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Dr. Scott Schell is a man in the know when it comes to technology trends within the healthcare sector.
With a background involving active work in clinical medicine and time spent within the executive leadership of hospitals and health systems, Scott now serves as the Chief Medical Officer at Cognizant, a position which gives him the opportunity to talk first-hand with senior medical leaders.
Rebecca Willumson: Hi there. I'm Rebecca Willumson. I'm the publisher of Fierce Healthcare, and I'm here today with Dr. Scott Schell, Chief Medical Officer at Cognizant. Dr. Schell, thank you so much for joining me,
Dr. Scott Schell: Rebecca, it's a real pleasure to be with you here today.
Rebecca Willumson: So before we begin, can you introduce yourself and tell us a little bit about your role at Cognizant?
Dr. Scott Schell: Sure. Well, I joined Cognizant earlier this year as the chief medical officer supporting the healthcare line of business and with a particular focus on the provider and health systems portfolios and business units. My background involves active work in clinical medicine. As an academic, I spent time in executive leadership and hospital and health systems and also helped build a number of pretty sizable population health systems, including founding the population health department at the Cleveland Clinic.
Rebecca Willumson: So from your conversations with hospitals and health systems, how much process and technology automation is happening?
Dr. Scott Schell: I have the opportunity to chat with healthcare C-Suite, IT and business leaders almost all the time, and really virtually every one of them are telling me that they're actively seeking and deploying new automation technologies within their operations. And half of these organizations are also saying that they've begun the implementation efforts that they're undertaking. And the 2023 Cognizant Healthcare Provider Automation survey for which we surveyed 300 C-Suite, IT and business executives, 90% of these individuals reported that automation is essential for workforce effectiveness and for financial success. Healthcare executives view this post pandemic workforce and labor pressures actually is significantly worse than other business sectors in our economy, and they really have a focus on productivity and their workforce.
Rebecca Willumson: So are hospitals and health systems targeting specific objectives with automation and what would you say is driving them?
Dr. Scott Schell: Yeah, I mean, that's a great question as well because automation has a number of flavors and forms really I think the primary objective driving automation is for managing costs and driving additional revenue, improving productivity, and optimizing patient satisfaction and outcomes. Each business unit comes with their own objectives and ways of measuring R O I and executive leadership sits on top of this and tries to manage them in a both holistic and strategic manner. The unifying themes, and I think this is really the core, is that the need for automation is related to post pandemic cost and labor pressures, the impacts of the inflation reduction Act and increasing competition from other healthcare providers in the same network and by payers. And if you look at specifically who, again from our survey experience, it's the IT leaders that are driving much of this and with the C-suite leaders following quite close behind.
Rebecca Willumson: So in your opinion, where are the most common areas where health systems are focusing their automation, development and deployment, and which functions do you think they should be prioritizing?
Dr. Scott Schell: So when you bring all the rev cycle activities together, this represents about 50% of the total bundle. As I mentioned in the previous question. Another significant area of focus is on workforce productivity, quality of workplace life and decreasing burnout. Staffing issues are extremely important for executives, again in the post pandemic labor markets. And then finally, patient experience IT infrastructure and application support really round out the top categories. Actually, as I look forward in the next three to five years, I think there's going to be an increasing focus on human resources automation and a meaningful transition into automating care delivery services and even more focus on patient financial services more broadly. So are these the areas where we should be focusing? Yeah, I think emphatically yes. We know that strategic automation investments can bring significant return on investment metrics driving at least 25% cost savings into administrative or out of administrative costs. And these healthcare organizations aren't just thinking about these projects, they're actually doing them. And I interact with small to medium to large regional hospitals and systems and fully half of them have already started or completed creating these solutions. And 80% of the executives feel that automation activities are not only important, but urgent or essential to their survival.
Rebecca Willumson: So let's talk about budgets. Do automation effort investments get the funding they need or would you say this is a challenge?
Dr. Scott Schell: Budgets are a really common topic and clearly certain organizations are much better situated when it comes to funding these projects while the remaining smaller health systems view these technology expenditures in the same context as other capital and operational expenditures, cost benefit, competing alternatives. And how funding challenges are perceived, again, depends upon the leadership group that you're engaged with. As I mentioned C-suite executives, they seem focused on patient and public and staff resistance to automation as blockers that really sort of impacts how they make decisions for funding because if the patients and the staff are going to push back, they're going to say, well, we won't be able to get the R O I. And they also worry about the adequate adequacy of IT resources. In other words, do we have enough IT infrastructures in order to make this work? And then after implementation, they really have to worry about training and change management because if you dramatically change a workforce activity change doesn't come easily to most of us.
We see between two and $5 million on average being spent annually in about 75% of our health system partners. And in those same systems, about 80% intend to increase their spending between five and 25% year on year for the next few years. If you're not a large system and you face these challenges from the infrastructure and staffing perspective, there really are excellent technology providers that can help with design implementation and training. And this really can be an excellent strategy to consider because it leverages outside resources in design and implementation and decreases the stresses on IT and staff.
Rebecca Willumson: So are hospitals and health systems undertaking these projects with internal IT and technology resources or are they leveraging outside health?
Dr. Scott Schell: Yeah, again, the largest healthcare systems, particularly the I D F S systems, they have enough internal capacity and resources to take some of this work on alone. But smaller healthcare systems and particularly those operating under stress just can't afford the capital or time resources to do this alone and generally don't have the technical or strategic leadership inside their organizations. A full automation implementation consists of really multiple separate transformations, each requiring different skills and staff and health systems really seem to struggle managing the priorities and timing, especially with staff, since the staff required for deployment are generally only temporary. So together these factors really make it difficult for healthcare systems to accomplish this alone. And most are working with technology platform providers and digital agency groups and these tech providers bring the experience on how to advise which functions deploy first, identify the low hanging fruit and then can also offer the scope and scale to put them into place without disrupting regular hospital operations system integrations. Consulting houses are also working in this space as well, and they add sort of different flavors to the same metaphor.
Rebecca Willumson: Now we know that not everything goes smoothly with automation projects. Are there specific complaints and struggles that you hear about from healthcare executives implementing automation initiatives?
Dr. Scott Schell: Yeah, that's certainly true. And again, our automation survey provided really specific help on this because we asked these questions. Number one, number one, number one is cost overruns. Although I would conjecture that cost overruns are actually a greater issue during the first implementations. Projects change scope, organizations get practical insight about what IT and manpower assets are going to be required and they learn. So I think that is less of a problem moving forward clearly. Second, however, is the healthcare leadership really needing useful analytics from their automation solutions and then using these data for strategic and operational pivots. And as you know, automation systems can produce a massive amount of data and it makes the need for automated ingestion analysis and presentational essential. And so the reasons that projects can go off budget is that adding additional analytics will drive additional cost. I think the third concern really has to do with R O I and timing because not infrequently there's a lag between deployment and really the full recognition of R O I and that really is compounded by some of the topics I just mentioned. And then lastly, cost analytics and R O I. It's really barriers to implementation training, the staff managing change and the complexities related to implementation as it touches on other parts of the technology structure. And that can limit some of the system capabilities and the tools roll rollout.
Rebecca Willumson: So clearly the biggest buzz topic is generative ai. Where do you see AI in the mix of automation solutions? How much emphasis are healthcare executives placing on ai? Are there killer AI apps in the marketplace?
Dr. Scott Schell: Yeah, AI certainly dominates the news cycle not only in healthcare but across society generally. Over the past year, I've really spent a great deal of my time discussing the topic of AI and healthcare and health system operations. Chat, G P T and other generative AI solutions have really taken society, healthcare technology and daily life by storm. Until two weeks ago, I joked that I expected AI to be in laundry detergent and other household supplies. I was at a big box store last week and I saw a toothbrush and a vacuum cleaner each advertising that they were powered by ai. So maybe Skynet is really going to activate every single healthcare I know, and I've just come back from a conference, has a focus on ai and every health system has a budget and a plan to identify pilots and investments in ai. And the specifics are not fully formed, but the killer app would ideally be one that dramatically improves operations and outcomes in whatever context these systems are currently struggling.
And coming back to the health systems, I think there are a number of real opportunities to use AI in its very forms and operations and rev cycle management contracting and human resources. And our survey results validate that these applications are really key targets as well. And as we discussed a little bit earlier, these are areas that can really help the bottom line and do so while we're working. The other questions of data privacy, governance, accuracy of the systems, and maintaining excellence in patient care delivery.
Rebecca Willumson: So what's the takeaway? If hospitals and health systems haven't yet started or deployed much automation or have had limited success, what do you recommend their next steps be?
Dr. Scott Schell: The way to answer it is that automation initiatives can cover a massive proportion of the operation and strategic landscape, business operations, patient engagement, et cetera. Some deployments need to be standalone, other needs technology change and integration to infrastructure, APIs and of course ai. So the takeaways are first, focus on identifying the most important functional solutions that your system needs because one size does not fit all. Next, find those technology solutions to solve those problems and connect with business partners that can help you deploy them without disrupting your system and operations. Next, don't forget about the change management part of deployment. Pay careful attention to the people and be concerned about their perceptions of changes to role daily work and job securities. And I guess the way to cap off this answer is to basically talk about some of what I've seen in organizations that seem to get it right and those institutions established an internal center of excellence or leadership team to supervise the automation. So it's a core group that has leadership and executive sponsorship. They work with partners who maximize the benefits of technologies and who can help them with integration and deployment and manage with things like transient staffing. In order to get the automation in place, make sure that your goals and objectives are clear, set the KPIs and make sure that both leadership and the stakeholders can own them, and then measure the project, the timelines, the costs, the goals, and the KPIs so that you keep things consistent and are not surprised if changes come along.
Rebecca Willumson: That feels like a perfect place to wrap up. Thank you so much for joining me today. I really appreciate the conversation.