Hello, everyone. This is Erica Spicer-Mason with Becker's Healthcare, and welcome to Healthcare Upside Down, a podcast by Becker's Healthcare and ECG Management Consultants, where we explore the upsides and the downsides of healthcare and the industry's most current trends. Really appreciate you all tuning in today. So joining me for today's episode, we have two leaders with us. We have Dr. William Morris, the Chief Medical Officer at Tenor, and Sarah Keir, Principal at ECG Management Consultants. Dr. Morris, Sarah, welcome to the podcast. Thank you so much for being here today. Thank you for having us. Thank you. So thrilled to have you both. And before we get into the conversation, I wanted to see if you could each share just a little bit about yourselves just to give our listeners an idea of where you're coming from, the perspective you're bringing. Dr. Morris, would you like to kick us off with a brief intro? Sure. Please call me Will. So I'm a hospitalist. So I experienced upside down clinically, I would say for my entire clinical practice where I saw those patients who probably would have benefited from care orchestration coming into the hospital. And then when I discharged a patient, not sure if they necessarily got to the right provider at the right time at the right cost. So really, really passionate around kind of the care orchestration piece clinically from a technology perspective, excited, but there's also people in process that is really, really required to think about transitions of care and care navigation. And so Tenor is a company laser focused on referral orchestration, and it's a real pleasure to have a true subject matter expert like Sarah, who's been, I would say, at the fulcrum of referral and access management. What a great tee up for Sarah. Thanks, Will. Appreciate it. Sarah, you want to tell us a little bit about yourself as well? Yeah, thank you so much, Erica. Sarah Keir, I have been in healthcare operations management for over 25 years. Across that time, I've had the opportunity to serve at three different academic medical centers, most recently at Emory Healthcare, where I served as their senior vice president of enterprise patient access. So that did include referral management and all of the glorious facts issues that we're going to get into here in a minute. I joined ECG management earlier this year in January. I have been there for five months and now have the opportunity to help solve these critical access issues nationwide, taking the lens of people, processing technology, knowing that without the people and process component, you can have the best tech stack in America and make bad things happen more quickly. I'm so excited to get into this today. Yeah, Sarah, thanks for rounding us out with intros and the experience that both of you are bringing to this conversation. I appreciate it so much. Before we get into kind of the more granular pieces of access and what that's looking like, I wanted to start high level. When you both think about where organizations are losing patience and revenue right now, where does your mind go first? And I'm curious if upstream intake, as we've kind of touched on already, is it ever part of that conversation? Sarah, you want to kick us off? Yeah, I'd be happy to. And I will declare my bias, which is upstream is always part of my conversation. I am an upstream gal. And so when I think about where we lose patients, one of the things I've heard as a refrain in almost every health system I've worked with is once people get here and once the clinicians lay hands on them, we are really confident and the patient is really confident in the care that they're receiving. It is the journey that we make the patient go on to get into that clinical care setting that is frustrating and a burden and really full of friction and confusion and anxiety. And so when I think about where we're losing the opportunity to serve folks, I think it really is if you make it that hard to try to find your way to the right care at the right time with the right provider for the right diagnosis, folks will make a different choice. They will vote with their feet and go to a health care system that has placed a bigger emphasis on making that easy. There's also a conversation to be had about revenue loss as you get into those clinical care settings and making sure that our documentation supports what we're doing, that we have all the right information in the right places. But I would argue there needs to be much more emphasis on upstream than there is today. The fact that we lose the opportunity to care for patients before they've ever seen or heard from a clinical care provider is an invisible problem in many organizations. We're not measuring it well. We're not monitoring it well, but it is very real. Yeah, Sarah, thank you so much. Interesting how you framed that as kind of an invisible problem. Will, I'm curious how this stacks up against your point of view here and where you're thinking about organizations losing patients and revenue. What comes to mind? Yeah, I mean, I think about, it is about the patient. And while the organization might be losing it, so is the patient, so is the referring provider, and so is the originating provider. I think, through the lens of the patient experience, you know, you're navigating a really, really complex environment clinically, lots of medical jargon, words being told I need to go see to provider, but you have financial barriers, right? What is in network? What is not? What is required? Prior authorization. And where should I go? How do I know a high quality provider who delivers appropriate care at lowest cost? And today, it feels very much like an invisible problem because it is. It's Brownian motion. You know, at Tenor, we've been really blessed to kind of start out at the periphery of large, complex organizations because that's where patients go, right? They can't get in to a highly qualified neurologist within, you know, an AMC. And so they will be happily absorbed in the community. And that's great. But how is that information then communicated back to the referring provider? How does that information take an action on? How do you actually manage, you know, those patients? And so access is such a complex issue. It's a financial complexity. There's a technical reality. Sarah mentioned the word fax. Yes, fax is still the number one interface. And even though if you have a small lowercase e in front of it, it's still an unstructured fax. And so how do you kind of manage that from a technical spot? How do you make the invisible visible? How do you create actionable data such that at the end of the day, we want the right patient going to the right provider at the right time, at the right cost, in the right format. Format being could be asynchronous, it could be a virtual visit, or an in-person visit. Yeah, well, appreciate that additional perspective. And you mentioned, you brought up the specialty areas. I think the specialty example you gave was neurology. And so I want to go a little bit deeper here on when it comes to patient access. Let's talk about what happens after a referral successfully lands. You know specialist wait times and wait lists can be a lot higher than I sure many organizations would like to see and patients as well So how are teams deciding who gets seen first Where is that prioritization happening and how? And what are the consequences of getting that wrong? Yeah, I mean, again, through the lens of a patient we've all experienced. You go to a doc, they go, you need to go see X provider. We'll do neurology, dermatology. and they're like, yeah, you should be seen soon. You walk out, they're like, great, we'd love to see you. How's next nine months? That is scary if I'm a patient, right? I Google my condition and now I'm really scared. And so we think about then the side of the providers, right? They want to see the right patient. But when you really, really weigh into any specialist queue, And you ask the fundamental question, hey, last time you were in clinic, you saw 20 patients. Of those 20 patients, which of those patients actually were more appropriate for a different provider? We're actually more appropriate with a e-consult back to the primary care physician where you can support the primary care physician, but they can facilitate it. We're actually more appropriate for a specialist, but it would have been nice if you did X, Y, and Z beforehand. And there's a lot of this work, and I think it breeds burnout, which is top of mind for providers, because that's not a satisfying day in clinic when 40 to 50% of your patients could have been triaged better. That shows up in burnout, but it also shows up in, hey, that's 50% of my capacity that maybe I don't need a six-month waiting period, right? Maybe I can actually manage my wait list a lot more appropriately if I have the right prioritization and triage schema upstream. And so we're really, really excited about this concept of kind of care orchestration of how do I get patients to the right provider at the right time? And I think that has the paradoxical impact of increasing a supply-limited specialist and actually improving access. I appreciate you expanding on the care orchestration piece, Will. I know you had mentioned that in some of your introductory comments. So the way you laid that out makes a lot of sense. Sarah, anything else you'd add? I mean, I think the only thing I would add is what Will lays out is so exciting, and it is not the way it's happening in most organizations right now. Right. Just want to call into contrast. That is where we need to get to. For the 20 plus years I've been focused on access, clinical acuity based scheduling, clinical acuity based prioritization has been what we've considered the holy grail. Right. The folks that can't wait because their disease trajectory is progressing at such a rapid rate that weeks matter. getting those folks in now for now, the folks who are stable enough to wait, having them either go through a different care channel, like we'll articulate it, an e-visit, a virtual visit. That is the panacea. That's what we're going for, right? I don't think many organizations are doing it well today. I think I would offer a couple of perspectives or thoughts. One of the ways I've seen it work well at organizations is if you have a clinical specialty who's got a really long wait time. And almost everyone picks on neurology, right? Like that is just a, it's a, it's a national crisis, truly. It's not anyone's fault. It's not that organizations aren't doing the best with what they have. It is a real limitation. We implemented something called a rapid access virtual evaluation, which is instead of scheduling you for that appointment nine months out, we're going to schedule you for an assessment, a 15 minute video visit with an advanced practice provider or a position, where we do that intake to say, how sick are you? What's going on? What does it look like? That's one piece of the puzzle. And that helps because you can catch the folks who are not going to do well. You also establish that we've got you. We're aware of you. We are here for you. And if anything changes as you're waiting, you can reach out. You've got lines of communication open. But the second piece we have to get after in that is, what if I tell Will that he is going to wait for nine months because even though it's a big deal, he's more stable than Erica. We need to do a better job there. We need to do a better job of making milestones for patients, keeping them engaged, keeping them encouraged, reducing anxiety. And so I think there are complementary lenses here about, yes, we can. And if there's not an appropriate offshoot path, and you're really just going to wait in line for nine months, we need to make that feel better than it does today because it's a really hard job to sell to someone. Yeah. Yeah. The rapid access virtual evaluation. That's a really great example, Sarah. And on that, I would just love to pile on what Sarah said, I think is so profound around thinking of novel ways to engage the patient and route them. Just talk to a very, very large system and they are using clinical pharmacists for a lot of med management and triage. So there is an embarrassment of riches within a large system. And shame on us if we don't think creatively in ways to expose and bring to life a lot of these men and women at the benefit of patients and access. Which, I mean, when Sarah gives me that example, like I just like the hair stands up on the back because that is just fundamentally different. in the way that we have to do things differently. Yeah. Yeah. Thank you for those add-ons. Well, let's go a little bit deeper there. So, you know, whether we're talking about the rapid access virtual evaluations, whether we're talking about tech enabled triaging, you know, organizations right now are looking at technology, especially AI investments to support some of these access initiatives. And there's been a wave of investment across health systems in order to do so. But I know that it's also something that organizations need to have a very discerning eye for. So I'd love to know from you both, and Sarah, maybe you can start us with this based on your work with partners. What should executives really be looking for when it comes to technology partners and solutions? And what are maybe some signs that something won't hold up once it's put into practice? Yeah. Erica, thank you for that question. It's really important, and it is certainly top of mind. So a couple of comments on this. Everyone I speak to, dozens of conversations every week, every executive I'm talking to at Health Systems Nationally believe they are way behind on AI. There is this pervasive sentiment that everyone else is doing more than we are, and we need to hurry up and catch up. It's just an observation, not a commentary, not a judgment call. But if everyone's behind, then no one's really ahead. And so I think that the anxiety that everyone is channeling on this is hot right now. I hope that our temperature stays in the posture of bias to action but becomes a little bit less maybe frenetic is the word I would choose as we mature here The second thing I would say is there no shortage of vendors There no shortage of technology solutions that can, in fact, really help solve some of these problems. But the very first step always needs to be which workflow are we trying to address? I have seen time and again that we use AI for the sake of saying that we are using AI in an attempt to gain efficiency or automation or reduce handling costs, cost to serve. And we skip a step, which is you have to really define what getting it right looks like in the workflow. You have to have really clearly codified exception-based processes. and the exception-based process cannot be, it depends, go ask a human every single time or the technology isn't gonna be allowed to do its job. And so the argument I would make for AI is if you meet the criteria of, you are really clear on the problem you are trying to solve, you know what getting it right looks like and you have governance around how you're handling exceptions and those things are standardized in the workflow that you're talking about, AI is a really useful tool, and it can, and I've seen it, deliver meaningful results inside organizations. But if you try to outsource workflow or process to technology or AI, what will happen is your problems will happen faster, and they will happen more often because now you've hardwired it. And so, Erica, I hope that that answers kind of the question, which is what to look for. looking inside as the first important step is critical. And then as you're choosing a dance partner, as you're choosing a vendor, speaking to clients who've used them about the real real, how did it go? What did it take? How was training? Were they responsive? Always check your references. And then leveraging, right, partners who are an industry, I'll use ECG, but really, any firm that is working across hundreds of clients at a time, they've got a really informed perspective on what is happening, what's working and what's struggling. And so ask other folks, you don't need to do it by yourself. And I'll ask, see what Will would add to that from his perspective. Yeah. I mean, listen, as someone who ran IT, technical debt and application rationalization is top of mind. Complexity kills. So one is a degree of humility when, you know, you show up now wearing a vendor hat, because there is unbelievable hyperbole out there. There is a lot of prioritization distraction. And I'll be the first to say that anyone whose claims that access is solved by a widget, you run away. Because it's not. It is enabled a specific workflow, and you got to get it right. And so as much as Tenor is a technical platform, we are absolutely a services and services partner company. We need to partner with companies that strategically look at the workflow. Again, Sarah says it eloquently, automating broken just makes broken faster. As a physician and someone who lives forever in a large academic medical center like Cleveland Clinic, we know that the unbelievable financial pressures that health systems face. So shame on us. It can't cost a dollar and not create value. It has to have hard ROI. why. So the way I kind of think about it is the following. Number one is it is such a complex solution. There is no point solution. It has to be kind of more of a platform play because healthcare is local and the environment, the different EHRs, and you might think, oh, well, we have an enterprise EHR, but your patients are coming from every variety known to man or woman. And so you got to have kind of an extensible platform. Number two is you got to show up with ears, not your voice. You got to listen and look at the workflows and really ask the five why questions and have core metrics of success. We are just absolutely maniacal about doing a pilot and having milestones because if you don't measure an outcome, then how do you know that you've actually achieved anything, right? You can't just have AI for AI sakes. I didn't make the jump into vendor world to check the box for the board to say, yay, we use AI. That's not a win. I want to be invisible to the clinician's EHR workflow. I want to enable it quietly, but demonstrate value. And so two, the second point is pilot, measure, drive outcome. And then three is, this is a journey. It's continuous improvement. There is no magical solution to, quote, solve access. Turning on open scheduling is not, yay, mission accomplished. Because you will always deploy something, measure, and elevate a new constraint. And so to Sarah's point, it is absolutely a continuous improvement model that to me fundamentally thinks about the patient care ecosystem and the environments of care. So if you're looking for a one and done, If you're looking for a point solution and it's a pretty PowerPoint from Silicon Valley, please call me and I'll walk you off the ledge. Oh, well, I appreciate it. And Sarah, excellent considerations as well. Just really candid advice you're sharing here. So to round us out and to really bring it all together, I know we've touched on what these access challenges are looking like, what to look for in technology and innovation to solve some of these problems. You know, if a CEO or a CFO is listening right now and thinking, we have this problem, whether that be the access points or, you know, vetting technology partners and providers, but they're having a hard time making a decision or prioritizing these issues, what do you both think is the right first move to make next? I would offer clarify your problem statement and your desired outcome. Be really, really explicit, not just make it better, make it faster. Think about accuracy. Think about fidelity. Think about consistency and experience. Thinking about will it reduce anxiety in our patient population and move them closer to care in a more efficient way. I think so getting clear on your problem statement and making sure that there is broad support and alignment, that if we were to fix this, it would substantively help. It would make it better. That would be recommendation number one. And then recommendation number two is find folks who have gone before you. Everyone is moving at light speed towards AI. Everyone has chosen a different starting place, right? There's pockets of organizations who focused on back-end first or front-end first. Almost everybody's in on the ambient listening game, right? So find a colleague who has done this, who's evaluated vendors, who's actually up and live. And if you don't know who to ask, reach out, ECG. We can help provide some examples or point you in the right direction But make sure that the vendors you entertaining hold up not just when they doing a pitch deck or a demo because those almost always go well Make sure they stand up to the Monday morning, 10 a.m. operational rush and that it holds water in that moment. And finally, I think to Will's point, which is really well taken, this is a journey and it will be continuous improvement. So plan on resources that will not just implement a project, but own new work. Make sure you're engaging the right stakeholders from the jump about if we do, like for an example, if we make fax transcription go from 100% manual effort to 20% manual effort, what are we not doing today that we can do with that energy in the future? How do job descriptions need to shift? How does upskilling need to happen inside of our own workforce? So think about sustainability and think about the ripple effects that your improvements will have and just get ahead of that conversation. I think those would be my three. Yeah, fantastic. Will, anything you'd add before we get to some closing thoughts here? Yeah, I'll just add, you know, from my vantage point, every large health system that I talk to or read their Google, you know, values and mission, access is their number one priority. And so if you're a CFO, CEO or board, ask the question, is your person who is in charge of access today at the C-suite? Because I would implore that they should be. Access is probably the one, if not the second next to quality as, you know, this is about Patients seeking the best care within your organization. And I can't think of any other kind of more laudable goal and initiative. It is not a program. It is certainly not a project. It is a responsibility. It needs kind of at the C-suite level endorsement. So for the men and women who are performing these roles today as access officers or others, having, you know, that charge, which is important, but also the prerequisite influence, because you have to be able to influence IT, you have to be able to influence rev cycle, you have to be able to influence the medical group. And so I think of it through the lens of if it is a priority for your organization, then you need to elevate that person with not just the responsibility, they need to be empowered with accountability and leverage. Because I think that's kind of the number one observation is, if everyone owes access, then no one does. And empowering the people who are performing it, enabling them and giving them the tools to do bold, courageous, and different things, I think will immediately distinguish those systems that are doing it right, like Sarah kind of shared, and those systems that will have access up on a slide, but still at the end of the day, they know when their loved ones are sick, they're not going in the same queue, they're going around it. Yeah. Well, I love what you just said, because as the closing question of the day, I was curious what, from both your points of view, it looks like when a health system either ignores some of these pain points or really leans into them. When a system genuinely gets this right, what does that look like? And I think you're speaking to that there and it brings us back full circle to that care orchestration principle. But wanted to open up the floor just for one more minute and give you both the chance to share any closing thoughts in that regard. I mean, my favorite new little game is any kind of chance to kind of convene folks and leaders, whether it be chief medical officers or IT folks. I ask a fundamental, easy question. Hey, you work within a hospital when you get sick or your loved one does. What do you do? And it is fascinating, probably not shocking that they go, well, listen, Part of the benefit of working at St. Elsewhere Famous Hospital is I know the person to call, and I call them. And miraculously, I'm able to get seen. And everyone kind of chuckles. But when you think about that, that is a sobering reality that patients in the community certainly don't get. And I'm not saying that we're all to blame, but it is a universal truth. And that, to me, is universally unacceptable. We have to think about equitable, fair, appropriate care, regardless of what your badge says. And so, again, I think the call to action. And then the second point is there is an amazing people in systems who have done amazing things. And, you know, Sarah can share. We have an embarrassment of riches of not what necessarily like here are the things that work, but probably a laundry list of things that haven't worked. And I think information sharing and thought leadership is my walkaway message. Fantastic. Sarah, what would you add here to close this out? Yeah, I couldn't agree more with what Will said in that question, what do you do when you need care, I think is incredibly powerful. I guess, you know, what it should like look like in the future, if we get it right, is that the answer to that question is I reach out through our our standard engagement channels and I'm confident that they're going to get me the care I need and the options that I need with the right information that I need to feel like I'm receiving the care that's intended. I don't know that any health system right now across the country is there. I think we're all aspiring to that. So I do think that's a really powerful and easy way to kind of measure where are we at relative to that journey. To answer the inverse of the question, what does this look like for folks who kind of ignore this as a pain point? I think that we are going to begin to realize on a much larger scale that access to care is safety and quality. The adverse events that happen while people are waiting for nine months if we aren't doing acuity-based screening, the fact that we are delaying care by sometimes weeks and months because of administrative errors and unstructured data, I think that's going to begin to compile. I think that's about to be a larger conversation nationally. And I think organizations that ignore access to care systems and front-end work streams as critical to safety and quality do so at their own peril. Sarah, thank you so much. And Will, it's been great having you both on this podcast today. Appreciate your candor, your insights, and really sharing what you're seeing at a high level view in healthcare right now. It's been immensely helpful for me and I imagine our listeners as well. And of course, today we'd also like to thank our podcast sponsor for this episode, ECG Management Consultants. Listeners, please be sure to tune into more podcasts from Becker's healthcare by visiting our podcast page at beckershospitalreview.com.
