How Innovating Cardiac Care Can Help Advance Population Health with Jonathan Adam Fialkow, the Chief Medical Executive of Population Health, Value, and Primary Care for Baptist Health

[00:00:05] 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.

[00:00:18] Hi everyone, this is Dr. Jamie Olbert, Chief Medical Officer of Memora Health and host of the Care Delivery Podcast. I'm joined today by Dr. Jonathan Fialkow, Chief Medical Executive over Medical Specialties and Population Health at Baptist Health South Florida. Thanks Jonathan for joining us today.

[00:00:37] Just to get us started, why don't you tell us your story? How did you end up in your physician leadership role today? What was the kind of abbreviated journey that you took?

[00:00:48] Yeah, it's a pleasure being with you today, Jamie, and I appreciate the opportunity to share some insights and some experiences with your audience.

[00:00:54] I've had a kind of interesting trajectory. People ask me a lot, how'd you get in this role? Because I have very disparate roles. And I'll try and be relatively brief, but it does give a relatively unique perspective.

[00:01:04] Going back to childhood, when did you decide to be a doctor? My father, unfortunately, when I was in high school, had a major medical event. He actually survived it, but spent a long time in a hospital in New York City.

[00:01:14] We grew up in Long Island, six weeks in the hospital, so weeks in ICU. My mom and I would be at the bedside and in a waiting room for 15-minute visits three times a day.

[00:01:23] And I remember one form of experience, which I've shared, which is true, which is my father's kidneys had failed as a result of the shock. And the doctor came in and basically said to my mom and me, and my mom's not in the medical industry and I'm in high school,

[00:01:35] oh, your husband's kidneys have failed. We're putting him on dialysis and walked out. And of course, we're in absolute shock and upset. And about 20 minutes later, another associate came in.

[00:01:43] And we sat down with us, put her hand in my mom's lap and said, listen, this is not unusual in this situation. It's probably temporary. We're doing this.

[00:01:51] And walked out and I said that to my mom. The information was the same in the sense that the medical condition was the same.

[00:01:58] But the two different approaches were seminal in my thought processes, as I said, relevant to a young person. And that's where I said, I want to go to medical school.

[00:02:06] And I want to be the kind of doctor that is empathetic and can help support people through good and bad times and not the, we'll say, automaton of just this is the science.

[00:02:14] And I took that through my professional career. I went into cardiology, specifically preventive cardiology, trained as a lipidologist.

[00:02:20] And I think part of that's as well, because we tend to manage people who are, as I tell people, either sick or scared or more commonly sick and scared.

[00:02:29] So it's not just the medical aspects, but how we treat them as a human being, how we treat them within their own ways of managing their lifestyle and their medical care and how it intersects.

[00:02:39] And through that, I also started getting more involved in efficiencies and standardized care and realizing how people suffer when there's lack of standardization and variations and how doctors and health systems manage populations.

[00:02:52] So I started getting more involved in value-based care and population strategies.

[00:02:55] And the confluence between, I think, a practicing clinical cardiologist, lipidologist, and the idea of how we manage people outside of the four walls of a hospital is of preeminent importance brought me into these leadership roles.

[00:03:09] The one other part of that I'll add, Jamie, is I'm a tech guy.

[00:03:12] I'm an early adopter.

[00:03:14] I love toys.

[00:03:14] The cardiology space and certainly population health affords a lot of early exposure and perhaps development of innovative strategies using tech tools and data and patient engagement strategies.

[00:03:26] And that all came together, which gives me the expertise in terms of value-based care, population health strategies, efficiencies and what's effective, what's efficient.

[00:03:35] But also remember that these are people that we're taking care of and they have lives and they have obligations and they have desires and they have fears.

[00:03:41] And I think if ultimately you put that together, it makes you a little more successful in taking any of those components in isolation.

[00:03:48] That's great.

[00:03:48] What a journey you have.

[00:03:50] And in you speaking about some of your interest in overseeing population health and making impact on a larger scale than just the one-on-one interactions you're having in your cardiology clinic,

[00:04:04] I'd love to dig in there a little bit more.

[00:04:06] Tell me, what were some of the challenges and some of the problems that you saw in your training and some of your early years as a practitioner that led you to want to take on more of a population health approach

[00:04:21] and think about how to affect change across that larger segment of patients?

[00:04:27] Yeah, again, I appreciate that question because it actually makes me be a little insightful to answer it.

[00:04:33] And I think, again, I think through this quite a bit because it's a pendulum swing.

[00:04:36] If you think about this, or I think about this, in your clinical training, you learn physiology, you learn disease management,

[00:04:41] you learn how to apply certain pieces of information that you might get from a patient or from a chart or from a procedural information.

[00:04:50] And you have to process it to collate it in a way that provides a beneficial impact for the patient.

[00:04:55] So you think about it, it starts in a very personalized, I will say precise way.

[00:05:00] I have a patient in front of me and I got to figure out what's going on with them.

[00:05:03] But then we move into population.

[00:05:04] So what helps us guide that information?

[00:05:06] If we look at, let's say, lipid management guidelines or hypertension management guidelines or diabetes management guidelines,

[00:05:12] those are population data, right?

[00:05:13] You can't tell a 60-year-old diabetic smoking you're going to die of an AR attack.

[00:05:16] You can say you're more likely than if you didn't smoke and you can't tell a 60-year-old smoker, non-smoker, you won't have an ARB tech.

[00:05:23] So it starts with our training with someone in front of you and you're taking personalized, precise information.

[00:05:29] But the decisions you make go into the population space, right?

[00:05:33] Probabilities regarding outcome trials looking at thousands of patients.

[00:05:37] Now, I think we're moving back towards with great opportunities, whether it's through remote monitoring devices and physiological monitoring,

[00:05:43] whether it's through genetic testing, whether it's through various imaging and various other biomarkers,

[00:05:46] we're getting back to the personalized approach.

[00:05:48] So now I know I may have, let's say, hyperlipidemia or hypertension.

[00:05:53] But we can actually get down to the point of what do you need for your risk reduction?

[00:05:58] What do you need?

[00:06:00] Not everyone is salt responsive.

[00:06:01] So maybe we get more precise.

[00:06:02] So going back, the challenges, I think, is when we just think of the person as a medical condition

[00:06:08] or is the health system a disease state, right?

[00:06:11] We want, or a test, right?

[00:06:12] We want mammography because we want the imaging, not we want to help people determine if they have breast cancer so we can improve survivals.

[00:06:20] The challenge is the big wave was towards doing more for people under large population-based informations.

[00:06:28] But now we're moving into the ability to take the particular populations and more individualized and make it more precise.

[00:06:33] And I think when doctors think of people as a number or a disease, that's the ultimate challenge to me.

[00:06:40] No, they're not.

[00:06:41] Let's think of what this person wants and what would work best for that person and how we apply it.

[00:06:45] So hopefully they're articulating that sense of we take big data in populations, but we got to apply it to the individual now.

[00:06:50] And I think that's where there's a little tension, but also quite a lot of excitement as we move in that direction.

[00:06:56] Yeah, very well said.

[00:06:57] You mentioned also an interest in technology.

[00:07:00] I'd love to hear more about that.

[00:07:02] How did you first get exposed to using technology as part of your own practice and caring for patients?

[00:07:09] It starts, and I think this is one of the reasons why I think nationally, maybe a little less so now,

[00:07:14] but in the early in games regarding patient monitoring tools and various tools,

[00:07:18] cardiologists are a little bit at the forefront.

[00:07:19] And part of it's because we've been using monitoring technologies for decades between pacemakers and implantable defibrillators,

[00:07:26] Holter monitors, things like that.

[00:07:28] So we have comfort with tech tools doing physiological monitoring at home,

[00:07:33] and then we have to get the data and aggregate it and use it purposefully and or be alerted.

[00:07:37] So I think it's a little bit in our ilk.

[00:07:39] It's also one of the things that excited me about cardiology in a sense in that we do get to know people

[00:07:44] and quite often for their lifetime because a lot of it is around disease management,

[00:07:47] but we also have our toys, right?

[00:07:49] We have echocardiography, echocardiography.

[00:07:51] We do the procedures and stuff, stress testing, nuclear stress testing, stress echo.

[00:07:55] So we have this mix between enjoying the use of technological tools as well as caring for people in a continuum of their lifestyle.

[00:08:03] But I think it's natural within the cardiology space.

[00:08:05] In my particular space, I'm always like, I say, I'm a skeptic, but I'm not a cynic.

[00:08:10] A cynic would say, why bother?

[00:08:12] It's not going to work.

[00:08:13] I'm more of a, hey, let's prove it to me.

[00:08:15] Let's make sure we don't fool ourselves in what we're doing here.

[00:08:18] And with that, again, like an early adapt in some of the tech tools, you start seeing the gaps in, we'll say,

[00:08:25] ability to know what happens to a patient if they've left,

[00:08:28] or even some operational things like how they make an appointment, how they get their labs done, etc.

[00:08:33] And I started really getting excited about seeing tech solutions for that, whether it's through apps or whether it's by large data sets to give us predictive analytics, etc.

[00:08:43] What I'm basically saying is we've had experience using tech tools for data aggregation and physiological monitoring.

[00:08:48] The population health space gives me a lot of interest also regarding what these large data sets and tech tools are in the sense of, like I mentioned, predictive analytics.

[00:08:56] We do not have enough dollars to take care of all the people who need healthcare or their healthcare.

[00:09:01] We don't have enough doctors to take care of every person who needs a healthcare environment.

[00:09:06] So how do we triage?

[00:09:08] How do we determine what might predict a person who will need more intense care, need more intense support, and not put a lot of effort into someone who doesn't, right?

[00:09:18] Because we only have a limited number of resources available.

[00:09:20] The ability of the tech industry to provide solutions for problems we have has been extraordinarily rewarding.

[00:09:28] But first, we have to establish what is the problem we have, and is it the solution?

[00:09:33] The caveat to that, Jamie, of course, is I've just been exposed to hundreds of really cool tech-related innovative, we'll say, products that don't have a benefit.

[00:09:45] There's really no use case for them.

[00:09:46] Or the person they might be pitching it to is not the person who might benefit from a solution.

[00:09:51] I think the mindset, being comfortable with technology, being comfortable with digitally managed information, being comfortable with big data and how it can be used to be more predictive in resource allocation and deployment.

[00:10:01] It's always been in my mindset, and it's really exciting now because of all the opportunities that are out there to take advantage of these offerings.

[00:10:08] Any learnings you can share from a project that you were involved with to implement technology, to help with monitoring patients, to help with how patients are interacting with their care teams or sharing data?

[00:10:24] I'm curious if there are any learnings that you'd be able to share.

[00:10:27] Again, great question.

[00:10:28] I appreciate it.

[00:10:29] I'll try to give a cogent answer.

[00:10:31] Before I do, though, from a context standpoint, there are many different circumstances around that.

[00:10:35] And to the point I made before, heck, related companies or companies with type of, we'll say, digital solutions, they want business.

[00:10:42] That's appropriate.

[00:10:43] But, and I actually lecture a little bit about this, and I'm on a couple of other advisory boards.

[00:10:47] You have to make sure you connect the audience need with what you're pitching and selling.

[00:10:52] Sometimes people are such zealots about what they can provide, they're mistaking the communication or who they're talking to or why they're talking.

[00:10:59] Whenever I'm going to talk to a company who says, we have a solution for you, it's always make sure you know who we are, how we built, what we need.

[00:11:06] Don't tell me what you did in some system 5,000 miles away that had a completely different need and use case.

[00:11:11] So I think that's one thing involved.

[00:11:13] One thing I'll tell you, because this is very seminal, and I think it was like many systems accelerated through the COVID environment.

[00:11:18] But shortly when COVID was hitting us, and in South Florida, we were hit very significantly at one point, it'll wait to start the system.

[00:11:24] But because we were a little bit later than what we were seeing in the northeast and other areas, and I was very attuned to it, I was able to get us prepared for certain components.

[00:11:31] And the specific issue with COVID, of course, was bed capacity, right?

[00:11:34] Hospitals are filling up with COVID patients.

[00:11:36] We couldn't do the care for the regular patients.

[00:11:39] In anticipating that, I started inquiring through some systems in the north regarding certain tech tools they did.

[00:11:46] And there was a particular company, it was a remote patient-minded device, that when a patient came into ER with COVID symptoms, but they weren't at the point where they absolutely needed to be admitted.

[00:11:54] They weren't sure if they were going to decompensate.

[00:11:56] Historically, we would have admitted them and watched them.

[00:11:58] But by able to rapidly deploy this remote monitoring device and send them home, we were able to decompress our hospitals a little bit.

[00:12:05] And then, of course, if they decompensated at home, we were able to capture it.

[00:12:08] But the reason it was seminal is not the device itself, it was no two-sensor and a thermometer, but how we had to rapidly pull pieces together because we had to leverage the ER doctors to recognize this was available.

[00:12:18] We had to get the confidence of the case managers and the patients to go home.

[00:12:22] We had to leverage, we had an EIC, so we were able to leverage them to monitor the information that was coming in.

[00:12:28] We'd have to build a team, so it was the ability to say, or I sit, look at the different pieces within our system that historically had nothing to do with each other and say, look what we can do together.

[00:12:37] And then the tech tool becomes the tactic, if you will.

[00:12:41] It's not we want a tech tool, it's we want to decompress our ERs.

[00:12:44] Oh, here's a tech tool, and how do we rapidly deploy it?

[00:12:47] That experience, of course, since 2020 has led us well because then we've been able to drive, I've been able to drive these kind of integrated approaches,

[00:12:55] get all the stakeholders together for a more rapid acceleration of deployments around a, let's say, tech-related solution.

[00:13:02] And I think that's what it comes to, especially with health systems.

[00:13:05] There's so many silos and disparate interests, and I've never seen people really not want other people to succeed,

[00:13:12] but it's not really their interest for other people to succeed.

[00:13:15] They have their own imperatives.

[00:13:17] Going back, how you pull those people together, how you be credible, how you speak to the pain points,

[00:13:21] and how you create that value proposition.

[00:13:23] I think that was an example early on that we replicated elsewhere for an incoming need.

[00:13:28] It wasn't after we started having the bad capacity, we were prepared for it.

[00:13:31] People were waiting and talking about, we don't need this.

[00:13:33] But previously, we would have no vehicle to work with a tech partner,

[00:13:37] to bring a device in and send people home that we're responsible for.

[00:13:42] So it really was a very rewarding experience that we've templated and replicated elsewhere.

[00:13:46] Yeah, great example.

[00:13:47] I can even relate from my own experience as a hospitalist caring for patients during the height of 2020

[00:13:54] with the number of COVID patients we were seeing in the hospital and the fact that

[00:13:58] many of them were actually not so acutely ill that they truly needed to be in the hospital,

[00:14:03] but there was always that risk of deterioration.

[00:14:06] I also was using some of these devices to help monitor oxygen levels, to monitor blood pressure, respiratory rate,

[00:14:15] just to have a way to check in virtually with some of these patients, whether that's through video visits or over the phone.

[00:14:21] And that also allowed us at our hospital here in Boston to accomplish some of the things that you did.

[00:14:27] And so as we recognize, it's really a change management strategy, right?

[00:14:30] The doctors have to get, how many patients are held in the hospital bed?

[00:14:33] Because the doctor says, I need one more day.

[00:14:36] I don't know what's going to happen to you.

[00:14:38] But if we're able to afford the comfort that the doctor says,

[00:14:42] I know this person is going to be monitored for this.

[00:14:44] I'm both case sending them home.

[00:14:45] And the patient, of course, being comfortable having that.

[00:14:48] It's extraordinary how that's exploded.

[00:14:50] Now there's a hospital at home and there's no discharge.

[00:14:52] And the CAR-T patients, there's lots of other use cases.

[00:14:55] But I think it was really accelerated through that post-COVID experience as you experienced as well.

[00:14:59] Yeah, no, exactly.

[00:15:00] I think that there's a kind of abundance of caution that we take as a profession, right?

[00:15:06] To want somebody to be in a monitor setting where we feel like we have everything under control.

[00:15:13] If anything goes wrong, we can respond right away.

[00:15:16] But in some cases, we need to adapt and think about, well, what's actually best for these patients?

[00:15:22] What do the patients want?

[00:15:23] Where would they be most comfortable?

[00:15:25] What's an effective use of healthcare resources?

[00:15:28] And if you use some of those criteria to think about who needs to be in a hospital and who can be at home,

[00:15:35] you realize quickly that a good percentage of the patients that we hospitalize,

[00:15:40] that we monitor in an inpatient setting, really could be fairly well served.

[00:15:45] As long as you trust the patient, right?

[00:15:47] As long as you are able to empower that patient to be their own advocate,

[00:15:52] to let somebody know if they're feeling new symptoms, if they're worried, right?

[00:15:57] You then perhaps bring them back to the hospital.

[00:16:00] You have a video visit.

[00:16:01] You check in.

[00:16:02] You send a nurse to their house.

[00:16:04] There are so many other options that in the past were not even considered just because we had this longstanding model of the hospital being the center of care delivery.

[00:16:15] And so all of the care had to happen in the hospital.

[00:16:18] And anyone who was potentially going to become ill, right, even if they weren't ill today, right, might still lead to be in a hospital.

[00:16:27] So I think we say the same thing.

[00:16:28] And I love that concept in dialogue going back to my original comments, which is twofold in that circumstance.

[00:16:34] First thing, of course, not every solution is for every patient.

[00:16:37] So you know when you're bringing something to the table as well, what about this?

[00:16:40] Okay, that's not.

[00:16:41] So fine, we'll let that one go.

[00:16:42] But we still have a lot of success here.

[00:16:44] We always want to look at those who may have a good point, but that shouldn't prohibit you from moving forward with something innovative or whatever.

[00:16:51] And the second part is to question status quo, right?

[00:16:53] You need a nurse at bedside for every patient.

[00:16:55] Around like day three of an pneumonia treatment or with the scyllitus, can a nurse check in twice a day?

[00:17:01] It'd be available.

[00:17:02] And there's so much of that.

[00:17:03] That's the way we've done stuff.

[00:17:04] This is true in medicine as well.

[00:17:06] Somebody, you go back to hormone replacement therapy, you go back to controversies over proper macronutrients in the diet and stuff.

[00:17:12] And there's certain things we just assume are correct because it's the way we've done it.

[00:17:16] But if you stop and look and say, is that really necessary right now?

[00:17:19] Or if I can do that, do I still need that?

[00:17:21] Versus, of course, we need both.

[00:17:23] It affords us the opportunity to both innovate and create new models that might be more commensurate towards where healthcare is going.

[00:17:30] That's the exciting part of the job and the role.

[00:17:32] It's that challenge status quo.

[00:17:33] Get people to think outside the box.

[00:17:34] I'm not unique in this world.

[00:17:42] We'll say the internal disruptor.

[00:17:45] Yeah.

[00:17:45] Are there any interesting initiatives that you're working on right now within your health system in South Florida that you could share with our listeners?

[00:17:54] So I'll tell you, there's two things in parallel.

[00:17:56] And again, you think they're the yin and yang, but I always look at things with the string theory.

[00:18:00] Obviously, from a system standpoint, we're moving heavy into AI solutions.

[00:18:03] Our system has, it's a very successful system, very smart leadership, very well run.

[00:18:08] And for a long time, we felt we had to build everything.

[00:18:11] We don't need to third party or buy.

[00:18:13] And I think with some recognition, especially with the explosion of AI related, which is more than a buzzword, real functional AI related solutions, the recognition is that we can partner with others and get a more rapid implementation.

[00:18:24] So the opportunity cost is not there and stuff.

[00:18:27] But I think that's a transition.

[00:18:28] So we're really starting to work towards a lot of AI solutions, whether it's revenue cycle management or bed deployment or staffing utilizations.

[00:18:34] And again, on the clinical side as well for predictive analytics.

[00:18:37] And I think there's a push for that.

[00:18:39] It's very rewarding and exciting, though, like everything else, has to be managed so things don't spin into multiple different directions.

[00:18:45] On the other side, and I think Semilus comes in to sell the tech tools we're looking to partner with.

[00:18:49] I think it's fairly innovative.

[00:18:50] And I'll speak for the South Florida community, but I speak with folks nationally, and this seems to be fairly recurrent, which is basically, I look at hospitals as really very well taken care of.

[00:19:01] We'll say that top 5% of the population who are critically ill or need real significant surgeries, treatments, procedures, therapies, whether it's a valve replacement or a brain surgery, et cetera, et cetera.

[00:19:13] We do that.

[00:19:13] And then the next level of the population are those people who already have chronic disease or have the rising risk.

[00:19:19] The person gaining weight, the kidney function may be diminishing, the blood sugar might be going up, blood pressure going up.

[00:19:26] And those that truly have mild to moderate renal insufficiency, diabetes out of control, et cetera.

[00:19:31] And those people I could tell you as a country, we're really not managing well.

[00:19:35] We're not even identifying them that well, but when we do identify them, who knows what happens to them?

[00:19:39] They could see a doctor.

[00:19:40] Oh, you need to lose weight.

[00:19:41] You need to go on these three pills.

[00:19:43] They walk out the door.

[00:19:43] Who knows what happens?

[00:19:45] To cut the story short, I'm looking at enterprise-wide four counties, but they still know population health data, how we can start identifying people who have evidence of some early to later stage chronic disease.

[00:19:56] But the key is not how we get them an appointment with a doctor, which is how it's generally done and hope they can get to see a doctor.

[00:20:04] I hope the doctor can manage their conditions.

[00:20:06] But enterprise-wide, we're building around care teams for these patients using digital tools, both for patient engagement.

[00:20:12] How often can a patient have a question answered or monitored without a phone call from the office when already there's an access problem and we can't get in?

[00:20:19] Or tell us who's trending up.

[00:20:20] So it's a confluence of remote patient monitoring, chronic disease management, guideline-directed medical therapies using the role of clinical pharmacists and pharmaceutical protocols.

[00:20:29] And if we can, through protocols, identify these patients, maybe it starts with the doctor, but the care is managed.

[00:20:35] We think that, number one, the populations will be healthier.

[00:20:38] Number two, we will find pathology.

[00:20:41] For example, as a preventative cardiologist, and I do this, we find people that might have a severe mitral regurgitation that didn't know it.

[00:20:47] We'll find people that might have a left main stenosis.

[00:20:50] So we still make sure they get the procedures because I don't want to ruin that business model.

[00:20:54] But let's get it on the right people and, more importantly, before they wind up with a heart attack and before they wind up with heart failure.

[00:21:00] So I think what we're exciting about is we're using digital resources, data, to provide an enterprise-wide care management platform for early to later disease management.

[00:21:11] And then tethering that towards various components through our medical institutes for the high-risk patients, through payers, how we can manage their populations for them, which are not being well managed in the community.

[00:21:22] And actually, I'll just make one other point, Jamie.

[00:21:24] It's great for the patient, of course, but it's great for the primary care doctor who are just overwhelmed, overburdened, and underappreciated in our healthcare environment.

[00:21:32] Because they can set the pathway, you have this, I'm going to help you, but all the management is by someone as part of their care team down the road.

[00:21:42] Change management, the doctor has to get used to other people managing their conditions.

[00:21:45] The patient has to get used to the care team being their provider and not ask the doctor if it's okay if I double my medication, et cetera.

[00:21:51] But we've been successful with that in a small area, and now we're building out a big strategic client enterprise-wide data.

[00:21:57] And I'm excited about that.

[00:21:58] We couldn't do it without data.

[00:21:59] We couldn't do it without some of the digital tools we need for the patient engagement or remote monitoring.

[00:22:02] Otherwise, it's just a lot of manual labor.

[00:22:05] Yeah.

[00:22:05] I'm glad you mentioned the piece about the burden on our providers and the fact that there is a real issue with burnout right now.

[00:22:14] And we know that we can't just hire as many providers as we might want to take care of all the patients and all the patient needs that are out there.

[00:22:23] I'm curious if you have any thoughts on what are some ways that we can help to alleviate some of that burden on providers of dealing with the administrative challenges and administrative requirements of caring for patients in today's day and age, just managing the back and forth of patients, answering their question.

[00:22:42] But what do you see as some solutions to make practice of medicine a more sustainable career for these providers who are burning out?

[00:22:51] It's absolutely essential.

[00:22:52] It's a trajectory that started a few years ago.

[00:22:54] It's only accelerating.

[00:22:55] The aging of the physician population that's retiring or not going to do the extra work is outweighing the doctors coming into the community.

[00:23:03] My view is, in South Park particularly, there will be two kinds of care, quite frankly.

[00:23:06] Concierge care, which I do not want to denigrate.

[00:23:08] There are people who pay membership models.

[00:23:10] They want a higher level of access.

[00:23:11] Doctors will have smaller panels.

[00:23:13] As long as they're getting good healthcare and not more healthcare, which sometimes is a risk.

[00:23:19] Well, I think people get more healthcare, not necessarily better healthcare.

[00:23:22] I think that's viable.

[00:23:23] And then there's everyone else.

[00:23:24] And the obligation to us is to manage, we'll say, both populations, but more than everyone else.

[00:23:29] And the everyone else comes towards that team-based care, right?

[00:23:31] You're managed by your team, not the doctor.

[00:23:33] Going back to the specific question, this is really the exciting part of bringing in these technologies.

[00:23:38] We're looking at systems and tools that can manage the physician inbox.

[00:23:42] How much of the burden is answering messages?

[00:23:45] Some of them are boilerplate.

[00:23:46] Some of them are just forwarding that the doctor has.

[00:23:48] But if some of that can be automated based on protocols or a sense of what kind of questions are being asked,

[00:23:52] either responded to using tech tools or properly triaged and diverted so the doctors need to be exposed to something they're exposed to,

[00:24:00] I think that's a major win.

[00:24:02] The advent of virtual scribing is phenomenal towards the patient management.

[00:24:07] We've moved into the regulatory environment that supports these electronic medical records,

[00:24:12] which you as a practitioner knows do not provide a better data communication between providers.

[00:24:18] It's to document things for billing and coding.

[00:24:20] It's to document things for payers.

[00:24:22] If the physician can have a natural conversation with the patient,

[00:24:25] but the virtual scribe can document that and template that into something purposeful for the note,

[00:24:31] both to maintain information and for billing and collecting, et cetera, that's great.

[00:24:35] The other one we're seeing, of course, is the chart prep is incredible as well.

[00:24:39] He's a cardiologist.

[00:24:40] And granted, I'm a lipidologist, but you get complex patients with long histories.

[00:24:43] The amount of time you go through medical records or you prepare what happened since I last saw you,

[00:24:48] I think these are also the technical tools that will come in and make that provider experience very much rewarding

[00:24:53] and they can spend more time with the patient cognitively thinking what's going on and supporting them empathetically.

[00:24:58] And then many others like that.

[00:24:59] But I think the recognition that there's a benefit to that drives the industry to build it.

[00:25:04] The recognition that there's a value to that drives the systems to buy them and support them

[00:25:08] because right away it's expensive.

[00:25:09] Yes, but you will have better physician retention.

[00:25:12] You'll have better vision satisfaction.

[00:25:14] Happier doctors make for happier patients.

[00:25:15] Make for happier staff.

[00:25:17] Better outcomes.

[00:25:18] I think we're moving positively in that direction.

[00:25:20] And it's less pie in the thigh because I've been hearing about these things for a couple of years,

[00:25:24] but they're actually available now and are rapidly developing.

[00:25:27] The other parts, of course, we've talked about, Jamie, is if we can get big data so we can determine

[00:25:31] this person's visited the hospital three times that we didn't know,

[00:25:33] or this person's weight's been going up a pound a month,

[00:25:36] things that you don't see and it can alert you that maybe there's something going on here.

[00:25:40] We've done that with our remote patient monitoring.

[00:25:42] It's extraordinary when with heart failure patients, you call them up,

[00:25:45] hey, your blood pressure's been going up.

[00:25:46] What happened?

[00:25:47] Oh, I ran out of my medications four days ago.

[00:25:49] Well, let's get you back on the medications.

[00:25:51] Or you're gaining weight.

[00:25:52] What happened?

[00:25:52] Oh, we had a family picnic and I had a lot of Kentucky.

[00:25:55] All right, let's make sure you get a little extra diuretic.

[00:25:57] It really is robust in that.

[00:25:58] The difference is we have to scale it, right?

[00:26:00] It can't be a patient or a few patients.

[00:26:02] We have to really bring the infrastructure.

[00:26:04] This is done on a larger population basis.

[00:26:06] No, that's great.

[00:26:08] I realize we're coming to the end of our time,

[00:26:09] but I think that was a great note to close on just in terms of the opportunity to better leverage technology,

[00:26:16] to really ensure that we are allowing our providers to practice top-of-license,

[00:26:21] to help them be as efficient as possible,

[00:26:24] such that they can really have meaningful interactions with their patients.

[00:26:28] And that on the patient side,

[00:26:29] the patients also feel like they're getting what they need out of the healthcare system.

[00:26:33] So I think we're both aligned and we're both practicing physicians.

[00:26:37] We've seen firsthand all of the challenges of caring for patients in this era with just all of the requirements around compliance,

[00:26:45] documentation, the hurdles that it puts in front of us as providers,

[00:26:49] but then also the opportunity that we are still learning about how best to deploy these technologies.

[00:26:56] There are many new technologies that I think need to be further tested,

[00:27:00] and we need to better understand, right,

[00:27:03] how best to get them into our workflows such that we can truly be more efficient

[00:27:09] and can deliver the care that we want to deliver.

[00:27:12] On that note, I just want to thank you, Jonathan,

[00:27:14] for spending time with me and our listeners today.

[00:27:18] And until next time, this is Jamie Colbert from the Care Delivery Podcast.

[00:27:30] Thanks for listening to the Memora Health Care Delivery Podcast.

[00:27:33] For more ideas on simplifying complex care for care teams and patients,

[00:27:37] visit memorahealth.com.