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Care Model Engineering at Advocate Health: A Product Lens on How Care Gets Built · The Strategy Catalyst Dispatch

• 0:00
  Shoeb Sitafalwalla: So our pilot prototype, we said it has to be at least 100,000 patients.
• 0:03
  Shoeb Sitafalwalla: you can't
• 0:04
  Anika: Wow
• 0:04
  Shoeb Sitafalwalla: 100,000 patients, you have no business scaling to six million patients.
• 0:08
  Shoeb Sitafalwalla: it forces people to think, how do I build this, in the right way?"
• 0:18
  Anika (2): Welcome to the Strategy Catalyst Dispatch, a podcast from the Strategy Catalyst team at the Health Management Academy.
• 0:25
  Anika (2): I'm your host, Anika Rashid Senior Analyst, and each episode we'll explore The trends and insights shaping healthcare strategy today.
• 0:33
  Anika (2): Let's dive in.
• 0:40
  Anika: Every health system talks about transforming care delivery But what does transformation actually mean?
• 0:46
  Anika: Here's what often happens.
• 0:48
  Anika: Someone has a good idea, they pilot it with a few hundred patients at one site, and then they spend years trying to figure out how to scale it At Advocate Health, they're figuring out how to break out of that cycle And really transform and redesign care delivery.
• 1:03
  Anika: I'm joined today by Shoaib Sattawalla.
• 1:07
  Anika: Shoaib is the Senior Executive Vice President and Chief Strategy Officer at Advocate Health, one of the largest health systems in the country After the merger that formed Advocate in 2022, He and his team took the opportunity to ask, what is their core product?
• 1:23
  Anika: And answering that has changed how the organization builds and delivers care.
• 1:29
  Anika: Today, Shoaib walks us through what Advocate calls care model engineering, how they design care models the way a tech company might design products, how they went from a ten-month first build to launching a new product every three or four weeks, and why they won't even consider a pilot unless it can reach 100,000 patients Shoaib, thanks so much for joining us today.
• 1:50
  Anika: so tend to find that, health system CSOs often wear a lot of different hats in their organizations, and your current role combines, both strategy and operational responsibilities.
• 2:02
  Anika: could you tell us a little bit about that?
• 2:04
  Shoeb Sitafalwalla: Yeah.
• 2:04
  Shoeb Sitafalwalla: So, in my role at Advocate Health, I kind of wear two hats.
• 2:08
  Shoeb Sitafalwalla: The first is a strategic hat, which is really understanding and helping architect the global strategy of, of our organization, and then I matriculate that strategy down to the market level.
• 2:19
  Shoeb Sitafalwalla: So my team also oversees our market strategy i- in all of our respective markets, and then in a second kind of parallel role, I also oversee clinical operations, for our three what we call national service lines.
• 2:33
  Shoeb Sitafalwalla: So all of cardiovascular, neurosciences, and oncology, across the entire enterprise from the frontline clinicians, the technicians, and the office staff in our ambulatory and acute settings all collect under one set of national service lines for those three respective fields.
• 2:51
  Shoeb Sitafalwalla: And it also includes, our academic, work in those spaces as well, and that also flows under me.
• 2:57
  Shoeb Sitafalwalla: And so it's a really interesting opportunity for a strategist to come up with a theory but also put it into practice and create a good feedback loop between strategy and operations.
• 3:07
  Anika: and you're also a physician by trade,
• 3:08
  Shoeb Sitafalwalla: Yeah, no, I'm a cardiologist and, so far still see patients, just to keep it real.
• 3:13
  Shoeb Sitafalwalla: But, it's a great opportunity for me to get back to my clinical roots and, I'm fortunate to have the opportunity
• 3:19
  Anika: a lot of leaders that we talk to can sometimes describe a gap between setting direction and executing on it.
• 3:26
  Anika: So it sounds like, your role is designed to help close that gap as well.
• 3:30
  Anika: in setting up for the conversation that we're gonna have today, I would love to talk about how Advocate got to where it is.
• 3:37
  Anika: So can you talk to me a little bit about how bringing together two legacy organizations, Advocate, Atrium, and the integration work that followed kinda set the stage or gave you the opportunity for what you're doing now with enterprise care models?
• 3:51
  Shoeb Sitafalwalla: Yeah.
• 3:51
  Shoeb Sitafalwalla: Advocate is obviously the amalgamation of two legacy organizations, which in and of themselves had a number of integrations, our two CEOs at the time, Jean Woods and Jim Skogsbergh, really had this idea, what could you do to bring these two non-contiguous health systems rather, together?
• 4:09
  Shoeb Sitafalwalla: Both had experienced the value of integration, the value of scale, but the question is, could you take this to the next level and really create something new for the communities that we serve?
• 4:19
  Shoeb Sitafalwalla: And that's how Advocate Health was born, roughly three years ago.
• 4:23
  Shoeb Sitafalwalla: And, in that process, I was fortunate enough to be chief strategy officer of Advocate Aurora Health and then, assume the position of chief strategy officer for the new entity, the combined entity, Advocate Health.
• 4:34
  Shoeb Sitafalwalla: But, I have to say that, of all the chief strategy officers, I was probably the luckiest because there's always eagerness to run right into strategy, in the setting of a merger and acquisition.
• 4:45
  Shoeb Sitafalwalla: And, under the guidance of our leadership what we decided to do was actually take a breath much of healthcare in that country was still recovering from the pandemic.
• 4:53
  Shoeb Sitafalwalla: And what we really decided to do is spend a year really focusing on, how could we bring these two organizations together in their current form in the right way.
• 5:04
  Shoeb Sitafalwalla: and that obviously has generated well over a billion dollars in synergy savings for the organization but also gave us a chance to culturally come together.
• 5:14
  Shoeb Sitafalwalla: And so as I got this front seat view at our integration, I had a chance to really gut check a lot of assumptions, right?
• 5:23
  Shoeb Sitafalwalla: How do we think about the future of our revenue?
• 5:26
  Shoeb Sitafalwalla: How do we think about the future of consumer needs?
• 5:29
  Shoeb Sitafalwalla: what do we even mean when we say the word transformation?
• 5:32
  Shoeb Sitafalwalla: and then most notably, the question I would ask fairly repeatedly and annoyingly, I think, to some of my colleagues was, what is our core product or service?
• 5:41
  Shoeb Sitafalwalla: because what I realized is everybody defined it separately.
• 5:46
  Shoeb Sitafalwalla: hospital operators said, create the most efficient hospital operations and reduce length of stay and improve quality.
• 5:51
  Shoeb Sitafalwalla: ambulatory operations talked about access.
• 5:54
  Shoeb Sitafalwalla: Academic operations talked about research and, extramural funding and discovery and innovation.
• 6:01
  Shoeb Sitafalwalla: And so this was really a fascinating opportunity for me to see how everything came together.
• 6:07
  Shoeb Sitafalwalla: And then it was after that one year of discovery that we went into a very deep, strategic formulation phase in twenty twenty-four, and then in twenty twenty-five, we officially launched the strategy
• 6:19
  Anika: Yeah, so it sounds like, it was an opportunity to really think through, what do we want this to look like?
• 6:25
  Anika: How do we want to, really deliver the best care so ultimately I think that kind of brings us to, what I think is the heart of the conversation, which is what you decided to build.
• 6:35
  Anika: can you talk me through that?
• 6:37
  Shoeb Sitafalwalla: yeah, the crack I made at the CSO forum was, you know, you can ask 10 different healthcare leaders what your core product or service is, and you're gonna get 12 different answers.
• 6:44
  Shoeb Sitafalwalla: And, so much about strategy is about asking the right question, right?
• 6:48
  Shoeb Sitafalwalla: And I found that question was not only illuminating for me, but it was actually illuminating for a lot of my colleagues as well.
• 6:54
  Shoeb Sitafalwalla: It's like, well, what is our core product or service, right?
• 6:56
  Shoeb Sitafalwalla: And how do you reconcile the tension between where hospital operators wanna go versus where medical group operators wanna go versus where our academic and innovation, leaders want to go?
• 7:06
  Shoeb Sitafalwalla: it allowed us to take a breath and say, Maybe we're all right and all wrong at the same time," our core product or service the ability to take the academic enterprise, the clinical enterprise, the operational, capabilities, the technical and technology, the data, and bring it all together into a care model?
• 7:27
  Shoeb Sitafalwalla: care model is fundamentally the who, where, and how we deliver care to our patients that take a patient diagnosis to treatment, screening to prevention, acuity to stabilization.
• 7:41
  Shoeb Sitafalwalla: And if we can all work together knowing that the patient's at the center of what we do, And our job is to take them from point A to point B in their clinical journey, and that is the care model, right?
• 7:53
  Shoeb Sitafalwalla: it gives us a table, a space to all sit together and co-create with.
• 7:58
  Shoeb Sitafalwalla: And that was both, I think, illuminating to my strategy team, but illuminating to, I think, my counterparts as well, and set us on the journey that we've been on since.
• 8:08
  Anika: for the care models, it sounds like it's really thinking about that end-to-end experience, who's using it, how they're moving through it, how they're gonna experience it.
• 8:19
  Anika: I think a lot of systems might hear that description of, care model engineering and think,"You know, we do that, too." So what do you think is the gap between how most systems approach this and what Advocate is doing, and, like, how you really, differentiate that?
• 8:35
  Shoeb Sitafalwalla: and we had those same conversations in the organization, like,"Well, we have care models." And I was like,"No, It's kind of standard operating procedure.
• 8:41
  Shoeb Sitafalwalla: and clearly, you want your care models to be standard operating procedure.
• 8:44
  Shoeb Sitafalwalla: If you build the right care model, then everybody's g-going to want to use it.
• 8:49
  Shoeb Sitafalwalla: But a care model, what it forces you i-in the way we con-contextualize it, is really a product, right?
• 8:56
  Shoeb Sitafalwalla: it designs around a set of consumers, a set of resources, And the engineering com-component is a set of constraints, right?
• 9:03
  Shoeb Sitafalwalla: Because if you think in the regular product world, I'm sure we would want to make every pen out of the highest end material, but sometimes you just need a pen to write a quick note, and so you can't afford to spend a hundred dollars on a pen, right?
• 9:16
  Shoeb Sitafalwalla: and so there are economic constraints in what we can do.
• 9:19
  Shoeb Sitafalwalla: There are logistical constraints in what we can do.
• 9:22
  Shoeb Sitafalwalla: But then within those constraints, you're able to really question, the who, where, and how care is delivered.
• 9:28
  Shoeb Sitafalwalla: So maybe the easiest way for me to break this down is through some examples.
• 9:32
  Shoeb Sitafalwalla: I think we all agree that, memory care, cognitive, issues are an increasing, higher clinical issue for a lot of our clinicians, right?
• 9:41
  Shoeb Sitafalwalla: We have, Americans overall are growing older, right?
• 9:45
  Shoeb Sitafalwalla: And, they're living longer.
• 9:47
  Shoeb Sitafalwalla: And if they survive their heart disease, which was a big thing that used to kill people in the past, they're now suffering neurological issues, and symptoms of dementia.
• 9:58
  Shoeb Sitafalwalla: Well, currently, if you have signs of cognitive impairment or dementia, it can take you nearly ninety days to see a cognitive specialist in this country.
• 10:06
  Shoeb Sitafalwalla: We don't have enough of them how do you solve for that?
• 10:09
  Shoeb Sitafalwalla: We have a standard protocol, like many health systems do, of, what you should do like, can you accept the fact that it still takes ninety days, right?
• 10:18
  Shoeb Sitafalwalla: And statistically, we probably underestimate the number of individuals who have th-this condition and need this treatment by eighty percent because you're rate limited by what your primary care doctor can see, and people have limited access to primary care in this country.
• 10:36
  Shoeb Sitafalwalla: So we fundamentally question the who, where, and how you diagnose and treat cognitive impairment.
• 10:43
  Shoeb Sitafalwalla: And we said,"Let's not just wait for the primary care doctor," although we need to give the primary care doctor an easy button on this.
• 10:49
  Shoeb Sitafalwalla: But we started, again, through our Wake Forest School of Medicine research capability, we built a, learning algorithm that helped identify patients early through our electronic medical record.
• 11:01
  Shoeb Sitafalwalla: Once you've identified those patients, how do you reach out to them?
• 11:04
  Shoeb Sitafalwalla: Do you just send a note to their primary doctor and say,"Hey, bring them along"?
• 11:09
  Shoeb Sitafalwalla: No.
• 11:10
  Shoeb Sitafalwalla: You can actually reach out directly to them or their families through electronic means, through the either the EMR or text message or what have you.
• 11:17
  Shoeb Sitafalwalla: Great.
• 11:18
  Shoeb Sitafalwalla: And then once you've activated that patient, what do you do with them?
• 11:21
  Shoeb Sitafalwalla: How do you screen them You know, we worked with different vendors and partnerships to build digital screens so that in the convenience of that patient's own home, we can screen them.
• 11:30
  Shoeb Sitafalwalla: Then from there, we put them into virtual care capability, then from there into more highly specialized care capability.
• 11:36
  Shoeb Sitafalwalla: And as a result of that, as we re-engineered that process, we went from taking ninety days to see one patient to in the first three weeks, we were able to process eight thousand patients.
• 11:47
  Shoeb Sitafalwalla: And so it fundamentally flips the who, where, when, and how you deliver care.
• 11:54
  Anika: I kinda wanna understand, how is this different from patient journey mapping?
• 11:58
  Shoeb Sitafalwalla: I think patient journey mapping is a key component of this, right?
• 12:02
  Shoeb Sitafalwalla: But often what it doesn't do is it doesn't question the tools you have to meet that patient's journey needs, right?
• 12:10
  Shoeb Sitafalwalla: and what we're saying is let's expand That we don't have to bend the patient's journey towards us, we can meet the patient where they are, but that changes a lot of things, because this actually forces you to rethink the way you look at cost and revenue.
• 12:26
  Shoeb Sitafalwalla: It has questions on legal and compliance, and we have to make sure we stay within the confines of the regulatory framework we're in.
• 12:33
  Shoeb Sitafalwalla: it has, fundamental questions, particularly when you build scaled products of, where do you want to send that patient?
• 12:40
  Shoeb Sitafalwalla: How is that gonna have secondary and tertiary effects on your more traditional methods of care delivery?
• 12:46
  Shoeb Sitafalwalla: it doesn't live on the side, it's fully integrated into the business planning of the organization.
• 12:51
  Anika: okay.
• 12:51
  Anika: So I know that you've already talked us through an example of what care model engineering looks like.
• 12:58
  Anika: What does it look like from the moment someone says,"We should do something about XYZ," to the moment that patients are flowing through it at scale?
• 13:07
  Shoeb Sitafalwalla: our Caremodel engineering process is really driven by a pipeline process, right?
• 13:12
  Shoeb Sitafalwalla: phase one is really a, a concept, right?
• 13:15
  Shoeb Sitafalwalla: does the concept make sense?
• 13:16
  Shoeb Sitafalwalla: Does it hold water?
• 13:18
  Shoeb Sitafalwalla: then you go into right?
• 13:20
  Shoeb Sitafalwalla: How do you build prototype that's appropriate, small, contained?
• 13:25
  Shoeb Sitafalwalla: And, and I say small in a relative sense, right?
• 13:27
  Shoeb Sitafalwalla: Like I said, our prototypes, uh, need to have sufficient scale that we can scale it across our entire enterprise.
• 13:34
  Shoeb Sitafalwalla: And then what do you learn from that prototype?
• 13:36
  Shoeb Sitafalwalla: You need to have very specific questions and measures of success.
• 13:39
  Shoeb Sitafalwalla: And then if the prototype works, then it really gets into a, a scale and launch phase, right?
• 13:44
  Shoeb Sitafalwalla: with close monitoring.
• 13:46
  Shoeb Sitafalwalla: you need a lot of ideas before you get to a good idea, right?
• 13:50
  Shoeb Sitafalwalla: way I often frame is that there are a lot of good ideas out there, but there's a finite number of right ideas for us that are consistent with our strategy.
• 13:57
  Shoeb Sitafalwalla: so we use a top do-down and a bottom-up approach, right?
• 14:01
  Shoeb Sitafalwalla: There is clearly clinical operational issues that we need to solve that we're seeing globally across the enterprise.
• 14:08
  Shoeb Sitafalwalla: And so there's a lot of ideas that come from our executive level leadership.
• 14:12
  Shoeb Sitafalwalla: then you never want to shortchange the power of innovation of your frontline, And so there are a lot of interesting concepts that we see there, and then we bring that all together into what we call, our care model engineering steering committee.
• 14:25
  Shoeb Sitafalwalla: And our care model engineering steering committee is quite large.
• 14:28
  Shoeb Sitafalwalla: It's it's almost 50 people, which, if you've ever had to do meetings with 50 people on Zoom, you know that you know, it's not always the easiest thing to do.
• 14:36
  Shoeb Sitafalwalla: But, the-these 50 people represent a true cross-section of Advocate Health.
• 14:40
  Shoeb Sitafalwalla: We have academics and translational scientists, legal and compliance and regulatory, finance, operations at the local level, at the enterprise level, clinicians, our service line leaders, strategy, everybody kind of represented, at this table.
• 14:57
  Shoeb Sitafalwalla: And we have people throw their concept in front of this group, and we beat it up, people throw errors at it and say,"Well, did you think about this?
• 15:06
  Shoeb Sitafalwalla: Did you think about that?" we actually vote, as a whole on whether this concept is worthy of resources from all of the different, parties that need to be there, finance, legal, IT, what have you, to actually develop the prototype.
• 15:20
  Shoeb Sitafalwalla: 'Cause too often we're so busy creating a pilot that you almost become married to it and whether the pilot is good or not.
• 15:26
  Shoeb Sitafalwalla: So we, this allows us to de-risk, across the pipeline We need to be able to say no to something.
• 15:31
  Shoeb Sitafalwalla: If we say yes to everything, then, it doesn't work.
• 15:34
  Shoeb Sitafalwalla: so that's how we source our ideas from all over, right?
• 15:37
  Shoeb Sitafalwalla: So primary care was a enterprise issue that we were having.
• 15:41
  Shoeb Sitafalwalla: Everybody has issues with access to primary care.
• 15:44
  Shoeb Sitafalwalla: Ours was like most of the country, 26, 24 days to first appointment, for a new patient get to primary care.
• 15:51
  Shoeb Sitafalwalla: And one of the first products we built out of the gate was virtual primary care.
• 15:56
  Shoeb Sitafalwalla: And, we built it, to scale right away, right?
• 15:59
  Shoeb Sitafalwalla: So our pilot prototype, we said it has to be at least 100,000 patients.
• 16:03
  Shoeb Sitafalwalla: you can't
• 16:04
  Anika: Wow
• 16:04
  Shoeb Sitafalwalla: 100,000 patients, you have no business scaling to six million patients.
• 16:08
  Shoeb Sitafalwalla: So it has to be 100,000 patients, which was a tall order, and it forces people to think, how do I build this, in the right way?" that's something that came from the enterprise.
• 16:19
  Shoeb Sitafalwalla: Virtual primary care went from 100,000 visits to now it, it's on track to do five times that for us, this year, right?
• 16:27
  Shoeb Sitafalwalla: And that's less than two years.
• 16:29
  Anika: I'm curious if you could tell me, a little bit more about the learning curve.
• 16:33
  Anika: I think we've sort of touched on this a little bit.
• 16:35
  Anika: so with Virtual Primary Care, that first product, how was setting that up different from the ones that kind of came after?
• 16:43
  Shoeb Sitafalwalla: I, I think the first product, took time, right?
• 16:46
  Shoeb Sitafalwalla: Because forces everybody in your organization to think differently about the work they do.
• 16:54
  Shoeb Sitafalwalla: IT, legal, finance, everybody needed to create new assumptions.
• 16:58
  Shoeb Sitafalwalla: with virtual primary care is, how do you think about your cost structure in a virtual primary care?
• 17:03
  Shoeb Sitafalwalla: Because this was a true virtual primary care.
• 17:06
  Shoeb Sitafalwalla: This wasn't a primary care doctor that does virtual care.
• 17:09
  Shoeb Sitafalwalla: This was doctor that's dedicated to the virtual practice alone.
• 17:14
  Shoeb Sitafalwalla: how do you attribute like enterprise costs to, you know, or corporate overhead, if they're living in a particular market, do they have to share the cost of the brick-and-mortar facilities in that area?
• 17:25
  Shoeb Sitafalwalla: There, there are all these interesting debates that you have, right?
• 17:28
  Shoeb Sitafalwalla: and so we worked all that out, if you will.
• 17:31
  Shoeb Sitafalwalla: but IT, from a build perspective, needed to think of a different cadence of how they work.
• 17:36
  Shoeb Sitafalwalla: Because often, I can't speak for every health organization, but often when you get a window where everybody's paying attention to you, you wanna make the most perfect product possible.
• 17:45
  Shoeb Sitafalwalla: And sometimes perfection gets in the way of progress, like things then go super slow.
• 17:49
  Shoeb Sitafalwalla: And one, one of the things we do with care model engineering is you need to work in quick intervals, like 90 days to go from one phase to the other, max.
• 17:56
  Shoeb Sitafalwalla: And so the idea isn't to be perfect, but create version 1.0.
• 18:02
  Shoeb Sitafalwalla: to be safe, has to be quality, but what's the minimum viable product?
• 18:06
  Shoeb Sitafalwalla: And then you'll have another chance to create 2.0 and put more bells and whistles on it.
• 18:10
  Shoeb Sitafalwalla: But this keeps momentum going.
• 18:11
  Shoeb Sitafalwalla: It helps people learn together.
• 18:14
  Shoeb Sitafalwalla: And so I would say our first product, by the time we got all, everything figured out, it took us like 10 months.
• 18:20
  Shoeb Sitafalwalla: it was exhausting, right?
• 18:22
  Shoeb Sitafalwalla: But now we are at a point where we are either launching, scaling, or upgrading a product every three to four weeks.
• 18:28
  Shoeb Sitafalwalla: And that 50-person steering crew meets on a monthly basis, they all show up.
• 18:33
  Shoeb Sitafalwalla: It's been an amazing cultural concept for the organization because people know if they wanna make a change clinically, this is the place to be.
• 18:42
  Anika: it's really fascinating to hear how everything has come together, and especially that point about, when people think they have a finite window and they feel like they have to get it all perfectly done that first time, and that kind of can be a barrier in a way.
• 18:56
  Anika: And that when people know there is a 2.0 version and they're gonna have, this process of iteration, how that accelerates it.
• 19:03
  Anika: and so it sounds like, you know, the work from one product, the learnings, they do carry over, do you have a shared template for care model redesigns?
• 19:11
  Anika: Were you able to templatize it a little bit?
• 19:13
  Shoeb Sitafalwalla: So for example, one of the products that we developed was our virtual weight management, weight management is obviously hot across the consumer market, we weren't trying to compete against, the consumer, products out there, right?
• 19:27
  Shoeb Sitafalwalla: But we know that just within the confines of our clinical enterprise, we have people who need weight management services.
• 19:33
  Shoeb Sitafalwalla: our primary doctors were looking for a bit of an easy button on that work as well, so they could focus on other issues, as well as supplement the chronic disease, work that they already do.
• 19:42
  Shoeb Sitafalwalla: And so we actually spent a lot of time building the virtual weight management chassis, And we wanted to build it right because what do you need to do to do virtual weight management?
• 19:50
  Shoeb Sitafalwalla: You need to have clinical interaction.
• 19:52
  Shoeb Sitafalwalla: You need to titrate medicines.
• 19:53
  Shoeb Sitafalwalla: You need to monitor weight, right?
• 19:56
  Shoeb Sitafalwalla: those are the same three things you need to do heart failure management.
• 19:59
  Shoeb Sitafalwalla: which we just launched a few weeks ago, Only difference is you're titrating, instead of titrating one medicine, you're titrating five.
• 20:06
  Shoeb Sitafalwalla: But the other principles stay the same.
• 20:09
  Shoeb Sitafalwalla: And so we were able to build products on top of each other, and that's what allows us to go faster and faster.
• 20:15
  Anika: Yeah, that makes a lot of sense.
• 20:16
  Anika: And I heard you use the word chassis.
• 20:18
  Anika: Is that something that you often use to
• 20:20
  Shoeb Sitafalwalla: yeah.
• 20:21
  Anika: that?
• 20:22
  Shoeb Sitafalwalla: we- when we're having this debate about what product should go next, right?
• 20:26
  Shoeb Sitafalwalla: We're always asking ourselves kind of two questions.
• 20:29
  Shoeb Sitafalwalla: The first question is, are we gonna be able to move faster on this because it fits on top of an existing chassis?
• 20:35
  Shoeb Sitafalwalla: it, right?
• 20:35
  Shoeb Sitafalwalla: if it doesn't, is this the product or is this the care model I wanna build a new Chassis for, more rigorous debate because there is just a net new level of investment that has to go into developing that.
• 20:49
  Anika: That makes sense.
• 20:50
  Anika: I'm so fascinated by, if using language like care model engineering, product chassis, like really productizing the way we think about things, that kinda change how people show up to the table?
• 21:02
  Shoeb Sitafalwalla: I think it really threw people off at first, you know, we had some detractors at first.
• 21:06
  Shoeb Sitafalwalla: They're like,"Well, I'm a clinician.
• 21:08
  Shoeb Sitafalwalla: I'm a physician.
• 21:09
  Shoeb Sitafalwalla: We're trying to deliver care." my counter to that was, one, I'm a clinician too, and We're trying to give you more tools so you can deliver that care, you're a primary care doctor.
• 21:20
  Shoeb Sitafalwalla: You only have 20 minutes to see that patient and take care of everything.
• 21:25
  Shoeb Sitafalwalla: let's find a way to build products that give you more tools to do that work, right?
• 21:30
  Shoeb Sitafalwalla: so that was the first unlock, I think, for maybe some of the skeptics out there.
• 21:35
  Shoeb Sitafalwalla: and then the second unlock was, I would say, when you think of things in product form, you give yourself far more latitude again, the components of that product, the who, where, and how.
• 21:46
  Shoeb Sitafalwalla: Does it have to happen in the hospital?
• 21:47
  Shoeb Sitafalwalla: Does
• 21:47
  Anika: Right
• 21:48
  Shoeb Sitafalwalla: to happen in the, in the clinic?
• 21:50
  Shoeb Sitafalwalla: so it just gives people a sense of flexibility.
• 21:53
  Shoeb Sitafalwalla: then the engineering component was this interesting, what I would say intentional use, because I think the word transformation has been overused in healthcare and transformation means many things to many people.
• 22:05
  Shoeb Sitafalwalla: And so we just decided to create a new word in our corporate lexicon to say, this is transformation, but it's transformation under a set of preconditions.
• 22:13
  Shoeb Sitafalwalla: And my background prior to medicine was I'm an engineer, so that, that appealed to me too.
• 22:17
  Shoeb Sitafalwalla: But, engineers, are creative, but they're creative under very set constraints, right?
• 22:21
  Shoeb Sitafalwalla: There's like freedom within a framework, right?
• 22:23
  Shoeb Sitafalwalla: you can't make a million dollar pen,
• 22:25
  Anika: I can totally understand the point about there being skeptics at first, but how this sort of allows you to expand your thinking and be more flexible, but also with, this clear framework as well.
• 22:35
  Anika: so I also kinda wanna ask, a lot of systems organize around service lines, departments or specialties, and then, when you're organizing around products instead, what kinda happens to those traditional structures?
• 22:47
  Anika: do they coexist?
• 22:48
  Anika: bit?
• 22:49
  Anika: Talk me through that.
• 22:50
  Shoeb Sitafalwalla: I think service lines are often are organizing structures on kind of the where clinical care exists, right?
• 22:58
  Shoeb Sitafalwalla: Or where it's organized, if you will.
• 23:00
  Shoeb Sitafalwalla: But, product mindset is what those service lines do.
• 23:04
  Shoeb Sitafalwalla: maybe another way to think about it is the service lines are their shelf, right?
• 23:09
  Shoeb Sitafalwalla: The products are what goes on the shelf, our heart failure, care model was built, between our product strategy team, our clinical virtual team, and our cardiovascular service line.
• 23:21
  Shoeb Sitafalwalla: They work together.
• 23:22
  Shoeb Sitafalwalla: The cardiovascular service line was able to provide, I think, the clinical insight and the pathway, the true evidence-based pathway.
• 23:30
  Shoeb Sitafalwalla: That's the what you do, The product team and the virtual team then were able to add in the who, where, and how you execute on that pathway, And so it actually marries very well together.
• 23:41
  Shoeb Sitafalwalla: And so now we have multiple service lines that are actually working now to figure out what their product schedule is gonna look like over the next number of years.
• 23:51
  Anika: Okay, that's really helpful to understand how, they're complementary to each other.
• 23:56
  Anika: I also want to go back to something that you mentioned earlier.
• 23:59
  Anika: you've set a minimum of 100,000 patients for a pilot, which I think is a pretty striking number.
• 24:07
  Anika: How did you land on that, and what does it force you to do differently?
• 24:11
  Shoeb Sitafalwalla: One of the things that we were dealing with is when people were thinking pilots, everybody had a different definition in mind, they were all fairly small.
• 24:18
  Shoeb Sitafalwalla: And when you design a pilot for, let's say, five hundred patients, you don't actually build your IT structure or your revenue cycle structure to s- to handle more than that, right?
• 24:30
  Shoeb Sitafalwalla: You're just trying to test the concept, does it work, right?
• 24:32
  Shoeb Sitafalwalla: But That's when, you get this pilot purgatory, right?
• 24:35
  Shoeb Sitafalwalla: Where, things stay in constant pilot mode, and they can never actually be applied across multiple geographies.
• 24:42
  Shoeb Sitafalwalla: And so we thought we'd just put a, big, hairy, audacious goal out there and say that,"Look, if your pilot can't hit a hundred thousand patients by the end of the year, if you're not designing for that, then you're creating something that never has any potential to break out of pilot mode." So it changes the way IT will resource the project.
• 25:03
  Shoeb Sitafalwalla: It changes the way the clinicians think about the implications of that project, right?
• 25:09
  Shoeb Sitafalwalla: If I'm gonna build a screening product, then I need to have the downstream capability to take on the screens, right?
• 25:14
  Shoeb Sitafalwalla: it forces you to think about the downstream capital of it, right?
• 25:18
  Shoeb Sitafalwalla: it just forces everybody to think about the next step.
• 25:21
  Shoeb Sitafalwalla: otherwise, the pilot stays the pilot.
• 25:24
  Shoeb Sitafalwalla: could it be fifty thousand?
• 25:25
  Shoeb Sitafalwalla: I guess.
• 25:25
  Shoeb Sitafalwalla: I wish I could tell you there's some science behind a hundred thousand, but it just, it's a crystallizing number.
• 25:31
  Shoeb Sitafalwalla: There is the Advocate way for us, and if we're gonna do something in a particular way, then we need to make sure all of our patients have appropriate access to it.
• 25:39
  Anika: I think you're capturing something that's pretty im- important, with the traditional pilot model and how that might set you up in a way without you meaning to, to just never scale, because that's not what you're designing it for.
• 25:51
  Anika: so what do you do when something isn't working?
• 25:55
  Shoeb Sitafalwalla: we do kill ideas, if you will, But because we do it as a collective, and we all agreed at the beginning what success looks like for these products, and when you don't hit those success metrics then it's easier to say,"Look, I tried, I couldn't do it," right?
• 26:09
  Shoeb Sitafalwalla: and what we've done, interestingly enough, is we've been able to put those on the side and going back to that chassis concept, we've had opportunities to like reintroduce them not necessarily as products, but as features on an existing chassis.
• 26:24
  Shoeb Sitafalwalla: So one example is we wanted to find a way to make smoking cessation work as a care model, right?
• 26:31
  Shoeb Sitafalwalla: But we couldn't make it work.
• 26:33
  Shoeb Sitafalwalla: And then, some almost a year later, we built a product around lung cancer screening and realized that the product, the chassis was good on its own, but it had an infrastructure that could absorb, for those patients that in the intake that screen positive as smokers, we could actually add smoking cessation counseling and therapy on top of that.
• 26:54
  Shoeb Sitafalwalla: So we actually resurrected it, but in a much more economically and operation sustainable manner
• 27:00
  Anika: Yeah.
• 27:01
  Anika: Okay, so it sounds like, even if something doesn't work, you're able to repurpose it later down the line perhaps.
• 27:07
  Anika: I think having that discipline of, being a, being willing to stop something, is really important, I think it's probably easier to start things than it is to kill them.
• 27:15
  Anika: so I know we're coming up on time, but I kinda wanna pull a little bit on that technology thread a little bit.
• 27:21
  Anika: and this is, a little bit of a pivot, but how do you think new technologies like agentic AI are gonna change how health systems design care models and products?
• 27:31
  Anika: would love to ground this in, what you're seeing, but feel free to be a little speculative as well
• 27:35
  Shoeb Sitafalwalla: so my basic construct behind AI and Advocate is very forward-leaning on the promise of AI.
• 27:41
  Shoeb Sitafalwalla: But we wanna do it in the most responsible way possible.
• 27:45
  Shoeb Sitafalwalla: just by way of background, we have a dedicated leadership team to our AI strategy, we're big believers in responsible AI utilization.
• 27:54
  Shoeb Sitafalwalla: So, uh, we published what is considered an industry standard for AI evaluation called Fair AI, which is a, very, important kind of use of ethics and IT evaluation to make sure that agentic solutions are done in the best interest of our patients.
• 28:10
  Shoeb Sitafalwalla: But with all that background in mind, I think the way I think of this is that for the last 40-plus years, healthcare transformation has been defined by scarcity, right?
• 28:20
  Shoeb Sitafalwalla: Everything from HMOs retail revolution to, you know, the ACA has all been built around this idea that we don't have enough doctors, we don't have enough clinicians, we don't have enough time, we don't have enough access to take care of the growing Uh, disease burden of our population.
• 28:36
  Shoeb Sitafalwalla: I think AI introduces this concept of abundance.
• 28:40
  Shoeb Sitafalwalla: for the first time, we have an opportunity to solve for abundance, solve for the idea that, we may have the ability to solve for time One example is, recently we were looking at hypertension management gaps in We have, I think, about a hundred and thirty something outpatient care managers that call a number of patients to close quality gaps in, you know, hypertension being one of them.
• 29:07
  Shoeb Sitafalwalla: And we recently incorporated an agentic solution to help us do that, to call patients.
• 29:13
  Shoeb Sitafalwalla: we're able
• 29:14
  Anika: Yeah
• 29:14
  Shoeb Sitafalwalla: thousands of patients at the same time parallel, in multiple languages, seven, and these calls can last ten to twenty minutes, and that's okay.
• 29:24
  Shoeb Sitafalwalla: Having a human stay on hold for ten to twenty minutes is sometimes difficult, right?
• 29:28
  Shoeb Sitafalwalla: 'Cause they have a list to go through.
• 29:31
  Shoeb Sitafalwalla: so there is an opportunity to solve for abundance in a fundamentally new way, which I think changes the way we do primary care in the future, changes the way we do chronic disease management in the future.
• 29:42
  Shoeb Sitafalwalla: us to put more resources in the hands of patients and take the finite resources we have, our clinicians, and use them at the best possible way, right?
• 29:50
  Shoeb Sitafalwalla: so that's my quick, three-minute, r- answer to your far more complicated question.
• 29:56
  Anika: Yeah, no, thank you for getting a little speculative with me.
• 29:59
  Anika: I think that's, really interesting to hear your perspective on things.
• 30:02
  Anika: I think it'll be really interesting to see how things play out over the next few years last question for you.
• 30:07
  Anika: for, a peer chief strategy officer who kind of wants to try, care model engineering but they don't have you know, a recent merger to be a force function, or they don't have advocate scale, for example, what's some advice you would give?
• 30:21
  Shoeb Sitafalwalla: you cannot transform your way in a silo, right?
• 30:24
  Shoeb Sitafalwalla: So if at minimum you don't have your clinical counterpart and your IT counterpart with you on this journey, it's a no-go.
• 30:33
  Shoeb Sitafalwalla: I think then, you need to have a very clear focus.
• 30:37
  Shoeb Sitafalwalla: What is the problem you're trying to solve for?
• 30:40
  Shoeb Sitafalwalla: And then the last I would say is you need to have a process, right?
• 30:43
  Shoeb Sitafalwalla: You need to have like a pipeline process, and you need to have dedicated time for that.
• 30:47
  Shoeb Sitafalwalla: This isn't something you do on the side while also trying to figure out, know, how we're gonna open up the next, you know, clinic on the corner of First and Main, right?
• 30:54
  Shoeb Sitafalwalla: you need dedicated time and then you need to have the willingness to disrupt yourself and say,"Maybe we don't open the clinic on the corner of First and Main because we're doing this." that's kind of like three or four basic things I would say to start with.
• 31:08
  Shoeb Sitafalwalla: It's not easy.
• 31:09
  Shoeb Sitafalwalla: there's been a lot of challenges and difficult conversations along the way, but there was a commitment to do something different because that was always the hypothesis behind Advocate, that we were gonna do something different with our scale, and that's what we're trying to do.
• 31:21
  Anika: Shoaib, this has been a really great conversation.
• 31:23
  Anika: I think the way you're thinking about care models as products is really fascinating.
• 31:27
  Anika: It's gonna resonate with, a lot of the listeners.
• 31:30
  Anika: So thank you so much for being so generous with your time and your thinking
• 31:33
  Shoeb Sitafalwalla: Yeah.
• 31:34
  Shoeb Sitafalwalla: Thank you
• 31:35
  Anika: That was Showup Satafalwala, Chief Strategy Officer at Advocate Health.
• 31:39
  Anika: if this conversation sparked something you wanna dig into further, you can reach us at strategycatalyst@hmacademy.com And if you know a health system leader doing something worth talking about, send them our way.
• 31:51
  Anika: We're always looking for the next conversation
• 31:54
  Anika (2): That wraps up this episode of the Strategy Catalyst Dispatch.
• 31:57
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• 32:03
  Anika (2): If you have other thoughts or questions, we'd love to hear them.
• 32:06
  Anika (2): Email us at Strategy catalyst@hmacademy.com.
• 32:10
  Anika (2): You can also find more of our resources on HM academy.com/strategy-catalyst.
• 32:17
  Anika (2): That's it for this dispatch.
• 32:19
  Anika (2): Thanks for listening.