<v Jordan Cooper>We are here today with Sandra Powell Elliott, Chief Innovation and Commercialization Officer of Hackensack, Meridian Health. Sandra, thank you for joining us today.</v>

<v Elliott, Sandra>Thank you for having me.</v>

<v Jordan Cooper>So I've listened to stories that you've told in the past and and you've been known to say that you use digital data, Hackensack, Meridian, to create a story of patient and the patient and care journey. You've said that we're wired for stories and you're looking to make Hackensack Meridian health care delivery, more patient centered. You're trying to learn who patients are and what their needs are. Can you tell me more about these initiatives?</v>

<v Elliott, Sandra>Yeah. So we we actually at Hackensack Meridian Health have been really working to do 2 things. One is build the digital kind of framework that's necessary for us to really kind of create what I would call kind of a standardized platform. It's not you know uncommon obviously, but as an organization that continues to evolve, it's always a challenge to to make sure that everybody's on the same platform and what's important in in is obviously important for that is for patient continuity particularly on the clinical care side.</v>

<v Elliott, Sandra>But one of the things that's been extremely interesting to us is really beginning to leverage that data and information in a new way to really begin to think about what is the story of the patient and what I mean by that is where do they start in their healthcare journey, what's important to them at that point in time? What are the challenges that they're facing, not just clinical but social determinants of health come in. Diversity, inclusion and equality come into that as well. And then how do we begin to make sure that we're meeting as many of those needs as we possibly can?</v>

<v Elliott, Sandra>And at the same time identifying gaps, where are we not doing such a great job and understanding what we need to do to begin to think innovatively about how we can kind of fill those gaps. But the goal is to really try and understand from what I'll call the that the digital story, but also the digital front door, how people access us in different ways. We have all types of different services throughout the network. We're one of the largest integrated delivery systems in, in not only just New Jersey, but in the region. And one of the things about that is.</v>

<v Elliott, Sandra>Sometimes you have a lot of fragmentation of data and that data is a part of that patient's journey and that patient's story, so it's important for us to begin to understand how we can make those connections and begin to understand each one of our patients individually as much as possible. And then how does that translate into a new standard of care for them?</v>

<v Jordan Cooper>So there is for those listening something you'll be quite familiar with is the quality measurement enterprise and in that quality measurement enterprise there are basically two different kinds of measures, process measures and outcome measures. Now there's a lot of provider resistance to outcome measures as opposed to process measures. Why? Because providers can control their processes, they can hand a list of medications that patients but they can't necessarily control the outcomes. How do you control patient adherence to that medication list, for instance?</v>

<v Jordan Cooper>So providers cannot control patient behaviors. But as you have more risk coming into the provider organizations with accountable care organizations and shared payment models, you actually see more risk being shared by that provider organizations and therefore more incentives to control behaviors. The question I have for you, Sandra, is where do you draw the line of responsibility between what is something at the hospital needs to be concerned about with the patients well-being and something that is outside the patients well-being. I mentioned this because you mentioned there are many challenges or social determinants of health.</v>

<v Jordan Cooper>How was your housing situation? What about poverty? What about working three jobs, not getting sleep? Maybe someone's incarcerated? How do you deal with different situations in society that healthcare organizations are being asked to care for as a safety net for society? How do you distinguish between what is the responsibility of Hackensack Meridian for your patients and what's simply your patients responsibility?</v>

<v Elliott, Sandra>You know, it's a, it's an ongoing challenge obviously, but we can't solve world hunger. So I think it's one of those things where you really kind of focus in on kind of a a a centralized or kind of a focused approach in area of opportunity. And one of the things that's very interesting and and particularly for our organization is you know you mentioned that we were drawn the line between outcomes and and process measures. And I would say that.</v>

<v Elliott, Sandra>Many of our clinicians, in particular, we've actually tried to push back and say no, we have to work on outcomes and we have to focus in on outcomes and start them from a clinical need. For example, on those outcomes and work backwards, I kind of call it backwards logic. And there are what I would call that 8020 rule, the 20% that first many patients that are difficult to treat or maybe are not responding to treatment or maybe not compliant.</v>

<v Elliott, Sandra>What are we gonna say? That we're just not gonna address those individuals, that we're gonna be OK with the 80% that that everything works extremely well and people are compliant? No, we're going to try and say we really want to address these challenges and so for different kinds of patient populations, what's been important for us is to get cross functional teams to really begin to think about this as a scientific challenge, for lack of a better analogy. So we know what impacts outcomes. But the question is, how do we begin to understand even more?</v>

<v Elliott, Sandra>The difference between what we can do as clinicians and as a health delivery system versus addressing some of the challenges that may be out of our scope, for example, with regard to a society, but at the same time, better understand how we can connect resources that are sometimes in the our local society to really help meet the needs of those individuals. So I I guess one of the things is you can't, there will be those patients who will just not be compliant and sometimes you know you you nudge and you push and you try to control. But the question then becomes.</v>

<v Elliott, Sandra>Trust. What are they compliant with? What is important for that individual and is there a way that we can meet the gap and sometimes it's an individual challenge and sometimes it's more of a a population challenge. But I think for us we just don't choose to not address the clinical component first and then understand what can actually be addressed within the societal process at large.</v>

<v Jordan Cooper>So Sandra, you've spoken previously about creating the importance of creating an innovative culture at Hackensack, Meridian Health that strives to experiment and learn. And I imagine that that must be important as you're trying to bridge these different teams within the the healthcare delivery system in order to address these 20% of high need patients.</v>

<v Jordan Cooper>How are you going about creating that these in this innovative culture and what are some of the challenges in doing so?</v>

<v Elliott, Sandra>You know, it's interesting. We just we had this year a an innovation challenge within the network. So we have 36,000 employees. So that's a large group of people with with very different perspectives who can bring different ideas to the table. And what we decided to do was run a network wide innovation challenge where we could really get people to focus in on either patient safety or team member safety. So it's an all all all people can participate in something like that because they can come up with ideas on how to make it a safe environment for themselves.</v>

<v Elliott, Sandra>So it was a lot. It allowed us to really engage as many people as we possibly could and as a result, one of the things that they were asked to do was to identify an idea, an idea to overcome a patient, team member safety challenge. And as a result, we had tons of ideas that came in. We actually worked with a large group of people within the network to become evaluators of those ideas. So we structured the challenge where we had key components that we asked people to submit with their idea.</v>

<v Elliott, Sandra>Those ideas were then.</v>

<v Elliott, Sandra>Evaluated by well over 40 individuals throughout the network from all different perspectives. Some of them were volunteering and saying I want to be an evaluator. They evaluated those ideas and then based on those scores we we upped the ante on the next level of evaluation. So what we did was actually engage a lot of our leadership, subject matter experts, etcetera in the whole process to help number one vet ideas. But more importantly is as as those ideas.</v>

<v Elliott, Sandra>That further further up the chain for potential.</v>

<v Elliott, Sandra>Resource allocation people began to also help those individual team members in preparing their pitches, understanding the challenges of implementing a pilot. So we really engaged as many people throughout the organization as we possibly could, and we highlighted that, you know, engagement with others and what we found is people really want to help others, right? We're all in this healthcare space to help people, and we're really seeing that as part of the evaluation process where ideas but also more importantly is.</v>

<v Elliott, Sandra>Pitching those ideas and getting the resources for them and for us, you know, an innovative culture is.</v>

<v Elliott, Sandra>Really about helping people with develop skill sets to ask questions, to ask the right question, and then begin to understand. How do you begin to solve that question? How do you begin to create ideas that potentially can resolve those issues or or challenges and as a result, what we've done is actually engage a larger group of people to potentially kind of scale ideas, facilitate implementation and part of that implementation of pilots for example.</v>

<v Elliott, Sandra>Is that experimentation? What did we learn? How do we share what we learned? And that's what one of the things that we really are super excited about is because it really is driving collaboration in the culture of the organization and recognizing that while innovation is sometimes seen as a solitary act, that it really most successful innovative products and solutions come from collaboration with a lot of people. So it's been extremely exciting to see those and we we literally just had our final.</v>

<v Elliott, Sandra>Presentation to our board and we have outside venture capital folks who also sit on the the that that Innovation Board and they couldn't pick a winner. So they they they made sure that everybody is a winner for a good reasons because they just didn't think that they wanted to.</v>

<v Elliott, Sandra>See any of those ideas? Go to the wayside, and in fact, they ask us to bring back the next level of ideas so they can begin to see those as well. So it's that embedding and that that recognition and really just engagement of people in the process.</v>

<v Jordan Cooper>So, Sandra, I think our I'd like to walk, if possible, walk our listeners through a particular use case and it doesn't have to be from this innovation challenge in particular. For instance, you've spoken about connecting external data elements into personal and Ehlers, you've spoken about voice technology, automating data collection, diagnosing different types of clinicians, particularly in radiology, sensor testing point and care testing, diagnostic testing. There's a lot of tech that you've projects that you've begun implementing at Hackensack, Meridian.</v>

<v Jordan Cooper>What I'd like to do is take one of those as an example, or potentially one of those innovative solutions. That was a response to the challenge I'd like you to walk me and our listeners through exactly how you implemented this new idea. There's often a lot of organizational resistance to trying something new. There are a lot of challenges, even with just getting one data type to mesh with another data type and be interoperable when you're going into the into the field and you're trying to get Healthcare at Home, you're trying to coordinate with external sources that aren't.</v>

<v Jordan Cooper>Maybe a food pantry that isn't used to coordinating with the hospital. There's gonna be a lot of challenges. And so our audiences, your peers and other healthcare delivery institutions around the nation are probably very interested in learning. All right, so we've had a lot of innovative ideas that are institution and some other place in the US how is it that you succeeded in overcoming these challenges? I think we wanna hear a lot about the challenges and how you overcame them.</v>

<v Elliott, Sandra>Yeah. I think before we go through an individual example, I think one of the comments that I would make is that we've gone through a lot of different innovative ideas that could be extremely valuable to the organization. It could be extremely valuable to the patients that we serve. But I think one of the critical elements for us to really see full-fledged implementation and buy in to really move the needle on an outcome for example, has been really focused in around getting the key.</v>

<v Elliott, Sandra>Clinical and administrative support and what I'll call the leader that sponsor to really help make sure that we embed a new technology in a way that makes sense and we're thinking about it and how it actually translates to workflow. So I think it's it what I would try and say here is find the clinician or group clinicians that are super excited about this and understand that it's going to be a challenge, but are committed to.</v>

<v Elliott, Sandra>Helping it evolve through the organization and usually that clinical expertise is going to be supported by an administrative individual, whether it's a, A vice president or a department director, whomever it is. I think it's really critical to have that diad, if you will, and we we will support them and helping move it and we'll guide them to move it. But you need that clinical and administrative buy in who are willing to take it to the next level.</v>

<v Elliott, Sandra>So I'll use an example. I'll go back to speech. Uh, one of the things that we've been doing is we've actually worked with a company that is evaluated, as I've mentioned before, the ability to to leverage speech in a way that not, not just automates process, but really dives down into the the sound waves as a non-technical person might say to really understand the nuances of sound at a nanosecond level.</v>

<v Elliott, Sandra>What that means clinically and part of that is, is making sure that we understand what those, what I'll call voice biomarkers are. So we've been in the process of with them of working through stress and anxiety and understanding that it's not just the word selection and the speed and the power, it is down deep inside of that voice to know and understand whether or not a person's stress or anxiety and potentially depression is being able to be identified. So many of us.</v>

<v Elliott, Sandra>Throughout the organization, we know that physicians, clinicians need to evaluate patients both at an anxiety level, but also at A at a for depression, for example. So two elements to that, one being are they depressed and we already have, you know tools for example in a physician practice where they're evaluating there's, you know standard tools to use, but they're usually in paper or people are asking questions.</v>

<v Elliott, Sandra>And most of the time, a lot of times you're not necessarily going to understand the nuance that maybe is down deep inside of that individual and maybe they don't 100% answer accurately, but the voice will tell you and I think that's one of the things that we've tried to understand, how do we actually take that paper.</v>

<v Elliott, Sandra>A tool or that tool of key questions? Maybe ask it in a different way, but more importantly, get the voice levers. The voice. I mean, think about it. We as individuals use voice all the time. We communicate that way, but also we're used to using technology that allows us to say, hey Siri, what's you know, what's the closest restaurant to me or I need to get gas. What's the closest gas station? Whatever. But I think at the end of the day, leveraging that because it's easy thinking about, you know, one of your questions earlier about patient compliance.</v>

<v Elliott, Sandra>It's a lot easier for people to be compliant with technology that is easy for them, that they're comfortable with as what I would call consumers. You know, your typical consumer. But having said that, I I'm going off on a tangent here, but one of the things that I think is important for us is we test it out and really helped understand when people got the information that maybe their stress level was increasing or they're depression levels maybe.</v>

<v Elliott, Sandra>It at a level that they can control without, you know, seeking help that they began to leverage that information in a way to help manage themselves. And we saw, you know, a decline, if you will, in anxiety levels when people were engaging with that software, the software on their phone. And we're seeking resources or doing exercise to alleviate stress and anxiety that then in turn could build up into something very different. So now we're in the process of of looking at how do we leverage that technology in a new way.</v>

<v Elliott, Sandra>The better it to a physician practice or even urgent care, for example, to better understand how we can leverage that information and an ongoing clinical record to facilitate and better manage that patient condition. So we've got clinicians both in the behavioral health side as well as our primary care side who are engaged in helping to understand how do we use this in a way that's easy for the patient but doesn't create a new burden for the for the clinician and.</v>

<v Elliott, Sandra>Doing it in such a way that it engages in the executive in the electronic health record and we can track and trend it over time, particularly as they're they're, medications change, etcetera. So we're trying to embed it in a way that makes it a user friendly for all but creates that information that we wouldn't have had otherwise.</v>

<v Jordan Cooper>So as we approach the end of this podcast episode, Sandra I, I'd like to bring us back to the beginning of this episode when I asked about how we're wired for stories, I'd like to ask you to expound for the benefit of our listeners on what the story is of a successful, innovative patient centered health care delivery organization like Hackensack, Meridian Health and how, if they would like to be more like your organization, they may go about doing so.</v>

<v Elliott, Sandra>Wow, that's a that's a loaded question.</v>

<v Elliott, Sandra>I'm glad you left it for the end.</v>

<v Elliott, Sandra>I think you know being wired for story is, you know, we are as an organization really trying to focus in on individuals and individuals have stories, right, patient centered stories. I think understanding stories means that you understand people, people, you know throughout history are are our brains in A and I go back to our brains are wired for this. If you think about historic change or things that have been impacted you as an individual.</v>

<v Elliott, Sandra>You can tell a story about it, and stories are the easiest way to communicate. And if we're trying to help patients, communication is critical thing.</v>

<v Elliott, Sandra>I'm gonna ask you to repeat your question because I got on a track and I was thinking about a story of a patient and I apologize that who who actually is at Costco patient actually a Costco example of a patient who was trying to better manage their congestive heart failure. And once we learned his story about going to Costco every Friday night and getting a a roasted chicken that his it was the reason that his.</v>

<v Elliott, Sandra>A blood pressure went up significantly over the weekend because of all the sodium that was in the chicken, but those are examples. Stories of what you learn when you start asking people about their story. But as far as how it embeds into our organization, I think the critical thing is seeing people as individuals, patients as people. People have stories and you know it's a it's the easiest way for us all to communicate the story of a successful organization from innovation is I think that.</v>

<v Elliott, Sandra>That they are.</v>

<v Elliott, Sandra>Sharing their patient stories, number one, but I think more importantly, is there always trying to improve clinical outcomes and the overall health and well-being. And I think if if someone said Hackensack, Meridian health is all about really aggressively changing and increasing the well-being of its community, that's that's the story that says to us that we've been successful because we've we are really making change in our local communities wherever we're serving patients.</v>

<v Elliott, Sandra>But I'm not sure if that answer your question.</v>

<v Jordan Cooper>That you've done wonderfully, Sandra. I'd like to thank you for joining us. This is for our listeners. This has been Sandra Powell Elliott, the chief innovation and commercialization officer at Hackensack Meridian Health, and she's spoken about many things. But I think fundamentally she's talking about humanizing people, people. Patients aren't just patients, they aren't diseases, they aren't and oncology patient, they aren't just covered lives, billing codes, risk bearing populations, but they're individuals. And when you begin to approach individuals and see what their story is.</v>

<v Jordan Cooper>And it may be as simple as saying don't get that chicken at Costco on a Friday night and it can save us a whole bottle of bunch of of of of risk, with having them being readmitted for congested heart failure complications and more pills. Just avoid that Friday night chicken. So Sandra, I'd like to thank you very much for joining us today.</v>

<v Elliott, Sandra>Thank you.</v>