If you’re going to lead an organization through a merger, the one thing you can’t be afraid to do is step on few landmines, says Bobbie Byrne, who encountered several during the union that created Edward-Elmhurst Health three years ago. What leaders can do is to be sensitive of the differences that exist between cultures, and keep the lines of communication open. In this interview, she talks about how to navigate partnerships with competing organizations, how her own experience as a pediatrician factors into her rollout strategy, how getting people to think “Epic first can be both a blessing and a curse.” Byrne also discusses her new role, which is a reflection on the organization’s strong focus on consumer driven health, her thoughts on managing expectations, and what she considers to be the “most fun part” of her job.
- EVP of Consumer Driven Health
- Engagement strategy — “We need to keep pulling people along and showing them the convenience.”
- Learning curve with video visits
- Reflecting on merger: “You’re learning another organization’s culture and trying to create relationships really quickly.”
- Waiting to get Elmhurst on Epic
- “You don’t know each other well. You don’t know the land mines.”
Managing big expectations
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There is not really one consumer anymore. My 91-year-old mother is very different than my 18-year-old daughter in the way that they consume health care, and the way they want to consume health care. We really need to be responsive to the different segments of our patients as they really do act more like consumers.
I do think we are ready now. I think from a technology perspective, from a patient interest standpoint, and from a provider interest standpoint, I think that we are there. So even though people have been talking about video visits for really a long time, I feel like there’s just enough coming together that we can do this.
In some other organizations, I know that people want things to be really fully baked before you roll them out. We have no problem piloting, and no problem saying, ‘That was a bad idea. Let’s not do that again.’
You just don’t know each other very well. You don’t know the land mines, you don’t know how things really get done within another organization, and you really rely on those things within an implementation.
You have to spend a whole lot of money to get onto a single platform, to get onto a single system, a single network, single email. You have to spend a whole bunch of money before you ever start seeing savings. I think that’s a big education piece for myself and for my peers.
Gamble: One of the other areas I wanted to touch on was your new role as Executive VP of Consumer Driven Health. It seems like something that should dovetail pretty well with the CIO role, but can you just talk about what this role entails?
Byrne: It’s interesting because I had been talking about this role with our CEO, Pam Davis. We were trying to figure out exactly where the boundaries of the role are and what types of things we should be doing. I was describing it to a colleague in the organization and they asked, ‘What does this mean?” So I was talking a little bit about some of the strategies and they said, ‘Oh, I didn’t know that that was consumer driven health. I thought that’s just the way we did things.’
I think that’s part of it; we really pride ourselves in moving quickly, tolerating mistakes, failing fast, moving on and trying something new and different. So with this role and this consumer driven health team, the concept is that healthcare is changing, we absolutely want to be leading in some areas and fast following in other areas, and we want to make sure that the focus on the consumer is first and foremost as we’re making some of these changes. It’s not a total left turn for the organization. It’s just a continuation of what we’ve been doing.
We really think of it as sort of a couple of different categories. One is, how do we increase access — how do we make it easier for patients to access our system? So there are a whole bunch of things around online scheduling, chat, patient engagement, and access type of things. The second piece is virtual care, which is video visits and figuring out how do we do video visits in all of these different kinds of categories. And then the third area is really around pricing — pricing transparency, selective discounting, how do we respond to the consumer who is increasingly paying a lot more of their healthcare dollar with high-deductible plans, etc.; how do we really appeal to that kind of consumer?
Underlying it all is the idea that there is not really one consumer anymore. My 91-year-old mother is very different than my 18-year-old daughter in the way that they consume health care, and the way they want to consume health care. We really need to be responsive to the different segments of our patients as they really do act more like consumers.
Gamble: Right. I can imagine that’s a difficult thing to get a handle on because, like you said, we’re talking about a really huge variety in terms of patients. With the youngest generation we’re just seeing so much more engagement than ever before, and I’m sure it’s a lot to stay on top of those various needs.
Byrne: And I would say that it’s not even just generational, but it’s almost even within the generations. The market segments are more and more personalized. Months ago we used to have these arguments about whether we should be really involved in wearables and Fitbit and how that kind of came into the EMR and those types of things, and then you realize it is a small segment of the population who is very excited about that. That doesn’t mean that our entire strategy is around wearables, because that would be silly — that would be leaving out a huge portion of the population, but we need to have something for that small segment of the population that’s really, really into their Fitbit and wants to make sure that their Fitbit record and their activity record is in some way linked with their medical record.
What it ends up being is a huge list of different initiatives that hit a segment of the population — even something like online scheduling, which you would think is for everybody because nobody books an airline ticket on the phone anymore, but it’s not for everybody. Not yet. We have to let that evolve and educate people that it’s available and get them to use it.
Gamble: So it’s just really an ever evolving strategy.
Byrne: Yes. I think we are trying to pull our patients a little bit along with this. I think I cannot imagine why anybody for a routine appointment would want to pick up the phone when they could just go onto our website, peruse the available appointments for their physician, compare it with their own work and family calendar, and pick the time and location that works best for them. To me, I can’t even imagine why I’d want to sit on the phone and do that. But we just need to keep pulling people along and showing them the convenience.
Gamble: Right. I want to get into a little bit more about some of the virtual care offerings. This is something that I think seems to be ramping up a bit again and I just wanted to talk a little bit about some of the things you’re doing there. You mentioned video visits.
Byrne: Yes. Video visits, I will say, are a challenge. I do think we are ready now. I think from a technology perspective, from a patient interest standpoint, and from a provider interest standpoint, I think that we are there. So even though people have been talking about video visits for really a long time, I feel like there’s just enough coming together that we can do this.
What we have done so far is launched low acuity video visits, which would be rashes, colds, flus, sinusitis, UTI, those types of things. We’ve launched it only to our employees and for no charge. That’s because we really want to get some adoption and really start to learn quite a bit about the pace and the cadence of how video visits work. The clinicians that we have on the other end receiving these video visits are advanced practice clinicians, so APNs and PAs, who actually are currently located in our retail sites in Jewel Osco stores, which is a grocery store/pharmacy. We have 13 Jewel Osco locations, so we have a fair number of clinicians that are out in the retail sites who also can be set up for video visits.
We’ve only been doing this now for about a month, but the things that we have learned even in a short timeframe are really tremendous. There are certainly some technology issues, especially as you’re trying to get connectivity through a camera. There’s no doubt you need to troubleshoot some of those. Patients are not always 100 percent sure what’s appropriate for a video visit, even if we put the list of types of complaints on the screen. And the clinicians themselves are learning how to do video visits and how do you do a physical exam over a video. It’s very different. So there’s a fair amount of learnings that we’ve already gotten from these on these low acuity visits. I think as we do our next round of visits, which will be behavioral health and some chronic care conditions, I think we can take the learnings from this first pilot and translate them.
The other challenge that we’ve taken care of because these are our employees and we’ve made them free, is the whole payment mechanism. At least in our state, it’s a little bit unclear. Video visits are not covered under most insurances as an in-person visit would be, and so trying to figure out where the dollars flow in this scenario is interesting.
I keep saying it’s the return of cash to healthcare. Some people are very likely to be willing to pay between $30 and $50 for a video visit if it means they don’t have to leave work, take their kid out of school, and do all of those things. The convenience might be there. But for some of these other mechanisms, people may not be willing to pay cash for them. So we have to figure that one out, too. That’s not always clear.
Gamble: Right. That’s interesting, and it seems like a smart way to kind of pilot this on that level and be able to apply some of the lessons learned. Because this has been talked about for a while but it needs that jump start, so maybe getting some results and getting some learnings is the way to do that.
Byrne: Absolutely. And that goes back to our culture where it’s okay to try something and then make the decision that it worked great and let’s keep going, or ‘hey, that didn’t really work, we’ve got to make a turn.’ In some other organizations, I know that people want things to be really fully baked before you roll them out. We have no problem piloting, and no problem saying, ‘That was a bad idea. Let’s not do that again.’
So the jury’s still out on how these employee video visits are working. The employees that have had a successful visit are very satisfied, but we’ve had some employees who have attempted to have a video visit and it wasn’t an appropriate reason for a visit and they ended up having to be seen in person anyway. So we have to just figure out that balance.
Gamble: Right. It’s one of those things where you have to start somewhere or it’s never going to get off the ground.
Byrne: Exactly. That’s exactly it.
Gamble: Okay. You mentioned earlier about the merger, which was about three years ago. Now you had already been with the organization for a couple years at that point, right?
Byrne: Yes. I was on the legacy Edward side for, oh boy, about six and a half years.
Gamble: Okay. So the merger goes through, and obviously it’s not a simple thing; there are so many moving parts and pieces. One thing I wanted to ask was what you found to be challenging from a leadership aspect in going through this big change.
Byrne: I think when you have a merger, it’s really, really hard work. The challenge is that you’re learning another organization’s culture very, very quickly and trying to create relationships very quickly. When we first merged I really wanted to get Elmhurst Hospital on Epic as soon as possible because I knew that until we sort of were all on one system we were always going to be struggling with certain problems. But I’m actually glad now that we didn’t. This implementation has been so much smoother because now people know each other, they have some trust, they have relationships, they understand the differences and the processes. We were really able to plan and do a nice, quality job.
We implemented the physicians right after the merger and we did it very quickly. The reason why we did that is because we were up against the first ICD-10 timeline, so we were trying to get the system in prior to the first ICD-10 date. We were about 50 percent through the implementation when the date moved. But since we were already in our implementation, we kept going.
The challenge was that there was huge amounts of staff turnover, which I think always happens in a merger, but it really can make implementations very difficult when you have key leaders and key personnel who are leaving. The person that you’re partnering with today on a particularly tough topic is two weeks from now not here anymore, so that’s a huge problem. You just don’t know each other very well. You don’t know the land mines, you don’t know how things really get done within another organization, and you really rely on those things within an implementation.
The other piece that I don’t think I expected was how you interact with your peers — even your peers who had been my peers from before the merger — and how much of a learning process it is for everybody. We were maybe six months into the merger and we had been talking about combining data centers because Edward had two legacy data centers, Elmhurst had two legacy data centers, and DuPage Medical (who we have a partnership with) had two data centers. I actually have no idea what the right number of data centers for us to have, but it’s not six, so it seemed like we needed to start doing some work here.
We engaged one of our partners in a consulting manner in order to help us go through the data centers. I’m at our senior team meeting and I said, ‘We have our data center consolidation strategy back from the consultant. The recommendations are it’s a 13-step process — over four years, $10 million.’ Everybody around the table said, ‘It’s going to save $10 million?’ I said, ‘no, it’s going to cost $10 million.’ It was really interesting to me that everybody looks at IT and they say, ‘there’s a lot of money being spent on IT. We merged; for sure we should be able to save some money.’
I think long term you probably can save some money. I will tell you that three years in, we’re maybe starting to hit some money saving opportunities, because you have to spend a whole lot of money to get onto a single platform, to get onto a single system, a single network, single email. You have to spend a whole bunch of money before you ever start seeing savings. I think that’s a big education piece for myself and for my peers.