[00:00:01] Stacey Richter: "How Do Digital Health Vendors Deliver Patient Outcomes and Experiences?" Today I speak with Rik Renard

American Healthcare Entrepreneurs and Executives You Want to Know. Talking, Relentlessly Seeking Value. 

The Importance of Listening to Relentless Health Value

[00:00:25] Stacey Richter: Hey, Relentless Health Value Tribe. Thanks so much for being here this week. I gotta say, I really appreciate all of you who write and tell me that you kick off your Thursdays by listening to this show every week. 

You just pop open your app and you listen to the show. Because yeah, we're a pretty sure thing over here. If the guest was boring or if the guest was talking about stuff that I already know and probably you already know, the guest would not be on the show. So listening to Relentless Health Value every week is a hugely easy way to just keep up with what's going on and at the same time get a pretty holistic deep dive into how all of the various parts of the industry fit together and how they ultimately impact patients and anybody who is at risk to pay for their care. 

The Role of Guests in the Show

[00:01:08] Stacey Richter: One thing that you'll notice about the guests who we invite to come on Relentless Health Value, they are usually not the ones who are merely going to recite a very well curated point of view that is fully in line with some marketing pitch. It would be easy enough, honestly, it would be so much easier to just invite all of the bigwigs who we get pitched, like I get 50 pitches a day. 

From PR teams who want to get their executives to come on this show because they want to get their message out to you, Relentless Health Value Tribe, you, for sure, have a reputation of being industry movers and shakers. Although it would be super easy for me to phone it in and let them have their way with you, I've never been one to take the easy way. 

I want to find those individuals to be guests who are willing to share actionable insights, to actually tell the truth. I'm really not into someone hijacking this platform for their own self-interest when that self-interest is not aligned with anything that I would consider a win-win for patients. 

You'll probably find more actionable insights here than listening to talk tracks. Even if you're just listening to figure out what to include in your pitch to some of these industry insiders, I'm going to tell you that repeating their marketing spin or their party line, isn't probably going to sell much what they will say in public and what they really want to do are so very often, sadly at counterpoint. 

So come here for the real story. 

The Need for Digital Health Vendors to Perform Better

[00:02:32] Stacey Richter: Alright, so let's get to the conversation that we're going to have today, which is about and for digital health vendors or virtual care providers point solutions. They go by many names and also for anybody who is a customer of said solutions. If we're taking it from the top here, let me just make a captain obvious point. 

These digital health vendors, they kind of have to perform better than the traditional community health providers. Otherwise, they have no reason to exist, really, right? Purchasers would just go with the local gang of care providers. So then, what does perform better actually mean? Let's discuss. I'd say perform better means to offer better measurable patient outcomes probably, both clinically and patient reported. 

I'd also say it means to offer more affordability. Also, better engagement, accessibility, and maybe all of this at a better cost profile for purchasers such as employers or health plans that are taking on actual risk. So, if all things are equal, again, why the heck would an employer or other purchaser even bother? 

It couldn't even be considered, honestly, a member benefit from a regular benefit perspective if the local standard of care is superior or just as good. Now, if any clinical entity is looking to actually achieve better performance in any or all of the ways that I just mentioned, with any level of consistency, and in a way that is profitable for them and their investors. 

The Importance of Standardized Care Delivery

[00:03:59] Stacey Richter: You got to do a few things, and one of them is to design and implement care flows, care processes, pathways, again, you can pick a name and define it how you like. But bottom line, there needs to be a standardized way to deliver high quality care that is measurable. Here's Dr. Ali Khan, who is chief medical officer over at Oak Street Health talking about this. 

He says: “At Oak Street Health, we think about standardization as a 70/30 split. It is important that the largest aspects of what your care team does are standardized. The bulk of the work that we do is to make sure not only that we set standards, but that we also disseminate standards, coach standards, review standards, and then update and iterate those based on the things that we've learned. Our standards are constantly evolving and improving.”

Okay, so said another way, gotta have and use care flows. This doesn't seem like rocket science, but yeah, that is a blues clue for what's coming up here. So how are most digital health vendors doing when it comes to care flows performing better? 

Survey Findings on Care Flows Among Digital Health Vendors

[00:05:05] Stacey Richter: Rik Renard and Thomas Vande Casteele from Awell have done a survey with a group called Health Tech Nerds and have dug into the usage of care flows amongst specifically digital health vendors. 

Given everything after-mentioned, I wasn't surprised to hear that 84 percent of digital health vendors use care flows in 2023. 84%, but it was kind of shocking, to be honest, to hear that in 2023, only 16 percent use care flows that they feel are based on evidence and the science of medicine. If you don't follow the latest science, then outcomes, both clinically as well as probably patient reported outcomes, won't be of the perform better variety. 

Oh boy. Also, only 7 percent of respondents have the ingredients to build a 360 degree picture of how their flows impact finances and quality of care. And I say that because only 7 percent can and do measure four things.  

And here's the four things. Number one, performance metrics such as patient engagement and compliance rates. 

That's number one. Number two, financial metrics such as revenue per patient slash per member. Number three, clinician reported outcomes, and number four, patient reported outcomes or PROMs. Seven percent. That is less than one out of ten of these digital health vendors. There are other higher, but still pretty sad, percentages that measure combinations of the above four factors, but only seven percent measure all of them. 

And if you don't or can't measure what you're doing, then you wind up with what my guest Rik Renard calls black box care, which is another way of saying if you don't measure it, you can't manage it? Because think about it, if you have black box care, well, the solutions to perform better are also a black box. 

If you don't know the problem, good luck finding the solution to it. A few things as we contemplate all of this. First of all, as Stacy Mays pointed out to me, if that digital health vendor is working for different payers or different purchasers, those different payers or purchasers might demand different care flows, and those different care flows might ladder up to different ultimate goals. 

The hard part about being a digital health vendor employed by a payer or purchaser is that your customer is the boss of you. So, complication. The other relevant conversation I had is with David Claud, who told me that many employers slash customers evaluating healthcare vendors, like on site clinics, do not have the clinical expertise to meaningfully evaluate the quality of care, so they tend to focus more on cost and service. 

When this happens, you kind of wind up with a race to the bottom where being really nice and being cheap are more important than actually delivering high quality care that no one can measure anyway. And the last point that I'll bring up is what Sanat Dixit, MD, brought up the other day, and I love how he put it. 

He said, Doctors don't tend to caucus well. And coming up with care standards and best practice care flows means getting everybody to walk the same pathways. 

The Challenges of Being a Digital Health Entrepreneur

[00:08:09] Stacey Richter: Bottom line, it's really pretty hard to be a digital health entrepreneur these days. Coming up here, I have a conversation with Barbara Wachsman. 

Barbara was the Managing Director over at Disney. She's worked for PE as well as being Executive Director over at PBGH, the Purchasers Business Group on Health. So that's upcoming in a couple of weeks. But the point that Barbara makes, which I think is really apropos here. She said that in the United States, we desperately need really talented and great digital health vendors, great entrepreneurs, ones who actually can deliver real results and do it at a fair price. 

So my hope is that we get better at these care flows. Now I say all this to say, let's take the conversation today as an opportunity for both entrepreneurs, vendors, as well as customers like employers and other purchasers or payers. It's an opportunity to recognize and work together. Where there's room for improvement and also place value on achieving that headroom. 

As I mentioned earlier today, I am speaking with Rik Renard from Awell. Rik has a background in nursing and healthcare management. He joined Awell four years ago and now manages strategic accounts. My name is Stacey Richter. This podcast is sponsored by Aventria Health Group and all of the above names and links that I mentioned are in the show notes. 

Interview with Rik Renard

[00:09:22] Stacey Richter: Rik Renard, welcome to Relentless Health Value.  

[00:09:24] Rik Renard: Thank you so much for having me, Stacey.  

The Importance of Well-Mapped Patient Journeys

[00:09:26] Stacey Richter: If I am a clinician or the boss of clinicians, why do care processes or care flows even matter? I have a lot of priorities. I am being pulled in a lot of different directions. I may be understaffed. Why should I be investing any time, really, in creating care flows or care processes? 

[00:09:48] Rik Renard: It's a question that I get asked a lot. To me, it feels like the healthcare industry often overlooks the power of well mapped patient journeys. To give you a personal example, why care processes matter, so my grandfather recently died of lung cancer. He had no care pathway whatsoever during his journey. 

We needed to re-explain and re-explain. Things again and again, and then he suddenly moved to a different type of chemotherapy, but it wasn't communicated with me or my mother. And we just needed to have a lot of phone calls with doctors, with nurses asking like, okay, but do you know about his background as a heart failure patient? 

Sometimes they didn't know that. Do you know that he also has kidney failure? Most cases they also didn't know that and it was a very frustrating journey. One that touched me emotionally as well as you can imagine and especially when that care journey is not very structured and it's very chaotic. 

[00:10:42] Stacey Richter: Summing up what you just said there, there's important reasons from a patient outcome standpoint like it would be very dangerous actually for a patient if it's a lung cancer patient, but there's comorbidities. So someone's got kidney failure and they just got prescribed a drug that is metabolized in the kidney and they're now not going to die from lung cancer, they're going to die from kidney failure. 

Like there's a lot of reasons from a patient standpoint. Why it's so important that a clinical team has figured out best practice ways to work together. Also, a patient's family or care unit is usually uncompensated, and most have day jobs and or are not medical professionals. If the care team doesn't have a care process or a care flow, the patient will need to sculpt their own out of a bunch of fragmented bits and pieces, and if they don't succeed, they're going to get suboptimal care. 

The Role of Standardization in Care Flows

[00:11:32] Rik Renard: There was a study done in 2013 that showcases that by implementing these care processes or care flows, you reduce your clinical burnout and you have better teamwork. Why is that? Is because when you have these care flows designed, and implemented, the team knows very well what needs to happen when. There is no question like, hey, who needs to pick up this and who needs to pick up that. 

[00:11:54] Stacey Richter: Summing up, if we could think about this from a, let's just try to prevent clinician burnout standpoint and obviously we're talking about care ops and clinical pathways, etc, that are done well. I think to a certain extent care processes and care flows and even pathways have gotten a really bad reputation. 

We need to probably take a step back on that and realize that things done poorly should have a bad reputation, right? And a lot of the issues that are very well founded and cited are a result of things being done not well, but we don't want to throw babies out with bathwater here. If you were looking at a good, well done pathway, what are the components that a good pathway is going to have to include? 

[00:12:39] Rik Renard: So I think the first one is based on the best available evidence. This can be based on both internal data, so data that you collect from your patients, or external data, which can be the guidelines, research, CMS requirements, etc. What's interesting there is that, in our report, which we'll also talk about is less than 16% of all the people that we surveyed. So all the tech enabled care organizations mostly use new medical research to drive these iterations.  

[00:13:07] Stacey Richter: 16% you said 1, 6.  

[00:13:09] Rik Renard: 16. One six, yes. Which is a major red flag, but we can discuss it a little bit later in the show. Then the second point is real time access to data, which is a huge pain point. 

And what's interesting there is that yesterday, Yubin Park, Chief Data Officer of ApolloMed posted an interesting quote. The frequency of intervention improvement depends on the frequency of data refresh. And that's something that's lacking in healthcare. For example, if you are an ACO and you want to understand your patient satisfaction results, you get that by the end of the year from the government, from CMS, like here is your CHAP score and we will punish you on that or you get more money on that, which is absolutely crazy. 

Every hospital, every care provider whatsoever should have a dashboard with real time data on the most important metrics like HEDIS, for example. That's, for example, the problem that ApolloMed is trying to solve with their technology stack. And then the last thing is not like a typical tool set. 

It's more a mindset and it's a continuous improvement mindset, which is also often lacking. And I think one of the reasons why care pathways to your point got a bad reputation is because people think that a V1 needs to stay a V1 forever and that we need to base our pathway based on a scientific research paper and then we maybe iterate every 10 years or so. 

[00:14:32] Stacey Richter: V1, meaning version one, like you create a pathway and then assume it's perfect. The end. There's not an intention or an overall plan in the organization for when and how care pathways can and should be updated to align with new evidence or just learnings from the people who are implementing.  

[00:14:51] Rik Renard: Where we should go is this continuous improvement mindset and being more agile. 

It's all that you need to have one big gigantic care pathway defined from day one. Start small and iterate and become bigger or grow bigger from there. But more importantly, continuously to challenge the pathway or the flow that you've designed and find ways to make it better every day.  

[00:15:14] Stacey Richter: There's two words here, and I just want to make this clear. 

One of them is, what is the pathway, i. e. what does the science say? And then the care flow is how our organization follows that pathway as a team. And I think one of the things that you're saying is that if you look at what is the underlying pathway that we are trying to make sure, or maybe a synonym would be the treatment plan, you know, like really trying to make sure that patients that meet a certain criteria get best practice care. 

There are times when that might be less clear, like whether it's the right treatment plan and there's times where that's really clear, like for diabetes management, etc. There are things that have to be done for it to be good care, like the patient gets eye exams on a regular basis, they get foot exams, these things are kind of inarguable, but whatever that care flow is the care pathway that sits underneath it has to be based on evidence and what your survey concluded is that about 16 percent of the time that is true. 

I also could see that there are payers in the mix here. You probably want to make sure that your pathway was based on CMS or payer quality guidelines because otherwise you're going to be trying to retroactively backfill. So probably that's important. And then you'd have to standardize it at least to the degree that it's not a black box. 

It'd have to be standardized in a way that can collect outcomes. You were saying, in addition, that there has to be, as part of this, some way for the clinicians to have access to data because how are you supposed to figure out what the best treatment plan is if, for example, you have a patient with kidney failure, right? 

How do you know that? So there has to be some kind of data capabilities as part of this. And then just the mindset, right, like just the idea of continuously improving, you look at the outcomes, you evolve. So there's a bunch of what good looks like aspects to this whole thing. 

The Results of the Care Operations Survey

[00:17:16] Stacey Richter: You had mentioned that some of the information like that 16 percent number, which is horrifying, but that 16 percent number came from a care operations survey that you did. 

So let's talk about that for a sec. Who answered that survey?  

[00:17:30] Rik Renard: We surveyed 235 people from various roles. So some are clinical operations, some are business ops, product managers, clinicians, data engineers, and then just software engineers as well. Most of them were based in the US and then most, mostly or tech enabled care organizations. 

So think about like the VC backed care organizations that provide care 100 percent virtually or partly virtually. So in the mix, we have no traditional health systems whatsoever. It's really the stack enabled VC backed care organizations that, that answer to survey.  

[00:18:05] Stacey Richter: Who you were interviewing, as you just said, it wasn't traditional provider organizations. 

It was these tech enabled ones who talk repeatedly. I mean, this is striking to me, actually, that a lot of these entities are venture backed and I'm sure the front page of a lot of their PowerPoint presentations is, let's do things scalably and repeatably. And yet, in order to do anything scalably and repeatedly, you'd have to have a process. 

So it's kind of crazy to me, the numbers that you're like, just that 16 percent number here. How many of them were actually using, I mean, maybe they were using care flows, but they just weren't based on evidence. How many of them are actually using care flows?  

[00:18:45] Rik Renard: So about 84 percent of the people that we interviewed adopted care flows. 

That was 80 percent in 2022. So it's a 4 percent increase. And I think the question there is, what does it mean exactly? Because does it mean that they documented the care flow somewhere or does it mean that they practice it and use it every day? So that's the limitation of our survey right now. The answer is we don't know. 

So what we do know is that there is a spectrum when it comes to using care flows. So on the left side of the spectrum, we have all care flows live on PDFs or in Lucid charts. So I was talking to an organization a few weeks back. They are treating more than 500,000 patients. And everything, literally everything lives inside a Google Sheet and then the Google Sheet has columns and then, for example, they have a link to a diabetes care flow or they have a sheet to a heart failure care flow. 

And then when you click on that link, you just get referred to a Google Doc. So when you as a patient are seeing a primary care physician within that organization, and you have a teleconsultation, what will happen is on the left, you will have the consultation and on the right, you have a provider that is following a Google Doc with a certain care flow. 

Another example is we had an MSO that I was talking about a few months back. And she spent more than three months designing six care flows for chronic diseases like COPD was one, diabetes was one. And I asked her, okay, so now you spend this time designing these care flows, which is amazing. It was based on scientific evidence. 

She did it together with a doctor. She did it together with some nurses. And I asked, how are you now going to implement this care flow into clinical practice? And she told me, I will just fax the care flows. It's literally a doc. I will fax the doc to all our PCPs and just hope and pray to God that they adopt it. 

That is a reality where we are operating in. And it's not only for MSOs because his MSO was a bit more traditional, but to me, many enabled care organizations. What they really are, are companies that use spreadsheets in a probably more smarter way than traditionals. And instead of paper, they use Google Docs. 

[00:21:12] Stacey Richter: I guess kudos to both of them for doing something like, I mean, maybe it's a minimum viable product. Maybe they're in the beginning stages and they actually are going to evolve. But I certainly could see that even if you had a Google Doc, you definitely have a playbook of some kind, which points for that. 

And then on the other hand, as you said, you had somebody that really took a lot of time documenting this patient journey and was still using the fax machine. I guess, again, kind of par for the course. And so better than nothing. For sure, because you're going to avoid some of the issues that we talked about when you have nothing. 

On the other side of the spectrum, what do you think the leading edge, what are those who are really good at care flows doing?  

[00:21:52] Rik Renard: Yeah, so I organized the panel a few weeks back about clinical adoption of care flows and there we had Jessica Green, the VP of operations or clinical operations at Thyme Care. And the one thing that she told me is that the product should inform the care flow. 

So it should really be your product saying, Hey, you have your diabetes patient that's scheduled their annual wellness visits. This is the data that we have in the EHR, based on the data, based on the last results. These are the next steps that we suggest to you.  

[00:22:29] Stacey Richter: So let me clarify here. We're talking about virtual care providers. 

In this context, if we're considering that what the value prop that is being sold is patient outcomes. If you have a product being sold over in one corner and then kind of like care flows in some other silo somewhere else, that's not realistically going to work. How is the product going to produce any kind of consistently excellent clinical outcomes? 

It doesn't even make sense. Then the last step, the product has to be integrated and integratable into provider EHR systems.  

[00:23:04] Rik Renard: At Thyme Care, they showed me their product. It's exactly that. So it's a non-engineer that designs a flow and then once it's designed and it's a protocol. The product team, they then import that flow into their EHR and then once it's live and validated. Then the product gets used or the care flow gets used and adopted immediately because it's really inside the EHR so that the provider doesn't need to leave the EHR to get informed. 

And it's really based on the latest data from that specific patient and Thyme Care is a good example. But our customers, because that's partly what we are building with Awell, BetterHealth, for example, is a mental health provider. It's the exact same. So it's a non-engineer, a program manager that designs these care flows. And then the care flows are integrated within their EHR.

And then the last example, Wellings, it's also an Awell customer they are operating in COPD and they have multiple care flows designed in into our no-code editor. What happens is the clinical person designs the flow then they click on publish and then we integrate that with their EHR and then it's really integrated into their system and they actually showed this care flow integrated into their product to the payer because they were trying to sign a big payroll contract and the payer said I never have seen that, but because of the fact that your care flow is embedded into your product, I know that your providers will follow it because the jump to adoption is much lower. 

And two, I also know that your organization is set to scale because that's mostly a question that payer ask is, okay, you're now treating a hundred patients. Can you treat 10,000 patients? In most cases, the answer is, I don't know, but if your product informs the care processes or the care flows that you have designed. 

You need to spend less time on training and you need to spend less time on worrying if they really follow the protocols or the flows that you've designed.  

[00:25:04] Stacey Richter: So it's interesting what you're talking about. The people that you're working with, they're selling a product and what that product is, maybe it's a point solution that consists of some technology. 

But also clinicians who are driving that technology. And I think the point that you're making when you say the product has to embed the care flows or inform the clinicians, to create something which is repeatable and scalable. The product itself has to embed care flows that incorporate some level of standardization that incorporate a way to measure all this stuff. 

Otherwise, your results that you can promise, whatever would be measurable is going to be very, very dependent on the individual clinician. For more on this whole topic, do listen to the show with Bob Matthews from a couple of years ago. That was episode 315. It's actually really interesting, that show 315. 

If you do not have anything standardized at best, you're going to hit about 70 percent of what is possible just because there's going to be bad clinicians and great clinicians and it's going to wind up averaging out. And you had mentioned Thyme Care, which is time like the spice, T H Y M E Care, Jess Green, they do oncology, you mentioned Wellings and also BetterHealth, which is mental health. 

So in many different clinical scenarios, obviously, this is still something for sure. And if you can do it, one of the things that clinicians are always very concerned about is making sure that it doesn't become an administrative nightmare to do the right thing. So it sounds like by embedding these things in the EHR, it becomes less burdensome on the clinician and anytime something becomes less burdensome, the easier it is. We had Emily Kagan Trenchard on the podcast and she very clearly said, people will do what is easiest, you know? So if it's the easiest thing to follow the care plan, then that is what is most likely going to happen. 

[00:26:59] Rik Renard: One maybe big caveat here is obviously whenever you implement the care flow and you have your care flow or your product informing the care flow, it's crucial to get to adoption is also the fact that you need to respect the autonomy of the physician or the doctor. Because at the end of the day, you can have a very defined or well thought through care flow, but not every patient is the same. 

Every patient is unique. So, allowing your providers to deviate from the care flow based on their clinical assessment is also super important to get that adoption. And Ali Khan, which is the Chief Medical Officer of Oak Street Health, he told me that they think about standardization as a sort of 70/30 splits when it comes to care flow. 

So, it's important that the largest aspects of what your care team does are standardized because, again, from the data and the data quality and improvement and measuring. But the bulk of the work that we do is also make sure that not only that we are following the standards, but then we can also deviate from the standards based on what the patient's unique journey has been.  

[00:28:10] Stacey Richter: Yeah, absolutely. And I think what we're talking about right now are potentially barriers, maybe a better word is considerations as we contemplate these care plans. And I kind of alluded to this earlier, Dr. Robert Pearl said something that was really fascinating on the podcast about this. 

He said that what we want to make sure is that based on patient preferences, there is the ability to treat the patient according to that patient's preference. He said, what you don't want to have is that it's according to the doctor's preference, especially if there's science behind it, then it should be clear what that treatment paradigm should be. 

And we shouldn't have deviation from something that there's science, which I mean, I could think as a doctor, right? Like there's how many millions of patients of literature that comes out every single day. Like to, as a team, be able to cull through all that literature, figure out what the care flow is then based on that literature, I could see that it actually could be quite time saving as long as this was done well. 

And I think this kind of keeps coming back to like, you can do this well and it's great or you could do this not well and it's terrible. That's kind of my, one of my biggest takeaways.  

[00:29:21] Rik Renard: And I also think the second takeaway is If you don't just do something at least map your care processes because we have the 84 percent of adoption of care flow, but it still means that 16%, so 1, 6 percent of the care organizations have no care flows documented whatsoever. 

So it's really patient comes in, provided us whatever they got learned 20 years ago, patient goes out and they have no idea if what they did made sense, it was clinically correct or whatever. So If you based on this conversation think, damn, this is a very hard job and I don't have time to do that. 

Just document something to your point, Stacey, even if you are only have this care process designed in a Google Doc, you're already ahead of the curve and doing much better than 60 percent of the other people that we surveyed.  

[00:30:14] Stacey Richter: Was there anything that was really shocking about the care operations report? 

I mean, besides what we've already talked about, was there anything that was really shocking about the report that you did? Is there anything that we didn't talk about that really threw you for a loop?  

[00:30:27] Rik Renard: 60 percent said that they don't know or they are not measuring anything, which, yeah, is not even acceptable or shouldn't never be acceptable in health care because in health care you have the obligation to know whatever the care that you are providing is working and anything less is really unacceptable. 

The Role of AI in Care Flows

[00:30:45] Rik Renard: It's like driving a car blindfolded and hoping you won't crash because you have no data on your clinical outcomes whatsoever.  

[00:30:52] Stacey Richter: That is pretty shocking. And again, as you contemplate what good processes all do, they achieve some sort of goal, right? There's just, there's certainly best practices and care operations just like anything else. 

So is AI the answer here? I mean, I could certainly see that there's probably some futurist who's thinking, you know what, I'm just gonna put this off because at some juncture AI is just gonna be able to do it for me.  

[00:31:18] Rik Renard: Maybe a note to everyone that is listening, it's funny to see that. So many health tech companies are like boasting about they have cutting edge AI technology to triage patients and to do care coordination. 

But then when you look under the hood, you will find a team in the Philippines handling tasks manually. So first, let's be intellectually honest about AI and how AI is going to change this journey. What I think the biggest problem right now is the simple concept of garbage in is garbage out. We know what we need to do. 

We need to design these processes or care flows more efficiently. We need to design these based on scientific research, but the problem is that we don't have the right inputs. We lack a lot of data and the data that we have is from low quality. That AI right now is probably not the right solution because it will not get there. 

But once we have data and we have companies like ApolloMed that are really doubling down on data quality, then AI will definitely, definitely help there.  

[00:32:20] Stacey Richter: You made a couple of interesting points. One of them is that there's maybe some, you said intellectual dishonesty, where there's a pitch deck and it talks about AI. 

But if you actually look at what they're doing, they have a gigantic facility in the Philippines or something like that, where they're paying people to be the AI engine. So it's not really artificial, it's human intelligence. Yeah. So what is actually going on there? And is it all marketing? And then I think the second point that you're making is you actually probably can't do in AI anything unless there's enough data to train the engine on, but if you haven't standardized care flows, then you're going back to the earlier points that we're making, then you don't have the information to know what the better way to do it is. So you get yourself into this catch 22. I was reading J. Michael Connors, MD, wrote on LinkedIn about this. I just found what he wrote because I thought it was great.

He wrote: “There's an overestimation in artificial intelligence's role in rectifying workflow inefficiencies. Instead, we should aim to eliminate redundant tasks, embrace a less is more philosophy for smarter workflows and patient centered care.” Which I think is also. effectively what you're saying. 

[00:33:35] Rik Renard: I was talking to a mental health provider. One of the questionnaires that is commonly used in mental health is the PHQ 9, which is a mental health screener. 

And they published research showing that with their services, they improve the PHQ 9 score. And I asked her then, okay, if you have that data, does that mean that you continuously collect that data and then continuously see where in which states or which provider have a better PHQ score than others? And she said, no, no. 

We just collected that data for the research paper. We're now back to usual and we don't collect it anymore. And that's a very good example again of like, if you want to use data and you want to train indeed your models. You first need to have data and you need to have quality data and that's really lacking right now. 

So what we should do is first get the foundations right and then leverage AI to improve that 100x because that's really the promise of AI.  

[00:34:31] Stacey Richter: There's a difference between trying to figure out how to improve your patient outcomes and write a paper. I think is an implicit point that you're making, that like, what's your goal here? 

To do a white paper or to actually transform, to do some kind of practice transformation or something like that. And obviously, in the case that you just mentioned, their goal was to write a paper. This isn't, by the way, the first time that I've heard this. So if I'm an employer, and I'm listening to this whole thing, and I'm thinking to myself, how would I potentially use this if I'm vetting vendors? 

I think one thing that I would do is ask to see their care flows and ask a lot of questions about what they're doing and how. Maybe even ask to peer over the shoulder of one of the clinicians and look at their screen while role playing with them, being a patient or something. Rik Renard, where can people go to learn more about Awell if they're interested in learning more and or get their hands on this report? 

[00:35:22] Rik Renard: and then the report is on and then people can find me on LinkedIn and also on Twitter. I'm also a frequent Twitter as well, or should I say X?  

[00:35:33] Stacey Richter:,, and Rik Renard will put links in the show notes to LinkedIn and X, I guess. Perfect. Rik Renard, thank you so much for being on Relentless Health by you today. 

[00:35:47] Rik Renard: Thank you for having me, Stacey.  

Conclusion and Final Thoughts

[00:35:49] Stacey Richter: So let's talk about going over to our website and typing your email address in the box to get the weekly email about the show that has come out. Sometimes people don't do that because they have subscribed on iTunes or Spotify and or we're friends on LinkedIn. What you get in that email is a full and unredacted, unedited version of the whole introduction of the show transcribed. 

There's also show notes with timestamps just apprising you of the options that are available. Thanks so much for listening.