What was life like within the first healthcare organization to have a COVID case in the United States? How did the government fail its citizens while the industry rallied? How did the calamity that was funding for hospitals and doctors impact those on the front lines of the pandemic? How were routine and hugely important doctor visits affected by the prevalence of the virus? This talk explores all of the above from a first hand perspective.
All right, so currently I work for VMware. Insert quick plug for Tanzu, therefore I can expense this. There we go.
>> We’ll have a conversation about that, but what my day job is really working with other folks that are generally in a kind of a C-suite title or V-suite title and how you deal with what is basically in the health care environment a black swan event. Right? How would you deal with something like this on the next one?
But who am I? You know, my favorite saying of the pandemic is a lot of people got a puppy, we went and bought an entire farm.
If anybody wants to talk about the challenge of trying to miniaturize devices to track activities of chickens, believe it or not, that’s what I’m doing in my free time.
Also a board member of First Robotics, which is one of the coolest things I get to do. Those are all pictures from the world championships that we were lucky enough to be able to have. Bottom right, kids standing up in the stands cheering, is actually the first-ever team from Libya and they had to do it under the table given politics and stuff, but the logistics they had to do, given export restrictions and just their ability to come over, one of the coolest things that I’ve ever been a part of.
Because this is us, this is what we refer to at our house as our Covid flight, so any time we could have people over, you know, do the outdoor thing when the weather allowed, this is what we had. By the way, Total Wine did have a bug in their system that if you went in and said redo my last order between visits three times, it crashed. And that’s fixed, by the way. That was fun to find out.
I do want to say I’m going to talk, you know, not kind of, I’m absolutely going to talk about the pandemic, right? And I don’t want to lose track of the human toll and impact in that, but also if, you know, folks have a reaction of any kind to this topic, by all means you’re not going to insult me by stepping or or things like that, but I just kind of wanted to give you a heads up.
So what was my position in all this? At the time I was the CIO of Premera Blue Cross, and so this was a very interesting, you know, from this perspective. I’ll also jump forward and say, working for a health insurance company does not win you a whole lot of popularity points.
I share what I’m going to guess is a large reaction about the US health care system in that it’s fundamentally broken. You know, and my belief, MFA is not only an acronym that I think a lot of us think about protecting our account, but it could go a long way towards protecting our health. This talk is not an application for medical cache for all.
But Premera, Blue Cross, we’re based in Seattle. And if you put on your wayback machine, we were the first publicly in the United States dealing with Covid. Now, also want to stipulate what we quickly learned is New York City was already having a big battle and we just didn’t know it at the time. But from an organization, government response, those kind of things, we ended up being the tip of that spear from that perspective.
Largely what time frame am I talking about? I’m really talking about the absolute beginning, right? From the whole kind of January — December-January when this thing started, you know, you started hearing stories about it, really through the March time frame and April time frame. After that it becomes much more of a US, a national story and everything related to that.
Big thanks to the Seattle Times. I really used a lot of their archives to put the timeline back together. In January, I think this was pretty consistent around the United States. This wasn’t something that was unique to the Seattle area at this time, it was trying to figure out what this thing was, right? We’re hearing stories out of China, we’re absolutely seeing the spread through other parts of the world, including Europe at the time.
What do we even do about this? Right? One thing that is, I think, not widely known or understood in the relationships of, you know, the US health care system, health insurers, and something I frankly didn’t know until I was working for them for a long time, are really also seen as a place where employers, especially, go for advice. Right? If you think about the primary customers in the US system of Blue Cross and Blue Shield, we’re largely sold to employers. Amazon and Microsoft are one of our big customers, for example. We’ve got doctors and nurse, actually more doctors and nurses work for us than a lot of the providers, but insert that’s probably backwards, but it is a reality. And so calling us for advice, and so we’re literally trying to figure it out on the fly, too, right? And this is the time, like that one article says, what was the best thing you could do to avoid coronavirus is wash your hands. washing your hands is a good thing but so I’m glad we’re all doing that, but this in hindsight is something that is so crazy but it is what we thought at the time.
Also from a regular business perspective, we started triggering our business continuity plans and I know we were far from alone in that. Like, what were we going to do if this came through and I’ll say our plans were pretty good, they just didn’t go far enough, which is how do you get people home, which we’ll talk about in a few minutes. The other thing is the supply chain, I will say was at this point. So from my CIO perspective, I was worried about things like how was I going to do server or network switches and things, because of the shutdown in Asia at that point, it had already started to become really hard. now, no idea what the supply chain would become, right, for everything, pretty quick after that.
But this was — I will say while we were trying to answer the questions, we didn’t know how severe this was going to be at that point, so we were trying to give advice, but frankly we were just trying to figure out how to keep our own operations going as we went through it.
And then it happened.
First case in the state of emergency — this is the Governor’s proclamation, Snohomish County. King County is the county Seattle is in. Snohomish County is the — so Snohomish County is the county north and then Pierce County. Snohomish County has the first case, and this is, you know, you went from theoretical to real at this point.
But it was still just one, right? The state of emergency starts to cause a bunch of things to happen in the background. When you get into states of emergency, things like frankly how testing was going to be paid for and all of that, already some of those plans were starting to be put in place, right? How do you make sure that not — some doctor does not think they need a preauthorization, right, to treat, and again, we can have all sorts of discussions about whether prior authorization is a thing we should have, but how do we free that up and make sure this system can go?
It was only a week later, frankly, and I will say this more than anything is when reality hit. The Kirkland Life Care Center, which is an assisted living, nursing home type situation, up in Kirkland, off to the east side, kind of in the tech corridor of Seattle, significant outbreak within there, right, and spreads like wildfire.
What I will say brought it home to us even more as a business — I mean obviously we get how serious it is, and all of that, was actually the firefighters. And why that mattered, right? So suddenly you had the firefighters that responded, not only a few of them started to get sick, but then they all had to isolate, right? That quickly led to 12 employees having to be isolated because they were spouses of partners and because this was happening in our community, what we saw in our office was suddenly people not able to come to work. Knock on wood, in the beginning we didn’t have any illnesses with that, but all the logistics, all the business continuity things you think about, start to become very real.
Again, we were kind of in the first ones in this. What do we do about this? Like, how do we A, make sure everybody stays safe, first and foremost. 2, make sure we can respond, because again our phone lines are blowing up, everybody from Joe’s Plumbing to Amazon and Microsoft saying what should we do? Right?
A good thing, and I’ll explain some of these pictures in a minute, was how, I will say, everybody really worked together. So the county called us, being the large health insurer there, and they also called Amazon and Microsoft and I’ll remember that call. We were in our kind of executive boardroom, meeting room, where we were in Premera, when and we said, would you please send everybody home because it would make it OK for everybody else? If Amazon and Microsoft, who are the big employers, yes, Boeing, you existing, too, in Seattle will send people home, it makes it OK for others, right, to start to figure this out. And so we did, I will say, the person in the hospital bed that you can’t see his face is because I promised him I wouldn’t, is my son. Ironically, I don’t actually know the word, he had such a significant sinus infection at this time, he needed surgery.
And so, you know, all your worst fears as a parent, because is it a sinus infection? Is it Covid? Because again, you didn’t have a test at that point.
His surgery was the very last day before elective care shut down. But that is where I was trying to kind of help lead, getting from a technology perspective, everybody home was in the waiting room of that. But that picture is right after he came out of surgery. So he’s quite high, to be honest.
And so I promised him I wouldn’t show that picture. That far picture is actually the lobby of one of the technology buildings, and that’s like rolls of bubble wrap, boxes, tape, you know, because it was like, we don’t know what everybody needs, but go, right? Pack what you need.
And it’s hard to believe at the time, we thought this would be like a 6-week thing? Right, we’re just going to go home for 6 weeks. You know, that didn’t happen.
I didn’t say in my intro, you know, I started my career journey in the Navy in submarines. You know, we’re getting home, we’re trying to — do the things.
So the symbol on right is the submarine, and it’s very accurate about submarines, including the grammatical error, nothing lands submarines home. My fun with Marines is where’s meg so I know where she is before she gives me the finger, and of course, bread-making. I was making bread before, but —
Something I will say we underestimated from I would say health industry, not just Premera in the Northwest, but — and where this really started to become a black swan event, was elective care shut down, and we didn’t know, right when we say elective care, that’s not like oh, I just want to go get Botox or something, the things that are elective care are things that are not immediately life-impacting, meaning if you are not having a heart attack, you can wait. My son’s surgery, despite how strong a need it was, would not have been able to happen under this. So not only do you have some health impacts and I’ll talk about that in a minute, but you have a financial impact to that industry. Elective care makes 50 to 60% of the revenue of providers and when I mean provider, I think about anybody that does care, right, a lab, a hospital, but also doctor’s offices. Think about general practitioners that maybe aren’t part of a large, you know, hospital system, or things like that, they’re really just a small business. They provide an incredibly important function in keeping us all going, right, and taking care of us, but suddenly they have no revenue.
And there wasn’t any facility to fund them, right? So I have the Premera press release, I promise you there were a bunch of other payers and everybody else, we started fronting money as fast as we could, right?
This is why you have reserves as an insurance company. This was please take this money so you stay in business, right? How do we keep this system running, right, because we also at the time, you know, by now, we’ve started to realize our whole estimates about being home for 6 weeks, that wasn’t really a thing, but then you start to ask the question, well how long do I keep elective care shut down? Even large hospital systems were starting to nervous.
An indication of that, and I was going to do it and last night I was doing something else — I was going to put the chart up here if you started to look at the bond market related to provider systems, you can start to see their ratings go down, because people were starting to wonder, were they going to be able to repay their debts? Luckily it didn’t get that close to the brink, but it was enough that I can tell you there were some pretty interesting conversations going on.
What worries me going forward, personally — I mean I think structurally we’ve learned a lot in the health care system, even in the financing and, you know, what providers should do, right, what their reserves, what their continuity plans should be for black swan events that impact just having to shut it things down and things like that. But there are a whole lot of people missed a whole lot of tests, right? And as an entire health care industry, whether you’re an insurer, a provider, anybody else, we’ve spent years, right, getting people comfortable to go get their breast exams, colorectal exams, none of those are fun, nobody is like yay colonoscopy, yes! But they’re really fucking important, OK? And we missed a lot of them, right? The percentages, breast exams down over 90% in 2020, right? 90%. 9 out of 10 people that would have gotten them didn’t get them. That’s a huge number. We’re starting to see some of them come back but we’re very concerned about who’s missed and most importantly who’s now going to have a discovery and it’s a year later or two years later. So my homework for all of you is to go get those tests that nobody likes to talk about, they’re really fucking important and need to go get them now.
From here I would say we achieved a new normal, and more importantly, there was a new national system in place. There’s these magical things called ICD codes. That’s like — the fact that you got a sliver in your right big toe has an ICD code different than one you got in your left toe kind of thing. We had to create these for Covid and coronavirus, you know, the industry did. A lot of technology fun at that point about how do you update your systems at a rapid rate to keep up with that. But from there that was a national perspective. So that’s my view about a national pandemic, sleep well. The system is, I think, OK. I think it’s OK to talk about the risk that the health care system had from just a structural perspective, now that we know that I think we’ve largely corrected that even for the going-forward.