Podcast
AMSURG to Investor: Pioneering Nashville’s Healthcare Future
Eric Thrailkill
NEC Project Healthcare
With the current rate of technological growth, CIOs are tasked with the impossible: staying up-to-date and ahead of the curve with new technologies, products, and systems that help increase value across their business. Eric Thrailkill, former CIO at AMSURG and current investor, knows this struggle from experience. But, he sees it as an opportunity for continued learning and growth, as well as the advancement of the healthcare industry. In this episode of Healthcare Market Matrix, Eric joins host John Farkas to discuss continued learning, challenges healthcare companies face, and Telehealth Academy—an opportunity for the healthcare industry to come together and create solutions.
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Transcript
Introducing Eric Thrailkill and His Journey to the CIO Role
John Farkas:
Welcome everybody to Healthcare Market Matrix, and I am excited today to welcome Eric Thrailkill, who has served as CIO at three publicly traded healthcare companies in his tenure, and now is leading his own firm, Allee Advisory Services, where he accelerates growth through strategic partnerships and bringing an ecosystem approach to strategy. What I can tell you about Eric, aside from the formalities, is he is certainly one of the most generous humans I know, with his time, with his wisdom, and sharing the meaning of his experience, and his commitment to collaboration is really evident in a number of meaningful ways.
He has lot of involvement in the number of professional organizations, and his role as chairman of Project Healthcare and as a part of the Nashville Entrepreneur Center is a remarkable involvement where he has had the opportunity to impact a number of organizations. And he is also in the third year of leading the Telehealth Academy, and we’re going to hear more about that later. But that’s, if you touch telehealth in any way, shape, or form, something that you’re going to want to make note of and take part in this coming year. Eric, we are so thrilled to have you here. Thanks for joining us.
Eric Thrailkill:
Well, thanks a lot, John, to you and your team, and I feel committed to the industry and to the community in which I’ve enjoyed being a part of for 40 plus years. So thanks for having me.
John Farkas:
Well, I hear this from other people too, and independent of my own experience, but when I see somebody, who has experienced as much as you have in the context of healthcare, be willing to continue to invest and continue to work to try and improve the ecosystem for everybody involved, it’s just such an encouragement to me. I would love to hear some of your journey, rewinding and take us back a little bit to… what was your journey to that CIO role, and give us the highlights of that trip because I know there’s a lot going on.
Eric Thrailkill:
Yeah, no, I’m happy to do it then. And I’d say at the outset, I’ve got a non-traditional career path into healthcare CIO. I’m an accountant by education, University of Florida, studied accounting, became a CPA, worked one time with one of the Big Eight firms, Touche Ross, that was merged in to Deloitte, and that was the firm that actually brought me to Nashville in 1983. I stayed 11 years with that firm. And being in Nashville for the bulk of that career, most of the work that we were doing on the firm side was in the healthcare industry, a number of just notable reputable clients, and that really triggered my interest in that particular industry. I worked for a couple of companies before AMSURG, PhyCor was one of those, a pioneer, perhaps, 25 years before its time in physician practice management in the 90s, and then a company that was known as America Service Group, now known as Corizon, that was a leader in the provision of health services for inmates in prisons and jails.
And in that company, you learn a lot about caregiver needs, you learn a lot about the special relationship between those that are listening, relieving pain, and caring for individuals in a very vulnerable population. And then I had the opportunity to join AMSURG as the first ever CIO in 2007. And it was just a tremendous organization, 15 years old at the time, a disruptor, and the fact that the company was focused on bringing safe surgical procedures to a lower side of service in a community or an ambulatory surgery center. And as medical innovation continues to provide more and more opportunities to do so, it allowed that company and many others to continue to drive value, true value in the healthcare industry. So my background, education as accountant, a lot of finance roles, and appreciation for strategy and business models, and then surrounding myself with individuals that were sharp on the technical side of information technology.
John Farkas:
So what I know about the CIO role is that it has a whole lot to do with value, you have to be making decisions for the organization and it is directly related. So I understand the accountant piece because there’s a lot of equations that you have to factor through, I’ve got to think, to make those decisions in ways that have the best benefit to the organization. Talk about your experience in that regard, and how that has worked itself out?
Eric Thrailkill:
No, it’s a great question and it’s a good observation, and it was something that, frankly, I always enjoyed. So I love the strategy part of a business operation. AMSURG is a unique company, and that when I started with them in 2007, and still primarily today, the company is comprised of individual partnerships with physicians that own and operate ambulatory surgery centers. And value to those individual partnerships that translated to value to patients and payers of those health services is all around, how do you deliver both clinical, administrative, and technology solutions in a shared services format at a very good price that’s as competitive, or more competitive, than they could receive from the outside, but had actually a higher quality level in the service delivery. And a lot of my time was spent with listening and learning from others, in clinical roles, or in operations roles, or in business development roles, about how we could use technology as a company and therefore differentiate in partnership with physicians in that regard.
Creating an Environment for Learning and Growth
John Farkas:
So talk to us a little bit about… you’re giving us a sense of it, but give us an idea of a day in the life, what are some of the factors, as you’re looking at that role and how you’re interfacing with the rest of the organization? You just said, “I’m doing a lot of learning, I’m listening, I’m trying to understand what are some of the problems that we have and how can we solve them?” What did that look like? How did it work itself out?
Eric Thrailkill:
Yeah, I think key was ensuring that we had a top flight motivated team of individuals, and I was fortunate to, out of the blocks, be with a team and then to continue to grow that team that was dedicated to the work that we were doing. I’d probably say I spent 80 plus percent of my time learning and listening, and in corporate meetings, and very purposefully trying to understand the business as much as I could. And it’s an extraordinary amount of time, I think if you had a survey of CIOs, you’d say that they spend a lopsided amount of time working with senior management and others in their organization to better understand the business and the capabilities that IT could bring.
I’m a big believer in investing, and education, and conferences, and events, and associations, whether those are in our community or society, because it just, again, enables that learning to occur. I’m fortunate to be with some IT leaders that we spend a lot of time together in the battle professionally, but we spent a lot of time outside of work getting to know each other, and really trying to build a team and a culture that others that we were recruiting wanted to be a part of. And it’s probably overlooked, is very, very difficult in today’s times, and I have a lot of empathy for those that are in that seat today, moving through really tremendous workforce challenges.
But it’s something that will consume a lot and does require a lot of a leader’s time to ensure that it’s a safe place to work in a learning environment, where professionals can get better with what they’re doing. Part of the greatest tribute that you see is, folks that you use to work with move on in CIO roles, or elevate to VP level roles, or stay within the industry and migrate maybe to an operations or business development role, and it’s really satisfying to know that we were a small part of their professional development.
John Farkas:
I can imagine. If you look at your tenure there, what would be some of the key abilities, some of the things you brought to the picture that might have been superpowers or things that that role ideally has that helps a person be successful in that role?
Eric Thrailkill:
Yeah. I think that’s a good question. I think giving them the time and space, and encouraging professional development and community professional activities is one of the best things that an individual can do. I was fortunate to be with a senior management team. Our CEO, and our CFO, and executive leaders encouraged all of us to be visible in the community, to participate in community organizations, to attend conferences, to even host, AMSURG has a great facility for being able to host an event and bring those events and those learnings together. When I joined AMSURG, it was 2007, and it was prior to the HITECH Act, which was really responsible for, as a country, us moving from a small percentage of Americans, clinical histories documented in electronic health records, to now a large number.
And federal funds as part of the stimulus bill, the ARRA Act of 2009, were made available to healthcare, and helping the company navigate these very complex business relationships with physicians, and at the same time, improve our abilities to ensure clinical documentation that leads almost 100% of the time to safer procedures and higher quality, and good documentation on the revenue cycle side was a challenge. And without being surrounded by a team that was always about learning and contributing and getting some personal reward for the projects that we were doing, it would’ve been really, really difficult.
John Farkas:
So really, what I’m hearing is staying connected to the community you’re serving, in a lot of different ways, is an important piece.
Eric Thrailkill:
Yes.
Eric’s Thoughts on Pitching to CIOs
John Farkas:
Yeah, that doesn’t surprise me about you, Eric, at all. So what I know in this realm is that, especially today that the CIO is one of the targeted entities for young health tech companies trying to get a foot into the provider space, the CIOs almost always a stakeholder for a tech technology solution moving into that arena. I’m curious, in that role, as you were considering vendors, and as you were looking at different opportunities and options and weighing the importance and how you would look at implementing them, what is effective for an organization to do and what just really didn’t work? If somebody was interested in getting noticed, if they were interested in getting your ear in some way, shape, or form, to communicate a solution that they had, what works and what doesn’t?
Eric Thrailkill:
Yeah, I think it’s a good question. I also think it’s a good time maybe to chat just a little bit about the convergence of a number of factors that actually improves the opportunities for early stage companies, or smaller organizations, that have a real technical solution to be of greater benefit maybe today than it was a decade ago. Again, when I started at AMSURG, very few healthcare organizations had migrated their data centers and their data to the cloud, and of primary interest to anyone selling into a CIO would’ve been security and privacy, and was it an application that would fit into the tech stack of the organization? Secondarily, I think, like so many other healthcare businesses that are based in Nashville, enterprise scale is something that’s front and center. So many organizations really wouldn’t entertain something on maybe the low end, or early stage, or small size company because they wouldn’t believe that they had the firepower to continue to support and roll out those solutions on a national basis.
So right out of the box, it might eliminated some very good founders with excellent tech solutions that lack the enterprise scale. Probably best that if you asked maybe what doesn’t work, it’s never really worked. And my opinion, for me, is just a use of email, and regarding without a clear message and an understanding of where the value proposition actually was. If there was an introduction or an opportunity to listen to a story, I like to learn, so I probably spent a lopsided amount of time exploring and listening, where, perhaps, maybe many of my peers wouldn’t have done that without a better reason to do so. And I think a lot for the early stage companies, and we’re seeing this now post pandemic, the regional conferences, the events, the opportunities to attend true learning activities, and in some of these situations where you can meet up with individuals that are decision makers, is a grand opportunity.
John Farkas:
Things like the hosted buyer meetings, that some of these events that we’re seeing. And absolutely, I think that is a great opportunity and important because what I know is, when you’re in that role, you’ve got a lot of elements that you have purview over, and staying up on every new instance and way of doing things is not necessarily an approachable goal. And so having those opportunities to say, “Hey, here’s another way to look at this or another way to think about it,” those are important moments, a lot of times
Utilizing Vendor Partnerships to Stay Current on Rapid Technology Development
Eric Thrailkill:
I do think that we relied on and put in place a couple of enterprise agreement, one was with a clinical system vendor, and then one was with a revenue cycle and backend office vendor. And those relationships were central to the success, and I think at large part, are still with the company today and how they use them. So those key vendors that you could continue to work with and help them in future product strategy, and really forming not just a supplier of a service and the recipient of a service or a product, but a true partnership approach, both financially as well as insight to the product strategy is key. I think the other thing that’s occurring now, this convergence of cloud compute storage capabilities that are exponentially increasing the opportunities for early stage companies, combined with what I’ll call favorable government influence, and that would be generally bipartisan support for interoperability, bridging different presidential administrations, things like the 21st Century Cures Act, with data exchanges, creating the national framework, a lot of interoperability standards, again, supported by both parties and bridging administrations is driving a lot of the innovation.
And then finally on this topic, I’d say, we’re at a time where innovation internally by large healthcare systems was maybe an afterthought, or maybe secondary, or maybe something that happened tangentially, or in the corner, or had a low amount of funding. And now, John, I think you can appreciate this, there is no way for any contemporary healthcare provider organizations that’s facing the fiercest headwinds ever, in my opinion, in United States healthcare history, to stay contemporary on the pace of change that’s occurring on the tech side. And so now, it’s almost a requirement to try to figure out what that model looks like to address current operations, but also have a foot in the future and really partner on some of the innovation that’s occurring almost overnight to reduce a lot of the challenges that exist in the industry. And frankly, I’m really excited about that. In my role at Project Healthcare and working with community leaders, I see new receptivity, new opportunities for flourishment of partnerships to really drive the industry forward.
Challenges Healthcare Companies Face Today and Their Solutions
John Farkas:
Yeah. And you have an interesting seat in that realm right now, both as an advisor, as an investor, as a leader of a lot of innovation ecosystems. I’m curious to know what are you seeing as some of the biggest challenges right now, there’s plenty of them, but what are some of the biggest challenges? And when you talk about that level of innovation, what you’re seeing come across that big ideas, solving big problems, what are some of the things that you’re excited about?
Eric Thrailkill:
Yeah. Maybe start a little bit with the challenges today. I’d say, number one, no surprise here, every organization is facing just tremendous workforce challenges. A lot of the demand for healthcare services that took a backseat during the past three years of the pandemic is renewing, consumer expectations are very different than they were before the pandemic, and the clinical workforce and the administrative workforce that’s in the industry today is just tired, exhausted, and perhaps no longer has the degree of joy in practicing, whether that’s clinically or administratively, as they did before. And this is obviously a significant issue. I’d also say, since my career is so long, when I started, all of the major stakeholders pretty much stayed within their lanes, and you had provider organizations, and payer organizations, insurance companies, you had pharma organizations, and you had some role for the government to play with Medicare and Medicaid and setting some of the standards that exist in the industry.
There is a tremendous blurring of the lines today. Payer organizations are acquiring physician practices, physician, organizations are banding together to take risk for certain insurance products and certainly impacting Medicare, where almost half or a little slightly over half of Medicare beneficiaries are now in a managed care plan. Small organizations, digital and virtual first organizations are a real threat. And we’ve seen consumer expectations with these technologies be a real benefit, when getting to a physical place of service was a real challenge in the last three years. And then finally, I’d say that retailers, CVS, Walgreens, Walmart, Best Buy Health, Dollar General, Kroger Health, that were largely dismissed, maybe a decade ago because they were starting at the low end of low acuity services, by traditional incumbent organizations, have now had their day, and they’re acquiring large value-based physician practices like VillageMD and Oak Street.
They’re gearing up for truly taking risk and participating in Medicare Advantage, they’ve set a high bar for consumer expectations, being able to see a provider, share information, receive prescriptions, perform telehealth and virtual care visits. And now, this challenge from incumbent organizations, how do we really work, or perhaps partner with retailers that now have set a very high bar for consumer expectations is a very real one.
John Farkas:
So in that realm… so definitely, some mega trends there, as you are looking at companies that are working to solve some of the problems, so looking at, and from the provider perspective, companies that are looking to jump in and say, “Okay, let’s take a look at this particular problem.” Is there a technology? Are there things that you’re seeing come forward that have your attention as really promising and able to make some big dents in some of those issues?
Eric Thrailkill:
Yeah, I do. One is, anything that can reduce, what we’ll call, the clinician burden that exists today, would be an instantaneous benefit. Providers now are spending maybe upwards of half of their time, many hours at night and on the weekends, with documentation, and their electronic health records, and there’s a lot of companies that are thinking about how to do that better, even ambient documentation in certain situations. And the tech has improved, and again, with cloud compute and storage capabilities, there’s ways in which many companies are addressing that issue. I think the other one on the provider side, and really, providers and payers, there’s a lot of friction that exists between those two primary stakeholders, things like prior authorizations, or denied claims, or submitting a claim, or EOBs and management of these really rigorous high friction transactions on the revenue cycle side.
Many companies are building middle layer platform capabilities to reduce that friction and enable lower expense on the provider side, a better consumer experience, and hopefully, a better payment mechanism for the provision of services. I like those two areas, we’re seeing a lot of companies really invest in the true drivers of health. I’m a fan of the Christensen Institute that has… it’s maybe changed the title a little bit, you might have heard of Social Determinants of Health, and the real factors plus individual risk behaviors that determine 80% of our longevity and quality of life. And traditionally, healthcare has not addressed those factors or those true drivers of health.
So tech to support ordering and referral services of community, or social based services that can be delivered, that are targeting those drivers of health or social determinants of health, and an intersection I think of fintech and health tech around eligibility and payment and support for what I’ll call non-traditional services. So things like food and nutrition, and housing support, caregiver support, transportation, all important factors in enabling a population of people to receive the kind of care that they need, but somewhat difficult to navigate without the right technologies there.
Optimizing Telehealth Solutions for True Hybrid Care
John Farkas:
Yeah, there’s certainly a whole lot of activity going around each one of those fields. I know that you have a particular interest and have spent a lot of time in and around telehealth, digital health universe, and clearly, the pandemic rapidly accelerated the adoption of that universe and the things related to it. We just saw unprecedented movement in the space, which has been really exciting in a lot of ways, and absolutely necessary in others. But talk about that arena a little bit too, and what you’re seeing as some of the critical components that are coming forward in that realm.
Eric Thrailkill:
Yeah, no, great question. At the onset of the public health emergency, and the official date of the end of the public health emergency was May 11th, with 151 day timeframe to unwind a lot of the waivers that were put in place that made the adoption of those technologies capable, so almost overnight, two-way video visits, the ability to have a phone call or a FaceTime and get reimbursed at parity for that particular service, the prescription of certain medications without seeing the provider in person on the front end, telehealth performed in a big way, and CIOs, and peers, and technology solutions were, as you said, John, rolled up overnight, where, as a country, we might have gone from low single digit percentage of telehealth and virtual care to maybe upwards of 85% in many markets. I think the real challenge now is, were those solutions optimized for true hybrid care, which a lot of us believe is our future?
Some combination of virtual and in-person care, certain service obviously can only occur in a physical location, but there are many elements within healthcare, even pre-op and post-op services that can be done in a telehealth or a virtual care setting. But because those solutions were rolled out so rapidly, they were generally with two-way video, they lacked integration with documentation, they didn’t incorporate maybe an interpreter or a family care member, and they weren’t optimized the way in which healthcare operates today or could operate in a far more efficient way. So I see a lot of companies, there’s still a lot of opportunity there. A lot of companies focused on data exchanges, a platform to support multiple specialists, the ability to bring in a specialist, or an interpreter, or a family member during a visit to relieve the documentation burden. So if we were on a telehealth visit, I wouldn’t have to turn around and key in what we are talking about now, but we would be able to document that encounter at the same time.
The intersection with medication history and access to diagnostic results and images within that visit, all of those things were just really early on, but have full expectations that the industry will adopt. Many of the waivers were extended, hospital at home waivers, some certain CMS payment waivers, narcotics, as an example by the DEA, were extended for a period of time, but will still be left to congress and policymakers and payment regulation to see if those extensions that have occurred will become permanent. And again, I’m hopeful, but many people believe that with those extensions, and giving healthcare really the ability to adopt these tools without the limitations that existed pre-pandemic, is a real key to unlocking a lot of value in healthcare.
Starting Conversations with Telehealth Academy
John Farkas:
This would be a good opportunity for us to touch base quick around Telehealth Academy. So this has been, I’d call it, a passion project of yours, bringing this out of the ground, and now, we’re in its third year. Tell us a little bit about what the Telehealth Academy is, what you’re hoping to see happen as we grow and that conversation expands.
Eric Thrailkill:
No, thanks for bringing that up. So in partnership with The Disruption Lab and Sage Growth Partners, in 2021, we put together a series of events that had expert speakers. Seven of those eight events, three hour events, were conducted virtually, and one was in-person in November of 2021, and it really enabled the organization to have these really good up-to-date conversations around what was happening in regard to the fast implementation of these telehealth and virtual care solutions, including digital solutions. Year two, 2022, we did just two virtual events and then one full day event in Nashville, and we were really interested in learning from leading health systems like HCA Healthcare, and Lifepoint Health here in Nashville, Ardent Health Services participated as well, along with the Mayo Clinic, along with Intermountain Healthcare, Banner Health, many others from around the country participated in Nashville. And you have the benefit of what Nashville does really well, which is, knows how to have a good time around an interesting topic, but to actually bring the people together to have the conversations, and we’ve had an overwhelming demand by the sponsors, and the participants, and the speakers to do that again.
So our third year is themed Scaling Impact. So now, we’re about not only just implementing those solutions but optimizing those solutions, and really scaling those for impact in terms of access and equity, and lower cost and better clinical outcomes, safer experiences for patients. So we’re excited. It’s going to be held during Nashville Healthcare Sessions week. Our date will be September the 21st. During that week, there’s a ton of activity with the organizers, the Nashville Healthcare Council, and several other events for those of you that are outside of Nashville, to give us a visit during that week and leave educated and inspired, and we welcome you into the community. Our Telehealth Academy is really designed for the innovators, the health systems, the technology companies, policy, payment expertise, clinical leaders. We’ll have sessions on medical education and the future of education and how it needs to change to create the workforce of the future that we believe will be in a hybrid care environment.
John Farkas:
And yeah, I would say that make sure that everybody else knows that this is in Nashville, but not just for Nashville, everybody’s welcome and would benefit to be there. There’s going to be some great thought leaders that’ll be taking part of that, and it’ll be a very valuable time for anybody who’s touching that realm. It’s an important part of healthcare’s future and really grateful for your work, and working to pull that together.
Understanding the Value of Collaboration and Partnerships across Healthcare
John Farkas:
Which leads me into my next question, Eric, you’ve said several times in the context of our conversation here, the importance of getting out there in the community, importance of convening. I know that you are one of the great conveners in our community and you value collaboration and partnerships.
You’re part of our advisory board here at Golden Spiral, and many other ways that you’re seeking to bring people together, I would say, to solve problems, to move the field of healthcare ahead. Talk about the importance of collaboration and the importance of partnerships, the importance of crossing lines and bringing people together, how have you seen that transform the field and what’s your hope for that in the context of the future?
Eric Thrailkill:
Yeah, thanks for that, and I’m biased in this regard, but I’m a big fan of the history of what this community, the healthcare community that’s in Nashville, but also, Nashville and surrounding areas is a place where these conversations can be held up. If you haven’t seen the Ken Burns documentary on the origin of country music, it might date back to singers and songwriters and studio musicians who gathered and shared songs, wrote together, maybe did it without really understanding the revenue and the impact of that, but built a culture that exists today in an ecosystem to support that particular industry. We’ve been fortunate that HCA was founded 53 years ago and is a real pillar in the community. And from that, several hundred, if not thousand, companies have been created, and decades of, and generations of experts within the industry are really willing to share their time and their experience knowing that if we, as an industry, can improve in a lot of different areas and tackle these macro challenges, then clinically, we’ll all benefit from a cost standpoint, we’ll all benefit from access to high quality care.
I love to learn, so when I attend conferences, or HIMSS events, or health events, or VIVE events, I love to see the stages, I’d like to hear from the contemporary speakers, I like to hear those that are addressing challenges. And I’ve found that you can have a handshake, or a conversation, or send an email, or have a hallway conversation and follow up on that, and that could produce, in and of itself, a new network member, a network note, if you will, and a new opportunity to continue the conversation. So I think it’s a time when traditional healthcare incumbent provider organizations might have been a little bit proprietary with their secret sauce of how they actually did things to opening up a little bit and sharing those problems. I think you said it well, John, is like, what are those real pain points? And there are many that these health systems are identifying, and knowing that they might not be able to solve them all, or any of them, without a true partnership approach.
What I’m excited about on the tech front, and maybe we’ll talk about some of the leading technologies coming up here too, but you can be an early stage company with an enterprise grade tech backbone and be very, very helpful to a lot of these organizations that are looking to solve some of these challenges, and let that health system think about how to scale that impact across its domain. And that’s really our role at Project Healthcare, is we have an accelerator program, but we also have partners in the community that really help the founders and the entrepreneurs understand these problems at a deep and personal level. And collaboration is just something that I think all of us need to take out a little bit more time for in our days. It’s valuable, I love to engage in conversations and I love to continue to learn, and I think it benefits the companies in both directions that are a part of that.
John Farkas:
Yeah, it absolutely does. The reality of the problems that we’re facing right now and the things that we have to overcome, if we try and do it in silos, if we try and optimize certain profit centers to the neglect of others, it really is a moment for the community to draw together and say, “Okay, how are we going to do this?” Because there’s not any good alternatives. This is a moment where, when we look at the curves and what is getting ready to happen on the horizon, as the patient population increases in the face of the provider population decreasing, that problem alone is bigger than any one of us.
Eric Thrailkill:
Yeah, you know the numbers, we spend twice as much or more as every other industrialized country in the world. There’s 10,000 Americans every day that turn 65, and that will continue for several more years. By the year 2040, 22% of the population will be over 65, when Medicare originated back in the ’60s, that number was 10%. The cost of care is expected to rise. So this 4.1 or 2, or 3, trillion dollar annual spend that we know in United States healthcare today is expected to be 6.2 trillion. By 2027, the level of uninsured with the pandemic, with the public health emergency, allowed states and provided the funding to support an expanded Medicaid population. Now, states are going through a redetermination process.
I think most forecasters are looking at several million Americans now rolling off an insured product from Medicaid to being uninsured again. So the challenges are significant, John, as you mentioned, and it’s an interesting time. And these macro challenges of cost, and quality, and safety, and equal access to care are real, and how the industry really collaborates, like we’ve done in the last three years and solve some of these macro challenges, will determine our fate in the future.
Three Areas of Healthcare that Eric Is Excited About
John Farkas:
So Eric, if you were to bet on a technology right now, pick a horse, if you were to bet on one that you see as being particularly promising that is vectoring into the problem set that we’re facing, is there a particular technology that you’re interested in that you think is going to be the headliner?
Eric Thrailkill:
I think, maybe three things here, and maybe I’ll start off with what the last decade, and the ability for the federal government to support EHR implementation has allowed us to do with a whole lot of pain for the clinicians, but we have a lot of health records that are digitized and that amount of data is growing at a significant pace, and that data is very, very valuable to lead toward true precision medicine, whether those are diagnostics, or treatment therapies, as well as personalized. So understanding that you and I are very different and we might have the same condition, but we might get treated for it differently. And the ability to drive that personalized precision approach and leverage the data that’s been collected, and then to incorporate two new huge data sets, so everything genomic related and everything social determinant, sits outside of healthcare. But it’s more about the person and their care support and teams, to use that data is an area that I’m really, really excited about.
I think we’ve all been fascinated with generative AI and large language models, and we’ve seen, almost overnight, a hundred million users of OpenAI’s ChatGPT. Andreessen just put out a piece this week and funded a company out of stealth that’s getting a lot of looks, called Hippocratic AI. And it’s really using large language models, that are built and designed for healthcare, to reduce some of these transactions that are estimated to take about $50 of a professional’s time just for a couple of minutes to reply to a voicemail, or to an email, or to a patient portal, or to an individual question, maybe leveraging generative AI to do that, for maybe 10 cents a transaction, and reduce a lot of the cost and the burden associated with that. I think those are two, and I’m also intrigued with these two-sided platforms and marketplaces.
There’s a lot of data marketplaces that are being created, and while the industry combines a lot of data from a lot of different data sources and does that with privacy and security in mind, there are investments that are being made by life sciences, and diagnostics, and bio companies that can really use that data to accelerate treatment therapies and low cost therapies, whether they’re diagnostic or therapeutic, in ways that are hard to understand for us today but certainly we’re on the cusp of. And every one of those requires just new collaboration that has to exist within the industry to be able to support those.
John Farkas:
Yeah, there’s definitely some big horizons on all those fronts and it’s going to be… when I think about what data has the power to do in healthcare as we are able to have the tools to make more and more meaning, and more accurate meaning, accurate’s a big important part of that, it truly is exciting to think about what can be possible because it has to get easier, and anything that’s going to help more providers provide more, feels to me to be in the crossroad and in the crosshairs of what’s important for sure.
Eric’s Favorite Sources for Continued Learning and Problem Solving
John Farkas:
Well, a couple final questions here, Eric. As a former CIO and now an investor, and as you are trying to keep your finger on the pulse of what’s going on, where do you look for input, or I guess, intel when you’re looking to solve some of these problems?
What are some of the sources? You said email is not the source, and I did hear that conferences, and events, and the opportunity to get in to listen and learn in those environments are definitely something that you take in. But as you think back at your AMSURG days, what were some of the channels you were tuned into that you would be looking to get input from?
Eric Thrailkill:
Yeah, I’m intrigued by, and I don’t want to send the wrong message on email, so feel free to email me with questions. I’m respectful of-
John Farkas:
You might be part of a consensus there, I can pretty much confirm that.
Eric Thrailkill:
Yeah. I do email a lot of folks that I know, and I usually started with, “I have a really quick question,” so I try to set the stage up front, “This is going to be painless, but I have a really quick question, and if I could borrow just a portion of your time, that’d be really helpful.” I’m intrigued by, John, there’s a new generation of creative writers that are using different platforms than traditional media sources today, and they’re growing and they’re subscriber base, and they’re building communities with people that are really, really interested in continuing to learn. So there’s a host of publications and podcasts that I’d like, if it’s okay, I’ll mention a few here. I think Paul Keckley, The Keckley Report, is a good periodical. That’s a free subscription that comes out once a week. Paul’s usually on time with that, it should hit your email inbox on Monday morning.
And he does a great job of summarizing the activities for the week with his narrative on it. There’s a newsletter by the name of Hospitality, it’s gaining a lot of momentum. I was able to meet up with the originator of that. It’s more business focused, transaction focused, but it’s really trying to help all of us understand some of the financial transactions that are occurring that are going to impact the industry and the tech that’s utilized. On the podcasting front, it’s just by nature and it’s out there a lot. I love Guy Raz’s How I Built This. I think the story of a founder or an entrepreneur is always interesting. I’ve learned a lot by being associated with the Nashville Entrepreneur Center, who we had a speaker not too long ago that talked about characteristics of an entrepreneur, and he phrased it as anger, curiosity, and then storytelling.
And some of our most successful founders are those that identified a problem that drove them crazy to the point of being really, really angry about it that nobody was solving it. And if you just think a little bit in healthcare about all the things that really bug you, that really drive you crazy sometimes, like filling out your personal information on a clipboard every time you visit a physician office, it drives somebody to the point that they’re angry enough to do something about it. And that next phase is curiosity, and thinking about solutions, and talking to other people and really validating some of those ideas. And then that third phase is telling a story around it where it also has value. We talk a lot to our founders that it’s generally their tech and their solutions and their devices. They generally work. The tricky part in healthcare is finding the right business model, and sometimes the person that’s using the tech is not the person that’s paying for it, and getting those business models right is part of that storytelling.
Podcasts and these new creative writers and a few books lately, I think, for me, personally, Steve Case’s book called The Rise of the Rest was around how different communities across the country were thinking about building the innovation ecosystems, and some are by industry, some are just generally tax solutions that I think is a real applicable book today in the work that I’m doing and how we’re thinking about this in Nashville. And I’m a big fan of a book, I might have mentioned it to you, it’s called the Cold Start Problem. And it’s platform business models, and two-sided networks, and the Cold Start Problem is the first phase in building a tech solution that really does generate network effects and which side of the platform do you start out on. But it’s similar to what we were talking about around these data marketplaces, that you’ve got contributors of data and consumers of data, and how do you build one side of the marketplace to ensure that when additional data is dropped into the marketplace, that it’s valuable for everybody. And that’s true network effects.
John Farkas:
I have about a three-quarter of the way written book summary of the Cold Start Problem that I’ve been working on for a little too long. I need to finish it and maybe we’ll put it out there in parallel to this podcast. So that’s a great recommendation.
Closing Thoughts
John Farkas:
Well, Eric, I am really grateful for your willingness to jump in here with us and have this conversation. Remember folks, make sure you check out the Telehealth Academy. And again, Eric, those dates are going to be-
Eric Thrailkill:
September 21st. It’ll be in-
John Farkas:
September 20?
Eric Thrailkill:
For those of you in Nashville, it’s going to be at the Bell Tower. It’s an event venue around 4th and Korean Vet Boulevard, right across the street from the Omni, I believe, down there.
John Farkas:
Yep. Yep. So make sure you check that out. We’ll put out some information along with the podcast so you can find it easily. Eric Thrailkill, thank you so much for your time and jumping in here with us. It is great to have you a part of our advisory board, and again, thank you for your generosity and how you have invested in, and continue to invest in the healthcare community. It is really appreciated by many, and I just want to take the time here, as we conclude, to say that again out loud, we really do appreciate you.
Eric Thrailkill:
Well, thanks. You’re kind, I’ve enjoyed this, and the industry and the community has been great for me and I’m proud to be a part of it, and have many more years to go.
John Farkas:
That’s right.
Transcript (custom)
Introducing Eric Thrailkill and His Journey to the CIO Role
John Farkas:
Welcome everybody to Healthcare Market Matrix, and I am excited today to welcome Eric Thrailkill, who has served as CIO at three publicly traded healthcare companies in his tenure, and now is leading his own firm, Allee Advisory Services, where he accelerates growth through strategic partnerships and bringing an ecosystem approach to strategy. What I can tell you about Eric, aside from the formalities, is he is certainly one of the most generous humans I know, with his time, with his wisdom, and sharing the meaning of his experience, and his commitment to collaboration is really evident in a number of meaningful ways.
He has lot of involvement in the number of professional organizations, and his role as chairman of Project Healthcare and as a part of the Nashville Entrepreneur Center is a remarkable involvement where he has had the opportunity to impact a number of organizations. And he is also in the third year of leading the Telehealth Academy, and we’re going to hear more about that later. But that’s, if you touch telehealth in any way, shape, or form, something that you’re going to want to make note of and take part in this coming year. Eric, we are so thrilled to have you here. Thanks for joining us.
Eric Thrailkill:
Well, thanks a lot, John, to you and your team, and I feel committed to the industry and to the community in which I’ve enjoyed being a part of for 40 plus years. So thanks for having me.
John Farkas:
Well, I hear this from other people too, and independent of my own experience, but when I see somebody, who has experienced as much as you have in the context of healthcare, be willing to continue to invest and continue to work to try and improve the ecosystem for everybody involved, it’s just such an encouragement to me. I would love to hear some of your journey, rewinding and take us back a little bit to… what was your journey to that CIO role, and give us the highlights of that trip because I know there’s a lot going on.
Eric Thrailkill:
Yeah, no, I’m happy to do it then. And I’d say at the outset, I’ve got a non-traditional career path into healthcare CIO. I’m an accountant by education, University of Florida, studied accounting, became a CPA, worked one time with one of the Big Eight firms, Touche Ross, that was merged in to Deloitte, and that was the firm that actually brought me to Nashville in 1983. I stayed 11 years with that firm. And being in Nashville for the bulk of that career, most of the work that we were doing on the firm side was in the healthcare industry, a number of just notable reputable clients, and that really triggered my interest in that particular industry. I worked for a couple of companies before AMSURG, PhyCor was one of those, a pioneer, perhaps, 25 years before its time in physician practice management in the 90s, and then a company that was known as America Service Group, now known as Corizon, that was a leader in the provision of health services for inmates in prisons and jails.
And in that company, you learn a lot about caregiver needs, you learn a lot about the special relationship between those that are listening, relieving pain, and caring for individuals in a very vulnerable population. And then I had the opportunity to join AMSURG as the first ever CIO in 2007. And it was just a tremendous organization, 15 years old at the time, a disruptor, and the fact that the company was focused on bringing safe surgical procedures to a lower side of service in a community or an ambulatory surgery center. And as medical innovation continues to provide more and more opportunities to do so, it allowed that company and many others to continue to drive value, true value in the healthcare industry. So my background, education as accountant, a lot of finance roles, and appreciation for strategy and business models, and then surrounding myself with individuals that were sharp on the technical side of information technology.
John Farkas:
So what I know about the CIO role is that it has a whole lot to do with value, you have to be making decisions for the organization and it is directly related. So I understand the accountant piece because there’s a lot of equations that you have to factor through, I’ve got to think, to make those decisions in ways that have the best benefit to the organization. Talk about your experience in that regard, and how that has worked itself out?
Eric Thrailkill:
No, it’s a great question and it’s a good observation, and it was something that, frankly, I always enjoyed. So I love the strategy part of a business operation. AMSURG is a unique company, and that when I started with them in 2007, and still primarily today, the company is comprised of individual partnerships with physicians that own and operate ambulatory surgery centers. And value to those individual partnerships that translated to value to patients and payers of those health services is all around, how do you deliver both clinical, administrative, and technology solutions in a shared services format at a very good price that’s as competitive, or more competitive, than they could receive from the outside, but had actually a higher quality level in the service delivery. And a lot of my time was spent with listening and learning from others, in clinical roles, or in operations roles, or in business development roles, about how we could use technology as a company and therefore differentiate in partnership with physicians in that regard.
Creating an Environment for Learning and Growth
John Farkas:
So talk to us a little bit about… you’re giving us a sense of it, but give us an idea of a day in the life, what are some of the factors, as you’re looking at that role and how you’re interfacing with the rest of the organization? You just said, “I’m doing a lot of learning, I’m listening, I’m trying to understand what are some of the problems that we have and how can we solve them?” What did that look like? How did it work itself out?
Eric Thrailkill:
Yeah, I think key was ensuring that we had a top flight motivated team of individuals, and I was fortunate to, out of the blocks, be with a team and then to continue to grow that team that was dedicated to the work that we were doing. I’d probably say I spent 80 plus percent of my time learning and listening, and in corporate meetings, and very purposefully trying to understand the business as much as I could. And it’s an extraordinary amount of time, I think if you had a survey of CIOs, you’d say that they spend a lopsided amount of time working with senior management and others in their organization to better understand the business and the capabilities that IT could bring.
I’m a big believer in investing, and education, and conferences, and events, and associations, whether those are in our community or society, because it just, again, enables that learning to occur. I’m fortunate to be with some IT leaders that we spend a lot of time together in the battle professionally, but we spent a lot of time outside of work getting to know each other, and really trying to build a team and a culture that others that we were recruiting wanted to be a part of. And it’s probably overlooked, is very, very difficult in today’s times, and I have a lot of empathy for those that are in that seat today, moving through really tremendous workforce challenges.
But it’s something that will consume a lot and does require a lot of a leader’s time to ensure that it’s a safe place to work in a learning environment, where professionals can get better with what they’re doing. Part of the greatest tribute that you see is, folks that you use to work with move on in CIO roles, or elevate to VP level roles, or stay within the industry and migrate maybe to an operations or business development role, and it’s really satisfying to know that we were a small part of their professional development.
John Farkas:
I can imagine. If you look at your tenure there, what would be some of the key abilities, some of the things you brought to the picture that might have been superpowers or things that that role ideally has that helps a person be successful in that role?
Eric Thrailkill:
Yeah. I think that’s a good question. I think giving them the time and space, and encouraging professional development and community professional activities is one of the best things that an individual can do. I was fortunate to be with a senior management team. Our CEO, and our CFO, and executive leaders encouraged all of us to be visible in the community, to participate in community organizations, to attend conferences, to even host, AMSURG has a great facility for being able to host an event and bring those events and those learnings together. When I joined AMSURG, it was 2007, and it was prior to the HITECH Act, which was really responsible for, as a country, us moving from a small percentage of Americans, clinical histories documented in electronic health records, to now a large number.
And federal funds as part of the stimulus bill, the ARRA Act of 2009, were made available to healthcare, and helping the company navigate these very complex business relationships with physicians, and at the same time, improve our abilities to ensure clinical documentation that leads almost 100% of the time to safer procedures and higher quality, and good documentation on the revenue cycle side was a challenge. And without being surrounded by a team that was always about learning and contributing and getting some personal reward for the projects that we were doing, it would’ve been really, really difficult.
John Farkas:
So really, what I’m hearing is staying connected to the community you’re serving, in a lot of different ways, is an important piece.
Eric Thrailkill:
Yes.
Eric’s Thoughts on Pitching to CIOs
John Farkas:
Yeah, that doesn’t surprise me about you, Eric, at all. So what I know in this realm is that, especially today that the CIO is one of the targeted entities for young health tech companies trying to get a foot into the provider space, the CIOs almost always a stakeholder for a tech technology solution moving into that arena. I’m curious, in that role, as you were considering vendors, and as you were looking at different opportunities and options and weighing the importance and how you would look at implementing them, what is effective for an organization to do and what just really didn’t work? If somebody was interested in getting noticed, if they were interested in getting your ear in some way, shape, or form, to communicate a solution that they had, what works and what doesn’t?
Eric Thrailkill:
Yeah, I think it’s a good question. I also think it’s a good time maybe to chat just a little bit about the convergence of a number of factors that actually improves the opportunities for early stage companies, or smaller organizations, that have a real technical solution to be of greater benefit maybe today than it was a decade ago. Again, when I started at AMSURG, very few healthcare organizations had migrated their data centers and their data to the cloud, and of primary interest to anyone selling into a CIO would’ve been security and privacy, and was it an application that would fit into the tech stack of the organization? Secondarily, I think, like so many other healthcare businesses that are based in Nashville, enterprise scale is something that’s front and center. So many organizations really wouldn’t entertain something on maybe the low end, or early stage, or small size company because they wouldn’t believe that they had the firepower to continue to support and roll out those solutions on a national basis.
So right out of the box, it might eliminated some very good founders with excellent tech solutions that lack the enterprise scale. Probably best that if you asked maybe what doesn’t work, it’s never really worked. And my opinion, for me, is just a use of email, and regarding without a clear message and an understanding of where the value proposition actually was. If there was an introduction or an opportunity to listen to a story, I like to learn, so I probably spent a lopsided amount of time exploring and listening, where, perhaps, maybe many of my peers wouldn’t have done that without a better reason to do so. And I think a lot for the early stage companies, and we’re seeing this now post pandemic, the regional conferences, the events, the opportunities to attend true learning activities, and in some of these situations where you can meet up with individuals that are decision makers, is a grand opportunity.
John Farkas:
Things like the hosted buyer meetings, that some of these events that we’re seeing. And absolutely, I think that is a great opportunity and important because what I know is, when you’re in that role, you’ve got a lot of elements that you have purview over, and staying up on every new instance and way of doing things is not necessarily an approachable goal. And so having those opportunities to say, “Hey, here’s another way to look at this or another way to think about it,” those are important moments, a lot of times
Utilizing Vendor Partnerships to Stay Current on Rapid Technology Development
Eric Thrailkill:
I do think that we relied on and put in place a couple of enterprise agreement, one was with a clinical system vendor, and then one was with a revenue cycle and backend office vendor. And those relationships were central to the success, and I think at large part, are still with the company today and how they use them. So those key vendors that you could continue to work with and help them in future product strategy, and really forming not just a supplier of a service and the recipient of a service or a product, but a true partnership approach, both financially as well as insight to the product strategy is key. I think the other thing that’s occurring now, this convergence of cloud compute storage capabilities that are exponentially increasing the opportunities for early stage companies, combined with what I’ll call favorable government influence, and that would be generally bipartisan support for interoperability, bridging different presidential administrations, things like the 21st Century Cures Act, with data exchanges, creating the national framework, a lot of interoperability standards, again, supported by both parties and bridging administrations is driving a lot of the innovation.
And then finally on this topic, I’d say, we’re at a time where innovation internally by large healthcare systems was maybe an afterthought, or maybe secondary, or maybe something that happened tangentially, or in the corner, or had a low amount of funding. And now, John, I think you can appreciate this, there is no way for any contemporary healthcare provider organizations that’s facing the fiercest headwinds ever, in my opinion, in United States healthcare history, to stay contemporary on the pace of change that’s occurring on the tech side. And so now, it’s almost a requirement to try to figure out what that model looks like to address current operations, but also have a foot in the future and really partner on some of the innovation that’s occurring almost overnight to reduce a lot of the challenges that exist in the industry. And frankly, I’m really excited about that. In my role at Project Healthcare and working with community leaders, I see new receptivity, new opportunities for flourishment of partnerships to really drive the industry forward.
Challenges Healthcare Companies Face Today and Their Solutions
John Farkas:
Yeah. And you have an interesting seat in that realm right now, both as an advisor, as an investor, as a leader of a lot of innovation ecosystems. I’m curious to know what are you seeing as some of the biggest challenges right now, there’s plenty of them, but what are some of the biggest challenges? And when you talk about that level of innovation, what you’re seeing come across that big ideas, solving big problems, what are some of the things that you’re excited about?
Eric Thrailkill:
Yeah. Maybe start a little bit with the challenges today. I’d say, number one, no surprise here, every organization is facing just tremendous workforce challenges. A lot of the demand for healthcare services that took a backseat during the past three years of the pandemic is renewing, consumer expectations are very different than they were before the pandemic, and the clinical workforce and the administrative workforce that’s in the industry today is just tired, exhausted, and perhaps no longer has the degree of joy in practicing, whether that’s clinically or administratively, as they did before. And this is obviously a significant issue. I’d also say, since my career is so long, when I started, all of the major stakeholders pretty much stayed within their lanes, and you had provider organizations, and payer organizations, insurance companies, you had pharma organizations, and you had some role for the government to play with Medicare and Medicaid and setting some of the standards that exist in the industry.
There is a tremendous blurring of the lines today. Payer organizations are acquiring physician practices, physician, organizations are banding together to take risk for certain insurance products and certainly impacting Medicare, where almost half or a little slightly over half of Medicare beneficiaries are now in a managed care plan. Small organizations, digital and virtual first organizations are a real threat. And we’ve seen consumer expectations with these technologies be a real benefit, when getting to a physical place of service was a real challenge in the last three years. And then finally, I’d say that retailers, CVS, Walgreens, Walmart, Best Buy Health, Dollar General, Kroger Health, that were largely dismissed, maybe a decade ago because they were starting at the low end of low acuity services, by traditional incumbent organizations, have now had their day, and they’re acquiring large value-based physician practices like VillageMD and Oak Street.
They’re gearing up for truly taking risk and participating in Medicare Advantage, they’ve set a high bar for consumer expectations, being able to see a provider, share information, receive prescriptions, perform telehealth and virtual care visits. And now, this challenge from incumbent organizations, how do we really work, or perhaps partner with retailers that now have set a very high bar for consumer expectations is a very real one.
John Farkas:
So in that realm… so definitely, some mega trends there, as you are looking at companies that are working to solve some of the problems, so looking at, and from the provider perspective, companies that are looking to jump in and say, “Okay, let’s take a look at this particular problem.” Is there a technology? Are there things that you’re seeing come forward that have your attention as really promising and able to make some big dents in some of those issues?
Eric Thrailkill:
Yeah, I do. One is, anything that can reduce, what we’ll call, the clinician burden that exists today, would be an instantaneous benefit. Providers now are spending maybe upwards of half of their time, many hours at night and on the weekends, with documentation, and their electronic health records, and there’s a lot of companies that are thinking about how to do that better, even ambient documentation in certain situations. And the tech has improved, and again, with cloud compute and storage capabilities, there’s ways in which many companies are addressing that issue. I think the other one on the provider side, and really, providers and payers, there’s a lot of friction that exists between those two primary stakeholders, things like prior authorizations, or denied claims, or submitting a claim, or EOBs and management of these really rigorous high friction transactions on the revenue cycle side.
Many companies are building middle layer platform capabilities to reduce that friction and enable lower expense on the provider side, a better consumer experience, and hopefully, a better payment mechanism for the provision of services. I like those two areas, we’re seeing a lot of companies really invest in the true drivers of health. I’m a fan of the Christensen Institute that has… it’s maybe changed the title a little bit, you might have heard of Social Determinants of Health, and the real factors plus individual risk behaviors that determine 80% of our longevity and quality of life. And traditionally, healthcare has not addressed those factors or those true drivers of health.
So tech to support ordering and referral services of community, or social based services that can be delivered, that are targeting those drivers of health or social determinants of health, and an intersection I think of fintech and health tech around eligibility and payment and support for what I’ll call non-traditional services. So things like food and nutrition, and housing support, caregiver support, transportation, all important factors in enabling a population of people to receive the kind of care that they need, but somewhat difficult to navigate without the right technologies there.
Optimizing Telehealth Solutions for True Hybrid Care
John Farkas:
Yeah, there’s certainly a whole lot of activity going around each one of those fields. I know that you have a particular interest and have spent a lot of time in and around telehealth, digital health universe, and clearly, the pandemic rapidly accelerated the adoption of that universe and the things related to it. We just saw unprecedented movement in the space, which has been really exciting in a lot of ways, and absolutely necessary in others. But talk about that arena a little bit too, and what you’re seeing as some of the critical components that are coming forward in that realm.
Eric Thrailkill:
Yeah, no, great question. At the onset of the public health emergency, and the official date of the end of the public health emergency was May 11th, with 151 day timeframe to unwind a lot of the waivers that were put in place that made the adoption of those technologies capable, so almost overnight, two-way video visits, the ability to have a phone call or a FaceTime and get reimbursed at parity for that particular service, the prescription of certain medications without seeing the provider in person on the front end, telehealth performed in a big way, and CIOs, and peers, and technology solutions were, as you said, John, rolled up overnight, where, as a country, we might have gone from low single digit percentage of telehealth and virtual care to maybe upwards of 85% in many markets. I think the real challenge now is, were those solutions optimized for true hybrid care, which a lot of us believe is our future?
Some combination of virtual and in-person care, certain service obviously can only occur in a physical location, but there are many elements within healthcare, even pre-op and post-op services that can be done in a telehealth or a virtual care setting. But because those solutions were rolled out so rapidly, they were generally with two-way video, they lacked integration with documentation, they didn’t incorporate maybe an interpreter or a family care member, and they weren’t optimized the way in which healthcare operates today or could operate in a far more efficient way. So I see a lot of companies, there’s still a lot of opportunity there. A lot of companies focused on data exchanges, a platform to support multiple specialists, the ability to bring in a specialist, or an interpreter, or a family member during a visit to relieve the documentation burden. So if we were on a telehealth visit, I wouldn’t have to turn around and key in what we are talking about now, but we would be able to document that encounter at the same time.
The intersection with medication history and access to diagnostic results and images within that visit, all of those things were just really early on, but have full expectations that the industry will adopt. Many of the waivers were extended, hospital at home waivers, some certain CMS payment waivers, narcotics, as an example by the DEA, were extended for a period of time, but will still be left to congress and policymakers and payment regulation to see if those extensions that have occurred will become permanent. And again, I’m hopeful, but many people believe that with those extensions, and giving healthcare really the ability to adopt these tools without the limitations that existed pre-pandemic, is a real key to unlocking a lot of value in healthcare.
Starting Conversations with Telehealth Academy
John Farkas:
This would be a good opportunity for us to touch base quick around Telehealth Academy. So this has been, I’d call it, a passion project of yours, bringing this out of the ground, and now, we’re in its third year. Tell us a little bit about what the Telehealth Academy is, what you’re hoping to see happen as we grow and that conversation expands.
Eric Thrailkill:
No, thanks for bringing that up. So in partnership with The Disruption Lab and Sage Growth Partners, in 2021, we put together a series of events that had expert speakers. Seven of those eight events, three hour events, were conducted virtually, and one was in-person in November of 2021, and it really enabled the organization to have these really good up-to-date conversations around what was happening in regard to the fast implementation of these telehealth and virtual care solutions, including digital solutions. Year two, 2022, we did just two virtual events and then one full day event in Nashville, and we were really interested in learning from leading health systems like HCA Healthcare, and Lifepoint Health here in Nashville, Ardent Health Services participated as well, along with the Mayo Clinic, along with Intermountain Healthcare, Banner Health, many others from around the country participated in Nashville. And you have the benefit of what Nashville does really well, which is, knows how to have a good time around an interesting topic, but to actually bring the people together to have the conversations, and we’ve had an overwhelming demand by the sponsors, and the participants, and the speakers to do that again.
So our third year is themed Scaling Impact. So now, we’re about not only just implementing those solutions but optimizing those solutions, and really scaling those for impact in terms of access and equity, and lower cost and better clinical outcomes, safer experiences for patients. So we’re excited. It’s going to be held during Nashville Healthcare Sessions week. Our date will be September the 21st. During that week, there’s a ton of activity with the organizers, the Nashville Healthcare Council, and several other events for those of you that are outside of Nashville, to give us a visit during that week and leave educated and inspired, and we welcome you into the community. Our Telehealth Academy is really designed for the innovators, the health systems, the technology companies, policy, payment expertise, clinical leaders. We’ll have sessions on medical education and the future of education and how it needs to change to create the workforce of the future that we believe will be in a hybrid care environment.
John Farkas:
And yeah, I would say that make sure that everybody else knows that this is in Nashville, but not just for Nashville, everybody’s welcome and would benefit to be there. There’s going to be some great thought leaders that’ll be taking part of that, and it’ll be a very valuable time for anybody who’s touching that realm. It’s an important part of healthcare’s future and really grateful for your work, and working to pull that together.
Understanding the Value of Collaboration and Partnerships across Healthcare
John Farkas:
Which leads me into my next question, Eric, you’ve said several times in the context of our conversation here, the importance of getting out there in the community, importance of convening. I know that you are one of the great conveners in our community and you value collaboration and partnerships.
You’re part of our advisory board here at Golden Spiral, and many other ways that you’re seeking to bring people together, I would say, to solve problems, to move the field of healthcare ahead. Talk about the importance of collaboration and the importance of partnerships, the importance of crossing lines and bringing people together, how have you seen that transform the field and what’s your hope for that in the context of the future?
Eric Thrailkill:
Yeah, thanks for that, and I’m biased in this regard, but I’m a big fan of the history of what this community, the healthcare community that’s in Nashville, but also, Nashville and surrounding areas is a place where these conversations can be held up. If you haven’t seen the Ken Burns documentary on the origin of country music, it might date back to singers and songwriters and studio musicians who gathered and shared songs, wrote together, maybe did it without really understanding the revenue and the impact of that, but built a culture that exists today in an ecosystem to support that particular industry. We’ve been fortunate that HCA was founded 53 years ago and is a real pillar in the community. And from that, several hundred, if not thousand, companies have been created, and decades of, and generations of experts within the industry are really willing to share their time and their experience knowing that if we, as an industry, can improve in a lot of different areas and tackle these macro challenges, then clinically, we’ll all benefit from a cost standpoint, we’ll all benefit from access to high quality care.
I love to learn, so when I attend conferences, or HIMSS events, or health events, or VIVE events, I love to see the stages, I’d like to hear from the contemporary speakers, I like to hear those that are addressing challenges. And I’ve found that you can have a handshake, or a conversation, or send an email, or have a hallway conversation and follow up on that, and that could produce, in and of itself, a new network member, a network note, if you will, and a new opportunity to continue the conversation. So I think it’s a time when traditional healthcare incumbent provider organizations might have been a little bit proprietary with their secret sauce of how they actually did things to opening up a little bit and sharing those problems. I think you said it well, John, is like, what are those real pain points? And there are many that these health systems are identifying, and knowing that they might not be able to solve them all, or any of them, without a true partnership approach.
What I’m excited about on the tech front, and maybe we’ll talk about some of the leading technologies coming up here too, but you can be an early stage company with an enterprise grade tech backbone and be very, very helpful to a lot of these organizations that are looking to solve some of these challenges, and let that health system think about how to scale that impact across its domain. And that’s really our role at Project Healthcare, is we have an accelerator program, but we also have partners in the community that really help the founders and the entrepreneurs understand these problems at a deep and personal level. And collaboration is just something that I think all of us need to take out a little bit more time for in our days. It’s valuable, I love to engage in conversations and I love to continue to learn, and I think it benefits the companies in both directions that are a part of that.
John Farkas:
Yeah, it absolutely does. The reality of the problems that we’re facing right now and the things that we have to overcome, if we try and do it in silos, if we try and optimize certain profit centers to the neglect of others, it really is a moment for the community to draw together and say, “Okay, how are we going to do this?” Because there’s not any good alternatives. This is a moment where, when we look at the curves and what is getting ready to happen on the horizon, as the patient population increases in the face of the provider population decreasing, that problem alone is bigger than any one of us.
Eric Thrailkill:
Yeah, you know the numbers, we spend twice as much or more as every other industrialized country in the world. There’s 10,000 Americans every day that turn 65, and that will continue for several more years. By the year 2040, 22% of the population will be over 65, when Medicare originated back in the ’60s, that number was 10%. The cost of care is expected to rise. So this 4.1 or 2, or 3, trillion dollar annual spend that we know in United States healthcare today is expected to be 6.2 trillion. By 2027, the level of uninsured with the pandemic, with the public health emergency, allowed states and provided the funding to support an expanded Medicaid population. Now, states are going through a redetermination process.
I think most forecasters are looking at several million Americans now rolling off an insured product from Medicaid to being uninsured again. So the challenges are significant, John, as you mentioned, and it’s an interesting time. And these macro challenges of cost, and quality, and safety, and equal access to care are real, and how the industry really collaborates, like we’ve done in the last three years and solve some of these macro challenges, will determine our fate in the future.
Three Areas of Healthcare that Eric Is Excited About
John Farkas:
So Eric, if you were to bet on a technology right now, pick a horse, if you were to bet on one that you see as being particularly promising that is vectoring into the problem set that we’re facing, is there a particular technology that you’re interested in that you think is going to be the headliner?
Eric Thrailkill:
I think, maybe three things here, and maybe I’ll start off with what the last decade, and the ability for the federal government to support EHR implementation has allowed us to do with a whole lot of pain for the clinicians, but we have a lot of health records that are digitized and that amount of data is growing at a significant pace, and that data is very, very valuable to lead toward true precision medicine, whether those are diagnostics, or treatment therapies, as well as personalized. So understanding that you and I are very different and we might have the same condition, but we might get treated for it differently. And the ability to drive that personalized precision approach and leverage the data that’s been collected, and then to incorporate two new huge data sets, so everything genomic related and everything social determinant, sits outside of healthcare. But it’s more about the person and their care support and teams, to use that data is an area that I’m really, really excited about.
I think we’ve all been fascinated with generative AI and large language models, and we’ve seen, almost overnight, a hundred million users of OpenAI’s ChatGPT. Andreessen just put out a piece this week and funded a company out of stealth that’s getting a lot of looks, called Hippocratic AI. And it’s really using large language models, that are built and designed for healthcare, to reduce some of these transactions that are estimated to take about $50 of a professional’s time just for a couple of minutes to reply to a voicemail, or to an email, or to a patient portal, or to an individual question, maybe leveraging generative AI to do that, for maybe 10 cents a transaction, and reduce a lot of the cost and the burden associated with that. I think those are two, and I’m also intrigued with these two-sided platforms and marketplaces.
There’s a lot of data marketplaces that are being created, and while the industry combines a lot of data from a lot of different data sources and does that with privacy and security in mind, there are investments that are being made by life sciences, and diagnostics, and bio companies that can really use that data to accelerate treatment therapies and low cost therapies, whether they’re diagnostic or therapeutic, in ways that are hard to understand for us today but certainly we’re on the cusp of. And every one of those requires just new collaboration that has to exist within the industry to be able to support those.
John Farkas:
Yeah, there’s definitely some big horizons on all those fronts and it’s going to be… when I think about what data has the power to do in healthcare as we are able to have the tools to make more and more meaning, and more accurate meaning, accurate’s a big important part of that, it truly is exciting to think about what can be possible because it has to get easier, and anything that’s going to help more providers provide more, feels to me to be in the crossroad and in the crosshairs of what’s important for sure.
Eric’s Favorite Sources for Continued Learning and Problem Solving
John Farkas:
Well, a couple final questions here, Eric. As a former CIO and now an investor, and as you are trying to keep your finger on the pulse of what’s going on, where do you look for input, or I guess, intel when you’re looking to solve some of these problems?
What are some of the sources? You said email is not the source, and I did hear that conferences, and events, and the opportunity to get in to listen and learn in those environments are definitely something that you take in. But as you think back at your AMSURG days, what were some of the channels you were tuned into that you would be looking to get input from?
Eric Thrailkill:
Yeah, I’m intrigued by, and I don’t want to send the wrong message on email, so feel free to email me with questions. I’m respectful of-
John Farkas:
You might be part of a consensus there, I can pretty much confirm that.
Eric Thrailkill:
Yeah. I do email a lot of folks that I know, and I usually started with, “I have a really quick question,” so I try to set the stage up front, “This is going to be painless, but I have a really quick question, and if I could borrow just a portion of your time, that’d be really helpful.” I’m intrigued by, John, there’s a new generation of creative writers that are using different platforms than traditional media sources today, and they’re growing and they’re subscriber base, and they’re building communities with people that are really, really interested in continuing to learn. So there’s a host of publications and podcasts that I’d like, if it’s okay, I’ll mention a few here. I think Paul Keckley, The Keckley Report, is a good periodical. That’s a free subscription that comes out once a week. Paul’s usually on time with that, it should hit your email inbox on Monday morning.
And he does a great job of summarizing the activities for the week with his narrative on it. There’s a newsletter by the name of Hospitality, it’s gaining a lot of momentum. I was able to meet up with the originator of that. It’s more business focused, transaction focused, but it’s really trying to help all of us understand some of the financial transactions that are occurring that are going to impact the industry and the tech that’s utilized. On the podcasting front, it’s just by nature and it’s out there a lot. I love Guy Raz’s How I Built This. I think the story of a founder or an entrepreneur is always interesting. I’ve learned a lot by being associated with the Nashville Entrepreneur Center, who we had a speaker not too long ago that talked about characteristics of an entrepreneur, and he phrased it as anger, curiosity, and then storytelling.
And some of our most successful founders are those that identified a problem that drove them crazy to the point of being really, really angry about it that nobody was solving it. And if you just think a little bit in healthcare about all the things that really bug you, that really drive you crazy sometimes, like filling out your personal information on a clipboard every time you visit a physician office, it drives somebody to the point that they’re angry enough to do something about it. And that next phase is curiosity, and thinking about solutions, and talking to other people and really validating some of those ideas. And then that third phase is telling a story around it where it also has value. We talk a lot to our founders that it’s generally their tech and their solutions and their devices. They generally work. The tricky part in healthcare is finding the right business model, and sometimes the person that’s using the tech is not the person that’s paying for it, and getting those business models right is part of that storytelling.
Podcasts and these new creative writers and a few books lately, I think, for me, personally, Steve Case’s book called The Rise of the Rest was around how different communities across the country were thinking about building the innovation ecosystems, and some are by industry, some are just generally tax solutions that I think is a real applicable book today in the work that I’m doing and how we’re thinking about this in Nashville. And I’m a big fan of a book, I might have mentioned it to you, it’s called the Cold Start Problem. And it’s platform business models, and two-sided networks, and the Cold Start Problem is the first phase in building a tech solution that really does generate network effects and which side of the platform do you start out on. But it’s similar to what we were talking about around these data marketplaces, that you’ve got contributors of data and consumers of data, and how do you build one side of the marketplace to ensure that when additional data is dropped into the marketplace, that it’s valuable for everybody. And that’s true network effects.
John Farkas:
I have about a three-quarter of the way written book summary of the Cold Start Problem that I’ve been working on for a little too long. I need to finish it and maybe we’ll put it out there in parallel to this podcast. So that’s a great recommendation.
Closing Thoughts
John Farkas:
Well, Eric, I am really grateful for your willingness to jump in here with us and have this conversation. Remember folks, make sure you check out the Telehealth Academy. And again, Eric, those dates are going to be-
Eric Thrailkill:
September 21st. It’ll be in-
John Farkas:
September 20?
Eric Thrailkill:
For those of you in Nashville, it’s going to be at the Bell Tower. It’s an event venue around 4th and Korean Vet Boulevard, right across the street from the Omni, I believe, down there.
John Farkas:
Yep. Yep. So make sure you check that out. We’ll put out some information along with the podcast so you can find it easily. Eric Thrailkill, thank you so much for your time and jumping in here with us. It is great to have you a part of our advisory board, and again, thank you for your generosity and how you have invested in, and continue to invest in the healthcare community. It is really appreciated by many, and I just want to take the time here, as we conclude, to say that again out loud, we really do appreciate you.
Eric Thrailkill:
Well, thanks. You’re kind, I’ve enjoyed this, and the industry and the community has been great for me and I’m proud to be a part of it, and have many more years to go.
John Farkas:
That’s right.
About Eric Thrailkill
Eric Thrailkill is a recognized healthcare technology leader specializing in strategy, data analytics, business model innovation, revenue cycle optimization, value creation and partnerships. He previously served as CIO at three publicly traded healthcare companies – PhyCor, America Service Group and AMSURG – and currently leads his own company, Allee Advisory Services. In this role, he consults with provider and health technology organizations to accelerate growth through partnerships, bringing an ecosystem approach to strategy.
Before founding his company, Eric worked as SVP, Business Intelligence and Analytics at Envision Healthcare, a leading national medical group that delivers physician and advanced practice provider services to more than 1,800 clinical departments in healthcare facilities in 45 states and the District of Columbia. At Envision, he built the enterprise’s first analytics team in the domains of operations, revenue cycle, finance and quality.
As VP and CIO at AMSURG, Eric was responsible for strategy, operations, centralized technology platform services, quality and analytics. Among many other projects, he developed an internal team to launch a revenue cycle solution specifically designed for single specialty ambulatory surgery centers (ASCs). He also led the development of the company’s cybersecurity program, designed to mitigate threats and ensure continuous operations. Additionally, he led an analytics approach to value demonstration with the approximate 260 ASCs, architecting data sharing relationships between physician practices, anesthesia resources, health system equity partners, community referrals, health plans, payers and more.
An active participant in local and national professional organizations, Eric is enthusiastic about connecting technology leaders for meaningful collaborations. He is chairman of Project Healthcare at the Nashville Entrepreneur Center, a program designed to assist entrepreneurs and innovators as they grow and scale healthcare solutions. From 2018 to 2020, he served as the president of the Tennessee Chapter of HIMSS. He is actively involved in the Nashville Health Care Council and has served on the board of the Greater Nashville Technology Council.
Eric practiced as a certified public accountant (Deloitte) and earned his bachelor’s degree in accounting from the University of Florida.