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Interview In Action: Beyond the Buzzword - Inside Misunderstood AI with Aaron Neinstein

GMT20250519-231322_Recording: [00:00:00] This episode is brought to you by notable notable's. Proven AI platform is revolutionizing healthcare operations by dramatically reducing patient check-in times, eliminating thousands of no-shows, and freeing up valuable staff hours each month using AI agents that seamlessly integrate with your existing systems.

Notable helps health systems streamline workflows across patient access, revenue cycle, quality and risk, and clinical care without adding it burden. Its low-code platform enables quick deployment with minimal training required. Discover how Notable's AI platform can help your organization build your workforce of the future at this week, health.com/notable,

Welcome to This Week Health. I'm Sarah Richardson, a former CIO and President of this Week Health's 2 2 9 Community development where we are dedicated to transforming healthcare one connection at a time. Our interviews in action are a series of interviews catching up with healthcare leaders throughout the industry.

Now onto our interview

Sarah Richardson: (Interview 1) [00:01:00] Welcome to this Week Health. I am Sarah Richardson, and today I'm joined by Aaron Neinstien, chief Medical Officer at Notable Health. From patient intake to backend automation, Notable has been making ways in the healthcare tech landscape by blending AI, workflow intelligence, and thoughtful design.

Today we're talking about what it takes to operationalize AI meaningfully, not as a buzzword, but as a lever for transformation across health systems. Aaron, welcome to the show.

Aaron Neinstein: Thanks, Sarah. Great to see you.

Sarah Richardson: Great to see you as well. And thank you for your partnership. We always love spending time with a Notable team, but I wanna start with your journey.

What brought you into the healthcare technology space and the inspiration to move to Notable

Aaron Neinstein: dumb luck. It was a literally a Christmas Eve conversation in the hallway, so I was a resident in internal medicine at UCSF and I was on call on Christmas Eve as you know, all the Jews. We take call on Christmas Eve and so I was in the hallway talking with our chief medical officer. Dr. Adrian Green at the time about [00:02:00] career opportunities, and she said, you know, we, we just signed a contract yesterday with this company called Epic, and we need doctors to help us implement Epic. Are you interested? And I said, yeah sounds interesting. And so I met the following week with the CMIO.

Signed on and was on an airplane to Verona as a third year internal medicine resident. Getting Epic certified and trained., Was the front lines of support and build and training and everything for UCSF's Epic implementation. And just fell in love with health IT from there I think what grabbed me and made me feel like it was.

What I wanted to spend my career doing was the, you know, there's so much as a doctor working in the system where people complain about the system, this doesn't work, right? This is broken, this is frustrating. And it felt like working in health, it gives you agency to actually do something about [00:03:00] it versus just complain about things being broken.

And so, just fell in love with the ability to actually drive change in a meaningful way.

Sarah Richardson: I love that it gives you agency. I might borrow that actually because it's true. You wanna be able to solve the problems that people are bringing forward and you have a platform to be able to do that. And Notable's best known for intelligent automation, although that means a lot of things to a lot of different people.

How do you best describe what you do to a healthcare leader who's still trying to figure out all the AI noise?

Aaron Neinstein: Yeah, so the simplest thing is we're focused on doubling workforce productivity at a fraction of the cost. And so, if you look across healthcare delivery systems today.

You know, there's a handful of roles that are nonclinical. So think about front desk staff, call center staff revenue cycle staff and population health who are doing chart scrubbing, chart reviews, reporting on quality registries. So, so there are dozens of roles that [00:04:00] are nonclinical but part of the administrative workforce, if you look at any one of those jobs.

And you've looked at a job description, there's 10 or 20 different tasks that each of those jobs do. And in today's world, look, AI cannot automate and complete all of those. There's no job that can be completely done by AI, but every job description has at least three, four, or five tasks that can be automated by AI today.

And so what Notable has done over the last decade is find those tasks that. Can be automated or highly manual, repetitive and that are, can drive significant business value because they're done over and over again and they're where the operational friction occurs. And we use our software to help complete those tasks in an automated fashion.

So that can be anything from. Fax transcription to outbound phone calls, to automated chart scrubbing to submit data for quality [00:05:00] registries. Anything that fits in the top corner of the two by two of being high business value low risk, and potentially automateable is where we focus our efforts.

Sarah Richardson: Well, and what I love about your product, and I got to geek out and go to your event and play in the lab with your team, is you asked that question, what is high value, low risk that you don't wanna be doing anymore, and you just started plugging the blocks literally into these screens. And then you tested the workflow and the automation.

So people can take this tool and this capability and start to utilize it themselves. It's not just like they have to wait for you to have a release and what you're providing. And so that alone was a fascinating aspect about what Notable brings to the table.

Aaron Neinstein: That has been transformative.

I mean, for the first many years of the company's existence we were focused on the exact same problems, but we did the build, we did the configuration, we did the deployment. And what's changed over the past year or two [00:06:00] is we've now released our internal toolkit that you saw Flow Builder to our customers.

Now they get to use the same toolkit to build their own automated workflows. And it's just amazing to see the innovation among our customers. They're having ideas and building things that , I never would've thought of, we never would've thought of as a company. And they're now building it themselves and automating workflows.

You know, one example that comes to mind. You know, again, something like you just would never think of every health system has apps, nurse practitioners, PAs, physician assistants and they audit their charts for quality reviews, right? For peer review today, they pay a human to review a couple of charts a quarter, because that's all you can afford to pay someone to do.

One of our customers said, we can automate this. They're just following a script. They're following a guideline to produce that peer chart review. And so they built it in a day and they're now [00:07:00] reviewing a hundred percent of all of their NPS notes with no human touch. Was never something we would've built, never would've had on our product roadmap, but they took the toolkit and made it happen.

Sarah Richardson: How available are those innovations? From one health system to another made, how are they sharing ideas across the continuum?

Aaron Neinstein: Yeah, so we think it's important that people have choice in how they do that. In some cases a health system is gonna want to keep that workflow proprietary to themselves.

In other cases they're gonna want to share that. We also think that they should recognize some benefit from that. So we actually do have a builder program where if you know, think of this as sort of an app store model, right? If you publish. A workflow that you've developed and other Notable customers make use of it.

There is some revenue back to the originator of that workflow. And so we're trying to encourage an [00:08:00] ecosystem of people building new automated workflows, using our toolkit, sharing them with each other and benefiting from the broader ecosystem.

Sarah Richardson: It is such a way to give back to organizations because everything's about efficiency and containment from a cost perspective.

And here you are, like these workflows can generate revenue opportunities for you and also help you like keep your team super engaged and wanna utilize the product to its maximum capability. And I'm curious if you can also share, Aaron, an example of how Notable's automation has closed the gap between operational friction and some of the patient engagement outcomes that are important to us.

Aaron Neinstein: It's great to hear you make that connection because I think something that often gets lost when people talk about patient experience, patient engagement, there tends to be a focus on what's visible above the surface, which is the, you know, the tangible patient experience. But if you think about what actually gets in the way, it's all the broken stuff and the friction under the [00:09:00] surface.

It is the operations that if you remove the blockers in operations that improve the patient experience. because what are people frustrated about? They're frustrated that no one's doing their prior auth, or they've not heard back about whether their prior auth is completed. They're frustrated that a referral to a specialist.

Was sent two weeks ago and it's sitting on a fax machine and no one's touched it. So, you know, you often hear, like, when people talk about patient experience, they're like, oh, is it an app? And patient experience is not an app, it's serving their needs by removing friction from the operational processes.

So those are all the places we're focused. So let me give you some examples. At Baptist Healthcare in Jacksonville, we're now processing more than 200 faxes a day. Automatically, each fax that hits their fax queue in under 10 minutes is automatically processed, transcribed, and in their electronic health records so they can, you know, immediately contact the patient to schedule [00:10:00] their

mRI, their CT scan, their specialty appointment. At Sanford Healthcare. We're doing chart scrubbing for care gap, so looking to see if someone needs a mammogram or a colonoscopy et cetera. We're doing 30,000 charts per month without a human touching it. Some pretty incredible numbers and volumes that can be processed automatically and driving care for patients.

The other big one, of course, is prior authorization. We are now seeing the ability to complete prior authorizations in under 30 minutes from the time and order is placed. So, you know, think about the last time you were. At a doctor's office and they said, oh, you need an MRI or a CT scan or something that was gonna require prior auth.

And you knew that was probably gonna take a week or two or three for that to like wind its way through the system. But instead, imagine that the second they [00:11:00] write the order in the EHR, less than half an hour later, the prior auth is done. And what that means in terms of patient experience, removing that friction and that barrier.

And so we're seeing that across several of our customers under half an hour from order placement to prior auth completion.

Sarah Richardson: That's such a huge deal because how often do you and I get the phone calls about people asking us how to navigate healthcare or get their prior auth taken care of or get the documentation that they need.

We tell them how to do that, and yet now you work for an organization that literally automatically does that.

Aaron Neinstein: We recently lost a friend in the health IT space. Atul Butte.

Sarah Richardson: Yeah.

Aaron Neinstein: Um, who, Who passed recently. And I think what you're speaking to resonates just deeply. To the core. He coined a term called scalable privilege.

And his point was exactly what you're describing, which is, in American healthcare today, the only way to get access is through the back door. You have to know somebody, you have to email a [00:12:00] doctor, you have to email someone who works at a hospital and find your way. Through, you know, essentially like concierge access to get healthcare and Atul's point was that the opportunity that AI brings is the opportunity to scale that level of access, information, experience to everybody.

And that's the thing that drives me and drives a lot of what we have always believed at Notable is our core mission is. You shouldn't need special access. Anybody should be able to get their prior auth completed immediately. Anybody should have a phone call the day their referral is placed to offer them a cardiology appointment.

Anybody should be able to access health information on demand. And so, just wanted to call out a note about atul in his memory.

Sarah Richardson: I'm glad you did. There were actually several people like Mike Peffer at Stanford who posted about his passing as well and how impactful Atul was to

[00:13:00] industry and why it's so important that the conversation of those legacies continues because everyone is talking about AI and not everybody knows how to really intentionally use it with the outcomes that are expected. How does Notable help a health system shift from, let's do a pilot and see if it works to what you've already shared in some of the enterprise-wide transformation efforts?

Aaron Neinstein: There's a couple of core things. One is don't pick something small because e everything is hard to do. Yeah. And so you can spend your time you know, going through the energy for something small, or you can pick a very large, meaningful target. And so. When we meet with our customers, when we meet with, you know, people who are considering partnering with Notable oftentimes people will bring ideas or problems that are meaningful, they're real problems, but it's a problem for like one person in a corner of the organization, or and [00:14:00] people often want to start there because it feels safe, it feels contained.

The damage might be smaller if something goes wrong. But so is the upside, and so we focus on the biggest problems, which is. Let's go after all of your prior authorizations. Let's talk about your contact center where there are literally a thousand people answering phones and still not able to deliver the level of service that patients need.

Let's talk about your revenue cycle where you've got a thousand people working in coding and billing. Let's talk about your quality department, where every hospital has 50 people, you know, scrubbing charts to just type information from the EHR into registries. And so we look for the biggest problems.

That's one really important thing. Another principle we have as a company is partnering at the enterprise level. It kind of goes along with going after big problems. It can be very easy as [00:15:00] a you know, company working in the healthcare technology space to find someone in the orthopedics department or cardiology department who wants to try something new or different, and that's great, but it's not gonna drive enterprise level transformation.

And so we align at the board strategy level with our partners to make sure that we're going where they're going and they're going where we're going. And we have an aligned mission, vision, values. direction together because the world is gonna change next year and the year after.

And so, um, focusing on one small problem that one department has is not really gonna move the needle. So we really try to partner at the enterprise level align on vision, mission, and values and then focus on the biggest problems.

Sarah Richardson: I love the you go after the hard stuff first, because to your point, pilots might solve a microcosm of what's happening in an organization.

You're like, yeah, but we have [00:16:00] this, you know, BHAG out here we need to solve for. But the human aspect's the hardest part, Erin. So when you consider how you address the organizational change management aspect of what needs to happen, but also ensuring they don't make a bunch of automation missteps, how do those things come together?

So the biggest problems can be solved first.

Aaron Neinstein: Look it takes leadership, courage. This is not easy and a lot of this technology is still new. And so it does take executives who are bought into the vision and have you know, courage to understand that not everything is gonna go perfectly and that there will be bumps in the road.

I think that's really important. And one of our partner CIOs, Jerry Kester who was at Marshfield Health System, she always said, you know, just try, her motto was, just try. And I always love that. I think that was a very smart and easy thing to remember. Something else is including the workforce so important for change management.[00:17:00]

People are very afraid across the board. Like you look at any industry, everyone is afraid about their jobs and the disruption that may come with ai. And so I think the thing that is the most potentially damaging is AI happening in a back room in secret. And so involving. People all the way from executives to middle managers to the front lines in the conversation and in the change is important because people have to feel like they're being empowered.

Like AI is a tool that's gonna help them do their jobs better, have you know more meaning in their jobs and not something that's coming to replace them. Is AI gonna replace work that people are doing? Absolutely. Is it gonna change the nature of everyone's jobs over the next few years of, from how they look today?

Absolutely. Should people be partners in how that happens? Yes. So I think that part is also really important. Another thing we [00:18:00] encourage, so, you know, we work with our partners, not just on the technology. Part of AI, but also, you know, the strategy in terms of organizational transformation.

And I think Bill Gates had a really simple, useful framework. With the productivity gains from ai, you, you basically have three choices and you, it's not an either or you can do all three in different amounts, but you can either. Cut costs. So right, you can drive efficiency, reduce workforce and cut costs.

You can serve more quantity. So as a health system, you could serve more patients, grow your value-based care organization take on growth, or you can improve quality. So you can, you know, keep your headcount the same, you can serve the same population size, but you can do more. For your existing patients and that's kind of the choice.

And so we work with our partners to talk that through how much do they want to [00:19:00] grow versus. Improve quality and experience versus cut costs. And it's kind of, you know, a sliding bar between those three choices as you gain productivity. But you have to be intentional about that. You have to really decide which direction and

how you want to drive those changes and be clear in communicating with the organization, we are doing this to improve service levels or we're doing this to cut costs, or we're doing it to improve service levels and cut costs. So I think that's another useful framework.

Sarah Richardson: It made me think about a keynote you gave last fall specific to, it takes nine people to really service one patient.

Yeah, technology can. And then we have the hockey stick of the aging population coming at us and the reduction of providers of availability and reimbursement challenges. All the perfect storm of everything. You can be like, I can't solve for this, but to your point. Notable comes in and says, we can help with 1, 2, 3, or all of the above.

When you are [00:20:00] talking to organizations and it's not, hey, one doctor can see 5,000 patients in their panel. Maybe that's true, but that's not the intent. Maybe you can reduce a thousand people to 500. Where are you truly seeing? The realization of what's coming forward from using Notable in an organization, like what are some of those wins that you feel good about?

And it's not just chop, chop, it's like a creative in so many different ways that makes so many of these scenarios true. If that's what they actually want.

Aaron Neinstein: I think it goes back to removing the. If you ask people the things that are frustrating them, that are repetitive tasks that they don't want to be doing, that they know that are impeding the patient experience and outcomes it's being able to show people that work can get done on their behalf

that's really transformational. And watching people's delight as those things get done, as those prior authorizations get completed, as the [00:21:00] faxes get transcribed on their behalf as work that the front desk, you know, think about every front desk you've ever been to in a clinic, right? There's a line.

People are waiting in line to like hand over their insurance cards. And then what ends up happening is as the doctor, you're waiting in the back, in a room actually waiting for patients and getting behind in your schedule because of that line at the front desk. So by automating a lot of the work that happens there, you can eliminate the line at the front desk.

You can get clinics running on time and so. I think honestly what's most meaningful is seeing the improvements in quality and in experience and outcomes that are possible when you remove those administrative blockers. And there's you know, for people, everyone who works in healthcare did it.

Because of the mission, right? They did it because they want to help serve patients. They find it meaningful to help [00:22:00] be with people in their vulnerable moments and help people get the care and improve the health that they need. And the system gets in the way. And so there's this huge gulf between the care that people want to be able to provide and what they actually are able to.

And the way we think about it is we're shrinking that distance between the care that our care teams and staff and providers want to provide in what they're actually able to.

Sarah Richardson: That's really powerful. When you say we give clinicians an opportunity to provide the care

they want to provide.

It's not the 15 minute scheduled timetable. It's like, think of how much more can happen in those 15 minutes because of what you bring to the table. And as a patient, yeah, appreciate it. I just gotta have my local healthcare system start using your product and I happen to know their CIO. So think we can make some progress there for sure.

Aaron Neinstein: This is where

the informatics community, I think really got things wrong with AI for the last like 30 years, which is, there's, and [00:23:00] frankly the media doesn't help here either, which is there's so much focus on can AI make a medical diagnosis, right?

Like that's every article that you always read in the newspaper, and there's so much talk about that and like, that's not the problem. That's, that is not what's. You know, driving doctors and nurses to burnout and leaving the workforce and frustrated that they're not able to provide care. It's the problem is not can we make a better medical diagnosis.

The problem is when you have cancer, you have to spend 50 hours a month dealing with prior auth and scheduling and the billing department and. You know, getting the referrals and communication between your doctors, it's all of those friction points. That's what's driving people to burnout.

That's why doctors are leaving the workforce is because I prescribe Ozempic and my patient loses 30 pounds and then they come back and they've regained the 30 pounds because their prior auth couldn't [00:24:00] get done in time. Someone I think coined the term, I can't remember where this came from of moral distress.

And that's why people are burned out and leaving the workforce is the moral distress of knowing what the care plan should be. This person must be on Ozempic that person must get a PET scan to stage their cancer, and we can't make it happen.

Aaron Neinstein: [Mic bleed]

Sarah Richardson: Well, and if you have a condition like you're battling cancer, you also have your hours in chemo, that can may come with that as well.

And so, and that you're not at your best version of yourself when you're having to be sick and figure out how to get everything coordinated. So the fact that those are the stories that I love that come forward, that not the people are sick, but in their toughest times of their lives, how we're actually making that something that doesn't have to be one more thing they have to worry about.

Aaron Neinstein: Yeah.

Sarah Richardson: Yeah. Okay. I love what you and Notable are doing. I'm so glad you are there as well. Like, when you know people from previous settings and then you see them [00:25:00] solving for real problems, you know that we have a lot of faith in what's gonna be the future of what we're all endeavoring to deliver, which means I get to ask you like three speed round questions.

Are you ready? Okay. Okay.

Aaron Neinstein: Let's do it.

Sarah Richardson: What automation opportunity do most health systems overlook?

Aaron Neinstein: Fax, transcription, say fax. Nobody, Nobody wants to talk about it. I've been hearing for 10 years

everyone thinks faxes are gonna go away. And you know what? It's invisible. It's boring. Nobody wants there to be faxes. But guess what? Every large health system gets a million faxes a year and you know what's in those faxes. It's somebody's referral to oncology, it's somebody's PET scan.

It's somebody's prior auth. And so when they sit on the fax machine for two weeks before they're transcribed, it delays care. And so it's an easy one. It's high value, it's quick it can be done. You just have to accept the fact that faxes are gonna keep coming [00:26:00] and just get them transcribed automatically.

Sarah Richardson: If you're listening to this as a provider, you're like, Hey, I can bring a Notable, and maybe that's where I start. Is just getting the fax cloud space, like the whole just, you know, dark cloud. As I think about it over your head, start with your faxing, start your prior auth faxing, and boom, you have such a huge win across the continuum.

And you get to say, I'm the person who helped to eliminate some of the right on the faxing issues. With all this AI we have, we're still talking about fax machines. If you could retire a healthcare buzzword, what would it be?

Aaron Neinstein: We're not ready. Okay, so you've probably seen this in the health IT space for years, but I look, health systems are under immense pressure and they serve a large population with a really complex range of services.

And so. This idea that we're not ready for ai, we're not ready to transform because we've gotta get our house in order first before we're ready. It's a [00:27:00] trap. It's like my to-do list, right? I can sit down and I can spend my day just like answering emails or answering Slack messages. because there's always like urgent

feeling things that you can do, but you have to step back and think about what work is gonna have a 10x impact. That's gonna be the highest leverage. And so it's very easy to feel busy and to do the things and feel productive, but that's different than being effective and driving the highest leverage.

And so I would get rid of this idea that we're not ready because , we're too busy.

Sarah Richardson: That's an excellent perspective. Last question. What is one thing you wish every HIT executive knew about notable?

Aaron Neinstein: I'm gonna make this maybe less about Notable and more about ai. I'm gonna come back to abundance and Atul's phrase, scalable privilege. I think it's easy to look at AI. It's a common reaction to look at it as labor replacement. There's a [00:28:00] task that a human does

aI is gonna do that task. It's actually so much more than that because we're constrained today by the limits of what humans can do. And so, you know, think about the last time you had a family member in the hospital or for a surgery. Imagine if they're getting phone calls every day before they're coming in for that surgery, asking them if they had any questions, making sure they were educated, making sure that they were, stopped their blood thinners or any important medications. And then every day after they leave the hospital, they're getting a phone call every day checking in on them, making sure they're not having symptoms. We think these things are impossible because we're constrained by can we afford to hire enough humans to do this?

And that sounds like, oh my gosh, only a VIP gets that level of care and attention. But once you start realizing that you have access to this elastic workforce that can expand to do as many tasks as you need it [00:29:00] to, and it doesn't get tired, and it'll work at 2:00 AM on a Saturday you know, transcribing faxes and answering the phone in any language at 2:00 AM on a, you know.

You start to think about abundance and the type of healthcare that we can deliver. And it's incredibly exciting. So I think what I encourage people to know or think about is remove the constraints. You know, get out of scarcity thinking. Remove this constraints of, we're limited by what humans can do today, and think about what becomes possible when you have access to an unlimited workforce.

Sarah Richardson: I love that. In fact, I'm also gonna call it like abundant intelligence because to your point, it doesn't call in sick. It can do a lot of the things that, yeah, democratization of access to care, regardless of your political beliefs is something that everyone should feel like they matter, especially when they're dealing with their health care and

you make that possible. Erin, thank you so much for an insightful look behind the curtain of intelligent [00:30:00] automation and for everything that Notable is already doing and how people can explore new ideas. And if they don't know where to start, I would say reach out to the Notable team. Reach out to me.

I'll point you in the right direction. So Erin, thanks again for being on the show.

Aaron Neinstein: Thanks, Sarah. Always great to talk to you.

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