Things You’ll Learn:

• How problems are most effectively solved by understanding the root cause before proposing solutions.
• The ways to address the asymmetry of data needs to work towards a more collaborative healthcare ecosystem.
• How economic alignment and value-based care arrangements can pave the way for better collaboration.
• A view of disruption from within the healthcare system that enables innovators to navigate the industry's complexities.
• How knowledge of healthcare workflows and technological infrastructure are crucial for creating scalable and impactful solutions.

Resources:

• Connect with and follow Andy Chu on LinkedIn.
• Learn more about Providence Digital Innovation Group on LinkedIn and their website.

Transcript: 

Rachel: 

Hello and welcome to the Spark, a view of innovation in healthcare. I'm Rachel Schreiber, your co-host, and in this episode we're speaking with Andy Chu, senior Vice President of Product and Technology in the Providence Digital Innovation Group, which furthers the providence vision of health for a better world. We've spoken with quite a few founders and visionaries, and I'm excited to speak with Andy about his view on how organizations can challenge the status quo and grow from an idea to a company making an impact. I'm also joined by Stuart Hanson, CEO of Avaneer Health. 

Stuart: 

Thanks Rachel. And Andy, thank you, huge for the time this morning. We really appreciate you taking the time to talk with us. We've actually been looking, I think it's been on my calendar for a couple months now. Really been looking forward to it because we've had some good discussions with your group. We've definitely admired the progress that you've made in just less than three years in the role that you're in. So congrats on the huge impact that you've had so far. And just thanks again for being here with us. I love what you're doing from a consumer perspective, especially because I do think consumerism is the common thread that links everyone's experiences to want a better healthcare infrastructure and interactions and better data access and all those things that we struggle with in healthcare that are so natural in almost other digital experiences. So really excited to hear more about what you're doing with the Digital Innovations Group. And I guess before we get started, we always ask the question and no one's asked me back, but you're welcome to ask me back what my spark has been. But we'd love to learn more about what brought you into healthcare, what inspires you about what you're doing in healthcare, how did you get started, what's your spark for the team that you've started? 

Andy Chu:   

Well thank you again for having me. Yeah, this goes back to even when I was back at Microsoft, which has been a long time. Microsoft back in the days had a product called Microsoft Health Vault, and that's when I started looking into healthcare because at the end of the day, all of us are recipient of healthcare services. So this concept was super interesting at the time, decided not to join that group just because I thought it was a little bit too early. The infrastructure is not quite there, data interoperability is not there. Of course, Microsoft a great vision, but all the pieces have to be there in order for you to really move. Just didn't feel right at the time. Long story short, spent 12 years at Microsoft, dabbled into retail and then went to doing two different startups. And then during that time, one of my former bosses, he was the chief experience officer at Express Script also reached out. And so at that time, again, once again started looking into healthcare again from a different point of view, not a healthcare delivery integrated system point of view, more from a BPMs point of view, but once again, started dabbling into it. What's fascinating to me was after over a decade seems like the problems hasn't really changed and still has the same set of issues and patient experience seems to be actually gotten even because of all the requirements, but the benefit also has gotten worse. 

So ended up not going there either. So a few years ago this role came up and I thought, well, maybe let me take a look. Maybe a third time is a charm. And so what actually inspired me to join was actually the mission of Providence, 

Second also is the traction the team has already made in digital health and services. And third, I would say were the people that actually are really committed to the mission, but it's also looking from the perspective of a health delivery system. Because at the end of the day, as someone's relatively new to healthcare, really need to understand how care is being delivered. And so I thought what better way to really learn and contribute is by going really deep into a very large health delivery network and try to innovate from the inside out. So that's what drove me here and I'm having a lot of fun doing what I do. 

Stuart: 

You can tell. So that's a great story. And I for one had signed up for Microsoft HealthVault or committed to it. I don't even remember what the commitment was, but I linked it to my email account and I was definitely looking forward to that. And it's, to your point, and is still one of the use cases we talk about that's a broken consumer experience. I've referenced going to the basement of a hospital for imaging CD ROM multiple times in past interviews, and it's still troublesome how little access to real-time data and ubiquitous data flow exists to support care coordination and enrollment and registration and all the things that kind of break from a consumer perspective. So it was too early for sure, for a bunch of reasons, but still a great vision for personal health record. 

Andy Chu: 

Oh yeah, totally, totally. 

Stuart: 

Well, you guys have done some really exciting things we've read and heard a lot about lately. So congrats on Praia Health and DexCare and Xealth and Circle. I had love to learn a little bit more about what you're working on now to challenge the status quo and what really drives the priorities for what you guys spend time on. 

Andy Chu: 

So one is we've spun out prior health, which focusing on patient identity and engagement. So that's just really the beginning. So now Al, I'm actually the customer of Praia, and so we're actually now building on top of it. The way I like to talk about it is how do we digitizing all these different various endpoints across the hospital system so we can actually bring a more cohesive experience for our patients. And also that's one. Number two, there are services and offerings that's going to be delivered outside of the four walls of the hospital. How do we bring those experiences in? So again, our patients don't have to go to a million places to receive care. So we can actually provide that more personalized experience to our patients. It's expected in every other industries healthcare. So that's sort of my digital transformation hat that I wear on behalf of Providence. 

So we're actively doing a lot of things on that front. The second that we are actively working on is dealing with inbox messaging. So over the last few years, the messages from a patient to our doctor's office have exploded. And when we start looking at this problem a couple years back, as you can imagine, it's actually pretty intuitive when we start looking at the data about a third of messages have nothing to do with clinical questions. They are billing, administrative, all kinds of these questions. Really, we don't need any of our clinicians to be answering any of those questions. So we started looking at this problem set and said, Hey, we already have a bot that we have built for Covid, so how do we evolve it to now maybe perhaps we can start answering a lot of these questions. So make the long story short throughout the last two years with a journey and also the rise of the LLM. 

So now we're using a combination of more traditional machine learning technique as well as large language model. And we have now multiple interfaces where a patient can actually interact with our AI platform to get their answers, so even before they send a message. So I guess, and then that's one part of it. The second part of it, as we know in healthcare, most of the questions still require a human being. There's just no way around it. So we make that very easy for a patient if they don't want to talk to the chat bot anymore or a separate interface. We actually, within the Providence app, we actually have a native client that we have built. It's a very different experience. When you compose a message, we actually understand the intent. We actually give you recommendations, what you can go do, but be it the chat bot can't answer the question or you just want to talk to an agent, we can do a soft transfer for the patient to talk to someone at the call center. 

And so now anything related to billing, payment, financial assistance, all that workflow is completely done. And then thirdly is within the EHR, there's specific clinical workflow that we have billed at the clinic level. And oftentimes the care teams still have to figure it out exactly what the message is about, what is the complaint, what is specific protocol, what is the response I want to provide to total those questions. We now can automate a lot of those to help the care team. Rather than spending three five minutes to getting the response, we can get it done within 30 seconds. We can also help prioritizing it so they know what other messages that are more important. And so that's important, right? Because one instance, we actually got a message early in the morning, it's like seven something within two hours. The care team saw the message got prioritized because it called out their reflex symptoms related to mental crisis. 

And then we got that patient into the doctor's office that afternoon. That's great. So that's just one example of the impact of some of these systems that we have made. So that's super exciting because not only we are helping the patient finding the information that they need so they don't have to send a message, but it's also we're helping the care team not to deal with all these messages that they don't know what to do with anyway. Or they either forward, they just copy and paste from some other places getting the information. So it's completely sort of wastes everybody's time. So we can automate a lot of those. 

And then we're also dabbling into other areas including payer and provider data exchange. Obviously there are a lot of data standards they're pushing from the ONC, CMS, so our population health team have been leaning in very heavily in that space. So we're also partnering very closely with them on that front. And there are a bunch of couple other projects that we're also looking at from workforce management all the way to clinical trial and data platform. So yeah, cool. No shortage of range, wide range of topics. 

Stuart: 

That's really interesting. Love the idea of trying to help reduce the drag on clinical and support staff through that level of inbox automation. That's awesome. We hear a lot about how frustrating it is for clinicians to have to filter through pages and pages, and I've asked for prescription refills, I've asked for analysis of my blood work, clinical and nonclinical things, and it is kind of something we've heard a lot about. So very cool on the inbox side especially, would love to also hear more when you're ready to share it about the payer provider interactions. We feel really strongly that that's a big cost drag. And another source of provider burnout is just not having access to the right information at the right point in time. And with more and more movement to value-based care and risk sharing models and things like that, access to that data at the right time to have those interventions. 

You highlighted a really good one on the behavioral side, but there's just the same, there's dozens of examples on the clinical side I'm sure as well. So we'd love to hear more about that. So you guys have done a lot of innovation through an inside out, as you called it, exploration driven approach to identify problems that need to be solved and can be solved digitally. Any lessons learned that you would share for startups or for other maybe even payers that are working to innovate or others in the industry in terms of how to interact with your team or just lessons learned in general in terms of how to best manage really being disruptive because there's so many areas that need disruption, obviously in healthcare. 

Andy Chu: 

I mean the approach that we take is we don't have a mandate to go disrupt. That's not really the intent. 

And I think oftentimes people also, because you have existing workflow and systems, I think that's where a lot of startup, they sort of get it wrong because there are good reasons why certain protocols have been put in place. So if you're taking an approach around, oh, this should be extremely simple, we can just simplify all these processes and just buy my app. Yeah, 

Stuart: 

That naivete. Yeah. 

Andy Chu: 

Yeah. This is just dead on arrival. I think a lot of time, a big bulk of my team's time is actually figuring it out exactly what problem we're trying to solve for. I think that's the single's biggest seems very simple, but it's very hard to do. Also, what we're trying to solve for are not point problems or develop point solutions, which there are a lot  

Rachel: that's important.  

Andy Chu: That's one of the things that I think one of the motivation that I had back to what I was saying earlier, why I joined a health delivery network is because you have to understand how things are done and why certain things are done. And the close partnership with clinicians, with our administrators and operators are really key. You have to understand the why. I think the second thing is, like I mentioned, the workflow is no way around it. So you have to also understand all the intricate details around the workflow and lastly of the applications that actually they have to deal with 

And truly understanding all that, then you can start thinking about going back to a hundred thousand foot level and saying, okay, we're going to go solve this problem differently. How are we going to do that? And if we're going to put a new application in place, what are the two or three five applications we get removed? So they are not doing yet another application that they have to go deal with. So I think historically over the last, I would say 20 years, exactly what's happened, right? Because no one really go talk to the frontline folks that are actually doing the work. They're like, Hey, this is great if we going to solve this one problem. And then the frontline person say, oh yeah, great, but..... So it created this extremely heterogeneous but also very cumbersome environment for the people that actually doing the work on a day-to-day basis. 

So I think that's the approach that my team would take. We actually go spend a lot of time and we are lucky that we have a lot of clinicians and various payment models across Providence, across our seven state footprints value-based care arrangement, fee for service, and everything else in between. We have a lot of expertise around the organization. A big part of it, this is all about teamwork and partnership. So I think last but not least is I think as someone's doing technologies, we also have to really take a more humble approach to how we actually dealing with these problems. The traditional mindset of shaking things up and break things and go fast in healthcare is just fundamentally, it doesn't work. Because again, there two reasons why certain things are there. 

Stuart: 

I think you make a really good point on why the inside out is essential if you try to be outside in, which is why the industry can't wait to solve its own problems. It really needs to be done from within because of all the things you're talking about. I think that was really well said. I appreciate that response. Thanks. Great insight. 

Andy Chu: 

So I think my advice to a lot of startups wanting to work with health system is do a lot of learning. You need to make sure the problem that you're solving for it can actually resonate. That's one thing. The second thing is you also have to understand the payment model. At the end of the day, over the last few years, hospital systems across the country have lost a lot of money. Now we just turning around the corner. So there's still a lot of systems are struggling. So you need to be able to articulate how is your solution going to benefit at the bottom line level, be it helping drive more revenue or substantially reducing the cost. So oftentimes I have seen companies, it's a point solution, so they don't really actually understand, okay, yeah, if I deploy this one thing in my operation, but how do you deal with these four or five, six applications that someone has to go deal with? So I think really understand deeply of the problem space is very important. 

Rachel: 

So you've talked a lot about how approaching the problem with a solution is a better approach versus this tech forward, or this is a great widget that could help healthcare. Are there companies that you've worked with or that your organization's been incubating that have done that well that you could share? 

Andy Chu: 

Well, I would imagine the companies that we incubated would do this well, and I think it's actually back to your last question around challenging the status quo. So I think when we started prior, actually the group started it actually before I got here, one of the problem space that they were trying to solve for was the patient identity. I mean, there's a lot of talk around open standard and interoperability, but the end of the day, it hasn't really happened. We haven't seen it and we've been talking about it for quite some time. So one, the problem space that we were trying to solve for at the time was we know how people are going to receive care and how are we going to deliver care over the next five to 10 years can be very different than the last 150 years. So then the question is, as digital going to play an even more important role in how we deliver care, the patient identity is very important. Today. Everything is locked within the EHR 

And it's not very easy for a health delivery network to bring other services into the fold, again from a digital standpoint. So it's more seamless to patient. So when we start looking at this problem, everyone's like, we don't need it. We have the rating id. Why are you guys doing all this stuff? But we just keep going at it. And then about three years ago when we started actually deliver the identity product, and then after I arrived, we looked at the entire problem space and then really focusing on everything that we have done and then we spun out prior. So this was an example of keep going at the problem, going at the root cause. There's going to be a lot of naysayers. There are going to be a lot of competitive forces. But I think if you believe in the mission, you believe in truly, this is a big problem that we are seeing. And again, you can connect to the bigger story and where things are going, you just have to keep going at it. So I think that would be an example of how we just kind of really focusing on the problem and try to solve it. 

Rachel: 

Regarding collaboration between payers and providers, are there ways that you see that that could be better and you could speed innovation if payers and providers could work better together to solve the problems that clinicians face daily and patients? Of course. 

Andy Chu: 

I think there are a lot of opportunities for providers and payer to work together. I think in general, there's asymmetry of data between providers and payers. Stuart, you mentioned at the point of care we need, wait, if the clinician actually knows all this information, I think we're still quite away before we can get there. I think there are standards are being pushed. However, this has to be a more private collaboration between entities. I think the ONC are trying to draft the right framework to put in place, ultimately requires both of us to play. So I think there are a lot of areas for us to collaborate. I think the question is how do we do a better job from an economic alignment standpoint. I think that's very important. So hopefully, and one would argue that the value-based care arrangement should be a great place to start. So then the question is why hasn't happened? So I think there are a few reasons. One is just the understanding the economic value of these individual lives and contracts. 

I think between, on the provider side, provider side, most providers organization don't have a really good grasp ultimately. So while they want to lean in more, but currently there's a lot of manual processes right back and forth between those. And why is because a lot of provider organizations don't have the right infrastructure that they have put in place for them to get to the right value at the point of care. So they know exactly what's missing, what needs to be done. And then I would say on the receiving end, on the payer side is similar, right? They have legacy infrastructure as well. They're in going through a lot of modernization effort that's happening. I mean, still we're getting flat files from payers or any format that you can imagine over the last 30 years. So I think there's definitely a technology gap and depends on the maturity of the various organization. They're just in different cycle. So that's why you haven't seen truly the scale aspect of it that you would think we're in 2024, we should be able to do this very easily. We're not there yet. Because a lot of it has to do with the infrastructure 

Stuart: 

Too. Yeah, you would think a lot of the investments the industry has made would've helped solve that. But I think you're exactly right. I think without that value collaboration between stakeholders that don't have the same incentives aligned exactly all the time has made it really difficult. So I think that partnership between payers and providers is really key. 

Andy Chu: 

Yep. Yeah, 

Stuart: 

Well said. 

Rachel: 

Well, you shared some really great insights both for startup organizations, for payers, providers. As a wrap up, what key phrase describes the vision of what you're creating at Providence? 

Andy Chu: 

Anything that we do, we want to make sure that is actually scalable is actually we're building platform rather than solutions. And we want to make sure the things that we do is actually going to benefit our patients, our providers, and ultimately our financials as well. I think all those things have need to align in order for us to move any technologies forward and actually make a big impact in healthcare. 

Rachel: 

Well, we definitely need more leaders like you and we really appreciate you sharing your insight and expertise. If our listeners want to keep up with your thought leadership, they can follow Andy Chu and Providence Digital Lab or Providence Digital Innovations on LinkedIn. Thank you for joining us, Andy, and continue to inspire that transformation in healthcare. 

Andy Chu: 

Thank you so much. 

Stuart: 

Keep up the great work and thanks for your time. 

Andy Chu: 

Thank you