This university team is pushing the health system forward with digital health innovations.
In this episode of Bite the Orange, Michael Hasselberg, Chief Digital Health Officer at Rochester Medicine, talks about moving the whole health system forward into a technology-enabled, data-driven care delivery mechanism through research and development of innovative digital solutions. In the world of telemedicine, he negotiated value-based reimbursement with payers by arguing its cost-saving potential and built telemedicine programs in the state of New York by leveraging the Project ECHO model. From the University of Rochester Health Lab’s digital health incubator, he helps build solutions that make a positive impact on healthcare internally or with external experienced or new companies. He also explains why they mainly focused on solutions that improve data management, workforce wellness, and patient engagement.
Tune in and learn how the University of Rochester is driving digital transformation in healthcare!
FULL EPISODE
BTO_Michael Hasselberg: Audio automatically transcribed by Sonix
BTO_Michael Hasselberg: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Emmanuel Fombu:
Welcome to Bite the Orange. Through our conversations, we create a roadmap for the future of health with the most impactful leaders in the space. This is your host, Dr. Manny Fombu. Let's make the future of healthcare a reality together.
Emmanuel Fombu:
Good morning, good afternoon, good evening, ladies and gentlemen. Welcome to another episode of Bite the Orange, and today we have a very special guest all the way from Rochester, New York. We go way back, and it's a great way to connect today. And since I first met him, I remember our initial conversation about digital health, and since then he is the jefe, a boss of the digital health community today. I'm sure he would not say that, but I do believe that, and I think he's someone in the cutting edge of innovation. And so today, please, if you haven't met him, take a moment to read his bio, and I'll let him choose himself shortly. But welcome to the show, Dr. Michael Hasselberg.
Michael Hasselberg:
Hey, Manny. Thanks for having me. And yeah, coming all the way from Rochester, New York, your second home that I just learned.
Emmanuel Fombu:
It's actually my second home. And there is a lot it's a long story about Rochester, New York, is the home of Xerox, among many other things, correct?
Michael Hasselberg:
Home of Xerox and Kodak. I mean, we were Silicon Valley before there was a Silicon Valley. So very proud innovation hub in the country.
Emmanuel Fombu:
Exactly, so with that being said, so tell us about yourself. For those that don't know you and for those that are getting to know you, who is Dr. Michael Hesselberg?
Michael Hasselberg:
Sure, yeah, yeah, first and foremost, I'm a nurse. I'm very proud of my nursing background. I ended up going on to school to become a nurse practitioner and then finishing my PhD after that. My claim to fame, very early in my career, I was tasked to develop a telemedicine program for the University of Rochester before telemedicine was a cool thing, or before that was even reimbursed, and was really successful in doing that, specifically for behavioral health, and figured out reimbursements before again, payers were really paying for this type of modality, but then I couldn't grow it any further because I couldn't graduate psychiatrists fast enough to take on more patients. So I got involved in more innovation and got into the mobile app space and then the VR and AR space and then machine learning and so, yeah, right now say I've got the coolest job in the world. So like I get to innovate and play with new technologies and try to solve problems. And the real problem that I'm trying to solve is how do we get care out to rural and underserved communities. So yeah, that's my background and my why.
Emmanuel Fombu:
That is actually quite interesting because I remember, I think about 4 or 5 years ago, at Rochester, New York, where we first met, when I was down there for a conference, I remember talking to several clinicians out of University of Rochester Medicine and they were talking about how they actually provide care to all the little rural communities around Rochester itself. And I spoke to my dear friend and also your dear friend, Dr. Ray Dorsey, and found out that he's been doing telemedicine for as long as I could possibly imagine. He's been doing it, right? So tell us ... that origin piece and where we started and now your current role as chief Digital Health Officer at Rochester Medicine, which is quite impressive, right? This is a new kind of role that hospitals are creating, and I love to see people like yourself at the forefront of this, shows innovation in healthcare, especially around health systems. So tell us, how long ago did you start working in telemedicine, right, and what have you learned through that journey, from the beginning, to where we are today?
Michael Hasselberg:
I started working in telemedicine around 2009. Ray Dorsey is a prime example of one of, I think, the godfathers of telemedicine. He had been doing it well before I got involved and he was an early mentor to my work. And even prior to Ray, our Department of Pediatrics were leaders around one of the first programs in the country to do pediatrics into schools. So telemedicine had been something at the University of Rochester, we had experience with, we had been doing it for years. When I got involved with it, yet, despite all of our proud history with it, outside of research grants no one was paying for telemedicine. And so when I started my programs in psychiatry, I had to start somewhere to find money, and I started in the research space and got grants to start building the infrastructure, but then quickly learned that chasing the next grant wasn't going to be sustainable. So I ended up going back to school and getting this post-doctorate-like business certificate, and I started understanding outcomes through the lens of a payer, and I quickly learned that the things that the payer cared about wasn't necessarily what I cared about as a clinician or as a researcher. And so when I started measuring the outcomes of my models through the lens of a payer, I was able to crack that reimbursement nut and to make an argument to the payers like, hey, this is really high-quality care, and it's increasing access, and patients are really engaged, and it's saving cost downstream, and was able to really start negotiating very early value-based reimbursement kind of contracts for the models that we built. How I got into my current position of Chief Digital Health Officer was COVID. COVID hit, and every health system in the country had to turn on telemedicine for everything pretty much overnight. And my boss, one of our CEOs, kind of tapped me on the shoulder and said, hey, can you help us do that? Which we were able to do, and we were able to stand up telemedicine across all of our ambulatory service lines in about a week. And we went from pre-COVID, doing about 2% of our outpatient volume being telemedicine to 90% again almost overnight. But then what we quickly learned six months into the pandemic was, hey, COVID's not going away. And we need to start leveraging technology for lots of different things. And we didn't, as a health system, we didn't have a strategy, we didn't have a way to prioritize essentially our digital transformation. And so what that resulted in was a lot of people raising their hands, saying, I need technology over here, us saying, yes, we'll give you technology. And operationally and from an IT resource standpoint, we got stretched really thin and weren't able to really deliver on all the things that we needed to deliver on. And so I was then again tapped on the shoulder and asked to take my current role of Chief Digital Health Officer to develop that digital transformation strategy for the system, so we could prioritize our resources, so we could move the whole health system forward into becoming a technology-enabled, data-driven care delivery mechanism.
Emmanuel Fombu:
Which is quite fascinating, you know, Michael? So with that being said, so tell me this technology, like telemedicine, for example, psychiatry, I know you founded, I think like Project Echo, and you worked on Project Echo. Am I saying it right? Did you found?
Michael Hasselberg:
Yeah, I founded the first Project Echo program in the state of New York. Project Echo started at the University of New Mexico in hepatitis C Care back in the early 2000. I was the champion that brought that model to New York State and then leveraged that model and built more synchronous provider-to-patient telemedicine programs on top of that model. And then on top of the synchronous telemedicine, I started developing asynchronous consults e-visit programs on top of that.
Emmanuel Fombu:
This is quite interesting to me. I think I haven't found anyone at the health system that is more innovative or more passionate and driven like you and Dr. Dorsey, in general, okay. And I say this out of a lot of respect, it's quite fascinating. So do you develop these technologies yourself at University of Rochester, or do you partner with third-party vendors that provide these solutions?
Michael Hasselberg:
Both, so one of the things that makes the University of Rochester unique as an academic health system is we're one of only a handful of academic health systems left in the country that still fully integrated into its parent university. Now, the downside of that is, a good portion of our margins on our health system side, go over to the university to help subsidize the academic and research mission. So most academic health systems realize, hey, if I break away from my parent university, it's much easier for me to make my annual 1 or 2% margins that we're trying to make every year. Again, we've made a conscious decision at the University of Rochester that the health system will not break away from the university. Now we leverage that to our advantage, where at the University of Rochester we have a true digital health incubator, we're under one roof. I have faculty from the engineering school, our computer science department, our data science institute, our business school, even our school of music, under the same roof as faculty from the medical school, the dental school, and the nursing school. And it's not a research shop, our KPIs are not to generate RO1 grants or publish papers. Now we do research, but that again is not our driver. Our, we are paid for, by the health system and by the university, to fill gaps in our digital transformation strategy and push the health system forward. Now how we fill those gaps is essentially threefold. When we think about our technology stack, on the health system side, we're an Epic shop, and we're, for most part Epic-first. So if Epic has the functionality to solve our problem, even if it's just good enough and there's better solutions out there, we're going to go with Epic every single time. If it's not on Epic's roadmap or it is on the roadmap, but we need it to, that solution sooner than when Epic is going to get to it, that's when we look to partner externally. And we do that by looking at the best-of-breed companies where we'll purchase their solution or will partner with early-stage startups and onboard their solutions into the health system ecosystem to test out those earlier technologies. And then, if we're not able to find the external partner, then we'll build it ourselves in-house in our team in the innovation incubator. We build everything from mobile apps to chatbots to VR and AR apps to, we build our own sensor, we do a 3D printing, and really any machine learning that touches our clinical service lines, our incubator had a finger on developing those models, but we're also not, our KPI is not to spin out companies. And so if we find or develop a solution that works for the University of Rochester and we know that other health systems or organizations around the country would benefit from it, we're more likely than not to open-source our code and give away our technology than trying to figure out a way of how to make money on it, because we feel like we can have a bigger impact on the world by pushing out the technology for others to take versus us trying to make money off of that technology.
Emmanuel Fombu:
Wow, which is quite fascinating. I think if you talk, the lab you're referring to, is this the UR Health Lab?
Michael Hasselberg:
It is, yes.
Emmanuel Fombu:
It sounds quite fascinating. I would really love to actually come up there one day and actually spend some, like spend some time. Actually, it sounds.
Michael Hasselberg:
We would love to have you, and appreciate you having me on the podcast to talk about it. So we've had some of the most influential leaders in healthcare come visit us, and they're blown away with what we do and how successful we are actually getting stuff done. What we've been told, however, what we do really poorly is nobody knows about us. We don't disseminate or tell or brag about all the stuff that we're doing, and we've been encouraged to disseminate our great work better. And so I appreciate you, Manny, having me on the show to talk about the University of Rochester and the kind of innovation that we do.
Emmanuel Fombu:
Which is interesting. When people mentioned Rochester, I think there's something special about the name Rochester, because in Rochester, Minnesota, they think about the Mayo Clinic, right? Rochester, New York, and they haven't mentioned Rochester, the amount of innovation that comes out of there. Myself, my, first time we first met was my first time up in Rochester, and I've been quite impressed by the amount of innovation that comes out of that region, and it's quite fascinating. And I think it's definitely something that everyone should keep an eye out for, and I think it's quite fascinating. But I wanted to pick point on something. So you mentioned like three main parameters. One was you guys are an Epic shop. It makes sense because Epic is part of your workflow, it makes sense just to embed things within your workflow than going against the workflow, right? So I understand the piece of it, but then if something you need is not on the roadmap for Epic, you mentioned finding external partners, so I'm curious about that. How do you go about finding these external partners? Because they could be several listeners right now that might have companies or have possible partnerships with you, for example. So how do they reach out to you or how do you go about selecting the right partner?
Michael Hasselberg:
Yeah, so, you know, we, a couple of ways. First, we identify what the problem is that we're trying to solve. So we're, companies come to us. Oftentimes the company is trying to tell me what my problem is, and here is the solution that we have to solve it, and oftentimes it is not my problem or I have not yet identified it as my problem. And so we'll do our homework, we know what our problems are, and then we will go look at the market of who's out there. Now, how we do that is, the world, like you said, the Chief Digital Officer role, the Chief Digital Health Officer role, kind of Chief Transformation Officer, Chief Innovation Officer, this is, these are new roles to health systems, and we're a small community, we know each other. And I will reach out to my partners out at Stanford or Providence up in Seattle and say, hey, do you have this problem? And more likely or not, they have the same problem that I have. And I say, what have you done to solve it, or who are you working with? And so right off the bat, that's my first go-to before I Google what are the best-of-breed companies I should be reaching out to. Then the second is, the West Coast in particular, there's just so much innovation happening out there. That's where most of the VC stuff is happening. And so we've found a few VC funds out on the West Coast that have the same mission that we have, that their mission is they want to impact healthcare for the good, and they identify companies based off of who is going to have the biggest impact, positive impact on healthcare. And you know what? The return will come if that company is able to do that. And so those are the VC funds that we partner with versus the VC funds that are just looking for the next shiny idea or object that may have a 10x return. We really truly want to impact healthcare at a large scale, and we'll go to those VC funds, and we'll say, hey, does any of your portfolio companies solve this problem? And if not, can you do a thesis for us and identify those best-of-breed companies? And then that VC fund, when they find that company, we'll often make that financial investment, and we'll de-risk that investment by onboarding them into our health system.
Emmanuel Fombu:
Which is quite interesting that, I mean, VCs could be a great source because clearly, they go about investing in companies, and I'm very happy to hear that this is, talk to you directly because that way they invested in companies that actually provide a need or a solution, right, to a need. And I do agree with you, so I think the lesson from that is, it's good to listen, not everyone has the same problem, right? Don't show up with a problem looking for a solution, right? So you want to show up, and you say, hey, what is the problem? So how many companies, in general, would you say, external companies or partners, do you actually engage within a year?
Michael Hasselberg:
Right now, in our innovation incubator, we've got about 11, early stage, so mostly Series-A-level companies that were in various stages of working with, in the health system. And then on top of those startups, there are more established later-stage companies that, we're one of their first customers, that we've actually kind of bought the solution and deployed it. So at any given time, 15 or so companies that we'll partner with, and some are just very small pilots, and some are much larger-scale pilots across our system.
Emmanuel Fombu:
Which is quite interesting here. So you are on the health system side, and I spent some part of my career working on the pharma side, right? Like actually creating all this like, digital health kind of solutions. So, for example, building apps and sensors to predict heart failure readmissions, or predicting, I don't know, your background's in psychiatry, or predicting suicide or depression or progression in depression or things like that. And pharma usually partners with third-party vendors, but what we are missing is, are the patients which, you have the patients, right? Have you thought about a collaboration where you have, where like the registered medicine, for example, could partner with third-party vendors to, right, research? Like similar to how you run a traditional research as a clinical trial site where this could be a site where you could say, hey, can we do like a solution partner with a pharma company and a third-party vendor, and you get to provide the patients, and they run that process flow? That's something you've done before, like a pilot within the health system?
Michael Hasselberg:
The university has, yes, and they actually sits more over on my colleague Ray Dorsey's kind of side of the house. And so we have a whole research arm to our health system where we do clinical trials with pharma companies, but also technology companies. That's kind of outside of my purview and ...
Emmanuel Fombu:
... to say, maybe because I mentioned the word pharma and it brings up an idea of drug in the conversation, right? It goes in that direction, right? So, for example, I worked on a project several years ago where we using voice, for example, to predict Alzheimer's. So you can use voice for Parkinson's or voice for depression and suicide prediction. If wanted to run a study like that, as an example, right, is that something, general, that could be run under your umbrella? When I say your umbrella, I'm not meaning you particularly, Michael, I mean something over the university's umbrella, that it's something that is possible they're interested in.
Michael Hasselberg:
Absolutely, for sure. Again, that's one of the perks of working at an academic medical center. Evidence-based care is one of our pillars and doing research is one of our pillars, and so, yes, both on the research arm of the health system, but also in the innovation incubator. So like I said, it's not a traditional research shop. We do research, we do get IRB protocols through the research arm, and so we'll do more research-like projects within the health system, but the way we choose those projects, because we only have a finite number of resources, even the innovation incubator, it has to be something that pushes the larger health system forward. So if it's some type of natural language processing application to diagnose Alzheimer's disease early, as a clinician that works in psychiatry, that specializes in geriatric psychiatry, that super excites me, but probably wouldn't be done through the innovation incubator because that isn't a problem that is health system-wide. So, you know, that would be really perfect for Ray's Shop, that focuses in on more of those kind of narrow-focused projects that could have huge impact, right? So like, for example, if you could diagnose Alzheimer's disease by nuances in speech, well before people start having clinical symptoms, that could have a major impact on the world. But again, on the health system side, it isn't one of our big priorities to the health system forward.
Emmanuel Fombu:
Exactly, so with that being said, I'm sure we have someone that's probably listening right now, and they're saying, hey, I have a solution for Michael, right? So before they come back with their solutions without knowing your problems, what are some of, if I could say, what are your top four main areas of focus right now, or the areas where you have gaps and where you focus most of your time on right now? What are big challenges that you're facing?
Michael Hasselberg:
Yeah, so, you know, first big challenge is data. And when I say data, for us, it's creating a data warehouse and understanding our data, cleaning our data, aggregating our data, essentially setting the foundation. So all of those machine learning companies out there who've got the next great model to solve healthcare's ills, I have to have the right data foundation for your model to work. And so that is priority one, is we're getting control of our data. ... two kind of has come up, it's bubbled up over the last year, or two years, it's been our workforce, and healthcare is in a tough spot right now. Clinicians on the front line are burnt out, and wellness of our clinicians and our staff is top priority. And so we're starting to really prioritize where are the kind of technology innovations to keep our workforce well, but also, you know, automate or take low-hanging fruit off of their plate so they can do the things that they went into healthcare, like delivering clinical care, more efficiently, and so that is a big priority area. And then our third priority area is keeping our patients engaged using technology. We now have a patient group that is more consumer-oriented, consumer-focused, that have been now reliant, like all of us during the COVID, on technology, and how do we keep them not only engaged with our health system, but just engage in their own health promotion using technology? And so I would say digital patient engagement is a priority. I would say right now I like to talk about priorities in threes, not fours, because I think threes are what people remember, and it also keeps us organized so we can actually move stuff forward. So those would be the kind of three top areas: data, workforce wellness, and patient engagement.
Emmanuel Fombu:
Which is, I really liked how you wrapped it up with the patient engagement component because it's all about the patient at the end of the day, right? And so we do, everything that we do is about outcomes.
Michael Hasselberg:
Patient and clinicians, it's the whole, I've heard, you know, a mentor of mine, Aaron Martin, VP of Healthcare at Amazon, he talks about this all the time. It's the ends of the value chain. And in healthcare, the ends of the value chain are patients at one end, clinicians on the other end. There's a lot of stuff in the middle, and it's like, how do we disrupt all that stuff in the middle or delete it so we can bring those ends of the value chain together? And so for us, yes, it's the patients, but if we don't keep our clinicians healthy, then there's going to be no one to deliver the care to those patients. So that's the two focus areas.
Emmanuel Fombu:
That is, I couldn't have said it any better. I think you have a fantastic mentor. I think, yes, it's about the clinician and the patient, right? Just the humans in the middle of it, and so the goal is to make things very efficient. I think this is quite incredible, Michael, thanks a lot, and it's quite an honor having you on the show today. And I would love to come up, definitely, to visit you up at Rochester and learn more, and definitely follow up on this conversation. So thank you very much, and welcome, and thanks for taking your time today to join us.
Michael Hasselberg:
Yeah, thank you, Manny, come visit anytime. And those that would love to collaborate with the University of Rochester, just ping me on LinkedIn. We love to collaborate and partner. So thanks again, Manny.
Emmanuel Fombu:
Yeah, thank you. And I will have Michael's contact information at the bottom of the show in the show notes, and definitely, a way to reach out to him. Please do reach out. Clearly, as you can see, Michael is very open to partnering, right, is very special when we meet people like Mike. So thank you again, Michael.
Emmanuel Fombu:
Thank you for listening to Bite the Orange. If you want to change healthcare with us, please contact us at info@EmmanuelFombu.com, or you can visit us at EmmanuelFombu.com or BiteTheOrange.com. If you liked this episode and want more information about us, you can also visit us at EmmanuelFombu.com.
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About Michael Hasselberg:
Dr. Hasselberg is an ANCC Board-Certified Psychiatric Nurse Practitioner. He received his PhD degree in Health Practice Research from the University of Rochester School of Nursing in 2013 and is a graduate of The Academy for Healthcare Leadership Advancement through the Healthcare Association of New York State and Cornell University. Dr. Hasselberg is currently a Robert Wood Johnson Foundation Clinical Scholar Fellow. He founded the UR Medicine Telepsychiatry program and Project ECHO®, which leverage technology to provide health care at a distance within rural hospitals, primary care practices, and skilled nursing facilities. He is the Chief Digital Health Officer for UR Medicine and is also the Co-Director of the UR Medicine Health Lab, a space in which our University’s best thinkers collaborate to create digital products that transform healthcare delivery. Dr. Hasselberg has served as an expert advisor to the Department of Health and Human Services, the National Quality Forum, the New York State Department of Health, and multiple health systems across the United States on digital health innovation.
Things You’ll Learn:
When COVID hit, health systems turned to telemedicine overnight, going from doing 2% of outpatient care to 90% through this care delivery model.
The Project ECHO (Extension for Community Healthcare Outcomes) started at the University of New Mexico in the early 2000s, focusing on Hepatitis C care, and Michael used its model in the state of New York to build telemedicine programs.
The University of Rochester is one of a few academic health systems in the US that is still fully integrated into its parent university.
If the University of Rochester finds or develops a solution that works, it’s more likely than not to open-source it for other health systems or organizations around the country to benefit from it.
The UR Health System has a research arm where they do clinical trials with pharma and technology companies.