What a Year! — Looking back on 2022 (and at the year ahead) with Justin, Brittany, and Todd

"Definitively Speaking" is a Definitive Healthcare podcast series recorded and produced in Framingham, Massachusetts. To learn more about healthcare commercial intelligence, please visit us at definitivehc.com. Hello, happy new year, and welcome to the latest episode of "Definitively Speaking," the podcast where we have data-driven conversations on the current state of healthcare. I'm Justin Steinman, Chief Marketing Officer at Definitive Healthcare and your host for this podcast. I'm joined today by my friends, colleagues, and frequent co-hosts, Todd Bellemare and Brittany Morin-Mezzadri, for our 2022 year review special episode. Hard to believe, but this is our 25th episode of "Definitively Speaking." In 2022, we did 19 episodes of external guests and five special afterwards episodes, with the three of us went into more depth around a particular speaker and what he or she said. So this is the Big 25, and what better way to kick off 2023 than with a look back at some of our favorite guests of 2022. And then a look forward to what we think we're gonna see in 2023. Todd, Brittany, great to have here with me today.

Wonderful to be here.

What's up, guys?

Hello, hello, hello. So for all our listeners out there, if you're wondering why we may sound a little bit different today, well, here's a story. Brittany just moved to Texas, so she's now remote, and she's got a new dog, that's awesome. Todd is at home recovering from bed with COVID, and I'm all by myself in the "Definitively Speaking" podcast studio, battling a holiday head code, which thankfully is not COVID, so says the 30 plus negative COVID tests at my house. So while we're all not at peak efficiency today, we're still ready to kick around some healthcare data. Alright, so we covered a lot of ground in 2022 on "Definitively Speaking," but as we prepared for this episode, several themes emerged, and we'll cover that and see if what we were talking about back in April, 2022 still resonates here at the start of 2023. So, Brittany, let's start with a simple, obvious, but very important question. Who is your favorite guest that we had on "Definitively Speaking" last year and why? And you can't say Todd.

Okay, but Todd is my favorite.

Okay, other than Todd, who is your favorite?

Other than Todd, I really enjoyed our conversations with Dr. Pimentel and Cara McNulty. Those conversations were really exciting and thought-provoking for me. I ended up buying Dr. Pimentel's book as well for cookbook for gut health, which I found very helpful. And then Cara's conversation around mental health and mental wellbeing, I thought that was so timely and so necessary.

Yeah, yeah.

Todd, who's your favorite guest?

So I actually picked out five different episodes that I was really interested in, and I knew that I would probably have picked the same ones that you or Brittany would've. So, yes, Cara was definitely in those top five. I thought that that conversation was just out of this world. She was a fantastic guest, but I'm gonna go in a direction that is probably not a surprise to you guys and talk a little bit about the conversation, it was Episode 18 with Chase Zaputil of Veda. That conversation, just talking about data, it felt like it was done in five minutes. I was listening to it in the car, and I was transported from my home to the place I was going in two seconds. And I was like, "I can't believe I just listened to 30 to 40 minutes "worth of that, and it just went right like that." So that was fantastic. I love hearing people talk about data, especially when it comes to healthcare data, because some of the things he first said, I was like, "That's what I would've said." It was very much like listening to somebody who had the same brain. So I was so happy to hear his take on the way that healthcare data can be manipulated and used and the complexities within it. He was just a great guest. So that was my favorite, I'm gonna say.

Yeah, talk about someone being on point for a podcast. I mean, this is a podcast about healthcare data, and that's all Chase does every day, all day long. So he really was spot on for the podcast. I'm not surprised to hear you say that at all, Todd.

You know, I'm gonna cheat and talk about a few of my favorite guests, Joel, our multimedia producer, and the guy who makes us all sound so good in this podcast, big shout out to Joel, by the way. He likes to give me a lot of grief and call me a little bit of a nerd, and all right, I'll admit, I'm a little bit of a geek and definitely a nerd when it comes to healthcare. So if I were to go back and pick my top three guests from last year, and honestly, all the way back to our first guest, which is over a year ago at this point, Michael Greeley from Flare Capital, who really kicked off the year and gave us a great overview from a macroeconomic perspective about what was gonna happen in healthcare in 2022, where he was investing. And while Michael did not predict the recession, so we'll definitely give him a strike for that, he was actually pretty accurate in terms of the key investment areas and the rise of certain themes around healthcare throughout the year. And so you'd expect that from Michael. But it really was interesting, and it was fascinating to go back and read in December, I read the transcript, what he said back in January how true it happened in 2022. On the flip side, going from the macro perspective down to the micro perspective, I really, really enjoyed the time with Brian Fugere from Symplr. That was definitely a nerd out podcast, where we talked a lot, and Todd's back here shaking his head, yes it was, where we got into interoperability and hospital operations and how we pass different procedures and to keep it all secure and governance and regulation and compliance. But if you're somebody who works in a hospital at any level in any job, I really thought that podcast was on point. And really, Brian had some great insights, as you expect from someone who'd been in healthcare for 25 years. And then I fast forward to the end of the year, probably my favorite episode's when I got to geek out with Othman Laraki, the CEO of Color, all about macroeconomics, and really, Othman had some really fascinating thoughts about what's wrong with healthcare and how we need to change it. And we really got into some deep macroeconomic analysis, I was back in business school, I said on that podcast, and I really enjoyed that time with him. And so if you're out there listening to this conversation today and you haven't listened to these episodes, I'd encourage you to go back and listen to them. So that's kind of my favorite guests. I'll be nice, and I wanna ask the two of you to name your least favorite guests, 'cause, hey, we love all of our guests here on "Definitively Speaking," but I do wanna know what your most memorable moment from the podcast was. Todd, why don't you go first this time?

You know, that's interesting, 'cause I think one of the most surprising guests that really sucked me in was Beth Holmes at Hint Health. I honestly walked into that conversation about direct primary care not knowing too much about it. And I just found her fascinating and her story fascinating. And so kind of going through that, and just some of the numbers, even like the number of patients that are using direct primary care, 'cause I had always had it in my head that, you know, I had associated these direct primary care with the concierge service, right? And so, I think of a bunch of rich people just getting a doctor whenever they want. That's kind of what I thought, right? So that was, to hear it in a little bit more of a real sense and to hear some of the details that she went through. That was Episode 14, and that was something I actually have listened to twice now 'cause I thought she was so good. So that was something that I kind of have gone back to. When you think about all of the upheaval we've seen in the healthcare market in the last, I'll go way back 15 years, it's been just a crazy amount of upheaval. And even now with rural health closing and telehealth booming and all these different pieces of the puzzle coming into play, and as a person who spends his day thinking about how we're going to quantify and look at trends and the different things that are happening in the healthcare market to understand what is not there in the data versus what is, understanding what is not there is almost as important as understanding what is there. Because when you look at a patient journey and start to look for where patients may fall in and out of data sources, not having a claim generated because someone's going through direct primary care, that's a substantial chunk of patients going through there. So it's just endlessly fascinating to me in the different ways in which we can look at and analyze and understand what patients are going through. And then of course, from a patient perspective, understand what their options are, because I know a lot of people, and this is anecdotal, of course, but I'm sure we could go look up some numbers, but there's a substantial number of people who use the emergency room as their PCP. And so that is something that is a huge strain on the healthcare system. And so to look at alternatives for that, whether it's direct primary care or something else, I just loved it. To me, that surprised me the most, 'cause I walked in there thinking, "Oh, I kind of know what this is," and she just blew me away.

Yeah, and to tease an upcoming podcast, we're gonna talk with a guest pretty soon about virtual specialty care, which is kind of an analogous to direct primary care and where that's going. I'm gonna get you in a second, Brittany, but I wanna pick something Todd up said there. A big theme that emerged, Todd, and you hit on it there throughout the year, was the shift in care models. And I think in 2022, we really saw a big acceleration in the shift in care models, some stats, 'cause we talk about stats here on "Definitively Speaking," in 2022, roughly 32% of procedures went through a hospital, which was down from nearly 37% in 2016. That's a five point shift in six years, really showing that cares leaving hospitals despite the fact that people are using the ER for their primary care. I tell you that people who can have the ability to shift more towards ambulatory procedures, I think we saw the rise in telemedicine up 70% to where it was or from where it was pre-pandemic. So I think 2022 will really be reflected on as coming out of the pandemic, the shift in care models.

So we have been looking at even slices of that shift in different markets. So I'll give an example. So we've looked at the shift in care from emergency emergency room visit versus urgent care clinic visits. And when you look at that over time, there's a seasonality to it, There's like more in the summer and then a little less in the winter, the percentage of emergency visits that is split between hospitals, emergency rooms, and urgent care clinics, it was 60-40 for all through 2019. And then once COVID hit, the percentage of emergency visits going urgent care clinics skyrocketed. And it was almost a 50-50 split. And so you kind of expected, as 2021 rolled around, that that would start to ebb and flow back to what it was before. But it really looks like those percentages, not that urgent care clinic is gonna overtake hospitals as a share of emergency visits, but they're no longer in the 35 to 40% range, they're in the 48% range or so. So it is getting close to a 50-50 split. And I think what you can read into that really is that people have looked at those models and have started to see that, "Hey, this actually works for me." And so that is something that I found just super fascinating just looking at the data from that shift.

Brittany, what was your most memorable moment from last year?

Well, I'm gonna be an overachiever like Todd, and I have two.

Nice.

So, yeah, so my first one is just about the podcast in and of itself. In our day-to-day jobs, I feel like we do a lot of presenting and a lot of on-directional conversations with our clients, which I really enjoy. I enjoy talking about our data and our insights and what we've learned for them. But with the podcast, what I appreciate is that we're learning from other folks in the industry. We're having conversation, and it's definitely more, it's a more conversational atmosphere, and we're able to share ideas and to think about data in different ways that we don't get to when we're just presenting the data. The other episode that stands out to me was the afterwards to Cara's episode, when we had a very personal and very intimate conversation about our own mental health and how that shows up in the workplace and how, as a company, Definitive is really investing in the emotional and mental safety of its employees and making way for space for us to be able to talk about mental health issues and taking care of each other in ways that I've never experienced before, and as you had mentioned, that you had never experienced before, and I thought that was a very powerful episode, it was a really powerful experience to be able to share that with you guys.

Yeah, I feel like the three of us grew closer throughout, I know you guys infinitely better than I did this time last year, absolutely. And I really appreciate that. You know, we've talked a lot about Cara, that also is my most memorable thing, the one phrase, if I say, "Justin, what's the one phrase that sticks in your brain "from this year's podcast?" It's the 'brushing your brain,' when we kind of hit with that with Cara about such an interesting idea, a lot of people, myself included, probably pay more attention in my daily dental health than I do to my daily mental health. And I brush my teeth twice a day, maybe I should say brush my brain, keep it clean. "How do I keep my brain healthy?" And if we really paid a little bit more attention to our mental health in the same level of preventative care, we all might be a little bit healthier. I also thought it was fascinated that Cara's job title was not just precedent of mental health services, but it was mental health services and wellbeing, and I would say, five years ago, no one would have that 'and wellbeing' in their title. And personally I'm kind of thankful that we've actually evolved as a culture and as a country to really kind of think about wellbeing and bring that conversation forward. And I'm glad that we were able to be part of that conversation last year.

And that mental health is part of physical wellness, and that your wellbeing does include your mental health.

Yeah, amen to that. So a couple themes, I didn't re-listen to all 20 hours of the podcast, so I'll confess. I did cheat, I have a written transcript of every episode. I did actually reread all the 20 transcripts, but I can read faster than I can listen. So a couple of themes that popped up, and so I'm just gonna throw them out there and kind of get your response to them, the first thing that jumped out at me was supply and demand. We had a lot of conversations about staffing shortages, increased COVID, we talked about the COVID bubble, the bulge, I guess, coming through, the snake and the frog, and kind of, it's a frog, the snake thought something really big ass, maybe the antelope or the deer, and it goes through it all that. Todd, what was your perspective takeaway from supply and demand last year?

So whenever people talk about supply and demand in healthcare, it gives me a weird feeling because it's, we're treating healthcare like a gallon of milk on the shelf, and it's like, "Oh well, a lot of people wanna buy milk, "so therefore the price of milk's gonna go up, "and the supply from farmers to get it," healthcare is not a commodity, even though we treat it like a commodity here in the US. That's always what I think about when we talk about the economics of healthcare, about how the cost structures and the amount of money that people have to spend to just stay ahead of their illnesses. It drives me crazy a little bit, but it's kind of why I always wanted to stay in the healthcare market is to look at how it works, how it flows, and where are there opportunities to make things better. But the thing that really sunk me a little bit this year was talking about the physician shortage, and that is a true supply-demand problem, right? And forget the costs, not that you can, but forget about the cost part of it, but just the sheer numbers of people that need healthcare and the number of physicians or ancillary health services folks that are out there, those numbers are not great numbers. And so I did like, quite a bit, the conversations we had around what can be done to help with the top of funnel of getting physicians and HCPs back into the market and whether that's making the education portion of becoming a physician or a therapists a little bit easier, a little more affordable to what can government do to help with people moving from state to state and accreditation and things like that. So reducing some of those complexities and making it easier for people to become home health aids 'cause that is, to me, when I look at the coming tide of boomers retiring and that sort of thing, the need for home health aids is just skyrocketing, there's a billion articles and publications that can back that up. So I think that's really when I think supply and demand, other than my first comment there about the commodity, I think that I always go back to just the sheer numbers, and I've had no less than 30 conversations with different organizations this year that centered around that concern about where we're gonna get the physicians to fill these gaps that we're seeing.

I couldn't agree with you more. Another theme that popped out was, Brittany, I expect one that you'll probably be very interested in was remote patient management. We had Hinge Health, Omada, OncoHealth, B-Secur, among other people talk to us about remote patient management. What are kind of your thoughts on patient management both in 2022 and looking into 2023?

So probably a more optimistic outlook than our staffing focus.

Good.

What I have found this year in talking to our clients and also running reports for them and looking at the data, COVID forced us to adopt telehealth in ways that we hadn't before. And I think that we had to adopt new ways to use telehealth and then other, as we were adopting it, each of the specialties were finding innovative ways to be able to reach their patients. I think we did a report at one point that we're finding more LGBTQ youth are accessing care because of telehealth or other folks are able to manage some of their chronic conditions because of biometric monitoring and telehealth management. So seeing the positive impact on different populations and different communities because of telehealth, I was really excited to see that, and I'm hopeful that we see more innovation in this space.

Yeah, opening up like that, certainly, seeing the doors open for people who may not otherwise have been able to access healthcare before, that is definitely a great story. And it's the feel good sort of details behind some of the scarier things we heard this year for sure. The most hardening thing I sort of see what that is, you see the huge surge in March, April, May of 2020, and there's obviously some coming down a little bit of that in terms of the usage, but it is still huge in terms of its staying power. And I think everyone, just like with my comment with urgent care, I think people started using it and said, "Oh, hey, this works for me." I'm in my own private, especially for youth that want to have that privacy, you're not in a doctor's office feeling exposed, you're at home, you're in your own room probably having those conversations, that certainly a heartening story, and I hope we continue to see that and continue to see the support for it.

So Brittany, I'm glad you brought up the fact that you spend all day every day talking to our customers. So that gives you a unique vantage point, you talk to dozens if not hundreds of people a month, right? So as you're talking to these folks, what are some of the things that they're concerned at or looking forward to in 2023 about the healthcare?

That's a really great question. Most of my conversations with clients are either around staffing shortages for sure, but also patient retention. I have done a lot of projects for clients who are interested in the leakage and keepage of patients, how are they able to attract and keep patients within their network? What services do they need to offer or why are patients leaving their network? So I definitely see a more patient-focused or patient-centric effort coming our way, a lot of patient engagement, a lot of investment in being able to retain these patients within a network. Yeah, I think that that's going to be the big focus in 2023 is now that patients are coming back into the healthcare system, how do we keep those patients? And that's going to certainly spark some innovation, hopefully.

I think that's a really good point, 'cause I read recently some research we pulled out of our database that said the average hospital operating margin is -2%, which if I go back to my business school, a negative operating margin is also known as a loss. So these hospitals are losing money, and so, they need to increase their revenue, and a number one target for doing that is exactly what you just said, which is addressing leakage and really trying to eliminate some of that.

I did a project for a client who is interested in seeing which facilities in their state were offering colonoscopies on the weekends, so routine colonoscopies on the weekends as opposed to emergency. So they found that those systems that were offering routine care, routine screenings on the weekends were able to keep their patients, because a lot of folks don't wanna take time off, and especially for procedures that require anesthesia or going under in any capacity, you now have to have find a second person to take time off to drive you home. So by having them on the weekends, they're able to see more patients and keep more patients. I thought that was a really interesting approach.

That's fascinating, actually, that's kind of bringing consumer marketing, if you will, to healthcare, meet the patient where they are and what they want. That's a really interesting study, I didn't heard about that.

Yeah, that was a cool project. It was the first time that I used the day of the week to sort of segment our claims.

Aggregation talk.

Was it in one state?

I did it for a particular client just to keep them anonymous, I won't name the state, but we could certainly run that nationally and see what that looks like.

I'm curious, all right, we'll definitely follow up with that one offline. Todd, what are you seeing as key themes for 2023 we should look out for?

The current thing that we're sort of looking at is the huge surge in the tripledemic of COVID, RSV, and influenza. What I looked in early October, or at the data from early October, the percentage of patients coming in or the volumes of patients that are coming in were three times the typical amount you would see in an October. So that is something that absolutely keeping your eye on. The other is something you just mentioned is operating income and loss, which is, I've read article after article after article that is basically covering how all these hospitals are coming through, with the end of the year, which typically is September 30th, with negative operating margins. And so that is something, if you look at the bigger hospitals who, in the past, have had 2 billion plus in the positive for operating margins, they can kind of handle a year or two being out of sorts, but all of those hospitals that are in rural areas or who have a string of four to five years with negative operating margins, that is something you gotta watch to see, are they gonna get acquired, are they gonna be just shut down, what's gonna happen? And so, that has spillover effects into patient outcomes, into services offered, and what other types of services might pop up. So those are all things that we're keeping an eye on for 2023.

I'm actually really curious about where precision medicine's gonna go this year and biotechnology and all these new drugs, I think we saw a lot of research and a lot of drugs going into the pipeline. I think 2023 is gonna be that you see a lot of drugs come out of the pipeline and start to get to the market. And I'll be curious to see what advances we have with some of these new drugs hitting the market, precision medicine, genetic testing, genetic personalized medicine, I think 2023, maybe I'm a bit early, might be a year off, we'll see, we'll talk about this in a year and wrap up 12 months from now. But I really do think personalized medicine is coming, and it's either gonna be 2023 or 2024, but I'm gonna watch out for that this coming year.

And if it happens, we'll see it in the data for sure.

I love that, I love that. All right, so our closing question here, as frequent listeners of this podcast know by now, I like to wrap up this podcast with my famous big question, so I get to ask each of you at my big question. As you think about 2023 and perhaps even beyond, what's the big change you'd like to see in the US healthcare ecosystem? Brittany, you go first.

So considering your comment about precision medicine and personalized medicine, I really want to make sure or I'd love to see everyone be able to access that. I think that precision medicine and personalized medicine is incredible and innovative and also probably expensive. And I want to make sure that it's not just the healthiest and wealthiest who can access that, but that everyone would have access to that type of healthcare.

Got it, Todd, what about you?

I'm gonna go a little outside the box here and say, if you graduate from medical school with a B or higher, you're dead as wipe clean, I know, obviously, it's not happening, but I always go back, and again, the dire warnings about the staffing shortages we're gonna see from a physician standpoint, if we can get more people in, there's a ton of smart people that would make fantastic physicians that just can't afford to go to school and get it done. And so if we could even, hey, let's say that was certainly a pie in the sky type of a statement there, but having a little bit more of a support system for people to get into med school and to stay in med school, that is something that I really wish we could change about our healthcare system today is to get people in the funnel, and it is a good job, it is a worthwhile cause to work as a physician and to help with healthcare outcomes for people. And so, the more folks we can get in and, and I wish that, there's a weird trend of of some people that we had in during COVID, people clapping at 10 o'clock every night in New York City for the first responders and the people working in the hospital, and there was a little bit of a turn against that, if I could just like shut that off and have it, everyone go back to hey, this is a worthwhile and a very great profession to be in. Just get that feeling back again in the United States, if I had my magical wish, those would be my magical wishes.

Do I hear a presidential platform in there? Bellemare 2028?

Hey, don't threaten me with a good time.

So the change that I want to kind of splits the difference between the two of you is I'd really like to do something to address access and equity in healthcare. Access and equity really was a theme we talked about through all of last year, and frankly, so we're gonna continue to talk about this year. We've got a situation where the people who need the healthcare, particularly in rural communities, underserved communities, are under consuming the healthcare they need. And then we've got another situation where some people are over consuming healthcare that they need, go into a specialist when a primary care doctor would do, going to a PCP what a nurse practitioner could do. And if we could figure out a way to rebalance the healthcare system to get people to consume what they need and get people to practice the top of their license and increase access for people who don't have access today, I think it'd probably impact not only everybody's physical health, their mental health, but even be as so bold as to say the US GDP, 'cause we'll probably be a little bit more productive, and probably not as ambitious, Todd, as waving medical debt for everybody graduating with it be, but I don't think anybody solved the problem that I just said I could magically leave my magic wand and fix, so.

Hey, if we're giving out magic wands, I mean, I might as well use 'em.

Absolutely, so Brittany, Todd, thanks for joining me today. This has been a great wrap up of last year, and I'm looking forward to continuing the conversation with you guys in 2023 and all of our guests. And for all our listeners out there, thank you for listening to "Definitively Speaking," a Definitive Healthcare podcast. I hope you enjoyed the podcast throughout 2022, and you'll join us again throughout 2023. Our first guest of this year will be David Ting, CTO of Tausight. David founded Tausight in 2018 with the vision of reducing healthcare-specific cybersecurity incidents by simplifying the way that hospitals and healthcare systems tack and manage PHI risk in today's decentralized healthcare ecosystem. So we'll have a great discussion about data privacy and safety and healthcare and what you can do to protect yourself and what you should expect from doctor, your privacy, and your private data. If you like what you've heard today, please remember to rate, review, and subscribe to the show on Apple Podcast, Google Podcast, Spotify, or if you get your podcast. If you have a favorite guest from 2022 or something you'd like us to bring back for a second episode, or even a suggestion of a new guest, I'd invite you to leave your feedback in the comments section of the podcast or send us an email to "Definitively Speaking" at definitivehc.com. To learn more about how healthcare commercial intelligence can support your business, please follow us on Twitter at DefinitiveHC or visit us at definitivehc.com. Until next time, take care. Please stay healthy, and happy New Year.