Predicting Healthcare Costs and Improving Quality of Care with Chris DeRienzo


Welcome to the outcomes rocket podcast where we inspire collaborative thinking improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers and now your host so Marquez welcome back to the podcast everybody today. I have a guest that you guys have met before the outstanding Dr Chris Dairy Enzo. He's a chief medical officer at Karnal analytics as the chief medical officer there he leads the company's clinical enterprise helping connect world class data science to better care sooner for patients employees and plan members across the nation. He's been recognized by modern healthcare in twenty eighteen as one of the up incomers under forty and Bekker's as one of healthcare's rising stars Chris has published and presented internationally on leveraging analytics addicts to drive continuous improvement implementing data science and health care and the intersection of humanity and technology. He's also the author of tiny medicine one doctors actors biggest lessons from his smallest patients prior to joining cardinal he served as an and one thing that I that I do WanNa <hes> clarify here cardiac cardinal health health it is cardinal analytics prior to that. He served as chief quality officer for mission health. which if you guys haven't had a chance to listen to that interview type in in mission help in the search bar at about health? You'll you'll hear that amazing interview where we talked about value based care among other things mission health is a two billion dollar integrated delivery system in Asheville North Carolina there he practised both pediatrics and neonatologist. He completed his M._D. and masters. Here's in public policy in postgraduate medical training at Duke University. He is still a practicing neonatologist in the mission children's Nick you follow up clinic and volunteer tear has a member of the mercy health or Quality Committee and the Y._M._C._a.. Blue Ridge Assembly board of Directors Nationally Dairy Enzo was the fourth medical student and elected and re elected to serve on the board of trustees and appointed by the North Carolina Secretary of Health and Human Services in two thousand eighteen to serve on on the Medical Care Advisory Committee says you all can see here Chris vary involved clinically as well as in business now and I'm really excited to dive into his new you track at cardinal analytics and hear the latest in his thoughts and work so Chris <hes> just want to extend a very warm welcome to you as always thank you for for such incredible credible introduction. It's a pleasure to be back on your show yeah it's. I'm glad you're here now. You're on the industry side so just to kick it off. I like to hear why oh I you you took the switch and how things are going. You got it so I I had a tremendous team at mission and really enjoyed my role in the role. I served there. <hes> most recently I covered a quality patient safety patient experience a pop health and then analytics and one of the things I was most excited about where the things that we were beginning to do admission that crossed the intersection there of a population health so our value base care and risk based contracting as we covered a little bit in our last last time on the podcast and some of the real emerging data science trends and specifically in machine learning I within the mission team I was fortunate to work with a couple of really bright right data scientists and they were beginning to show what we could do to drive pop health outcomes of by leveraging newer technologies that are enabled and so several months ago ago I got a tap on the shoulder from the folks at cardinal who said hey you know this this really something you're passionate about. Why don't you consider joining us and getting to do that not just the million people of Western North Carolina but for a three hundred and fifty million people nationwide and so that's really what what sparked the interest and <hes> we'll we'll talk a little bit about the cardinal team and what we do and I think once you hear that the switch will become clear now? That's really really great. Chris and you know I applaud you for the switch. It's not easy to go from you know provider working as a caregiver to industry but you saw the bigger picture so to speak and I applaud you for that so Chris. What would you say now that you're working on? The work that you're working is a hot topic that needs to be on health leaders agenda and how is your organization Karnal analytics tackling it yeah. It's a as always follow a great question. I think one of the major challenges facing Health Tresin as an industry today is grappling with the intersection of technology and humanity and especially as our data science development pathways offered for new a enabled tools. I think it'll be really important for us to ensure that we're pointing those tools at the right thing for defining the right core purpose and then ensuring that as we implement those tools what we do with them is really driving a better care for patients better outcomes and truly better workflows for our clinicians and so what I think about it. Do we really know today what the ideal state of an A._I.. Enabled health plan or an A._I.. Naval Population Health Manager looks like I think that is a challenge in the industry is really going to grapple with that. This is a great point Chris in so as we think about some examples. Maybe something that you've done on early on with cardinal analytics. Maybe you could share with us something that you guys have used A._I.. Four to improve the way that things happen outcomes and business processes Aziz. It'd be good to hear that from you so cardinal really isn't a I I company the company was born out of Stanford's incubator about four years ago when Dr Arne Milstein who's a famous professor from Stanford has been working in the public health space for decades at noted that when you look at folks within in a population who become high cost each year about sixty percent of them are totally new so about half of people who are are high cost and therefore high acuity eighty patients a drop out revert to the meeting each year and he asked the question of one of his his partners there at Stanford. Hey is this something we could predict and Seductive Nigam Shaw who's one of the countries machine learning experts said you know that we can so for years ago. They trained a model on international data set and sure enough approved that we could predict who are going into bloom and cost next year moved from the bottom. You know ninety percent into that top de silent cost so that The engine driving better care sooner for as we noted patient's health plan members and employees nationwide when he thinks all about what is the power of machine learning what what can we do at the biggest utilizations of A._i.. Enabled software today have really been using massive labeled data sets to dramatically improve approve workflows and sort of match kind of right place right time right thing like you've got a I in your pocket many times A._I.. Powers Theory theory to tell you what she thinks you're going to want to say next or if you're identifying pictures on anywhere on the Internet that is the power of machine learning using unlabeled data set and within healthcare we have tons of labeled data sets that we just haven't put them to use in ways that could improve patient outcomes and that is exactly what we're doing you hear cardinal while it's fascinating Chris and I think a lot of folks take a look at this topic of A._I.. In healthcare and in particular the predictive fictive models and and stripping away variability to improve outcomes so the thought goes into what at are you pulling and how are you pulling it. It's where you pulling it from to get these analytics because if you could prevent these high cost patients from having these continual issues hunter you do it correctly right today we predominantly use a combination of medical claims prescription drug claims lab results and then other data that at different clients may have access to so perhaps this year economic data or other sources and with each new client we learn about interesting new data sets and the the idea fall is if we can look no catch multiple years worth claims history and then say okay. There's a high likelihood that Chris Thirty eight year old male with these various conditions who's had these kinds of encounters lives in this area. He has a really high probability of blooming next year moving from low cost now too high cost the question then is okay. Is there anything we can do to prevent that and the answer is yes that you know sometimes that bloom in cost is driven by someone who's heading down a surgical pathway and and perhaps you know they have not gone through the right process to see if that surgery is really needed or if it is needed have they really connected with the provider in their space is going to be a both the highest quality and and most cost effective or perhaps. It's someone who's Kinda fallen through the cracks of healthcare delivery system. Maybe maybe they don't have solid primary care. They connected with a couple of specialists or they've in the E.. D. For these ambulatory care sensitive conditions and really what they need is better care coordination the we've. We've got a ton of examples now of folks effort one of our clients who we've caught kind of in this state and through some some pretty basic sort of simple care management Benjamin interventions we've been able to connect them into the right pathways sort of captured them from falling off the cliff and then both improved their health outcome as well as reduced a cost for <hes> for the health plan. I think that's brilliant and are you guys. Mainly working with insurance plans providers a little bit of both both coming. Our approach is really relevant to anyone who is is in the role of managing populations health and in cost imagine how plans have been sort of the folks most attracted initially to the Darren offerings that we have been in that space for a long time that we are working with a <hes> a large integrated plan provider and they'll be a public announcement on that in the very near future and then the employer space employers who are large arch enough to really be able to think holistically about the health of their workforce. Those are folks who had worked with US L. Fascinating Yeah because at the end of the day folks we really have to look at this from the perspective of the payer in the and the population level the impact that these things are these these technologies is that Chris Dr Dairy Enzo and his team are using are definitely making a difference for outcomes and cost to the things that need to be solved for so as as you all have been working on this Chris. What would you say a setback or a lesson that you guys learned along the process of the programs? You've been implementing yeah. <hes> I think that any time in healthcare we try to integrate new technology into workflows. There's going to be challenges with implementation. I remember the very first time I tried to bring machine learning into a program admission. It was an objectively better model way better predictive capacity than the tool full of teams using previously but that took several months to really be able to integrate into the workflow in a way that the team could know us and so I think as we've worked with early clients it's clear there are definitely a new universe of opportunities that a enabled technologies are offering and so we've become very focused on helping ensure that that we're connecting with health plan or a provider or employers different lever arms so that we maximally support the humans who are at the other end of connecting eighteen those predictions to action and that really is where our focus as a company is is yes the different machine learning models can predict off costs and what their cost really means though Oh is a person's life who's getting sicker which is leading them to need to engage in more high-cost care and so we can prevent a person from I'm getting sicker than it's the person has gotten better care sooner as a result they're experiencing lower healthcare costs and that leads to a more sustainable healthcare model overall. That's really fascinating so now that you guys have been cranking so Carl. Analytics has been in business for how long again Chris five four years. Yes we spun out of Stanford starbucks for years ago like I said the the first hire was really break. Data scientists are now. I lose track depending on the day we're eighty to twenty five or twenty six employees scaling rapidly bringing on almost one new person every week to really keep pace with the market demand that we're Chrissy amazing amazing and so now you guys have scaled to a larger size. You're continuing to grow in the history of the work that you guys have done. What's the proudest moments that's a really good question? You know what I think about what we can do at a population level. It's really impresses. The delta that we can demonstrate straight across multi-million lives within a population is dramatic but I think some of the proudest moments that I've had are when Story was woman in her fifties. I think as she had significant cardiac risk she's a tobacco user shed some underlying behavioral health challenges a number of of pain issues and was on multiple opiates she had engaged in something like twenty plus different outpatient visits and had a year one cost that was significant thing was over eleven seven thousand dollars and so as a as a partner. We predicted hey. This is someone who looks like she's going to bloom in year two and said the three drivers that we're seeing of that are those cardiac combined with tobacco risk and then behavioral health combined with this pain plus opiates and then this is a person who had never hit a plan <hes> you know high cost claim world or providers you know high needs populations that she was not totally well but she was not so sick that you would have gotten kind of the high touch bespoke spoke care management about we found her and the plans care management side engaged and they linked her again to sort of not sprain surgery sort of things they they found really high quality counseling for her. They found her tobacco cessation program that worked and she's now most of the way through her year to less than fifty percent kind of the cost less than fifty percents utilization in terms of outpatient visits but more importantly she now has continued you know pain and diagnosed us of depression but is not on opiates so she's gotten off of these highly addictive and highly expensive medications and despite her existent cardiac risk she's no longer using using tobacco so she's markedly improved future risk profile but I've seen a person like that and I know that but for our partnership with clients she would very likely have continued to fall through the cracks at makes me really proud of what we do. Have that's really big. Chris and you know one of the things that I've noticed as as more physicians like yourself join industry to help make things better. I see the dots being connected in a way that really will will help us continue to improve the care pathways and the overall results. I mean you mentioned something really really important. As that yeah you watt as we take cost out of the system or actually improving lives so as the dollars that we spend go down health goes up. It's inversely. Lee Related and we need more folks like you Dr Dairy Enzo in the business. I appreciate that saw one of the things I like most about my new job is I get the clinical side and I can work on that all day. I have no clue had a program in python or an our work with these ridiculously absolutely brilliant people who when we drive a problem they say I don't have a model that and then they go to work on their their giant Mac books whatever and then sometime later they come out and they say look here's what we're now able to do with this prediction and then I get to say well. Here's what we can do that to change someone's life. I think as a doctor you're on the health system side the folks who worked in industry who I was most excited to partner with your really got the problems that we were trying to solve and where they were as partners to help us solve them and and there are many ways I think to be able to do that in a a revenue sustainable manner and ultimately drive total cost down just in part because of the way that today with limited resources were not focusing on folks. I think who can sometimes most benefit from engagement finding someone like this this woman and I've got tons of examples like her who are about to deflect you know. They're about to fall off off that cliff. Their health is about to get worse. Their cost is going to rise dramatically we if we can keep that from happening over and over and over and over again think about the deflection in the overall health of the country to the positive and the total cost to the the negative so I if that's not something doctor I could get excited about than I.. I'm not sure why I went into medicine in the first place lava Chris and you know one of the things things that that <hes> just kind of a side note of had the privilege of speaking with several other successful physicians like yourself that that have taken a turn in the industry industry and I noticed really can have two two characteristics one is a strong passion and desire to help and then the second thing is the desire desire to scale beyond what you could do on your own or at an institution and joining industry definitely helps provide that scale ability because like you said right going from two million patients to three hundred fifty million potentially. It's a big thing and I congratulate you for that. What would you say is an exciting project. You're working. GonNa one of the most exciting things about working at a company at this stage is the speed of growth and the the pace in which we can drive change and so the the three offerings that we have out there right now on cost bloom on kind of matching <hes> folks who have preference sensitive conditions with bright spots providers using Arnie's researches language and then on risk assessment adjustment. Those are kind of the three things we get to do today but working with Brian in the data science team means that by the end of the year even by the end of the quarter entirely new things that we're getting to bring to market and so some of the most exciting work kind of in our skunkworks. I can't really talk about yet but if you keep an eye on cardinal over the course of the year I think you'll see some really exciting connections that that will be able to make that but I've not yet been able to see made in the market fascinating so you get people confusing you card and a half a lot or no you know. I think the spelling of Our Name Kinda helps helps distinguish. That's the cardinal analytics with the ex and the fact that cardinal healthcare they're. They're a big insignificant industry player but there. I think been historically more on a different side of the road. That's true yeah very very different but it's worth distinguishing here for the listeners right. I mean these guys are innovating in a big way. Using a I and data science to help population health decrease costs improve outcomes while the other side. It's distribution Armagh very different <hes> as to deduct it does point so here. We've gotten to the lightning rounds. I got a couple of questions for you. Chris followed by a book obviously aside from your book which is tiny medicine one doctors biggest lesson from his smallest patients a recommendation that you'd make their and listeners just a note. If you go to the each show notes you'll be able to find a link to Dr Chris Derian those book as well as our entire transcript than short notes go to outcomes rocket etc health and in the search bar type in cardinal analytics with an x and you'll find it bare but Chrissy ready for the lightning around. Hey I've gone through this once before your veteran all right. What's the best way to improve healthcare outcomes. I answered this. This one for you already. I'll answer it the same way to continuously get better. The best way to improve healthcare outcomes is focused on always getting better. What's the biggest mistake or pitfall to avoid? I think that sometimes folks see a new technology or a new approach and either out of fear fear or out of fear of the unknown or fear of change a can initially be challenged by that and that's a normal human instinct and totally understandable but I think it would be a mistake to fall victim to only feeling that fear without offering yourself the opportunity to see what different might look like because any of the the major major transformational changes in healthcare at any industry have really needed someone to take that next step and say I really can't envision a future that is both different and better. How do you stay relevant as an organization despite constant change constant changes what keeps US relevant? I think that in a world that is exceptionally sleep dynamic in healthcare. It's not just about being on trend but about continuing to focus every day. On what tools do I need. How do I need to equip my teams to be better tomorrow than they are today? What scenario focus that drives everything in your work there at Cardinal Carlo? That's a simple answer. It's better care sooner which means that we get to to serve people so plan members patients employees all across the nation and we get to serve the people who are trying to support them so the the care managers suggest the care coordinators folks doctors offices in employee health. You know locations they are doing their very best to try to serve their people and as a result we get to serve so Chris. Since last time we were together. I started asking to new ones. These are more surprise the listeners to get another guests a little bit better so on a personal now. What is your number one health habit? I am a bit of a movement junkie anymore. I'm good friends with Eric Eric Eric Lanes Sharon Nick clamp the authors of start here which is a New York Times bestseller few years ago <hes> that drove the beginning of a company call life x t and I've done. I've done some work with them over time. I really believe in their mission within their construct. They've got sort of US nine. He's nine different components of driving having personal well-being so meditation. There's a core group on that gratitude is when there for me I find that movement everyday are really helps. Keep Me League grounded and so I'm I'm a triathlete. I took that up when running boxed my niece and I've realized that if I had woman biked Endrin I could do all three without being injured all the time though I <hes> I gotTa make sure I get movement every day. Love it love it Chris and what is your number one success habit my number one success at it. Oh Gosh I'm not sure how to answer that one but it reminds me of a passage from Colin Powell's book <hes> one of my favorite books it worked for me and he was talking about how he came home one day in his brand spanking new general dress uniform looking all fifty and he walked in to his house us and one of his kids bomb G._I.. Joe Is home and is point. Obviously was having family who keeps you grounded as a wonderful gift. Then I think for me I would say the same thing that's unfortunate to have three kids and I'm married to a wonderful woman and I think much of my ability to succeed. Professionally is how rewarding my my my life personally. That's awesome Chris. Thanks for sharing that and <hes> yeah. It's a good reminder to all of us. You know the why of what we do remember it. Don't keep it front and center and so obviously you wrote a book so aside from tiny medicine. Which book would you recommend the listeners yeah? I certainly would would recommend that one out to June eleven by the time you're podcast is is up. <hes> Amazon preorder should be live but a book that I read recently recently that I I really enjoyed. I was educated by terror westover. I read it on a recommendation from Troy. WHO's one of the C._V._S. executives and men it was a really powerful a message my wife and I actually got to read it together which is rare as she likes to read books in hardback form and I do most of my reading the audible on planes and and unfit to Evelyn all around the world to we sort of contemporary earnestly read it together and just it was a really powerful I really powerful story Great Recommendation Chris Chris <hes> definitely put that one on your list listeners and again a reminder to go to outcomes rocket dot health in the search bar type in cardinal analytics with an x risk and you'll be able to find our conversation and links to Dr Durians those recommendations there before we conclude Chris I love if you could just just share a party messes with the listeners and then the best place where they could learn more about you and what you're doing you bet so as always saw really appreciative of folks like you who are willing to bring members from all across healthcare folks on the provider side in industry and plans and employers really really what I find? Is You bring together folks who are pushing the edge and really trying to drive change and healthcare as an industry that is ripe for a disruption in a a number of ways and I think that in reflecting on both of the Times I've gotten to join you kind of one of the core messages to me. I think is if as a doctor her clinicians are constantly focusing on not only how do I how do I treat the patient in front of me today. But how do I make the system better to treat treats patients including me all across the country better and better and better and better than it'll lead to the kind of change that we need in healthcare their industries that reach each our size. I've gotten disrupted effectively every century since the founding of our nation and since disruption is coming to our our work in healthcare it gives me a great degree of comfort that folks like the people you have on your podcast are are helping drive because I think that means we'll be pointing it in the right direction to get in touch with me. <hes> you can reach reject me on Lincoln. Our website is also also live. I just google cardinal analytics and you'll see it there outstanding Chris Listen this has been a pleasure once again super excited with this new turn in your career and this exciting company that you've become a part of and <hes> definitely looking forward to stay in touch and maybe a year from now <hes> getting you back on to hear the progress. That sounds great so I could be your first three peat you would be hey would love the opportunity Chris. Thanks again. You bet take care. Thanks for listening to the outcomes rocket podcast fast be sure to visit

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