in this field know me for a role that I had in government a few years ago. I went to the Department of Health and Human Services in NC and the national coordinator for health I.T. when they were ready the beginning of figuring out what Meaningful Use Policy looked like. And as your listeners probably know that the thirty 36 billion dollar program more or less that has been largely responsible. I would say for helping us as a country move from paper health records to online. Records. So I jumped in there and I said if we’re doing this process and where revamping healthcare and be thinking about how it could be digital let’s not just make it about providers and hospitals. Patients need access to their own information as well. So I worked on a variety of things I created the Office of Consumer e-health and really pushed to have patients and consumers be part of the equation. So part of meaningful use requirements are that patients and families need to have online access to their own records. So one simple answer to your question if you’re already in the health care industry is make it easier for patients to get their own data. And make it not just a one way thing so that they can find out about test results or read their records. But make it a two way think about how you can incorporate only questions they may have. But we’ve had this immense explosion of technology in the outside world and by outside I mean outside of healthcare. Yes. Phones for example just in the last five or ten years everybody now carries around what has been a supercomputer 10 15 20 years ago in our pockets as well as all kinds of wearables. And there are all these new technologies that are collecting data about us that is potentially extremely relevant in a healthcare setting. So if you are in the current health care system think about again not only opening things up to patients but being receptive and open to their information and their priorities as well. So that’s probably in some ways the lowest hanging fruit. From my perspective.
Saul Marquez: [00:06:08] That’s a really great idea and would you give the listeners any example of how maybe a project that you’ve been involved with or discussion that you’ve had that led to improved outcomes because of this.
Lygeia Ricciardi: [00:06:21] Yeah. So I’ll give one example of a project that I’ve worked with called open notes that you may have heard of some of your listeners may have heard of. It comes out of Boston and it is a program that essentially helps hospitals and healthcare providers to give access not only to medical records their patients but also to the doctor’s notes. So these are these little notes that physicians in the past and other clinicians would make to themselves only that were always presumably because patients would have no need to understand them or wouldn’t understand them or wouldn’t be interested. But it turns out that really isn’t the case. And so with notes as unable to spread awareness of this idea of access to data including patient notes really on a national basis and they’ve found that in situations in which providers were very reluctant to share their notes and don’t have the data in front of me. But essentially one of the biggest concerns was providers just didn’t want to share their notes didn’t are comfortable with that. And almost everybody who’s participated in that program from a provider perspective has found that it impacted their relationship with their patients positively and impacted outcomes. Similarly patients who were perhaps a little reticent and bought out. Does that apply to me or why I wouldn’t want to look at my notes anyway or any of the studies found that they were more engaged they understood their healthcare better. Other data certainly from other projects you know there’s some data that I cite often from AARP which has to do with the fact that more engaged patients are more likely to avoid medical errors and to be readmitted to a hospital within 30 days you know significantly as well as to help avoid this basic communications error or issues that come up because the patient knows their body better than anyone else. So you don’t have to you know have an M.D. to know all of that if you’re a man and you’re listed as pregnant. There might be something wrong perhaps your records are messed up. So some of these are sort of basic things like finding errors. But there are a lot of other things too like patients often know usually have a much clearer idea of what’s going on with their medications than anybody else whether they’re taking the medications they picked up or not or why they’re not why they didn’t work or how they are hugely important.
Saul Marquez: [00:08:46] That’s a great call out and definitely patient engagement huge. We were both at the Health 2.0 conference and I was eating breakfast and I was sitting next to this gentleman Danny Sands. He’s the physician out of Boston not sure if you’ve heard of the guy.
Lygeia Ricciardi: [00:09:04] Oh Danny Well yes.
Saul Marquez: [00:09:07] You know and he was just kind of making some great points. You are all about patient engagement and the patient engagement movement and how it does improve outcomes and so appreciated taking that path down that lane. I really do agree on. So the question is incentives. You know it comes back to incentives and how do we get companies or providers to start doing this if there are no financial incentives. Because oftentimes that’s what drives it right.
Lygeia Ricciardi: [00:09:37] Right. So great question. First of all the question is incentives per se. You know I spoke earlier about the meaningful use program that for instance a billion dollar program that is still alive and well and going on and in order to participate in health care providers need to show that they have the capability and have exercised to a more limited extent than I would like but nevertheless have given patients the ability to view download or transmit share their records. So there are incentives in the sense that a piece of that finger 36 billion dollar pie requires that participants use an H.R. that has this type of capability and that they actually engage in it. And I hope that that will just be the beginning that helps health care providers to see that this is worthwhile. What’s as interesting or maybe more interesting to me right now is that we’re starting to see health care organizations organically understanding are coming up with their own theories and motivations to invest in patient engagement that have nothing to do with meaningful use. So for example a little earlier in the fall I was at the inter systems health care Leadership Conference. And they bring together folks from not only the U.S. but China the U.K. Australia and other areas. And I wanted to find out I’m now helping them think about what was going on with patient engagement I led some sessions I did presentations. I moderated some panels and I was expecting to hear more about meaningful use as a motivator for investing in patient engagementt. But what I heard was that the biggest motivator was really paving the way for value based care which makes complete sense. Now like hands down. That was what people were talking about and that’s why they were investing because they’re figuring health care depends to a large extent on what patients do outside of the clinical setting. It’s about when you decide to seek care and whether you follow up on what was prescribed or not. And it’s also about daily behaviors do you choose to smoke. Do you use the seatbelts. What do you eat. Do you exercise all that stuff matters. You may have seen or heard the statistics that only about 10 percent of your overall health is determined by what happens directly determined by what happens in the health system. So if that bigger picture depends in large part on things that are within patients control you have to engage them. If you’re going to see better outcomes over the long term and I think a lot of folks are recognizing that. But they also gave a couple of other reasons too. One was some were seeing immediate cost savings in engaging patients. So your example. Well there are a couple reasons. So one issue is that there are an awful lot of higher than I realized a large number of no shows when patients sign up for appointments. So it’s actually 42 percent of appointments result in no shows. Wow. So you can imagine. Yeah it sure is. So you can imagine that again if you think of engaging patients generally as reaching out to them having a conversation all that stuff. Reaching out to somebody having a relationship and ensuring that they’re more likely to actually come in for that appointment. Makes sense no matter what your payment model is certainly in a fee for service world. You don’t want to miss those appointments because they might be missing not only you know one appointment but perhaps it’s a consultation or something larger like a surgery or something like that. So there’s that basic idea of pulling patients in and keeping them engaged. There’s also the point that sometimes if you can get patients to do some online preparation before a visit for example filling out some basic details or looking over their medication list to see whether it’s correct and flagging any issues you can save a lot of time person time and effort not only for the health care system but also for the individual. If you get that all done ahead of time these are the kinds of things. Again it’s not rocket science. Lots of other businesses are doing it but it’s nice to see health care recognizing some of these benefits as well. There’s another reason they came up during these conversations that they address this summit and that was that essentially customers or consumers expectations are starting to shift. So it’s really about marketing and customer attention. And people are used to a much higher level of service than health care generally gives. In many areas of our lives and we think about how many services are available basically on demand you can have things delivered to your door within hours by your own name. You know there are lot kinds of stuff going on in the locker down the street. What have you. So you know people are less interested in sort of the game you have to play sometimes to participate in the traditional healthcare system. You know you’re calling oh sorry they’re out for lunch you cannot leave a message to people. This whole thing is a lot harder than getting online to book a consultation. And certainly there are a lot of particularly smaller new companies that are helping to bridge some of those service gaps. So it’s not just that health care organizations are providing those services directly but there are companies that are doing that for them that they hired to work with.
Saul Marquez: [00:15:07] Hey Legia that’s a really great point and I’m glad you pushed back on my initial hey you know the incentives aren’t there. Like why. Why would people do it. So thank you for doing that. Why do you think this idea of health care consumerism rights come up. Why do you think it’s becoming more pronounced now compared to in the past.
Lygeia Ricciardi: [00:15:26] I think a couple of reasons. One is that healthcare costs are really hurting us badly in a broad brash sense our whole economy is suffering. Certainly companies that are suffering and providing healthcare services but individuals are suffering a great deal too. There’s been a lot of obviously uncertainty over coverage and costs related to political debates about care reform but the fact is health care costs continue to go up and continue to be one of the main reasons for personal bankruptcy and other kinds of just strain and stress. Even people who don’t file for. Bankruptcy may be really struggling under the burden of health care costs. So there’s that issue and sort of hoping that we could pull in consumerism harness it to make it to help people make better choices. And another initiative that I think is really terrific by the way is the one called Choosing Wisely which helps people better understand that sometimes one of the problems we have in this country is over care there’s too much care prescribed and there can be too much of an incentive even financially for healthcare providers to say let’s run another test or let’s do that procedure. So really thinking about whether that makes sense for you as an individual either from a health care wellness perspective and or from a financial perspective is important.
Saul Marquez: [00:16:46] Totally and even like for instance that’s for the access to your care information can make sense to write like over prescription MRIs as a result. Oftentimes a lack of interoperability.
Lygeia Ricciardi: [00:16:59] Exactly right. Yeah. Yeah. Because it’s hard to pull up that test from two months ago or even two days ago. You know it’s like oh let’s run another one so we can get the answers immediately. That’s that’s a lot of waste and cost but it’s also potentially with some tests opening the patient up to some unnecessary risks totally whether or not.
Saul Marquez: [00:17:19] And and so if you’re a patient listening to this aka you are and you are you’re an employer listening to this let’s pause for a second and think about what we can do to get more access to this information because there are ways for us to curb costs. You’ve got to look and think creatively that things like Lygeia’s mentioning she does put some blog posts out there with ideas on the things that she’s working on as well. So definitely encourage you to check out her work. And so, Lygeia tell us a little bit about something you’re excited about working on today.
Lygeia Ricciardi: [00:17:58] Sure. I think something I’m interested in is I mean I’m been exploring a lot of ways in which we can kind of take patient engagement to the next level. I see it as sort of barebones that we exchange information with patients and that we draw them into the care process even though their partners in their own health care. But as I kind of look forward and think not only what is health care going to look like in say five years 10 years but what is health going to look like. I’m really interested in exploring ways in which people are taking a health and making it their own. So for example I just did an interview for a podcast series that I’m going to be launching later exciting 2018 but it has room to admit it right around the corner. I didn’t say exactly when to burn it but you know there’s some really fascinating stories out there about people who have taken what we might think of and by people I mean often patients have taken what we might think of as a disability or a health care problem and turn it into a source of strength and something really unique. So for example somebody who doesn’t have a limb like maybe lacking half a leg or something like that and instead of saying like Okay well what can I do to kind of be like everybody else. And I get a prosthetic for people to thinking that I’m quote normal cause you know just like everybody else instead. What could you do with that leg to make it yours uniquely yours and maybe even give us sort of an edge like this superpower above what other people might happen to think of it as something cool. I mean I’m on a much more everyday level. You know when I was a kid when people had to wear braces they hated it it was like embarrassing metal mouth you know you looked really stupid. Well I have a daughter pre-teen daughter who has braces and she was kind of excited to get now that they’d do anything special. But the point is she is allowed to update by putting colored hops on them. So she’s got like her December holidays thing going on and she’s got red and green for Christmas. The point is it’s not just oh health care is like beige, dull, boring an awful something you have to do but it’s more about like helping you be your most awesome healthy self. Yeah I didn’t get that direction I’m exploring absolutely and trying to support the thing.
Saul Marquez: [00:20:32] That’s really interesting and excited for your thoughts and that and the podcast to let me know when it launches. Do you have a link for it. By the way yet or not yet.
Lygeia Ricciardi: [00:20:41] Not yet but stay tuned. You’ll hear about it.
Saul Marquez: [00:20:44] Ok. Fantastic. All right Lygeia. Time flies when you’re having fun let’s pretend you and I are building a medical leadership course on what it takes to be successful in medicine today and in fact the patient engagement today. And so we’re going to call it the 101 of Lygeia Ricciardi and so we’re going to write out the syllabus. We’ve got four lightning round questions followed by a book you recommend to the listeners. Ready.
Lygeia Ricciardi: [00:21:09] Oh OK. I think we should do this.
Saul Marquez: [00:21:12] Let’s. So what is the best way to improve. Health care outcomes.
Lygeia Ricciardi: [00:21:18] The best way to improve healthcare outcomes is to empower the patients and families who are actually more responsible for shaping them than anybody else.
Saul Marquez: [00:21:28] Love it. What is the biggest mistake or pitfall to avoid.
Lygeia Ricciardi: [00:21:32] One mistake I’m not sure it’s the biggest but it’s certainly big is assuming a kind of a one size fits all solution where I have seen that healthcare systems be particularly successful and technology companies too is thinking about how you can use technology to tailor things to the needs of the individual. So whether that means a larger font size for people who have trouble reading something small or it means putting it in their native language or maybe it means the approach. So for example there is an app I like Noom which is supposed to help with weight loss and motivation. And it asks you what kind of coach do you want do you want like a drill sergeant who’s going to let you go or do you want a really supportive friendly you got this kind of coach. And those kinds of things play into personal preference in a way that isn’t just something you might know about somebody from the demographics. So pulling in those individual needs and addressing the specific case of the individual is something you really want to do to succeed. And can you avoid doing so again at your peril.
Saul Marquez: [00:22:47] And you mentioned Noom how do you spell that.
Lygeia Ricciardi: [00:22:49] NOOM
Saul Marquez: [00:22:50] And and that’s an app from the apple store. Ok cool. Our listeners will include that as well as any other links that Legia mentions in the show notes. So how do you stay relevant as an organization. Despite constant change.
Lygeia Ricciardi: [00:23:05] Ok so are you asking about me and my organization or one. This is the syllabus for our class. How do you say yes. I think the best way to do that is to build a real connection to your customer who again may not directly be patient but increasingly in a value based world. Patients and families need to think of them as your customer. And you need to sort of keep communication keep in lock step with them because they’re going to be changing their needs are going to be changing their expectations are changing and you’re not going to know where that comes from unless you can have that communication going and certainly there’s a lot going on with sort of population based health and tracking large populations and understanding differences in how particular groups are acting or what their needs are. That’s really important too. But having those really personal connections there’s nothing else like.
Saul Marquez: [00:24:00] A great call out. And finally what’s one area of focus that should drive everything else in your organization.
Lygeia Ricciardi: [00:24:06] I mean it really has to be the patient and their family. It has to be like what’s going to make them healthy and help them meet their own goals. So I choose those words deliberately. It’s not just about making them healthy. There are certain health care situations in which there may be a tradeoffs. How quickly do you want to get better versus how much range of motion is it important for you to something like that you need to keep talking about patient and family and find out what they want. Maybe they don’t want to live as long as possible but they want a higher quality of life. Listen and respond to that as opposed to some generic sense of either. This is what we think health means or we’ve managed to heal a particular problem you know we fix the hip but the patient died anyway. You know it’s like what matters. That is what you should always keep front and center.
Saul Marquez: [00:24:58] Awesome. I love it. And what book would you recommend to the listeners Lygeia.
Lygeia Ricciardi: [00:25:01] So I want to recommend a book that doesn’t really have to do with health care or with patient engagement. I recently finished reading tools of titans by Tim Ferriss and what he does for the book is to interview a whole lot of people who are exceptional leaders in their fields. Some of them are amazing athletes some of them are amazing business people thinkers podcasters even all kinds of folks and tries to understand their secrets and put them all. Secrets of Success and put them all in a book. And I found that really inspiring and I you know I kept putting little tabs on stickies and as I was going and by the time I was done it’s quite a long book. It was like all covered in flour. There was so much that was so inspirational and it made me you know want to be a better person professionally as well as just in a very holistic sense.
Saul Marquez: [00:25:59] What a great recommendation. And yeah you know we got to think outside of the healthcare box. I think this is a great recommendation idea listeners if you want just check this book out as well as the syllabus that we just created for you. Go to outcomesrocket.com/lygeia that’s l y g e i a. And you’re going to be able to find all the show notes, as well as links to the resources we checked out with her today. So before we conclude Legia this has been a lot of fun. I’d love for you to just share a closing out with the listeners and the best place where they could get a hold.
Lygeia Ricciardi: [00:26:32] Thank you so much, Saul. And you know I think I like that point that you made about thinking outside of the box and we often talk in health care about silos and how there are silos maybe within industries different health systems don’t talk to one another even within conferences. There are too many tracks and people stay in their tracks. So maybe a resolution for folks for 2018 would be to get outside your silo. And by that I mean not just in healthcare. Think broader think always about how what you are experiencing maybe with technology or quality of life generally outside of healthcare. How can you bring some of that back. You go to a restaurant you have an amazing customer service experience. How might that relate to something you know within your health care waiting room for example or something like that. So let’s try to be creative and get outside of the usual silos.
Saul Marquez: [00:27:25] A great call out Legia and what would you say the best place for the listeners to reach out to you or follow you would be.
Lygeia Ricciardi: [00:27:32] You can follow me on Twitter. I’m at @lygeia you can reach me on LinkedIn. I was just elected to the 2018 class of HIMMS social media ambassadors.
Saul Marquez: [00:27:43] Congratulations.
Lygeia Ricciardi: [00:27:44] Hang out online. I was lucky to be part of that group in 2017 as well and it’s a lot of fun. But yeah I mean I’m out there on social media. I also have a Website lygeia.com so you know please feel free to reach out and share ideas, reactions, thoughts.
Saul Marquez: [00:28:02] that’s outstanding, Lygeia. So again listeners just join me in saying a big thank you to Lygeia. We really appreciate the time you took to talk to us about patient engagement today.
Lygeia Ricciardi: [00:28:12] Sure. My pleasure.
: [00:28:17] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes resources inspiration and so much more.
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