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  📍

  📍 I'm Bill Russell, creator of this week Health, where our mission is to transform healthcare one connection at a time. Welcome to Newsday, breaking Down the Health it headlines that matter most. Let's jump into the news.

 All right. It's Newsday. And today I'm joined by Will Akers with Switchboard md. And obviously the beautiful Sarah Richardson and the incomparable direct to Ford incomparable. That's twice I've called you incomparable. That's okay. Yeah. You okay? And will incomprehensible man.

I don't know you well enough to come up with an adjective just yet, but  Well,

he's not just another pretty face. How about that?

Yeah.   welcome to the conversation. Appreciate you being here.  

Yeah, thrilled to have a chance to chat with you guys and share some experiences from what we're seeing and talk about some of these articles and themes in the market. 

This is the day before Thanksgiving and we are all I'm sure getting close to the end of the day, and I know we have a day off on Friday. Did, does switchboard give you off on Friday?  

We don't technically have off, but I'm taking the second half of the day to get a watch Georgia Tech, where hopefully we're gonna notch or.

You know, next win of the season for the Georgia Bulldogs.

 will that be a good game?  It could be.  I think it bit of a shaking, or it could

be the exact opposite.  Yeah, I mean, Georgia Tech's had a shaky last couple games. I think if you asked me that three weeks ago, I would've said It's gonna be a great game.

because both teams were ranked in the top 10. But they've had a couple challenges the last few weeks and lost to Pittsburgh last week, which was unexpected.  

Will, you're chief Strategy Officer for switchboard md clinical communications and really addressing a pretty vital challenge. We were talking a little bit before this about the pool from the industry towards patient communication.

But you know, where I wanna start is something else. We were talking about you, you spent a fair amount of time abroad. Had a child abroad, had a child in the us I'd love to hear about your experience. In, in both health systems, right, in, health system abroad and health system in the states and compare those a little bit for us.

 Yeah, definitely. So I spent 12 years in Hong Kong and Singapore and met my wife in Hong Kong in 2016. And we had our first child as a COVID baby in late 2020 in Hong Kong. And it was a very interesting experience for us. It was obviously our first child, and having been abroad a long time, getting exposure to the healthcare system in Hong Kong.

Was you know, frankly a, just a great experience overall. Some of the things that I noticed as part of that process of engaging with an O-B-G-Y-N and then going through the process of meeting with doctors on a regular basis, leading up to the child's birth was versus the US experience. There was just so many fewer people involved, and so.

A typical appointment in Hong Kong would be going in. We go straight in to see the doctor. They would put the gel on my wife's belly, immediately launch into ultrasound in real time, pointing at the baby, taking pictures, talking through what was happening, and giving us all of that. And within less than 10 minutes, we were done with the doctor.

We were done with the radiology the, or the ultrasound.

 Did you feel slighted? because it was only 10 minutes.  

No, I mean we covered every single thing that, that we would've needed to cover in that period. I think it was just a matter of what I would consider like multitasking versus the experience in the US where you go and you wait and you do the scan and the person doing the scan is talking to you, and then you kind of done with that, and then the scans are all sent over to your doctor.

Mm-hmm. And then you go to the next waiting room and you wait again, and then you get to sit with the doctor and you go through the scan. And it kind of immediately jumped out to us when we came back to the US of why are we, why are we going to two separate people for this? This seems like one doctor could do the whole thing.

And then at the checkout counter we're going to pay, and in Hong Kong, that appointment would probably cost in the neighborhood of 120 US dollars. And here in the US we're looking at, that might be 500 bucks, that might be $800. Covered by insurance. Of course, we're paying just the copay, but we are just like, man, what a discrepancy here with the amount of time it took for us to get through and get in and get out.

And then the amount of money being exchanged for effectively the same, you know, the same type of appointment.

 Do we think it's inefficient by design or is it inefficient By structure, why is it inefficient?  

I think it's by design in order to maximize insurance payout to get the most dollars you can.

Yeah, I think that's the key driver here. That is different. You know, most people in Hong Kong are, you know. Most of the groups that we were visiting or dealing with insured patients that work for banks or work for financial institutions over there. But I think the insurance approach there is just very different.

And we're typically paying out of pocket and getting reimbursed, but there's just a lot simpler system. Same with when we actually gave birth in the hospital in Hong Kong. We had a prior auth. We completed that process. We actually had an emergency c-section. As we had an what I like to refer to as a gigantic American baby  being born in my Chinese, my, my wife's Chinese. 

So my Chinese wife couldn't sustain that. So we ended up staying a little bit longer. Wasn't exactly the procedure. We got the prior auth for, I probably paid $200 US out of pocket. Oh my gosh. Prior thing. And we stayed at the nicest hospital in the country that's on a mountaintop where we have a balcony view overlooking the harbor and they cater food from the Shangri La five Star hotel to come in for the group.

So that's, and then to compare that to here, where it's like literally my wife went in to deliver our second child. Her water had broken, we're in the room. Three different nurses had to come in to find a vein to just put the IV in, and then we end up having to go to the operating room and they tell her, why don't you just walk there?

She's like, well, I'm, my water's broke. I'm like, leaking fluids everywhere. Oh, don't worry. We'll just mop it up.

Oh

gosh.

 First of all, you gave me an image from like the movie elf, like my huge American baby and Yeah. You know, nine pounds?

Yeah. How many pounds?

 Nine pound baby. Typical Asian babies were like five to six pounds. Oh, wow. At this hospital that were in the same little nursery. So, so,  

so my picture is not that off. Like you would look into the nursery and you'd see these babies and you'd be like.

That's ours. That one right there.  

It looked like ours ate the baby next day.    

Kind of crazy. I the, I remember a quote from David Feinberg uh, now with Oracle formerly with a lot of companies, but he, when he was with Geisinger, he did an interview and, he said you know, one of the biggest problems we have in our health system is everything's designed to maximize the time of a doctor.

And he said, so the reason we have waiting rooms is because we wanna maximize the doctor time. And the reason we have, you know, you see this, the nurse like gets all these things outta the way first because we wanna maximize the time of the doctor. And he said it's a really it's an interesting model, but it creates a ton of inefficiencies.

In our system. So I agree with you. There's absolute maximization of the insurance dollar, but there's also the the design around the doctor's time, especially the specialist. I mean, They're very expensive.

 Now. Don't, Don't you think those things kind of go hand in hand though?

You wanna maximize the time of the doctors so they can bill as many things as they can possibly bill, so that, you know, I mean, I feel like they're kind of tied together.  

Well, it, but they're also a constrained resource now is, you know, we're getting to that point where it's like, you know, how many specialists?

Well first of all, how many specialists can you afford to have at your health system? And then second of all, we're not printing enough of them.  

A lot of this gets to will's. I think, you know, some of the stuff we're gonna talk with Will about too, which is the coordination between those doctors and all of those elements of the healthcare system.

And as a patient travels through, there's a lot of waste in that process. A lot of interruptions in care that don't have to be there

  absolutely. I mean, I think one of the things that I've experienced firsthand, right after moving back our child was sick. It was after hours. I call our pediatrician.

I get the after hours, you know, outsourced call person. They take down all my information. They ask me tons of questions. Somebody's gonna call you back, you know? 20 minutes later, I get another call. I get somebody on the line, all the same questions, everything all over again for like 10 minutes. Then they say, somebody's gonna call you back.

Oh gosh. Third person calls me all the same stuff for the third time. And then the conclusion was, wait and see if you need to come in tomorrow. So just like something's off here.  

Where does technology step in? I mean, I mean, that's one of the things you're looking at.  

That's right. You know, I think one of the challenges we have is a lot of these things could be streamlined so much with technology, and you think about if I had the ability to call in and the system could prompt me with the right questions and I could give answers, and then it could determine this is something that's clinically urgent, you need to go to the er, or this is something that's really important, we're gonna page the doctor to give you a call immediately.

Or we're gonna know that this is not that urgent. We're gonna take it down and we're gonna have someone get back to you tomorrow. because the other challenge we're hearing from our clients is they get calls at all hours. That's like, I just need my refill done. I need to Right, you know, reschedule my appointment and they're calling in at 10 o'clock at night because they're too busy during other times of the day.

And just resolving that and getting it to the right person. When it's needed to be urgent versus just handling it the next day is is a massive pain point.  

it's interesting, one of the articles you sent over that I was reading through this morning, seniors spend the equivalent of three weeks a year on healthcare.

This comes outta the Washington Post. This idea that and a lot of them, even a lot more than that on the phone, traveling to and from the doctor, waiting in the waiting room, all that kind of stuff. It's it, I mean, it's maddening I think for a lot of folks who, especially. A lot of these seniors don't necessarily have chronic care conditions either.

They're just getting routine care. It takes forever.  

We're not seniors yet, and Sarah's definitely not a senior yet, but I Sarah, how many portals do you have? You've lived in a bunch of different places. You probably have a similar profile that I do,  

so I'm probably the worst example because I don't like.

Bring all my care forward. I go to Teladoc more than anything else that never gets into a record. I now have a MyChart account and they happen to all be linked because I have three different health systems, even in my tiny county. And that data. So the data since 2022 is all here my entire life before 2022.

It's everywhere. I've never bothered to aggregate it. I've been fortunate, I've been pretty healthy, but. I don't keep it all in one place. I just, it's just not one of those things. I spend more time managing my elderly relatives portals and healthcare. I'm the navigator. I took four hours just to help.

My mom's best friend figure out which Medicare Advantage plan to think about because her old one got canceled after 12 years.  

So do we des do we design for that? I'm curious. You know, we're helping to coordinate my parents' care. We helped to coordinate my my in-laws care. I mean, do we design for that?

Is that something we design for as a health system? That whole care circle of.  No.

You're hopeful your kids do, and if you don't have kids, you hope that someone else will help you do it. That knows how to navigate the system because it's hard. Like I had to buy my aunt like a giant monitor because she knew how to log in, but she couldn't see anything.

She had this tiny little 15 inch monitor. I'm like, you know, I can get you like a 22 inch curved monitor. I ran down to Costco, got one, plugged it in so she at least see the portal.  But wait,

but you have to do that same thing I do, which is, I'm like, okay. Can you log into your portal? Yep. I, I, I, which one?

Yep. I'm like uh, yeah, it's, it should be the one that says Saint something. It's like, oh, okay. Yeah. Open that one. Oh. You don't know your password. You're gonna have to do forgot password and Yeah. You know, and my gosh,  

what email is it coming to?  I know

it's that exact Yes.  And then they get locked outta their phone and you had taken to the at and t store to reset their phone because they didn't have their phone password.

That also happened three weeks ago.  

So I was chatting with my dad about this. My dad's 75. He has 10 different doctors that he sees on a regular basis. He's a reasonably healthy individual, but he's, you know, he is older, he is got, you know, a heart doctor, a mm-hmm. A lot of different specialists that he is seeing, and he's got six different portals and I'm like, well, how do you keep track of all this?

He's like, I don't, I have no idea which portals, which doctor, I just pick up the phone every time. I'm just calling in and I just do everything over the phone because I can't remember my password. I don't wanna do the forgot password and go through that thing. I'd rather just talk to somebody and I think that's the generation that is now about to add another, you know, 15 million more baby boomers retiring, entering that senior stage of care over the next decade.

And you can imagine if they're all got 10 doctors. And they're having those things all happening over the phone, what is that gonna do to,  well, well, well, how

do you, how do you design for that? I mean, first of all, you have privacy issues like my mom gives me her login. I go in as her, but but I don't think she has an easy way to just go, give Grant my son access.

In this system. I haven't looked at it. Maybe there is, but I  There is,

but you have to submit the documentation sometimes for the proxy, for you to be able to have access to her information. And that can get stuck in the system as well, which recently happened to someone else I know, who's a lawyer took three days to get access to her mom's account, even though she already had proxy rights.

So she actually called their legal team because she's a lawyer. That's the kind of stuff though. Like what if that, what if she didn't have her daughter to do that? Yeah. . 

Yeah. And what if they wanna call in to get their lab results because they're not logging into the portal.  

Good luck. And those third party apps that create aggregation capabilities aren't necessarily have to follow HIPAA rights.

If you have to really look at what the rules are around some of these third party apps, because they're not governed under HIPAA if they take some of your information. And so if you're self-loading that it then becomes information to a degree. You hit the click I accept button, they can now monetize your data. 

We have two groups of people that often get talked about in this. I remember when I was presenting to the sisters about our portal and we were gonna roll it out and that kinda stuff. They were concerned about two groups. One is the older generation who, you know, how are we gonna make this easy for them?

The other was. The disenfranchised and you know, we were in rural healthcare. In fact, we were one of the hospitals near Sarah. Sarah lives rural. She tries to portray this cosmopolitan, but she's, she lives in wine country. Yes, it's kind of an upscale rural, but it's rural nonetheless, in rural. But yeah, they were concerned about that community as well.

because they're like, Hey, you know, there's a fair number of people that may not have connectivity, may not have cell phones, may not have, you know, how do you design for these things? How do you design? You know, both of my parents now do not use laptops and computers. They both use iPads.

Like that is their primary computer because they just, they didn't like navigating the complexity of a Mac, but the, because the iPad just at one level easier for them. And now they're both 88 years old. But but yeah, I mean, they jet us in that. So you're designing for that. How do you design for that?

I mean, will your organization's gonna be designing a system to start. You know, not only clinical communication, but also to the patient. How do you address that?  

Yeah, so I mean, I think there's a couple things that we're looking at, and one is for, this is the combination of managing both the inbound calls that inundate a healthcare system on any given day, as well as how do you streamline the outbound access.

And from an inbound standpoint, one of the things that we're finding is anywhere from 25 to 40% of all calls coming into a given health system. Are related to, I need to cancel my appointment. I need to reschedule my appointment, I need to confirm what time my appointment is, or find directions to like the office because I forgot, you know, I've got 10 doctors.

Where's your office again? And a lot of that stuff is very ripe for automation at this point. Doesn't require a lot of complexity outside of a name, a date of birth, and the ability to integrate with the health record system for technology to. To handle that end to end. And if you're able to take that load off of the contact center team, that allows them to then refocus their time and handling the more complicated queries coming in.

So I think that's one piece of it is kind of taking the administrative work that's easy and kind of fits in that Venn diagram of high degree of. Probability that you can resolve it without a human low risk if it does get, you know, go wrong somehow, and high value to freeing up that agent to focus on more, more important work.

The other element is all the outbound stuff like lab results and things that today get sent out via the portal, where an older person may not know how to log into the portal. They may never even create their login for the portal, and being able to have an outbound call. That can authenticate who they are and then talk through those results and determine, do they need to have a call with a physician to kind of go deeper on it, or it's just knowing the results, you know, as far as they need to go. 

And so even somebody just telling you, we got your results and they're all normal.  Exactly. It could be as simple as that.  

I'd love to go round robin and hear from everybody. What's the one thing you would like the health system to do for you as a patient? 

This is fun question because I had a podcast recently with a CIO who said their part of their strategy is the Imagine If campaign.

Imagine if we could do these things for our patients and for me it's imagine if I really can't have all of my records. Aggregated into, I'm gonna say my chart because I can just push a button and send my Teladoc and send my prescriptions and send all that information. Like I have a whole holistic practitioner I see for most of my care.

Now, none of that is going to my PCP. So I would love there to be a way to aggregate my records in a way that keeps them safe, but also makes it easy for them to get to. And those practitioners, all those care providers. Know what's happening in my life because I would say a significant amount of my current care is unknown to my hospital system. Mm-hmm.

 Drex.

 So, sort of in line with Sarah's, I, from time to time, I will mention the personal health record, which doesn't actually exist, but this idea that you could pull data from lots of different places into my personal health record, and I could share that data then with whoever I need to share it with, including things like research that I may be participating in.

Lots of other stuff. Maybe I can even monetize some of that data for research or other things. I would love for that to be a thing. We've taken it, I mean, as an industry, we've taken a run at it a couple of times with Google and Microsoft and I don't know, the tech wasn't there. The world wasn't really ready for it.

Somebody needs to take another run at this. I think we're ready for PHRs.

 well, as a patient, one thing you'd like to see,

 well, I'm gonna say as a patient, that's my generation, self-service, everything for what I need to get. Like, I never wanna have to pick up the phone. To speak to anybody.

And if I could get it via a text or  more texting

you, youngsters, you're all, you know, self-serve, don't, I don't want to talk to people, just let's get it done.

 Make it simple. Yeah. Make it simple and self-serve. I, and which I realize that's the ideal solution for me. But when I talk to my dad and the 75-year-old generation and older, that's the antithesis of what they want.

They want to talk to people, they want to deal with. Humans as much as they can because a lot of 'em are lonely. They want to talk to people and they, that's just how they've always done things.

 The number one thing I would say is I want you to redo your call centers. And I don't care if, I don't care if AI answers because quite frankly, I mean, no offense to my parents, but they're not gonna know the difference at some point. And and I've seen Hippocratic have full-blown conversations with people and I'm like you know, we're at that point where AI can have a full-blown conversation. So if my dad wants to talk about the Eagles, it'll talk to 'em about the Eagles.

That'll, that would be fine. It's say, oh yeah, I saw they won last night. That's great. What do you need from the health system? Kind of thing. So I would like to see them redo. the call center experience. And by the way, let's not stop at healthcare. Let's go ahead to the airlines and everybody else while we're at it. 

By the way, we almost got through the whole episode without saying AI and Bill just blew it, so good job, bill.  

All right, everybody take a drink. All I have is water.  

I got electrolytes.  

Electrolytes. That's why we did one of our city tour dinners. We started with a drinking game every time AO was said, and like after the fifth time, we're like, all right, we gotta stop.

And it's like, we're gonna be,  

you notice I deliberately avoided, I said, technology consultancy.  

Yes. I know. You did a great job. I saw you like, I know you were itching to say right up to

the

edge. But  there's so

much good that Switchboard is doing with it. But here's what I love. It's the value proposition of what you're bringing to the table.

It happens to have AI components that are baked in if you're not leading with it, it's just something you've harnessed. And that's important for all the solutions that are being put out there. It's, here's how we're utilizing it, but it's not how we're leading it necessarily.  Alright. We're

gonna get in trouble from Landon if we don't close quickly, but I do want to get this since it's Wednesday before Thanksgiving.

What are you looking forward to tomorrow? Thanksgiving day. Sarah. I think yours is predictable. What's yours?  Football. I knew it. I knew it.  I knew it'd be football  uh, and family.

I should said family and football, but you know, they're kind of one and the same.

 Drex

apple pie. I'm gonna go for the apple pie. 

Just keep, go straight for dessert.

Mm-hmm.

Got it. Will, what about you?

 two things. We got a Turkey trot in the morning, which, you know, always feels more rewarding to have a big Thanksgiving feast if you've done a good run to start the day.  Right. Good

for you. You get the payoff.  

Yeah. And then Turkey and stuffing, which, you know, we really only have once a year, so it's always makes it extra special with family.

 we will be doing a Turkey trot as well. It's a walking 5K, which I'm okay with. That'll be that'll be fun. So my wife and I gonna start there and what am I looking forward to? I'm looking forward to spending time with my wife. Don't tell her, but I am looking forward to spending time with my wife because we've been on the road a lot and it's nice to be home for a little bit.

So, hey, I want to thank you. Well, I will, especially I thank you for coming on the show and sharing your experience. With healthcare abroad and within the states and exploring these topics with us. Really appreciate it.

That's Newsday. Stay informed between episodes with our Daily Insights email. And remember, every healthcare leader needs a community they can lean on and learn from. Subscribe at this week, health.com/subscribe. Thanks for listening. That's all for now.