This month’s episode of “News you can Use” on HealthcareNOWRadio features news from the month of April 2023
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners.
With the recent announcement “Risant Health launches with Geisinger” with Kaiser Foundation Hospitals and Geisinger Health joining forces we discuss what this Kaiser Permanente and Geisinger merger might mean. As we note Kaiser Permanente is a large healthcare system that operates across the United States, while Geisinger is a smaller but well-regarded health system. This new company resulting from the merger will be focused on value-based care, which rewards providers for delivering high-quality care. No firm predictions on the likely outcome of this including if it will even be approved by the regulators but a suggestion to send something to “FutureMe” to keep track of predictions.
We talk about our respective experiences at Vive and HIMSS and compare and contrast – the networking, learning, and overall conference experience, including the use of scooters to get around. It was notable that ChatGPT was not to be found at Vive but was, as Craig puts it, “everywhere” at HIMSS including some interesting announcements of its use in healthcare.
Listen in to hear the new insights Craig discovered from ChatGPT in healthcare for patient communications. we were both impressed with how the AI was able to empathize with the patient and include important information that we would not have thought to include. It is important to have an open mind to the potential benefits AI and Machine Learning can bring to the healthcare space.
You can read more about the series here and the concept of keeping up with innovation in healthcare. Please send me your suggestions on topics you’d like to see covered. You can reach out direct via the contact form on my website, send me a message on LinkedIn or on my Facebook page (DrNickvT), or on Twitter by tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in:
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Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
Today as I am each and every month, I’m delighted to welcome Dr. Craig Joseph. He’s the chief medical officer at Nordic consulting partners, Craig, thanks for joining me.
Craig Joseph
Always a pleasure, Doctor Nick.
Nick van Terheyden
So this is our news you can use for April. And my goodness, we’ve certainly got some news this month with a large piece of consolidation Kaiser is buying geissinger I hopefully I got that both those words right, but I’m not sure I’m gonna get the next one. Right. And they’re becoming resistant. Is that right
Craig Joseph
result? Right isn’t? Right.
Nick van Terheyden
Rise? Results?
Craig Joseph
I don’t know. And I and it’s a little unclear what their what that is. Because apparently everyone’s keeping their name. So Kaiser Permanente is still going to be Kaiser Permanente and geissinger are still going to be geissinger. But there’s a some kind of something something this rise didn’t or resigned company. This won’t be confusing at all? No, no, this is going to be very clear once it’s explained to us. But it is, you know, these are very big players, Kaiser Permanente is in a number What about a dozen or maybe more states, across the country from the East Coast to the West Coast. And and Geisinger is a very well known, at least in the healthcare community, very well known health system. If small, and, and, and kind of out of the way, but still a well regarded system from quality perspective. So it’ll be interesting to see what they’re what they’re going to do with this.
Nick van Terheyden
Yeah. So I mean, I saw the news, as you as did you, I think I had a number of initial thoughts. I mean, the first one, and for anybody that has ever been to geissinger, not as a patient. So that’s people that don’t live in the area. It is pretty isolated. It’s not easy. I mean, there is no airport that I know of that’s near to this organization, because it’s sort of in the hills is my best sort of analogy, which gives me pause in all of this. Why geissinger? And, you know, to be clear, I think they have a fantastic reputation. from a quality standpoint, they put out some amazing research, they’ve done, you know, really impressive things. But if you were going to expand why this isolated facility, do you think?
Craig Joseph
Well, you know, there’s a hint that this company, again, I’m going to call it rice, and not sure that’s exactly how it should be calling it, but I’m going to choose to call it that until I’m told otherwise, you know, they’re going to kind of concentrate in value based care. And just so that we’re all on the same page. Traditionally, and, and often, in the United States. Today, physicians and hospitals are paid on a fee for service basis, meaning you, if someone’s sick, and they come to the office, you get paid. And if someone is sick and needs to go into the hospital, the hospital gets paid. And another way of paying for health care services is from from the perspective of value. Meaning, hey, if you practice high quality care, however you define that, then you get paid either more, or you get paid at all. And to do that, to get paid to get reimbursed based on value that you offer to either the insurance company or to the patient or to both, you have to be really good at what you do. And you have to make sure that your doctors and nurses and operations folks are really at the top of their game. And we certainly know that Kaiser’s is good at that. That’s how they operate for the vast majority of their of their members or patients. And I think that certainly other organizations like Geisinger are also good at that. There’s not a lot, right. So there’s not there’s not dozens and dozens of healthcare systems that you would say yeah, they’re nationally known for, for providing value and putting their money where their mouth is and taking financial risks to say that, hey, we know that we do a better job at this type of care or for this operation, then some of our competitors do and and if we don’t perform and the outcomes aren’t there, then we’re willing to take a hit from the money. And so maybe that’s why I this is this makes sense. This is
Nick van Terheyden
a like with like merger, I think you, you were certainly one of the early commenters that said, Well, okay, that’s great. You guys are both doing the same thing. But all we’ve done is consolidated. And we’ve lost. I’m gonna call it competition, albeit they’re on different coasts and whatever. And wouldn’t it be better to sort of spread some of the good capabilities that you see? I mean, my, my sort of, I don’t know, I’m a little bit mixed on this consolidation. Is it really good for patients? When you lose another competitor in the market place? I’m not so sure. I, we’ve seen lots of loss of competitors, I think, no more buying of bed linen anymore. Bed Bath and Beyond is gone. So that competition and you know, that’s a whole history in its own making. But is this a good thing? I’m not so sure. Or at least I don’t know that I feel it as a good thing, even if it’s the combination of two really good systems.
Craig Joseph
Yeah, well, you know, welcome to the club of not knowing the future. Certainly.
Nick van Terheyden
Thank you very much. Yeah,
Craig Joseph
certainly. I mean, I know that you have high expectations for my future, telling, and I appreciate that. And, and also, I’ve never been wrong in making predictions. So I appreciate you, you noting that as well. Oh, wait, I just noted it. Well, someone noted, I heard someone say that I’m never wrong. That’s what I’m gonna go with. However, I you know, I don’t know, I think what you’re, you’re the worry is very real. And I think that’s in all aspects, healthcare or not, is more competition better? Or? Or can you now when you start to get some scale? Can you actually, you know, make a bigger dent. And as we said, both of these are, are excellent organizations with reputations for very high quality. And so is there something that they can do together under one roof that they couldn’t do apart? But of course, the risk is, especially if the answer is yes, they can that then ultimately, can they charge more for that? Or will they start to decrease the amount of money that they’re, they’re putting into some of the quality endeavors, because they don’t need to, and it becomes, you know, it becomes, there’s less competition. So hence, everyone can kind of let their their guard down. So it remains to be seen, of course, this has to be approved by the federal authorities, this would be a big, this will be a big consolidation. And I think they’re going to certainly ask the question that you just asked as well, I’m not sure what their answer is going to be, though?
Nick van Terheyden
Well, let’s be clear in terms of your answers, and your predictions, you know, we capture all of those and send them to future mean, if you’re not familiar with that website, you should use it all the time. Because it’s, it’s very helpful to keep track of these predictions that you make. And you can set a timeline for when you get an email back saying, well, Craig said this was going to happen by this day. And you realize, of course, he was wrong, as usual. But I, I would just recommend you incorporate that into your sort of general workflow. When it comes to geissinger. And rezanov. I’m sorry, I just I don’t know why I just that’s the way I want to pronounce it. I am, I’m thinking they’ll consolidate. So they create more. And, you know, potentially could do it at lower cost. We’ve seen people sent to other countries from this country for care for drugs, even perhaps this is a domestic version of this. And you know, we see it I guess, in other places in other systems that have you know, a reputation for high quality is the some scope that this would I you know, consolidation down to a single system that’s just doing brilliantly might be also a end trajectory. But nobody likes that idea in this country. I don’t think
Craig Joseph
I think you’re right. You know? Yes. Oh, did I say that out loud? Yes,
Nick van Terheyden
you did. It’s recorded. It’s there for posterity. I’m sorry. The future me.
Craig Joseph
I thought I was I was talking. I thought that was an internal conversation. I get those confused sometimes. Sorry about that. Dr. Nick. You know, you kind of think about it as medical tourism, but there are certainly big companies thinking Walmart as one of them that has looked into the quality and the financial savings potentially associated with sending their employees or their their covered, you know, they’re covered folks with the insurance sending them across the country for specific kinds of treatments or operations. So imagine open heart surgery at Walmart has decided, and I think Geisinger might be one of the hospitals or, or the hospital, Walmart has decided that, hey, if you need this kind of an operation, we are going to put you on a plane, we’re going to take a significant other and put them on a plane as well. And we’re going to have you treated there, because their outcomes are superior to the one that’s maybe just down the road from you. And ultimately, we’re going to pay we being Walmart, the company, it’s going to cost us less money, even with all those added expenses, like a hotel and other things, because you’re going to get out of the hospital faster, your risk of getting complications, long term are are lower. And from that standpoint, you know, Geisinger, think of Mayo Clinic, and in Rochester, Minnesota, not really the center of anything, yet really super high quality, really innovative, really kind of put your money where your mouth is organizations. And so from that perspective, yeah, we’re it’s kind of internal tourism. But instead of you kind of deciding that you want to go to this place, because they do it better than everyone else, whatever it is, the your, the, your employer, or whoever you get your insurance from, is making that decision. So yeah, I mean, it makes sense on multiple levels. Will it work? Who knows?
Nick van Terheyden
Well, before we close out on that topic, you know, what does chat GPT have to say about it? Well, it’s hedging its bets like you and I both said, it could be good because it’s you know, synergies and efficiencies. But, you know, there are challenges in particular different populations, cultures, and indeed, you know, the anti trust scrutinization that would come. It will boil down to execution as it does with many things. But I once again chat, GBT comes out probably summarized it better than you and I did this time. For those of you just listening, I’m Dr. Nick the incrementalist today. I’m talking to Dr. Craig Joseph. He is the chief medical officer at Nordic consulting partners, we’re on our news you can use for April this year, we were just talking about the geissinger Kaiser merger that was announced recently and the new organization that sort of sits above it rise and let’s move on. You and I both went to different conferences. But they were both healthcare, healthcare technology. I went to vive ordinarily, I would be at HIMS. But this year, I was unable to go for a variety of reasons. And you went to HIMS. For the benefit of the listeners, you know, maybe I can give a quick summary of what I thought of the Vive experience. I think once again, they did a really good job of blending the commercial aspects of a conference and the educational experiences, they had some great people on stage, they certainly do a fantastic production, there’s no question the sort of experience the way it was all held. And I have to say it was nice to be in Nashville. In this case, that was where we were. That was very convenient. I was able, in fact, I rode my first scooter and didn’t manage to have any accidents and end up in as a billing code somewhere for something although I hear that’s certainly a frequent or an increasingly frequent problem, but it was very convenient. And I thought there was some great content, really enjoyed some of the networking opportunities, and it was all in one floor. The one thing that really surprised me and you know, we were knee deep into the whole chat GPT was, I don’t think I saw a single mention of it anywhere in the fall, there was certainly AI there was at least one track and you know, some people but no real mention of chat GPT overall, I thought great conference certainly seemed for me value of time, I think different costs between the two conferences, but can I say it was an ROI. That’s harder to say I was fortunate to have an opportunity to attend but I felt it was well worth certainly time and resource for me and a good location. What about you?
Craig Joseph
Well, hims was in Chicago this year and I think it’s a it’s a bigger conference. I think there were something like 40 or 50,000 people and this is a A healthcare IT conference. And so I think the main reason that people go to hims is that all of your vendors are there. So if you’re a big hospital system or our healthcare system, everyone that provides your technology and even things that aren’t directly related to technology, like, stands for your computers, you know, so it’s not just software, that they’re all there, and it’s easy to talk to, and that you talk with everyone. And, and there are educational sessions, I thought it was I thought it was pretty good this year, actually. There were there were it seemed busier, people were more focused on, you know, really kind of asking solid questions and trying to they came with an agenda, I guess, is what I’m trying to say, you know, I represented the my employer. So I was I was in the booth from time to time, and I was also walking around from time to time. And so I kind of saw both sides. And I thought it was good, I think there was a lot of positivity, I did not ride a scooter. And I will continue to not ride a scooter because the chances of me becoming a billing code are exceedingly high. And there’s actually codes not only for billing, but for accidents. There’s a whole, as you may know, a whole list of ICD 10 codes for for accidents. And I would probably be described by three or four of those if I were to go on that. So I’m gonna I’m gonna tell you know, with respect to chat, GPT, it was everywhere. It was everywhere at HIMS. So there were formal announcements of of the open AI technology being incorporated into electronic health records by by one of the biggest vendors out there. And so this concept of generative AI was really, really a big deal last week, or a few weeks ago at HIMS.
Nick van Terheyden
Yeah, I had to be clear that one of the reasons that the scooters were a thing for me was it was actually pretty safe. There was they were, I think they were bike lanes, although I didn’t see any bicycles. What I saw was lots of people with scooters. And I’ve been to Chicago, I used to go every year to Rs and a and boy, I would not want to i Oh, and by the way, you had snow didn’t you in in Chicago for yours? We didn’t, we had a really nice weather.
Craig Joseph
We actually missed I think I missed the snow by one day. So I think the conference started Monday, and it was like Sunday night, Monday morning, maybe where there was some, there were some snow. So I think I got a little bit lucky. But yeah, it was 80 degrees, two days prior, and then it kind of dropped to 30. So that was fun.
Nick van Terheyden
Wow, exciting. So front and center chat. GPT is delivering all this value proposition. And I gotta say, I mean, you and I are both I think fans of the potential in this space, I don’t think we disagree much on the potential. And in fact, you have seen, I’m gonna say you’ve learned something from chat GPT in terms of what it can bring to the patient experience. Right?
Craig Joseph
Yeah, you know, one of the certainly we all I think by now know that this stuff, this technology is good at summarizing for humans. So kind of taking a large amount of data and, or a large number of words and, and making it make sense, an aspect that I was just fascinated with, I read a an article where someone fed some some patient information into something similar to chat GPT, or essentially a private version, because you certainly don’t want to upload personal health information into chat GPT because the way it’s set up for the public is that’s going to be for everyone to see. However, they did this for an imaginary 1010 year old who was newly diagnosed with diabetes mellitus. And, and one of the tasks of the of the AI was to write a summary of what happened, how the, how the patient got to where they they were, and make it age appropriate. And again, this is this is a 10 year old so Hey, write a write a few paragraphs to tell the 10 year old what happened and why it happened and and summarize what’s going to happen in the future. And one of the first senses that this AI wrote was, you should know, Johnny, that this is not your fault that you didn’t do anything to make this diabetes happen. It’s not because you You were being bad or you were eating sugar, though, those are not reasons that you got diabetes, it just happens to some people. And and that’s true. And so, so good on on, on open AI for for making functionality like that. But that is not something that I would have thought of it to when I if you would have given me that assignment, as a physician, I would not have said that I would not have put that in there because I would not have thought that a 10 year old could reasonably think that they were responsible for the for getting diabetes. Why? Because I wasn’t thinking, because of course, they’re going to think that they did something wrong. I mean, that makes complete sense to me from from a 10 year olds head. And I even as a pediatrician, I wasn’t in that 10 year olds head as well as I should have been. So just that kind of an aspect that that empathy that, that the AI somehow has, is was just amazing to me. And and, you know, I think there’s a lot that humans can learn from from an AI like this and can add and make sure that we’re always kind of, Hey, did you think about this? When many when often we have it?
Nick van Terheyden
Yeah, I gotta say, it’s sort of reemphasizes. For me the point that I’ve been trying to make, I mean, we’ve seen this sort of the letter that’s been circulated, a bunch of people have signed, you know, hold all pro progress and so forth. And, you know, I just, I think that’s entirely wrong. And for me, you have captured the essence of one of the great opportunities here. Now, should you take your exact note and your clinical information, as you rightly point out, no, don’t do that don’t dump real clinical information and pH AI into this public system. Now you can do it in a private system, appropriately protected, and so forth. But the important thing is, is testing this out with an open mind. And as you rightly highlighted here, it came back with something that I think will, you know, would change your clinical behavior in the way that you interact with patients. And not just for that 10 year old, but you know, that would be across, potentially a larger, and the contribution to me is this ongoing learning, which we all have, I mean, at least I do, I’m always learning each and every day. And I use it as this sort of bounce off, it gives me thoughts and ideas that I might not necessarily have had, I just, you know, wouldn’t phrase things necessarily, it just brings this tremendous amount of value. And I think the key thing is, the reason or one of the reasons I’m oversimplifying this is it comes to that realisation, because somewhere in the corpus of knowledge that it’s absorbed, has been commentary from 10 year old saying, I don’t understand what I did to get diabetes. So you know, it just, it’s far better read than you and I and others are. But it still gets things wrong and has all of the challenges, but it brings this enormous value. So I’m just I’m continue to be excited about this. And, you know, looking forward to where all of this is going, I think we’re going to see more of it. i My question is, you know, what do you think you’ll see in the balance of, you know, the conferences upcoming? Are we going to see more and more of this? Or is it just going to peter out like a lot of these, Hey, is it at the top of the hype cycle? Or is it perhaps in you know, or maybe it is at the top, but it’s going to progress through that whole trough and disappear? Not disappear, but continue into the future? Here’s,
Craig Joseph
here’s, you’re going to hear it. You heard it here. First, I don’t think this thing is on the hype and hype curve. It’s not hype. It’s real. And it’s here, and it’s working. And that was the big announcement at HIMS. That one of the biggest electronic health record vendors in the country, the world has already incorporated it into an experimental way with three of their customers incorporated into physician workflow to say, hey, physician, you have to send a message back to a patient who asked about results who asked about certain symptoms, and they’ve got the protections in so that the, the, the AI can, I think have access to some of those some of that information in a safe and kind of walled way that is happening today with three big clients in the US. So I don’t think this is hype, I have to say and so hence I don’t think it belongs on the And the hype scale or, you know, I don’t think it’s gonna go up. I don’t think it’s gonna go down. I think it’s just wow this stuff works now and we haven’t even really started to finagle with it. So yeah, I think it’s, it’s gonna be it’s gonna be with us for a long, long time.
Nick van Terheyden
Chad GPT is here folks. Unfortunately as we do each and every week we’ve run out of time. Thanks again, as always, Craig for joining me on the show.
Craig Joseph
Always a pleasure.
