Understanding Healthcare Consumerism

Transcript

Nicole

Welcome to the Digital Health Transformers podcast series. This podcast explores the dynamic world of healthcare innovation, one conversation at a time. I’m your host, Nicole Guevara, and today, we have an inspiring guest at the forefront of transforming the healthcare landscape.

Today, we are honored to welcome Dr. Jeff Dobro, a distinguished leader who has played pivotal roles in some of the most innovative and impactful organizations in healthcare. As a former Chief Innovation Officer of Transcarent, Dr. Dobro led efforts to create a unified platform for all consumers’ health and care needs. With an extensive background, including positions such as Chief Medical Officer at One Medical Group and Red Brick Health, and being a partner of Willis Towers Watson, he has significantly contributed to shaping the healthcare space.

Currently, he is serving as the CEO of Eudaimonia Concepts and continues his dedication to bring creative solutions to organizations, empowering them to flourish and thrive. Dr. Dobro recently became a board member of VHCI (Virginia Center for Health Innovation)  In this episode, we’ll discuss Dr. Dobro’s journey and learn his thoughts on personalization, impacting patient healthcare and healthcare technologies. Thank you for joining us today, Jeff.

Jeff

Nicole, thanks so much for having me. I am so excited about the future of healthcare, excited to talk to you today about what we can do in the healthcare system, thinking about technology, finance, personalization and consumerism and all the things that I think are going to drive huge changes and huge improvements in the healthcare system over the next maybe 5, maybe 10 years, even though I would love it to be more like the next one year.

Nicole 

Absolutely. We would love to hear all about your insights. Let us start. Can you share some vital moments from your professional journey in healthcare that shape your perspective on personalized patient care and the role of technology in healthcare?

Jeff 

Wow. Fine. One moment that’s really interesting. Well, I’ll share a couple of them if that’s okay with you. One of them was a really interesting insight going way back early in my career when I was a Chief Resident in Internal Medicine and had the opportunity just to look at the data around outcomes and experience.

It became very clear that there were specific ways of doing things, including specific doctors and the way that they practiced and certain patient cohorts that just did better with certain problems than others. It was clear that if we could use our data and the way that we were practicing to meet the needs of particular patients and the way that they needed to be treated, we could do a much better job. It became clear that if I had all that information, which I had some, this goes back a few decades, if we could get better data, better understand people’s own personal habits and patterns and their medical conditions, I knew that we could do much better.

Going forward a couple of other decades, a really interesting set of insights came out of my time at Red Brick Health. I was the Chief Medical Officer there, where we had deep data on millions of people, we called them members or consumers, participants, patients, whatever would be the appropriate thing. We just called them members.

What was interesting there was that the key insight around helping somebody improve their health was giving them a range of tools, whether they were digital tools, self-service tools, coaching, like one-on-one kinds of tools, and then understanding what their condition was. What we found, they did a really interesting study there, is that as long as we gave people tools that they felt were appropriate for them by giving them a limited choice of what they could do, it didn’t matter how they engaged. They all did equally well around their subjective and objective health metrics that we monitored over time.

So it didn’t matter if you wore an Apple watch or you did a digital app or you wanted a coach, everybody did about the same. The insight there was personalizing it to let people do what they felt was most meaningful and engaging to them. So that was like one of the key learnings that I took forward with all of the other businesses, whether it was consulting or Transcarent or whatever it was I was doing in healthcare.

So choice mattered a lot. Having data matters a lot. Being able to personalize content for people matters a lot. And then building trust, which is hard to measure, was the fourth main insight. And that tends to be what works.

Nicole 

Thank you for that insight. That’s wonderful that you pointed out patient engagement and personalizing the patient engagement. Because, for instance, in retail or other businesses, they have that concierge sort of personalization.

And to get that, we should also input that in healthcare because people these days, you know, your disease management is personalized. Why can’t the other aspects of healthcare be personalized? Thank you. So my next question is about healthcare consumerism today. How do you perceive the current situation of healthcare consumerism?

Jeff 

You know, people look at the way that they can book an airline ticket or go on Amazon or use any of these services, and it is very tailored to them. Now, granted, when it comes to healthcare, that’s a little bit different than buying a shirt on Amazon or whatever somebody might buy because it’s your health.

But people are increasingly expecting that whoever they’re interacting with will know much more about them and that they’ll have relevant choices. They’ll be able to use digital tools to identify maybe what providers they want or to learn about their condition or to figure out how to prevent a disease or what the nutritional aspect of whatever their concern is. Maybe it’s more in the younger generation than in older generations.

But you asked about another key insight. One of the things that we learned at Transcarent, is people are using these digital tools at all ages and for all sorts of uses. So to say, oh, you know, those baby boomers, they’re never going to use digital tools. Well, they do a lot. Or those millennials or the Gen Zs, they always do things a certain way. Well, they don’t.

It’s very much of a mix, and people are looking for that personalized experience as well as looking to take more control over their own healthcare. People can get educated much more easily than they were in the past. They can ask great questions, which they should be doing.

They have access to more information. So this aspect of tailoring the healthcare system, understanding that people have access to this information, and in fact, promoting access and a better understanding is core to where, as I was saying, the healthcare system is going in the next 5, 10 years. Even at Transcarent, we had built some tools to allow individual people to look at the objective data around the quality of the care they might be able to get by a specific doctor, by a specific hospital, or a health system. And people were using those tools to a very high degree.

I could talk to you about this for a long time, but I’ll let you ask more questions. But I think you’re onto something here, that personalization, that consumer aspect of healthcare.

That’s where the field will go. Not only does it have to go, but will go, whether we like it or not, as people expect that same level of access and information and personalization as they get around every other aspect of their life right now.

Nicole 

I love what you said also about having those Fitbits or Apple Watch and having a very active role in your healthcare, not just how millennials or Gen Zs, but even baby boomers are very active in healthcare right now, and it’s going to continue to grow. A lot of the Google searches are about healthcare, and it’s important to have content that is tailored towards people’s expectations and behaviors, which segues to my next question.

What key trends do you think are shaping patient expectations and behaviors right now?

Jeff 

Well, there are a couple of things. We did talk about access to information, which is important. Related to that, I’m just going to bring in the topic of artificial intelligence in healthcare.

Now you can go in your Google search, or you can go to ChatGPT and ask a medical question, which is on the cusp of being a great thing because those kinds of tools will collect information from the entire internet, from every place that there’s any piece of information related to that question, and try to create kind of a layperson or smart answer to your question. I’ll share with you the reason I said I think we’re on the cusp is some of the more general AI tools that are out there don’t present accurate answers yet. And as a physician, I’ve gone out and asked a lot of questions because I want to get a sense of where those tools are right now.

We all think that since ChatGPT kind of hit the press a couple of months ago, that was a brand new thing, like, oh my goodness, AI never existed before this came out. I’ve been following and supporting the AI environment in healthcare for a few decades. The use of AI in healthcare is going to change the way healthcare is practiced, perceived, and received by consumers, whether it’s around the administrative and operational improvements that it will make for practitioners or even for the general consumer, patients. That’s one aspect that will happen very quickly.

But then there’s also all of that decision support and information gathering, which you can see the next generation is starting to focus on more evidence-based resources to build their large language models that may be semi-large or sort of large language models because they’re now more restricted to data sets that have an evidence base. So, if, Nicole, you can go on and say, what’s the right treatment for my kind of pneumonia, right?

That’s a common question. You see that in Google,  I have a urinary tract infection, what should I do? Right now, CHATGPT looks at every known source that ever mentioned a urinary tract infection, some of which is very accurate, important information, whether it be an antibiotic or some nutritional supplement. But some of it is just collecting information from wildly unreliable or incorrect sources. And CHATGPT doesn’t know or care. I mean, there are many LLMs now. It just merges it all together. So, the average consumer is getting information that’s anywhere from wildly accurate to crazy.

So, that’s something I think that people will be able to use themselves. I’ll share something with you. I, you know, you asked about a trip I recently took to Southeast Asia where there’s a huge shortage of trained medical people, whether they’re physicians or nurses.

And people relied on the local shaman to tell you the truth. And it made me think a lot about, well, you know, we’ve been around for many hundreds of thousands of years as a species. What did we do for medical care before, “organized medicine” happened? Well, we used fruits and vegetables and spices, and we relied on people who knew a lot. Maybe it wasn’t always right. But if there was a way for people like that to even get better information, you know, it makes you think, I don’t know, what exactly is the need for doctors?

I mean, I don’t really mean that we don’t need doctors, but could we create another layer within the health system that’s more accessible to people and use maybe trained, but not totally medically, trained by med school level professionals? Anyway, it started a whole train of thinking around how we interact and how we get accurate information to the average person on the street, or if you’re in Southeast Asia in the village. And there are many, many, many more ways that we can use technology and human beings and data sets to create a better system.

Nicole 

Wow, that’s a lot of information right there. Thank you for sharing that. I appreciate that.

You’re right. You know, giving the patients the power to take care of their health and just having that first layer of education and awareness of their health could be a huge impact, especially for evidence-based personalized care that’s powerful as well. So going back to my question, how can personalized healthcare technologies enhance patient engagement and empowerment within the current healthcare ecosystem?

Jeff 

All right. So we did talk a little bit about just direct connectivity through, we’ll call it internet or digital connectivity. But we also have the rise now of, let’s say, home-based testing that consumers, right, COVID did this for everybody.

It was like, oh my goodness, you know, I’m sneezing. I’m going to run to the drugstore, buy a COVID test, or you can do that now for flu, and urinary tract infections. People can start to better understand their own health and do self-diagnosis.

You know, we’ve also talked about things like Apple Watches and kind of just the general health monitoring so people can know their blood pressure. Somebody just told me they were measuring their VO2 max, which, you know, normally requires a big piece of equipment and measuring oxygen intake and outflows. Your Apple Watch can actually now do a reasonable estimate.

It’s not accurate. You wouldn’t publish a paper based on your Apple Watch VO2 max, but there’s much more information. So that self-diagnosis or even I’ll call it a co-diagnosis.

So we now have companies like TytolCare, they’re putting out very effective home testing and monitoring devices. So, moms and dads can look in their child’s ear and use the AI that’s built into that particular tool. I’m not endorsing it, but it’s a tool that you could use.

Oh, that eardrum looks infected. Now it would say then call your pediatrician or whatever, or it can do a scan of your skin or listen to breath sounds and heartbeats and transmit that to a physician. So it brings in all sorts of new models of care and patient active involvement, consumerism active involvement.

So there are so many things now that people will be able to do with those kinds of tools. And that kind of connectivity will just continue to grow and grow and grow as well as access to datasets that are pretty accurately displaying to people docs are good at what they do and who are not maybe so good at what they do. And that is just going to continue. There’s this explosion of healthcare data out in the world. I think, Nicole, I may have read something recently that like a quarter of all the data on the internet is healthcare data, something crazy like that. I totally believe it.

And you’ve commented that the number one or two searches on Google searches are about healthcare issues. You know, who’s a good doctor? What do I do for this rash? Or I have a blurry eye, what am I supposed to do? And people will largely be able to figure some of this out for themselves and probably have a better and more efficient interaction with a provider if they then need one. We could talk about AI symptom checkers, which have come a long way, like those started maybe even before COVID, but those are now out there.

You can go online and have a little digital chat and the symptom checker is saying, Jeff, yeah, you know, likely you’ve got a significant problem there. You should probably see your doctor. Can I help you make an appointment? And it just does it. That is not the healthcare of five years ago or even maybe two years ago. So things are changing and changing fast.

Nicole 

I love what you said about connectivity, especially when it comes to those current AI and remote patient monitoring devices. I remember buying my mom a home EKG, just using your thumbs to do the six-lead EKG. And that’s amazing that you could do that now before you have to go to the doctor’s office and be put into wires and leads and whatnot. But now, you know, the advent of technology is just everywhere and it’s booming and it’s just great to have that in our hands.

Jeff 

I’ll give you an example. Can I share just an example? You brought up a great point.

So when I was at Red Brick, our Officer lived in Wyoming and I happened to be in Minnesota at the time. And he calls me at 2 in the morning to say, oh, my heart is beating fast. What should I do?

I’m like, I don’t know. I’m 1500 miles away. You should go to the ER if you think.

And I said, oh, wait a second, you have an Apple watch, right? And it was only a single lead. I said, just, you know, capture your heart rate, even if it’s a single lead, let me see what it is.

And it turned out it was very clear he was having atrial fibrillation. And then I said, wow, have you ever had this before? Which he had not.

I said, okay, you’re a young guy with atrial fibrillation. You need to go to the ER now. So go.

And in fact, it was confirmed. That’s what he had. And they went through the proper treatment for him. And that was quite a while ago. And you’re bringing up a great point. You can now do a six lead or you could do a chest auscultation, right? There are so many things that you can do now.

Nicole 

That’s great. Thank you for sharing that. Absolutely. These technologies can be lifesaving. From your perspective, how is AI influencing patient care and drug discovery in the future of medicine?

Jeff 

Right. Well, we talked a little bit about AI. And I look at AI right now in healthcare as number one, helping around kind of operational administrative issues. It’s really kind of goofy for patients to try to call up an office and they never get a callback and they just want to make an appointment or they want to let the doctor know or someone, yes, you gave me the medicine. I feel good now. And they’re typing away in My Chart, which nobody looks at any way at the doctor’s office.

So, you know, we’re kind of very immature in the way that we’re using connectivity, but AI in that way can make scheduling an appointment incredibly easier, getting results from a test, reporting your symptoms back to a doctor. And a lot of this can and will be automated. Simple things from a provider’s perspective where they spend a ton of time with their electronic health record typing away instead of looking and talking to their patient, which totally destroys that trusted relationship.

Well, with, you know, natural language processing that’s been in the works forever and ever, now doctors and patients can have just a conversation. Imagine talking to people, like what a novel innovation, but you now have your machine capturing that, translating it, summarizing it, and then creating a structured documentation of what happened that’s now instantly available both to the provider and the patient. And if the referrals that are needed to be made, it’s all instantaneous.

So that’s the second piece, I think, that will help just in the natural practice of care. And some of that can be captured through the verbal, even just like a telephonic conversation. And then you get to the decision-making, which we talked about before, but I’ll share with you my view around healthcare is mostly what we do is collect data, process it, and then come up with some kind of a recommendation out of the collection processing. And that’s the three-step process. Now, if you’re a surgeon, you’re then going in and curing things or, you know, moving or changing, removing body parts. That maybe different, but most medical care is about chronic conditions.

And you’re either trying to make a diagnosis or understand the status that somebody has. Well, you know, for medical professionals, collecting all of the relevant data in the time that they have is, I was going to say impossible, but maybe impossible. And then with all of the new information that is coming out daily and all the new journals and stuff that’s published online, to have all of that in your head and be able to process it and understand all the correlations, that’s impossible.

But if you think about, oh, do we have tools around that are really good at collecting data efficiently and appropriately and processing data? Oh yeah. We call them computers, right?

That’s what we call them and we have them. And I think that’s where AI will be able to go soon. And probably as an adjunct, you know, maybe eventually taking over a lot of the role of now what clinicians do, but as an adjunct, because what an AI and a computer can’t do is build trust in the way that a personal relationship can.

It can’t elicit when somebody’s making kind of a face and they’re sort of answering the question, but it’s clear that there’s something else that they’re not willing to say that a person-to-person interaction has to add to it. In addition, you know, AI, you can’t do a physical exam. You can’t squeeze the liver. You can’t feel the lymph nodes, right? There’s a lot that a machine can do, but there’s a lot that it can’t do. So I think AI is going to be from that diagnostic and recommendation perspective, incredibly important.

There’ll probably come a time soon where physicians and clinicians that are not using an AI decision support tool will have a liability issue. It’d be pretty easy to be a lawyer in court and saying, Dr. Jeff, you know, you didn’t think of this diagnosis and that’s what it turned out to be and I get it. It’s an unusual diagnosis and you’ve never seen it before, but guess what?

Your patient suffered some harm and there was a tool that you could have used that would have said, oh yeah, these three unusual symptoms with that one piece of the physical exam together would make it pretty clear that this unusual disease is likely to be what’s going on and you just didn’t use the tool, did you, Dr. Jeff? So we’re not there. We’re not there yet, but it feels like we will be there.

The other thing you did bring up, and we can talk about this later, is drug discovery. And to think of how we’ve been doing drug discovery for such a long time as we went out and collected a bunch of plants and had people eat them and see what happened. Okay, well that worked.

It probably made some people sick, but a lot of people got better. And then we said, well, what’s the chemistry in those plants? And we made specific medicines out of that, but we still didn’t really know why.

And then we said, well, let’s study what we can know about those chemicals and try to make derivatives of that. But think of all of the configurations of proteins and different DNA and RNA molecules that could be therapeutic that we just, in a million years, you’d never think of that. And that’s the beauty of big data and then putting an intelligence around big data to say, given all of these kinds of interactions that we now know, and all of the interactions that we know around how cells work, even if we’re still, I think, very primitive in our understanding of how the body works, machines can now try all sorts of configurations, things that we would never have the time or money or energy to do in an actual clinical trial or a chemistry lab, it can work them out in a computer. I think we’re already seeing some evidence of that.

I follow a lot of the blogs and articles about AI and drug discovery, and it feels like our eyes have been kind of clouded over for a hundred years, maybe a thousand years. And now the ability to see more clearly through machine learning is remarkable. If you can tell, I’m pretty excited about the power of technology and computers and the way that we use data science and artificial intelligence in improving just the health of everyone in America, and everyone in the world.

It’s an eye-opening experience.

Nicole 

Yes, I’m quite excited about it too. Every time I hear or read anything about AI and healthcare, it’s just so exciting. I love what you said about natural language processing and how currently when we use the EHRs, the doctors would sit in front of a computer before talking to their patients and we try to capture as much as they can regarding the history.

But like you said, AI can’t do a physical examination, and about 90% of a diagnostic is the history and physical examination so you can arrive at a diagnosis. And it’s important to think also that with the drug discoveries that they have formulations that they can do the biochemistry in the background by a computer, and then you can have your formulation instead of doing years and years on for drug discovery, you can turn it to just a few years. So it’s exciting that kind of technology exists right now and thank you for sharing those examples with us.

Now let’s move into the personal healthcare tech tools and impact. How do you envision personalized healthcare technologies impacting the delivery of patient care and what are the key tools driving this transformation?

Jeff 

Yeah, that’s a good question to summarize all these things that we’ve been talking about. I could see a day not too long from now, where your average patient, maybe even on their phone, just starts talking. They say, oh, here’s how I’m feeling today.It connects to their digital device, their Fitbit or digital watch, which is also now connected to the scale that they happen to get on every once in a while and they’ve checked their blood pressure and there’s now this aggregation of important data. And I’ve now just added my subjective, here’s how I feel today. And I’ve got my digital doctor who is connected to my human doctor or provider who says, yeah, Jeff, you know, I see a change.

You’re a diabetic. I get it. Your blood pressure has changed. Your weight’s up a little bit. I’ve kind of monitored your skin patch for your blood sugar. You know, here’s what your diet ought to look like today. I know for breakfast, you were planning on those pancakes with a little extra insulin. Not such a good idea today. You know, we now have data around the last five times you did that and whatever it did, that’s not impossible.

It’s not even actually that hard. Now, all of those things that I just described sit in disparate areas and they’re not connected. And I know we should be talking about privacy and security because all of that stuff if I know it, you know it, anybody could know it.

We’ll get to that next, but there’s not a reason that that couldn’t happen with input from your doctor, you know, who’s got now that same little alert that, oh, Jeff’s sugar’s up a little bit. The weight’s not quite right. Here’s my optimal diabetes program for Jeff, which because we’ve now tracked Jeff over a while, you know, the normal thing that I would have done, added whatever kind of new insulin or, you know, adjusted the Ozempic dose or the metformin, that’s just not the right thing for Jeff because there are now 10,000 other people that seem to profile a lot like Jeff, and they also want to have pancakes for breakfast. Here’s the thing that tends to work for him, and we’ve now been able to test that idea on 10,000 other people who are a lot like him.

So it’s like a mix of all that data, it’s instantly available, it’s available to me real time so I don’t have to get on the phone or go onto my chart and wait for an answer in five days from Dr. Nicole about what should I do. Oh, I already did it, too late. That’s real-time, it’s available to me, it’s available to my doctor, and maybe it’s available to a care team, which we haven’t talked about in the practice of medicine and healthcare. You can have all sorts of professionals now interacting.

We talked about engagement in a real time. When it’s something like that, it’s much more engaging for the actual person, because they can now even choose how they want to engage and what they want to do, and how much information they want. So I think that that is where we’re going.

And that’s how we’re going to use these kinds of tools. We talked a little bit about the AI symptom checker, maybe there’s no information about me, but I just come on and say, hey, there’s a bunch of things that are bothering me and I’m talking into my phone, and uses NLP and big data and AI and some of these other things and says, Oh, Jeff, that sounds pretty darn bad. Can I call 911 for you?

You know, or I’m a woman who has very atypical symptoms for a heart attack. And the AI goes, yeah, you know, indigestion plus left ear lobe pain and sneezing in a 57-year-old woman with this history. Yeah, you’re right. I would never have thought of that as a doctor, but that’s not a good thing. So all of this, using this information and this ability to come up with evidence-based recommendations based on unusual collections of data, or even the usual ones, and make real-time recommendations for people that they can then act on and we can follow up on. It’s a game-changer.

It’s nothing like that in healthcare practice today. Although look, we’re doctors. It’s like, we would like it to be that way. There’s no good reason that somebody should have to wait three weeks. If they say I’m sick today, wait three weeks, or go to urgent care where nobody knows anything about them or go to the ER or they’re going to sit and wait for five hours because they’ve got no life-threatening symptoms. Like we all know that’s just bad and we’d like it to be better. And these are the kinds of tools and processes that will make it better.

Nicole 

I love what you said that these are the kinds of tools and processes that will make it better. Absolutely. I completely agree with you. Could you share some examples, which you probably already have or a case study where personalized healthcare technology has significantly improved patient outcomes?

Jeff 

Absolutely. So there are a couple of things. Let me just share some studies that we did at Transcarent because they’re very specific. So Transcarent has a surgical bundle care program where they look for surgeons and facilities and support groups. So where could somebody go to get top-quality surgery? And we looked at a bunch of different things like who’s doing appropriate work, right?

We’ll take ENT as an example. It was one of the specialties we looked at and looked at the variance of how often patients get scoped on a risk-adjusted basis. There’s such a huge variance.

It was hard to believe that it was real data. It’s like anyone with a sniffle gets a scope at one end. And then unless you’ve got like CAT scan evidence of, you know, a sinus abscess at the other extreme and probably somewhere in the middle is right. But that’s available data. Like who in America has that? Like nobody.

And it took a lot of work. We worked with great partners and that’s around appropriateness. We said, all right, for all of these different kinds of procedures, roughly who’s practicing appropriately, like most people in their specialty. Then we’re able to look at outcomes, things like infections and death rates and mobility when it comes to orthopedic procedures, lots of different variables that are measurable around outcomes. Well, the variance is like 9:1 in complication rates and other kinds of things. And then we put together some other data around some other quality measures and what’s called cost efficiency to just help us understand like who , I don’t know, who should we go work with?

I’m a doctor, you’re a doctor. You know, if somebody asked you, oh, who should do my hip replacement in Toledo, Ohio? You go, I have no idea. Probably an orthopedist, right? That’s as close as we could get. And you will go look up their training. But what you really want to know, are they doing the right procedure for the right people. Are they trained in doing lots of procedures? Good shoulder doctors are not necessarily good hip doctors, even though they could be great orthopedists. So we put all of that together and build some algorithms and it helped us figure out who should we work with?

Because we want to send people where they’re going to get a good outcome and get the right care at the right time by people that do this kind of work a lot. And then we said what if we gave that tool to our members, to the consumers? We talked about consumerism and it was really interesting.

Now, early on, there was not a lot of engagement, but we just looked at people who used the tools versus the ones who didn’t. They had much better outcomes, and much lower cost. And just when we looked at the whole population, it was 5 or 10% of the people that were getting procedures used the tool. We already had cut the total cost of care by 1 to 2% and improved outcomes.

This was just kind of a thought experiment. Well, what if everybody in the country moved from the bottom half performers to the top half?It was over a 10% improvement in total cost of care and reduced complication rates from about 9% to about 1%. So to me, that was like, wow, this is what data could show us. This is what we can share with regular everyday consumers. And if people really wanted the information going to Google or Reddit or one of these other sources where the information is wildly variable if we had a source that was reliable, evidence-based, and trusted, just doing that alone, I mean, forget all the other things that we could do, just identifying who in the current system is already providing better outcomes and better care for people. That would be a game changer, just doing that alone. And there are companies that are doing that.

But I thought, wow, what an interesting and kind of very low-level, basic use of data and engagement strategies to improve the outcomes and the quality and cost of care. Anyway, that was just one example.

Nicole 

That is so exciting. I love what you did with Transcarent. I remember reading an article saying that 60% of patients look up their doctors to make sure that they have feedback, positive feedback.

So it’s important to see what the best outcomes are there for your specialists. So that’s absolutely, that’s great. And I wish we could have that more in the market.

Jeff 

So people are currently going on whatever search engine, Google, and they look up reviews and think that that’s an accurate measure of quality. So I like Yelp when I want to figure out where to go for like, cheeseburgers or something. But I don’t know that I would want to have my hip surgery based on Yelp reviews. Because it’s very, it’s good to have good patient interaction and have it be a good experience, but that’s not telling you who’s really good at doing whatever work you need or whatever their specialty is.

And I’ll just share with you having managed thousands of doctors over many decades, some of the most popular doctors that I know, really good, nice people. They’re just not very good doctors. They just have great personalities. They’re very warm with people. They’re good healers because they create a nice relationship, but they’re not very good doctors. So it makes me cringe a little bit when I see people going, yeah, I did research on what doctor, I went on Yelp or Google reviews to find out who should be my doctor for this next procedure. It’s scary to me.

Nicole 

Absolutely. And that’s why what you did with Transcarent, it’s great. And I wish we could have that more in the huge, bigger population so we could leverage the information about the patient outcomes as well as their expertise. That’s great.

Jeff 

We’ll get them to try, get someone else to try.

Nicole 

In your experience, what roles of data privacy and security play in developing and adapting personalized healthcare technologies and how can organizations effectively navigate these concerns?

Jeff 

That is the million-dollar question. We talked about how great it is to have access to this information and process it and share it with individual consumers or their providers or anyone else that they want to give consent to. But look at all the hacks that we’ve seen, of healthcare systems, of hospitals, medical practices.

So do any of us want all of that information just kind of wildly available out there or even available at all? It’s really hard. I don’t think that we’ve solved the security issue. I look at things like blockchain and the ability to capture data in a block that is wildly secure because you either crack everybody’s data or nobody’s. And that’s a different use for blockchain than cryptocurrency, which I’m not investing in cryptocurrency – I will share with you.

But I think that this privacy and security issue is serious and will hold us back from doing some of these great things that we’ve talked about. I don’t have the answer. I know some really smart people are working on this. Maybe quantum computing will change how we do this. Just using whatever the password manager is that people use is not very secure, even though we think it is.

So I don’t really have a good answer. And that’s why I think this may take a number of years for us to match security with the wonderful benefits that we’re talking about. Or we get to some point where we all become more like Gen Zs and nobody cares. The fact that whatever my blood pressure is, high, I don’t care if other people know. What are they going to do. You don’t want life insurance company. You know, it’s very complicated. It just really is.

And I know I was practicing medicine when AIDS was first an issue. It was like nobody talked about it.You couldn’t even write an order for an AIDS test in the regular medical record in the beginning because there were restrictions. I mean, lots of people could get to a medical record. So even to order the test or write the diagnosis, you have to go through special forms and get triple-level consent. We’re a little more open about that now as culture has come to accept that it’s just a condition that people have. But it’s hard. And I am very concerned about data privacy.

One of the things that is pretty open to anyone that wants to pay for it, is all of your consumer data, all of your purchasing data, your voting records, whether you drive or not, like all of that is open and helps in creating kind of a social record for individuals that can be matched with a medical record to create amazing insights that could help people with their general life. But it’s a little frightening, recognizing how much data is already out there. Adding personal health data to that is scary.

Nicole 

Absolutely. And data and privacy is a very intricate topic by itself that we could probably spend hours on. I remember reading an article that healthcare data is more expensive and pricier than financial data. So hackers are involved with, ransomware and whatnot with hospitals and healthcare system, which is kind of sad. But hopefully, like you said, it’s very complicated and hopefully will get better in a few years. My next topic is healthcare consumerism.

From your perspective, why is healthcare consumerism increasingly recognized as essential for driving positive outcomes and experiences in modern healthcare delivery?

Jeff 

I think of consumerism and engagement going together. If people are more aware and more engaged in their own health, they’ll just be healthier. We had all of that evidence I shared with you from Redbrick. The people that were more engaged and did more things had better outcomes. And in fact, here’s an interesting case study for you.

It didn’t even matter what people did. If people started walking more, their mental health got better, their cholesterol got better, their blood sugar got better. And it wasn’t just the amount of exercise that they did because their drug compliance went up. So when people start to become a little more engaged and accountable in their health, everything gets better. They’ll be more interested in preventive care. And the evidence is out there that people will do it.

And that is part of consumerism for me. If people have more understandable access to information about themselves and are a little bit more involved in their health, they’re going to feel better. Their outcomes will be better and costs will go down. And we’ll be able to use all of these new tools in ways that we never thought of before. And then we have people demanding, as you and I talked about, they just want more involvement. They want more consumer-based tools.

They don’t necessarily want to rely on professionals as much. They want to kind of make their own decisions for themselves. And they’re doing it anyway with some reliable and some very unreliable information. So we are, I think, at a cusp where, at least in the United States, people want to have more involvement in their own health. And now we’ve got the ability to provide them with tools and information and resources to actually do a better job for themselves.

Nicole 

Absolutely. I love that. Especially these days when consumerism is skyrocketing in the retail industry, and they want to feel the same sort of concierge in also the healthcare industry.

My next question is, what steps can healthcare organizations take to foster a culture of patient-centered care and personalized health management, prioritizing individual preferences and needs?

Jeff 

Whoa, that’s such a big question. health systems, at least for now and probably into the future, are where people look to get their care, right? We’ve seen the trend of health systems consolidating hospitals.

So there are very few independent hospitals and these systems are buying up specialists and primary care doctors. Or you look at Optum as a public company, they’re now the largest owner of primary care practices in the country. So large organizations, health systems like this, can start to use the tools that we talk about.

They’ve got engaged or captive populations of people where they can try some of these new tools out. They can use new marketing tools. We think of marketing as kind of a, you’re trying to sell me something I don’t want to buy. But there’s a lot of really interesting psychology that can be adapted from what advertisers do, which I don’t personally like very much, but tools and insights around how people think about themselves and how to get engagement that health systems can use in an ethical, good way. And we’ve never really had anything like that. We had five different hospitals that had nothing to do with each other, and 25 different doctors that wouldn’t even talk to each other.

That’s kind of coming together. You know, the unified medical record will help. Health information exchanges and aggregators can get disparate data sets together that a health system can now use. So all of that is available. So, they have the data. It’s not really used very well yet. They have large patient populations. There’s even an economic system as value-based care starts to take hold, where it’s even economically in their best interest to figure out what the best thing to do is for individual patients. Not the most things, but the best things.

And that’s a very, very different mindset, a different way of thinking. So I’m encouraged. You know, do I think that health systems by themselves are going to be able to easily make this transition necessarily? I’ll call it from a fee-for-service to a fee-for-value model, even though they’ve got the tools, that’s a hard thing to do. There’s that classic thought around the innovator’s dilemma, in which you’re the big gorilla.You know, the new thing is coming, but you’re the big thing and the new thing potentially destroys the way you do things now or changes it enough so you’re reluctant. And then some little organization is going to have the new big idea and somehow they’re going to grow. So could Amazon be the next big healthcare system? I mean, they’ve got data, they’ve got money, they’ve got people, they’ve got primary care, they’ve got a drugstore. I don’t know. You know, the next iteration of what healthcare in America looks like could come from places we don’t expect, it could be Transcarent.

I mean, I retired from there. I wish them the best, but it could be something like that. It could be, who knows, it could be Optum as a health company, you know, related to a health insurance company.

It could be Intermountain Healthcare out in, you know, Utah and in the Pacific Northwest, who’s thinking about healthcare in a totally different way. I think the average healthcare system is, this is just an opinion, is going to find it difficult to make those kinds of changes.

And there may be some that are very innovative, a Transcarent or General Catalyst have put together aggregations of really innovative systems that are going to try to use these tools and make the big change and jump over the barbwire fence and hope they don’t get caught on the top. They’re trying. And, I hope whoever listens to our podcast gets excited and wants to go back to their health system and say, we could do it, we could do it, we could make a change, people. But I think it’s going to be hard.

Nicole 

Absolutely. And what jumped in me with what you said are the health information exchanges. And right now it’s a volume of data that they have, as well as if you go to a hospital, they send information to your PCP regarding your visit to the hospital.

So it’s just a cost. Like you said, we are just at the edge of greater and more patient-oriented discoveries and whatnot. So it’s quite exciting. And like you mentioned, Amazon, Berkshire Hathaway, Amazon, and I think, Berkshire Hathaway and Google have developed the Haven and other healthcare systems have evolved from big consumers or big retailers, such as CVS or Walgreens. Walmart is trying to buy an acquisition. Absolutely. There’s so many. And you can imagine how the healthcare system would evolve from these particular mergers and acquisitions. It’s great to see what healthcare has in store for us. So exciting!

Jeff 

Nicole, you look at the FDA, who’s now licensing digital therapeutics, an app you could do on your phone, or CBT for sleep instead of insomnia pills. You know, there’s so much that’s going on. Imagine you go onto your phone and you get five digital therapeutics to choose from.

In your health system, your primary care doctors organized all of this, or at least are aware of them. There’s so much that’s going on. It’s a really exciting time.

Nicole 

I completely agree with you. Now, in what ways can personalized healthcare technologies contribute to reducing healthcare disparities and improving access to healthcare for underserved communities?

Jeff 

Big, big, important question. So, you know, I mentioned to you maybe even before we got live, I don’t think the healthcare system is broken. It’s just very disparate. Access to good quality care is just not there. I think the healthcare model of the future will be a combination of digital, telehealth, and AI, but some in-person care. And as we talked about, some remote patient monitoring and digital therapeutics.

Well, all of that doesn’t require a big brick-and-mortar building to do all of this, right? As long as people have internet connectivity, which I think is important for probably states or federal government to make sure that everybody across the country has access to the internet, just like we did, after whatever it was, the depression, we built out electricity for everybody, right? Well, almost everybody, whether it’s satellites or cable or however, as long as people can get online, we can provide the same kind of information, the tooling, the things that we’ve talked about, whether it’s chat or video for telehealth, I think that’s got an important point.

I also think that there are just low-cost ways to get in-person care out to remote environments. One of the projects I worked on at one point was putting very small nurse-based, I’ll call them clinics, all over the place. Getting back to my shaman concept, just somebody who’s educated about healthcare and could feel the lymph nodes or squeeze the liver or give an injection or, put the blood pressure cuff on correctly if somebody can’t do it.

You don’t have to have gone to medical school for four years and done three or four or five years of additional training. Basically, healthcare workers can do much of this. So we have the ability now to provide low-cost access to high-quality healthcare to all, I don’t know how many people live in America, 350 million people.

There’s really nowhere, whether it’s rural or inner city or anywhere, that we have to reproduce the same expensive model that we’ve put out for the last whatever, 100 years. So better models, better connectivity, and better use of data and technology, everybody in America now could have access to really good healthcare. We just have to go do it and then we have to have an economic model that would reinforce it because, you know, people do what they get paid to do, unfortunately, not always a good thing or the right thing.

So we have to match the technology, the system, the process and design, and the financial systems. And I know we can do it. It’s not even that hard. So I’m looking forward to solving that issue as well.

Nicole 

Perfect. Thank you so much. That’s a lot of information there. Final thoughts, this is the second to the last question. Considering your wealth of experience, what advice would you offer healthcare organizations looking to integrate personalized healthcare technologies effectively?

Jeff 

So I think it’s similar to what we talked around healthcare systems. It’s recognizing the assets that you have, like what’s already in existence, what is missing that could then extend care more efficiently, more effectively into more people, because a lot of what we’ve talked about exists right now. It may not be perfect, but we can take some baby steps, maybe even some big steps around using these tools, whether it’s to improve our operational efficiency or to make the process, just the experience feel better for patients or to make them feel a little bit more trusted or have more real-time access to information.

I would start with these kinds of more low-hanging fruit. I would also recommend that organizations not get too far ahead of themselves. To see my local hospital say, Jeff, just go on ChatGPT and you’ll get the answer to that healthcare question. It’s like, no, I get that that’s easy, but that’s not a very good answer. So putting the pieces together and creating a five and 10-year work plan on how to get to that next iteration, whether it’s phase two, phase three, or phase four, think carefully about how to use the tools that we have. Also work really closely with your communities and say, what do you need?

What are you ready for? How can we build this together, getting back to your concept of consumerism? Because people will take their own health much more so into their own hands, whether we like it or not. The tools are out there, and whether that disintermediates doctors or people say, I’ve heard about that hospital at home thing. I’m leaving after day two in the ICU and I’m going home, and I don’t care if it’s against medical advice. Well, how do we do that in a way that really helps people?

Because we can. So to think stepwise, stepwise, stepwise, how do we get to the next level and the next level after that in a structured way, bring the community in, use technology, use the tooling that we have, and then build upon that as it all develops. And to learn, we need to be in a learning environment. We’re going to do a whole bunch of things that just turned out to be the wrong answer, but you learn from that and you bring it to your next iteration in your next phase.

Nicole 

Thank you. That’s the best answer that I could get from all of that information that we currently shared and just a wealth of knowledge, Jeff. Thank you so much. Lastly, Jeff, I would love to give you the floor to do a shout out or call to action or to talk about whatever you currently are working on and how people can get involved with you or your organization. This is your time to talk about what your current projects are.

Jeff 

Oh, thank you. Yeah, so I have a few things that I think are pretty cool that are going on. You know, one of them is, as I mentioned earlier, I’m retired. I’ve spent many, many decades doing the kinds of things that we’ve talked about, but I’m looking for that next generation or two of leaders, like people that think like you and maybe a little bit like me or others that are really trying to transform the system. And I’ve worked with the college I went to, Muhlenberg College, to create a Master’s in Medical Leadership. And we’re looking for people that are maybe doctors, nurses, in pharma, in digital health, in insurance, whatever it is, because all of these will come together as we’ve talked about to build the next iterations of a much better healthcare system.

So I’d encourage people to go online, look at the program, and sign up. It’s amazing. We’ll have great guest speakers.

It’s a year-and-a-half to two-year Master’s program. And I want to see those leaders get out there and be able to finish all the work that I’ve been able to do. Another cool thing I’m working on is working with the Virginia Center for Health Innovation, which is saying in one state, can we bring all of the stakeholders together, government, Medicaid administrators, doctors, hospitals, insurance companies, community leaders, and to say in one state where we have all the people, we know who the people are, they live in the state, we can get the data that we can get. We’ve got a bunch of innovative ideas.

Can we build a model that can improve healthcare and the outcomes for a set number of people? Learn from that and maybe find a way to export that to other states or other large organizations. So that’s early on for me, but I’m really excited about what the group is doing. So those are two cool things. What else am I working on?

Some data management projects, some direct primary care projects, and remote patient monitoring projects. I know I told you I was retired, but it doesn’t sound like it does. So I’m looking forward to continuing to push the market and push our country ahead and develop the kind of healthcare system I know we all deserve and can build. This is not impossible.

Nicole 

That seems like the best way to retire, having those passion projects. It’s amazing. Well, thank you so much, Jeff Dobro, for sharing your valuable perspectives on personalized healthcare technologies and their profound impact on patient care. It has been a very enlightening discussion, shedding light on the transformative potential of technology and shaping the future of healthcare consumerism. Thank you to our listeners.

This podcast was brought to you by OSP Labs, a leading healthcare software and product development, and solutions enhancement company. They have developed solutions for revenue cycle management, practice management, medical billing and coding, advanced telehealth, remote patient monitoring, healthcare patient payment systems, healthcare cloud solutions, EHR development, and so much more. For more information, please reach out to me at docnicoleg@gmail.com. Again, Jeff, this is amazing. Thank you so much for your time.

Jeff 

And thank you, Nicole. This was great.