Latest / The Advancing Healthcare Innovation Show / E190: The Patient Story AI Still Can’t See | Jenni Gudapati, PhD

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E190: The Patient Story AI Still Can’t See | Jenni Gudapati, PhD · The Advancing Healthcare Innovation Show

0:10
Hello and welcome back to the Advancing
0:12
Healthcare Innovation Show. I am your
0:14
host, Michael Stamatinos, and if you're
0:16
new to us, welcome. We are so glad that
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you are here. We're having some
0:20
incredible conversations with real
0:23
leaders that are painstakingly reshaping
0:26
the future of healthcare. So, we're
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pretty passionate about a few different
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areas. We're passionate about access,
0:32
about leadership, about innovation, and
0:34
the adoption of those innovations. And
0:35
if it's your first time tuning in, let
0:38
me just take a quick step back, um, give
0:40
you a little bit of the rundown of what
0:42
we're really trying to get done here.
0:43
So, our focus is on bringing real
0:46
stories of innovation to life. Not just
0:48
the stuff that you, uh, read in
0:50
headlines, but real people that are
0:52
really truly innovating in the trenches.
0:54
What's working? You know, what are some
0:56
of the learnings? and giving them the
0:58
opportunity to sort of share those
0:59
things uh with our community and
1:02
ultimately with the world. If you
1:04
haven't had the opportunity to check out
1:05
any of our historical interviews,
1:07
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please hit the subscribe button now so
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that any of the new episodes come
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directly to you. So, I I'm I'm actually
1:24
really excited about today's
1:26
conversation for a few different
1:27
reasons. Um, generally we do
1:29
conversations prior just to kind of kind
1:31
of get a get to know you and then
1:32
there's usually kind of get to know
1:34
whether or not like if you if you really
1:36
gel with someone and
1:39
this person really gel with. So, Dr.
1:42
Jenny Gurapati, she started out as a
1:45
nurse. Um, so she's been in the room.
1:47
She understands care delivery at a at a
1:49
very deep level. And she's seen what
1:50
good care looks like. And at the same
1:52
time, she's she's seen seen it when
1:55
things kind of fall apart. And she went
1:58
on to build a graduate program at Boise
2:02
State University that won not one but
2:04
two national awards. She co-chared
2:07
Idaho's telealth task force. uh and she
2:10
was picked by the Centers for Medicare
2:14
and Medicaid Services to help write the
2:17
health equity standards that health
2:20
plans across the country have to follow
2:23
today. Um so she's trained healthcare
2:26
leaders, she's worked with lawmakers,
2:28
she has spoken um at conferences across
2:31
the country, but I think here's what
2:34
drives her. the people who've been
2:37
getting left behind, seniors, people in
2:40
rural towns, people dealing with complex
2:43
health conditions, people who had
2:45
insurance, had a care plan, uh we're
2:48
supposed to get help but never did. And
2:51
now she's gone on to co-found a company,
2:53
Healthy Insights AI, a company that is
2:56
built on one belief that every patient's
2:59
story deserves to be seen and that the
3:02
care people are promised to should
3:06
actually reach them. So she's helping
3:08
organizations generate insight um not
3:10
just by working with one insight alone.
3:12
That's obviously not enough. But what
3:14
does it actually take to move a team
3:16
from knowing about something to actually
3:19
doing something? And I think if we're
3:21
honest in healthcare, we don't have a
3:23
shortage of information. If anything, we
3:26
have a sea of data that we're just not
3:28
seeing. And I think folks are having a
3:30
harder time now more than ever with
3:32
trust and alignment and ultimately, you
3:35
know, action. So what I'm excited about
3:37
today is kind of digging deeper. what
3:40
has shaped her perspective, some of the
3:42
stuff that she's seen early on that she
3:44
still holds true, and maybe where she
3:47
believes things tend to break down um
3:50
even in wellresourced organizations that
3:53
um have all the data in the world. So,
3:55
that's what I'm really excited about.
3:57
Jenny, it's great to see you. Welcome to
3:59
the show.
4:01
>> Hey, thank you, Michael. Thank you for
4:03
having me. I too was excited to be on
4:05
today. I think the last time we talked,
4:08
it's very rare that you meet somebody
4:10
and all of a sudden your entire
4:12
scheduled time is gone because you've
4:14
talked so much. And
4:17
>> you know, when you have the energy level
4:19
that I do,
4:20
>> it's also kind of rare to meet somebody
4:22
where that energy and the passion for
4:24
better health care is equal to mine. And
4:26
I felt like when we connected, it was
4:29
just a different level of people that
4:32
really care about where healthcare
4:33
should be going and excited about things
4:36
that are moving in that direction.
4:38
>> Yeah. You know, the kind of the universe
4:40
is scheming to have us um you know, jam
4:42
out together. So that's u that's
4:44
interesting. Before we kind of dive in,
4:47
um I I kind of want to start where maybe
4:48
most people don't start because you
4:50
started off as a nurse, as a clinician.
4:53
um you you got to see things that you
4:56
know others don't necessarily get to see
4:59
as a frontline care delivery worker.
5:01
What what was it like uh just sort of
5:04
being bedside in in rural America?
5:08
>> Yeah, that that's a great question and
5:10
you know you're right. I mean, I think
5:12
I've been, you know, so much in in value
5:15
based care and trying to change staying
5:17
on on the healthcare payment reform kind
5:19
of things that I think a lot of people
5:21
tend to forget that I started out as a
5:23
nurse, right? So, I became or began my
5:27
career well over two decades ago in the
5:30
emergency room and critical care
5:32
departments of um I'm going to do a
5:34
shout out, Holy Rosary Medical Center.
5:37
Um, it has since been bought by a larger
5:40
system, but all of us at Holy Rosary
5:42
remember the the days. And you know, I
5:45
think everything that I learned both at
5:49
the hospital and then when I left in the
5:50
hospital and got into home health really
5:53
drives what I do, right? Um, as an
5:57
emergency room nurse and then seeing our
5:59
critical patients in the hospital, what
6:01
I really saw was the same patients
6:04
bouncing back and forth into the
6:07
emergency room
6:08
>> time and time again. And the viewpoint
6:11
was, you know, we'd see these patients
6:14
and oftentimes, you know, they get
6:16
mclassified as like, oh, these are our
6:19
frequent flyers or these are our
6:21
non-compliant patients. And I think the
6:24
thing that I've learned from being at
6:26
the bedside, being from the health
6:28
system, and then going into the patients
6:30
homes is we didn't understand our
6:32
patients, right? Like when you go to
6:34
nursing school or medical school, we are
6:38
really really good at teaching body
6:40
systems or chemistry or these are the
6:43
way things are and this is why this lab
6:47
is going to create this result. But what
6:50
we we haven't done really really well is
6:53
taught clinicians on how to actually
6:56
listen to their patients and that so
6:59
much outside of just the physical
7:02
properties of a patient really dictate
7:05
how they do in their healthcare
7:06
environment. And I think you know a lot
7:08
of what you've touched on already like
7:10
how much the patients trust the system
7:12
or you know what are their social needs
7:15
or what are those things they are very
7:18
very large factors in how patients are
7:21
going to respond to care whether or not
7:24
they are going to be accountable in
7:26
their care and that's what really I
7:29
think you know for me has driven my
7:31
career on how do we bring our patients
7:34
stories into our care planning
7:37
So that even though we may not always
7:38
agree on things like right now you bring
7:41
up trust, right? Like if I sat down with
7:43
10 patients, I'm going to have 10
7:45
different views on what they think they
7:48
need to make their health most optimal,
7:50
>> right?
7:50
>> So let's see if we can sit down and work
7:52
together to figure that out. Was there
7:55
was there like a specific moment or
7:57
maybe a patient or a situation I guess
8:00
something that made you kind of realize
8:01
that this problem is actually way bigger
8:03
than what you could sort of fix from
8:06
from the bedside?
8:09
>> Absolutely. I I have one patient in
8:13
general that I will change everything
8:15
about them just because of Hippo, right?
8:17
Like I hate for my patient to be
8:19
listening to your podcast and be like, I
8:21
think Jenny's talking about me today.
8:23
Um, but I had one patient in particular
8:27
that used to come into the emergency
8:29
room quite frequently and you know they
8:33
would they would come in and always
8:36
complaining and we'll just say today
8:37
it's back pain. So they would come in
8:39
time and time again for back pain. And
8:42
so one night in the emergency room
8:44
because I am a night shift emergency
8:46
room back when I was at the hospital. I
8:48
was one of those crazy
8:51
>> um but one night we were flumped. I mean
8:54
we had a lot of critical patients. We
8:57
had a backlog
8:58
>> and this patient came in and you know to
9:01
my embarrassment I walked in. I was a
9:03
little bit frustrated and I sat down and
9:06
we'll just say that today her name is
9:08
Sally. Sally did you make it to the pain
9:11
clinic? Did you make it to physical
9:12
therapy? You know all of the things. And
9:16
the patient looked and she was, "No,
9:18
Jenny, I I didn't do that. I didn't do
9:20
that." And so, in my frustration, you
9:23
know, because as a nurse, we are a lot
9:26
of times under a lot of stress. You're
9:28
running in and out of rooms. You're
9:29
trying to take care of a lot of
9:31
patients. And so, here was a patient
9:32
that number one, I didn't see as
9:35
critical as a lot of the other patients
9:36
in there, but one that
9:38
>> I just didn't feel like she was
9:39
listening to what we should do. And so,
9:42
you know, I'm kind of like, why why
9:44
didn't you do these things? Like, we
9:46
we've sent you, you know, we've given
9:48
you our instruction.
9:50
>> And, you know, she looked at me and
9:52
she's like, you know, Jenny, um, you're
9:55
right. You see me a lot. I I do I
9:59
request you as a nurse. And she goes,
10:01
because when I come in, you give me a
10:04
sandwich, graham crackers, and a carton
10:06
of milk.
10:08
and she goes, "Sometimes I don't come to
10:11
the emergency room because my back is
10:13
hurting. It's because I'm hungry."
10:16
And that one moment changed the entire
10:20
way that I saw
10:23
discrepancies in how we should be caring
10:25
for patients because I had never thought
10:27
to ask our patients like, you know, they
10:30
say they're coming in for one thing. Can
10:32
I can I assume that? And so as the
10:35
evening rolled out, um, you know, I
10:40
realized she didn't know how to fill out
10:41
her paperwork to get the services that
10:43
she needed.
10:45
>> And so I called in social work in the
10:47
middle of the night and said, "I am
10:49
going to get this patient taken care of.
10:52
We are going to get her signed up. We're
10:55
going to get things taken care of." And
10:57
what was interesting is of course as the
10:59
days played out I'm thinking I am going
11:01
to get the day Daisy award for this
11:03
right I have gone above and beyond the
11:06
call of duty I have figured this out I
11:09
called in social work
11:11
>> and instead I got in trouble
11:13
>> right because I called in an unnecessary
11:16
social work visit into the middle of the
11:18
night so not only did it cost the
11:20
hospital more money because it wasn't a
11:22
reimburseable reason to call a clinician
11:24
>> but they had to do so at after hours
11:28
wages. And you know what was
11:31
interesting? I could have been mad at
11:32
the hospital. I could have been mad at
11:33
my supervisor for letting me know that
11:35
is not something I should be doing as a
11:37
night shift emergency room.
11:39
>> But instead, I really explored the
11:41
problem in a much deeper realm, which is
11:43
why didn't the hospital get reimbursed
11:46
for this? What do we mean? Like this was
11:48
an expense that if you look
11:50
longitudinally by getting the patients
11:53
needs met, we stopped. so many
11:57
unnecessary ED visits for this patient.
12:00
We actually gave right her the ability
12:03
to get, you know, what she needed in a
12:06
much more appropriate manner, which was
12:10
truly the services that should have been
12:12
provided to her the first time she came
12:15
in. And so it led me to leave the
12:17
hospital and get into home health. So I
12:20
got into post-accute care. I became the
12:23
admissions nurse for my agency. So, I
12:26
got to go into the homes of majority of
12:28
our patients, do the initial
12:30
assessments, and then write a 60-day
12:33
care plan for them. Right? How do you go
12:35
and admit a patient in a couple hours
12:38
and figure out what their needs are over
12:40
60 days? And through that experience and
12:43
having the ability to talk with my
12:45
patients, because those assessments can
12:47
take one to two hours, right? By the
12:48
time you're there, you're you're doing
12:50
this with your patient. You're also
12:51
observing the environment, too. Like
12:53
you're you're you're you know, they're
12:54
saying things, but you're also kind of
12:56
seeing things with your eyes and you're
12:57
kind of putting all this data together.
13:01
>> Oh, absolutely. And things you'd never
13:03
think of, right? Like I would walk in
13:05
and find patients who, you know, in the
13:07
emergency room we saw with diabetic keto
13:10
acidosis only to find out there was no
13:12
working refrigerator to house insulin,
13:15
right? So, it wasn't that the patient
13:18
wasn't trying to take the medicine. it
13:20
was just that it wasn't effective. Or I
13:22
would see patients that would cut their
13:24
medicine in half,
13:26
>> thinking they would only have to buy the
13:28
prescription once every 60 days instead
13:30
of once every 30 days because they
13:32
couldn't afford to take it
13:34
>> on the regularly dose schedule. And they
13:36
thought that was the best thing that
13:39
they could do. And so it really did open
13:41
my eyes to how can we change the way we
13:46
view health care, the way we pay for
13:49
health care
13:50
>> to where we work together to incentivize
13:54
best patient outcomes without waiting
13:57
for our patients to get sick or need
13:59
emergency medicine. H so is that sort of
14:03
a a nice on-ramp to you because you're
14:07
now going from bedside you transitioned
14:09
you're doing you know your doctorate and
14:11
then some other additional post-graduate
14:13
training. It seems like you know did
14:14
that sort of accidentally happen and
14:16
guess what what what were you trying to
14:19
to figure out that you couldn't see from
14:22
where you were at that moment?
14:25
Yeah, I I think there were a couple
14:26
things uh Michael that that changed the
14:29
course of the career about that same
14:30
time. Um I also lost my father and I
14:35
lost my father
14:38
uh in my opinion in a totally avoidable
14:41
secondary stroke situation
14:44
>> um where he was discharged from hospital
14:47
with no
14:49
post discharge coordination. So, they
14:52
had changed his medicines or at least
14:54
the dosages and forgot to tell his
14:56
primary care provider. And so, when I
14:58
brought my dad home, I asked him like,
15:00
"Did they change your medications?" And
15:02
he told me, "No, because they were the
15:04
same medications, but I didn't think to
15:06
ask him, did they change the doses?" And
15:08
so, my dad had initially gone in for a
15:11
blood clot because his blood was too
15:13
thin. They took him off of his blood
15:16
pressure medicine and up his couadin in
15:18
the hospital, then forgot to tell him to
15:20
go back to normal dosages and said,
15:22
"Hey, when it's time to get back to your
15:24
normal doses, your primary care doc will
15:26
reach out to you."
15:28
>> And so my dad two and a half weeks later
15:30
had a brain bleed.
15:32
And
15:34
I figured if this could happen to me, an
15:37
emergency room critical care certified
15:40
nurse who also is in home health and I
15:43
let my own father who was my best friend
15:46
fall through the cracks. What is
15:48
happening to the rest of the country?
15:50
And why don't hospitals at that time get
15:53
paid for discharge planning? You know,
15:55
why is it that they only get paid when
15:57
patients are sick or hurting? And so I
16:00
started to investigate, learn about
16:03
value- based care, um things like remote
16:06
patient monitoring, post-accute care,
16:09
and that's when I became passionate and
16:11
be kind of started the mission of I'm
16:14
going to change health care, right? Like
16:16
I've lived it, I've seen it, it's time
16:19
for somebody to start doing something
16:20
about it. And so it became a, you know,
16:24
a personal mission of mine to change the
16:26
way we get better at healthcare, which
16:29
in my opinion, the only way to do that
16:31
is by changing the way we pay for it.
16:38
>> Pretty fascinating.
16:41
Do you in terms of where you are now?
16:44
Are there certain things that you kind
16:46
of used to believe and now that you
16:48
understand how money flows, how policy
16:51
works that you kind of changed
16:54
completely change your mind on?
16:57
>> Absolutely. I mean, you know, I I used
17:00
to think that, you know, the answer is
17:04
to just start pointing fingers, right?
17:06
like why do hospitals charge so much
17:09
money or why are they only taking care
17:12
of patients that are sick? Like why
17:13
aren't they doing case management? And
17:16
then at the same you know time you you
17:18
blame health insurance companies that
17:21
you know are maybe denying claims or you
17:24
know require prior authorization. And
17:27
what you realize is in my opinion I
17:30
don't see that there's any real enemies
17:32
at all in healthcare. what we have is a
17:35
system with no that
17:37
>> just don't have guard rails in place
17:39
that are appropriate, right? Like so for
17:41
a while, health systems would,
17:44
>> you know, they would charge for every
17:46
single uh fe uh good or service
17:49
provided, right? And so the more goods
17:51
and services that they produced, the
17:53
more money they made. So what happens
17:56
insurance companies are like wait a
17:57
minute you're ordering all these goods
17:59
and services sometimes you know multiple
18:01
echo cardiograms in a week or why can't
18:04
we share health records so that we don't
18:06
have to do repeat testing
18:09
>> and the reason was is because it's what
18:11
drove revenue for their system right
18:12
it's what kept their doors open it was
18:15
what they needed to do um or even just
18:19
didn't think about it any anything else
18:21
like as an emergency room nurse I can
18:23
tell you there was a times where I would
18:26
bring in four IV start kits, not
18:28
thinking that the patient was going to
18:29
get charged for four, but I knew if I
18:31
brought in four IV start kits, I'd get
18:33
the IV on the first stick because, you
18:36
know, they'd have extra. And if you only
18:37
brought one, the uh IV gods were going
18:40
to make me miss, right? So, I'd have to
18:42
leave the room and get another IV start.
18:45
And so, I never thought about cost
18:47
containment
18:49
>> for practice, right? It was just this
18:52
different type of thinking. And I think
18:54
when you look at health care both on the
18:56
delivery side and the payment side, it's
18:59
just like everything else. It works in a
19:01
pendulum, right? So we had a health
19:02
system that were charging for the goods
19:04
and services that they were delivering.
19:06
I I you know I I want to believe that it
19:09
was not done out of ill intent. It's not
19:11
like they were trying to make people go
19:12
bankrupt across the country, right? They
19:14
were doing what they were doing on the
19:16
easiest manner possible. Right? There's
19:19
a lot of times it was easier. Like if
19:20
you go to your primary care doc, you
19:22
find out you've got a cardiac diagnosis,
19:25
they do a, you know, an EKG. Oh, there's
19:27
a problem. Let me send you to uh the
19:30
cardiologist, you go to the
19:31
cardiologist, he'll repeat the EKG,
19:34
he'll repeat these studies
19:36
>> without ever thinking that even our
19:39
Medicare patients a lot of times have to
19:40
pay 20% for every single time they get
19:44
these services done. And so, you know, I
19:47
I believe it's not it was not due out of
19:49
ill intent. It was just due out of ease
19:52
and just doing what we could to try and
19:54
get care done as quickly as possible
19:57
without the thought of crosscontainment
19:59
strategy. And then on the payers too, I
20:01
think the payers get labeled a lot as
20:04
the bad guys. You know, especially in um
20:08
today's world, you know, the the big
20:10
guys are like, "Oh, all they care about
20:12
is their profits. they're denying all
20:14
these services and to some extent some
20:17
of that has happened too. But I don't
20:19
think that's what gets all of the people
20:21
in the, you know, in the insurance
20:23
companies up every morning to say, I'm
20:25
going to see how I can deny someone
20:27
healthcare coverage today.
20:28
>> I think was that we had all of these
20:31
repeat tests and studies coming in and
20:33
excess goods and services that maybe
20:35
weren't needed for our patients. And so
20:38
again, they were given the authorization
20:40
to do things like prior authorizations
20:42
or denials. And so again, without guard
20:46
rails in place that said, you know what,
20:49
you can't just deny care, right? We you
20:51
can't just do this. And so that's why I
20:55
think healthcare should change. And I
20:57
think we're moving in the right
20:58
direction. I mean, I'm really I'm a huge
21:01
fan of managed care programs, whether
21:04
that be managed Medicaid, whether that
21:06
be um managed Medicare. Um I was really
21:10
pleased to see the um final rulings come
21:13
out for the Medicare Advantage programs
21:15
because I was a little bit nervous as
21:17
far as
21:18
>> what that was going to look like. And I
21:21
think what this does is it when you have
21:25
a properly managed population, right, if
21:29
if we get into population health,
21:30
>> yeah,
21:31
>> that's where the beauty comes in, right?
21:33
You've got your payers and your
21:35
providers hopefully working together
21:38
>> to promote the best outcomes of our
21:40
patients based off an accurate risk of
21:44
patients, right? Not one that is mined
21:47
out of charts with AI software that
21:49
looks for every single diagnosis that
21:51
patient has had for the last five years
21:53
that you can pull a hit code off of, but
21:55
when you're really looking at how do we
21:58
take care of patient risk together to
22:02
promote what's best for the patient and
22:05
do it at the most cost containment um
22:08
you know methodology that we can come up
22:10
together. That's where I think
22:12
population health management comes in.
22:15
And I've seen it from, you know, my
22:17
early days in the bedside. It's really
22:20
just changing the way we think.
22:23
It's so interesting you bring that point
22:24
up because it's like like we're in this
22:26
moment now where
22:29
like I don't know if it's everyone but a
22:31
lot of people are talking about you know
22:32
data AI insights and yet you still like
22:37
walk into rooms where people look at the
22:39
same metrics and yet they they walk away
22:43
with different conclusions
22:47
like like how how does that happen?
22:51
Well, I I think like you know I took
22:54
statistics,
22:56
right? You know, I've got my PhD. You
22:59
can take data and make it look any way
23:02
you want.
23:03
>> I guess what I'm trying to say you're
23:04
trying to find
23:06
>> is that a data problem or is it a people
23:08
problem?
23:10
>> I think it's a combination of the both
23:11
of both, right? Like if I'm an insurance
23:14
company without those guard rails in
23:16
place and I'm trying to take care of
23:17
these patients, I am going to try and
23:21
get that money so that I can hopefully
23:23
provide as many resources as possible.
23:25
Right? When you look at a risk-based
23:27
arrangement, if you could think about it
23:29
as patient risk and identifi
23:32
identification of patient risk, it's
23:35
supposed to give a little bit more
23:36
reimbursement so that you can make the
23:39
resources available to your providers to
23:42
take the care that they need to slow
23:44
down or stop the progression of disease
23:46
exacerbation. Right? That's the idea of
23:50
risk. And so, you know, what it's turned
23:53
into is, to your point, like data where
23:56
we're going to look at this data. We're
23:58
going to pull this data and we're going
23:59
to try and show this madeup risk score
24:04
for a patient that in all honesty has
24:06
absolutely zero meaning to the
24:08
providers, right? There's nothing in a
24:10
risk score that talks about intervention
24:13
or what the provider is going to do. So
24:15
it's key, you know, let's link our risk
24:20
score on interventions or care planning
24:22
that can make a difference. And I think
24:24
that's hopefully, you know, the route
24:26
that we're moving towards. The other
24:29
thing about data which as we look at the
24:33
current systems and you know some of the
24:35
problems I think with risk scoring that
24:36
we're we have is I don't know how much
24:42
data is actually created by the patient
24:45
right that's the whole reason why I
24:47
created healthy insights is very rarely
24:50
is it the patient themselves creating
24:52
their own data about their current
24:54
conditions or about their own health or
24:58
their own life needs or their social
25:00
needs. And so I think if we really want
25:03
to create accurate data, the most
25:07
accurate way to get that data is from
25:09
the patients and the caregivers of the
25:11
patients themselves. And I think that's
25:13
when data can become more reflective and
25:16
a truer picture or snapshot of the
25:20
patient condition at that given time.
25:24
you because you mentioned um healthy
25:26
insights, it kind of triggered a thought
25:28
in my mind because look, you're a tenure
25:30
professor um nationally recognized
25:33
program director, you know, kudos to
25:36
you. You you're building something very
25:37
real at Boise State and yet you've found
25:41
time to co-ound a company, I guess. What
25:44
what was going through your mind when
25:46
you decided to kind of make that call?
25:49
>> Yes. So, first off, I'm not tenured. if
25:52
there's anybody that uh I work part-time
25:56
at the university. I created the
25:58
master's degree program because I saw
26:00
the need. So um you know my heart is
26:04
truly in transforming patient care. And
26:07
so I created the master's degree program
26:09
to teach the next generation of leaders
26:12
on population health management. And I
26:15
employed o employed most of them all are
26:18
volunteers right that have given their
26:20
time to be guest lecturers in our
26:22
program you know the top of the top the
26:25
best of the best to teach how to do this
26:27
right so we're not sitting in siloed
26:29
systems and so as I was recording all of
26:34
these guest lectures you know the one
26:36
thing I I try and pride myself on every
26:40
day is I think I know a lot about
26:42
healthcare but I don't everything and my
26:46
curiosity and passion to make it better
26:50
has really driven me to listen to those
26:52
that are doing it correct. And so as I
26:55
interviewed all of these top healthcare
26:58
experts across the country and even I
27:00
guess lesser you know head of value
27:01
based care of Europe um I listened to
27:04
see what I could learn from them because
27:06
I think you know so many times we solve
27:09
problems and then we never hear about it
27:12
>> and what I heard time and time again is
27:14
the same argument right but on opposite
27:18
sides. So here I'm just this neutral gal
27:21
in Boisee, Idaho recording the best of
27:24
the best, but the complaints of all of
27:26
the providers were the same.
27:28
>> The complaints of all of the peers were
27:30
the same.
27:31
>> And it was really the disconnect in how
27:35
do we get accurate patient assessment
27:40
and to me it was like well that's a
27:43
pretty easy problem to solve, right?
27:45
Like we know I have guest lecturers that
27:49
say that the true um the true way to be
27:53
successful in value based or riskbased
27:55
contracts is annual wellness visit
27:58
compliance and it's taking the time to
28:01
get to know our patients, right? But
28:03
then at the same time providers get on
28:05
there and say that's great. We all know
28:07
that would be the dream. Unfortunately
28:10
across the country we have less than a
28:11
30% compliance rating for annual
28:14
wellness visits. Is that
28:18
>> Yeah. Yep. At the time of my guest
28:21
lecture, he had a slide. So, you know,
28:23
um
28:24
>> slow
28:25
>> and even if we get those numbers up
28:27
there, they're not they're a lot of
28:30
times annual wellness visits are done to
28:32
check a box, right? They have to get
28:34
them in. They're under contracts where
28:37
it's imperative. But what what I heard
28:40
from the providers, you know, is we're
28:43
doing the best we can. We all know that
28:46
there's a workforce shortage and we all
28:49
know that to do these assessments, the
28:52
administrative burdens can take up to 45
28:54
minutes to an hour of my clinic time.
28:57
And under a current RVU system, I'm
29:00
expected to see 18 plus patients a day.
29:03
How can I spend 45 minutes with this
29:06
patient collecting all these this data?
29:09
And then at the same token, health
29:11
insurance companies have to do a health
29:12
risk assessment of their own to do a lot
29:16
of the same things for the quality
29:17
measures that insurance plans are
29:20
governing. You know, under NCQA, you've
29:22
got to do this, you've got to do this.
29:23
And the um the rate that, you know,
29:27
beneficiaries send in their HASS are
29:30
pretty low. So there's plans that pay
29:32
providers to try and fill the HA or
29:34
they'll send people to patients houses
29:36
to try and get these done. And so you
29:38
know I'm a big believer in tellaalth and
29:41
tele medicine and technology. And so as
29:43
I kept hearing these stories from payers
29:46
and providers I was like gosh has
29:49
anybody really listened to each other it
29:51
would be so easy to solve this problem.
29:55
Let's screen patients before the visit.
29:58
Let's meet the requirements of an HRA.
30:01
Let's get all of that information before
30:04
the visit so that the provider when the
30:07
patient comes in from their annual
30:08
wellness visit, they could have a report
30:11
that gives them that snapshot with all
30:14
of the caregiver concerns, all of the
30:16
patient concerns in an easy to digest
30:20
report so that the annual wellness visit
30:22
or other screening visits, you know,
30:24
depending on the age bracket could
30:27
actually be done for the provider to
30:30
correctly diagnose their patient
30:33
>> correctly. Understand where their
30:35
patients are and use that time to make a
30:39
plan through shared decision making with
30:41
their patients that promote best
30:44
outcomes with their patient, reduce
30:47
screen time and actually make healthcare
30:50
collaborative. And as I started talking
30:54
to people across the country and saying,
30:55
"Hey, what what are your ideas?" They're
30:57
like, "Oh my gosh, Jenny, this is great.
30:59
like this is this would help me so much.
31:01
>> Yeah.
31:02
>> And so, yep, I dropped down to part-time
31:04
at Boyise State. I was thinking this was
31:06
going to be a great job uh to cruise
31:08
along. Got down to part-time and said,
31:11
"Well, I'm still going to teach. I'm
31:13
still going to do this program because
31:15
it's important, but I'm also going to
31:18
found a technology solution to give
31:21
patients their voice, reduce the burden
31:23
for providers, and at the same time
31:26
hopefully give that documentation to
31:28
payers need to get an accurate risk
31:31
score for their patients to be able to
31:32
provide those resources to providers for
31:34
better care management, but do it in a
31:37
meaningful way that's allowing the
31:40
patient themselves to enter into the
31:42
equation and not just be a couple of
31:45
digits on a piece of paper or across a
31:48
computer screen.
31:49
So, I mean, and this I'm loving this
31:51
conversation and it's like you your
31:53
nurse is coming out that persona is
31:56
coming out and there's um there's a
31:59
there's a page on your on your website
32:01
called like the the nurse's story and it
32:04
and you basically you describe the
32:05
platform as something as like um it
32:08
behaves like a great nurse and and and I
32:11
love that by the way. What what does um
32:14
a great nurse notice that maybe a a
32:19
great algorithm
32:22
still misses?
32:25
Yeah, that is the things that
32:30
honestly the story behind the number,
32:33
right? A great nurse or a great
32:37
clinician of any kind because I've
32:38
known, you know, a ton of of of great
32:41
providers, you know, whether it be
32:43
respiratory care or X-ray technicians,
32:45
right, that'll come in and be like,
32:47
Jenny, I noticed this on the patient. It
32:49
is looking at the things that are
32:52
outside of the norms, right? Like like I
32:55
mentioned, you know, the time that you
32:57
know, luckily being a home health nurse
33:00
where
33:01
>> the patient could be coming in a lot of
33:03
times with high blood pressure, right?
33:05
And their blood pressure keeps going up
33:07
and up and up and up, but it's the nurse
33:10
or, you know, the true reflection of are
33:14
you able to afford your medication? Is
33:16
that the question that's been asked?
33:18
Right? because I've seen with my own
33:20
eyes
33:21
patients cutting their pills in half to
33:24
try and be able to afford their
33:25
medication without thinking maybe the
33:27
reason that their blood pressure is not
33:29
getting controlled is because they're
33:30
not
33:31
>> getting the correct doses. And a
33:34
computer doesn't think that way, right?
33:36
It's just going to look and say
33:37
hypertension, hypertension,
33:39
hypertension. And it's that critical
33:41
thinking and assessment skill that data
33:45
doesn't provide and only the patient can
33:47
truly provide that story behind those
33:50
numbers.
33:53
>> Speaking of stories, um, so you were
33:57
selected by CMS to basically help write
34:00
health equity standards for the whole
34:02
country. It's kind of a small role,
34:04
right? Just kidding. It's a big it's a
34:06
big it's a big task. Okay. Um, and
34:08
that's like a that's like a really big
34:10
room to be in, I guess. Um, what what
34:14
like surprised you most about how
34:17
people, you know, in in those rooms at
34:20
that level
34:21
>> think about this problem?
34:24
>> So, I I question first, if you're
34:27
referring to my previous appointment, I
34:30
was on the CMS technical expert panel or
34:32
if you're talking about the HHA advisory
34:35
committee I was just appointed to. Well,
34:37
both obviously those are those those are
34:39
both important rooms to be in. I mean,
34:41
just kind of give both. I mean, I feel
34:42
like context to both probably applies.
34:45
>> So, in in the CMS technical expert panel
34:49
that I I I was, you know, able to serve
34:51
on um I I was nominated for that
34:53
position by the at time director of uh
34:56
health and welfare for Idaho, David
34:58
Jeepson. and they were looking for
35:01
somebody that had like home health or
35:03
hospice expertise with policy to really
35:06
look at health equity and quality
35:07
standards. And so, you know, Dave had
35:10
reached out and he's like, Jenny, what
35:12
do you think? Like, this seems like it's
35:14
right up your alley. And I'm like, Dave,
35:17
let's go for it. And so, he had
35:18
nominated me and I was selected.
35:20
>> And I think what the the cool and
35:22
interesting thing for for me when you
35:24
sit in a room like that, because there's
35:26
all these really smart people from
35:27
around the country, right?
35:29
they're trying to look at health equity
35:31
is so many times we look at health
35:34
equity through our own lenses like
35:36
what's our passion right like even
35:39
myself I I'll admit I can be biased
35:41
right when I hear health equity and
35:44
quality if you are not talking about
35:47
seniors and Medicare okay whatever right
35:50
like I am thinking of rural seniors and
35:53
the patients that I took care of for
35:56
years and what was cool about being in a
35:58
like that is being able to move outside
36:01
of your normal passion for these type of
36:04
topics and listen to others that are
36:06
like you know I am wor worried about you
36:09
know like these underserved populations
36:11
for like pediatric in urban areas which
36:15
as a nurse where all most of my clinical
36:17
background I was living in Weezer Idaho
36:20
I had never gotten the opportunity to
36:22
hear those stories and so you realize in
36:26
those conversations that what you see as
36:30
you know not equitable care or difficult
36:33
access to care.
36:34
>> Yeah.
36:35
>> In my mind when I think about difficult
36:37
access is 150 miles from my patient's
36:39
house to a doctor.
36:41
>> Yeah.
36:41
>> But for me to hear that there's this kid
36:44
in like downtown New York or something
36:46
that can't get to a pediatrician.
36:50
That's when you really start seeing that
36:52
if we could, you know, understand the
36:55
true access problems and look at things
36:57
like technology and tele medicine and
37:00
all of those things, the problems are
37:02
very very similar. And so I think that's
37:05
the the coolest thing about being in
37:07
those committees is you start to see a
37:10
much larger
37:11
>> Yeah.
37:11
>> problem than what maybe you've seen in
37:13
your own backyard, if that makes sense.
37:15
>> Yeah. Do you feel like now as a part of
37:17
being in those rooms like your your
37:18
pattern recognition is even greater and
37:21
then you kind of go back and you then
37:23
can apply it and obviously being able to
37:25
teach those skills to your students
37:27
because it's not just about you now
37:28
you're like hey I've got generations of
37:30
of other leaders that are behind me and
37:32
it's like if I really want to make an
37:34
impact it's like there's only so much
37:35
that you could do as an individual but
37:36
if you want to see exponential it's
37:39
really about those next line of leaders
37:40
that are coming through.
37:43
>> Oh 100%. And you know, I think you know,
37:45
you can get me excited because that's
37:47
why we created this master's degree
37:49
program. I mean, we have like great
37:51
people like Gordon Chen, you know, he
37:53
teaches a lecture on healthcare
37:54
transformation and second Jane on
37:57
Medicare advantage and you know,
37:58
Kimberly Brand teaches a class in
38:01
healthcare law. And out of all of these
38:04
people that I reached out to, no one
38:07
said no, Michael, when I said, "Hey, I
38:09
am trying to create a program to teach
38:12
the next generation of healthcare
38:14
leaders." All of these great said yes.
38:18
And it let me know that those of us that
38:21
have been in it down and dirty, we've
38:23
learned the b we've learned what we've
38:25
learned. We've fought the battles.
38:27
>> And we need to pass those learnings on.
38:29
And what's incredible is the students
38:31
that have graduated from our program are
38:34
doing incredible things. Like they are
38:37
becoming leaders within their
38:39
organizations and you know I advise all
38:42
of the students probably because I'm
38:43
selfish and I want to be able to advise
38:45
all these students and we stay connected
38:48
and so you know they'll text me or call
38:50
me and Jane we're doing this or I just
38:53
got pulled into this meeting because I
38:55
view things differently. And so it's
38:58
again that's where we initially thought
39:00
about it. I don't think health care has
39:02
ever been ill intent because if so, I
39:05
would never have become a nurse, right?
39:07
I want to help people and I believe
39:09
>> everyone that gets into healthcare wants
39:12
to help people
39:13
>> but it's just changing the way we think
39:16
to
39:17
>> a different mindset and I and I think
39:19
our students are getting that and they
39:21
are leading their organizations in doing
39:24
wonderful jobs which makes me prouder
39:26
than any accomplishment I've ever done
39:28
myself. Right? Like when my students
39:29
call me and they're like, "Jenny, would
39:31
you write a letter of recommendation?
39:32
I'm up for this or you know, would can I
39:34
put you as a reference?" 100% all day
39:38
long. Yes. Because I know that they have
39:41
the skills to really change and move the
39:44
needle as we transition.
39:46
Did you realize back then as you were
39:48
pre-seelelecting these rockstar kind of
39:52
folks that are going to come in and
39:53
lecture and become these guest
39:55
lecturers? Did did you realize back
39:56
then, hey, these relationships can be
39:58
springboard into what I'm doing with
40:00
Healthy Insights AI? Did you sort of see
40:03
that many steps ahead or were you just
40:04
like, "Hey, these are some great
40:06
relationships and we have a good
40:07
foundation and I see this gap and I feel
40:10
like I can close this gap and I'm going
40:12
to kind of leverage these relationships
40:14
or is this was this part of your
40:17
grandmaster plan?"
40:20
>> No. No. In fact, quite opposite. In
40:22
fact, you know, um
40:26
I was hoping to stay full-time at
40:28
Boyisee State for at least 10 years for
40:30
my PSLF, right, to get my student loan
40:33
paid off. So, having to not stay at
40:35
Boyisee State full-time for 10 years
40:38
really was not financially the best
40:41
decision. But no, I mean joking aside,
40:44
no I mean I literally when I took on the
40:48
cast and you know was given the
40:50
opportunity by Boyisey State and then we
40:52
partnered with Healthcare Financial
40:53
Management Association I had just felt
40:56
like I was given a gift right nobody is
41:00
given a directive like Jenny just do
41:02
what you want to do and that's what the
41:05
leadership did and so I took that very
41:08
seriously. I have colleagues that helped
41:12
me that actually are our core faculty,
41:14
you know, in in the program that I'd
41:17
known that were great that I knew would
41:19
also want to do it. But then as each
41:22
week as we were planning out the course
41:25
and you know like I'm trying to figure
41:27
out I am not an actuarist
41:31
>> who should be the best actuarist to
41:34
teach you know in this week this week or
41:36
this week because we have core faculty
41:39
that you know work with the students
41:41
every week have a live zoom session
41:42
because it's an online program
41:44
>> but then each week I wanted to find like
41:46
the area industry expert for that topic
41:50
And so it's like, oh, who's who's an
41:52
expert on actuary? Well, shoot, you
41:56
know, I stuck LinkedIn. Like, I'm
41:59
surprised someone did not file a
42:01
retraining order. And I find this guy,
42:04
Big Dylan, right, who's now president
42:06
for the Society of Activists. I'm like,
42:08
I think this guy's the best. Let me
42:10
message him and see if he would do my
42:12
guest lecture. And you know, next it was
42:15
like Brian Swatman, you know, I think
42:17
he's chief actuarist and principal for
42:19
Miller, right? Like, hello, Brian, my
42:21
name's Jenny. You know, basically, I'm
42:23
trying to change the world. Will you
42:25
help me do it? And you know, it was all
42:30
out of trying to find the best of the
42:34
best people. And um the fact that so
42:39
many of us now I think our colleagues
42:41
and friends was totally unplanned but
42:45
again I think it has to do with when you
42:48
meet people that are so impassioned to
42:51
change and believe in our heart
42:53
>> that we can do better.
42:55
>> It just creates its own network. And I
42:57
think that's that's kind of what we have
42:59
created is just a network of amazing
43:02
people
43:03
>> that believe we can do better for our
43:05
patients.
43:07
>> So I hate to break it to you, but that
43:10
is entrepreneurship.
43:12
>> You basically
43:14
at that point in time, you didn't
43:15
realize it, but you were like doing your
43:17
training, but you were given this this
43:19
task building this program. Essentially,
43:21
you're an entrepreneur. And it came to a
43:23
point where like, all right, here's the
43:25
vision. who am I going to get? And you
43:27
find the best people because you cast
43:30
the vision. People get get in and get
43:32
get excited about it and they come like,
43:33
"Oh, of course, of course I want to help
43:34
you. Of course I want to help you."
43:36
You're using those same muscles as
43:39
you're building your company now because
43:41
it's the relationship like, "Hey, I I I
43:43
want to change this world. I want to
43:45
make things better and here's the vision
43:48
and here's why I'm excited and here's
43:50
why I'm passionate about it." And what
43:51
happens is is people they gravitate
43:55
towards the passion. Like no one ever
43:57
got excited about someone who was not
43:59
excited about something. If you were
44:01
just like sitting here and like yeah,
44:03
you know, kind of doing this, it's it's
44:06
okay. It's fairly decent. But it's like
44:09
no one's going to be excited about that.
44:11
However, on the other hand, I mean, you
44:15
radiate
44:16
passion and joy. That that's like a
44:18
superpower. And I'm just saying that as
44:20
another person on the other side of the
44:22
screen right now, but that's definitely
44:24
a superpower and that's a way for people
44:26
to say, I don't know what it is, but I
44:29
want to kind of be there because like
44:33
she's on to something. It's kind of
44:35
cool. It's cool to see. It really,
44:37
really is.
44:38
>> Thank you. Thank you. And then if but
44:41
one more quick thing because we are
44:43
going to bring up the appointment to the
44:45
uh Department of Health and Human
44:47
Services and CMS advisory committee that
44:49
I was just appointed to. Um again like
44:54
honestly
44:56
I it's still surreal to me, right? Like
44:59
I look at all of the other people on
45:02
this committee that I'm with and they're
45:03
all like really famous, right? Like I
45:05
think I got a notice from LinkedIn after
45:07
it was announced like Jenny you have one
45:09
of the most viewed link profile view or
45:11
you know LinkedIn profiles today because
45:13
I know everybody's like who's Jenny
45:15
Gudapati like who is this girl like all
45:18
these other people we know and what's
45:21
the coolest thing about this appointment
45:24
and you know I think which again in my
45:28
opinion shows that we want to change is
45:31
how cool is it that Dr. Roz and you know
45:35
Robert Kennedy it's a nurse from Weezer
45:38
Idaho
45:40
on this committee to say like Jenny we
45:42
want to change health polic like we want
45:44
to understand where where does the
45:46
rubber meet the road right like what
45:48
does that look like and I still just
45:51
can't believe it like I have not only my
45:54
voice but all of the providers I've
45:56
worked with all of the patients that
45:58
I've worked with for nearly three
46:00
decades
46:01
>> and the 80 people that volunt unteered
46:03
to help me build this master's degree
46:06
program. I hope I can bring their voices
46:09
into that room because I I truly
46:12
believe, you know, Dr. Oz called and
46:14
interviewed me the day before Christmas
46:16
Eve. Like that's how dedicated these
46:18
people are, right? Like he's calling me
46:20
two days before Christmas and you know,
46:23
he was so serious. I actually thought I
46:25
bombed the interview because, you know,
46:27
you see this guy on TV that is just
46:30
larger than life. And then, you know, he
46:33
called me and he was just so serious
46:35
asking questions like, you know, Jenny,
46:37
what do you think about this or what do
46:39
you think about that? and just the
46:42
seriousness and sincerity that he had.
46:45
like I don't think I slept for three
46:49
months waiting to see if I made this
46:50
committee because I truly feel they want
46:53
to make a difference and to be a part of
46:55
that is just it's just unreal to me that
46:59
hopefully all of these voices of the
47:02
patients like I said before I hope I can
47:05
bring that to DC so that you know the
47:08
patient I took care of in Huntington
47:10
Oregon that was struggling
47:12
those are the stories in DC that need to
47:15
be heard. If we're truly going to solve
47:17
the problems, we have to correctly
47:19
identify it and hear from those that are
47:21
mostly influenced.
47:23
>> That's so fantastic. Before I forget,
47:26
um, do like a little commercial before
47:28
we wrap. Do a commercial for healthy
47:31
insights. Say, hi. Where can people find
47:32
you? Where can people follow your work?
47:34
Like, shout it out.
47:37
>> Absolutely. Thank you for that. Um, now
47:40
that's the one question I probably
47:41
wasn't prepared for. So, number one,
47:44
easiest thing to do, I'm a terrible
47:47
sales person. So, like, they should not
47:49
have me in sales because I'd give it all
47:52
away for free if I could, right? I I
47:54
mean, if if it were up to me, like,
47:55
let's build this, let's get it out
47:57
there. Follow me on LinkedIn, you know,
48:00
especially as I'm on this committee. I'm
48:02
really hoping to post more to, you know,
48:06
work with people, talk with people,
48:07
follow me on LinkedIn. Uh and then our
48:10
uh website is healthyinsights.ai.
48:14
As far as a quick elevator speech
48:16
commercial um I guess what I would say
48:19
is I am we are a neutral health risk
48:23
assessment that is expansive covering
48:27
cognitive impairment and cognitive
48:29
testing. um social needs assessment and
48:33
then our aim as a company is to give an
48:37
accurate snapshot or insight into the
48:41
current patient condition because then
48:44
data becomes more than numbers on a
48:47
page. It becomes actual things that we
48:50
can use for proper care planning to
48:52
really move the needle on um providing
48:56
better outcomes and decreasing cost of
48:58
care.
49:00
That's so great. We'll make sure we put
49:01
that. Yeah, it works great. It works
49:03
perfectly. We'll make sure we put that
49:05
uh in the description of this. And you
49:07
know, um as you were kind of
49:10
articulating
49:11
your passion throughout the entire
49:14
conversation today, I was like, I know
49:17
exactly why you're on that committee
49:18
because number one, uh you do have
49:20
passion. Number two, you're curious and
49:23
you're you're like a lifelong learner.
49:25
So you're like, hey, I don't know what I
49:26
don't know. So you know what? let me let
49:27
me bring some other really smart people
49:29
in here to kind of and let me sort of
49:31
sit within these lectures and actually
49:33
sit with the students and actually learn
49:34
with them that there's a level of
49:36
humility there that like we need to have
49:39
ever present um now more than ever. So
49:42
I'd say that they definitely appointed
49:45
the right person and having the voice of
49:46
the clinician, the voice of the nurse
49:48
being there is pretty amazing and yeah,
49:50
I've just had a great time conversing
49:53
with you. So, for for those of you that
49:55
have been listening and if you're
49:57
hearing this, um, what a great story.
50:00
What a great story. If you're innovative
50:02
and you're curious where it can take
50:04
you, I mean, amazing stuff. So, if if
50:07
there is a topic that you want us to
50:09
explore or um, someone that you want to
50:12
have come on the show, please drop us a
50:14
comment. The way that you can support
50:16
the community is, you know, would you
50:18
mind sharing this particular
50:21
conversation, liking it, engaging with
50:23
it, maybe what stood out? Put that in
50:25
the comments. We read on like them.
50:26
Again, this is a platform that's not
50:28
just about content, it is about
50:30
community. So, thank you for listening.
50:32
Keep building with purpose and we will
50:34
see you next time on the Advancing
50:36
Healthcare Innovation Show.