Where Fintech & Healthcare Meet

Webinar

Shifts towards payviders and value-based care address financial structures, but what does that mean if patients don’t change behaviors?

Featuring

Description

Dr. Matt Cybulsky, healthcare consultant & behavioral economist, works at a unique intersection between digital health, finance, and patient engagement. Patient perspectives and incentives often get lost in grand conversations about strategy, revenue cycle, and payment reform. Dr. Cybulsky’s work focuses what it takes to get people to engage their care given an overall organizational strategy.

Dr. Cybulsky is an outstanding communicator, and we encourage you to share questions or stories on the topics we’re discussing:

  • What healthcare leaders should know about payment reform
  • Advances in financial technology and how they relate to healthcare adoption
  • Health care related patient engagement
  • Financial & revenue cycle related patient engagement

Matt Cybulsky

Healthcare Behavioral Economist
IONIA Healthcare Consulting

Chris Hemphill

VP, Applied AI & Growth
Actium Health

Audrey Wyman

Manager of Customer Success
Actium Health

1

Transcript



Chris Hemphill:
... gals. We're live. We're live. Hello, healthcare. Hello, LinkedIn. Hello, Youtube. However you are joining us for this webinar today. We are excited to have you. This conversation, you might notice we've been talking a lot about things around consumerism and the nexus between the consumer experience and healthcare technology.

Chris Hemphill:
This is an interesting conversation because our guests today, Dr. Matt Cybulsky, sits in a domain that covers all of those things at the same time. With his consulting firm and work that he's done in the past, he focuses on behavioral economics in healthcare, but also has a background in healthcare administration. He's led healthcare administration, even taught classes on that at UAB, as well as healthcare finance and financial technology.

Chris Hemphill:
It's really exciting to ... I was having a conversation with Matt a couple of weeks ago, and he was talking about some of the more recent innovations in financial technology, and how they apply to this changing landscape within healthcare. I thought that it would be a good idea to expose the audience to some of the thing ... As we're going through at the same time healthcare ...

Dr. Matt Cybulsky:
[crosstalk 00:01:19]

Chris Hemphill:
I'm sorry. What?

Dr. Matt Cybulsky:
Exposed them, yikes, look out.

Chris Hemphill:
But to be exposed to these technologies and that intersection between financial technology, behavioral economics and patient engagement. Matt, I wanted to brag on you for a few minutes. But now, you can brag a little bit, too.

Dr. Matt Cybulsky:
What am I bragging about? What I'm involved in?

Chris Hemphill:
Yeah. Yeah. Just want to say hello to the audience.

Dr. Matt Cybulsky:
Hello, audience. It's good to be here. I am very grateful for my friendship with Chris Hemphill. It goes back all the way to ... I think we were introduced 2012 in Birmingham, Alabama at a dinner location and immediately hit it off. Bright mind, curious mind, growth mind. Yeah. It's nice to build community with you, Chris. It's also nice to meet you, Audrey.
Audrey Wyman:
Hi there.
Chris Hemphill:
Happy to have Audrey on. Audrey actually works along with me at SymphonyRM. She has a really big enthusiasm for consumerism within healthcare. I just thought this would be a great connection to have for the audience. For the folks out there watching, if there's any questions that you have, or any kinds of issues that you might have been trying to address around patient engagement, or around digital health, or anything that we're discussing, it's designed to be an open conversation.
Chris Hemphill:
We use LinkedIn Live for a reason. Let's talk with Matt. He's excited to answer any questions that you have. I want to say hi first to Eliya here, and anybody else who wants to chime in, we're happy to have you. Before we get started, too, I just wanted to point out that for those who are interested in what some of the latest things that are going on with regards to healthcare consumerism, and a lot of the new changing care models that we're seeing from organizations like Walmart and CVS and those other organizations that so-called disruptors within healthcare.

Chris Hemphill:
We actually recently put out a podcast on our website, hellohealthcare.com where we go deep with that like on this subject, Dr. Paul Keckley, James Gardner, Shari Campbell and many others with regards to what these organizations are doing, and how conventional healthcare providers might be impacted by some of the more recent innovations. I just wanted to point out hellohealthcare.com for folks who aren't following the podcast.

Chris Hemphill:
Thanks, Matt. With all that, I just want to go ahead and get started. We brought up an interesting background, I [inaudible 00:04:06] set of things that you're doing in healthcare finance, administration, behavioral science, and that's obviously a really rare but interesting combination. Just curious about any background on why you've taken this journey and what's been keeping you going along the way.

Dr. Matt Cybulsky:
Yeah. It's a good conversation. I get asked that quite a bit because it is somewhat of a synthetic career path I've taken. I have always had a great interest in human behavior. I mean, I don't know who isn't. If you look at majors for psychology, for example, I think behavioral sciences are some of the most popular studies you see out of universities these days.

Dr. Matt Cybulsky:
But for myself, I was working in revenue cycle a while back and was noticing a lot of interesting patterns with how patients interacted with things like their EOB from insurers, or how they pay their bills, or how we interacted with them on the phone, or through any correspondence. I became curious enough about it where I thought, "Man, I wonder if there's some innovation to be had with our interactions, beyond the software that we had to process, any financial transaction or adjudication from an insurer."

Dr. Matt Cybulsky:
"How does our patient embody themselves? What can we do with them as far as innovating our connection with them when it comes to their satisfaction, keeping them in our community of providers? How they are perceiving their interaction with us has to get beyond just the clinical space with this, the procedure space?" Became something I started thinking a lot about. I thought, "Well, how do you measure that? How do you discover that?"

Dr. Matt Cybulsky:
I had a conversation with some executives, where I was working and made a proposition. I said, "There's some studies going on right now that are getting quite popular. They're calling it behavioral economics. They study how humans participate in the economies and how they participate as consumers but through the lens of what we know about human behavior."

Dr. Matt Cybulsky:
That proposition got a yes from one of the executives I was speaking with. I yippie ki-yayed to get a deeper study into human behavior in the context of healthcare participation and finance. How do patients interact and how do you study that, and all the things that I had to do to learn that? I did a PhD in behavioral sciences. It was really successful. What I discovered enough to confer the degree and then started doing some consulting work. I worked in some quality and safety places, which is interesting foray add to that in academic institution.

Dr. Matt Cybulsky:
Then I moved on to doing some work around consultancy and direct consumer work. That became really fascinating. When you send patients devices, how do they interact with it? How do patients and providers interact through telecommunication through digital means? How do you influence that behavior for all number of things when it comes to quality and safety, or it comes to satisfaction, or it comes to follow through, or it comes to the pills show up on the doorstep?

Dr. Matt Cybulsky:
Do they open them and take them at the regular intervals they were prescribed? Or do they stay in the cupboard? Then how do you move the needle on any of that? It has been quite an interesting journey. It started off just with curiosity, and then it became formal training, and then it became applying tool sets to remote care with patients through digital means. We ended up starting our own podcast.

Dr. Matt Cybulsky:
To be honest with you, I started it with a friend of mine just to have a reason to reach out to someone I had no business speaking to, reaching out to Eric Topol, reaching out to Lewis Levy at Teladoc. Then it just ballooned. It became quite popular. We were focusing on conversational AI and voice-first technologies, like Siri or Cortana, Amazon's product, et cetera.

Dr. Matt Cybulsky:
We started out with 300 listeners and ballooned to over 15,000. Then next thing you know, we're doing conferences at Harvard Medical School. Now we've moved the podcast to Twitter Spaces where we have dialogues and panels with experts. We always are talking about the human interest story. Digital health is nothing without the human story. Okay. The gold standard, for me, if I was a provider, would be to be in person with you.

Dr. Matt Cybulsky:
But because of a shortage of providers, an increase in costs, COVID-19, we've had to accelerate the silver standard, which is how do I connect with you through any medium in order to enact a healthy behavior, a healing modality, or a relationship. That relationship is the nuts and bolts of what healthcare is, whether it's on the Fintech side, or the clinical side, or through direct to consumer care, which I would even consider a company like Peloton to be healthcare company, just has a close community of people who can receive messages and take on a cultural identity of health and well-being.

Dr. Matt Cybulsky:
Those are all the spectrum of things that I've been involved in and then want to be involved in. But it started with just the question. It became about measuring an impact with dollars and volume on small behavioral changes that we started looking at. Then it ballooned into a podcast that would help me get consulting work, which then became me being known as a guy that interviews people doing interesting things and that's how this even event here is taking place.

Dr. Matt Cybulsky:
Chris, you've come to some of our events. You've been a part of our podcast. We've talked extensively over the years about the value of building a community. That community building is no different from my research on human behavior as well. Anyway, that's my history, and not a very short summary.

Chris Hemphill:
Well, thank you for providing the background. There's a whole lot of interesting stuff that we could go into on that one. I think we're going to start elucidating that throughout the conversation, one point that really stands out is the question on the strength of relationships, how you look at quantifying that through a behavioral science lens. I think that a lot of the conversation around digital health and that Nexus around Fintech will help bring light to that.

Chris Hemphill:
Just to start getting into it then. In these conversations, even today, you've spoken about this nexus between digital health and financial technology.

Dr. Matt Cybulsky:
Yeah.

Chris Hemphill:
To dig deeper on that, what's the top challenge that you see these types of technologies addressing?

Dr. Matt Cybulsky:
That's a hard question, Chris. Top challenge, top lists, and the most important things violates my own worldview on problem solving, which is it's never just one problem. It's a cadre of problems that you're addressing. There's a spectrum. I won't contend that I think I know what the number one issue is. What I will say that I'm focused on quite a bit is a consistency of messaging along with intrinsic motivation.

Dr. Matt Cybulsky:
How do I get a connection with patients in order to keep them interested enough where I don't fatigue them, they feel they're part of the continuum themselves as a co-teammate of care. That is an important takeaway that they don't ignore me, that I don't fatigue them, that they don't feel harassed. But they feel the interaction is easing some part of their continuum of care. They're a participant in that.

Dr. Matt Cybulsky:
That comes from a lot of looks at the UX, the user experience, the interfaces that we're using, coordinating messaging to patients, and then also inviting them to participate in some way, whether that's a payment plan, point-of-service collection, follow-up care, having some interaction, whether it'd be a conversational AI tool, or human about the next steps in their care.

Dr. Matt Cybulsky:
I focused on Fintech quite a bit lately, because majority of those interactions are going to be with pre-service, and then post-care follow-up, getting my prescriptions at the pharmacy, paying my bill, understanding my bill, understanding what my cost share might be going into a procedure. Now, the clinical and patient relationship, of course, is really important. The reason I'm going through this process is because of my health in one way or another.

Dr. Matt Cybulsky:
But there's a lot of touches to use an industry term for a patient that doesn't involve the actual clinical hands on procedure modality, you name it. But that still impacts the way they feel about their health, their care, and the burden of it. Money is time. Time is also burdensome. Money without it can make things hard, including taking care of yourself. That is a large place where I'm looking a lot is how do I interact with them in that regard? How do I coordinate systems so that they can join a payment plan if it's expensive.

Dr. Matt Cybulsky:
Or that what they owe after insurance doesn't impact their credit, and keep them from being able to house themselves efficiently, or drive their car to the grocery store, or have disposable income so they can buy healthy food. These are the indexes that I work upon right now. Beforehand, I was doing a lot of work on, if I sent Chris and Audrey a device to help monitor their health, how do I get them to open it, interact with it, put data in it, what are the UX, UI considerations I make there so that the thing they're monitoring is influenced and impacted in a way that gives them a healthier life?

Dr. Matt Cybulsky:
Money can give people a healthier life, managing it can help give them a healthier life. Not having them harassed, gives them a sense of connection to the healthcare provider or system that is endowing. They're part of a community. That community can lead to a lot of success. That's where I'm focusing a lot right now.

Chris Hemphill:
Excellent. The way you launched off with regards to the communication, without that exceeding into harassment, there's a lot of conversation around frequency and how we interact with people individually. Chris Saxman popped up on the screen earlier, but Chris Saxman had brought up a good point around treating people as individual consumers and how certain strategies that worked for one person might not work for another.

Chris Hemphill:
Just curious, there's a whole world of engagement examples of that opens up and I'm curious if there's any kind of story from the past, in that patient engagement perspective that you might be able to expand on.

Dr. Matt Cybulsky:
I think what Chris is saying resonates. It'll resonate with everybody. I think the risk with tackling a problem like Chris is defining is not falling into a relativistic world where everyone's so unique that we can't develop a pattern to deliver. That's a challenge. Okay. That is not a criticism of Chris' comment at all. It's a yes and how do we create at least an 80-20 to move the needle a little bit?

Dr. Matt Cybulsky:
Number one, yeah, I agree with him. I think AI and digital connections can turn into eventually a gold standard as the technology increases. I appreciate his comment very much and his interaction. As far as a use case example ... Actually spoke about this recently. There is a great story about some incredibly adept and experienced technologists who were creating a voice-first tool, a conversational AI tool for a man who had some disabilities due to a chronic condition.

Dr. Matt Cybulsky:
Met with the guy, looked at his living situation, learned about him as a human being, his interests, music, art, et cetera, looked at where he lived, and tried to come up with some tools to help him live better, given his limitations. They went back to the drawing board. They spent a great deal of time working through their own pedigrees. These are well trained Ivy League folks, MIT, Harvard, RISD out of Rhode Island. They came up with all this great stuff.

Dr. Matt Cybulsky:
They went back to him and said, "Hey, here's all the things that we can do for you." He says to them, and I'm paraphrasing, "This sounds great. This is wonderful. You all are obviously very talented. But the number one thing that I want is not to die alone." The big fault so many times in technology when it comes to healthcare is you neglect to ask the patients what the heck they want.

Dr. Matt Cybulsky:
This guy's scenario was, "I don't want to be alone. Can you create something to help me not be alone? There's a lot of other tools I have. I can feed myself. I have people come to help me clean up, shave, they buy my groceries. But I don't want to be alone if I'm here, and I think I might be dying." The conclusion that came to is this man's desires and passions were music. Of all the complicated things they made, they end up going back to something that was already easy to create and apply, which is creating a wake word that initiated a playlist of his choosing.

Dr. Matt Cybulsky:
In case he was actively dying, he could cry out or speak. This playlist would play. This music would remind him of family, of memories, of lovers past, and he was not alone. According to Chris' comment about the uniqueness of these things, nothing is more human than that. That story, to me, is one of these great examples of uniqueness using a tool set that isn't particularly unique per person, but has tool sets that can be segmented for needs.

Dr. Matt Cybulsky:
Sometimes the answer to connection and building community with patients and creating innovation is a lot more simpler than we like to make it out to be. That is one of my favorite examples when you work with a group of innovators and say, "There's a lot of things you can do. But what you ought to do can easily and shouldn't be influenced by the patients you're delivering for." Ask them first and then go to create.

Audrey Wyman:
That's a really touching story. Thank you for sharing that, Matt. That gets me. I was thinking of another technology I wanted you to comment on. It's top of mind for me because I just started using it. But I am using Noom ...

Dr. Matt Cybulsky:
Oh, yeah.

Audrey Wyman:
... which is an app that pairs me with a coach and helps me to ... I can track my food, I can track my exercise, and it color codes. But one of the things that was particularly striking to me was the language used, very geared toward millennial. There's a lot of hashtags. They've referenced Harry Potter at least two or three times. I think I'm on lesson three. But they're really speaking to my generation, I think.

Dr. Matt Cybulsky:
Yeah. Yeah. What works for you with Noom? There's a bajillion apps on my phone. There's so many apps on my phone, I've gotten good at like categorizing what I click on to make it fast or using the voice interface. What makes this messaging toolset, what creates the intrinsic move for you? Why is this working opposed to you saying yourself, "I'm going to write down on the whiteboard, on the fridge what I ate and how much I weighed today, and how much water I took in? What's different here?

Audrey Wyman:
I'm really holding myself accountable to a large audience right now.

Dr. Matt Cybulsky:
I'll make sure ...

Audrey Wyman:
I'll be very vulnerable, actually. I've tracked my food for about 10 days in a row. Yesterday, have an off day. I got kiddos that are sick, and I made a ... probably shouldn't have had that sandwich, maybe. I had a big Italian sandwich. I didn't want to log it in my own little way. I ignored my app. The app prompt me with a notification. Then a few, maybe in the afternoon, several hours after it realized I hadn't logged couple meals, my coach messaged me, and just said, "Hey, this is your SOS. Back when you signed up, you said do you want someone to check in with you if one of these things hasn't happened?"

Audrey Wyman:
I did self select into this. Someone wrote to me, and I logged my darn sandwich. That worked. That worked. I don't know if it's going to work every time. But it was a very effective intervention.

Dr. Matt Cybulsky:
Yeah. That's something that I've applied a lot in the past, social proof. A lot of times, the things that we do, how we dress, how we speak is social signals to the tribe of people we claim to show identity toward. There's a certain people that are going to join LinkedIn for this talk. There's also a huge swath of the population that's never going to hear about this nor care. Finding out the community standard, and being influenced by that is really important.

Dr. Matt Cybulsky:
This is not necessarily a patient-focused example. But there is great examples in ... a rev cycle world, where you have teams of people that are responsible for certain parts of the rev cycle, insurance debits, insurance AR, correspondence with insurers, and they work in groups. Those groups don't always interact with each other. But to optimize performance of those groups, instead of having a manager or someone top down, say, "Here's how I recorded your effective work. This is what I need you to improve upon."

Dr. Matt Cybulsky:
You can look at the teams themselves and say, "We're going to rate you guys as teams and tell you as a team, where you're succeeding and where you're failing. By the way, there's some bonus tied to that. We're going to share that individually in groups with you, help each other get better, so that you all can get this external incentive." You're combining this internal motivation of I want to do right by my community, my team, with if I do that, and I do that effectively, which is not that hard, because I'm wired as human to be pro-social with a group, then I also get this external reward.

Dr. Matt Cybulsky:
The internal motivation to be pro-social, and have your teammates say, "Good job. Trump's the external motivation of any dollar or treat you might get for following through with that." I think the similar thing is true with you, Audrey, or anyone using this tool you're talking about. There's a community standard that you're developing, and there's a tribal code that you're running by.

Dr. Matt Cybulsky:
The satisfaction of that, from evolution for you, and as human being probably is incentivizing you to be aware of the things that you're putting inside yourself, or creating opportunities for physical fitness or sleeping, right. Both of those things together is a powerful drug. In fact, the internal motivation that we can create and others if we set up systems right, we'll win, as Dan Pink says, in a heavyweight bout against extrinsic motivation every time.

Dr. Matt Cybulsky:
I try to think about that with every problem in innovation. How do I create whatever I'm creating with whatever firm comes to me that focuses on internal motivation of the human or participants that we're working with?

Audrey Wyman:
Yeah. I think one critical piece, and you said the word a number of times is connection. I felt a connection, and had that human not reached out to me. Now, it could be a robot, maybe doesn't necessarily need to be a person. But I did feel a connection with another person that incentivized me to ... or guilted me perhaps. But I realized, "Gosh, I need to interact with this. I should log this."

Dr. Matt Cybulsky:
Yeah. Awesome.

Chris Hemphill:
I think something great happened here where we started off talking about the grand landscape of digital health and Fintech. Then we zoomed in on a patient example. Then we zoomed in on the Noom app example and then started getting really specific on levers of influence like that. You called it out specifically a social proof, mirroring the book Influence by Robert Cialdini.

Dr. Matt Cybulsky:
Yeah.

Chris Hemphill:
What I wanted to get into Laurel Skurko, actually, she asked a question here. I just wanted to give her a shout out, first of all, because Laurel, my introduction to her was while doing this show and now we're coworkers. She's recently coming and started to work with us. But we've talked about this overall landscape of digital health and the levers of influence on how to drive behaviors. Her question leans into, "Okay. We have this influence, we have this engagement here, how are companies looking at this and actually valuing it?"

Chris Hemphill:
Goes in line with how leaders can push consumerism-driven efforts within the realms. How are they looking at this from a value perspective?

Dr. Matt Cybulsky:
Well, it's a great question. Once again, I'll caveat all of this. I don't have all the answers, but I have a unique view. Laurel's question is spot on. One thing that comes to mind here is we're bridging this gap between provider to patient. If I got a panel 1 to 4,000 for a year, and I'm a general practitioner, maybe I can manage that pretty well.

Dr. Matt Cybulsky:
But if I've got 9,000 patients, or I've got 20,000 patients, because of whatever system I'm set up in, or because there's a shortage of general practitioners with the increasing need of people to have connects, we've got to build some tools that allow that practitioner to shorten that ratio where it's more connected or that there's more influence. How do you do that?

Dr. Matt Cybulsky:
Well, creating tools for patients to monitor themselves and do something on their own, similar to what Audrey is talking about, but a much more expanded. You can do that by condition, hypertension, diabetes, hip fracture recovery, dementia. There's all kinds of applications with that. But those are the two big takeaways for me. Our large companies and healthcare companies are using digital means for patients to help themselves, but also to bridge the gap away from the gold standard, which to me, the one-to-one care is the gold standard.

Dr. Matt Cybulsky:
Me, showing up to your house and cooking a meal, showing you how to work out, putting you to bed on time, making you take your drugs, that is can't get better than that. But if I have a human standard, an AI tool, a cellphone, a mobile technology, a smart speaker in the house, monitoring when you have your coffee, when you go to bed, how many times you're opening the fridge, how many times you're flushing the toilet, if you've got COPD ... Excuse me, not COPD, congestive heart failure.

Dr. Matt Cybulsky:
If I can have microphones in your house and know how many liters of urine output or sewage is coming out of the house, I can get a sense of how much your output is, and maybe if you're managing that or not managing that. Back to your question originally, instead of framing the problem, let's look at something like access, healthcare access alone. There are a limited amount of family practitioners.

Dr. Matt Cybulsky:
I had a podcast with the AFP leadership recently where we talked about that, and a campaign of their own to recruit and grow residents for family practice to keep this ratio provider to patient better across the board. There's also a CDC initiative for social determinants of health, when it comes to how many people have an active relationship with a PCP or primary care provider. There is only a finite amount of humans involved in that. To bridge that gap, you've got to use some technology.

Dr. Matt Cybulsky:
Why is that useful for a company? Well, if you think about an insurer, for example, any kind of insurer, the more patients that are connected, either through digital means or to a physical person that's a PCP or a primary care provider, studies have shown. The longer we push out chronic condition diagnosis, the longer we stabilize someone who has a chronic condition and keep them from exacerbating, there is a quality of life component with that also.

Dr. Matt Cybulsky:
It's not just about money. But if you are ill or you are older and are coded in your DNA in your environment to end up with something that is going to need management, how do we do that in a way that keeps your quality of life as high as possible? This has to drive and does drive a lot of digital health. The direct consumer health companies, him and hers, folks, Peloton as I've mentioned, Roman, these are limiting to a degree because they are out-of-pocket most of them. There are disposable income.

Dr. Matt Cybulsky:
If you just look at something out-of-pocket costs required for an insured person, up to $5,000 a year, that's a limited volume of dollars per consumer. Then there's also very unique applications that each consumer are going to go in by themselves. The direct consumer market, compared to the insured market, is small. Now, I just heard this morning of a company that is extending remote care to Medicaid, insured folks, they got some funding.

Dr. Matt Cybulsky:
That, to me, is pretty exciting. If you're talking about moving a needle, if you're talking about quality of life, if you're talking about a limited amount of providers per person, or even provider deserts, I mean, there are parts of cities, huge American cities that don't have primary care or emergency clinic or an urgent care clinic near it in walking distance. This is something that, to me, is what digital health companies ought to be looking at and are looking at.

Dr. Matt Cybulsky:
For us to have this conversation and to say that people aren't looking at these problems, there's a ton of capital going into it, and there's a lot of smart people considering it. But that's a social determinant of health for access alone is a great example of where digital health firms are applying themselves. There's monitoring, and there's bridging the gap of ratio from PCP to consumer, all in the name of quality of life. Secondary claim is to curtail excessive healthcare spending.

Audrey Wyman:
Yeah. I think we've been talking about these chronic conditions with ... This has been a story for a long time. What has been happening that you've seen healthcare companies do or these direct to consumer companies do that hasn't worked? What can we rule out? Where do we know we need to trend towards?

Dr. Matt Cybulsky:
Moralizing and getting shoulds all over your consumers. What do I mean by that? Just call, they send you something that's going to make your life better, according to me, does not necessitate you're using it. The patient should do this. It's the right thing to do. Now, patients act in a certain way. Discover what patients segment behaviors are prominent in what you're trying to influence. Then create a product around that.

Dr. Matt Cybulsky:
Stop expecting people to be these moral soldiers, even for themselves. Expect humans to act like humans. Discover how they behave and then create systems around them. How do you do that? You lower barriers to access and barriers to activation for devices or for interaction. You look at social proof a great deal of time. You consider that the human model is to be lazy, and not to really do a whole lot of anything.

Dr. Matt Cybulsky:
Creating models around reducing barriers, the cost of action, which humans want to be misers about, they don't want to spend that energy. That's where a lot of folks go wrong. Goodwill is the chief aim of medicine. It is. But the reality is when it comes to direct consumer work, any product or service that's expecting the patient to carry a whole lot of that burden themselves is going to fail, in my opinion.

Audrey Wyman:
That makes sense. Can you talk about one of the health systems that you've worked with that is really thinking about the customer experience on the rev cycle side? What did they do that has worked?

Dr. Matt Cybulsky:
That's an interesting question. I think the innovation for rev cycle when it comes to how consumers are interacting is interesting. I'm not going to necessarily name some of these folks. But there are some firms that are interacting with patients that do take a human behavior approach first. A lot of that I've seen the innovation has been with their UX or even their texting campaigns.

Dr. Matt Cybulsky:
How are they communicating with these patients? What does it look like when the patient engages? How easy is it to navigate their tools? Are you putting patients through a laborious login signup process? Or, hey, are you using data and consent and assent from other systems, allowing someone to put in a birth date or use a face ID in order to interact from a rev cycle capability?

Dr. Matt Cybulsky:
The third place is conversational AI technology. Iterative communication through text is okay. It's definitely better than some other tools we've seen. But how many of those can field real questions from a patient? Why do I owe this? Having a conversational AI respond and say, "Oh, you owe it because you had this data service. Here's the EOB. This is the insurance we have on file. By the way, here's a link to go look at the bill again if you wish."

Dr. Matt Cybulsky:
That communication that supplants human wisdom is a big win for rev cycle companies that are trying to apply innovative tool sets. The other part is I've heard of some firms out of the Bay Area company called AKASA, a friend of mine, Ben Beadle-Ryby, got started. They've taken on some funding. They are purporting to have a technology that's artificial intelligence-driven rev cycle. On the system side of Rev cycle, how much AI are we applying to decision matrices when you interact with a payer?

Dr. Matt Cybulsky:
That's fascinating. All the name of speeding cash, reducing mistakes, reducing denials, stabilizing labor costs over time. AI being introduced to revenue cycle is an exciting thing to me. It is also a Herculean effort when you think about what might be considered. Some experts' minds, the infinite amount of variables that exist in any rev cycle process, it takes a lot of wisdom. It takes a hell of a lot of human experience in order to pull off a well-organized, well-operationalized efficient rev cycle cohort or department. I think the AI applications got me pretty excited.

Chris Hemphill:
Matt, Dr. Cybulsky, we got another good question from the audience. I think it synthesizes a lot of the things that you've been talking about today around influence. This again from Chris Saxman. But the gist of the question is there some thinking, is there a framework that people should consider when creating something that people would want to use eagerly?

Chris Hemphill:
He cited Peloton as an example of something that people are eagerly hopping on to, literally. But just wanted to get an idea on that framework that people should consider for eager consumption, going past the moralizing aspects of it.

Dr. Matt Cybulsky:
Sure. Great question. Chris is a ringer today. Lots of wonderful interactions. Thank you, Chris, for listening, I hope you're enjoying your coffee and smiling while I say that and highlight you. There's a great book that was written not long ago called The Myth of the Rational Voter. This book was about voting. But there was a really important human component to that, which was humans are really going to be more interested in things that cost them something.

Dr. Matt Cybulsky:
Humans are not as interested in what they gain from it. This is the famous Thaler maxim that was used for his work that conferred upon him the Nobel Prize, humans are two times as much concerned over what they'll lose from their status quos to what they'll gain. When you apply that to a direct consumer or health tool, humans are going to think about what they can lose by not engaging.

Dr. Matt Cybulsky:
If I've got a tool that helps someone prevent diabetes, am I going to use that if I don't have diabetes? Or am I going to be more interested in the monitoring tool after I have diabetes. You're going to be a lot more interested after you have diabetes. You're going to be a lot less interested about preventing your own diabetes until you're hit with that bug.

Dr. Matt Cybulsky:
Another example of this I think goes well is creating a need when there isn't one that exists, creating a cost preventer when there isn't one that exists and how do you do that? Habituation. Brett Kinsella has got this great term because it, he says, "Smart speakers are a gateway drug to using conversational AI," like Siri Cortana, Alexa's name. That's the case. If I'm habituating behavior for health, because I don't have a cost yet, I don't have diabetes, I don't have hypertension, I might not have something else I need to monitor on my own, you can habituate folks.

Dr. Matt Cybulsky:
But to do that, you have to have a lot of capital, and you got to have something in their hand already. One of the best companies in the world that's already done that, and I know this is going to be cliche, it's Apple healthcare. I got this smartwatch here. They were the number one watch seller in the world now. It tells me my heart rate, my respiration rate, how far I've walked, how long has I slept. Did I ask it to do that? No. Can I turn it off? Sure. But have I asked it to do that? No.

Dr. Matt Cybulsky:
But all of a sudden, "Oh, I know how much I sleep now. I know how much I walked now. I'm paying attention to it. That is one way to do it. The other way is cost. Unless someone has something to lose, whether it'd be quality of life, death is a great motivator. Terror management theory, chronic conditions can lead to that or can lead to debilitating outcomes. That's a motivator for humans.

Dr. Matt Cybulsky:
Yeah. I think habituation is the way you create that internal motivation to even care. You do so by making it interesting to see how you interact. 23andMe, where I've come from? Where's my family? Do I code for various DNA that might give me a certain probability to be at risk for a certain thing? I didn't know that before 23andMe. None of us did. Didn't have that capability. It's a great question.

Dr. Matt Cybulsky:
If I had the answer to it, I wouldn't be here. You and I would be probably in Hawaii, on my golf course, talking about the day that I figured this all out. I think we have a long way to go with it. But I think those two things are really important. You have to think about what people think about losing. You have to think about how habituating them into a product awareness can create a new market. Apple's done a great job of that. Amazon's doing a great job of that.

Dr. Matt Cybulsky:
But then again, the amount of capital they have to do it is unheralded in history of US business.

Audrey Wyman:
Yeah. You hit on something that I think resonates a lot with what Chris and I think about with some of our clients. You talked in the beginning about how we shouldn't should all over people, we should ...

Dr. Matt Cybulsky:
Sure. Don't get your shoulds all over them, Audrey. Don't do it.

Audrey Wyman:
But the gentle nudge, just the gentle suggestion that pops up on your smartphone or gives you a notification. How do you find their habits and nudge in on them in a way that doesn't tell them exactly what you should do, but just steers them right?

Dr. Matt Cybulsky:
Well, the last euphemism treadmill for this term, a euphemism term on a treadmill for this, Audrey, was big data. Remember when everyone's doing big data? We all did big data. Then you talk to firm. What's big data? You don't know but we do it. That's morphed. Data is still the value structure in digital anything. The phrase that I heard, which isn't exactly the most kosher phrases, data and digital technology, the digital industry, data is more valuable than cocaine and truffles by the ounce.

Dr. Matt Cybulsky:
The valuation from a lot of digital tools comes from the data that you can gain from it. Google Email is free. But the monitoring of that information allows them to make a dollar. That's where they win on that. But we've transitioned from big data, analytics to tool sets that can handle big data. Now we don't have enough people to monitor the data. What's the new industry term that a lot of people don't understand? They're still trying to apply. It's artificial intelligence.

Dr. Matt Cybulsky:
The difference being 10 years later, after big data, is that there are real applicable tools and software for artificial intelligence that can give you real results, real insights to how humans are behaving. To answer your question, a really longwinded way, which I'm really good at doing, Audrey, is that if we can apply the way I interact with myself, what are my Apple Watch uniquely to me, aggregate that to the millions of people that have these alerts, these software tools, these apps, we can run regressions, which is what AI is. It's a series of regressions.

Dr. Matt Cybulsky:
Then regressions built on the answers to the regressions. A lot of times, even in machine learning, some people don't even know how it works, believe it or not. We're still figuring it out. It's a real thing. But those answers and that all kinds of outcomes that we wouldn't get with just me, you, and Chris on a BI tool from Microsoft, just in our home computers. Let me give you an example from retail. I think retail, because of just the clear supply demand quotient of it has some great analogies to healthcare and how we can understand the data.

Dr. Matt Cybulsky:
Walmart is an Amazon now. But Walmart is just a masterful firm on understanding what the human does in their store. They've got these long betas and regressions. They've done it. One of my favorite examples is they figured out ... First of all, their server center in Bentonville is, I think, 11 times larger than the IRS is, just to give you a sense of size. Huge. They're always running regressions.

Dr. Matt Cybulsky:
Every time you hear a beep at Walmart ... When you walk through you hear beep that classic Walmart beep, you know what talking about? That sound when they scan an item. Every time that beep goes, there's regressions being run on their servers in Bentonville, every time. It measures really wild, interesting things. Weather patterns. If you swipe your credit card, what's your credit score? What your gender? What's your age? What's your median household income and the zip code that you live in?
Dr. Matt Cybulsky:
Where was the item next to? What I was at on? What's it currently priced? What was on the end cap? The end cap at Walmart usually has the deals. Why? Because you say, "Oh, there's a deal on chunky soup." Then you're like, "What else is on this aisle?" Then you stop thinking about deals because your mind can't do that and you start pulling stuff off the shelf you need, which translates to revenue.

Dr. Matt Cybulsky:
But one of the greatest things I remember hearing about them was they figured out that in the southeast, if there's a hurricane in the Gulf of Mexico, and ... Yeah, in the Gulf of Mexico, and they had boxes of Eveready flashlights with batteries in the package next to strawberry Pop-Tarts that were frosted. They couldn't be non-frosted. If they had those two things together in the front of the store, they would liquidate each box every 48 hours, as long as a hurricane was in the Gulf.

Dr. Matt Cybulsky:
Apparently, people like to eat strawberry frosted Pop-Tarts, and keep everybody flashlights around when there's a hurricane in the Gulf. That's just one example of just how specific you can get on regression analyses and maybe even modern times AI and machine learning to get a sense of how the consumer interacts. Apple probably can do the same thing. Other popularly used apps likely do the same thing. The one you're using probably does that as well.

Dr. Matt Cybulsky:
That's the future of excitement that is around the corner of unknown as we climb this mountain of data discovery, and there's more data than ever coming through. I mean, voice enabled tool sets are nine times the amount of data as search. Because when you speak, you could talk a lot in comparison to the physical output of your fingers. That's evolutions gift to all of us. The other part about evolution and the human mind is tone. Before we use words and sentences, we heard hemming and hawing and music. That influenced our emotional state of being.

Dr. Matt Cybulsky:
That emotional state of being gave us a sense of connection, or fear, or excitement, you name it. As voice tools start to become more prevalent and how we interact with our hardware as humans, the sound and the type of sound will become really important as well. The colors that we see also influences us. A red circular LED on my smart speaker looks bad. It usually is something is wrong. But if I see that happy, light-colored blue, oh, man, something good is happening. Little LED yellow, oh, man, what's going on Alexa? What's happening? Oh, you got a deliver, very exciting.

Dr. Matt Cybulsky:
These are all the things that we can do on top of what we've done in the past with data that can impart an emotional state of being with these direct consumer tools that has to be added to our understanding of the data itself and how humans respond to it. Don't be mistaken when those LED lights come up on a smart speaker to think that Amazon doesn't have that categorized and their data would be wrong, of course they do, and just adds the capabilities we've got.

Dr. Matt Cybulsky:
Data tones, social proof, what it costs you, focusing on the intrinsic motivation of the behavior of a consumer, whether it be paying your bill or taking care of yourself, the behavioral science influence upon healthcare and digital healthcare has beyond God started, but it is now endemic in the industry. If you're not thinking about these things, you ought to.

Chris Hemphill:
If you're not thinking about these things, you ought to. This is the best time to ask the question I have next. Unfortunately, I only have time for a couple more questions. I know that you and Chris has some golf to play in Hawaii right after this.

Dr. Matt Cybulsky:
Never been to Hawaii [inaudible 00:49:28].

Chris Hemphill:
I'll keep it at this question, though. Mainly because we've talked about this spectrum that includes things like value, outside of just the dollars and revenues and things like that, but the quality of life that anybody who's a healthcare leader might be able to assist their patients, members, population, people with. But when it comes to technology, when it comes to a lot of these innovations, there's organizational resistance, there's lack of understanding from other leaders.

Chris Hemphill:
One thing that I wanted to get from you, especially with all these levers of behavioral influence that you're discussing, is for the leader that wants to bring in a digital health solution into their organization, their health system more, or what have you. What are some steps that people can start taking or start focusing on to be able to help get their organizations to agree to ramp up in this manner?

Dr. Matt Cybulsky:
Yeah. I mean, this is what makes me a dangerous man across your table, Chris, if we're thinking about doing this work, because it's the master of storytelling and creating a storytelling component with the human interest story. I told you about a patient. You all probably remember that story. I just told us a little while ago. Why do you remember that? It's a good story. It's provocative. It imparts an emotional state, and it imparts yourself in that story, or a loved one in that story.

Dr. Matt Cybulsky:
Anytime you want to convince an organization to make a move in healthcare, the storyteller will be the master. The human interest story will be the fulcrum. Those are your two takeaways. You talk about the patients you're serving, the community you're in. You show examples of when technology could have taken you over the hump to something better, or would have improved something that was already good.

Dr. Matt Cybulsky:
You put your members of the organization leaders in that story as well. You put your rev cycle leader in that story. You put your data management guy in that story. You put the CEO and his or her legacy in that story. You talk about clinician who's got funding or as well-regarded in the community, or the healthcare industry, or nationally, or globally and you put them in that story. You look at technology as a toolset. You look at it as something that can hone and sharpen tools that are already in the carpenter's bag that you can apply with community where the problem is trying to solve.

Dr. Matt Cybulsky:
That will get you from, "Oh, that sounds cool" to, "Oh, I see how we can use that."

Chris Hemphill:
That is a powerful answer. Storytelling, I like the fact that you said dangerous, because knowing that, I mean, the book Influence wasn't necessarily written for people to learn how to influence others. It was to defend against typical levers of influence. Very powerful, but very dangerous advice that you've given to this audience here.

Dr. Matt Cybulsky:
Yeah. Be the dangerous person around the organizational table, tell the story, or take the time to develop it.

Chris Hemphill:
I want to finish off with, I mean, full transparency. Matt and I have known each other for 10 years. I think we talked about that at the beginning of the conversation. Each of those conversations, including this one, has resulted in a lot to reflect on. I want the audience to have that same thing. Whatever, Matt, your final thoughts are. What brought you here? What you're hoping that people can learn what most people don't know that perhaps they should know?

Chris Hemphill:
Audrey, I'm going to give you the same question, too. But Matt just wanted to hear from you. There's a reason you came on here today. What would you like people to take away from this?

Dr. Matt Cybulsky:
Well, I mean, I came on here today because you Chris, number one, I trust you. You built a great community for yourself as I've been building communities. You're part of my community. That's number one. Number two, I don't see success happening without building a community. To do the things that I want to accomplish when it comes to innovation, technology, and leaving something that matters to patients or organizations across the world or US, I have to build a pretty large community.

Dr. Matt Cybulsky:
I have to do it digitally, because I can't be in all these places. Creating these kinds of conversations are not about answers, but about defining problems. That's one thing. The other part is what I've mentioned already, stop thinking about things from a moralistic place with healthcare. Stop doing it. Don't do that to somebody. It's impossible. It's fun to think about. There is virtue in it. Yes.

Dr. Matt Cybulsky:
But the more realistic questions to ask is what's the intrinsic motivation driving this patient? How do I create a system around them to get to a place that actually is useful for them? That's a hard thing to do. But it's more important, I believe, than sitting around talking about lofty ethical constructs, about the shoulds and missing the human connection to the people you're serving. Those are my two takeaways. Build community, think about intrinsic motivation.

Chris Hemphill:
Appreciate that. Any final thoughts from you, Audrey?

Audrey Wyman:
What a great ending. I'm not sure how to top that. I think one piece that I really liked was you talked about craft the story and put all these characters in it. I'll put one more character that I think helps tell a really compelling story. That is find the naysayer and befriend them, find community and relationship and connection with that naysayer and help them be a part of the better story.

Audrey Wyman:
If the technology isn't working, then bring them on board and have them help you get it to a place where it does work. I love what you said. I think it is about telling stories, and it's about finding the people to be in them. I would encourage folks to find the folks who are resistant and intimidated by them. Bring them along.

Dr. Matt Cybulsky:
Audrey, I want to yes end you. Karl Popper, famous philosopher of science said, "Science's goal is to find out what's not working. The more that you find out what isn't working, the closer you get to an objective truth." Absolutely. Get the gadfly in the room and tell us what isn't working here. Nice said.

Chris Hemphill:
I'm going to yes end on that one, too. Is that just because somebody is a naysayer, just because they're voicing a disagreement doesn't mean that it's a personal attack, doesn't mean that they're fundamentally disagreeing you. You might have a lot of clinicians that we've spoken with in the past have been naysayers, because they're the most tied and most connected, have a significant amount at stake if something is incorrect or goes wrong.

Chris Hemphill:
I appreciate the naysayers. I'm looking for that feedback. I think that so long as it's not hostile or aggravated, there is a lot of growth that can come from it.

Dr. Matt Cybulsky:
Yeah. Healthy discourse really matters. Talking about what's not working really matters. The story really matters. This has been a really wonderful conversation, Chris. Thanks for curating it with Audrey and I.

Chris Hemphill:
Appreciate you, Matt and Audrey. Thank you for coming on as well. I think you brought a lot of light to this discussion. Signing out, I hope that this has given you a lot to think about over the weekend. I hope you've enjoyed it. Maybe if you've had a bad week, maybe it's been a bright spot where you can sit back and just think about overall big picture stuff and not have to deal with all the aggravating particulars.

Chris Hemphill:
Signing out, I just want to drop another reminder. A lot of these conversations we bring those into our new podcasts, Hello Healthcare where we go really deep into the subject matter. Last episode was about a couple of organizations that we mentioned, Walmart and CVS. We actually did a deep dive on that podcast with regards to the so-called disruptors in healthcare.

Chris Hemphill:
Next week, next Friday, same time, Ed Marx, we'll be bringing Ed back to the table to talk about the patient experience, specifically Ed. For those that aren't aware, formerly Chief Information Officer at Cleveland Clinic and now Chief Digital Officer in health and life services at Tech Mahindra.

Dr. Matt Cybulsky:
That sounds great, Chris.

Chris Hemphill:
Come on. Come on board. Hang out with us in the chat section.

Dr. Matt Cybulsky:
That was good.

Chris Hemphill:
Yes.

Audrey Wyman:
Hey, Matt, where can we get your book for our listeners?

Dr. Matt Cybulsky:
Oh, thanks very much. Yeah. My book is coming out in the next 60-day Voices of Healthcare: The Digital Acceleration. We've got fantastic people in there representing Teladoc, Google, City of Hope. We've got it all, and patients, ALS patients, adult patients, pediatric patients all talking about their experiences in healthcare and digital health and their hopes and dreams, even designers and creators.

Dr. Matt Cybulsky:
Grammy Award winners, we had some Grammy artists talking about being involved in creating music for voice apps for hand washing during the pandemic, and their views on healthcare in general. It's going to be available on Amazon as well as few other publishers. Follow me on LinkedIn and the announcement will come out and have a link to all of it.

Audrey Wyman:
Thank you.

Dr. Matt Cybulsky:
Yeah. You're welcome. Yeah.

Chris Hemphill:
Thank you very much. Thank you for everybody who joined us. Sorry. We went a little bit over time, literally doubled the allotted time, but ...

Dr. Matt Cybulsky:
Oh, wow.

Chris Hemphill:
It was a great conversation. I mean, everybody stayed engaged towards the end. I'm just really appreciative that everybody was interested in the subject. But that's all we have for the weekend folks.

Audrey Wyman:
Thanks.

Dr. Matt Cybulsky:
All right. [crosstalk 00:59:38]
 

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