The Future of Healthcare: Collaboration Over Competition with Srinivas Velamoor, President and Chief Operating Officer for Corporate Strategy at NextGen Healthcare

[00:00:00] Hey everybody, welcome back to the Outcomes Rocket recording here at Vive 2024, Los Angeles,

[00:00:10] California. Today I have the privilege of having Sree Velomor on the podcast. He is the president

[00:00:15] and chief operating officer for corporate strategy at NextGen Healthcare. Sree, thanks for joining me.

[00:00:22] Great to be here, Saul. Thanks for having me. Absolutely. The meeting has been fantastic.

[00:00:27] Today we're here. It's the last day. What have you been seeing, hearing? What sticks out to you?

[00:00:34] Yeah, it's been an interesting couple of days here meeting with folks and just walking around

[00:00:38] the halls here the last two and a half days. Really three or four themes that are popping into mind.

[00:00:43] One is we've got all the luminaries in the healthcare here. The healthcare IT folks,

[00:00:48] the Chime folks, the acute folks can't help but think about what healthy co-operation could

[00:00:54] look like in our industry. If all of us were working together to solve problems.

[00:01:00] The interesting news announcement yesterday about the DOJ bringing ant trust investigation

[00:01:05] against United Healthcare is top of mind as well. It begs the question, have the big gotten too

[00:01:10] big? How do we make sure that there's room for competition in the industry so we can all

[00:01:16] not consolidate each other but really accelerate the pace innovation in the industry? That's

[00:01:21] one very interesting topic. Then of course we'd be remiss if we didn't talk about AI. It seems that's

[00:01:26] part of every conversation. Definitely. It's a little bit of an interesting, certainly we're in

[00:01:31] the hype cycle with AI right now but we have implemented now clinical documentation with

[00:01:37] our providers with over 3,000 folks across different specialties and there's some very

[00:01:41] interesting lessons we're learning about how physicians use it and what kind of real

[00:01:46] world challenges there are once you start to bring AI into the marketplace. That's another

[00:01:50] thing that's been top of mind for me. I'm just curious about what others are seeing here in the

[00:01:54] industry as well. Then of course we've been talking about putting the patient at the center

[00:02:00] of care for a long time. A lot of the conversations here seem to have come around full circle

[00:02:05] to recognizing that importance and thinking about how to stitch together patient journeys

[00:02:10] across different aspects of the healthcare ecosystem. Some interesting themes at least.

[00:02:15] Yeah, I definitely agree. Let's unpack some of those on the first one regarding

[00:02:20] United. What are your thoughts there? What do you think was the catalyst that finally got the

[00:02:25] conversation started there? Because they've been acquiring a lot of different large adjacent,

[00:02:31] vertically, horizontally, just everything they could. What do you think it was that finally

[00:02:38] got the conversation going on that? Anytime you get large enough for your north of almost

[00:02:44] $530 million as a company, you're going to get a bullseye from the industry folks looking at you.

[00:02:49] But I'd say more recently, circling in awareness that when the insurance companies actually own

[00:02:54] the providers themselves and the insurance companies also own the pharmacy benefit managers

[00:02:58] and the pharmacy benefit managers are very tightly coupled with the providers, it begs the question

[00:03:03] on whether you're serving the interests of the patients when all those parties are aligned

[00:03:08] on one side of the table. It seems the government's taking a look at that saying

[00:03:13] we don't have an issue with horizontal and vertical consolidation but it can happen

[00:03:16] at the expense of the patients or at the expense of cost which seems to continue to rise in healthcare

[00:03:24] and hasn't come down. So they are not the first or rather they are the first but I'm sure they're

[00:03:29] not the last in terms who's going to attract this kind of scrutiny from the government.

[00:03:33] Yeah, no that's a good call. And then there's the technology,

[00:03:37] the basically a lot of the things that are happening here at Vive, the discussions around

[00:03:42] AI, machine learning, how do we advance care delivery with the use of technology? You brought

[00:03:49] up AI and the use of notes and so talk to us about what you guys are doing on that front.

[00:03:55] Yeah, Nextion Healthcare has been very deliberate about how we're deploying AI in our environment.

[00:04:02] We certainly recognize the disruptive potential of this technology but we also want

[00:04:07] to be very careful about how this tool gets put in the hands of doctors and patients.

[00:04:11] There are obviously privacy concerns and security concerns with making

[00:04:16] the data available for these models to work on and that there is appropriate consent and

[00:04:20] data storage guidelines and all that so that's certainly one part of the puzzle.

[00:04:24] But what's more intriguing for us has been we have over 3,000 providers using

[00:04:29] clinical documentation already in production environments and this is a one-click

[00:04:34] recorded transcript of your conversation with the patient. In seconds it turns it into a soap

[00:04:39] note. You can evaluate that as a provider, press a button and have it write it back into the HR

[00:04:44] with no incremental work required. And then it destroys the copy of the transcript for everyone's

[00:04:49] safety at that point and it's in the system of record and it gets secured and managed the

[00:04:53] right way. So we've learned some interesting things. The patterns with which you train

[00:04:59] as a physician how to use these AI documentation. We're getting a ton of very valuable feedback

[00:05:05] from our providers about how is this actually capturing things, when do I need to spell things

[00:05:10] out, when is it intuitive enough to learn things on its own. The other thing is many of our

[00:05:16] competitors we're learning are generating this note with AI but they don't automatically write

[00:05:21] it into the HR so any time you might have saved from using this documentation tool is lost with

[00:05:26] copying, pasting and trying to get it back into the right fields into the HR. So that's an

[00:05:30] interesting real world challenge of making sure it gets used. And then there's the other

[00:05:35] challenge which is every clinical specialty is different. So when you use a generic AI in a

[00:05:42] ortho environment or a pediatric environment or women's health environment, the workflows that

[00:05:48] it needs to integrate with an account for to write it back are highly variable and there's

[00:05:54] no one ring to rule them all. So as an AI company you have to be very thoughtful about

[00:05:59] working with that last mile delivery issue and make sure that providers understand how this

[00:06:04] will integrate into the workflows, what's getting left out, what's getting added that may be extraneous

[00:06:10] and doing a lot of that clinical change management with physicians and nurses on the

[00:06:15] ground they're actually using this technology to make sure that this truly meets their needs.

[00:06:19] So some fascinating kind of execution questions there.

[00:06:21] Yeah so is it meeting the needs today?

[00:06:24] The early feedback has been phenomenal so on the plus side of it folks are saving

[00:06:28] anywhere from 45 minutes to two hours worth of documentation time a day and that translates

[00:06:33] into significantly more appointments and revenue for a typical medical group which is terrific.

[00:06:40] On the other side of it, it's forcing providers to revisit the way in which they treat patients.

[00:06:46] If you are treating patients a certain way you could get AI to copy

[00:06:50] the current way of doing things and replicate all that or you can say hey I might need

[00:06:55] to change the way in which I interact with patients and do things differently because

[00:06:58] this AI is doing a lot of the extra work for me and it's that second part of getting folks to

[00:07:03] change old habits and think about care delivery very differently and how to transform it because

[00:07:09] this technology is now available to them. That part I'd say there's work to be done

[00:07:15] to get folks along.

[00:07:16] Yeah no that's really interesting you'd think something as value at as saving

[00:07:23] that time for the note integrated into the system would be an easy adoption but there's

[00:07:30] definitely a change. There's a change in the workflow and how the care gets delivered.

[00:07:35] Indeed and they say innovation happens at the speed of culture and change management and

[00:07:41] this is very much true when it comes to AI. Lots of hype about the potential but I think

[00:07:46] unless we get the folks on the ground to truly appreciate how their lives will be different

[00:07:50] and get them comfortable the speed at which even obvious things like these get used.

[00:07:55] It's going to slow down.

[00:07:56] Yeah great call anything that you guys are working on beyond the AI assist or for notes that you

[00:08:03] want to share today?

[00:08:04] Yeah this is just the first step. If you think about AI not just as artificial intelligence

[00:08:08] but truly augmented intelligence as a hey here's a co-pilot for someone on the ground

[00:08:13] taking care of patients what are all the ways in which this entity can assist you.

[00:08:17] Taking notes is the easiest and the most obvious place.

[00:08:21] We're looking at providing assistance on selecting the right codes for instance as an

[00:08:25] step. Another thing we're in the process of doing is intelligent and intuitive navigation.

[00:08:31] So the AI knows that when you ask question A and ask for data point A

[00:08:37] nine times out of ten the next thing you're going to ask for is x and y so it can actually

[00:08:41] present you fields and data points that you know you need to collect based on what it knows

[00:08:47] you did before we call these macros within the EHRs themselves. Those are two great steps

[00:08:53] providing assistance on prescribing the right medicine being able to go back and doing

[00:08:57] meta-theorin's reviews with folks giving you clarity into the patient's eligibility and

[00:09:03] benefit construct and status. These are just some of the use cases we're starting to look

[00:09:07] at that can start to pile on on the back of clinical document. Once the delivery

[00:09:10] mechanisms there and the physicians are trained and they're comfortable using the tool

[00:09:15] they're happy to take more and more of this decision support. That's great. It's a more

[00:09:20] tools to help with optimizing care delivery, optimizing the building side. A lot of things

[00:09:26] are missed a lot of revenue leakage that happens due to some of these misses so I think it's

[00:09:31] very exciting. On the patient front you did call out the importance of keeping the patient

[00:09:37] center and what are we doing to enhance that experience. Any thoughts around on that topic?

[00:09:42] Tons of thoughts on that topic. I'll start by saying the portal is dead. Long live the portal.

[00:09:48] I know we've been saying that for a long time but I just walking around here seeing some of

[00:09:52] the solutions even what we've deployed in our environment. It's an exciting time because

[00:09:58] the notion of this portal as something you needed to certify that was just the realm

[00:10:01] of the EHR companies I think has been appropriately challenged. On the acute side we have

[00:10:05] of course the large EHR players that had their native solutions. On the ambulatory side there's

[00:10:10] been very interesting innovation so we have these several companies including our partner who we

[00:10:14] work with, Luma Healthcare that is working with us to integrate very tightly with the

[00:10:21] electronic health record system and with the practice management system so we can create a

[00:10:25] complete digital front door that can close the loop from the patient experience. So everything

[00:10:30] from the ability to search, schedule, access care, do your televisit, pay for the care,

[00:10:37] do your wellness reviews, have your card on file and then even if you're in a value-based

[00:10:43] care environment continue to stay engaged with that patient with messaging. All happens on a

[00:10:47] single digital front door and platform and it's mobile first and it's based on quick links

[00:10:53] so you don't have to remember your credentials all the time. You can just

[00:10:57] log into your phone and do what you need to do quickly, get down and move on with your life and

[00:11:02] I think that convenience and that flexibility of going to one place and being able to do

[00:11:06] everything with as little friction as possible is extremely powerful. And the early results again

[00:11:11] here are terrific. The NPS promotes score from patients that are using these capabilities with

[00:11:16] us is north of 90 which is unheard of in healthcare. It's not about most industries but

[00:11:22] beyond next year and I'm really excited about what this means for patients and particularly

[00:11:26] in the ambulatory healthcare space where so many of our clients are independent medical groups,

[00:11:31] they're in rural communities, they're FQHCs, they're community health centers,

[00:11:35] they're folks that serve behavioral health folks. Having tools like these is incredibly valuable

[00:11:40] to make sure that patients get the care that they deserve. Yeah, that's fantastic.

[00:11:43] Well, Street, lots of great things happening. Always appreciate your insights on the podcast.

[00:11:49] What closing thought do you want to leave our listeners today with?

[00:11:52] There are over 10,000 companies in the healthcare technologies space and we're spending north of

[00:11:57] 40 billion dollars of invested capital in our industry year over year to try and transform our

[00:12:03] sector. There's room for that investment to be significantly smarter if so many of our

[00:12:10] colleagues over here and friends on the on the show floor here can start to work together

[00:12:13] more effectively. So there have been some terrific conversations about how we can be

[00:12:18] better at co-opetition, which I think needs to be the theme for the next two or three years

[00:12:23] between many of these parties. There's plenty of impact to go around. I think if we work together

[00:12:27] we can actually start to solve some real challenges here. So that's exciting.

[00:12:30] Totally agree. Great call to action there and something for all of us to think about

[00:12:34] that co-opetition. Let's keep it top of mind everyone and Street, just want to thank

[00:12:39] you for being on the podcast today. My pleasure. Thanks for having me, Saul.