Health Business Blog

This is the transcript of my recent interview with Harvard Pilgrim’s CEO Eric Schultz. An audio version is available here.

David E. Williams:  This is David Williams, President of the Health Business Group and author of the Health Business blog. I’m here today with Eric Schultz, President and CEO of Harvard Pilgrim Health Care.

Eric, there’s a lot of discussion these days about consumer engagement. What is consumer engagement and what is Harvard Pilgrim doing in that area?

Eric H. Schultz: I agree, David. Consumer engagement is finally starting to get real traction. It has been a bit of a third rail because so many parts of consumer engagement speak to the individual role and individual responsibility.

That doesn’t mean that we’re where we are with health care cost and quality because the consumers have failed to do something, not at all. But I think some policymakers, some elected officials might be concerned that the term consumer engagement is putting some sort of blame on consumers. And that’s not it at all.

The other piece I would mention upfront, just to get the language out of the way is I recognize that some actors in the health care system just don’t like the word consumer.

And I think what they’re getting to is that health care and wellness is very personal, it’s human. It’s not buying a refrigerator, and we understand that. Calling someone a health care a consumer is not meant to be disrespectful. It’s hard to imagine what more important decisions any one person can make.

But I would just lay that out and so when I speak about consumers, I mean no disrespect. There is a place for that word. There also is a place for the word patient. Maybe it’s informed patient rather than consumer. But let’s put the language off to the side.

The good news is that consumer engagement is getting real attention at the front line. Up until this point, we were seeing more attention being placed on the provider contracting strategies, moving away from fee-for-service and more toward payment for value, not for volume. And that’s essential for us in the United States getting our arms around more efficient care, more effective quality of care.

But that, in and of itself, is absolutely insufficient for the U.S. to get where it needs to be, because in some cases there are providers with great market power, great brand power, and great geographic control. They really don’t have the same reason to reduce their cost or invest in how they deliver care to reduce the cost of care.

That’s why we need this counter force, which is where the consumer comes in, to reward those providers that are doing a great job on cost and quality and frankly, to threaten those providers that are very costly. They may be high quality but don’t have the pressure yet to invest to become more cost-efficient.

So it’s a dual kind of strategy and it’s very welcome.

I’ve always felt that there are two ways for us to get control of cost trend. One is for the government to set rates, which I don’t believe is effective in dealing with trend over the long haul. And the second is for the market to work. And in United States, although some people say the market approach to health care has failed, I say the market has never been tested.

We all know, in a market, you’ve got supply, you’ve got demand and you’ve got price. Even today the price is largely separated from the demanders. There are oligopolies and monopolies and everything in between where your demanders of service don’t have to know how much things cost. And therefore we don’t have the regular market rules applying. This is a nice way to get that started.

There are really two major demanders. The first one that comes to mind most readily for most of us is the patient, the consumer. We demand care. The second is less obvious to those of us who are not in the business, clinical or otherwise, and that’s the referring physician.

There is value in physicians having transparency, especially for primary care physicians and a handful of specialists that have the responsibility and the authority to refer patients to other institutions or clinicians. And yet, even they don’t know how much these services cost nor do they know the quality. They may think they do, but it’s anecdotal, because that’s how we’ve always run this business as physicians. They need the information.

So it’s nice to see consumer engagement happening and it’s nice to engage the demanders in a way that’s going to really have an impact on the supply and on the price of the supply.

Williams:  Much of the recent discussion about consumer engagement focuses on transparency and specifically, price transparency. What is Harvard Pilgrim doing in that area?

Schultz: We’re very actively involved in price transparency. I will tell you that it’s been a journey. A worry of mine early on –and I’m past this point now—is that price transparency was occurring before there was quality of care transparency.

Even with value-based insurance plans that act an important reason or incentive to use information to make decisions, if we, as consumers, know the cost of something and we don’t know the quality of it, the majority of consumers believe that if it costs more, the quality is better. So I think we were creating a tension that insurers wanted members to go to lower quality providers to save money.

The other problem I had early on was that when you make prices that we’ve negotiated to pay physicians, hospitals and others available to the public, those providers who are being paid less are going to end pushing for more. And those who are being paid more, they’re not going to volunteer to get paid less.

So all boats rise, and I was worried that the prices were going to rise. In fact, they did rise after the Attorney General came out with the report, which I’m glad came out. It’s an outstanding report and I wouldn’t have it any other way. I’m glad she did it and it’s been very helpful.

But there’s been this evolution of thought. Now, I’m much more comfortable with being transparent on price because we’ve started producing better quality data at the provider-specific level or group level. So we’ve got some of that being balanced in.

And the other thing is that the real thought leaders, whether elected officials, business leaders, or others are being much more open around the role of consumer engagement and we have a lot of studies out there that have shown that just because it costs more doesn’t mean the quality is better.

So we’re moving forward aggressively in making cost and quality at the provider-specific level available to our customers and even more importantly to have it available with benefit-specific implications, because as you know, high-deductible plans have become very common.

They’ve grown quite a bit here in Massachusetts and in New Hampshire and Maine where we operate. More and more, our members are at risk for big costs. Now we have information that helps them make decisions that are going to complement their benefit plan designs better.

But it’s hard to know, with a $2,000 deductible, how much is left. If I have to go for an MRI and one is $1,900 and the other is $850, how much am I going to have to pay out of pocket, given whatever deductible is left? It’s complex.

So it’s really important to have tools that provide information that is person-specific with the benefits that you have. And that’s exactly what we’re introducing in the marketplace in September called Now iKnow. It’s a tool that we’ve branded that has “Castlight Inside” which is a play on Intel Inside. Castlight has a great software technology that helps us bring it to the market quicker.

The bottom line is to make more and more information available to complement the value-based insurance plans that we have, to complement tiered networks that we’re offering, and to put the consumers in the driver seat.

We want them to feel more control than they had back in the ’90s when managed care really took a black eye because there weren’t choices. People didn’t feel like they had the control in so many ways. And that’s really what guides our thinking around transparency: empowering individuals with the information and the tools to make more informed decisions that work for them or their family member.

There’s another interesting thing around transparency that we’ve identified, what we call aided transparency. One thing we know for sure here at Harvard Pilgrim is that this is definitely a journey that consumers are on. The notion of giving an individual information –even if it’s easy to access—along with value-based insurance plan designs, is a big shift on how people access care and think about paying for it.

Aided transparency is really a transitional phase where we help individuals use the information. We have nurses that help individuals who use information along with their benefit plan designs. This is in a product called SaveOn.

The idea behind SaveOn was to focus on those services that are easy to identify and where there is a huge swing in negotiated rates and a negligible difference in quality of care.

To no surprise, high-end diagnostics like MRIs and CT scans and high-volume diagnostics like colonoscopies are the focus. These services have grown over the last decade because hospitals and large multi-specialty group practices, have pursued very deliberate revenue strategies and they’ve been really successful.

The number of MRI machines out there in any given marketplace is outrageous. It’s overkill. But there’s never been a connection between demand and price and supply, so it’s worked. What we want to do now is provide an incentive to our members with SaveOn. If they are referred by their physician to get an MRI, we educate them that they can call our nurses.

If my doctor wants me to have an MRI of the spine, our nurse will look online and offer alternatives that are lower cost within that driving time.

Now you’d think that okay, that’s fine. But this is where the real value and nuances fall in place. If the members do this and they go get the care at the other place, we’ll pay them up to $75. So this is the first time we are keeping the benefits the same and paying a reward for making this choice.

The second thing and this is the aided piece, we’ll also say to Mrs. Jones, would you like us to call your physician? Would you like us to call this new facility and set up the appointment for you? Would you like us to call the other and cancel?

We address those administrative burdens and discomforting conversations you might have with your doctor. So many people don’t want to disagree with their physician; with our help they’re more likely to do it. It’s amazing. All of a sudden you feel their shoulders just dropping when you’re on the telephone with them because these issues have been a real barrier.

The other thing if a patient calls and it turns out they’re already  going to the most cost-effective provider we will say, “Mrs. Jones, thanks so much for calling. You’re at the best provider for cost and quality, but we’ll send you a check for $10 just for calling in.

We want to reward people, we want to help them get rid of some of the barriers. That’s the aided transparency that I’m talking about that we have to be ready to continue with. We don’t want to push the consumers too far too fast so they throw up their hands in frustration and then this strategy falls apart.

Williams:  You mentioned you see two fundamental approaches to cost containment, a government approach or a free-market approach. It seems in Massachusetts we have a hybrid. With recent health care reform laws, the government is taking some steps to require transparency. How does that fit in with what you’re doing? And is what the state government is doing helpful or unhelpful?

Schultz:  In Massachusetts, the state’s role has been largely helpful.

The role of the government can be to catalyze action, which has been really good. They don’t want to overly prescribe what things should look like. They want to see how the market can produce something because with competition, we’re desirous of having the better tool. And they want to take advantage of that. But they want to know that they’re pushing the industry to move in a direction that makes sense and where we all know it needs to go.

So Chapter 224 last July had a requirement to have insurers produce a tool to support transparency. So I think that’s been really good.

Another example of support from the government is to drive the conversation away from fee-for-service toward fee-for-value. That’s made a big difference. Providers, in particular, hospitals  have responded. We’re seeing medical trends well below four percent; and it’s really the hard collaborative effort between providers, physicians and insurers responding to the invisible (or not so invisible) hand or of the regulators.

Those are two good examples, where government is making a big difference.

The area where I think we need greater movement is in requiring hospitals to produce a standard set of quality measures on a more real-time basis.

A lot of data is used from Medicare reports and some other standard reports, but it’s not enough. Consumers should have access to that. The hospital level is a start, but we all know we’re moving toward a combination of physician and hospital department information; we have to get there but that’s down the road. So I’d like to see more movement to get better quality data. We’ve got a ways to go.

Williams: You mentioned two types of demanders, patients, but also referring physicians. You’ve been describing a lot of activities and initiatives that you’re undertaking for the consumers. What about for those referring physicians? Can these same tools be use? Are there other tools that you’re using to help the referrers?

Schultz:  We’re more advanced with our tools for the consumer to begin with. We do provide some information for our physicians about the cost of specialists and the cost of hospitals. We have a long way to go in that arena, though.

I know that tools, which will be in the hands of the consumers, will automatically have an influence on the referring physicians. My preference would have been –if the technology were there– to give the physicians, especially the referring physicians, the same tool at the same time. That’s where I would want to be if I were the physician.

The bottom line is the first phase was available for the consumers and I said let’s get that out. Let’s not wait for both or perfection. The good news is that Harvard Pilgrim insures a large number of the physicians in the state. They are members of ours and they’ll have the tool.

What we’re talking about here is only one slice of the pie, which is how we use the tool for acute services. We’re not talking about health and wellness. But transparency and value-based insurance have a big impact on our choices as consumers to be healthier. That’s probably a different subject than today’s discussion about price and quality transparency.

But even when in making decisions about health and wellness, we want people to select physicians who have high scores, partly because they’re focused on how they keep their patients well. Do they manage all of their diabetics well? If so the scores would reflect that. So their higher quality scores will be partially a reflection of how they help their patients manage their health.

Williams:  You mentioned that you chose Castlight in order to get to market sooner. But not many health plans are using it. In fact, you may be the first one. Are there any barriers to plans bringing Castlight on and do you see other plans following in your footsteps?

Schultz:  We were the first health plan to select Castlight. I suppose for some payers it was a little bit unsettling because Castlight is going directly to large employers and selling this feature that creates competitive pressure on insurers.

Our thinking here is first, we wanted speed-to-market. We were moving forward with the strategy before Massachusetts passed the law. So we were going to be fine anyway. We look at a number of products that were already existing and we felt this one was the best one that was out there.

We are glad we had the opportunity to brand it uniquely to our health plans, so that helped to deal with some of that concern about competitive pressure. Another health plan in the marketplace, Tufts, is using Castlight. I think they’re using it under the Castlight name.

There’s always a little bit of concern, but the greater value of bringing this to our customers won the day.

Williams:  I’ve been speaking today with Eric Schultz, President and CEO of Harvard Pilgrim. Thank you.

Schultz:  Nice to be here.

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HarvardPilgrim HealthCare, which has been ranked as the best health plan in the US for the past nine years, is taking new steps in the areas of consumer engagement and price transparency. It recently became the first health plan to select transparency vendor Castlight Health to provide patient-specific price information.

In this podcast interview, CEO Eric Schultz discusses the “journey” the organization has taken on price transparency, why they decided to work with Castlight, and the state of transparency tools for referring physicians. Schultz describes the concept of “aided” transparency to help consumers transition from established approaches to more value-oriented behavior, and explains HarvardPilgrim’s new Now iKnow and SaveOn initiatives.

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By David E. Williams of the Health Business Group.

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This is the transcript of my recent interview with Cancer Treatment Centers of America CEO Steve Bonner.

David Williams: This is David E. Williams from the Health Business Group. I’m speaking today with Steve Bonner, CEO of Cancer Treatment Centers of America.

Steve, thanks for joining me today.

Steve Bonner: You’re very welcome, David. It’s great to speak with you again.

David Williams: What is Cancer Treatment Centers of America and how does it differ from other well-known cancer centers?

Steve Bonner: Cancer Treatment Centers of America is a growing chain of hospitals that specialize in and treat only cancer. We tend to see later-stage, more complex patients, because they get the diagnosis and stay at home until it becomes more complex. At that point they then, go looking.

We have as comprehensive and complete an array of technology and talent for traditional cancer therapy under one roof as you can find anywhere. What really sets us apart is our commitment to a holistic and an integrated style of care. The traditional therapy treats the tumor but cancer is not the tumor, it’s the malfunction of the basic immune system. Therefore we provide a very robust array of complementary therapies, which include nutrition plans, naturopathic intervention, mind and body medicine, spiritual support, exercise, Reiki, yoga, Pilates and pain management, which includes acupuncture as well as more traditional methods of pain management.

We integrate these therapies for every patient in a way that you  don’t see elsewhere. If you go to the finest cancer providers, you’ll be able to see a great medical oncologist and a cancer-trained nutritionist and naturopath. However, those professionals will never talk to each other. We structure a team of those professionals around each patient and that team stays with that patient throughout  the course of their treatment at  CTCA.

David Williams: I’m curious about how you think about the definition of quality in patient care because  a more holistic and integrated approach, is more difficult to measure.

Steve Bonner: Exactly. Our corporate DNA is grounded in the philosophy of patient-centric care. Of course, everybody says that, but we were created by an international merchant banker and a libertarian whose mother got cancer. Our founder set out to create something that structurally keeps us focused on the patient. As a result, when it comes to quality, the question we keep asking is, for each patient, what is the patient’s definition of quality and how are we doing in achieving that?

We have our own extensive measures of the quality of the experience. We measure and publish data from the patient point of view, using a Bain Net Promoter Score and also do the conventional Press Ganey Measurement. – We also include HCAHPS, Leapfrog and many others.

We believe that as an industry, we have a long way to go to really understand quality from the patient’s point of view. When we talk about HCAHPS and Leapfrog, they’re useful, but they’re more for the industry’s point of view than the patient’s point of view.

We have two major initiatives that are underway to try to help us better understand quality measures and then provide information about quality that we think can lead to some breakthroughs. One is a new piece of research that we’ve just released called the “The Cancer Experience”. It is a national study of patients and caregivers. The Cancer Experience is composed of a thousand cancer patients, a thousand caregivers, and family members of cancer patients all of whom are people who have been treated in centers across the country. This isn’t specific to CTCA patients although our patients are included.

The headline of this study that was surprising to us is that one in four of these patients and caregivers are dissatisfied with the care that they’ve received across the US. We note that 20 percent of these patients have left the place they went first for care and have gone somewhere else as they try to find the quality of care and the price of care that matches their expectations.

The survey goes on to point out that there are three major events or elements of care that really drive the dissatisfaction. The first is that patients know how complex the disease is, know how complex the treatment is going to be, and know how  challenging it’s going to be to understand it.  They expect and want us to provide them with a care quarterback the minute they come into the hospital that can stay with them throughout their care. A person that understands their disease understands what we can do and can help them navigate the system.

The second issue is that patients want an integrated care team to make sure that they get care for this disease that addresses the mind, body, and spirit, not just the tumor. The survey told us that 86 percent of the patients and caregivers wanted an integrated team, but fewer than 70 percent actually were able to have one.

The third major driver of this dissatisfaction is pain management.   It is easy to imagine how important that is to a patient and to a caregiver.  It was interesting that the caregiver actually felt more strongly about pain management than the patients did. Half the population in the survey said they did not get the pain management that they needed and wanted to allow them to be able to navigate their treatment and get to the best possible outcome.

The other major activity that we’re involved with is to try to help the industry and help us understand quality from a patient’s point of view.  In response to this we’ve created a partnership with the National Patient Advocate Foundation, which is not-for-profit. We’re underwriting a piece of research that will be presented a year from now, next April. It is another survey of cancer patients and family members that will allow them to define the cancer value index in their terms.

It’s basically  trying to create the JD Power of oncology, where the association of research will conduct this research, they’ll publish the research and then, they’ll continue to manage it in a way that will allow providers to give them our performance information. They can then publish it in a way that will make it much more comparable for patients and allow them to more intelligently navigate the industry as they seek a combination of quality, price and as a result, value.

David Williams: I’d like to ask you more about the role of competition in terms of improving quality. You mentioned that your founder comes from a libertarian background and merchant banking. And of course you’re a for profit organization. In lots of places in the economy, competition drives quality, performance and value but not necessarily in health care. What role does competition play in driving quality in health care, both in oncology and more broadly?

Steve Bonner: Competition is one of the most powerful drivers of quality, cost and value that is available to us. An empowered consumer with choice will walk, talk and teach us what real value is. If we then compete based on those terms, we’re going to see quality naturally go up and price naturally come down.  Even in health care today — LASIK or elective plastic surgery — where it’s up to the patient to decide and pay you see continued improvement in the quality and in the technology. And you can see the price continuing to come down.

The way we’ve constrained competition in health care is a major factor in how expensive care has become and how elusive true quality is. That’s part of the reason we’re sponsoring these two significant efforts to engage the consumer to teach us how they want to define quality.

David Williams: In most markets, including ones you’ve described, there’s usually a market price for something, and the supplier sets their prices and customers either pay it or they don’t. Health care is also a little different where you have commercially-insured patients and you have Medicare and Medicaid patients. Medicare,  in particular, will tend to pay a lot less than what the commercial patients are paying.

In an area like oncology, what impact does that have on providers and on patients? What are the policy implications of this often wide disparity between the commercial reimbursement rates and what government programs are paying?

Steve Bonner: The implications are profound. I may back up a step and say that if we want competition to control the market, then we have to enable that competition with much better information, including information about price.

David Williams: Let me ask you about the recent Reuters Special Report that I’m sure you’ve seen. It was taking a look at your company’s claims that survival rates are higher for your patients than for other patients. It concluded that those claims couldn’t really be substantiated because there were differences in your patient population versus those you were comparing it with. Can you just provide some commentary on how you look at this issue more broadly and address some specific questions that came up in that Reuters Report?

Steve Bonner: We heard that these reporters were working on a story and we reached out to them and invited them to include us in the dialogue, which ultimately they did at some level. We invited them to come and visit our hospitals and talk to our patients and  understand the patient experience, which was part of what they were writing about. We explained to them what we’ve done with the publication of our outcomes and the rationale behind it and the evolution of it going forward.

We did tell them that all the data that we published on our website on outcomes is vetted by an independent research team at Washington University and offered them the opportunity to talk to the research team. They declined to come and  look at it. In my opinion, they wound up drawing unsustainable conclusions and making observations that simply aren’t supportable as they presented them.

We’re either the first or the second or the third in oncology to put any outcomes data on our website — but we publish all the outcomes on analytic patients who come to CTCA. These are patients who had not been treated elsewhere. We publish that by length of life, quality of life, match to location and stage of disease. It’s very clear that’s what is published.

The other way to come at it is what we don’t publish. We don’t publish data on the patients who have been treated elsewhere before they come. The question is why, and the reason is because we haven’t so far figured out a good frame of reference to offer people. With analytics of the disease, we have the SEER and NCI database and that’s what we use as a point of reference.  We think it’s fairly comparable to this segment of our patient population.

Where we have a fourth-stage pancreatic cancer patient who also has diabetes and a heart condition and has been treated in some very unique way in two or three organizations, to just publish their length of life data, we don’t think would be helpful to patients. We haven’t published that. We’re in the process of relooking at that and maybe we just need to put that out there and then, we’ll take on the questions as they come.

Some of the organizations that the reporter quoted in criticizing our methodology are organizations that so far had not published one statistic with respect to their own outcomes. They don’t publish HCAHPS data. They don’t publish Press Ganey data. We ask ourselves how valid and relevant and reliable are these as critics?

We do have a unique population and that’s a fair observation. We talked about the major elements of it. They are very engaged patients. Most are patients who have been diagnosed and treated elsewhere, they’re not happy, and they’re willing to travel. Our average patient travels 250 to 300 miles to come to us for care. These are people that really are in the game and are going to do what they need to do to find a cure.

They tend to be a more advanced stage population than  others. The article suggested that we culled out from inquiring patients those who were more advanced with their disease and that’s absolutely unsupportable.  We see many patients who had been told by MD Anderson, Sloan-Kettering, Cleveland Clinic that there’s nothing more than can be done for them at those institutions and to go home and get their affairs in order. We take those people in. We can introduce them  to patients who have heard that same thing from those institutions and others three years ago, five years ago, ten years ago.

We’re here for that kind of patient and do everything we can to bring them in. Every patient has to navigate their insurance structure, and that’s what culls out patients, not CTCA.  When the patients want to come to us, we’ll work very hard with their insurance company and with their employer to try to make sure everybody understands the situation. We look at what other options might be available for the patient and try to open doors that might otherwise be closed.

We see some insurance companies and some employers being much more flexible with these patients who clearly have no options elsewhere.  If a patient’s in an HMO and they’re not willing to let them opt out of the HMO into some sort of a PPO coverage, there’s really not going to be a way for them to come to CTCA. That’s the insurance market operating, not us culling patients.

David Williams: As you look at the next three or five years,  do you see any expansion opportunities? Is it putting facilities in different geographies from where you’ve been? Is it offering new kind of services? Where do you see the company heading over the medium term?

Steve Bonner: The future of health care is a really an exciting future to behold, and especially in oncology. For CTCA, we are looking at trying to make ourselves more conveniently accessible to patients. In the last seven years, we’ve gone from one center to five centers and we’re looking at a sixth center. We’re looking at the possibility of some less intensive centers that  we can put many more of them around the country and offer cancer information, central diagnostics and routine treatment. The therapeutic future may be even more exciting than that to us.  We think that the next major breakthrough in oncology is clear and that’s going to be understanding the disease at a genomic level and then being able to match known therapies much more precisely with the genomic abnormalities that a person’s expressing.

We’re working very hard on genomic innovation. Today, when you get cancer, a tumor shows up in one part of your body, insurance company providers go to an FDA-approved drop-down menu that says “if you have that cancer in that body location, this is the treatment that’s performed best in large population, placebo-controlled double-blinded studies”, and so you should get that. Every insurance company will pay for it and if you stay in network they’ll get it for you at a 40 percent discount.

The reality is that those large population studies produce the best tumor response in maybe 40 percent of the population. We’re prepared to pay for 100 percent of the population to get the therapy even though we know statistically only 40 percent are going to respond well.  As we dig underneath that, we find that your pancreatic cancer and my liver cancer may actually be driven by the same genomic abnormality, but our systems express tumors different., You’re going to get one therapy and I’m going to get another therapy. If we understood it genomically, we’d both get the same therapy and avoid a lot of unnecessary therapy that we deliver through the system today.  This is one way to take significant cost out of oncology care and really accelerate and enhance the quality and effectiveness of care. That’s the most exciting thing we see in the future.

David Williams: I’ve been speaking today with Steve Bonner. He is CEO of Cancer Treatment Centers of America. Steve, thanks so much for your time.

Steve Bonner: Thank you, David. Take care.

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Stephen Bonner is CEO of Cancer Treatment Centers of America (CTCA). In this podcast interview he discusses CTCA’s integrative approach and its commitment to measuring and reporting quality. He also takes on a Reuters report that concluded CTCA’s claims of higher survival rates could not be substantiated, and questions the credibility of CTCA’s critics.

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David Williams interviews Cancer Treatment Centers of America CEO Steve Bonner [ 20:28 ] Play Now | Play in Popup | Download

The business and operational needs of health plans are changing so quickly that it’s no wonder they’re running into information technology challenges. At the same time plans are by their nature are conservative about changing how they operate and swapping out old systems for new ones.

In this podcast interview, Joe Marabito, CEO of ikaSystems lays out the complexities of the health plan IT world, describes how health reform is providing new opportunities for administrative innovation, and speculates about the role Accountable Care Organizations will play in transforming the payer world.

ika provides a variety of next-generation IT infrastructure to health plans and so has a front row view of the changes.

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By David E. Williams of the Health Business Group.

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This is the transcript of yesterday’s podcast with Castlight Health President John Driscoll.

David E. Williams:  This is David Williams from the Health Business Group.  I’m speaking today with John Driscoll, president of Castlight Health.  John, nice to speak with you today.

John Driscoll:  Great to be with you, David.

Williams:  John, we’re going to talk about two topics today.  One is the new Castlight Pharmacy product and another is Castlight’s emergence in my home market of Massachusetts with its first health plan deal with Harvard Pilgrim.

Let’s talk about pharmacy first.  What is this Castlight pharmacy product?  What is the need that you’re addressing?

Driscoll:  As you know, David, we are absolutely aggressive about making sure that consumers have real time information that allows them to make the best choice.  And we are focused on the lack of cost and quality information in marketplace.  That’s an entirely new area for consumers and patients.

The one area where consumers are ready and able to make smart purchasing decisions is pharmacy.  So we thought it was important to invest in a new capability to allow consumers to make decisions right after they’ve left the doctor’s office with their mobile device or when they’re searching on the Internet.

Consumers are very focused on how much drugs cost.  And many patients are trading off drug costs against their weekly budget.  So we thought it was important to invest in this capability and roll it out quickly because we knew that patients and consumers needed it now.

Williams:  Pharmacy, as you said, is an area that consumers are really ready and able to engage in it.  It seems like that’s partly because it’s a discrete product that they identify as opposed to going to a hospital and not knowing what set of services they’re receiving.  But it also is maybe because it’s an area where there’s been some focus both from health plans and from PBMs.  I know you spent some time in that industry.  So can you distinguish what Castlight is doing from what’ already out there?

Driscoll:  It’s clear in other categories where we are providing cost information for the first time to patients.  But even in the pharmacy world, even with all the information and tools that health plans provide, they’re not focused on providing real time information at the point of decision in a way that impacts consumers immediately.

That’s probably a function of the fact that at Castlight we have a major focus on consumer behavior. Frankly, this is all we do.  We provide the best tools with the best information. So much of how you get a consumer engaged and keep them engaged is providing simple consumer-oriented tools that are as sophisticated as a consumer needs.

It could be as simple as making sure they know the difference between branded and generics and home delivery versus a local pharmacy.  Those basic choices –and providing them in a way that consumers can act on– extends the value of their benefit at the point where they are given a script.

Those tools really don’t exist in the marketplace in a way that really engage the consumer.  There’s an art to putting together the consumer interface and the product and then making sure that we’ve got real time information that is directly relevant to where the people are in their benefit.

Williams:  Unlike with medical benefits, there seems to be a fair amount of competition at the retail level on drug prices. So you have Wal-mart, which kicked things off with the $4 generic program and you see it extended into some pharmacies that offering low priced Lipitor or free antibiotics.  Can that information be integrated into Castlight pharmacy or does that stand outside of the system?

Driscoll:  What we are focused on is what’s covered under the insured benefit. Any part of the benefit that employers are paying for is integrated into the tool.  And it’s integrated in a simple way to enable the consumer to make a decision at the point of shopping.

Williams:  Is there a connection between what you offer on Castlight Pharmacy and the medical part of the benefit or are they standalone tools that are used separately?

Driscoll:  They’re really standalone tools, but the great thing about pharmacy is the richness of the data and the fact that the consumers are ready to comparison shop. What’s hard is integrating in a simple way that enables the consumer with limited time to make a decision.  And that’s really what this component of the product is.  It sits on top of the traditional Castlight transparency product.

Williams:  Does Castlight Pharmacy serve the Medicare Part D market or is this more for commercially insured patients?

Driscoll:  Today, our pharmacy product is focused exclusively on the commercially insured, but we absolutely are going to be looking at Medicare and Medicaid, because there are opportunities for consumers to save in every market.

Williams:  My understanding is that with Castlight, a consumer would need to have their employer be a customer of Castlight in order to access the tools.  Is that the case with the pharmacy product as well or is it available to individual consumers?

Driscoll:  Yes.  The employer has to buy it. It’s through the employer purchasing that enables us to gain access to information that powers the tool and allows the employee to understand exactly how much is covered and exactly how much things cost.

Williams:  Let me turn to another topic: health plans. I think about Castlight as somewhat of a competitor or threat to health plans. You may be revealing information to their customers that they perhaps should have revealed themselves.  And yet it seems you’re starting to work with health plans, beginning with Harvard Pilgrim, which is often ranked as the number one health plan in the U.S.

Can you talk about what you’re thinking with health plans and then what specifically is going on with Harvard Pilgrim?

Driscoll:  First of all, I would say that health reform is a team sport. We look at all of the health plans that work with us as partners. We’re all driving better outcomes and lower prices; the vast majority of people in the health insurance industry want to do that.  We feel like we’re all playing for the same cause.

We will partner with health plans in small ways or large to deliver value for their covered lives.  And we’re very excited to be able to adapt the cost estimator, our technology and our approach and to work with such a great partner as Harvard.

We look at the health plan marketplace as a real opportunity for Castlight.  In some cases, we’ll be working with employers. In other cases, we’ll be working directly for the health plan and with employers in that marketplace.

For us, it’s just a variation on what we think is a huge need in the market place – for better information and an empowered consumer.  As it happens, there’s a complete values match between what Harvard wants to achieve in the market place and what we’d like to achieve in the market place.  They are very focused on transparency and may want to empower their approach to have Harvard Pilgrim.

Williams: John, it’s interesting to see that you signed your first health plan in Massachusetts, which is a market that has led the way with health reform. The Affordable Care Act was modeled on the Massachusetts plan.  We’ve also been quite active in transparency.  Did the legislation and the move in the policy sector toward transparency have anything to do with why Massachusetts is the first market you’re entering with health plans?

Driscoll:  There is no question that the health plans in Massachusetts are particularly progressive. And obviously, Harvard Pilgrim is one of the best and the highest-ranked plans in the country.  I think it is no surprise that we are finding great partners in the most progressive markets in the country.  What’s interesting about the Massachusetts marketplace is its employers, its legislators, as well as health plan leadership that are driving a much more transparent system.  And I think where you’ll see transparency not just on cost but also on quality and outcomes.  It’s also a place where there’s a lot of very interesting and enlightened thinking around how to compensate for value and how to measure value.  It’s really a laboratory for the rest of the country in health reform innovation.

Williams:  Yes, it’s interesting.  We also had one of the earlier all-payer claims databases in Massachusetts.  My impression is there’s been a lot of information put into that database. The plans have submitted that information, but not all that much has come out of it.  Does Castlight complement the all-payer claims database?  Is it a substitute for it?

Driscoll:  I think it complements the all-payer database.  There’s still a fair amount of data gaps in every public database that’s been put up, but every time another database is developed and is improved, it’s another step towards having a more transparent system. That means a fairer system, a more accurate system and a system where not just software companies are selling services, but the patients and doctors and health plans and everyone else will gain from having a system where you can measure and then drive better results.

Ultimately, Castlight is more interested in getting access to information that historically folks haven’t had access to, making it actionable for employers and employees in a way that helps them drive better outcomes and lower costs.  And as of today, we need to be able to get more information and provide it in a particularly elegant way and constantly improve it. The bigger Castlight gets, the more we know about the consumers and we can create tools that have meaningful impacts on cost and quality.

Williams:  You talked about health reform being a team sport. Clearly Castlight and health plans and employers are on the team.  Are providers part of that team as well and if so, how do they play?

Driscoll:  They are.  We’re only in the first few innings of transparency for employers and employees, but I’m not even sure it’s the first inning of transparency for providers.  The majority of providers want to do the right thing but don’t have actionable information.  They don’t have tools they can use.  They don’t have tools that are meaningful, that fit their workflow and that can furnish providers with better information on cost and quality.

One of the concerns I have about some of the more progressive markets like Massachusetts is making sure that providers have access to that same information that Castlight currently provides to employers. Without that, to compensate doctors and hospitals on performance metrics seems unfair.  We will only have a fair system that can function and create better performance if providers have access to the same kinds of information that Castlight is currently providing to employees.

Williams:  Obviously, physicians are under a lot of pressure.  They’re being asked to do things that they weren’t asked to do in the past and didn’t learn about in medical school. They’ve got a lot of requirements to adopt health information technology, a lot of compliance requirements, and an imperative to do more with less.  And as I look at a lot of information systems that are out there, the providers really don’t have such great access to the kind of transparency data that you’re describing.

What’s the solution there?  And how long does it take?  And are there ways to see milestones along the way that may indicate longer term success?

Driscoll: Providers are only going to use tools that are meaningful.  They want to save money for their covered lives and the patients they serve and they want to create better outcomes.  But they don’t have information right now and certainly nothing’s been built into workflow. I think the next step is working, these companies life task is working with health plans to provide their network participants better information and to make certain that it is meaningful, simple and doesn’t slow down the hard work that doctors are doing.

The promise of companies like us or the promise of technology is to create this frictionless change where people can actually do more with less hassle. If you can integrate software tools into physician and hospital practices with the kind of information that the health plans have, doctors will make wiser choices.  There’s a real opportunity right now but I’m concerned that without those kinds of tools, that putting doctors on new kinds of performance metrics like bundling, or bonusing them more on value is unfair unless they have the information to make wise choices.

Williams:  I’m a member of a health plan in Massachusetts, a different one than the one you described, and my primary care physician is part of a contract that does pay based on value. I’m wondering what kind of information would it be useful for her to have that she probably doesn’t now that could help me and could help her?

Driscoll:  I don’t know what information your doctor has access to, but certainly every doctor needs to have better feedback for the covered member that they’re taking care of, what’s covered and what’s not.  For the doctors they refer to, what are their historic outcomes, how frequently have they done certain procedures, how satisfied are patient, and how do they fit into an episode of care? In a fee-for-service world there are informal referral networks.  We want to create a system leveraging information that creates an informed referral.

Williams:  I’ve been talking today with John Driscoll, President of Castlight Health.  We’ve been talking about the new Castlight Pharmacy product and also talking about Castlight’s first health plan customer, Harvard Pilgrim, in Massachusetts.

John, thanks so much for your time.

Driscoll:  Thank you.

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Health care transparency leader Castlight Health has launched a tool to manage pharmacy costs and signed its first deal with a health plan: Harvard Pilgrim. In this podcast interview, Castlight president John Driscoll and I discuss:

• What the new pharmacy tool adds to the offerings already on the market from health plans and PBMs
• Why the first health plan customer is in a market (Massachusetts) that’s already a leader in transparency
• The role of health care providers in the transparency movement

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David Williams interviews Castlight's John Driscoll [ 17:17 ] Play Now | Play in Popup | Download

This is the transcript of my recent podcast interview with Healthbox CEO Nina Nashif. The company just kicked off its second business accelerator program in Boston with 10 companies, in conjunction with Blue Cross Blue Shield of Massachusetts.

David E. Williams:  This is David Williams, president of the Health Business Group and author of the Health Business Blog.  I’m speaking today with Nina Nashif, CEO and founder of Healthbox.  Nina, thanks for joining me today.

Nina Nashif: Thanks for having me.

Williams:  What is Healthbox and what unmet need was Healthbox created to serve?

Nashif:  Healthbox was founded in January of last year and was intended initially to support health care entrepreneurs by providing seed capital, mentorship, a rigorous process to help them think about their business and how they grow it, as well as support in raising money at the end of a four-month program.

As we’ve evolved our program Healthbox has also shifted its own business model. We believe that it’s not only important to support health care entrepreneurs, but it’s also important to serve as a catalyst of change within the health care industry by exposing hospitals, payers and pharma and other types of organizations to new and different ways of thinking about how to solve the industry’s greatest challenges.

Williams:  Is the process that you’re using generic?  Could it be applied within other industries or is there something different about innovation in health care that makes it so that you’ve chosen a particular approach?

Nashif:  It’s really important that we develop a process that’s relevant in the health care industry.  So as we thought about creating the Healthbox platform we thought about the different nuances involved in building a company in health care.  As we know, the health care system is complex.  There is often a difference between who’s buying the product or the solution and who’s actually using it.  There are so many different stakeholders and different revenue models that make sense depending on the type of organization you’re selling into.

Given all of the dynamics it’s important to work with a company throughout the lifecycle and to think about how are they building their business in the context of the industry that they’re selling into.  We’ve refined the process that helps entrepreneurs think about these critical issues and develop a customized product and a business that will scale in the industry.

Williams:  You’re based in three cities. If somebody would ask me to guess what those three cities were just based on the description of your business, I would have guessed Boston, New York and San Francisco.  But you’re in Chicago, Boston and London.

So tell me how you thought about those three places and also how you incorporate what’s going on in London to what’s happening in the U.S., considering that the US and UK health care markets and health care systems are so different.

Nashif:  I’m actually based in Chicago and so is Sandbox Industries, which is the organization that I was working for when I founded Healthbox.  Our first program was based in Chicago for that reason and it actually ended up being a great place to start Healthbox, because despite what people may think Chicago does have a very vibrant health care community. There’s the strength of many large hospitals, many associations, and there’s pharma present. Many different dimensions of the health care system do exist.

Our first program was in Chicago.  As a result of the success there we were asked by Blue Cross Blue Shield of Massachusetts to consider bringing this program to Boston and the rationale for doing that was their interest in engaging in the broader community.  There’s a lot of activity in Boston and a lot of strengths in the health care industry.  But a lot of the activity from an entrepreneurial perspective is really revolving around the universities. TechStars has a strong program here in Boston, the MassChallenge and all the resources that you know that exist in the community.

But from a health care perspective, there wasn’t really a single external platform that was tying together all the unique organizations that are interested in innovation in Boston.  So we were pleased that our second program launched in Boston just because all of the existing activity that’s going on and we’ve been really well received and very happy to be testing the model in a new environment and to be working across the region.

London was a strategic decision and our presence there probably happened a bit quicker than we initially expected. I lived and worked in London before and so making the transition there was quite easy for us, relatively speaking.  But health care is global and we always knew that we wanted to be a global platform. So as a stepping stone to the rest of Europe, London and the UK just made sense for us.

Williams:  How does the Healthbox program work?

Nashif:  The Healthbox program initially was modeled after the spirit of a traditional tech accelerator program.  We took a lot of the same components in terms of the seed capital that’s provided, although we knew that starting a company in health care requires more resources, not because IT companies and health care aren’t capital-efficient businesses, but because the sales cycle takes longer and requires just a little bit more business development time.

We provide $50,000 in exchange for 7% equity.  We have a national network of mentors that represent different parts of the health care industry that are available to provide strategic advice, make introductions to their network and other potential customers or experts that can help the entrepreneurs.

We also have a pretty rigorous curriculum or process that we put the companies through.  From the very beginning we’re actually going back to my original comment about helping these entrepreneurs understand their business model, refine their business model, think about it in the context of the health care industry. We help them think about who is the buyer, who’s the user, what kind of revenue model would make sense given what they’re trying to develop.

We have a proprietary process that we’ve developed and we put companies through the three –and now expanding to four– month process.  At the end we help match entrepreneurs to investors and help them think about the right customers as well as investors that can help them grow their businesses in the long-term.

So those four are the main components that make up the Healthbox program.

Williams: I know that Healthbox is pretty new and you just alluded to the long sale cycles that are inherent in a lot of health care businesses.  But with that in mind, can you provide any examples of success stories or organizations that have been launched or accelerated as result of going through the program?

Nashif:  Sure.  There is a company called SwipeSense that went through our Chicago program. Given that they’re a year out, they’re a really good example because they’ve moved themselves through the product fund-raising and business development cycle in the last year.

They focus on what they call hand-hygiene 2.0.  The lack of hand sanitization in hospital environments is a big driver of hospital acquired infections.  It results in more than 100,000 deaths per year and adds billion of dollars worth of costs to the broader health care system.

There are two amazing entrepreneurs who are graduates of Northwestern University’s design school. While they were in school came up with a small device that clips on to a nurse’s scrubs.  The company is called SwipeSense because as a child we always think that if our hands get dirty we’re going to wipe our hands in a downward motion on our pants in order to get whatever’s on our hands off. This mimics that gesture in terms of a nurse who needs to sanitize his or her hands would swipe their hand down this device that will be clipped on to their scrubs.

They came in to the Healthbox program with a prototype of this product already developed, and throughout the process of going through Healthbox and talking to a number of different experts they were challenged on what business they are really in. They evolved their business to become a software as well as a hardware business and went through a process of getting feedback in the market from focus groups of nurses in different hospital settings.

By the end of the program they were able to secure a couple of new pilot sites.  So as they came in to the program with two pilots, they left with six and now as a result of coming out of the program and continuing to network, they have ten pilots that are ready to begin.

Also, as a result of going through some of the focus groups and their initial pilot, they ended up redesigning or streamlining the device that they’ve created because the feedback that they got was that it just needed to be a bit smaller, needed to clip on in a different way.

They also built out their web application and have continued to gain customer traction, and they also raised more than a million dollars at a pretty strong valuation.  So they have accomplished more than they had on their own as a result of coming through Healthbox.

Williams:  You’ve mentioned before that you had evolved to change the Healthbox business model.  Can you talk a little bit about that evolution and what your current business model is?

Nashif:  Given that Healthbox makes investments in companies, we’re set up as a venture fund.  We are a for-profit model, unlike some of the other accelerators in the industry.  As I mentioned before we’re making a $50,000 investment in exchange for 7% of the equity in these companies.

We also have funds available at the end of each program that are used to make follow-on investments in the form of a convertible note.  But Healthbox makes money as a result of the companies being successful.  We’re incentivized to help these companies grow in the long-term and become sustainable and scalable businesses.

We have an upside in terms of when these companies potentially exit and that’s really how we’re compensated in the long run.

Williams:  If you look back in a few years from now, how will you know if Healthbox has succeeded beyond the dollars and cents?  Are there other measures that you might look at to say this has really been what you were hoping it would be?

Nashif: As I mentioned before, I think that the traditional accelerator measures their success based on the number of financings immediately after a company leaves the program.  The typical metrics are on how many companies have raised X amount of dollars, how many companies have added jobs. There is an economic development aspect of this.

There’s also the metric around how many companies are even in business one year to two years or three years later, given that we know that across any industry there’s just a certain percentage of companies that don’t make it.  And so I think for us all of those metrics are really important, but as I mentioned before we’re also trying to be an agent of change in the industry.

We measure our more immediate success also around how many companies get pilots and how many users they are attracting and whether they are actually able to gain attraction in the industry, because if they’re not doing that then the financing is going to be harder to get. Because I think venture investors are traditionally even more risk averse.  They tend to like to see the customer attraction and validation of the market before they’ll invest and so I think those are some early metrics for us.

We certainly value the relationships we have with investors and with the broader entrepreneurial community.  But for us to really effect change and be successful at supporting our portfolio we need strong relationships in the industry, at all levels of the industry, and we need to gain broader attraction with opening up the industry.  I call it “unlocking the knowledge” and unlocking the industry to entrepreneurs so that they can be successful.

We also need to work on the other end of the value chain. So what I would want to say five years from now is that we built a great portfolio of companies.  We’ve had one or two exits that we feel proud of and we have really strong relationships across the ecosystem.

Williams:  I’ve been speaking today with Nina Nashif.  She is CEO and founder of Healthbox.  Nina, thank you so much for your time.

Nashif:  Thank you for having me.

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Earlier this month at the HIMSS conference in New Orleans I sat down with Phil Fasano, SVP and CIO of Kaiser Permanente to discuss his new book, Transforming Health Care: The Financial Impact of Technology, Electronic Tools and Data Mining.

We discussed how the health care industry can use information technology to make health care more affordable, convenient and accessible. Fasano believes health IT can help completely transform the relationship between patients and providers.

Fasano looks forward to an era where a patient’s medical record is available wherever he or she seeks care, where empowered consumers use mobile devices to access customized, personalized information that they can understand and use.

Fasano was encouraged at HIMSS to see a greater emphasis on connectivity than in the past.

–

Interviewed conducted by David E. Williams of the Health Business Group.

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David Williams interviews Kaiser CIO Phil Fasano [ 11:33 ] Play Now | Play in Popup | Download

This is the transcript of my recent podcast with J.P. Fingado of API Healthcare.

David Williams:  This is David E. Williams from the Health Business Group.  I’m speaking today with J.P. Fingado, President and CEO of API Healthcare.  We are at HIMSS in New Orleans.

What problem does API address?

J.P. Fingado: We’re trying to solve several problems.  The first is around quality of care, so we seek to put the right people at the right place at the right time to achieve the best possible outcome for the patient.

The second piece is helping hospitals control their cost and optimize the use of labor.  So if we actually optimize across everybody in the hospital, across all their facilities through the continuum of care, we’re saving the hospitals millions of dollars through the deployment of their staff on an annual basis.

There’s a third piece that’s also very important, which is improving that satisfaction of their entire workforce. Allowing them to have more control over their schedules, over their interaction with their human resource system leads to happier employees, which in return, increases productivity.

Williams:  Here at HIMSS there’s certainly a lot of discussion about electronic health records and health information exchange. Meanwhile you have a couple of things that sound like variants on those.  You’ve got not an EHR but an EER and not a health information exchange but a healthcare workforce information exchange.  Can you describe what those concepts are and how they fit in to the goals that you’re trying to achieve?

Fingado: The electronic employee record is a single repository of everything about every single health worker in an institution.  We’re actually tracking before they even come on board.  We’ll start the data collection at the recruiting phase to understanding the competencies and the scenarios and the environments that workers have been in prior to joining an organization.

Once they come then we’re tracking all their growth inside of an organization.  We’re tracking where they work inside of a hospital, the time that’s being tracked, all their HR information, all their training, all their performance reviews.  We ultimately go to full succession planning.

Putting these millions of data points into a single record allows the hospital to effectively deploy those people and put the best people on the field at any point in time.

The other piece that we brought to market from an innovation standpoint is the healthcare workforce information exchange. We take all these records –imagine in a hospital two or three thousand people and the millions of data points– and we optimize that across the continuum of care and share the information across every facility inside of a hospital.

We’ve got a hospital customer, for example, Advocate Health Care, which over 200 locations in their network with tens of thousands of people that we help them optimize.

Williams:  Interestingly, you seem to be combining clinical information about patients in the hospital with this EER concept. If a client is using your system, how much of a difference can it make for the patients that are in the hospital?  Is it just a minor or incremental improvement or do you see something that’s more dramatic. And if so, how could you measure that?

Fingado: So scheduling a nurse is not like scheduling a waitress.  You can not just give every nurse three patients and call it a day.  There’s a huge benefit when you can match up the needs of the patient to the expertise of the nurse.  So think about it. If you are in the ICU and there was one nurse that had treated 50 patients with the exact ailment and another nurse that treated one, which nurse do you want?

It’s pretty obvious.  So when you start to do that you really drive higher quality across the board, a better outcome for the patient. Now you’re talking about huge results for the organization.  With reform, reimbursements are going to get tied to quality.  Poor quality will drop reimbursements.

So now we’re not only saving the money on the expense side, we’re actually increasing the revenue of the organization, now making it a healthier environment, which in turn helps patients as well.

Williams:  You’ve been describing the tracking of nurses and others from the time they are hired into the organization and maybe even beforehand. But a lot of these health care organizations are a little more complex than that. A lot of them use agencies or other sorts of outside resources.  So how do you address that situation where you have many personnel that are not actually employees of the hospital?

Fingado:  That’s a unique thing that we do that nobody else in the industry does. We don’t think in terms of employees.  When you look at a hospital you’ve got the full-time employees and part-time employees, but you have volunteers, you have contractors and you have contingent workers.

When we put in the system we’re putting in the system for all the health care workers in an institution.  If somebody calls in sick a nurse manager or a manager of any department can look at all the available resources in their department, they could look in the float pools, they could across the entire organization.

But with our systems they can also look at any contingent staffing companies that are in their preferred network and it will show them just the resources that fit the need based on licenses, competencies, performance ratings, as well as cost.  And for the first time, a manager can make an instantaneous decision about picking the right resource, not just their full-time employees but anybody that can provide the highest level of care to the patient.

Williams:  I want to ask a broader policy question that relates to what you’re doing. We hear about the shortage of nurses and in particular about baby boomer nurses that are going to retire, but at the same time we also hear that nurses graduating from nursing school are actually having a hard time getting started in the profession.

So you could see a situation where you’ve got a lot of inexperienced nurses who don’t get experience and then a lot of nurses that eventually retire. You also have some people who will come in and out of the workforce. It all seems very dysfunctional. Does what you’re doing contribute to getting nurses into the funnel and helping them to get experience?

Help me understand this combination of a nursing shortage overall coupled with the difficulty a new nurse has getting hired.

Fingado:  A very astute observation.  So that’s actually a big reason why we’re seeing a lot of demand for the systems. Hospitals are bringing a lot of the nurses in who don’t have a lot of experience and what they can do as part of the system is match those nurses with the experienced nurses, put them in scenarios where they can really learn and get up to speed quicker, and then over time starting to move them to more independent roles where they’re learning and training on different types of patients going forward.

It’s a huge issue and one reason why hospital administrations are starting to make a big technology investment in workforce management. They recognize that there’s going to be a big shift in the workforce over the next decade.

Williams: I’ve been speaking today with J.P. Fingado, President and CEO of API Healthcare.  We’re at HIMSS in New Orleans.  J.P., thank you very much for your time.

Fingado:  David, thank you and I hope you have a great rest of the show.

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