Latest / Becker’s Healthcare Podcast / Healthcare Upside / Down: Redefining Patient Access and Physician Alignment

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Healthcare Upside / Down: Redefining Patient Access and Physician Alignment · Becker’s Healthcare Podcast

• 0:00
  Welcome everyone to Healthcare Upside Down, a podcast
• 0:03
  by Becker's Healthcare and ECG Management Consultants,
• 0:06
  where we'll explore the upsides and downsides of
• 0:08
  healthcare and the industry's latest trends.
• 0:10
  I'm Erica Spicer Mason with Becker's Healthcare, and
• 0:13
  today I'm thrilled to talk to two special
• 0:15
  guests about patient access and experience.
• 0:18
  So joining us for this conversation, we have
• 0:20
  doctor Joseph Cachon,
• 0:22
  CEO of Thomas Jefferson University and Jefferson Health,
• 0:25
  and Alex Pinto, a principal at ECG Management
• 0:28
  Consultants.
• 0:29
  Doctor. Ketcheone and Alex, thank you so much
• 0:31
  for being with us today. Yep. Happy to
• 0:34
  be here. Thank you. Great to have you
• 0:35
  with us. And before we get into the
• 0:37
  conversation, I wanted to see if you both
• 0:39
  like to share just a little bit more
• 0:40
  about yourselves and your work in healthcare.
• 0:43
  Doctor Ketchel, would you like to get us
• 0:44
  started? Sure. You know, I started,
• 0:46
  in health care a long time ago.
• 0:50
  I started and went to medical school, graduated
• 0:52
  from Hahnemann,
• 0:54
  medical school back in the back in the
• 0:57
  eighties
• 0:58
  and,
• 0:59
  was a practicing cardiologist for the first part
• 1:01
  of my career,
• 1:02
  interventional cardiologist, and then gradually over time became,
• 1:06
  more and more administrative
• 1:09
  and to this final job or, well, I
• 1:10
  guess it's gonna probably be my final job
• 1:12
  in health care, at least full time job
• 1:15
  as CEO of Jefferson. So,
• 1:17
  it's been a great journey. I've learned a
• 1:19
  lot along the way, and every stop has
• 1:21
  been an education,
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  and I've enjoyed it. Wonderful. Thank you so
• 1:25
  much. And, Alex, tell us a little bit
• 1:27
  about you. Yeah. Thanks for having me. I've
• 1:29
  been in health care around, twenty two years
• 1:31
  now. It actually started with a clinical background
• 1:34
  in, outpatient rehab sports medicine.
• 1:36
  Practice for a while before realizing I had
• 1:38
  a knack for more of the administrative and
• 1:40
  operational side of health care. I worked with
• 1:42
  health systems directly in leadership roles for ambulatory
• 1:45
  and,
• 1:46
  medical groups before moving into consulting around a
• 1:49
  decade ago, where I really focus in on
• 1:51
  just that patient access side.
• 1:53
  Touches on the clinical side for me, which
• 1:55
  is,
• 1:56
  timeliness of care is so critical to outcomes.
• 1:59
  And if we can make access
• 2:01
  a key part of health care delivery, then
• 2:03
  we can improve outcomes for patients and improve
• 2:06
  the case, patient experience as well. It's all
• 2:08
  a critical part of that life cycle. Yeah.
• 2:10
  Wonderful. Well, it's great to learn more about
• 2:12
  you both. And,
• 2:13
  I think, Alex, to your point, when we
• 2:15
  talk about patient access, there's a lot that
• 2:17
  factors into it. So I'm sure we'll cover
• 2:19
  a lot of areas of what patient access
• 2:20
  really means. But I wanted to get us
• 2:22
  started by talking a little bit about what's
• 2:24
  happening at Jefferson Health. So doctor Cachon,
• 2:27
  Jefferson has experienced significant growth. It's expanded across
• 2:31
  Pennsylvania,
• 2:32
  New Jersey, and I know most recently has
• 2:34
  merged with Lehigh Valley Health Network.
• 2:36
  So how are you thinking about the patient
• 2:38
  journey across this broad and diverse footprint, and
• 2:41
  in what ways has that growth shaped your
• 2:43
  approach to access and experience?
• 2:45
  Yeah. First of all, we are
• 2:48
  super regional, the way people describe today, and
• 2:50
  so we're in a concentrated area,
• 2:53
  concentrated
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  Eastern Pennsylvania
• 2:56
  and, Southern New Jersey. And,
• 2:59
  for us, there are multiple access points for
• 3:01
  care, whether it be our emergency room, whether
• 3:03
  it be our practices,
• 3:04
  whether it be our hospitals,
• 3:06
  our imaging centers. We have more than 750
• 3:10
  sites of care across the system.
• 3:12
  And, but, you know, access today is not
• 3:14
  always about a physical
• 3:16
  location.
• 3:17
  It's about the ability for patients to reach
• 3:19
  us or reach them, ours to reach the
• 3:21
  patients where they are. People have an expectation
• 3:24
  today because of other industries
• 3:27
  is being met where they are in their
• 3:28
  home.
• 3:29
  And that's the difference between when I started
• 3:31
  in health care where we were waiting for
• 3:33
  people to come to us. They come to
• 3:35
  the emergency room and come to the practice
• 3:36
  today. But we have, we have a home
• 3:39
  care program. We have home visits for we
• 3:41
  have physicians that do house calls.
• 3:44
  We have multiple channels to come in. We
• 3:46
  really wanna be the most accessible system in
• 3:49
  the country
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  and for sure in the region.
• 3:53
  It does a couple things. One is in
• 3:54
  the fee for service world, it works because
• 3:56
  it becomes a way to get people into
• 3:58
  the system that but more importantly, as we
• 4:01
  think payment models will change and hopefully will
• 4:04
  change, is it aligns the fact that we
• 4:07
  want people to have access to care to
• 4:09
  keep them out of the hospital. Mhmm. And
• 4:11
  having access
• 4:13
  access
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  before somebody ends up in the emergency room
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  with a a problem that needs admitted
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  is a much better solution for the patient.
• 4:19
  It's a much better solution for the health
• 4:21
  care,
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  but we have to incentivize it in a
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  in the correct way. And that's why we
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  believe that the financing of health care,
• 4:28
  is tied to this access issue.
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  How we pay for health care is tied
• 4:33
  is tied to the access issue even more
• 4:35
  importantly than it is in a fee for
• 4:36
  service world.
• 4:38
  Yeah. Really interesting. And and I definitely hear
• 4:40
  you in this trend on the stream approach
• 4:43
  to keeping folks out of the hospital and
• 4:44
  keeping them out of their care sites. But
• 4:46
  750 care sites, wow. What a number. So
• 4:49
  it's really great to hear that you're so
• 4:51
  focused on access in that way.
• 4:54
  And, Alex, I wanted to get your perspective
• 4:56
  on this too. You know, you work with
• 4:58
  health systems nationwide, and organizations
• 5:01
  are focusing patient access efforts, I'm sure, in
• 5:03
  a multitude of ways. So can you elaborate
• 5:06
  on what you're seeing and common challenges that
• 5:08
  you see them trying to to solve?
• 5:10
  Yeah. And I I wanna appreciate what doctor
• 5:12
  Gaston just said. 750
• 5:14
  care sites, but between your physicians making house
• 5:17
  calls, your digital platforms,
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  the number of unique ways your patients can
• 5:21
  connect with you are almost infinite. Right? And
• 5:24
  it's growing.
• 5:25
  And that's a common problem health systems are
• 5:27
  experiencing
• 5:28
  nationally. Whether you're super regional
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  or you're a single facility local health system,
• 5:33
  you're managing a very different platform for care
• 5:36
  delivery.
• 5:37
  And the ways your patients, I like to
• 5:39
  call them consumers because they have choice in
• 5:41
  their actions, your consumers are coming to you
• 5:44
  are gonna vary.
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  So what are we seeing nationally? I think
• 5:47
  that if I was to bring all of
• 5:49
  it together, we're seeing a dual transformation.
• 5:51
  Mhmm. Transformation
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  one is how health systems need to
• 5:55
  solve for their patients or their consumers'
• 5:58
  access to care problems today.
• 6:00
  Those are core changes, like how do we
• 6:02
  schedule?
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  How do our providers template? What does a
• 6:05
  contact center environment look like, and how is
• 6:07
  that run efficiently.
• 6:09
  Those are table stakes right now that health
• 6:12
  systems have to master.
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  Many of them have and they're moving on
• 6:15
  to transformation two,
• 6:17
  and some are working on transformation one while
• 6:19
  strategically planning for transformation two. So what's transformation
• 6:23
  two? This is the more optimistic, forward thinking
• 6:26
  aspect of access, and I think this speaks
• 6:28
  also a little bit to what doctor Kushon
• 6:30
  was,
• 6:31
  getting after into the payer reform and the
• 6:33
  future of health care.
• 6:35
  In that future, access has to be more
• 6:37
  than just the scheduling center or the patient
• 6:39
  contact center. It's gotta be a platform on
• 6:41
  which we're coordinating care across the system. We're
• 6:44
  doing it proactively. We're embedding AI and digital
• 6:46
  technologies.
• 6:48
  One of the concepts that we've seen very
• 6:49
  innovative in this space is things like predictive
• 6:52
  outpatient programming of your availability.
• 6:56
  Mhmm. If we've seen
• 6:57
  many health systems grow
• 6:59
  the inpatient command center,
• 7:01
  what does it mean to have an ambulatory
• 7:03
  command center that relates?
• 7:05
  Can that command center track flu admissions
• 7:08
  and dynamically adjust availability for same day sick
• 7:11
  care?
• 7:12
  Can that command center identify
• 7:14
  the number of inpatients being held because they
• 7:16
  don't have transition of care appointments and dynamically
• 7:19
  adjust primary care availability to accommodate those patients?
• 7:22
  Mhmm. It's looking at that master patient flow
• 7:24
  of patient care
• 7:25
  and aligning it, all of those health system
• 7:27
  resources across all of the platforms and points
• 7:30
  of care that the system can offer to
• 7:32
  meet those patients' needs. Yeah.
• 7:35
  Alex, I appreciate your insights there. And and
• 7:37
  two things that you said really struck me.
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  One is that you've mentioned this need for
• 7:42
  these kind of dynamic,
• 7:44
  workflows and and levels of insight into health
• 7:48
  system operations and also that platform approach. And
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  those are two concepts that I've heard underscored
• 7:53
  throughout conversations here at Becker's CEO CFO roundtable.
• 7:57
  So interesting to hear you touch on those
• 7:59
  as well. And doctor Khashone, I wanna bring
• 8:01
  it back to you. You know, as Jefferson
• 8:03
  continues to grow, how do you balance efficiency
• 8:06
  and consistency,
• 8:08
  whether that's through something like centralized services or
• 8:11
  maybe standardization,
• 8:13
  especially with the need to deliver personalized patient
• 8:15
  experience?
• 8:17
  Yeah. I think, you know, at the individual
• 8:19
  level, the experience need to be personalized. Right?
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  But at the ability
• 8:24
  to access the system should be more standardized.
• 8:27
  And that is not a small task.
• 8:29
  You know, Alex referenced
• 8:31
  physician templates. Yeah. People think that's an easy
• 8:34
  thing to change. It's not. There is
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  a a whole host of change management that
• 8:39
  has to go into that.
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  And you have to have that date where
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  you say, okay.
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  You no longer
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  that we would have docs that would come
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  in
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  and
• 8:47
  just take the afternoon off, not be on
• 8:50
  vacation,
• 8:51
  not have,
• 8:52
  any entries into Epic, not have administrative time.
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  And we just we didn't know where they
• 8:57
  were. And,
• 8:59
  and so think about if I'm two weeks
• 9:02
  out from an appointment and I have an
• 9:03
  appointment, I I need to get somebody in
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  to see doctor Kashone,
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  his template should be open. And so standardizing
• 9:09
  templates was is the first step in access,
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  whether it be a virtual template, whether it
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  be, you know, telehealth visit, whether it be
• 9:17
  physical visit, whether it be going home, there
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  has to be a standardized because we have
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  to have patients have
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  imagine doing your,
• 9:26
  imagine doing
• 9:27
  OpenTable.
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  Mhmm. And you go on to OpenTable and
• 9:30
  you schedule your reservation for and you go
• 9:33
  to the restaurant and it's closed. Yeah. You're
• 9:35
  not gonna be so happy about that. Yeah.
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  And so there has to be, you know,
• 9:39
  there has to be an infrastructure to this.
• 9:41
  Mhmm. And,
• 9:43
  you know, with doctors,
• 9:45
  typically, they're not always the most flexible group
• 9:47
  of people. I can say that since I'm
• 9:49
  one. We're not always the most flexible on
• 9:51
  how and so and, you know, a lot
• 9:53
  of them went into this at a time
• 9:54
  where they had a lot of autonomy.
• 9:56
  Those days of corporatized medicine, which, you know,
• 9:59
  unfortunately,
• 10:00
  there's a a reason why physicians have chosen
• 10:04
  not to go into private practice any longer.
• 10:06
  My first job was in private practice. Mhmm.
• 10:09
  We sort of policed ourselves.
• 10:11
  In today's world, you know, it's being policed
• 10:13
  because
• 10:14
  of the financial pressures within the system and
• 10:17
  the fact that the consumers
• 10:19
  have a much higher expectation today than they've
• 10:21
  ever had. They have so many other industries
• 10:23
  where they can book something, they can order
• 10:26
  something, they can access things immediately.
• 10:29
  And And in health care, we're just we're
• 10:30
  we're behind the times. Mhmm. And so it
• 10:32
  start to me, the self starts the access
• 10:35
  journey,
• 10:36
  which has got you know, can have AI
• 10:38
  embedded in all these things. At the end
• 10:40
  of the day, we have to be able
• 10:42
  to deliver better for our patients. Yeah. Yeah.
• 10:44
  So it sounds like standardizing those templates is
• 10:47
  one key way
• 10:48
  to ensure access, and and it's a really
• 10:50
  interesting strategy. So thank you for sharing, doctor
• 10:52
  Cichon. Alex, would love to know how you're
• 10:55
  seeing other systems approach this issue and and
• 10:58
  really strike that balance between centralized access and
• 11:00
  local relationships.
• 11:02
  Yeah. I I gotta triple down on what
• 11:04
  doctor Kashone is saying. The templates are the
• 11:06
  the base of it. Right? In any other
• 11:08
  industry,
• 11:09
  if we're in retail,
• 11:10
  we're managing an inventory.
• 11:12
  And in health care, our inventory is our
• 11:14
  physician's appointments. Mhmm. And if we can't describe
• 11:17
  what our inventory is on a daily basis
• 11:20
  and have a plan to deliver that inventory
• 11:23
  to our consumer,
• 11:24
  our patient,
• 11:25
  then we have what retail would call spoilage.
• 11:27
  Yeah. Spoilage is when something goes bad at
• 11:29
  the end of the day, and we can
• 11:30
  never sell it.
• 11:32
  When we don't template correctly, we have spoilage.
• 11:34
  We also have breakage.
• 11:36
  That's when we mishandle our inventory,
• 11:38
  and we lose the ability to sell that
• 11:40
  inventory.
• 11:41
  Now I don't mean to infer that health
• 11:43
  care is as simple as retail. We have
• 11:45
  our own set of complexities,
• 11:47
  physicians being at the core of that. Physicians
• 11:50
  see templates as the last bastion of their
• 11:52
  independent practice.
• 11:54
  I've had physicians say, you will change my
• 11:56
  template when you pry it from my cold
• 11:58
  dead hands. Right? This is a personal thing
• 12:01
  to physicians. Mhmm. And I would challenge that
• 12:04
  there can be two truths in this. The
• 12:06
  first truth being we can standardize,
• 12:09
  and the second truth being you can still
• 12:11
  have some autonomy in your practice.
• 12:13
  You as a physician can still dictate how
• 12:15
  you deliver care, how you engage with your
• 12:17
  patients,
• 12:18
  how you spend your time treating and and
• 12:21
  managing your patients' complex problems. Mhmm. They both
• 12:23
  can coexist,
• 12:24
  but we have to partner with physicians to
• 12:26
  be able to deliver that kind of transformation,
• 12:28
  and those transformations have to be built on
• 12:30
  some level of standardization and support of an
• 12:33
  economy of scale. Yeah. Yeah. I doubled down
• 12:35
  on that. I I just say that
• 12:37
  if you'd say I'm gonna see patients Monday
• 12:39
  through Friday,
• 12:41
  eight to four,
• 12:42
  you have to see patients eight to four.
• 12:44
  That's your template. You chose it. And it's
• 12:46
  okay. We're we're happy to be flexible within
• 12:49
  a framework. But once you commit to a
• 12:51
  template,
• 12:52
  you're gonna stick with it. Mhmm. It's not
• 12:54
  you know, used to be the old general
• 12:56
  practice person says, I'm going home early today.
• 12:59
  Marge, cancel the rest of the day. Mhmm.
• 13:01
  And, you know, Marge would just get on
• 13:03
  the phone and say, you know, doctor can't
• 13:04
  see it today. Mhmm. And there if there's
• 13:06
  an emergency, go to the emergency room. Our
• 13:08
  patients have much higher expectations. So
• 13:11
  there is some autonomy.
• 13:12
  When I used to acquire physician practices at
• 13:15
  one point in my career, I acquired
• 13:17
  all the practices for Cleveland Clinic. They used
• 13:20
  to tell me, you're gonna lose you're gonna
• 13:21
  lose control of a couple of things. One,
• 13:23
  you're gonna lose control of human resources. You're
• 13:26
  not gonna be able to just come in
• 13:27
  and say, you know, Erica, I don't like
• 13:29
  you. I don't like the dress you're wearing,
• 13:30
  so we're gonna fire you today.
• 13:32
  So health systems won't allow that to happen.
• 13:35
  And then the second thing is you're gonna
• 13:37
  lose some autonomy on your schedule.
• 13:40
  Your professional side, your professional practice, how you
• 13:43
  interact with patients on a day to day
• 13:44
  basis, we'll give you tools to help you.
• 13:46
  But we're what we really have to focus
• 13:48
  on is consistency,
• 13:50
  And that expectation is that I like the
• 13:53
  way you bring the retail industry in. It
• 13:55
  is. People
• 13:57
  if the if the product is not predictable
• 13:59
  for access, that's the that's table stakes. Yeah.
• 14:02
  Yeah. And and it leads me to a
• 14:05
  quick follow-up question, which is if there are
• 14:06
  health systems out there who are considering this
• 14:08
  change, standardizing templates, but it sounds like there
• 14:11
  is a change management component that would go
• 14:13
  into this, what's the best first step that
• 14:15
  an organization could take to get the physicians
• 14:18
  on board or at least get them aligned?
• 14:20
  I I would just say having done this
• 14:22
  Yeah. It's about it's creating a group of
• 14:24
  physicians that will help
• 14:27
  implement it. So and it's not coming from
• 14:29
  Joe Cushone, the CEO. Mhmm. But it's coming
• 14:32
  from a jury of their peers. Yeah. I
• 14:34
  had a, physician call me in my prior
• 14:37
  job and said, you ruined my career. You
• 14:39
  ruined my life because I have to see
• 14:41
  patients,
• 14:43
  on Saturday mornings from eight to twelve. Mhmm.
• 14:47
  And I said, listen.
• 14:48
  All all we we gave two rules
• 14:51
  to the physician oversight group is that they
• 14:53
  had to have some hours off time,
• 14:56
  outside of eight to five, and that the
• 14:59
  the templates had to be standardized. And then
• 15:01
  people could pick. Mhmm. And he said, you
• 15:03
  ruined my life. I said, I didn't know
• 15:04
  such thing. You chose your template Mhmm. Number
• 15:07
  one. Number two, a jury of your peers
• 15:09
  said, we think it's competitive for us to
• 15:12
  have off hours time, and everybody had to
• 15:14
  do at least two hours a week. Mhmm.
• 15:16
  You chose your schedule.
• 15:18
  And so I would say as much as
• 15:20
  self, self governance to a point, give them
• 15:23
  the autonomy where the autonomy
• 15:25
  doesn't matter,
• 15:27
  as much, and set up your own committee
• 15:30
  to do that. It can't be handed down
• 15:32
  as an edict. Yeah. It's a great great
• 15:34
  point of advice. Alex, anything you'd add? I'll
• 15:37
  I'll build on it. The
• 15:39
  physician governance side of this, the self governance
• 15:41
  side of it is key. You have to
• 15:42
  have physician stakeholders at the table, and ideally,
• 15:45
  those physician stakeholders are business oriented. They understand
• 15:48
  the the need of the patient, the consumer,
• 15:49
  and may have been out of private practice.
• 15:53
  The other thing I'll I'll throw in there,
• 15:54
  though, is a shared commitment amongst the leadership
• 15:57
  team, physician and otherwise.
• 15:59
  And something we'll often talk about with leadership
• 16:01
  teams contemplating this change is
• 16:05
  some number of physicians,
• 16:06
  call it one or 2%,
• 16:08
  when you're making these changes, they're gonna come
• 16:10
  to you and say, if you do this,
• 16:11
  I'm out. Mhmm.
• 16:13
  And the leadership team can't crack.
• 16:15
  They have to join together and say, well,
• 16:18
  doctor Smith,
• 16:19
  we've loved having you here, and you're a
• 16:21
  valued part of our organization. We prefer you
• 16:23
  stay. But if you can't see yourself into
• 16:26
  the future that we're building,
• 16:28
  then we understand we need to part ways.
• 16:29
  Yeah. And that's not to be cynical or
• 16:32
  to say that we have to be mean
• 16:33
  to physicians,
• 16:35
  but the economy of scale group practice mentality
• 16:38
  isn't for every physician, and that's what the
• 16:41
  standards are built built to do. Again, two
• 16:43
  truths are possible. We can still make it
• 16:45
  better for physicians
• 16:46
  within a set of ground rules for operating
• 16:49
  not just templates, but scheduling processes, referral management
• 16:53
  processes, patient contact processes.
• 16:55
  But we've gotta have a shared commitment from
• 16:57
  the leadership team when those objections start flying.
• 17:00
  We actually incentivize our docs. We don't do
• 17:03
  a lot of RVU based,
• 17:05
  linear relationship between comp and RVUs, but one
• 17:08
  of the metrics for you getting a payment,
• 17:11
  increase is access.
• 17:12
  Mhmm. And,
• 17:14
  the way to do that is to have
• 17:16
  it starts with, you know, I have a
• 17:18
  template that Yeah. Gets filled up every day.
• 17:20
  Yeah.
• 17:21
  One of the things we're seeing and to
• 17:23
  to build on that, a lot of health
• 17:24
  systems do is move around the RVU as
• 17:26
  a primary benchmark for their incentive compensation.
• 17:30
  And there's clever ways to migrate off, one
• 17:33
  of them being to focus on encounters
• 17:35
  instead of RVUs
• 17:37
  and then focus on how many RVUs you
• 17:39
  would generate per encounter.
• 17:41
  The idea being, if we're seeing the right
• 17:42
  volume of care and we're bringing the right
• 17:44
  number of patients into the procedural environment,
• 17:47
  our RVRs per encounter are still very strong.
• 17:49
  But the encounter base, what we're really incentivizing
• 17:52
  off of, adds directly into access and our
• 17:54
  commitment to our patients and our community. Are
• 17:56
  we inventorying ourselves correctly?
• 17:59
  So interesting. Thank you both for for the
• 18:01
  insights.
• 18:02
  And I wanna take our conversation as we
• 18:05
  are about to close here. I wanna make
• 18:07
  sure that we touch on what's ahead. And
• 18:08
  I know given the amount of change that
• 18:11
  health care organizations are dealing with right now
• 18:13
  and the pace at which that change is
• 18:14
  happening, it's hard to consider a few years
• 18:17
  from now. But when you both envision a
• 18:19
  few years from now, what innovations in technology
• 18:21
  or service design will most meaningfully improve patient
• 18:24
  access,
• 18:25
  perhaps in the next decade? And what can
• 18:27
  leaders do now to prepare?
• 18:30
  I I I'm I'm gonna come back. I
• 18:32
  may sound like a broken record. We've gotta
• 18:34
  align the economic model Yeah. To delivery of
• 18:36
  care in a different way.
• 18:38
  This idea that there's a turnstile that every
• 18:41
  time somebody walks in your office or has
• 18:43
  a procedure, there's a payment for that. We've
• 18:46
  we've bred a generation of RVU mercenaries,
• 18:49
  that want to just get RVUs.
• 18:51
  Mhmm. And for us, it's we we think
• 18:54
  the economic model has to change has to
• 18:56
  change, how we pay the docs,
• 18:59
  has to change how we get paid as
• 19:00
  a health system.
• 19:02
  And so, we're on a journey become a
• 19:04
  true IDFS,
• 19:06
  and I think that's gonna be innovation. It's
• 19:08
  clear that we spend too much on health
• 19:10
  care in this country. It's because we incentivize
• 19:13
  the behavior of more. Mhmm. And the way
• 19:15
  the third party system works is the more
• 19:18
  you do, the more you get paid. And
• 19:20
  so people are smart. They figure out how
• 19:23
  to,
• 19:24
  do more
• 19:25
  and get paid more. Yeah. And until we
• 19:27
  change the incentives and align the incentives
• 19:30
  to what's better for the patient, what's better
• 19:32
  for the the community, what's better for a
• 19:34
  population of people,
• 19:36
  with quality measures embedded.
• 19:38
  I don't I don't think we're gonna make
• 19:40
  meaningful
• 19:41
  financial
• 19:43
  re
• 19:44
  changes in the current health care system. Yeah.
• 19:46
  Thanks, doctor Kishon. And, Alex, what would you
• 19:49
  say? Yeah. So two things. One, to just
• 19:52
  build on doctor Kachon's statement.
• 19:54
  We've given physicians a rule book, and physicians
• 19:57
  are really smart, and they figured out how
• 19:59
  to use that rule book
• 20:01
  to maximize their their personal earning potential. And
• 20:04
  then that's a nefarious statement.
• 20:06
  Physicians still deliver on the whole amazing care.
• 20:09
  We've got amazing access to high quality care
• 20:11
  in our country.
• 20:13
  My goal would be how do we make
• 20:14
  it more accessible? And I think changing the
• 20:16
  rule book, that's spot on, doctor Krishan. I'm
• 20:17
  with you.
• 20:19
  When I look to the future with consumers,
• 20:21
  another point I would look with the Jefferson
• 20:24
  example, your super regional care. I think we
• 20:26
  will see more systems approach super regional status
• 20:29
  over the next couple years. That's gonna build
• 20:32
  a tremendous economy of scale
• 20:34
  and with the right leadership should be able
• 20:36
  to empower adoption of more technologies,
• 20:38
  better integration of AI.
• 20:40
  It's not here yet, but it's coming. We
• 20:42
  already see patient contact centers
• 20:45
  using AI driven passive listening
• 20:47
  to identify
• 20:48
  patients' concerns and help flag
• 20:51
  a routine skill
• 20:53
  team member with the right information to resolve
• 20:56
  that patient's issue based on that AI interpretation
• 20:59
  of the conversation.
• 21:00
  That's fundamental
• 21:02
  right now. Mhmm. But with the right investment
• 21:04
  and through building economies of scale,
• 21:07
  adoption of technology, our ability to service our
• 21:09
  patient in a nonclinical sense in support of
• 21:12
  the clinical outcomes
• 21:14
  is gonna be exponential.
• 21:16
  The only thing I'm gonna throw in there,
• 21:18
  and I think this is a key takeaway,
• 21:20
  it's not gonna be cheaper.
• 21:22
  Many people think, oh, when we centralize, we're
• 21:24
  gonna bring our costs down. It's probably not
• 21:26
  gonna maybe actually be cheaper to do it
• 21:28
  that way. But the economy of scale is
• 21:30
  gonna bring benefit
• 21:31
  in terms of outcomes, our cost to deliver
• 21:33
  care, and the revenue that we're able to
• 21:35
  manage on the other side of the transaction.
• 21:38
  Fantastic.
• 21:39
  It's been I I've really enjoyed learning from
• 21:41
  you both this afternoon, so thank you again
• 21:43
  for all the insights. Before we close, just
• 21:45
  wanted to check if there were any final
• 21:47
  takeaways or maybe anything we glossed over too
• 21:49
  quickly that you'd like to add.
• 21:51
  No. I think we covered it. I think,
• 21:52
  you know, you're hearing a lot of alignment
• 21:54
  between what we're saying. Mhmm.
• 21:56
  And, you know, frankly,
• 21:59
  there is a big overlay of change management
• 22:01
  for doctors.
• 22:02
  There's doctors are going through a grieving process.
• 22:05
  Mhmm.
• 22:06
  They feel like they've
• 22:08
  and especially generational docs. So the ones that
• 22:11
  are my vintage that came out may have
• 22:13
  been private practice and felt like they were
• 22:15
  a small businessman and small businessperson, and they
• 22:18
  could run their own practice.
• 22:20
  That's changed. And the new generation of docs
• 22:23
  wanna be employed. They wanna work eight to
• 22:25
  five. Yeah. And they have an expectation of
• 22:27
  work life balance.
• 22:29
  All these things are complicated,
• 22:31
  and they just add to the complication
• 22:34
  of standardizing access for patients. So,
• 22:36
  there is I wouldn't the parting message for
• 22:39
  me is other health systems. Don't underestimate the
• 22:42
  amount of change management's gonna have to happen
• 22:44
  and the generational differences between
• 22:47
  the boomer doctors and the Gen z doctors.
• 22:50
  Yeah. Absolutely. It's an important takeaway. Yeah. Thank
• 22:53
  you. And Alex?
• 22:54
  I've loved the conversation.
• 22:55
  We've spoke mostly about the physician
• 22:58
  side, which is where the bulk of the
• 22:59
  problem
• 23:00
  and opportunity exist.
• 23:02
  I just encourage health systems continue to look
• 23:04
  at the other avenues for that you deliver
• 23:06
  care. Look on your inpatient side, your ED
• 23:08
  side, like doctor Kishon brought in early in
• 23:10
  the conversation. Look at your diagnostic imaging.
• 23:13
  Another great area where we have tremendous resources
• 23:16
  as a country and as our health systems.
• 23:18
  And are we delivering the right amount of
• 23:20
  diagnostic care, whether it be imaging, laboratory, or
• 23:22
  otherwise, that help that patient along their journey?
• 23:25
  So access
• 23:27
  clearly has opportunity to drive on the physician
• 23:29
  side, but health systems are
• 23:32
  appropriately, hopefully, looking at the comprehensive nature of
• 23:35
  all of their
• 23:36
  assets in delivering care. Yeah. Well, doctor Cushone,
• 23:40
  Alex, thank you again. This has been a
• 23:41
  really interesting conversation on what's possible with patient
• 23:45
  access, whether it's care delivery and also business
• 23:48
  opportunities. It's an exciting future ahead despite some
• 23:50
  of the challenges and change management that will
• 23:52
  inevitably have to be made to get there.
• 23:54
  But I just wanna thank you both again
• 23:56
  for making time for Becker's today. Thank you.
• 23:58
  Thank you. And we'd also like to thank
• 24:00
  our podcast sponsor for this episode, ECG Management
• 24:03
  Consultants.
• 24:04
  Listeners, be sure to tune into more podcasts
• 24:06
  from Becker's by visiting our podcast page at
• 24:08
  beckershospitalreview.com.