e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/6-0
00:00:03.532 --> 00:00:06.284
Flynn,
the medical director of Health Management,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/6-1
00:00:06.284 --> 00:00:10.192
which is part of the Institute for
Community Health and West Wellness.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/6-2
00:00:10.192 --> 00:00:14.429
She's a hospitalist by background,
an assistant professor of medicine at the

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/6-3
00:00:14.429 --> 00:00:17.346
Zucker School of Medicine at Hofstra
Northwell. Ann,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/6-4
00:00:17.346 --> 00:00:19.492
thank you so much for joining us today.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/5-0
00:00:20.012 --> 00:00:21.332
Thank you, Jordan.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/8-0
00:00:20.492 --> 00:00:24.843
So just as background,
Northwell Health is a health system based

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/8-1
00:00:24.843 --> 00:00:28.056
in Long Island,
New York with 6600 beds and 14,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/8-2
00:00:28.056 --> 00:00:32.742
500 providers across 24 hospitals and
other care facilities with 100,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/8-3
00:00:32.742 --> 00:00:36.558
000 employees.
So today I'm very excited to discuss with

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/8-4
00:00:36.558 --> 00:00:40.172
Ann a topic that I think may prove to be
of interest.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/10-0
00:00:40.252 --> 00:00:44.145
With many listeners across the country,
Northwell is trying to improve star

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/10-1
00:00:44.145 --> 00:00:47.576
ratings to a reduced penalties.
I think every health system in the

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/10-2
00:00:47.576 --> 00:00:50.803
country is trying to improve their CMS
star ratings. To do so,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/10-3
00:00:50.803 --> 00:00:54.696
Northwell is trying to proactively
identify inpatients who are likely to be

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/9-0
00:00:50.972 --> 00:00:51.092
Right.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/10-4
00:00:54.696 --> 00:00:58.639
readmitted and advise their clinical care
teams to apply a checklist of best

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/10-5
00:00:58.639 --> 00:00:59.612
practices to those.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/11-0
00:00:59.772 --> 00:01:02.175
High risk patients.
Now here's the interesting part.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/11-1
00:01:02.175 --> 00:01:05.756
We're going to be approaching this story
today through the lens of Northwell's

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/11-2
00:01:05.756 --> 00:01:08.930
acquisition of Nuvance Health in
Connecticut and how Ann has extended

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/11-3
00:01:08.930 --> 00:01:12.330
Northwell's solution in Nuvance Health.
So Ann, please walk us through it.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/11-4
00:01:12.330 --> 00:01:13.372
How have you done that?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/14-0
00:01:14.052 --> 00:01:17.750
OK, great. Well,
let me just start with a little bit of

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/12-0
00:01:14.892 --> 00:01:15.412
Yeah.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/14-1
00:01:17.750 --> 00:01:23.032
background for Northwell in terms of our
journey through readmission reduction.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/13-0
00:01:18.132 --> 00:01:18.372
Sure.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/14-2
00:01:23.032 --> 00:01:27.654
We really started this in 2017 and it's
been you know a long process,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/14-3
00:01:27.654 --> 00:01:31.814
but we're we're very,
we've been very successful improving our

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/14-4
00:01:31.814 --> 00:01:33.332
star ratings which 22%.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/15-0
00:01:33.972 --> 00:01:40.172
Of is readmission reduction along with
reducing our readmission penalties

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/15-1
00:01:40.172 --> 00:01:44.277
significantly.
So we we feel you know we have a,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/15-2
00:01:44.277 --> 00:01:49.052
we have a great product and a great way
of doing things.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/17-0
00:01:49.332 --> 00:01:55.340
And there is certainly technology
involved in that and I know this is the

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/17-1
00:01:55.340 --> 00:02:00.048
the data podcast,
so I will add you know bring that up as

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/17-2
00:02:00.048 --> 00:02:03.377
well.
But basically you know we acquired

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/17-3
00:02:03.377 --> 00:02:08.572
Nuvance which is which is Northwell
acquired Nuvance last year.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/18-0
00:02:09.012 --> 00:02:12.846
It's six hospitals and three are in New
York,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/18-1
00:02:12.846 --> 00:02:18.762
a little north of our previous footprint
and three are in Connecticut.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/18-2
00:02:18.762 --> 00:02:24.096
So as you can imagine,
a lot has a lot of people are working on

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/18-3
00:02:24.096 --> 00:02:28.012
this integration on every level,
for instance.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/19-0
00:02:28.692 --> 00:02:33.614
My my bosses at the Institute of
Community Health and Wellness, Dr.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/19-1
00:02:33.614 --> 00:02:37.233
Deb Salas,
Lopez and Eddie Frazier have been very

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/19-2
00:02:37.233 --> 00:02:42.372
involved in the community work with
Nuvance in introducing Northwell's

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/19-3
00:02:42.372 --> 00:02:48.018
presence and the work that we can do in
the community and then on every other

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/19-4
00:02:48.018 --> 00:02:48.452
level.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/20-0
00:02:48.652 --> 00:02:52.381
You know,
from technology to finance to patient

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/20-1
00:02:52.381 --> 00:02:57.276
experience, et cetera.
So readmission reduction and quality is

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/20-2
00:02:57.276 --> 00:03:02.480
one piece of the puzzle in terms of this
integration with Nuvance.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/20-3
00:03:02.480 --> 00:03:07.452
And I think where we are is, you know,
you want to think about.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/22-0
00:03:08.412 --> 00:03:12.973
These things like in phases,
but in reality they aren't really phases.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/21-0
00:03:12.452 --> 00:03:15.652
And I'll bleed together, yeah.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/22-1
00:03:12.973 --> 00:03:16.056
You know,
they they kind of go up and down. So,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/22-2
00:03:16.056 --> 00:03:19.268
you know,
phase one would ideally be let's figure

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/22-3
00:03:19.268 --> 00:03:22.994
out the footprint,
let's figure out what all the data is,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/22-4
00:03:22.994 --> 00:03:26.912
the culture and everything,
but which we're certainly doing.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/22-5
00:03:26.912 --> 00:03:28.132
I think that's now.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/23-0
00:03:28.252 --> 00:03:33.265
Now kind of merged with in addition to
getting to know each other,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/23-1
00:03:33.265 --> 00:03:39.100
just starting starting to apply some of
some of the ways that we have reduced

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/23-2
00:03:39.100 --> 00:03:45.160
reemissions at Northwell and you know it
really started of course you have to be

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/23-3
00:03:45.160 --> 00:03:46.132
very mindful.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/24-0
00:03:47.892 --> 00:03:52.930
Of change management issues,
you always have to have that in the back

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/24-1
00:03:52.930 --> 00:03:57.536
of your mind. You know,
in terms of some people being resistant

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/24-2
00:03:57.536 --> 00:04:01.494
or having change fatigue, you know,
it's a it's a lot,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/27-0
00:04:01.132 --> 00:04:05.706
So, Ann, I think what I'd love,
I think what our listeners would love to

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/24-3
00:04:01.494 --> 00:04:04.012
it's a lot to take in and you know.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/27-1
00:04:05.706 --> 00:04:08.839
hear you.
I know that you have a prediction model

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/27-2
00:04:08.839 --> 00:04:13.664
and you leverage a lace score for risk
and mortality regarding readmissions.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/27-3
00:04:13.664 --> 00:04:17.110
I'd love for you to walk through the
model. All right,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/27-4
00:04:17.110 --> 00:04:20.932
we've acquired Nuvance Health.
They have six hospitals, Dan.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/28-0
00:04:21.132 --> 00:04:24.730
Health Danbury,
CT based system and we have this very

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/26-0
00:04:23.892 --> 00:04:24.692
Mm-hmm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/28-1
00:04:24.730 --> 00:04:28.527
special way of improving intractable
readmission scores.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/28-2
00:04:28.527 --> 00:04:33.924
It's very difficult for health systems
across the country to reduce their 30 day

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/28-3
00:04:33.924 --> 00:04:39.453
readmissions and at Northwell we found a
very innovative way to doing this and now

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/28-4
00:04:39.453 --> 00:04:40.652
we're tasked with.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/29-0
00:04:41.012 --> 00:04:45.638
Bringing our innovative approach to
improving our star score to the star

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/29-1
00:04:45.638 --> 00:04:48.490
score that Nuance previously did on its
own.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/29-2
00:04:48.490 --> 00:04:52.672
What's the first step when you first
acquire a new health system?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/29-3
00:04:52.672 --> 00:04:56.030
What's the first step that you took in
order to say,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/29-4
00:04:56.030 --> 00:05:00.212
here's how how we're going to improve the
star ratings at Nuance?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/32-0
00:05:01.772 --> 00:05:06.295
Yes, you know, absolutely.
It's really sort of understanding what

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/32-1
00:05:06.295 --> 00:05:11.915
processes they do or do not have in place
right now and how we can help them with

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/30-0
00:05:09.812 --> 00:05:10.292
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/32-2
00:05:11.915 --> 00:05:15.409
any processes that we have found to be
successful.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/32-3
00:05:15.409 --> 00:05:19.932
So to jump into what you were some of
what you were referring to.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/33-0
00:05:22.332 --> 00:05:28.814
One of our processes called case finding
or case creation and that is an effort

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/33-1
00:05:28.814 --> 00:05:33.999
between our analytics team,
our pop health informatics team and

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/33-2
00:05:33.999 --> 00:05:40.318
others to apply a logic or rules to
automatically finding the population that

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/33-3
00:05:40.318 --> 00:05:41.452
we would like.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/36-0
00:05:41.652 --> 00:05:49.207
To find that's currently in the hospital.
So we apply that and that produces a what

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/34-0
00:05:44.452 --> 00:05:44.972
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/36-1
00:05:49.207 --> 00:05:56.132
we call a chase list and that chase list
is sent out to the inpatient teams.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/35-0
00:05:56.732 --> 00:05:57.332
Mm-hmm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/37-0
00:05:57.012 --> 00:06:03.054
And that chase list is used so that they
can apply this. That is also automated.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/37-1
00:06:03.054 --> 00:06:06.858
Of course,
the chase list comes to them every day,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/37-2
00:06:06.858 --> 00:06:11.035
every morning,
and they use that so they can apply this

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/37-3
00:06:11.035 --> 00:06:16.852
checklist methodology to these patients,
which is really about best practice.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/39-0
00:06:16.932 --> 00:06:22.282
Services for reemission reduction,
you know, has this patient has CHF,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/39-1
00:06:22.282 --> 00:06:26.050
do they need,
have they had a cardiology consult?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/39-2
00:06:26.050 --> 00:06:31.173
They are we scheduling an appointment for
them? Are they, you know,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/38-0
00:06:27.532 --> 00:06:27.732
2.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/39-3
00:06:31.173 --> 00:06:36.372
they have a high lace score which is
which is a risk stratification.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/40-0
00:06:36.532 --> 00:06:41.239
Tool that predicts mortality and
readmission after the discharge.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/40-1
00:06:41.239 --> 00:06:46.160
So if they have a high lace score,
we recommend a goals of care or a

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/40-2
00:06:46.160 --> 00:06:50.582
palliative consult.
So that kind of thing is on the checklist

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/40-3
00:06:50.582 --> 00:06:53.292
and that is that is utilized and then.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/42-0
00:06:53.412 --> 00:06:59.332
Once the patient gets discharged,
there's all sorts of other methods that

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/42-1
00:06:59.332 --> 00:07:02.852
we use,
one being an automated notification

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/42-2
00:07:02.852 --> 00:07:06.532
system.
So if the patient is to return to the

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/41-0
00:07:05.812 --> 00:07:05.932
OK.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/42-3
00:07:06.532 --> 00:07:13.172
emergency room within the 30 days that we
are deemed responsible for that patient.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/44-0
00:07:15.532 --> 00:07:19.968
And their readmissions,
there's an automated notification that

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/44-1
00:07:19.968 --> 00:07:24.333
goes out to a certain team that we refer
to as the SWAT team.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/43-0
00:07:22.012 --> 00:07:22.532
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/44-2
00:07:24.333 --> 00:07:28.839
And that SWAT team works to see if
there's any other, you know,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/44-3
00:07:28.839 --> 00:07:32.852
disposition other than readmissions.
So I'll start with.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/47-0
00:07:32.932 --> 00:07:37.653
There's some others which I can get into
as well, but so with New Vance,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/47-1
00:07:37.653 --> 00:07:40.499
we presented to them all of this,
you know,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/45-0
00:07:40.252 --> 00:07:41.572
Mm-hmm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/47-2
00:07:40.499 --> 00:07:45.414
all of the work we do and the success
we've had and we've presented that to

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/47-3
00:07:45.414 --> 00:07:47.612
quality and to other stakeholders.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/46-0
00:07:47.372 --> 00:07:48.212
Yeah.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/49-0
00:07:48.292 --> 00:07:54.605
And you know immediately there are some
people that really want to get into this

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/49-1
00:07:54.605 --> 00:07:58.267
right and are really excited and and you
know,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/49-2
00:07:58.267 --> 00:08:03.255
so they are working and they've been
great to work with really.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/48-0
00:08:01.612 --> 00:08:02.212
Mm-hmm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/49-3
00:08:03.255 --> 00:08:07.852
They are working on #1 the case
identification already so.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/51-0
00:08:08.052 --> 00:08:14.222
The having a having a chase list in in
the hospital and also using utilizing the

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/51-1
00:08:14.222 --> 00:08:19.858
checklist and they they are implementing
that as we speak or they've even

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/50-0
00:08:15.732 --> 00:08:16.132
Thank you.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/51-2
00:08:19.858 --> 00:08:24.732
implemented the checklist already I think
at all the hospitals.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/53-0
00:08:25.892 --> 00:08:29.783
And they,
you know the next things that we really

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/53-1
00:08:29.783 --> 00:08:35.540
want to work on is the automated response
which requires you know quite a

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/53-2
00:08:35.540 --> 00:08:41.842
technology lift in terms of integrating
our systems and the and also buy in from

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/53-3
00:08:41.842 --> 00:08:45.732
the emergency room and the hospital
hospitalists.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/52-0
00:08:43.732 --> 00:08:43.972
OK.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/55-0
00:08:45.812 --> 00:08:50.921
So we've you know discussed that and
everyone seems on board with that and we

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/55-1
00:08:50.921 --> 00:08:56.422
also need to start implementing them into
our dashboards of course in in any way we

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/54-0
00:08:52.572 --> 00:08:52.772
Yes.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/55-2
00:08:56.422 --> 00:09:01.072
can. So when we're presenting,
we're presenting as with our legacy new

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/55-3
00:09:01.072 --> 00:09:04.412
Vance hospitals as part of Northwell,
so you know.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/57-0
00:09:05.132 --> 00:09:08.801
So I'd like to drill right into what you
just mentioned.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/56-0
00:09:05.452 --> 00:09:06.812
Um, yeah.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/57-1
00:09:08.801 --> 00:09:13.178
You mentioned that integrating,
there's an integration challenge in

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/57-2
00:09:13.178 --> 00:09:16.590
implementing the automated response.
Can we dive in?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/57-3
00:09:16.590 --> 00:09:21.803
What does that integration challenge look
like and what kind of data sources are

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/57-4
00:09:21.803 --> 00:09:23.412
you pulling from and how?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/58-0
00:09:24.652 --> 00:09:28.092
Are you planning on addressing that data
integration challenge?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/61-0
00:09:28.932 --> 00:09:33.526
Right.
They are not on the same platform as us.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/59-0
00:09:33.452 --> 00:09:34.132
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/61-1
00:09:33.526 --> 00:09:38.119
We are.
We are currently on our Epic journey in

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/61-2
00:09:38.119 --> 00:09:46.252
adopting Epic as our EMR. They will also,
but that will be a few years from now, so.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/60-0
00:09:44.852 --> 00:09:45.492
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/62-0
00:09:46.292 --> 00:09:47.612
The issue is is.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/65-0
00:09:49.612 --> 00:09:53.158
The the complexity and I am not the IT
person,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/63-0
00:09:52.652 --> 00:09:52.772
Yeah.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/65-1
00:09:53.158 --> 00:09:56.478
so I'm not going to get this totally
right,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/64-0
00:09:56.372 --> 00:09:56.412
I.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/65-2
00:09:56.478 --> 00:10:02.514
but the complexity of of bringing these
systems together in some way so that we

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/65-3
00:10:02.514 --> 00:10:08.172
can exchange data and data exchange and
that is where the complexity lies.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/66-0
00:10:08.852 --> 00:10:11.532
And how we can also.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/68-0
00:10:12.532 --> 00:10:18.356
Provide the same sort of resource,
the same sort of notification for these

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/67-0
00:10:17.932 --> 00:10:18.092
Right.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/68-1
00:10:18.356 --> 00:10:19.132
hospitals.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/70-0
00:10:19.492 --> 00:10:24.345
So from your perspective and and you know
you're the medical director of of health

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/70-1
00:10:24.345 --> 00:10:27.561
management here.
So from your perspective and we don't

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/70-2
00:10:27.561 --> 00:10:32.122
have to go into a too deeply into data
since we'll just focus on your area of

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/70-3
00:10:32.122 --> 00:10:34.812
expertise,
what do you think are the greatest

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/70-4
00:10:34.812 --> 00:10:37.852
challenges to the program?
Is it change management?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/71-0
00:10:38.372 --> 00:10:41.575
What are the greatest challenges,
the program that you've been able to

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/71-1
00:10:41.575 --> 00:10:44.732
address with your area of expertise and
how have you been doing that?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/75-0
00:10:46.932 --> 00:10:50.317
Yeah,
I think you know I haven't the challenges

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/75-1
00:10:50.317 --> 00:10:55.323
I would say are a lot in the technology
if we want to go back to that.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/72-0
00:10:51.332 --> 00:10:53.132
Yeah, yeah.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/75-2
00:10:55.323 --> 00:11:00.682
So you know because we are very reliant
on data and we are have become very

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/73-0
00:10:57.492 --> 00:10:58.132
Mm-hmm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/75-3
00:11:00.682 --> 00:11:06.252
reliant on these systems that we're very
used to and they do not have them so.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/74-0
00:11:04.812 --> 00:11:04.972
Right.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/76-0
00:11:06.572 --> 00:11:11.732
That that is the biggest challenge that
we are working through.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/77-0
00:11:09.612 --> 00:11:15.070
So I think a lot of our listeners may say,
you know, yeah, we have, you know,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/77-1
00:11:15.070 --> 00:11:19.827
a two-star rating out of CMS.
We're located in whatever area of the

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/77-2
00:11:19.827 --> 00:11:24.025
country we're in.
And we also don't have the resources of a

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/77-3
00:11:24.025 --> 00:11:27.523
Northwell Health.
We're not on Epic and you know,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/77-4
00:11:27.523 --> 00:11:28.852
we can't afford it.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/80-0
00:11:28.932 --> 00:11:33.583
And we don't have, you know,
these incredible technological platforms

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/80-1
00:11:33.583 --> 00:11:38.367
that Northwell has access to.
How should we go about improving our star

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/80-2
00:11:38.367 --> 00:11:43.350
rating? How can we reduce readmissions?
What can they learn from you here?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/78-0
00:11:38.412 --> 00:11:40.412
Right, yeah.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/83-0
00:11:43.012 --> 00:11:49.802
Absolutely. I I think that, you know,
I I think I started by saying we started

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/80-3
00:11:43.350 --> 00:11:44.612
What lessons? Yeah.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/81-0
00:11:45.052 --> 00:11:45.172
OK.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/83-1
00:11:49.802 --> 00:11:56.334
in 2017 and we did not have many of these
things either. So there are very,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/82-0
00:11:51.692 --> 00:11:52.172
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/83-2
00:11:56.334 --> 00:11:59.772
especially if you're a smaller hospital.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/84-0
00:12:00.132 --> 00:12:03.812
It's it's not that difficult to identify
your high risk patients.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/87-0
00:12:05.492 --> 00:12:08.806
In a non-automated way, but even,
you know,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/87-1
00:12:08.806 --> 00:12:14.906
in a probably kind of an automated way
that isn't as isn't as sophisticated than

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/87-2
00:12:14.906 --> 00:12:20.931
what we're doing because there's certain
criteria in terms of the insurance and

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/85-0
00:12:17.332 --> 00:12:17.812
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/87-3
00:12:20.931 --> 00:12:24.772
the age and the diagnosis and you can
start there.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/86-0
00:12:23.772 --> 00:12:24.252
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/88-0
00:12:25.012 --> 00:12:29.749
We even had some of our hospitals start
there because they,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/88-1
00:12:29.749 --> 00:12:36.144
you know we've acquired hospitals along
the way that are not on the same system.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/88-2
00:12:36.144 --> 00:12:40.012
So and and that's pretty effective as it
is and.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/90-0
00:12:38.532 --> 00:12:44.219
Do you have any workarounds or hacks that
you that you've seen work successful on a

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/89-0
00:12:43.212 --> 00:12:43.452
Yeah.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/90-1
00:12:44.219 --> 00:12:44.692
budget?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/92-0
00:12:45.692 --> 00:12:50.376
Yeah, I mean you can,
you can print out a list in your hospital,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/92-1
00:12:50.376 --> 00:12:53.907
you know,
on each floor and see who has Medicare

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/92-2
00:12:53.907 --> 00:12:59.456
fee for service or managed Medicare and
what their diagnosis is and is their

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/91-0
00:12:59.252 --> 00:12:59.972
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/92-3
00:12:59.456 --> 00:13:02.698
diagnosis CHF,
is their diagnosis pneumonia,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/92-4
00:13:02.698 --> 00:13:05.292
COPD or AM I? There's your patients.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/93-0
00:13:05.772 --> 00:13:10.853
Right. So if it hits such a so, so yeah,
I want to talk about that case finding in

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/93-1
00:13:10.853 --> 00:13:14.832
that in that chase list,
you said that you're applying different

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/93-2
00:13:14.832 --> 00:13:17.770
logic and rules to find the at risk
population.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/93-3
00:13:17.770 --> 00:13:22.667
Are you able to delve more deeply into
how that logic and what those rules are,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/93-4
00:13:22.667 --> 00:13:24.932
what they look like and how they are?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/94-0
00:13:25.692 --> 00:13:27.652
How you came to create those?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/97-0
00:13:28.212 --> 00:13:32.129
Sure.
They are basically the the CMS rules for

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/97-1
00:13:32.129 --> 00:13:35.962
who these patients are and who the cases
are.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/95-0
00:13:32.492 --> 00:13:33.132
Mm-hmm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/97-2
00:13:35.962 --> 00:13:40.129
The again like I said it's you look at
insurance,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/96-0
00:13:39.372 --> 00:13:39.852
OK.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/97-3
00:13:40.129 --> 00:13:43.212
you look at age and then you look at.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/101-0
00:13:43.652 --> 00:13:48.088
There's many,
many diagnoses or ICD 10 codes that fall

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/98-0
00:13:46.772 --> 00:13:48.172
You do.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/101-1
00:13:48.088 --> 00:13:51.798
under one of these larger umbrella
diagnoses.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/101-2
00:13:51.798 --> 00:13:57.362
So CHF may have you know like 12 or 20
ICD 10 codes that do qualify.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/99-0
00:13:51.852 --> 00:13:52.332
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/101-3
00:13:57.362 --> 00:14:03.572
So you need to if you're going to really
try and be as accurate as possible.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/100-0
00:13:59.372 --> 00:13:59.532
OK.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/104-0
00:14:03.652 --> 00:14:07.777
Captured as many people as possible and
not overcatch.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/104-1
00:14:07.777 --> 00:14:12.952
That's always a big problem.
Then you need to be integrating these I

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/102-0
00:14:08.212 --> 00:14:08.892
OK.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/104-2
00:14:12.952 --> 00:14:18.202
CD10 codes in and you need to be
monitoring it to see are we how many

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/104-3
00:14:18.202 --> 00:14:22.852
false positives are there?
How many true positives are there?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/103-0
00:14:23.172 --> 00:14:23.292
Yeah.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/107-0
00:14:23.532 --> 00:14:29.533
What percentage of which are we getting?
There always seems to be 1 little piece

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/105-0
00:14:27.052 --> 00:14:27.572
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/107-1
00:14:29.533 --> 00:14:33.311
that might put it over the edge into
overcatching.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/106-0
00:14:29.652 --> 00:14:30.252
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/107-2
00:14:33.311 --> 00:14:38.052
So you you kind of have to monitor that.
We did. Yes, question.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/108-0
00:14:37.012 --> 00:14:41.791
So I was just thinking,
so it sounds like CMS defines what the

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/108-1
00:14:41.791 --> 00:14:46.039
numerators and denominators are for their
star program.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/108-2
00:14:46.039 --> 00:14:51.653
So identifying the high risk patients
should be somewhat straightforward,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/108-3
00:14:51.653 --> 00:14:56.052
but yet you said that this is a very
intractable problem.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/110-0
00:14:56.612 --> 00:14:56.892
In fact.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/111-0
00:14:57.092 --> 00:15:00.819
22% of the star rating is dependent on
reducing readmissions and this is a

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/111-1
00:15:00.819 --> 00:15:04.496
problem that many hospitals and health
systems across the country do have

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/111-2
00:15:04.496 --> 00:15:07.428
challenges with.
So you know what are some of the reasons?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/111-3
00:15:07.428 --> 00:15:09.863
You know,
I'm sure every hospital can import the

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/111-4
00:15:09.863 --> 00:15:13.838
numerators and denominators and just look
is there congested heart failure. OK,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/109-0
00:15:10.332 --> 00:15:10.452
OK.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/111-5
00:15:13.838 --> 00:15:16.372
here are the 20 ICD 10 codes associated
with that.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/112-0
00:15:17.132 --> 00:15:19.380
OK,
these are high risk patients and these

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/112-1
00:15:19.380 --> 00:15:23.718
are the best practices and the checklist.
So why can't we just get our hospitalist

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/112-2
00:15:23.718 --> 00:15:27.377
to look at these four, you know,
high risk patients on this floor and

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/112-3
00:15:27.377 --> 00:15:30.670
prevent them from being remitted in the
next four weeks? What?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/112-4
00:15:30.670 --> 00:15:34.172
Why is it so intractable if it seems like
it's so straightforward?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/115-0
00:15:34.532 --> 00:15:39.895
Yeah, great question.
It's just not that straightforward.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/115-1
00:15:39.895 --> 00:15:47.199
It's so and it is intractable because
these are complex patients and these are

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/113-0
00:15:43.812 --> 00:15:45.532
Mm-hmm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/115-2
00:15:47.199 --> 00:15:51.452
complex chronic conditions that are you
know.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/114-0
00:15:47.212 --> 00:15:47.332
OK.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/117-0
00:15:51.812 --> 00:15:56.020
Often readmitted,
often being treated in the emergency room.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/117-1
00:15:56.020 --> 00:15:59.537
And This is why CMS targets these
patients, right?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/117-2
00:15:59.537 --> 00:16:04.779
They don't just randomly target patients,
they they target who are the most

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/117-3
00:16:04.779 --> 00:16:08.572
complicated patients or the the highest
risk patients.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/116-0
00:16:06.372 --> 00:16:08.012
Mm-hmm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/120-0
00:16:09.652 --> 00:16:12.959
And there's all sorts of reasons for
readmissions.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/120-1
00:16:12.959 --> 00:16:16.136
And a lot of that is in the transitions
of care,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/120-2
00:16:16.136 --> 00:16:21.128
which is why we also have a transitional
care management team. So, you know,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/118-0
00:16:20.012 --> 00:16:20.652
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/120-3
00:16:21.128 --> 00:16:24.111
you leave the hospital and then what
happens?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/120-4
00:16:24.111 --> 00:16:29.492
Your medication reconciliation is wrong.
You know you were supposed to be started.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/121-0
00:16:29.692 --> 00:16:35.118
on lay 680 but it says lay 620 and um is
there going to be somebody there on the

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/119-0
00:16:31.972 --> 00:16:32.172
N.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/121-1
00:16:35.118 --> 00:16:40.477
other end to pick that up or otherwise
you're going to end up back at the ED in

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/121-2
00:16:40.477 --> 00:16:44.630
in three three days.
So it's there's that's just one example.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/121-3
00:16:44.630 --> 00:16:49.252
Did you get an appointment?
Are you able to get to your appointment?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/123-0
00:16:49.252 --> 00:16:55.132
There's all sorts of SDOH, you know,
elements to it, and it's.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/122-0
00:16:52.732 --> 00:16:52.972
Yeah.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/125-0
00:16:55.252 --> 00:16:59.351
So on on that topic,
in addition to pulling clinical diagnosis

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/125-1
00:16:59.351 --> 00:17:02.473
from the EHR,
you're also pulling from surgical

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/125-2
00:17:02.473 --> 00:17:05.791
scheduling.
You're identifying a patient scheduled

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/125-3
00:17:05.791 --> 00:17:08.783
for elective hip replacements,
your schedule,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/125-4
00:17:08.783 --> 00:17:13.271
you're pulling from payer status,
who's on Medicaid fee-for-service,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/124-0
00:17:09.692 --> 00:17:09.812
OK.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/125-5
00:17:13.271 --> 00:17:14.572
you know those data.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/126-0
00:17:14.772 --> 00:17:19.527
Sources are all feeding into your HIE
analytics team to help produce that case

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/126-1
00:17:19.527 --> 00:17:21.452
finding automated report, right?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/128-0
00:17:21.772 --> 00:17:26.770
Yes, correct. You know,
it's depending on the population like the

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/127-0
00:17:22.612 --> 00:17:24.332
And so.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/128-1
00:17:26.770 --> 00:17:32.525
surgical scheduling would be the cabbage
and now the team surgical bundles,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/128-2
00:17:32.525 --> 00:17:35.932
which is the new mandatory bundles from
CMS.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/130-0
00:17:34.532 --> 00:17:37.515
Right.
So you're identifying you're you're

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/129-0
00:17:37.412 --> 00:17:37.532
OK.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/130-1
00:17:37.515 --> 00:17:42.440
pulling from all these different data
sources and you're creating this

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/130-2
00:17:42.440 --> 00:17:47.434
analytics report that then is
automatically sent to the inpatient teams

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/130-3
00:17:47.434 --> 00:17:52.844
and then they're they start implementing
A checklist and and it sounds like a

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/130-4
00:17:52.844 --> 00:17:54.092
nuvance they have.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/131-0
00:17:54.212 --> 00:17:59.532
You had some of these and you had to go
about identifying which metrics they were

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/131-1
00:17:59.532 --> 00:18:02.710
missing,
which areas of their workflow they were

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/131-2
00:18:02.710 --> 00:18:06.018
missing,
and just kind of plugging those holes and

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/131-3
00:18:06.018 --> 00:18:10.884
trying to do so without necessarily being
able to extend the technological

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/131-4
00:18:10.884 --> 00:18:13.932
solutions that Northwell relies on to
Nuvance.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/132-0
00:18:14.132 --> 00:18:17.372
That's going to take time to roll out.
Is that fair summary there?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/135-0
00:18:17.692 --> 00:18:22.298
Yes, that's correct.
So we're trying to make their case list

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/135-1
00:18:22.298 --> 00:18:27.507
as as accurate as possible.
You know we're we're working towards the

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/133-0
00:18:23.612 --> 00:18:24.092
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/135-2
00:18:27.507 --> 00:18:31.659
HIE notification.
The other thing that we utilize is a

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/135-3
00:18:31.659 --> 00:18:35.132
platform with our skilled nursing
facilities.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/134-0
00:18:35.092 --> 00:18:35.572
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/138-0
00:18:35.332 --> 00:18:42.034
And that allows our central OPS team,
which is our skilled nursing facility

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/138-1
00:18:42.034 --> 00:18:48.383
care management team to monitor patients
in skilled nursing facilities.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/136-0
00:18:42.132 --> 00:18:42.692
Which?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/137-0
00:18:47.252 --> 00:18:47.852
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/138-2
00:18:48.383 --> 00:18:50.852
So we have that on over 100.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/140-0
00:18:51.332 --> 00:18:55.075
Skilled nursing facilities now that
Northwell uses.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/140-1
00:18:55.075 --> 00:19:00.832
So we are talking about implementing that
in nursing homes around the new Vance

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/140-2
00:19:00.832 --> 00:19:06.589
hospitals and they're very excited about
that because they've basically had one

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/139-0
00:19:04.092 --> 00:19:04.332
Yeah.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/140-3
00:19:06.589 --> 00:19:08.532
woman trying to track them.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/141-0
00:19:08.812 --> 00:19:12.332
You know, in by herself.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/143-0
00:19:11.492 --> 00:19:14.992
Yeah.
So a centralized platform to to do the

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/143-1
00:19:14.992 --> 00:19:20.592
work that it sounds. So look,
we're approaching the end of this podcast

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/142-0
00:19:16.812 --> 00:19:17.052
Yeah.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/143-2
00:19:20.592 --> 00:19:26.892
episode and and I'd like to ask you if
you could reflect back on your journey to

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/143-3
00:19:26.892 --> 00:19:31.092
reducing 30 day readmissions and
improving our calls.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/144-0
00:19:31.172 --> 00:19:36.442
Star score and then do so and then also
consider Nuvance's journey to improve

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/144-1
00:19:36.442 --> 00:19:39.887
their star rating as now as a subset of
Northwell.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/144-2
00:19:39.887 --> 00:19:44.954
What advice would you give yourself or
what advice are you actively giving

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/144-3
00:19:44.954 --> 00:19:48.332
leadership over at Nuvance about how to
go about?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/145-0
00:19:49.052 --> 00:19:50.332
Achieving those goals.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/146-0
00:19:52.252 --> 00:19:56.342
Yeah, I I mean,
I think that it's a culture change in a

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/146-1
00:19:56.342 --> 00:20:00.212
lot of ways.
Some of the things that we implemented,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/146-2
00:20:00.212 --> 00:20:04.812
especially kind of the ED work and the
SWAT process, you know,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/146-3
00:20:04.812 --> 00:20:09.412
it means the hospitalist and the ED
provider working together.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/149-0
00:20:09.452 --> 00:20:14.324
In a way that, you know,
traditionally they haven't always worked

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/149-1
00:20:14.324 --> 00:20:18.311
well together.
So that that has been a culture change

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/147-0
00:20:14.812 --> 00:20:15.412
Mm-hmm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/149-2
00:20:18.311 --> 00:20:22.666
and a nice one. And it it takes time,
you know, it really,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/149-3
00:20:22.666 --> 00:20:25.692
it really takes time and they're they're.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/148-0
00:20:23.092 --> 00:20:23.652
OK.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/154-0
00:20:25.852 --> 00:20:29.010
You know,
they have some things that we can learn

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/154-1
00:20:29.010 --> 00:20:33.747
from as well. You know, they have,
they do something called a care partner

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/150-0
00:20:30.852 --> 00:20:31.572
OK.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/152-0
00:20:33.412 --> 00:20:33.532
OK.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/154-2
00:20:33.747 --> 00:20:38.168
huddle, which I which I love.
It's just that there it's not clear how

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/153-0
00:20:34.692 --> 00:20:35.692
Mm-hmm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/154-3
00:20:38.168 --> 00:20:41.894
to scale it, you know,
and that's what we do at Northwell,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/154-4
00:20:41.894 --> 00:20:42.652
we scale so.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/156-0
00:20:42.892 --> 00:20:46.183
I would,
I would love to scale that and bring that

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/156-1
00:20:46.183 --> 00:20:49.796
to to Northwell.
So it's it's a matter of being open to

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/155-0
00:20:48.972 --> 00:20:49.692
I know.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/156-2
00:20:49.796 --> 00:20:54.248
change and and you know we're open to
hearing what they're doing and

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/156-3
00:20:54.248 --> 00:20:59.022
understanding that we've been very
successful which which they seem to be

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/156-4
00:20:59.022 --> 00:21:01.732
very open to learning about our processes.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/160-0
00:21:02.172 --> 00:21:04.917
You know,
and I want to just reflect and

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/157-0
00:21:02.812 --> 00:21:02.852
Oh.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/160-1
00:21:04.917 --> 00:21:08.532
contextualize today's conversation for
our listeners.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/158-0
00:21:07.812 --> 00:21:07.892
Oh.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/160-2
00:21:08.532 --> 00:21:13.485
Checklist began in the airline industry
and it was initially Doctor Peter

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/159-0
00:21:12.852 --> 00:21:13.172
Oops.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/160-3
00:21:13.485 --> 00:21:18.572
Pronovos and his team with the Michigan
Keystone Project that began taking.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/164-0
00:21:18.572 --> 00:21:23.094
Airline checklists and applying them for
providers for central line associated

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/164-1
00:21:23.094 --> 00:21:27.445
bloodstream infections or CLABSI's.
And then when he went to Johns Hopkins,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/162-0
00:21:25.972 --> 00:21:26.532
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/164-2
00:21:27.445 --> 00:21:32.081
began expanding that workout and there
was always not only the importance of the

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/164-3
00:21:32.081 --> 00:21:36.203
checklist, but a culture change.
They had to have an executive sponsor.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/163-0
00:21:35.972 --> 00:21:36.292
Yes.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/164-4
00:21:36.203 --> 00:21:38.492
They had to empower nurses in different.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/168-0
00:21:38.572 --> 00:21:43.018
Of clinicians to be able to speak up in
the room and usurp somewhat the

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/168-1
00:21:43.018 --> 00:21:47.586
traditional power dynamic with the
physician most important and not being

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/165-0
00:21:44.172 --> 00:21:45.012
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/168-2
00:21:47.586 --> 00:21:50.673
challenged.
The ability to speak up and say there

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/166-0
00:21:50.612 --> 00:21:51.092
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/168-3
00:21:50.673 --> 00:21:54.625
could be a risk for an iatrogenic
infection here or we left us.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/167-0
00:21:53.372 --> 00:21:53.572
Yes.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/168-4
00:21:54.625 --> 00:21:58.452
I didn't count all the surgical tools
being removed from the.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/170-0
00:21:58.572 --> 00:22:03.758
Open body cavity from the surgery right
now and I think what you're really trying

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/170-1
00:22:03.758 --> 00:22:09.133
to say is not only is it about technology,
not only is it about following guidelines

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/170-2
00:22:09.133 --> 00:22:13.876
and best practices which are openly
available in the medical peer reviewed

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/170-3
00:22:13.876 --> 00:22:17.670
academic literature,
but importantly there's culture change

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/170-4
00:22:17.670 --> 00:22:18.492
and when you.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/169-0
00:22:17.692 --> 00:22:18.212
Yes.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/173-0
00:22:18.492 --> 00:22:22.541
Acquire a new organization.
It's not just about telling them you got

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/173-1
00:22:22.541 --> 00:22:25.592
to do steps AB and C,
but it's making sure that the

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/173-2
00:22:25.592 --> 00:22:29.054
hospitalists and the Ed physicians can
work well together.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/173-3
00:22:29.054 --> 00:22:33.396
It's making sure that if they're working
well with a care partner huddle,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/171-0
00:22:29.492 --> 00:22:29.612
OK.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/173-4
00:22:33.396 --> 00:22:37.972
that maybe you don't need to impose a top
down Northwell approach, but maybe.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/172-0
00:22:37.452 --> 00:22:38.892
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/174-0
00:22:38.092 --> 00:22:42.474
Let them work with what's continue to
succeed with what's working on a local

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/174-1
00:22:42.474 --> 00:22:44.750
level.
So I think being aware of people

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/174-2
00:22:44.750 --> 00:22:48.904
management and change management is
incredibly important to the success,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/174-3
00:22:48.904 --> 00:22:53.172
successful implementation of any
technological intervention. Any thoughts?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/176-0
00:22:53.532 --> 00:23:00.017
I couldn't agree more and that I think is,
you know, I I love checklists. You know,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/176-1
00:23:00.017 --> 00:23:05.730
you know the checklist manifesto is is is
a favorite. Yeah, but you know,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/175-0
00:23:04.332 --> 00:23:05.972
Patrol on the wand, yeah.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/176-2
00:23:05.730 --> 00:23:10.903
they really seem to work.
But I can see because it's it's happened

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/176-3
00:23:10.903 --> 00:23:12.292
at Northwell also.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/179-0
00:23:13.372 --> 00:23:17.373
That people get nervous about that.
It feels like it's more work. Why?

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/177-0
00:23:17.052 --> 00:23:17.732
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/179-1
00:23:17.373 --> 00:23:21.600
This is something else I have to do.
Who's responsible for this? You know,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/179-2
00:23:21.600 --> 00:23:24.812
all of those things.
And you can anticipate all of those

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/179-3
00:23:24.812 --> 00:23:27.404
things.
So you need to be able aware of that,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/179-4
00:23:27.404 --> 00:23:30.616
first of all,
just conscious of that and then, you know,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/179-5
00:23:30.616 --> 00:23:32.532
hopefully provide some quick wins.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/180-0
00:23:32.652 --> 00:23:36.244
You know,
hopefully in a few months we'll be able

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/180-1
00:23:36.244 --> 00:23:41.056
to show them that this checklist has has
helped already. You know,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/178-0
00:23:36.892 --> 00:23:37.412
Mhm.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/180-2
00:23:41.056 --> 00:23:45.869
in terms of if that patient got that
checklist, they're, you know,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/180-3
00:23:45.869 --> 00:23:49.532
the readmission rate is lower,
that type of thing.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/182-0
00:23:46.572 --> 00:23:50.322
Right, right.
And then of course this is all, you know,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/182-1
00:23:50.322 --> 00:23:55.144
payer directed efforts to change medical
practices to improve outcomes,

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/182-2
00:23:55.144 --> 00:24:00.032
reduce cost and at the same time
therefore by definition with the triple

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/182-3
00:24:00.032 --> 00:24:01.572
aim, improve value, so.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/181-0
00:24:00.572 --> 00:24:01.052
Yes.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/183-0
00:24:01.692 --> 00:24:04.212
And I'd like to thank you for joining us
today.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/184-0
00:24:04.332 --> 00:24:04.652
Thank you.

e6bdeda8-3e39-49c0-aa4b-40c2fa0d1628/185-0
00:24:06.652 --> 00:24:06.772
OK.