Episode 19 : Achieving Digital Innovation at Scale:

SFTS_Ashis Barad.mp3: Audio automatically transcribed by Sonix

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Intro/Outro:
Welcome to Smart From the Start presented by care.ai, the smart care facility, platform company, and leader in AI and ambient intelligence for healthcare. Join Steve Lieber, former CEO of HIMSS, as he interviews the brightest minds in the health provider space on truly transformative technologies that are modernizing healthcare.

Steve Lieber:
Hello, and welcome to Smart From the Start. I am your host, Steve Lieber, and it's my pleasure to bring to you a series of conversations with some of the sharpest minds in health information technology. On these broadcasts, we discussed the smart directions healthcare companies and providers are pursuing to create smart care facilities and teams. Today, I am joined by Doctor Ashis Barad. Doctor Barad is Allegheny Health Network's chief digital officer and information officer. He came to Pittsburgh in spring of 2022 from Baylor Scott and White Health. Most recently, Doctor Barad served as clinical lead for Baylor Scott and White's Digital Health Office, managing the office's general data analytics and spearheading the network's digital health and virtual clinical strategies. As chief Digital Officer, Doctor Barad now leads HN's efforts to deploy technologies that extend the reach, access, and effectiveness of HN's clinical care delivery, enhancing both the patient and clinician experience relative to electronic health records, artificial intelligence-powered data analytics, wearable devices, and other virtual tools and platforms. Welcome, doctor Barad.

Dr. Ashis Barad:
Hi, thank you Steve. I really appreciate you having me.

Steve Lieber:
Yeah, I'm looking forward to this conversation. You're an individual that's coming to us from a little bit of a different background in terms of of past two organizations that you've worked for, Baylor Scott and White and Allegheny Health; both are leaders in taking and managing risks across large populations through your health plans. And so the first question is, how does that impact or influence the ability that you have in prioritizing, evaluating, and adopting digital solutions? Or is it any different?

Dr. Ashis Barad:
Yeah, no, it's a great question, Steve. I think that I think at its core, it's actually very different. And it's a big reason why I had a wonderful stay, learned a lot at Baylor Scott White. But Texas and was what the commercial markets, the Medicare and Medicaid markets the to your point, the risk contracts are very different in Texas than they are in northwestern Pennsylvania. To your point, I think what we can do here with a large payer that the at the very largest blue in the country, with around 6 million members nationally, and then a provider systems that are owned by that payer. We look at the digital health world, the ecosystem in a much different way. And what problems are they here to solve than I did in, Texas, I believe, and that's not to say that we didn't solve for the same problems, but you may also be with different demographics and different conditions and, and what have you. You may go about solving them in different ways. So I'll just give you a really quick example, which is we may be more aggressive here in at Allegheny Health Network as part of western Pennsylvania, about the demand disruption of keeping people out of the hospital. Right. And whereas in Texas, although we all want to move upstream and take care of patients much earlier, that the timeline of really doing that demand destruction may have been different.

Steve Lieber:
With the large population being under risk-type contracts, does that drive you to adopt some different technologies? And maybe that's what you're alluding to there in your answer, that there are digital technologies that you use to help, for example, avoid readmission or the other sorts of factors that you really want to make sure you control in a risk environment like a payer-provider has. So, does that take you into some different sort of directions?

Dr. Ashis Barad:
Right. It does. And so for those that those listeners that may not understand the ecosystem, if you don't mind, I'll just talk about it. I alluded to it, but Allegheny Health Network is a 14-hospital health system, around 4.5 billion annual decent size, about 2000 physicians inside Pittsburgh and western Pennsylvania. We actually have a little bit of footprint in New York and up in Erie. So it traversed a little bit beyond Pittsburgh. And there is the health system, and that is owned by Highmark Health, which is a larger, obviously diversified as a insurance arm to it as well. Highmark Inc. that is a very large blue, as I said, about 6 million members. There's other there's actually a loss company. There's a 10,000 FTE IT company that Highmark Health owns. And it is a very complex kind of ecosystem. And within that, the arrangement may be different than one Y, which is a provider system that had a small payer. So it's just how you think about things and how you operate. And then the scale. With which you do it is different. So with that being said is how I look at solution is absolutely through the lens of that. But the AHM perspective, what we are not is a closed system. It's a complex ecosystem even within agent, which is about half our claims are through our Highmark payer. Right? which then we have our claims to be with other payers. Some of them are in risk-based contracts, but many of them are still living in a fee-for-service world. Our physicians, our nurses are all providers, administrators are living the one leg in both world. I have no illusions. That really is all really for both world. And then within that, Highmark Health has a lot of digital solutions that they as they now from like you're seeing a lot of payers really go into the direct to member digital health solutions to really from utilization and avoiding ERs and hospitalization perspective, we're tied in and help design and really implement and really activate some of those.

Steve Lieber:
I really and taking this opportunity to learn a little bit about this environment because I just really don't know it, that do you have a closer relationship with the payer? Because it's in the enterprise, so to speak. Talk a little bit about how that plays out. Do you have access to better data? Do they have better access to patient data? And that sort of thing. Is the relationship a little more collegial versus adversarial, a little more insight in terms of that relationship between the two?

Dr. Ashis Barad:
Steve, I think you hit the nail on the head of why I came. I came because I think data may be the only true differentiator we have. I think you know that and exactly what we're doing here. The experiment is something called Living Health, which is Highmark Health strategy and why there's Highmark Health, separate from being separate from AHN because of firewalls that do have to exist, as you well know, inside the ecosystem. So now we have a parent company, Highmark Health, that is able to cross that within the boundaries and constraints that exist. To your point, the data, the interaction model, the solution, and the design is in a what we call a blended manner. Absolutely we are. No, it is not a parent company that's off on somewhere off. And we look at solutions and then one day we may say, hey, do you have something that you're looking at as well? And let's just make sure we sync up. That is not what we're doing here. What we're really doing is saying, what does it really look when a payer and provider intimately work together from the start and really solve together, having both the clinical arm and the financing arm and and really can activate that.

Dr. Ashis Barad:
So that data that you talk about right? Where an epic EMR and we Highmark is actually announced that they're going to go with forward with epic payer platform. So from an EMR perspective, that alone is really what can we do together truly to realize all the gains within that epic ecosystem. But of course, as the world is much broader than just the epic ecosystem as well, the source of truth always is going to be claim data. So we do have that blendedness. So we have a chief data analytics officer, Richard Clarke, who's at Highmark Health. And he oversees and part of the governance, and I sit on that governance at the Highmark Health site. So we we solve together around that data. But that data is interoperable. And so we are really starting to peel back those layers that everyone for decades has complained about is the interoperability. So we're really trying to be leading much forward and leapfrog the industry on what is really possible in the world.

Steve Lieber:
You've headed right into the area where I wanted to go next. And so, moving out of the relationship between payer and provider here, and let's just focus within the provider organization. As I look over the past 20, 25 years or so, we spent years and billions on digitizing data. You go far enough back, and we were all using paper records. And so we got out of the paper, got it into electronic digitized formats with the EMR and such. But we also did a lot of point solutions. You touched on the challenge you have in terms of interoperability and integration. So where do you see things within the institution now in terms of where we are in overcoming the silos of data, and what have we learned? What are we working on? Where's that going? Just talk a little bit about interoperability and the integration of data and the use of that data in an integrated fashion within the provider setting.

Dr. Ashis Barad:
I think that the I always think of the analogy of Julia Child's when she makes the beef bolognese, right? He has all these complex ingredients on the table. And she says, today we're going to make the beef bolognese and we're going to start with whatever it may be. And that iconic thing. I always tell everybody they have a high mark, and there's a Google relationship as well as the high mark side. We have all the ingredients, the beef bolognese the potential to make this amazing meal there. And now we have to now. But the recipe is not laid out. No one's done it, so there is nothing to Google. There's nothing to go, pun intended, but there's nothing that we can do to say, all right, this is how it's done. Because X's other company did it or Y's system did it. We have to reinvent this from the get-go. And that's what excites me every day to wake up and go try to do that, create that recipe. So all that being said, I think the answer to your question is that there had to be, and there is a force function to take place for that to really activate. And I think that is going at risk pretty much fully at risk with the payer. And that has forced the function to say, we do now have to figure it out. There has to be a burning platform to say, look, it's nice to do a digital pilot and create some smart on-fire interoperability and put it in there. And we've done a lot, and I can talk about what we've done there. Here in literally, we're talking about days from now.

Dr. Ashis Barad:
All right. We are going to be at risk with our whole population inside western Pennsylvania with Highmark Health. And that's not just the activated population, the unattributed population as well. That really now creates that conundrum of I need to have data. I need to be able to really be able to have line of sight on those that I know that are in my EMR, and then those that are not known to me, not in my EMR. What are my growth strategies? What are my ways that I'm going to engage that population if they show up my Ed or not, that we're going to treat anybody differently. Because that's the other part of the conundrum is I'm not going to go to my doc and say, we're going to treat different people differently based on the insurance type. They don't do that. I'm a doc. I'm not going to do that. So we have to dial, figure out those complex issues of how to them. And I think data and interoperability and putting insights inside the EMR that do not burden our docs more are with just another BPA. So how do we really create that seamlessness and ease by which we know the population that we engage in, and the programs and solutions that our payers have for free, that do not create any burden on our care teams, how do we really allow them to our providers to that enroll, engage and get them plugged into all the things that they have access to that many patients don't know? So that is the complex problem that we're taking on these next three years based.

Steve Lieber:
On with your comment about seamlessness and ease and such, really the direction, I wanted to take next, which is thinking about smart technology, obviously, I'll call it mistakes, but just just simply the nature of the early forms of EMRs and such. We took doctors and nurses away from the patient and put them at the keyboard. And so now we've got to figure how to get them back to the patient and off the keyboard. A number of things like ambient monitoring, sensors, artificial intelligence, voice over type, variety of different technologies are out there that we're putting in that broad category of smart technology. How are you looking at those things, and what's on your mind in terms of those smart technologies that do make it easier for the clinician, better for the patient, and drives us to a different place than we are today?

Dr. Ashis Barad:
Yeah. Well, so the first thing I'll start with, which is title and not domain to say that I'm going to focus on title, but the actually now the chief information officer versus the CDO. And I say that personally, which is digital off on the side and someone doing digital doesn't really it's not going to many times I'm not going to say ever, but many times doesn't translate into true adoption, true engagement, true front right. The front lines really adopting that. So I say I only mention the title to say that I'm also in charge of accountable for the IT infrastructures and EMR infrastructure as well. So I'm also functioning as the CMIO of AHN as well. So at this point in time, I have the workflows of the EMR. I have the infrastructure of IT and other non-epic technical tools, and I have the digital and virtual arms of it. And that is not a power play that that is the ability to really seamlessly connect all three in a way that creates value. And that's the point I'm getting at with that. When you talk about smart technologies and funny, you ask for our session last week as they announced a new hospital being built in our southern region called Canonsburg. And the whole premise of this hospital and I and I actually pushed back and said, we're not going to call it a smart hospital, right. And the reason I did that is it's not about I understand you want it to be smart, and I want it to be the smartest hospital like everybody else wants it to be the smartest hospital.

Dr. Ashis Barad:
But I really want it to be a hospital that solves a real problem for our community and for our health system. And so what I'm getting at is we are looking at that hospital and saying, what does a value-based care hospital look like in America? All right. But that's not how hospitals are built. They're not built to the lens of value-based care. They're not built-in risk model and avoiding ER, and waiting hospital. Right. And every my mentor told me this in medical school so that she, you're going into a profession and being a doctor where every single day you work tirelessly at putting your thought, which is what we do. You're a good doctor, and you do well. You're healing people that don't no longer need you. No, I don't think I'll ever be out of a job for that reason, because there's plenty of people in need. But the principle, the philosophy is still there. And so this is a different kind of concept of hospital, that they're working tirelessly every day to put itself out of business, which. So then the smart technologies are looked at. And that's what we did. We spent four hours with hospital presidents, chairs, administrative leadership, and C-suite executives, and we sat down and said, what does that look like exactly? But that has to be done, obviously in a business model that has to be sustainable, right? So what does that really look like? And so then smart very different.

Dr. Ashis Barad:
And then you start looking at the pre-hospital, the post-hospital, the whole full transition of care. You don't look excuse me at just the four walls and what are you doing inside the four walls? You have to move upstream, and you have to move post. And so then the smart hospital is really solving a real problem. And I think I've heard this from other people like me who says the best technology is invisible, right? And I love that line, because then at the end of the day, that should just really be doing it in the background to allow people to really just do the right thing and do what they do. And then they have all the data, information and actionable items that they have within that. So we're looking at virtualizing, of course, like everybody else and modernizing and making it connected, patient monitoring. But like I said, we because of our highly complex matrix organization, we have a home program that we have our own DME companies. We have our own post-acute facilities that we have partnerships with right and tax. And we go on. So now we really say, what does it look like rose pre and post. And it's not just going to be focused on the hospital. So the smart technologies are to allow us to really be able to do that in a similar way.

Steve Lieber:
Building a new hospital seems like perhaps a easier not in the sense because you're starting with a greenfield and you've got to start out with digging the foundation and everything else that goes with it. But perhaps easier to bring in some smart technologies than retrofitting an existing facility. You mentioned before we came on the air that you're going through some remodeling there. Yeah, most of our listeners probably are in existing facilities. And so what do you see as perhaps some of the challenges in your existing facilities? That may be barriers, and barriers can be overcome, but what are the sort of things that you're having to deal with there in the existing facility?

Dr. Ashis Barad:
Yeah, no, I'm doing that too. Yeah. It's great. Easier to your point to talk about the new build. We're doing the same thing inside existing facilities that are over 100 years old. At one point, it's a difficult proposition. And again, as the digital guy that comes in and says, hey, we're going to do the biometrics and the wayfinding, everybody's going to go to a room. It's all going to come to Bam. And the Toyota method, whatever it may be, that's all nice. And then they look at me and go, pumps are connected to the Wi-Fi, right? Yeah, that's a true story on day one. And so I got the reality check pretty quickly 18 months ago. And listen, I'm living the life that you just talked about. And it is so by remediation standards, really fundamental in the bottom-of-the-dramid aspect of things. But I think that the new technologies and the companies that we're working with now, and I actively think about these companies and talk to them about leadership, about the talk about smart hospitals. So we're talking about the inpatient space, the whole world of smart technologies in the ambulatory. So I don't want to I just want to make sure that we're not trying to say smart is only inside hospitals. But since we're having that conversation, the smart inside the inpatient space is I do have robust conversations with these companies to say, how are you helping me solve for that? And how are your technologies retrofitting inside the infrastructure that I have? So I'm being very open and transparent about the infrastructure that I have and saying, how do you help me solve within those constraints? And those are the companies I'm working with, because a lot of these companies have done that with other hospital systems, have learned lessons. So I'm learning just as much from them as me than saying this N of one or maybe N of two because I was at Baylor, but right. That's still just an N of two. And some of these companies do now have N of 30, 50, 80, 100 of hospitals. They said, be creative about thinking about this and I. Where the park really does come in, because they're bringing just as much of the table as I am.

Steve Lieber:
Yeah, that's a great point in terms of looking at companies as a partner, because they do have experience across multiple settings and can bring things to you that you haven't experienced because you haven't been in that many different institutions compared to to their client base. And you truly do gain value from that relationship instead of just looking at them as someone selling you a product. That's a great insight. Yeah. To wrap up, our listeners, are people like you? CIOs, CNIOs, Chief Nursing Information Officers and such, and I do let me digress my question minute and reinforce what you said about your title and that bringing it all together. We did go through a period where IT was over here, digital was over there, innovation was still in a different place, and we just actually created more silos. So anyway, we still have some from different silos and all all are focused on generally the same sort of things in terms of how to use technology to drive better patient care and better patient experiences. So what we're looking for as a close here is your big takeaway. Things that you've learned that you would share with others as an important, practical piece of advice.

Dr. Ashis Barad:
But I'll condense it down to a couple. Listen, I'm a pediatrician, right? I'm a pediatric gastroenterologist, and I always tease, I'm a medicaid doctor and I am, and I started I was in rural Texas for a long time, serving people that lived eight, nine hours away with no, with nothing. And I say that because I think the Wheel of Innovations, I think government healthcare system turned slowly. And the political struggles are real, always in any organization. But I think we do have to always put our customers first. And those are the people we serve, the clinicians that serve them and really go forward and making sure we're really solving a problem that really solves for them and, and really solves for them at scale. And I think that's important work too, is scalability, because there's a lot of solutions that are not really sustainable. They work in a pilot and pilot alone because they're just really not going to be able to be. And then they're linked to sustainability and scalability and then they don't scale. Right. And then we go into pilot pyelitis and whatever the term is. But to really solve for scale and that's harder. But solve for scale. It's almost backwards. I think of everything I do and then a pilot, if I'm going to have to do a pilot, I go to scale first and then work backwards from there. And because I think all of us see wireless and never scale. And so I'm flipping the paradigm and saying, try to solve for scale first, right? Then start with those problems in mind. Now, you know, problems may exist at scale and then go pilot to solve.

Steve Lieber:
That's the great insight that really is you have you've turned the paradigm there so that you really are focused on what ultimately is the measure of success, the ability to scale, and then, as you say, work backwards and go back and solve what you need to in your pilots. That's a great insight. Ashis, I certainly do appreciate the time that that you've given us today. This has been a great conversation.

Dr. Ashis Barad:
Thank you for having me wonderful.

Steve Lieber:
Likewise. Thank you again and to our listeners. Thank you for joining us. I hope this series helps you make healthcare smarter and move at the speed of tech. Be well.

Intro/Outro:
Thanks for listening to Smart From the Start. For best practices in AI and ambient intelligence, and ways your organization can help lead the era of smart hospitals. Visit us at smarthospital.ai. And for information on the leading smart care facility platform, visit care.ai.

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