Creating an effective digital health strategy with Ajay Singh, MBA, Chief Commercial & Strategy Officer at Quality Reviews

<p>hello everyone this is Cole from the American Journal of healthc care strategy joined this afternoon by special guest AJ uh AJ please introduce yourself of course uh Cole thanks for having me on um my name is AJ AJ sing um I am the chief commercial officer and strategy officer for Quality reviews we are a digital Health company in the patient engagement space uh we offer a platform that allows providers payers and Valu Care organizations to deploy automated and customized and personalized workflows that are outbound to patients caregivers family members uh to allow them to stay engage uh across the care Journey um we uh have north of 30 Health System clients uh 22 million patients on the platform um and uh we're growing and always excited to talk to people like yourself that are trying to bring uh and connect people who are everyday operators in this industry to to people that are trying to support them through the means of technology so again appreciate being on the [Music] podcast yeah thank you so much for coming on and how many patients did you say were on the platform form we have 22 million and Counting um so by the end of the year we should be a little bit north of 23 but uh still running on the beginning of the year number on that so that's awesome that's a huge amount that's that's really good and so you you know the thing I want to ask first of all you know you got a Bachelor's in Biochemistry I believe right from Case Western and right it's a big Premed school you know very popular for that so I want to ask where where did you start out right what were your goals when you started out with that degree then how did you kind of transform to this role because you know 22 million patients 30 Health Systems being the chief commercial and strategy officer that is not you know uh an entry level role by any means so what was this this transition over the past 10 years like sure yeah uh when I went to college I grew up in the Northeast uh New York New Jersey um I wanted to leave the area and and go to the Midwest um you know I found Case Western to be a a fit for me um honestly the main reason why I went there is I had a scholarship um and when I went there I really didn't know what I wanted to major in um you know I kind of took the advice of my parents that college is where you go figure it out um and so I went in Undeclared at the time zero idea what I wanted to do with my career um like most College advising you know sat down with adviser and they said well you did AP Bio and you did AP Chemistry in high school you should be a biochemistry measure with no idea of how difficult biochemistry actually is and what it takes to do it I said sure why not um what really ended up happening was is I got kind of really into science and and and the process and everything Case Western is a great school because it is a research institute at a core and it really emphasized to me the idea of ask the question why and and dig in and what is the process and what are you evaluating and what are the data points and what's the change in that process it made science yes was the core but it actually got me more around how do you think about solving a problem and I I I I attribute that to my entire education at Case Western um from there graduating you know I had still no idea what I wanted to do um you know having been accepted in several graduate programs um um you know everything from Master's programs in research to med school you know med school itself I was graduating at the time of the Affordable Care Act and I tell everybody the story I I took a class my senior year it was the intro to master intro to Public Health Dr Scott Frank taught it you know primary care physician who was very rooted in the community efforts in Cleveland and he was using phrases that we know as buzzword today Access Health Equity social deter of health and he was saying that before it was cool to say it and what I realized was on coming out of the Affordable Care Act I realized that there are massive system issues that are going to be facing hospitals doctors payers and ultimately patients and I felt as an individual physician looking at the acceptance letters I said to myself I can't do this job you know I went and visited many these schools after I'd gotten and and I said to myself yeah I just can't do this like I I don't think I can affect massive change at a granular level not that affecting an individual patient is not important but having come from that education of process and and seeing the bigger picture I just felt that there's way too much opportunity in the space on the industry side on the administrative side the regulatory side the operational side and having been on campus you know many of my friends who who like me got into med school but actually went through with it they were already starting to talk about some of the issues that they were hearing from their peers or other people who were doctors who were older than them people they were interning with people that they were shadowing at you know cas's campus has University Hospitals it's Cleveland Clinic it's a great place to get your education is they started talking about those issues so after hearing Dr Frank talk about the Litany of issues and that was like after two weeks I was like all right I I can't do this I this is where I think there's a bigger opportunity so I took my first job in operations at a hospital University Hospitals uh great job great um Health System um I spent my time in in neurology neurosurgery working on you know projects I think that were very true at the time you know Joint Commission certifications you know length the stay uh readmissions these kinds of areas what I really learned was you know there was a gap in tying extremely bright clinical people to truly efficient operating people you know it's like talking two different languages and I felt they were just two wheels on the same track but running at different speeds at times or different directions at times or just not moving at all and so after spending a couple years there and really understanding what Physicians Care about what nurses care about what administrators care about this theme of like you know what are the actual up at night issues what I really felt was I wasn't doing Justice to the hospital because I only knew how to solve our problems I didn't really know what else was out there what are other people doing where could I go get knowledge without having going back to school get knowledge on how to solve even the bigger issue because as much as the challenges were at University hospital they were great they were still there still still are great health system you began to hear your friends that were going starting their residency going to certain places where there were it was smaller and you began to realize that there's a lot of issues Beyond I I don't want to just help one Health System how do I impact the larger piece so my journey went to The Advisory board company um and The Advisory board company was you know not only the place where I grew up as a professional you know I learned actually how to you talk to Executives how do you tell a story how do you problem solve how do you build playbooks but it really allowed me to understand the larger challenges that are affecting the industry not just one hospital but everybody and that there were the good thing was there was a lot of common challenges across the board so working around length of State readmissions you know helping people reduce PSI 90 driving physician engagement really what we were focused on or at least what I was focused on there was reducing clinical variation you know how do we get more standardization without reducing the quality and care after several years uh working there and and post acquisition from United Healthcare you know I kind of found myself thinking you know what's the next opportunity to do and that's where after I spent a little bit of time at University Miami Health System working with them advising them I came across the digital held startup space and I'll be the first one to admit you know I know I'm not wearing a shirt shirt and tie right now but I was always a shirt and tie person Hospital life shirt and tie Advisory Board Consulting shirt and tie so I was always kind of anti or I never saw myself fitting into what I thought was a culture of tech but what you really realize is is that there's super bright people in technology that have great tools Advanced tools but trying to connect it to the actual challenges of payers providers that's where the Gap was yeah and someone who was I believe felt these tools could really help people be successful in their goals they didn't the technology companies didn't really know how to bring that knowledge of what they were doing to tie to how do we really solve what you're trying to focus on so having been into space uh with a couple of companies uh you over the last few years some of them who exited and were acquired by larger companies you know I think everything you knew about digital health and patient engagement changed on in March of 2020 right we we came to a new world where whether you had worked at a hospital whether you worked at The Advisory Board whether you worked at you know epic Salesforce any these places for 10 15 years everything you knew was thrown out the window now at that moment I think people were everybody was back to I think Ground Zero in a nice way which is we're all together trying to figure out the issues together I think where we are today is we've normalized enough to realize that the strategy of today for a healthcare organization is Get Back to Basics right you know I think 2020 21 22 23 every year we just had a Litany of new problems 24 I think we started the year everyone's saying like Okay we have problems still but they're the same problems that we've been dealing with so it's not a new set of problems and I think that where you know kind of brought me to where we are today in technology and digital Health companies is we are all now being challenged in a good way by Health Care organizations to not just come in and press the demo button and then say hey now you know what my tool does do you want this I think we've all been challenged to say you got to really understand what my up and night issues are and understand it from the top to the front line and truly know what operations clinically financially you know coordination access whatever your realm is and what you're selling in you have to know how that world works and you have to be able to tie it not just to an Roi right I think that was something we were you know last few years everyone's like well we can help we do x amount in increase in caps and x amount reduction readmissions and PM PM comes out like that's not enough anymore right because if you're a technology company that has any value you should be generating Roi that's not it's hard to get Roi I agree having been there but you can't celebrate and pat yourself on the bat like well we have Roy so everybody should just buy what we're selling that's not enough it's okay how are you able to configure customize make your tool flexible to fit into the world of client and something that that is our Mantra is you know internally whenever we stand up a solution with any of our client either current clients or new clients is what does it mean to be flexible configurable and customizable to that client in that workflow in that area you know we have a health system that's going to go forward with us in our inpatient rounding tool they've got like six hospitals we're going to go live with all of them and as patients are getting the information they're going to make their requests and the question has come up well what is the best response time for someone at the hospital to respond to this request and what we've come down to is hey every hospital is going to be different every unit is going to be different and a unit is going to be different during the day versus night and we've put that on ourselves to actually change what the response time what the alerts what the triggers what the workflow is going to be for all of those use cases so a hospital to say hey here's this great rounding tool it does patient education and feels patient requests and routes them to the EHR and EVs and the cafeteria that's all great but requests on Orthopedics and requests on Med Surge and request in OB the patients are very different the workforce is very different so we need to change and that's what we've done um and I think that's the challenge that all digital Health companies have right now is how do you fit to that but I think the piece that the where providers and and payers can still meet us are are in truly sitting down and figuring out what is your digital Health strategy you as a healthc care organization that manages x amount of patients that has to deliver on y outcomes and has to deliver Z profit and revenue what is your strategy we can come all day and customize configure and make it flexible for you but a lot of times we talk to organizations where we ask them you know what is the goal for your digital Health strategy and they'll come back with I think kind of that 30,000 foot View and then when you begin to say you know who are the teams that are deploying this who's working on this do you have nurse buyin do you have care coordination Buy in you begin to real realiz that there's not really a they might even have a team but they don't have a strategy of what are we doing in Phase One what is phase two what's our goal what are we really trying to solve for T Health like or for digital so we've kind of come to this part where a lot of what we do is try to help people formulate their strategy before we even start talking about our product um and I think that's really where the Gap is right now in the market is how do organizations come with a strategy and I think it's on us and people like myself who have been very fortunate and I love my career to have been in the operation side been on the advising side been the tech side to say here is this framework here is the Playbook to kind of stand up that strategy um and I think we need to start having that conversation with people collectively um so I think that's where you know I stand on where we need to kind of go forward in the industry one of my questions on that I'm sure your past EXP experience has been relevant but the challenging part of getting a strategy as you've mentioned um the importance of this too is the front line staff and it's not just you know the the reception or medical assistants but Frontline staff is also includes your Physicians your nurses your you know um all all the people there the EEG technician the EKG you know all these people right in the various types of clinics and the thing is is there are so many different Specialties as you mentioned um there's so many different types of of technicians and things uh these groups are very separated from each other right the CL the you know the clinician excuse me the clinical group and then the business groups are often very separate the language is not the same one thing I wanted to ask is at The Advisory Board you were talking about setting up standardization making sure we're doing standardization Physicians often don't like that because it makes them feel like they don't have a voice they don't have a decision that they can make they're just kind of following the treat algorithm what what have you done in your experience to try to help these concerns when you've worked with physicians in the past so that you can get started with a strategy that encompasses the front line this episode of the strategy of Health was sponsored by modality Global advisors modality Global advisors optimizes Hospital Revenue enhances patient experience and delivers proven results visit modality global advisors.com to learn more no you know I think it's a no matter how many years you spend in the industry you know even people who spend more time than I have in this you know how to engage clinicians whether they're Physicians nurses is always a challenge but it's a good challenge I think the first you know there I think there's two kind of ways to do it I think thematically I'll say first is you have to meet them where they are right you know I think even the act of calling a physician to your office to talk to them is already setting up failure you have to actually meet them you know and I think that sitting with them and you know the phrase was always used in ADV I still use it today is what are your up and night issues you you have to connect with that right so when you talk about individ ual Physicians we talk about standardization we talk about systemness you know we've used so many buzzwords around at the end of the day like coming together to talk about a common goal that I think is the biggest problem to begin with is what are the common goals you know we talk about you know back in the day in any kind of Hospital operations we talk about from the administrative side on time starts and O waights and those top down things but when you talk the overall surgeon the overall surgeon is like yeah okay I'm bought into that but like uh I want prefer time of when I actually get to operate like I don't want to be operating at these times and you know like how many o slots is my practice actually going to get like I'm not GNA buy into this if you're not you know if we say Hey you know we all want to go to one knee implant and we want that antibiotic loaded it's like okay uh are you going to give me more slots are you g to give my practice more options like and so when you come with this idea of top down thematically you have to start by meeting them where they are and a showing data is helpful I think the challenge is don't just assume that data is 100% accurate because data is only as good as what you put into it but understand where they're also coming from and so I think in in in that's thematically tactically this is why you know we've always talked about governance committees I don't think they're something new I think the reason why so many governance committees have failed is because we're still stuck to like 2010 what the DNA of a governance team should be like it it 15 years later we got to change that mentality and so I think the big part like if we talk about it from like a digital standpoint is you've got to make a multi- disciplinary team and in that I don't just mean somebody who has an MD or you know a Nursing degree or you know is a technician you've got to find people that represent leadership as well as the front line for those inter multi-disciplinary teams so you can't you you know so I think when we talk about especially the digital side we have seen if you don't have a chief digital officer even if you do they have they there's no leader of a digital Health governance team there's always got to be two there has to be a clinical person there has to be a clinical person leading and feeling like an equal to the digital or the it counterpart because they're the ones that know the workflows in and out so I think that when we say hey we need to bring a m so bring a multip team you got to have that be not just different departments but it's got to be leadership plus Frontline people that are on it and I mean that not just clinically so if you're going to bring it don't just bring your VP of it bring the applications person bring the senior data analyst on it like bring top to the front line for all departments on this team then you have to really say like what is the goal of our digital health Team and I think it falls into two camps are we thinking about the larger strategy to affect the entire health system or are we going to be quick wins are we going to just find the gaps and close them up either one is fine you need to know a financially how much you can really put into this is it part of your larger Health Systems goals if it's you know based off that you're going to be able to say okay we're tasked with broad larger strategy to make it core to our everyday or our job is really to just kind of fill in and find where the gaps are and quickly get Solutions I think to manyen people's strategy for these things especially with digital is too little butter over too much bread and it's like a broad brush to cover like 30% and we're okay and that's setting up failure to begin with because that is not going to get down to your Frontline people and just going to annoy them and then it's going to annoy everybody else you're really not getting the goals that you really want so I think meeting people definitely front line but like having them in there and you got to give yourself like a solid month you know we talk about um Physicians you know why one thing that I learned at advisor board is if a physician is asking questions pushing back seems disgruntled you have the best physician Champion right there that is the The Physician that doesn't want to talk that's the problem like when I would walk in and meet surgeons and they'd get upset about care variation reduction all like that the ones who were the most angry I would turn to the chief medical officer and be like your uh surgical standardization team he or she is going to be the chair of that and they'll be like that person dude did you hear what that person said like that person doesn't that person just yelled at both of us and it's like yeah but like that's because they care so I think that once you get that you have to let this team vent for about a month so that everyone understands what the actual issues are because then the leadership team can then say okay here's where we're actually going to go here's how we're going to actually be able to address this I mean that's the storming norming forming kind of situation right I mean you have to deal with those situations and and like you said you have to kind of identify does it just mean that they're passionate are they actually like really upset and a lot of times it is just because of you know their passion for it um and it I like how you said too it's not just somebody with an MD or somebody with a Nursing degree it's people who are actually nurses who are actually practicing I mean it makes a big difference when the hospital CEO isn't just like a physician who hasn't practiced for 30 years but is actually a physician who practices in their specialty we've seen the differences um it makes a big difference them you know walking through the hospital knowing the staff because they don't just know their nurses or or their Mas they know the the EVS team they know all of those people and that is super meaningful I want to ask a final question though let's say that I've assembled this team I've gotten everyone together we've set our our objective um we have maybe a couple Physicians a couple nurses a couple people from the SE Suite on board we've discussed some things that we want to do and then now is kind of this period where we're all waiting for someone to make the first move right what is that first Move whose responsibility is it to take it yeah I think that when you talk about this is where I think leadership has to take the effort to start the process right away and I think that the leadership of the team you know I I'll give you like what I think you know kind of how we've done with other clients and how I advise still Health Systems today who reach out to me for this exact question I think the first thing of your digital Health team is you have to on once you know are you doing the broad or you're doing like quick fixes the first thing you need to know is that your digital Health strategy has to be tied to Patient engagement that's the first goal then saying it is to support patients when and where they need help the second thing you're doing is pick your key patient populations whether it's who you manage the most you're trying to build revenue from and map out what are the different stages for that patient's Journey generally I think they fall into five but I think if you're looking at oncology I don't think it's just five is very unique at that point you need to basically say you know so we always say is like it's discoverability it's you know booking care it's diagnosis it's Insight of insight of care followup at home but that could be different whatever it is pick your five populations and then say what is the stages of Journey then say to yourself for those stages or for those populations like I said is it a cost reduction focus is it a revenue or is it outcomes then look at the five stages and say where do we have gaps today in those five stages that I just example where are our gaps pick the three two whatever it is to have a gap then ask the question is the gap because we don't have people or is the gap that even with the people it's still not getting to where we want to be at that point you need to be able to say okay I've got my two or three gaps what type of scaling are we trying to do are we trying to automate are we trying to augment are we trying to accelerate are we trying to optimize are we trying to deflect categorize that because then that's going to tell you what are the gaps or where is the opportunity to bring a dig what is the goal the digital Health Solution for that gap for that patient population then you want to start evaluating the tools you do want to lean towards products that can solve multiple challenges at a time but you need to evaluate is that Gap and the type of scaling I'm trying to do can that be solved by a vendor that has multiple like a platform that can solve multiple challenges or is it best solved through a point solution you are not going to live in a world where you have one vendor like just sorry to tell every it person or Finance person like that's not going to be the solution you have and then what you want to be able to say is okay now that we know the the the populations the stages the gaps what type of scaling we want to do the next thing we want to be able to say is what are the challenges patients face as well as the workforce what do they feel is when the patient feels like I'm not able to connect and the work Force says I feel dis so the theme of disconnected where do patients feel disconnected where does the workforce feel disconnected and then figure out does this solution solve the disconnected challenges for the patient and then does this platform a make the clinicians and The Operators feel connected but also is it fit into their workflow because the last thing you want to do is ADD alert fatigue another thing for them to log into and something where they have to change their workflow that is actually an impedance no one's going to say I'm not going to change my workflow if it's better for the patient but that's where the front line really helps not just in the beginning of the evaluation of your committee but they better be evaluating your product as well too so those are kind of like the steps that we take from map you know find your populations so a are you doing the broad strategy or you're kind of doing quick wins from there you're figuring out it's rooted in patient engagement what are your five populations what are their stages then where are the gaps do you need people or technology if you're going to go with technology is it automate augment accelerate optimize deflect then when you start vetting the tools it's a combo of is it a point solution or is it a platform that helps us and then the last part when you're evaluate is it going to work is how do you reduce disconnection with patients and then how do you ensure that the workforce is not creating new work for them which can happen right I mean that really and then if you trace back so many of these issues right where we're Reinventing the wheel where this kind of excess work really waste right is being generated it does come from a lack of communication uh maybe you know under that a lack of effective communication and that all originates from that disconnect right uh you know patients are are Mis dissatisfied with their doctors because they're not communicating with them you know back and forth correctly you know doctors are mad at their nursing team and vice versa because of that lack of communication and then a lot of that frustration leads up to leadership and it's again that lack of communication you know major health systems still score low on their internal surveys in that area right it's an area that Healthcare has been trying to figure out for a long time so I really appreciate you giving us some strong advice in that area uh you know we're at the the time limit here so I hope that you'll consider coming back on again we'd really maybe a part two to to follow up on this so thank you for your time a no I appreciate it thanks everybody and uh go have a good one</p>