Covid 19 Letter to Patients

Innovation in the Boondocks

By: Dr. Pariksith Singh, MD. May 2021

Chapter I

Can innovation happen in the boondocks? This is the question we have grappled with over the last five years.

We live in Spring Hill, Hernando County, which is about 50 miles north of Tampa, known most for its mermaids locally than anything else. We are a small town, an urban city, which is a bedroom community for Tampa, truly a sleepy town. Our largest employers are Walmart supercenters (three of them), Publix, and three community hospitals in a population of 170,000. Our majority is above 50 years of age. We have minimal infrastructure in electronic highways, no major commercial hubs, or business centers. Even our malls are mini-malls. Transportation is poor with no real railway or bus services. Our only highways are 589 and 75, which connect us to Tampa and allow us to be a transit locale.

We have no major academic centers with pools of talent, teams, consultants, connections, relationships, mentors, experience, funds, and philanthropic endowments supporting the community. We now have had a state college for the last three years.

Our restaurants shut down at 8 pm. Roads go quiet by 9. We do not have a Silicon Valley or Koremangalam nearby. We do not have entrepreneurs hanging out in cafeterias working out startups on the back of paper napkins, with money pouring in from private equity or large investors from New York or California. We are collectively resigned to the fact that others will pave the way and we will follow.

We have no military establishments or industries. We were known a dozen or so years ago as cow country. We are not a center for Google or Zappos. Amazon does not have a huge warehouse here. We have mom and pop stores that are slowly being replaced by bigger corporate entities.

One might say an innovation center in Spring Hill, Hernando County is well-nigh impossible. And yet, a start has been made. A group of unrealistic healthcare professionals started innovating in healthcare and health IT.

In 2004, Optimum Health Care was started by our leadership, the first Health Maintenance Organization that had Hernando County as its home. Today, it is one of the biggest HMOs in Florida and one of the few 5-Star plans in the state. Access Health Care introduced a series of innovations in medicine over the next decade, including a robust compliance program, a quality initiative that was able to achieve a 5 Star Rating for Optimum Health Care, and a care management program that embedded its case managers amongst its hospitalists and SNFists. Today we have reached a point that we perform compliance testing not only for ourselves but we are delegated to do it for health plans. We achieved a 100% compliance score on an audit for all our managed care patients and all our Medicare fee-for-service billing in 2017. That is an achievement almost unheard of in this domain.

Along the way, we became delegated to provide credentialing services to two Fortune 100 companies, a great honor. We established Hernando County’s first home-grown Third Party Administrator in 2011 and its first Accountable Care Organization in 2013 and the first level 3 Patient-Centered Medical Home in 2015. We used local talent and did not outsource it to consultants from outside.

We created a SOC 2 certified data center over the last three years and created our own audio/video studio with our subject matter experts recording their knowledge and sharing it globally on our Learning Management System. The recording and editing were done, again, by artists from within the community.

We built our software modules and state-of-the-art architecture to help improve our services and move us to excellence. We created a utilization management software that is actively being used for our Humana patients following the most onerous and demanding requirements from CMS.

We programmed our claims gateway, which bills thousands of claims a day having reduced a 30% error rate to less than 0.1%, and claims adjudication software that is ready to disrupt the market, along with credentialing services, revenue cycle management, a universal platform with deep insight into healthcare along with expertise in granular processes integrating diverse data feeds and disparate software applications.

Today, we can dream of cutting-edge healthcare with the strongest possible emphasis on compliance, quality, and evidence-based medicine augmented by the most advanced health IT.

And we execute all these and more, with limited means, and wide skepticism even amongst our most fervent and committed leadership. We embarked on creating an innovation center in Spring Hill three years ago and were successful in doing so.

We found talent where no one knew it existed. We leveraged smarts from across the country and around the globe. We flew in experts and upskilled our knowledge in IT, video recording, creation of educational courses, and information systems along with getting our technical certifications and licenses.

We strained ourselves and our resources and broke through with new solutions, bringing together two disparate fields and domains. And we have accomplished so much in so little time. We learned to leverage our strength, which is healthcare expertise. We also learned to leverage our weaknesses by imagining projects that are not considered possible by the experts, and we were able to bring our dreams into reality. We showed that Spring Hill, Hernando County, can become a center of health IT innovation.


Chapter II


Lessons Learned: Our Explorations

  1. Self-Discovery: As we began leveraging our hidden strengths (and one always has some without realizing them) we began understanding who we were and what each team member’s most secret aspirations were. For example, we realized we were wasting our Chief Information Officer’s talents and passion. He wanted to be an inventor while he was spending his time with functions that a help desk normally would do, like answering phones or fixing computers for providers or working on phone lines and fiber cables. Our first mission was to free him of sundry activities which did not optimize his time, knowledge, drive, and experience. As we hired more IT professionals to free him, we brought him closer to the role he had in his previous life; he had been a software developer for Microsoft. Today, he handles a team of nearly 125 developers in India and 20 IT professionals in our backwaters.

We also realized while chatting with our Chief Quality Officer that her work was of interest to her only because it helped her make money while using her clinical skillset to assist the company. When I asked her what she wanted to do, her answer was simple, “I want to build sets and stage plays.” My response, “I can’t help you with that.” But we could. And did. Today, she leads our Edutainment Division, which creates creative educational programs for our employees, patients, and affiliate providers. Now, she has all the time to create stories, set stages and interviews, and allows her creativity a license to be as crazy and outlandish as possible (within allowable limits, of course). The journey of self-discovery is a long and continuous process. One just needs to be open to it constantly.

  1. Understanding Innovation: We realized that innovation is not only the creation of new software or to be like Google and Amazon. Innovation is creating something new, or rather, being new. That means that creativity can flower not only in producing new technology but also in improving processes or structures or even goals and mindsets. Innovation is not just Einsteinian mental leaps but could also deal with down-to-earth designs of office space and work-flows or in the creation of an enrichment center for our patients. It is about belief and faith in oneself and about questioning the status quo. Not taking anything for granted and rejecting authority without breaking industry regulations.

This implies that innovation is non-hierarchical and is not the monopoly of a single individual or department. The key is to question constantly and challenge our attitudes and complacency. Not being satisfied with what we do or who we are, it is the desire to compete not with others but with ourselves, to improve constantly and to become free and child-like in our work-space. To make work a play without losing the seriousness of our responsibilities.

  1. Radical Transparency: We realized how utterly opaque we were to criticism, how we were encrusted with habit and with the past. As we probed deeper into how we interacted with each other and how we had become siloed and compartmentalized, the awareness of realizing that this was only a function of ego and self-importance began to dawn on us.

In our experience with creating a culture of compliance, we found out that compliance has to become a part of everyone’s blood and DNA. For that to happen, each employee had to be empowered to raise red flags and challenge assumptions and be willing to share with anyone or everyone if they thought that something and anything was not in compliance with our operations. A culture of rewarding such a sharing of serious concerns had slowly become a part of our normal work atmosphere. Here, we had to continue the same processes, first at the level of top leadership and then, slowly, at the level of the middle managers. Creating a conscious corporation has become our goal since innovation is no longer the end of the journey, but its very inception and the journey itself.

  1. Commitment and Relationships: The fish rots from the head as an ancient Japanese proverb tells us. But enlightenment too begins from there. At the top levels of leadership, there came a growing realization that the company only reflected the values we held, believed in, and lived. That the world outside was only a reflection of what we are within. Such an exploration necessitates a clear and simple trust in our relationships and communications with one another

Over the last decade, we had pursued relationship management as one of the bedrocks of our organization. To keep things harmonious whenever there were strong disagreements whether at the professional or personal level. We were fortunate to have focused strongly right from the beginning on a culture that brought everyone together by creating harmony, improving discourse, and allowing each other the benefit of the doubt whenever things soured amongst us. This helped us stay cohesive despite the disparate tendencies and personalities, and work together with respect and cohesiveness. Listening to each other, allowing strong opinions, and still being able to enjoy each other can create sparks of fresh thoughts and ideas. This was our experience.

  1. Leveraging the Core: We realized that our hidden strength was our deep expertise in healthcare. That made us unique in what we tried to do despite our obvious handicap in technology and financing. We had people who had spent more than two to three decades in their domains, e.g., case management or coding and billing or compliance or risk management. Our goal was to hire the best in these fields and then push each other to make our processes better. Our focused implementation plan was conceived together and made everyone in the leadership a stakeholder. We then followed up on the progress of our execution and we excelled and beat our targets.

Realizing that we are subject matter experts in healthcare allowed us to tie up with IT professionals and create a synergy with them. The challenge of working with specialists from an entirely different field was many and extremely painful and disruptive. Yet we persisted and slowly learned the aspects of IT which pertain to software development. We learned their language and what they needed and how they thought and worked. Developing strong bonds with our IT professionals proved to be a catalyst in creating new healthcare modules that captured our granular requirements and niche specifications. When IT professionals created healthcare modules they did so out of very superficial knowledge of our domain. When we partnered with them and kept beating them (nicely), we were able to create products that fulfilled an essential need in the industry and had an immediate use for us.

  1. Leveraging Our Deficiencies: This sounds like a paradox but is so true. It is well known that experts get blinded by their paradigms and are unable to challenge their models. But those who do not know what is not possible can dream the impossible. We realized that in attempting to remove all our pain points we were taking on a huge enterprise approach to software in healthcare. Normally, we see vendors pedaling one module, which they have developed over decades caught up on old architectures.  We were able to dream of things that normally would not be attempted by a regular health IT company, e.g., trying to create a claims adjudication system in five months or a whole ecosystem of healthcare modules tackling multiple dimensions of each specialty.

While we did not know what we did not know, our lack of fixed information freed us up to dream big and work with a small budget, without the need for investors or marketing research. This allowed us to create freely what we needed for ourselves. Once we addressed our unique needs, we realized that this uniqueness itself created a universal application (pun intended).

  1. Think Immediate Impact: The advantage of our home-grown approach to our digital transformation was that we addressed first our most immediate and exigent requirements. Tackling our most painful points produced an immediate return and created success. Our initial mistake may have been to try to address everything that we needed, but as we zeroed in on the most critical areas, we found instant gratification, and this is extremely important in team settings. We proved to ourselves that we can do it and might be in a better position than others to create innovation in health IT

We realized that this is our niche. Health IT is where we can use our deep expertise and leverage our knowledge with our partners and vendors to create something of value. This made sense even in the boonies. Although we were the boonies as far as advanced technology and networks were concerned, we were the mainland when it came to cutting-edge healthcare, which we had developed over the last dozen years or so. This has been our lever, being the best in one thing, and just that one thing, which was healthcare.

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