The Edge of Healthcare: The 5% Problem: Why Your Healthcare Communication Strategy is Failing

Martin Cody: Welcome to The Edge of Healthcare, where the pulse of innovation meets the heartbeat of leadership. I’m Martin Cody, your guide through riveting conversations with the trailblazers of healthcare. Tune in to gain exclusive access to strategies, experiences, and groundbreaking solutions from influential payer and health system leaders. This isn’t just a podcast, it’s your VIP ticket to the minds shaping the future of healthcare right now. Buckle up, subscribe, and get ready to ride to The Edge of Healthcare, where lessons from leaders are ready for you to use today.

Martin Cody: Hello again everyone, and welcome to The Edge of Healthcare: Lessons from Leaders to Use Today. Not a year from now; today. I am ecstatic to have someone from the disruptive side, the technological side, who has seen the inner workings of many prestigious systems. And systems and he’s going to break some of it down, share a little bit about what makes a system successful, how to get things accomplished in this very slow-moving industry we know is healthcare. Ladies and gentlemen, please welcome Mike Kramer to the podcast. Mike, welcome.

Mike Kramer: Thank you, Martin. Glad to be here.

Martin Cody: I often start guests with a leading question about how did you get into healthcare. And I want to do the same with you, but I would like you to orient people on kind of what you’re doing today and then backtrack and say, My interest in healthcare essentially got started here.

Mike Kramer: Well, Martin, I’ve been involved in health IT going back to about 1995. I had my first publication on how the internet was going to change healthcare was published back then. And so I’ve been involved in large health systems, not-for-profits, for about the last 25 years, and as a role of a CMIO since about 2005. But I’ve always been interested in healthcare. My grandfather was a was a rural physician in Ada, Ohio. He was one of three doctors in that town, and unfortunately he graduated from Ohio State. I’m a Michigan fan. And ironically.

Martin Cody: Let the record reflect we’re fresh on the heels of an Ohio State national championship, which.

Mike Kramer: We did beat them. So. But yeah, it was funny. I was looking at some of his old records, and he paid $150 tuition per semester back in the 40s. So I was always a part of that sort of culture of being in a physician family. And my dad, ultimately, as I was growing up, he worked for the Cleveland Clinic. He was, he ran the pulmonary function testing lab there at the Cleveland Clinic. It was down in the basement next to the morgue. And he had the bright idea of, instead of using that lung function test with the pen, that would go up and down when you blew into it, he had the bright idea of hooking it to an Apple two plus and creating flow loops. And so that technology, along with the sitting in the basement of Cleveland Clinic, and I started programming back then at about fourth or fifth grade.

Martin Cody: Come on. So you were just sitting in the program or the Cleveland Clinic next to the morgue, which, you know, who doesn’t want to do that as a fifth grader? And starting to write code.

Mike Kramer: Yeah. Yeah. That was that’s my story. And, you know, he changed jobs. The computer went away. They were expensive. And I ended up going off to medical school. And I asked my wife, I said, Do you mind if I buy a computer with our honeymoon money? And she said, Okay, go ahead. And I started typing my notes there on the floors of Rainbow Babies and Children’s Hospital. And I had to be very, very careful because if I unplugged the lab printer at the time that the labs were being printed, they wouldn’t get their labs that day. So I had to figure out exactly when the batch jobs would run, plug the printer back in, and then I could print my note for the patients that I had seen that day. So that’s my history.

Martin Cody: Now, it’s a fascinating history and I have to, having walked the halls of many hospitals around the country and certainly the emergency departments of a lot of them, I’d be curious, when you were typing your notes, were other physicians looking at you like, What are you doing?

Mike Kramer: Well, that’s really.

Martin Cody: Or were they envious?

Mike Kramer: Yeah. You know, I don’t think they really understood, you know. And of course, that was the day when it was chicken scratch and you couldn’t quite read it. And now we’re in the day of cloning and copying and pasting and having voluminous maybe not relevant information. So, but at the time, I said, you know, that was the note everybody read. You know, it was like, Well, what’s going on with this kid whose parents are not around? We can’t get access to their primary care physician. That was the note everybody read, and it was that sort of spark to say, Hey, we have to change healthcare. This is not the way we should be practicing. We’re not doing right by our patients. And I set up, set apart, I actually met a guy named Bill Greer who founded an organization called the American Medical Directors of Information Systems. And he said, Why don’t you come to the University of Michigan and do your residency? And that set me down that path.

Martin Cody: Fascinating. Until you, Mike, I don’t know if you were aware of this, but until you the way that physicians documented notes hadn’t changed little in 5000 years, from stone tablet to pen and paper to Mike Kramer in the basement. Impressive evolution.

Mike Kramer: Yeah.

Martin Cody: And all the physicians have you to thank for the electronic medical record adoption, so.

Mike Kramer: I’m not taking credit for that. But, you know, I think there were a lot of like-minded people who felt similarly that we were not practicing medicine in the right way.

Martin Cody: Correct. And there had to be a better, more efficient way to do this. Now, you mentioned the role of CMIO: Chief Medical Information Officer. What is that person responsible for?

Mike Kramer: That varies. And I think there’s kind of three levels of physicians. And early on in the life of the of the CMIO was: can we get the physicians to do CPOE or computerized physician order entry? And it was really more about can we hire somebody that’s a colleague and an influencer? And it’s evolved quite a bit to being a strategic leader of the organization. And so the CMIO, I think we’re on the third generation now is really to be a part of the leadership team, a partner with the CIO, and it’s to really understand the clinical needs, the regulations that, the clinicians themselves, how they work, workflow. And then, of course, with all the change that is coming at us, whether it’s regulatory, payer, the payer models, and of course, the pressures that are on us to improve the well-being of clinicians, we really are a strong advocate for change management, partnership, and engaging with our clinicians across the organization. That sounds like a lot.

Martin Cody: That’s extremely helpful. And I like the fact that you pointed out that the role has evolved over the years. And if I can kind of pull it all together, from my vantage point, based upon what you just said, it sounds as if this role is a liaison, if you will, between IT, the CIO and the various aspects of information technology; between the clinicians, between compliance, you know, some of the regulatory things at a health system and trying to tie all this together so that all of the stakeholders have their needs met in a way that is benefiting the patient and benefiting the health system. Fair assessment?

Mike Kramer: I’d say that’s table stakes for most CMIOs. And as the CMIO has more management experience, they tend to take responsibility for pretty significant programs: clinical documentation improvement, quality, promoting interoperability, onboarding, and professional development. So I think you’re seeing CMIOs taking on more and more administrative functions and taking more and more staff and departmental operational responsibilities.

Martin Cody: So my head is immediately going to into the conflicts that are involved in that role, because you have a lot of folks that are kind of dug in from that standpoint. Technology CIOs, they have their preferred systems, their preferred vendors, their preferred methodologies, and that sort of stuff. So you’ve got that role. Positions are somewhat oftentimes of a similar mindset from a clinical standpoint. They’re evolving, I think, much to their credit, because value-based care is extremely important. And moving away from fee-for-service is going to both enhance the patient and, I believe, reduce their burnout. But how do you manage those conflicts and what types of classes, what types of programs, what type of books for you to kind of get up to speed on this very, very quickly from a management leadership level?

Mike Kramer: Yeah, that’s really challenging. I think, you know, physicians are perceived as being very much physicians. We’re clinically oriented. We tend to be sole practitioners. We make decisions by ourselves in front of the patient while we round. And so for me, developing my management skill set and my organizational intelligence and emotional intelligence has been really important. I will tell you that I’ve done a lot of IT work at at University of Michigan when I was there and the department chair there asked me if I wanted to stay on as an informatician, and he offered to pay for my MBA. And I said, Sounds great. And it was probably one of the most significant changes in my perception of the business of healthcare. But it was also because it was very practical. It was, you know, developing business plans, developing strategy in the context of that. And I think that’s the challenge we have is that many of the CMIOs have developed those skill sets, but they aren’t recognized for it.

Martin Cody: Interesting. And so the MBA program taught you a lot about the business side of healthcare. And then is there any mentors, any programs, you know, leadership philosophy and principles where you can say, Okay, I’ve got some knowledge in here, I need to go get some experience, but here’s what I’m going to do, and here’s some of the tools I’m going to take with me to impart some change management, which isn’t often, you know, bantered about phrase that has a lot of significant meaning? But I want to talk about your experience with change management and what you brought to the table based upon the MBA and other areas that you’ve learned.

Mike Kramer: You know, I had the great opportunity to work with some very wonderful mentors, and he was a physician, worked with GE and CMO of Trinity. He was very much a process improvement-oriented, very much wired around Lean and Six Sigma. You know, sometimes that’s not taught in the business school. And certainly the experience of doing it was not there. I think the quantitative side of things, in terms of the analytics and the quality reporting, being able to get data out of these systems, …, another person at Trinity. Mike Skievaski, for example, was very much driven on balanced scorecards and business goals and imperatives. And I’m sure he still behaves very much in that way. But all of those things were very practical experience, and having those types of mentor were very important adjuncts, I would say. I’d say for folks that are getting started in this career, I think any kind of additional training on top of the clinical background. You know, if you know the clinical workflows, how you learn the business. So whether it’s an operational role or business training or both. And then lastly, I think so much of this is changing so fast every day, whether it’s the regulation, whether it’s Epic rolling out a new upgrade that changes the, you know, the platform.

Martin Cody: Breaks 5000 of the previous workflows, something like that.

Mike Kramer: It does. And I think, you know, so the experience of process improvement, quality improvement, change management on top of understanding what’s in our heads up display. Because I think we, in this space, have to be constantly looking ahead, networking, learning from others outside of our organization. I can’t tell you how many times I’ve come to an organization, and many of the leaders have never been anywhere else, and it takes a lot of effort to stay within the same organization and still understand the dynamics of healthcare outside of your organization. You know, I think that’s, there isn’t really a forcing function. You have to take it upon yourself to build those external networks, both to learn and to develop oneself.

Martin Cody: Yeah, it’s a great observation. And I would consider, if I was joining an organization and all of the senior management or senior leadership that had been there for 15 or 20 years, how they would approach fresh perspectives or new ideas, and like you mentioned, things outside of healthcare, which then leads me to wonder, and you have probably experienced this, how do you get buy-in on some of the newer concepts or newer initiatives that you want to take? Because you talked about, and I appreciate kind of the book sense, the scholastic information, the mentors and things like that. There also has to be some soft skill development, you know, from an empathy standpoint, from a leadership standpoint. So I’m curious how you develop that and then how do you leverage that to get buy-in either on the physician ranks, the IT ranks, you know, compliance and regulatory to kind of move the health system where it needs to move?

Mike Kramer: So I had to make a decision at one point in my career: Do I continue to study medicine and get my board certifications and keep all of that up to date, or do I develop the soft skills and the administrative functions that I need to? And I had to make a decision because it’s just too much content, too much bandwidth. I don’t have enough bandwidth. So I chose intentionally to pursue any and every opportunity I could to develop leadership skills, emotional intelligence, and just absorbed anything that I could that was offered within the context of the work that I was doing. I think that lends itself then to developing myself as an influential leader, because now you’re sitting in the boardroom, you’re sitting in the medical staff meetings, and you have learned a structured methodology, you have a systematic approach to things because you’ve availed yourself. And as a clinician who understands the workflows and as somebody that’s developed with process improvement and other methodologies, change management, you cannot, you can go from here’s how we practice to here’s how we execute, and articulate that full plan. I think as you think about clinicians, you know, the traditional booksmart stuff, which is, you know, change management. Let’s take that for example. You’ve got eight steps of change. You’ve got shine and different change management methodologies. You can read about them, you can take classes on it. Clinicians don’t necessarily fit into those toolkits, and particularly physicians. And then I spent some time with some startups over of late, the understanding of independent medical staff versus a single medical staff. And how do you influence physicians that aren’t even employed by you, but practice within your facility and are subjected to all the goals and outcomes and quality improvements that you’re trying to bring forward? They don’t have the skin in the game. The employee does. So augmenting those basic change management was a model that I developed, which was kind of reinforced by some of the work that the KLASS organization did through the Arch Collaborative. They found that there were three things that drove EHR satisfaction. So, you know, everybody hates the electronic health records. You know, it’s the thing that gets in the way of everything. It’s always there. I have to be in it. I wouldn’t blame it on. I wouldn’t blame my experience on the EHR. It’s just part of the fabric. But three things. They say that if I get really well trained and understand what it is I’m being asked to do in this change. If I get support as I’m doing it, as I get help in an ongoing fashion that it’s not one and done, and then you disappear. And then it’s trust and building and having trust that maybe if it’s not what I expected, it will get better that I, that when I speak up I’ll be listened to. And so those three things become part of my change management model, right? So if I can say, Hey, here’s the change that’s coming, here’s the why, here’s the tools and the means by which you’re going to be able to do this. We’re going to be around, we’re not going away, to help you if you struggle. And by the way, we’re going to listen to you afterwards. That’s really important for any change within a health system. There’s one more layer to that. And I call this bidirectional change management. So I’m not just pushing things out, but I’m also pulling back. Did you adopt it? Are you using it effectively? Where in the organization do I need to focus my energies to help people who maybe need help? And that’s the last. So you talk about change management. The clinicians really need that trust and that communication. And then we need to identify where they need help because they often don’t tell us.

Martin Cody: You know, it’s funny. And I agree with all of that. And I really appreciate you mentioning the emotional intelligence aspect, because I often think that the scholastic achievement or academic achievement is viewed far more seriously than emotional intelligence. And you know, the Bible on Emotional Intelligence was written by Dan Goleman in the, I think, the early 2000. You’ve probably read it. Fantastic book. You know, not accidentally entitled Emotional Intelligence. So if you haven’t read that book, certainly it’s worthy of an Amazon pickup. And for the record, Amazon’s not a paid sponsor. As it relates to, and I wrote your three things down. I think trust is very important. And I really appreciate the fact that you said, you know, we’re going to be here when there’s problems. Because I have to tell you, doctor, there’s going to be problems. This is software. This is change management. I’m not going to sugarcoat it; this is going to be difficult. And the moment that that difficulty arises and they see you there in the trenches with them, metaphorically speaking, and helping them, that’s where the trust gets established. And the more often that you can repeat those interactions, the stronger that trust becomes. But boy, it’s not an easy process, is it?

Mike Kramer: It’s not. You know, what I just described isn’t something, you know, that you just do. It’s a machine. And, you know, an organization that builds itself knowing that every week there’s going to be a change. Theta Care when I toured them one time, they said, No, we just plan on change every week. You know, when we’re standing at the visual manager board, there’s a little section on the board for what’s new in Epic, and they talk about it with every shift change. Okay, they’re wired for change and they don’t, they built the machine there, knowing that every week there’s going to be something new.

Martin Cody: And it’s interesting you say that because I have been exposed to organizations where they will tell you that going in: If you don’t like change, this is probably not a good fit for you because of the amount of change that we experience, embrace, adopt, you know, introduce. So status quo is very seldom a good thing in leading healthcare organizations. And I abide by that principle. And luckily at Madaket, you will never hear anybody say, Well, this is the way we’ve always done it. Because if that’s the way we’ve always done it, then we aren’t improving, we aren’t pushing the envelope, we aren’t iterating, and we’re not doing our customers a service. So that’s fantastic that you talked about the bidirectional aspect and the trust. If you could identify either from a provider’s lens or an IT lens, you know, the top three things in change management that they don’t understand or is difficult for them to grasp that if they knew this going in, boy, it would accelerate the process.

Mike Kramer: So I talk about building the machine of change management within the organization. One of them is building the communication plan. And it was funny. I arrived at one organization and they said, Hey, you know, I need my friends in marketing communications. We’re going to work together a lot. And I said, Oh, well, we’re fine. You know, you just let us know. We’ll send it out by email, and all the doctors will get the get the message. Okay, read rate of doctors and emails is probably 5%.

Martin Cody: Yeah, especially if they’re on Epic. That’s one of 5000 communications they’ve received that day.

Mike Kramer: And I said, Okay, so tell me this. How do you have your email list, and how many different kinds of physicians are there? And they said, Well, we just have one list. It comes out of the credentialing system. I said, Okay. Did you include residents and medical students in that? Did you use, did you include the independent physicians? I said, Let me tell you this, there’s probably about 15 different types of physicians, and they all receive information differently. So it’s a machine. So okay, if there are 15 different types of physicians, an independent physician who is on, who’s not an Epic, who has their own practice, an independent physician who’s on Epic, but the community connect model, and employed physician. That’s just three right there.

Martin Cody: Sure.

Mike Kramer: Okay. So I’m going to communicate differently because there are different things that are important in different motivations, different whys that are going to help them. And again, so that’s one is just, you know, let’s not assume that we’ve got a homogeneous clinical staff and that they all receive information the same way. And I think that’s Captain Obvious. But what I would say is not obvious is you have to make a real investment and think deeply about it in order to be effective. I think, you know, the second thing about change management is that, you know, and again, this is another Captain Obvious. But, you know, you really, you cannot assume that change has occurred until you’ve measured it. And I think it’s really, really important. I think the beauty of the electronic medical record for me has been with the audit logs and a lot of the analytics, I really can get deeply down into what’s the function being used and it achieves the outcome. We implemented 18 AI models at OhioHealth over the course of 18 months, and we had a board goal that we would have positive outcomes for each of those models. Okay. So that’s not normal change management. That means I’m not only going to install it, but I’m going to measure whether or not it’s used and whether or not it’s driving outcomes. So I think that’s probably the second is that you’ve got to have some leading metrics while you’ve still got the project going and you still have the project resources so that you can then drive some of we’re ultimately going to be lagging outcomes. I think that the third is, you know, I think you’ve got to be strategic about what change you’re leading. I mean, there’s so many bright, shiny objects and so many things that you can pursue. And there’s change fatigue. And, you know, if half the organizations pursuing a certain set of strategic goals and key performance measures and you’re driving a project that’s not aligned with that, you’re probably going to be, you know, singing to an empty, you know, what’s the right metaphor? You’re not going to amplify your message. You’re not going to have the help of the organization. And the clinicians are going to be confused about what’s important.

Martin Cody: Yeah, all brilliant points. Those three should be written in stone somewhere and handed out to each CMIO as they walk in through the door. It’s funny you talked about the homogenization of the organization that just had one provider list for emails, and you can’t assume that the orthopedic surgeon is going to be viewing the email in the same light that the general practitioner or the OB-GYN and those sorts of things. One thing you can assume on those email lists is that the recipient has the mouse cursor above the X, seeing how fast they can delete this message because it does not apply to them. So you better write directly to them and not at them, so to speak, in a shotgun fashion. So brilliant points on that. Now, I understand that you’ve just begun a new role. Talk to us a little bit about that.

Mike Kramer: Yeah. So … I start a role with Cone Health, I kind of watched Cone Health from afar and has been a high quality organization in Greensboro, North Carolina. And they are recently engaged in the Risant, which is a not-for-profit that’s funded by Kaiser. And they are now partners with Kaiser, Geisinger, and Cone. And I think what’s really exciting about that is that has a mission, they are very invested in serving their community, driving value-based care, addressing the needs of that community. And you’ve got Kaiser and Geisinger with enormous amounts of intellectual capital and resources. All three of them are on Epic. And so I think there’s an enormous opportunity here to leverage the strength of all three organizations. What will be interesting is Kaiser being an employed physician model. Geisinger, I think, has expanded and now has more than one-group practice because they’ve acquired some additional Hospitals. And then, of course, Cohen has a very mixed practice model. So change management will be very important. Building trust will be very important. You can’t just come down from above with the Risant, Kaiser or Geisinger intellectual property and say, Thou shall use it. We’re going to really want to test it and engage with our clinicians and make sure that it fits with the culture and the processes that they have there.

Martin Cody: It’s funny you talk about that coming down from the mountain, because I was thinking the question, you know, what happens when six change management experts get into a room? And how do you build that model out? And so it’ll be interesting to watch and observe. And then you’ve got, you know, Kaiser: what I think the largest providers in the industry and the different models of care. And luckily you’re right, they do have a uniform platform with the technology on that side of things. But I’m going to be fascinated to watch the outcomes because I think it is going to be both from a business use case perspective and also from a clinical perspective, how it drives improvement in care. So congratulations on that role.

Mike Kramer: No pressure, right?

Martin Cody: No. None whatsoever. I think that should take, what, 90, 120 days to get all that ironed out and?

Mike Kramer: Yeah. No, exactly. There’s great folks that have been thinking deeply about it, and I’m really glad to join that team and add to it.

Martin Cody: No, super exciting. And I think the communities that those large organizations serve are going to be the recipients and the benefit of this improvement in care delivery, care access, care documentation and all of it. So, you know, hats off to those folks for making the decision. And congrats on the job. I’m going to switch gears now and we’re going to go into our speed round of questions. I’m fascinated by the answers that we have in this round. And it’s great. And I’ll do the same with you because you have got such varying experience and exposure to all different aspects within the industry. But if you, this is the speed round is predicated upon, I’m going to say a word or a phrase or a sentence, and you tell me the me the first thing that pops in your mind. And I will not say Ohio State. So that’s, I’m not going to give you a freebie like that, okay? But the first thing, I don’t have an edit button or a cough button. So there could be no profanity type of stuff. But one of the things I’m interested in is we talked about compliance, and we touched upon it that you have to entertain every day. So if you were running CMS for a day, what would be some of the things you would do from a compliance regulatory aspect that you would like to see improved?

Mike Kramer: Well, we’re going to have an interesting few years going forward on this one. I think that with meaningful use and promoting operability, I mean, there was a huge burden on the organization to move forward with that. But by and large, we’ve gotten to what the vision of that was. I will tell you that a burden reduction is probably one of the most important things that we can do in the industry. So how do you maintain the integrity of the health care system billing while you’re reducing the burden? And I would say that scrutinizing what’s the purpose of the documentation? How are we documenting? What’s the purpose of prior authorization? How are we managing evidence-based care? And I probably like to see us move more to systems of care and looking at compliance from a system of care then at the individual provider. So are you maintaining your order sets? Are they evidence based? By what means are you documenting those? Are you reducing alert fatigue? Are the alerts that you’re using effective? I think this gets to a little bit of what is a requirement within providing operability, which is the safer guides. As you know, you’re required, now as part of promoting interoperability, to sign off on the health and maintenance and well-being of your electronic health record. Unfortunately, the safer guides are being revised, which is good because they’re based on some older experience, probably circa 2005. So I’ll see that. I think the second thing is that around systems is interoperability. I think Tefca and where we’re going with creating a national health network and trusted networks is really important. What I found is that even with a leading organization like where I was recently at Inova, we had not avail ourselves of many of the tools of interoperability. So again, coming back to systems, it surprised me to know that our KLAS survey said that interoperability was the number one pain point at Inova. And then I realized 70% of the physicians had their own practices in their own EMRs. Okay, that makes sense. It might have been different at another organization, but we hadn’t really gone practice to practice and say, Are you aware of how you can connect to us? Have you plugged in? How can we help you? And again, I think more around how do we build systems and structures to make some of the vision of what we want electronic health records to be come true and let’s not put that burden on the clinicians.

Martin Cody: Got it. Agreed. And it’s interesting because, you know, burden reduction is something that is talked about and is it clinical burden, is it technological burden? I mean, all of it, it’s such a huge drain, administrative burden. But you also mentioned a word in there. That was one of my second one from a speed run. Tell me what your thoughts are on prior authorization.

Mike Kramer: Having worked for a payer, priority health in part, I was part of a provider system. Managing costs of care is incredibly difficult, right? And the amount of variation that’s out there is incredibly difficult. And how do you create the guardrails and the stop signs in a way that are friendly and appropriate and evidence based that a, this is not burdensome. It’s not a barrier, but yet we’re moving the needle to higher and higher quality. And if you’re waiting for individuals to be knowledgeable about evidence-based practice and stay current, we can’t. So prior authorization shouldn’t be a barrier. It somehow has to be built in as a support and an adjunct to evidence-based practice. And I may be naive, and I think that’s a huge high bar, but I think it’s, again, coming back to systems of care. If you could say, Hey, we’re an organization that has developed clinical pathways in these five, ten, 15 things and we are adherent to them, don’t ask me to do prior authorizations, and I don’t know how you build that auditing methodology. And I think one of the things that’s interesting about the rising collaborative is … a lot of that work. There are people and organizations that have done some of that work, and it is possible to embed that in the workflows and the EMRs. But it’s a big investment, and I don’t know that healthcare is prepared to make that investment.

Martin Cody: Good point. I could have a whole episode just on that topic alone, but I’ll move around to the next speed item, get your thoughts on directory accuracy.

Mike Kramer: Yeah. So working for University of Michigan, I was responsible for the fax machine routing of discharge summaries.

Martin Cody: So you’re to blame?

Mike Kramer: Yes.

Martin Cody: For the fax machine still being around.

Mike Kramer: 1999 to 2005, we built an automated discharge communication system. Our marketing department kept track of 16,000 physicians in the state of Michigan. Every day, every week, they were fixing and updating and correcting. I think, you know, we’ve advanced beyond that now. We now have, you know, some payer systems. And I listened to the podcast I think you had last week with Ron from, was it DeFacto Health? Yeah. University of Michigan, Henry Ford, Spectrum, all the health systems in the state of Michigan, all were managing those directories independently; what a waste and drain on the health care system just to. And what, and if it didn’t work, discharge summaries were being missed and people were, you know, transition to care failed. There’s so many ways in which failure to communicate affect the quality of health care. So yeah, I would take seriously, CMS put in a requirement that you, as a part of the national MPPI, the national provider, MPPI system acronyms that you include your secure direct email address, and that you also have your means of communication as a part of your NPI number stored in that directory. I think compliance, again, I think that ought to be a requirement that that’s revisited and reviewed part of maintaining your certifications.

Martin Cody: Agreed. It’s so funny because the computing power available to us today is beyond comprehension compared to what it was ten years ago, 20 years ago, when you were doing your notes in the morgue or adjacent to. And provider directory accuracy is solvable. I mean, it’s just a matter of leadership and leaning in and it can be done. Last question if you could pick one person in healthcare, living or deceased, to sit down and have an adult beverage with or any beverage, who is that person and what are you drinking?

Mike Kramer: You know, I thought about it. I’d like to sit down with some, you know, disruptors, you know, people that really have the opportunity to change healthcare. I thought about Greg Adams from Kaiser with my new role. … UpBridge. You know, he’s a disruptor. He’s done some great things. But I really think given the election and the uncertainty that’s going on, I came down to, you know, I’d like to sit down with Donald Trump and understand and pick his brain. And I won’t tell you what my politics are, but I think it’s a great opportunity to understand and learn from, you know, what he might be thinking. And I thought about the other is, the wine I would probably have, I think is a Hudson Winery Chat or I make a really good Smoky Manhattan. So one of the two.

Martin Cody: You might need both.

Mike Kramer: I might need both. I’m going to need both. I don’t know what President Trump prefers, but if you give me the opportunity, I certainly would love to understand his thoughts and maybe contribute to it.

Martin Cody: I like it. Mike, absolute brilliant wisdom and insight. And thank you for sharing. We’re delighted to have you on the program. And we’re wishing you and for the patients and the health system’s extreme success in the new role with Cone Health. And thank you for the time today.

Mike Kramer: Really appreciate it. I hope you find some material in this that your listeners will like. And please reach out.

Martin Cody: Absolutely.

Mike Kramer: And I’m happy to share with anybody that’s interested.

Martin Cody: Fantastic. And thank you, everyone for listening to The Edge of Healthcare.

Martin Cody: Thanks for diving into The Edge of Healthcare with us today. I hope these insights will fuel your journey in healthcare leadership. For more details, show notes, and ways to stay plugged in to the conversation, head over to MadaketHealth.com. Until next time, stay ahead of the curve with The Edge of Healthcare, where lessons from leaders are always within reach. Take care of yourselves and keep pushing the boundaries of healthcare innovation.