Healthcare Evolution: Lisa Shock on Population Health and AI's Role

[00:00:01] This podcast is produced by Outcomes Rocket, your healthcare exclusive digital marketing agency. Outcomes Rocket exists to help healthcare organizations like yours to maximize their impact and accelerate growth. Visit outcomesrocket.com or text us at 312-224-9945.

[00:00:29] Welcome to the Chalk Talk Gym podcast, where we explore insights into healthcare that help uncover new opportunities for growth and success. I'm your host, Jim Jordan.

[00:00:45] Welcome back to Chalk Talk Gym. Today we're honored to host Lisa Shock. She's a Chief Population Officer with a major healthcare payer. And Lisa's extensive background from a Duke University Physician Assistant to a Doctorate in Global Public Health from UNC Chapel Hill, empowers her to help us dissect the multifaceted concept of population health. We'll examine how population health tools vary in their deployment across sectors such as manufacturers, healthcare providers, and payers.

[00:01:15] And Lisa will also illuminate the challenges of healthcare disparities and illiteracy and their financial implications on our health systems. Finally, we'll delve into the transformative potential of predictive analytics and artificial intelligence in healthcare. So join us for a very captivating discussion. Lisa, please share more about your journey and insights with myself in the audience. I'm Lisa Shock. I'm a Duke PA and a Doctorate of Global Public Health from UNC Chapel Hill.

[00:01:43] I am a healthcare executive with a large insurance company. I'm the Chief Population Health Officer. And I enjoy combining my practical clinical experience with my experience in value-based care and corporate medicine and executive operations.

[00:02:03] So you've also worked at the state level from what I can see. You've done clinical services and programs. All that is sort of in your background. If you started from your time as a PA, how did you sort of get yourself from one-to-one care to multiple care, which is population? Sure. Yeah, great question. So I graduated from the Duke program and my very first job as a young PA was in rural North Carolina.

[00:02:30] And we had a small family practice. So we used to go up the hill to the hospital, catch the baby, come down the hill, do the well baby check. And I used to go up the street to see grandma in the nursing home.

[00:02:42] So I really enjoyed those years, really not only solidifying all of my training in medicine, but also really learning a lot about full-person care and what it takes to kind of blend behavioral health, community health, individual physical health. And really what I'm fond of saying, I was doing social determinants and drivers of health when it wasn't cool. Well, yeah, a lot before COVID talked about it.

[00:03:12] Right, way before. And practicing in a really underserved community that was very rural and small really put for me a perspective on my career that even though today I'm a part-time clinician and I always say I work in the nooks and crannies, so I do the nights and the weekends and grab the shifts when I can to keep that knife sharp because I really do enjoy taking care of patients.

[00:03:36] And I feel like it gives me a grounding and a credibility, quite honestly, in the C-suite that because I am still practicing and have had a really long run of uninterrupted practice in primary care, rural health and urgent care.

[00:03:49] But it really set that foundation for me later to get into population health with a really large physician group where I was just happened to meet my former boss at a state provider advisory committee that we were both sitting on for years. And she was one of the initial embracers of value-based care.

[00:04:14] So I ended up working for her and really kind of cutting my teeth on population health and what does that mean? And what is value-based care? And how can I partner with my CMO at the time to ride around a 300 provider network and convince people that this is a good idea? When I taught a course called Health Systems, which sort of walked public health all the way through to health care delivery.

[00:04:37] And one of the biggest challenges for me was sort of getting across population health because it's a term that's used in public health. It's a term that's used in health care delivery. It's a term that's used in insurance. So maybe we start out with the way I look at public health. I see it more as a disease prevention and health promotion at the community. Would you agree with that? I would. And then population health being broader where it's sort of the study of improvement of health outcomes, right? And determining all the little, I guess it's the social determinants of health, right?

[00:05:07] Improving those. So since you've been on the insurance side and provider side and the public health side, how do you play the game differently with those three hats on? It's a great question. So I very much am a healer clinician first, I think. And that's what really combining.

[00:05:25] So the way I view population health and my framework, and I've even implemented this in our work that I do in my executive role, I think about it as patient, provider of care and community, right? Because all three of those things, kind of like a Venn diagram, have to come together with the patient at the center in order to successfully improve health. And one of our physician leaders at the state level is fond, Dr. Betsy Tilson, is fond of saying more health, less care.

[00:05:55] And I really think that's true. I think if we as a system can do things in a more improved way because we're incredibly complex, incredibly matrixed and incredibly fractured in a lot of ways. If we can help that patient journey through those three realms or kingdoms in a better way, I think we can improve health. So when I think about population health, I kind of think about that holistic approach, if that makes sense.

[00:06:22] So where does health literacy come in to this? And I'm a crazy person about health literacy because in my community that was extremely underserved, third grade was probably high for some of my people that I was seeing. And I can remember having one patient that it took me a couple visits to figure out he couldn't read and really thinking about understanding. And I often quote Stephen Covey seven times seven ways.

[00:06:50] I don't ever assume understanding because I think at a lot of levels, we need to hear things differently and maybe have them presented differently. And then that depends on how we learn. I'm super visual. My husband is super audio. So I always kind of reflect on that. If you're a visual person, you might need to maybe have me draw a picture or explain something in a little more visual type of manner.

[00:07:19] Whereas if you're not an audio learner, you're not going to absorb that. And stress from the social drivers of care. If someone's stressed because they're homeless or they can't afford to have food on the table or they have no transportation, that's going to precede and overshadow managing a chronic disease like diabetes. I talked to, had invested in housing and said that housing has an implication on health care. It's part of it.

[00:07:47] I was very struck by the point he was trying to show is that by putting people back in housing, this poor community, the data went up on people's stress levels, food content. 100%. I've heard stories where people have said that literacy can account for almost 68% of health care costs. I've never been able, I've heard people quote that a hundred times. I've never been able to find any evidence on that. Have you heard of something? I have that particular statistic.

[00:08:17] A pretty similar statistic says that every prescription I write only about that many won't get filled. And one could extrapolate, right? And say, maybe that's a result of literacy. Because if I as a clinician am seeing you in clinic and you have a chronic condition like diabetes, and maybe you really need to be on insulin.

[00:08:40] Maybe you're taking pills right now and you really need to be on insulin because the pills just are getting our numbers the way we want to. Right. And what has been shown in the literature to improve your longevity and your morbidity and mortality statistics over the years. But if I don't, as a clinician, do a good job, in my opinion, of explaining to you why this is important and you have to believe it's important.

[00:09:06] And I've even said to patients, I can't care more about your body than you do. You live in that body. So I can give you information. I can tell you what literature says and what the guidelines might recommend. But if you don't feel that value, and that's part of literacy for you to understand that value and that impact it will have on your health, then we're not successful.

[00:09:31] When you look at it from a insurance provider now, what is the, as you look at the other segments from your purview and having sort of more data, what are the top three to five things that you think people could do to immediately improve population health just as a healthcare provider? I think definitely asking the questions. If you don't ask, you don't get in terms of information.

[00:09:54] And but even before that, I think, and I say this having been a provider in a community for a really long time. And even though I'm not a full time provider, I still have people find me on social media to ask me questions. And that speaks back to the core value of trust. I think the relationship between clinicians and providers and their patients is a precious one. I've always felt that way.

[00:10:20] And I feel like it's an honor to be chosen to deliver care to someone. And that's just my personal Lisa Schock philosophy. But I think with that comes a responsibility to do the very best we can, provide the best information we can and have that pure intention. And if we don't establish that trust, I think that's where we have more of an uphill battle. And I think especially on the insurance side, I think insurance companies do a lot of wonderful things.

[00:10:48] But I think they also are critically evaluated for maybe cost saving measures or efforts that might have an intention to really improve the health of a population. But to an individual person might feel really burdensome. Are you familiar with the concept of real time health care systems? Some of the dialogue that's been going on and basically is saying that 68% of the actionable data is outside of an acute care setting.

[00:11:16] So when you talk about this concept of trust, I also see it a little bit as cultural. And I see that with my aging family members when I go to the doctor with them. They don't want to bother them. Hey, dad, like this thing happened. Or one of the most interesting things when I was at Johnson & Johnson, they were doing a big roundtable on complications with prostate surgery. And it's 30 men in the room and people are asking questions behind the mirror, one of those formal situations. And no one's talking.

[00:11:44] And one wife came and she raised her hand. She said, aren't any of you other men having this issue and that issue? Next thing though, the room blew open with all the issues. So I think that part of it is how do we get doctors some information to ask the query that hits home of a person? I know that's true. So the concept is that our Apple Watches and our Alexa devices in all this other place has information that, quite frankly, physicians don't have access to. Now, I imagine that's part of the population health mission over time.

[00:12:14] Oh, definitely. And I think exactly what you're talking about is that intraoperability. Before my current role, I was in a tech company and they were using an app-based system to ingest or get more of that data from a Fitbit or a scale that might have a Bluetooth on it or a remote patient monitor that might check a blood pressure or an oxygen saturation. I think that's the interesting challenges.

[00:12:39] When you look at today, what are the challenges your organization faces with your services to match the future needs of healthcare? I think it's meeting patients where they are. And I think that's the challenge for all of us because everybody, just as we were saying a few minutes ago, people learn differently. People interact differently. A couple organizations ago, I worked for a company that was doing some really cool predictive analytics and modeling around different zip codes in the greater Washington, D.C. area.

[00:13:08] And they could tell by zip code who would answer the door if you knocked on the door for a home visit and who would be more likely to answer the phone. That's so cool to me to think about not just how people learn and how people intake information, but how people want to be contacted and how people want to have a reciprocity of information. And at the end of the day, it has to feel safe and it has to feel protected enough.

[00:13:35] I think there's a lot of people who get pretty nervous about, oh, should I share my information? Is that safe? Are you a scammer? Are you trying to steal my identity? I think there are some hurdles there when there are some digital solutions that are absolutely fantastic. But I think a lot of organizations struggle with those risk and compliance issues. And then federally, I know there was just a new regulation on kind of consents for patients. It becomes really complicated really quickly.

[00:14:04] It's not just a handshake and a cup of coffee and finding what someone's preference is. I think it's all our specialization. When you said meeting them where they are, I wrote to myself, where are they? Which is the other question. And when I worked at my previous organization that was digitally based and digital first, the big shtick was everybody's got a smartphone or at least that was the theory. So if you wanted care, you could get care right there and it could be as private or as public as you wanted.

[00:14:32] And I think that's where some of the, especially the mental health, right, space and some of those where you could actually get counseling and do some different things from the privacy of your home or your car or just anywhere. That opens a different world of flexibility beyond the traditional business hours of a brick and mortar. I was fortunate enough to be part of a congestive heart failure model in a big Fortune 50 company, which should narrow it down for you.

[00:14:57] And what was interesting is the nurses who took in this information decided all on their own without anybody sort of picking it up. They would team up so that they would talk to the person and they would become familiar to the person. And if person A wasn't around, person B. But there were only ever two people you'd talk to. And they also, in doing that, visited with the patients for the, they had a seven minute window, I think, or a nine minute window. And what the patient soon realized, if they did their vitals like they should, there was a three minute, you know, report in.

[00:15:27] And then there could be a five minute chat versus a seven to nine minute lecture. And what was interesting is that ended up being the success of the system is the ability to be digital, but have that personal touch. And I think that's probably the biggest challenge. Have you worked on any models that you thought was similar in the ability to get to that personal touch? I've had pieces and parts in different places. To your point, you will kind of start that pilot and you'll see little nuggets that might work.

[00:15:54] And then you want to kind of build the next one and either it's funded or it's not, right? And you move on to the next thing. But I think that there is some wisdom there in terms of finding a sweet spot because, and I think Amazon made it cool way back, right? If you read this book and you liked it, you might like this one. It almost implies that someone kind of cared what you were reading and that was thoughtful enough to make a recommendation.

[00:16:20] And I can share the value of it because I shared my account, my prime account with one of my daughters during college. And so the recommendations went a little south. And I have to say, even to this day, it's occasionally I'll get a nail polish or a dress or something. But the value of that is quite incredible. And speaking of that, how are you in your organization or you as a population health specialist looking at artificial intelligence? So it's a great question.

[00:16:47] And it's, I think AI has a wealth of possibilities. I also think it's pretty young and it's developed, right? And I say this having, you know, I also have, I do some adjunct teaching and I, we've had to revise our syllabus that students shouldn't be writing their papers using AI. We're supposed to be teaching them to be critical thinkers and it's okay to use AI for research, but we want to hear your thoughts. So there's a balance there and attention.

[00:17:15] And I think that holds true kind of cross-sectionally, right? Even as we think about data, I think in order to get a true picture of health, we need more data inputs and more creative data input. We don't just need how many times did you go to the hospital? How many prescriptions did you fill? How many times did you go to the doctor? What is on your problem list in terms of codes for diagnoses? We also might want to know, do you live in a food desert? What's your zip code?

[00:17:42] There's that whole school of thought about zip code versus genetic code. Some consumer data can be incredibly informative in ways that affect health and influence lifestyle choices that may or may not really be a choice depending on where you're living. So I was talking to someone today who's an expert in AI and was doing work outside of healthcare, which obviously is going to move fast. Healthcare lags generally because we're literally life and death in what we do.

[00:18:12] So we're going to see AI and scheduling and things that are innocuous like that. But one of the things in our discussion, it seemed to me that analytics is about identifying patterns and predicting future trends. And I think AI needs the insights from those systems to be able to continue to grow. So I think it's a hand in hand. And I think as healthcare, we're still in the predictive analytics phase for the most part. Would you agree with that? Yes. That's very interesting.

[00:18:38] So switching topics, can you tell us the time of how you've had to adapt your strategy quickly? And given your career path, there has to be numerous. Let's see. I'm trying to think of a really fun, good example. I would say in one of my former role, we as a company were really aggressively embracing value-based care. And we were partnering with some health systems that were eager to jump on the train, right?

[00:19:08] And I think some of that eagerness at the time was intention, but perhaps a little premature because we went full force or whole hog, as we say in the South, into this effort nationally with a bunch of partners.

[00:19:23] And then within a year to 18 months, we were unwinding because what we thought was going to be a financially good move for these hospitals and health systems and would perhaps reach more patients or deliver better care for that particular system ended up being too much of a financial risk. And it just meant that they had to slow down to speed up.

[00:19:48] That was a really important pivot for myself as a clinical leader. I love building teams and creating models of care where we can improve delivery. But having to build it up to tear it down was definitely a pivot. And I think for maybe an example for our audience, I started on the manufacturing side with medical devices and drugs. And we could tell you down to half a penny anything that was going on in our organization. We have those kind of systems.

[00:20:15] And working with chief financial officers of hospital systems, they basically put their costs in departments and they can get a broad view, but they can't basically say how much was each individual procedure and the dispersion among an individual procedure and how many sutures people. We've seen demonstration projects that people have done, but it's not something yet we can completely do abroad across all of healthcare. And I think that's part of the challenge. So how do you keep current on all the rapid changes that are going on?

[00:20:45] Because clearly in the population health arena, there's so much technology and interoperability based with cybersecurity concerns. There's sort of a balance there, right? How do you keep current? Where do you go to look at? 100%. One of my superpowers, I would say, and something I've truly been blessed with is I read really fast. And that has served me well in a lot of my role. And I must have at least 50 blog subscription. So my inbox is just flooded kind of daily.

[00:21:14] And that's kind of fun because then I can see the themes, right? If I can see something like five times in the morning, I'm probably reading that a little more closely. I definitely have those modern healthcare Becker's Hospital, some of those different ones that have the subsections that you just named, right? They've got a financial one and a payer one and reimbursement one and a coding one. There's a lot of those kind of 64 crayon bucks to expand upon.

[00:21:43] And I'm also always looking at some of the kind of writers. There's a couple of people who have kind of started their own laundry list kind of blog and then they link to other things. So I'm constantly like digging around. Can you share some of your favorites? Because that's people like it. So Jared Daszewski is one. And then Pathways Medical is another one. Those are two that I've been reading a lot lately. And they're both really good. Jared, I think, is a resident.

[00:22:13] So it's kind of cool to see his journey. And I think yesterday he's getting ready to do nights in cardiology. And in my clinical training at Duke, we were on all Q3s those days were long ago. But there's still used memories that are in there. Now, do you use Feedly or any sort of thing to keep these things organized? Because you read so fast? No, I'll have to check that out. Yeah. Okay. No, my wife has the skill that you have for reading. Literally, like when I hold a piece of paper up, she's done.

[00:22:42] And I often think she didn't read it. It's a tremendous skill. So how much reading do you do a day? Is it something you like do an hour in the morning or at night? At least. Yeah. I would say probably a couple hours a day. And then my Kindle is like full of different things. And then I have the brain candy stupid fiction. Just easy stuff. And like that kind of stuff, I can chew up two, three, four or five books a week if I'm on a roll or like in a series.

[00:23:09] But yeah, I would say probably one to two hours a day. I'm usually prowling around and reading some things. It seems to be a theme by successful people as they spend at least an hour to two hours a day doing that. At least. Very common. So what's the biggest lesson you've learned thus far in your journey? Oh, that's a great question. A few years ago, I had one of my bosses say to me that it's along the lines of slow down to speed up.

[00:23:37] And because I get excited, right? I get super passionate and really excited about the potential and the excitability of making a change. But change often is multidimensional and slow. And so you have to have a patience there and really be thoughtful. And don't jump from A to C. Don't forget about B. And really be thoughtful to go in the steps that need to happen in order to execute effectively.

[00:24:07] I think that's amazing advice. It strikes me as one of the things of working with Heinz College, which is part of Carnegie Mellon University. They do a lot of public policy work, obviously. And we've been part of projects where we've helped tease it apart after on success or failure is sort of, they call them a capstone. So the students do it. Sure. And so there was this one particular program where they were trying to put food into a food desert.

[00:24:32] And step one is they discovered people didn't necessarily have the pots and pans and utensils they needed. So they needed to do that. But again, they lost this company that was doing it, lost track of who's gotten what. And then secondly, they didn't put people of diversity on the panel and the food they selected were not culturally appropriate. So it always struck me that you can go out and get the 50 million in funding or whatever it is you're trying to get, which is an accomplishment.

[00:25:00] You step back and you thought you've done something. And there's so many details associated with deploying something. There's a lot of operational aspects to it. Definitely. So what do you see as the biggest opportunity for growth or the biggest threat in health care in the next decade? Great question. I think our continued silo ability. My husband just came back from out of town. We have a family member who's sick and there were four caseworkers over the weekend.

[00:25:26] And we had a plan on Friday and he literally went through four people and two years Monday. And the outcome was not different. I think in health care, we are so big. We get in our own way. And until we figure out how to streamline and make some of that more efficient, we will continue to get in our own way. I think part of it, too, is our systems. I was talking to someone who is a chief commercialization officer of a pharmaceutical company that has both Europe.

[00:25:56] He speaks seven languages and he grew up in Europe. And although there's public and private people think in France it's all public, there's private insurance there, too. The key difference is they were all running off the same backbone for billing. So the terms and the numbers are the same. Whereas in the United States, I did a podcast with a gentleman in New Jersey, a physician who had 35 different contracts with insurers between New Jersey and New York.

[00:26:21] And the paperwork was slightly different for everybody, even though you have your particular SF 1500 form or whatever. Right, right, right. You'd be 40 form. There's still other aspects of things you need to submit that just very different. And he probably had 100 quality metrics across those contracts. In my old ACO world, we used to struggle with that because if we had a value-based contract with six different payers,

[00:26:48] because that was what was in the state at the time, all the major payers in the market, each one of them would have differences and nuances in each contract. And in order to achieve the shared savings or the value, that burden on this system became increased. What do you see as the biggest threat going forward in the next decade? I think not paying attention to what the patient really needs or wants.

[00:27:16] Like in your food example, I wonder if they started by listening or started by asking. Yes. Instead of just being top heavy and throwing money at it. They didn't start that way. They started looking because they were failing. Yes. Exactly. So I think I'm always really nervous when I feel like there's a loss of compassion for the patient at the center and we lose that patient's voice. And that's why in my population health framework, I'm always thinking about community.

[00:27:44] And for me, community includes family and friends and church people and other cultural people of importance in their world, right? Whoever or whatever that is in their belief system, because it's part of who they are and it's going to be part of their key to successful health. And I think the challenge is I was talking to an executive director of extended care, home care and nursing home organization. And one of the things that she commented about is 30 years ago, people tended to live near their families.

[00:28:14] You and I could go see grandma at night or whatever. And today, everyone's all around the world. And who do you keep informed? And how do you keep informed? And where's the HIPAA line? And where's not the HIPAA line? It's a different kind of scenario from that perspective. But I think it comes down to, as I listen to this, meeting them where they are and where are they, I think is really kind of something that you bring forward.

[00:28:37] And it strikes me that I'm involved in a precision medicine play on pancreatitis, which is a very small, very narrow kind of niche thing. But what they've determined is from one to 10 on your way to probably pancreatic cancer, here's the signs of things that you could see. And here's how we can intervene. And in a practice that has 5,000 patients, you only have two or three that have those. I could have a rash, you could have a rash. But for me, I'm that genetic profile. It's a big issue, right?

[00:29:05] And the system can even come back and say, now that I've looked at hundreds and thousands of these people, there's something going on between point A and point B, a point five. Let's go in and look at it. And that sounds very simple and easy, but that is just one little piece of a much broader system. And I envision that someday you'd love to see that kind of precision play in the bigger context. But the data and the enormity of it is just, it's incomprehensible to me. Staggering. What else would you like to share with our audience?

[00:29:35] I am grateful to be here. I thank you for the opportunity. I would also share with the audience that if you're in healthcare, it's a hard time, especially post-pandemic. And I don't think that we've fully seen or appreciated all the effects. I think there really is some truth to giving grace and being kind and remembering that everybody's got a lot of stuff. And I tell my daughters, teenagers, I say, what you see on social media isn't always real.

[00:30:04] That's not always the perception. And I think at work and on social media and in our lives, people see one little snapshot. It's the way I describe EKGs to people. I say they're like Polaroid pictures. They look from this moment backward. I can't tell you if you have a clogged pipe. We need to do other tests for that. So I think just remembering in our interactions with other members of the healthcare team that we really are all rowing in the same direction to try to improve health and population health.

[00:30:32] But sometimes some days are really tough. For what you do, I think that I remember years ago, a very famous doctor decided to go be the chief medical officer of Medtronic at one point in time. And I had a chance to ask him why. And he said, I can handle as a physician, help the lives of one or two patients that I'm working with at any moment. But in this job, I can help the masses. And I think you started your career in a very similar fashion as a PA.

[00:30:58] And now you're able to look at it and bring that compassion to the systems level, which I think is what we're vastly missing in this country. There's a reason why our doctors and our nurses and our PAs are burning out, right? That we just don't understand what it's like to be a day in the life. So I thank you very much. Yeah, thank you. So great to have the opportunity. Thanks for tuning into the Chalk Talk Gym podcast.

[00:31:22] For resources, show notes, and ways to get in touch, visit us at chalktalkgym.com. This podcast is produced by Outcomes Rocket, your healthcare exclusive digital marketing agency.

[00:31:48] Outcomes Rocket exists to help healthcare organizations like yours to maximize their impact and accelerate growth. Visit outcomesrocket.com or text us at 312-224-9945.