AI Podcast Ep. 1: AI Improving Healthcare with Tammy Siragusano

Episode Description:

Dr. Jerry Smith welcomes you to the inaugural episode of AI Live and Unbiased to explore the breadth and depth of Artificial Intelligence and to encourage you to change the world, not just observe it!

Dr. Jerry is joined today by Tammy Siragusano who is a veteran in U.S. Health Care Reform whose focus has been on the enterprise approach to some of the most complex health care problems facing the industry today. She is experienced in healthcare IT, managed care operations, is a PBM-PBM migration specialist and takes care of a lot of operational issues. Tammy has also led the digital transformation for clinical logistics for drug and utilization review.

In today’s episode, she shares her vast knowledge and experience in the field of AI and shares great ideas and suggestions for better AI implementation in the healthcare field.

Key Takeaways

Tammy shares why she got involved in the healthcare field

Tammy belonged to the debate team and healthcare was at the center of their attention, a reform was desperately needed due to many delays in the care.
Tammy didn’t join the healthcare field as a software engineer but as a sports medicine practitioner

Three of the biggest aspects that drive decisions in healthcare:

Watching the pennies, the dollars will take care of themselves
The most convenient way that the patient can receive the care he/she needs
Where the focus of making the biggest long-term impact should be

Why is AI needed in healthcare?

Technology has to find a way to disrupt the status quo
Health practitioners need to focus on patient care
1/3 of healthcare practitioners are already using AI and almost 1/2 of the other companies are currently exploring it

What kind of problems is healthcare trying to solve through AI?

Upcoding and regulatory sides are two of the major fields where AI is needed
AI can make payments easier

There are three obstacles to AI implementation in the healthcare industry:

Limited resources
Different data that is unconnected
A Lack of tools and platforms to develop solutions

CMS (Centers for Medicare and Medicaid Services) set aside a considerable amount of money for technology companies to use for innovations

Budget is not an issue, the government will fund projects that develop platforms to create solutions

What are the biggest problems to focus attention on?

There are performance improvement plans for clinical groups that will be based on outcomes, not only they will have to be doing better, but being able to prove it, since the reimbursements will depend on it
Call centers collect very important patient information that could be utilized more effectively with the help of AI
AI could identify how the patient feels when calling and identify the level of urgency of the call

What does the future of wearable medical devices look like?

Wearable medical devices will get better and better
Wearables will help those who are currently restricted in their abilities because of a disease or characteristic of their body

Tammy talks about the possible uses of AI for prescription monitoring

There are outreach programs to follow up on how patients are taking their prescription medicine, for them to stay on track with their medication, and find out the reasons why some people are not

Where do we go from here?

The government is looking to fund great ideas, they are looking for creativity and new technology from the AI world

Transcript [This transcript is auto-generated and may not be completely accurate in its depiction of the English language or rules of grammar.]

Intro: [00:04] You’re listening to AI Live and Unbiased, the podcast where we explore how to apply artificial intelligence and the impact it has on enterprises and society. Now, here’s your host, Dr. Jerry Smith.

Dr. Jerry Smith: [00:20] Welcome to AI Live and Unbiased. I’m your host, Dr. Jerry, I’ll be with you on this journey as we explore the breadth and depth of artificial intelligence. Hello, everyone I’m pleased to have as a guest today Tammy Siragusano. Tammy is a veteran in US Healthcare Reform. Her focus has been on the enterprise approach to solving some of the most complex healthcare problems facing the industry today. She’s experience in healthcare IT, manage care operations, she’s a BPM to BPM migration specialist, and she gets her hands deep and dirty into a lot of operational issues. Tammy has led the digital transformation of clinical logistic for drug and utilization review. Tammy’s also a mother of two and married to a restaurant engineer, which is probably a different conversation down the road. Tammy and I have shared a lot of common ground, here at AgileThought and with other companies. She has been kind enough to let me experiment on her by being our first guest today. So, Tammy, thanks a lot for being here today. Did I miss anything? I often mispronounce your last name. I hopefully I I’m getting better at that today. ammy Siragusano: [01:34] No, you’re doing fine, Dr. Jerry. Thank you for having me. I think you’ve covered everything.

Dr. Jerry Smith: [01:39] Awesome. So, let’s think about this. So, Tammy, you know, one of the first places we probably should start with everybody is why healthcare? What brought you to this field of all the areas you can have explored and gotten into? What is it about healthcare that floats your boat?

Tammy Siragusano: [01:57] Well, I couldn’t run for Congress at the time, I was too young, but I was on the debate team. And one of the major things that we were constantly debating about was healthcare. So, after months of interviewing payers and clinicians, it was apparent that the reform was needed, you know, something had to be done to drive this monstrous vehicle and it needed to be done efficiently. There were delays, and I saw delays constantly and crucial decision making that needed to be done for patients to have access to the care that they need. These decisions cause delays in the care. Some of these people just went through an absolute personal hell experiencing all of the obstacles trying to find their way through the maze to get coverage and to get answers. It was just literally ridiculous. And this was so obvious at the time.

Dr. Jerry Smith: [02:55] Before we get too much deeper into the healthcare issues. I didn’t realize that this all started with you being on a debate team and challenging yourself to find out more about this. Did you know at the time that this was probably your future? Or is it like a lot of people, you know, they just sort of walk down that path and then years later when they look back, they go, “oh, heck, I’ve been on this path forever”. Did you know it? Or, did you realize it later on?

Tammy Siragusano: [03:23] You know, when I was in it and I started finding ways, the very first job that I got back into healthcare was probably eight years later after that debate. And when I got into it, it all came back to me. And I’m thinking, okay, here’s the billing, here’s the medical billing, this is the same stuff I was seeing eight years ago at Blue Cross Blue Shield when I did the interviews there. And things haven’t changed, nothing is changing. So, then I started doing some research and started looking into it. And the big light bulb finally went off when software started hitting the market and computers were coming out and they were getting involved in medical billing. And I started working with the software companies, just sending in a note, you know, can I make a suggestion? Why can’t it do this? Can you also do this? You know, just kind of trying to make things more efficient, easier to use, more streamlined. And as the years went on, some of the software companies started asking me to consult for them and try their products and give them feedback. Dr. Jerry Smith: [04:32] So, you were coming at this, not as a software engineer, not as an analyst, you were coming to this field as a practitioner in providing feedback on why it wasn’t useful and ways to make things better?

Tammy Siragusano: [04:48] Absolutely. That’s what it was doing. I was home care company selling DME and I was a sports Medicine.

Dr. Jerry Smith: [04:55] Wait, wait, DME for us folks that.

Tammy Siragusano: [04:59] Medical equipment. I could rebuild oxygen machines. I can deliver hospital beds and set them up. I can do all that stuff. Build wheelchairs. I got into it as a sports medicine practitioner, you know, I was fitting braces and prosthetics.

Dr. Jerry Smith: [05:18] Interesting. Interesting. Now, I’ve read some of your stuff in prep for today, and you talk about three of the biggest things that drive decision in this area. Can you talk briefly about what those are?

Tammy Siragusano: [05:31] So, yeah, I guess the things that drove the decisions that I made were, you know, watch the pennies, the dollars will take care of themselves. You know, these were my mottos. What’s the most convenient way that this patient can receive the care they need. And number three, where should I focus to make the biggest long term impact? And as long as I followed my motto of blending legacy business models and trying to disrupt the digital innovations that were out there. I was always trying to find a challenging new way, a new technology was out on the market and find a way to use it in healthcare operations.

Dr. Jerry Smith: [06:16] Interesting. I wasn’t going to ask you this, but now that I’m thinking about it, you know, the notion of focusing to make the biggest, long term impact, right. You know, a lot of people think about that, but never action It, they never measure that. And other people are very creative and they look at total contract value, the economics of the problem. Where do you fit on that scale? Do you use the term biggest, long term impact more emotionally to think about, oh, this is really gonna help people because I feel it, or were you one of those folks at the other end that say this is gonna help somebody because I understand the economic. Tammy Siragusano: [06:59] I would say it’s a little bit of both. Mostly, it’s usually something technical that helps to bring the patient closer to a better outcome in one way or another, whether it’s improving the customer service call center, and how they handle calls and what questions they ask and how they log those answers to those questions and how they use that data, or how the patient keeps track of when they take their medication and when they get their refills and, things like that to help remind them, to improve their their outcomes that way.

Dr. Jerry Smith: [07:44] All important. Well, let’s jump into the AI aspects of healthcare. So, why is AI needed in healthcare? We got all these great doctors, we got these great nurses that are out there doing things every day, wonderful administrators. We got lots of regulations and both federal state and local. So, why is AI needed in healthcare?

Tammy Siragusano: [08:12] We’ve got to find a way to disrupt the status quo. We’ve got a lot of technology out there. There’s a lot of machine learning, there’s the ability to a lot of people want to think that you are taking away a job from someone else, but I always like to remind them that you’re a nurse, you’re working at an insurance company, you’re a nurse. I would rather pay for your clinical skills and your knowledge and your experiences that a machine can’t learn. When it comes to repetitive tasks, I’d rather take those away from you and make your job easier, so that you can focus on what that patient needs, focus on the patient care.

Dr. Jerry Smith: [08:57] Yeah. So, do you have a perspective on how much of the industry today, the healthcare industry today, is actively using AI or is looking at AI?

Tammy Siragusano: [09:08] Well, some of the most recent articles that have been put out there, it shows that one third are already using AI in healthcare and almost half of other companies are currently exploring it and looking for ways to get into it.

Dr. Jerry Smith: [09:26] So, if I was the optimist, I’d say, it looks like there’s an opportunity, right? Two out of three chances to actually help an industry. If we like what it is to day and therefore using AI, we can improve it substantially. And the good news is, is that of that two thirds, a good portion of them are looking at it. That’s what I’m hearing from you. In that sort of AI space, Tammy. Do you have a general sense of what kind of problems there are that they’re looking at or are they just all over the board? On the spectrum of they’ve got them in a can they know exactly what they’re going for to there from Mesopotamia, they’re confused and they’re wandering in a wilderness alone. Where do you think healthcare is when understanding the use cases that are needed for AI?

Tammy Siragusano:[10:11] Well, if you think about healthcare in general. Over the years, it’s just been diced up into so many small pieces and the processes that we must follow just to obtain these services and get our hands around how to bill it and how to collect the money. It’s all become mince meat, you know, there’s upcoding additional regulatory oversight. The upcoding is necessary in the doctor’s eyes because their reimbursements have been cut so much, they can hardly stay afloat in their business. And then on the other hand, the regulatory is trying to keep a handle on the fraud, waste and abuse. So, their increase in the regulatory oversight, which increases the administration, and it’s that much harder to build things correctly. It’s that much harder to collect your money that you’re owed for the services that you provided. Dr. Jerry Smith: [11:10] It sounds like there is a road to the future that is filled with a ton of obstacles that are out there, that is just impediments to this process.

Tammy Siragusano: [11:21] It is, and that’s the disruption that we’ve got to cause, you know, we’ve got to find a way to pull these rains back and, reign in on the service expansion of coding and deliver database on what’s familiar. Let’s look at things that are so similar. Let’s try to simple things down a little bit. Let’s make it easier to get paid. Let’s get paid in 10 days instead of 45 days, you know, things like that will help everyone involved.

Dr. Jerry Smith: [11:51] I guess maybe I should have asked a clearer question, which is where AI is concerned, are there any obstacles that are impediments to the healthcare industry as a whole from implementing them?

Tammy Siragusano:[12:07] Yeah. Dr. Jerry, I’m glad you asked that because there are three big obstacles and a silver lining at the end of them too, I think is; number one, there’s such a limited resource in the AI skillset and the knowledge around what is AI, how can AI be used? What’s it mean to our company? And then you’ve got all of this different data that’s coming in, in healthcare, be it claims, be it lab results, imaging, all kinds of things that are in separate silos of data and nothing’s connected. So, we’ve got to find a way to take that data that’s grown substantially in its complexity and find a way to bring it into this, into the solution. And then we need better tools and platforms to develop those solutions. Dr. Jerry Smith: [13:06] Yeah. wow. Those three areas, it seems like we’re living with every day. I think the AI skill sets or lack thereof, or emergence thereof is an excellent one. I think we’re all aware of. And for the most part we’ve seen HR help us in that area. The second area that you hit, the silo data and the complexity of data, I think CIOs are really struggling with. I think that is, you’re number two concern, my guess would be both CIOs would say that’s their number one. And mostly it’s like listen to one CIO friend of mine said he wish he had a magic wand that he can wave and to tell him of all the data that he has, what data would help him cure cancer, right? And that goes to your number two point, which is the silo data and its complexity. The last one that better tools and platform. I think that’s like an invisible roadblock or a wall in the road. People don’t really think about it, but when you said it, I began to think, how many times have I heard, “Hey, Dr. Jerry, we really don’t want this to be a science project with us. Can’t you just bring in a platform that does XYZ” right? We’re at that stage where people are just sort of taking a deep breath, rolling their shoulders over and just going “really? It’s a science project? you don’t have a platform or you’ve not developed some darker models already for this, it doesn’t everybody has this problem?” Tammy Siragusano: [14:43] Here’s some of the silver lining that I was talking about. CMS is our health and human services oversight of everything in the United States. They’ve actually set aside quite a bit of money for technology companies to use their creative side and bring their creative best players up to the front, to come up with ideas, to create these tools and platforms. And I don’t think a lot of people realize that when they’re worried about budget constraints, that there’s seriously a lot of grant money out there, this money isn’t money that they can get from the government that they don’t have to pay back and it will fund these projects.

Dr. Jerry Smith: [15:27] And CMS stands for, do you know, I’m not familiar with that either. Tell you what we’ll do though, to not put us both on the spot, like what are all these acronyms? You don’t see the virtual finger, you won’t see the virtual finger pointing down, but in the show notes here, we’re going to provide a link to CMS for those folks that are interested. I certainly am interested because I don’t know if any client that hasn’t said the words, I really don’t have enough money for this. And if there is a partnership out there waiting for creative people to bring solutions to the healthcare world where they’ll help fund, I’m willing to spend a lot of time on that. Tammy Siragusano: [16:05] Yeah. cms.gov it’s a center for Medicare and Medicaid Services.

Dr. Jerry Smith: [16:09] Sounds awesome. So, where are the biggest problems then? So, Here’s what we have. We have a big industry. We have you who’s interested in it, right? We have some challenges and some issues associated with it. We have a secret lining that is a secret person who’s willing to help fund some of this stuff. Where do we start? Where are the biggest problems in your mind that we’d want to focus our attention on it?

Tammy Siragusano: [16:33] Well, I think one, it depends on who you are. If you’re a clinical group, a doctor’s practice, you’ve heard a lot about performance improvement plans and their reimbursement strategies in the next few years are going to be based on outcomes. They not only have to say their patients are doing better, they have to be able to prove it. And their level of reimbursement is going to be dependent on it. So, they’ve got to know what data is going to help them clear that hurdle and keep their reimbursements where they need to be. Because their clientele, their patients may rate them five stars all the time, and they’re the greatest doctor in the world, and I’ve been with them 20 years and you know, my diabetes, I haven’t been in the hospital for five years. Okay. That’s great, the doctor’s already telling them that. They know that from the medical records, but they’ve got to find other ways. They’ve got to find other improvement programs that they’ve got to put in place that are disease specific, where they’re surveilling the disease, any chronic disease state, they’re surveilling it on a regular basis. They’re looking for direct feedback from the patient and they want to increase the feedback so that the spectrum understands the personal barriers that their patients have and what’s their mental health, what other kind of public services could help them pick up their prescriptions or, you know, whatever it may be.

Dr. Jerry Smith: [18:15] And if you think real quick, if you think about that, today, who’s doing that work, right? It’s an observant nurse. That’s watching you in recovery or watching you in a room or today on a video chat with you, right? It’s a doctor who’s reviewing your records. And my point is, it’s human beings, right? And as human beings, there’s only, and this goes to your point before about the silo data. Well, guess what? one of the most siloed set of data and processing is in the human brain, right? I mean, we’ve yet to figure out a way to plug our brain into each other and share that. So, when we are trying to solve complex healthcare problems, as you pointed out to me in the past, by scaling on the back of doctors and nurses or administration people, it’s going to be broken, right? And, and so I agree with you. I think one of the best places to start is thinking about how do we drive better patient outcomes through AI? What else? So let’s just say we all agree with that. That’s going to occupy a lot of our time. Are there any other areas that are worthwhile mentioning today?

Tammy Siragusano: [19:21] Yeah. So you look at the call centers, they come in and the representatives that are on the phone with people. And they’re asking specific questions, or they’re searching for specific information, but in the meantime they’re hearing these stories about everything else that’s going on. If our tools and our collective questioning would have room to capture that information. I know a lot of times maybe the tech doesn’t have time to listen to the stories or whatever, but those stories are very important to these outcomes. And we just want to make sure that we’re taking advantage of every type of communication that the patient has. They’re wearing medical devices now. They’re looking at diabetic, they have their little monitors on their arm where they just slide their phone past it, and it automatically tells them what their glucose levels are, and their steps for the day or their sleep habits. All of these things are information that would help surveil their disease and help to come up with a better care plan.

Dr. Jerry Smith:[20:35] And I don’t want to go too far off the call center, and I’m going to come back to wearables because I want to talk about the apple watch for just a second. My plug for apple, I do own their stock. Call centers, interesting issue, right? I mean, a lot of us will call in and leave a voicemail or send a text these days, right? We chat a lot with our practitioners through their dashboards, their portals, and we leave notes. And it requires, again, a human being, a administrator, a nurse, a practitioner, a doctor to read those notes to figure out really what to do. I think you’ve hit on another really important area, which is being able to, this is the AI guy in me coming up, being able to take a look at the natural, by processing them with natural language processing, by understanding the emotional constructs. Is this person stressed? Oh my goodness. I think I have a tumor. I need to talk to a nurse right now. I think I’m gonna die. Or is this person calm? I’m writing to you to find out if I can set up my next appointment for my annual physical. One could begin their triage, that communication that isn’t done by voice, right? And elevate those to the top of the line. Right? You know, because if I were to call up and screaming and yelling, my wife’s on the floor, what do I do? They would drop everything and start helping me. If I call up and say, I really need to get an appointment for next week. They’re gonna say, well, let me get you over to administrator. So you’ve hit on something, right? These call centers, these call centers or contact centers, I guess, which do both calls and text are ripe for new kinds of AI processing that’ll help the delivery staff better understand organizing process. I think that’s a great call. Let’s go to the wearables though, because I live on my apple watch. I kid you not, I think I’ve just glued it to the surface of my skin and then put a little charger underneath it. I sleep with it every night. I get my oxygen levels. I look at my heart, I’m a runner, right. And I run eight miles every day, every day. And so I’m my own little platform out there. Is that good? I mean, is the fact that people are wearing, I mean, certainly there’s people wearing medical devices because it’s required to maintain their health. Right? As you point out. Folks that are looking to understand what their glucose levels are, so they don’t go into shock. Right? That’s one spectrum, on the other spectrum are crazy people like me who are just a walking platform for themselves. Where do you see the world going on that? Are we gonna become more and more dependent on these devices as we move on or what?

Tammy Siragusano: [23:16] I think technology has a huge role in the future. These wearables they’re just going to get better and better. Look at people that are wear them that have the heart rate monitors on them now, and didn’t even realize that anxious feeling that they had was actually AFib. And so, they call their doctor and say I got this thing and it’s telling me something’s crazy with my heart. And so, the doctor says, yeah, we just avoided a major future problem you could have had. And so now, they’ve got something on the radar that wasn’t on the radar before, and I know you’ve done some, I’ve read some of your work and you’ve done some research as well in looking at chronic kidney and breast cancer. You’ve had some great ideas. That is what has brought me to your stage to begin with, because I’ve been so impressed with some of the work that you’ve done.

Dr. Jerry Smith: [24:12] Well, one of the most interesting projects I did early on as a really young data scientist. I think I learned that data scientists was capitalized at that particular spot, that’s when I kind of grew up, it was actually a noun and not just words in a sentence. We were looking at how do you help people who have epilepsy drive again? I didn’t know this at the time. We had a woman in the office, she went into epileptic shock. She fell backwards, hit her head, pulled her skull cap off. And I had to triage her at the time and I saved her life. And after that we became friends and I found out all sorts of things like a. in California, if you were an epileptic, you couldn’t drive for obvious reasons. And then that begged the question to me, which is, can we predict when you’re going to go into epileptic seizure? Right? Cause if we can predict it, you can pull over and in theory, be treated and then move on with your life. And we looked at that and we were looking at wearables, at the time taking a look at all the various devices that we can pull in. And then, early days of neural networks, this is early days. And it was amazing to find that there was a set of technologies that could be personalized, albeit, at that day and age, there was no apple watch right? These were massive machines that we were trying to use that we knew over time would reduce down and do some stuff. And so today I think you’re right. I think the wearables will really change our world and help those who are currently restricted in their abilities because of a disease or characteristic of their body augmented a system in preventing them from going into those states. I think you’re right. What about prescriptions? Let’s think about this. So you have a disease, we talked about this, you got these wearables now that are out there. What are about on the flip side? Now, that you’ve been diagnosed now that you’ve got a doctor saying, okay, we understand what’s going on with you, Tammy. Here’s the deal, you need to take this medication. You need to do these things for some time. What about that area? Right? I mean, how many times have we heard somebody say, well, I’ve heard this in my own family. Did you take your medicine? I forgot. What about prescription monitoring and adherence? Is that an opportunity?

Tammy Siragusano: [26:30] Yeah, absolutely. A lot of insurance payers right now take the pharmacy claims and they’re monitoring their prescription refills. And they’re looking for adherence, they’re trying to make sure that these patients are staying on their medication. And if they’re seeing a little lag time in maybe a couple days to begin with then rolls into four or five days, maybe works into two weeks later past when their refill date were, they’re starting some outreach programs to talk to them about their prescriptions and how important it is to stay on track with their medications. And the biggest thing is, is to have those conversations and find out what the barriers are. Maybe they didn’t have a ride to the pharmacy. And when you find out that that’s the only reason why they missed their meds for two weeks and maybe ended up in the hospital, was just because they didn’t have a ride to the pharmacy. Then you start setting them up automatically on mail order plans and things like that, or find a pharmacy form that has delivery, maybe get a home health nurse in there to help them get back on track. Those kind of things, the quicker you can find out what’s going on in that home, the better off you’ll be.

Dr. Jerry Smith: [27:45] Those social determinants of health really play a huge impact. Especially, when it impacts your ability to attain and continue your treatment programs. I think you’re right there. Well, let’s start to wrap this thing up. Where do we go from here? So, we’re here. We covered quite a bit about healthcare, some of the challenges, some of the opportunities. I like the call center one. I’m going to really think about that one. I don’t think a lot of people have thought about that. And now, we’re sitting here going, all right. We have some folks out there that are sitting on an X, right? And they’re wondering whether they take a step or do they wait. Where do we go from here?

Tammy Siragusano: [28:26] Well, the key is, remember what I said about cms.gov, do your homework. Government’s looking to back some really great ideas. And they’re looking for creativity from the AI world. They’re looking for new technology and they’re just put your ideas out there. There’s so many of us that have sat over the years and said, boy, I wish I’d have just put that down on paper, because it was a great idea. And I would’ve been rich and famous and everything else, but these are things that are going to help all of us, they help your parents, they’ll help your kids. And, it’s good for the environment. It’s good for the world.

Dr. Jerry Smith: [29:05] Well, Tammy, I think this is a really good place to stop. I want to really thank you for being here today. Any last words of advice before we call it quits and we move on with the rest of our day. Tammy Siragusano: [29:19] Well, Dr. Jerry, thank you very much for having me on your program today and please go forward with all of the data operational projects that you have going on. I think you’re headed in the right direction. And I think all of us share some very valuable experience that work in the healthcare system. Just because you’re not familiar with technology, doesn’t mean your ideas aren’t exactly what they’re looking for. So, keep that in mind.

Dr. Jerry Smith: [29:49] Well, thank you, Tammy. Thanks for being our first guest, our very first guest here at AI Live and Unbiased.

Tammy Siragusano: [29:56] Thank you.

Dr. Jerry Smith: [29:58] Well, that’s it for the show. How did we do? Please send me a note about what you found interesting and how we can make our time together better. The team is working to develop a new content for future shows. We intend to produce about one show a week. So please stay tuned. Please give us a try over the next few weeks and let us know how we’re doing. So, this is Dr. Jerry, your host, your AI Uber driver, asking you to change the world, not just observe it. Until next time.

Outro:[30:35] This has been the AI Live and Unbiased podcast brought to you by AgileThought. The views, opinions and information expressed in this podcast are solely those of the hosts and the guests, and do not necessarily represent those of AgileThought. Get the show notes and other helpful tips for this episode and other episodes at agilethought.com/podcast.

Speakers

Dr. Jerry Smith

(Panelist), Managing Director, Global Analytics & Data Insights, AgileThought

Dr. Smith is a practicing AI & Data Scientist, Thought Leader, Innovator, Speaker, Author, and Philanthropist dedicated to advancing and transforming businesses through evolutionary computing, enterprise AI and data sciences, machine learning, and causal AI.

He’s presented at Gartner Conferences, CIO, SalesForce, DreamForce, and the World Pharma Congress, and is often who leaders turn to for help with developing practical methods for unifying insights and data to solve real problems facing today’s businesses.

10 Things a Java Developer Should Learn These Days

We are halfway into the year and, looking back at what the last 2 years of the COVID-19 pandemic left us, we can say that the advancements on technology and all the different languages, frameworks and development tools have not disappointed us and even in many cases have overtaken us. It doesn’t seem that long since Java 8 was released more than 8 years ago and, although it is true that today the latest version is Java 18, we must remember that there are still many companies stuck with Java 8 and even a few with Java 1.4 a 1.6 and a few other legacy frameworks.Because of this great advance in programming languages and frameworks in recent years, many programmers could feel overwhelmed due to the large number of updates that we are exposed to in our industry. However, we have begun to see very marked patterns in different industries, and we believe it is important to mention what are the 10 things that every Java programmer should learn.

6 min read

August 25, 2022

Succeeding at Cost Takeout – Improving Cost Management Strategy

The cost takeout is a strategic initiative that can help your company become more efficient. The goal of the initiative is to determine ways to reduce expenses without sacrificing quality, speed or customer satisfaction. A successful cost takeout requires an accurate understanding of where costs arise in your business process and how those costs can be reduced through new technologies. In this guide, we’ll look at some of the most common drivers of costs in IT departments and explain how you can identify them within your own organization’s processes.Cost drivers are the factors that cause your costs to increase. They’re different for every business, but you can identify them by asking yourself: “What makes my costs go up?”

10 min read

February 7, 2023

AI Podcast Ep. 1: AI Improving Healthcare with Tammy Siragusano

Intro: [00:04]

You’re listening to AI Live and Unbiased, the podcast where we explore how to apply artificial intelligence and the impact it has on enterprises and society. Now, here’s your host, Dr. Jerry Smith.

Dr. Jerry Smith: [00:20]

Welcome to AI Live and Unbiased. I’m your host, Dr. Jerry, I’ll be with you on this journey as we explore the breadth and depth of artificial intelligence. Hello, everyone I’m pleased to have as a guest today Tammy Siragusano. Tammy is a veteran in US Healthcare Reform. Her focus has been on the enterprise approach to solving some of the most complex healthcare problems facing the industry today. She’s experience in healthcare IT, manage care operations, she’s a BPM to BPM migration specialist, and she gets her hands deep and dirty into a lot of operational issues. Tammy has led the digital transformation of clinical logistic for drug and utilization review. Tammy’s also a mother of two and married to a restaurant engineer, which is probably a different conversation down the road. Tammy and I have shared a lot of common ground, here at AgileThought and with other companies. She has been kind enough to let me experiment on her by being our first guest today. So, Tammy, thanks a lot for being here today. Did I miss anything? I often mispronounce your last name. I hopefully I I’m getting better at that today.

Dr. Jerry Smith: [01:39]

Awesome. So, let’s think about this. So, Tammy, you know, one of the first places we probably should start with everybody is why healthcare? What brought you to this field of all the areas you can have explored and gotten into? What is it about healthcare that floats your boat?

Tammy Siragusano: [01:57]

Well, I couldn’t run for Congress at the time, I was too young, but I was on the debate team. And one of the major things that we were constantly debating about was healthcare. So, after months of interviewing payers and clinicians, it was apparent that the reform was needed, you know, something had to be done to drive this monstrous vehicle and it needed to be done efficiently. There were delays, and I saw delays constantly and crucial decision making that needed to be done for patients to have access to the care that they need. These decisions cause delays in the care. Some of these people just went through an absolute personal hell experiencing all of the obstacles trying to find their way through the maze to get coverage and to get answers. It was just literally ridiculous. And this was so obvious at the time.

Dr. Jerry Smith: [02:55]

Before we get too much deeper into the healthcare issues. I didn’t realize that this all started with you being on a debate team and challenging yourself to find out more about this. Did you know at the time that this was probably your future? Or is it like a lot of people, you know, they just sort of walk down that path and then years later when they look back, they go, “oh, heck, I’ve been on this path forever”. Did you know it? Or, did you realize it later on?

Tammy Siragusano: [03:23]

You know, when I was in it and I started finding ways, the very first job that I got back into healthcare was probably eight years later after that debate. And when I got into it, it all came back to me. And I’m thinking, okay, here’s the billing, here’s the medical billing, this is the same stuff I was seeing eight years ago at Blue Cross Blue Shield when I did the interviews there. And things haven’t changed, nothing is changing. So, then I started doing some research and started looking into it. And the big light bulb finally went off when software started hitting the market and computers were coming out and they were getting involved in medical billing. And I started working with the software companies, just sending in a note, you know, can I make a suggestion? Why can’t it do this? Can you also do this? You know, just kind of trying to make things more efficient, easier to use, more streamlined. And as the years went on, some of the software companies started asking me to consult for them and try their products and give them feedback.

Tammy Siragusano: [04:48]

Absolutely. That’s what it was doing. I was home care company selling DME and I was a sports Medicine.

Dr. Jerry Smith: [04:55]

Wait, wait, DME for us folks that.

Tammy Siragusano: [04:59]

Medical equipment. I could rebuild oxygen machines. I can deliver hospital beds and set them up. I can do all that stuff. Build wheelchairs. I got into it as a sports medicine practitioner, you know, I was fitting braces and prosthetics.

Dr. Jerry Smith: [05:18]

Interesting. Interesting. Now, I’ve read some of your stuff in prep for today, and you talk about three of the biggest things that drive decision in this area. Can you talk briefly about what those are?

Tammy Siragusano: [05:31]

So, yeah, I guess the things that drove the decisions that I made were, you know, watch the pennies, the dollars will take care of themselves. You know, these were my mottos. What’s the most convenient way that this patient can receive the care they need. And number three, where should I focus to make the biggest long term impact? And as long as I followed my motto of blending legacy business models and trying to disrupt the digital innovations that were out there. I was always trying to find a challenging new way, a new technology was out on the market and find a way to use it in healthcare operations.

Dr. Jerry Smith: [06:16]

Interesting. I wasn’t going to ask you this, but now that I’m thinking about it, you know, the notion of focusing to make the biggest, long term impact, right. You know, a lot of people think about that, but never action It, they never measure that. And other people are very creative and they look at total contract value, the economics of the problem. Where do you fit on that scale? Do you use the term biggest, long term impact more emotionally to think about, oh, this is really gonna help people because I feel it, or were you one of those folks at the other end that say this is gonna help somebody because I understand the economic.

Dr. Jerry Smith: [07:44]

All important. Well, let’s jump into the AI aspects of healthcare. So, why is AI needed in healthcare? We got all these great doctors, we got these great nurses that are out there doing things every day, wonderful administrators. We got lots of regulations and both federal state and local. So, why is AI needed in healthcare?

Tammy Siragusano: [08:12]

We’ve got to find a way to disrupt the status quo. We’ve got a lot of technology out there. There’s a lot of machine learning, there’s the ability to a lot of people want to think that you are taking away a job from someone else, but I always like to remind them that you’re a nurse, you’re working at an insurance company, you’re a nurse. I would rather pay for your clinical skills and your knowledge and your experiences that a machine can’t learn. When it comes to repetitive tasks, I’d rather take those away from you and make your job easier, so that you can focus on what that patient needs, focus on the patient care.

Dr. Jerry Smith: [08:57]

Yeah. So, do you have a perspective on how much of the industry today, the healthcare industry today, is actively using AI or is looking at AI?

Tammy Siragusano: [09:08]

Well, some of the most recent articles that have been put out there, it shows that one third are already using AI in healthcare and almost half of other companies are currently exploring it and looking for ways to get into it.

Dr. Jerry Smith: [09:26]

So, if I was the optimist, I’d say, it looks like there’s an opportunity, right? Two out of three chances to actually help an industry. If we like what it is to day and therefore using AI, we can improve it substantially. And the good news is, is that of that two thirds, a good portion of them are looking at it. That’s what I’m hearing from you. In that sort of AI space, Tammy. Do you have a general sense of what kind of problems there are that they’re looking at or are they just all over the board? On the spectrum of they’ve got them in a can they know exactly what they’re going for to there from Mesopotamia, they’re confused and they’re wandering in a wilderness alone. Where do you think healthcare is when understanding the use cases that are needed for AI?

Tammy Siragusano:[10:11]

Well, if you think about healthcare in general. Over the years, it’s just been diced up into so many small pieces and the processes that we must follow just to obtain these services and get our hands around how to bill it and how to collect the money. It’s all become mince meat, you know, there’s upcoding additional regulatory oversight. The upcoding is necessary in the doctor’s eyes because their reimbursements have been cut so much, they can hardly stay afloat in their business. And then on the other hand, the regulatory is trying to keep a handle on the fraud, waste and abuse. So, their increase in the regulatory oversight, which increases the administration, and it’s that much harder to build things correctly. It’s that much harder to collect your money that you’re owed for the services that you provided.

Tammy Siragusano: [11:21]

It is, and that’s the disruption that we’ve got to cause, you know, we’ve got to find a way to pull these rains back and, reign in on the service expansion of coding and deliver database on what’s familiar. Let’s look at things that are so similar. Let’s try to simple things down a little bit. Let’s make it easier to get paid. Let’s get paid in 10 days instead of 45 days, you know, things like that will help everyone involved.

Dr. Jerry Smith: [11:51]

I guess maybe I should have asked a clearer question, which is where AI is concerned, are there any obstacles that are impediments to the healthcare industry as a whole from implementing them?

Tammy Siragusano:[12:07]

Yeah. Dr. Jerry, I’m glad you asked that because there are three big obstacles and a silver lining at the end of them too, I think is; number one, there’s such a limited resource in the AI skillset and the knowledge around what is AI, how can AI be used? What’s it mean to our company? And then you’ve got all of this different data that’s coming in, in healthcare, be it claims, be it lab results, imaging, all kinds of things that are in separate silos of data and nothing’s connected. So, we’ve got to find a way to take that data that’s grown substantially in its complexity and find a way to bring it into this, into the solution. And then we need better tools and platforms to develop those solutions.

Dr. Jerry Smith: [15:27]

And CMS stands for, do you know, I’m not familiar with that either. Tell you what we’ll do though, to not put us both on the spot, like what are all these acronyms? You don’t see the virtual finger, you won’t see the virtual finger pointing down, but in the show notes here, we’re going to provide a link to CMS for those folks that are interested. I certainly am interested because I don’t know if any client that hasn’t said the words, I really don’t have enough money for this. And if there is a partnership out there waiting for creative people to bring solutions to the healthcare world where they’ll help fund, I’m willing to spend a lot of time on that.

Dr. Jerry Smith: [16:09]

Sounds awesome. So, where are the biggest problems then? So, Here’s what we have. We have a big industry. We have you who’s interested in it, right? We have some challenges and some issues associated with it. We have a secret lining that is a secret person who’s willing to help fund some of this stuff. Where do we start? Where are the biggest problems in your mind that we’d want to focus our attention on it?

Tammy Siragusano: [16:33]

Well, I think one, it depends on who you are. If you’re a clinical group, a doctor’s practice, you’ve heard a lot about performance improvement plans and their reimbursement strategies in the next few years are going to be based on outcomes. They not only have to say their patients are doing better, they have to be able to prove it. And their level of reimbursement is going to be dependent on it. So, they’ve got to know what data is going to help them clear that hurdle and keep their reimbursements where they need to be. Because their clientele, their patients may rate them five stars all the time, and they’re the greatest doctor in the world, and I’ve been with them 20 years and you know, my diabetes, I haven’t been in the hospital for five years. Okay. That’s great, the doctor’s already telling them that. They know that from the medical records, but they’ve got to find other ways. They’ve got to find other improvement programs that they’ve got to put in place that are disease specific, where they’re surveilling the disease, any chronic disease state, they’re surveilling it on a regular basis. They’re looking for direct feedback from the patient and they want to increase the feedback so that the spectrum understands the personal barriers that their patients have and what’s their mental health, what other kind of public services could help them pick up their prescriptions or, you know, whatever it may be.

Dr. Jerry Smith: [18:15]

And if you think real quick, if you think about that, today, who’s doing that work, right? It’s an observant nurse. That’s watching you in recovery or watching you in a room or today on a video chat with you, right? It’s a doctor who’s reviewing your records. And my point is, it’s human beings, right? And as human beings, there’s only, and this goes to your point before about the silo data. Well, guess what? one of the most siloed set of data and processing is in the human brain, right? I mean, we’ve yet to figure out a way to plug our brain into each other and share that. So, when we are trying to solve complex healthcare problems, as you pointed out to me in the past, by scaling on the back of doctors and nurses or administration people, it’s going to be broken, right? And, and so I agree with you. I think one of the best places to start is thinking about how do we drive better patient outcomes through AI? What else? So let’s just say we all agree with that. That’s going to occupy a lot of our time. Are there any other areas that are worthwhile mentioning today?

Tammy Siragusano: [19:21]

Yeah. So you look at the call centers, they come in and the representatives that are on the phone with people. And they’re asking specific questions, or they’re searching for specific information, but in the meantime they’re hearing these stories about everything else that’s going on. If our tools and our collective questioning would have room to capture that information. I know a lot of times maybe the tech doesn’t have time to listen to the stories or whatever, but those stories are very important to these outcomes. And we just want to make sure that we’re taking advantage of every type of communication that the patient has. They’re wearing medical devices now. They’re looking at diabetic, they have their little monitors on their arm where they just slide their phone past it, and it automatically tells them what their glucose levels are, and their steps for the day or their sleep habits. All of these things are information that would help surveil their disease and help to come up with a better care plan.

Dr. Jerry Smith:[20:35]

And I don’t want to go too far off the call center, and I’m going to come back to wearables because I want to talk about the apple watch for just a second. My plug for apple, I do own their stock. Call centers, interesting issue, right? I mean, a lot of us will call in and leave a voicemail or send a text these days, right? We chat a lot with our practitioners through their dashboards, their portals, and we leave notes. And it requires, again, a human being, a administrator, a nurse, a practitioner, a doctor to read those notes to figure out really what to do. I think you’ve hit on another really important area, which is being able to, this is the AI guy in me coming up, being able to take a look at the natural, by processing them with natural language processing, by understanding the emotional constructs. Is this person stressed? Oh my goodness. I think I have a tumor. I need to talk to a nurse right now. I think I’m gonna die. Or is this person calm? I’m writing to you to find out if I can set up my next appointment for my annual physical. One could begin their triage, that communication that isn’t done by voice, right? And elevate those to the top of the line. Right? You know, because if I were to call up and screaming and yelling, my wife’s on the floor, what do I do? They would drop everything and start helping me. If I call up and say, I really need to get an appointment for next week. They’re gonna say, well, let me get you over to administrator. So you’ve hit on something, right? These call centers, these call centers or contact centers, I guess, which do both calls and text are ripe for new kinds of AI processing that’ll help the delivery staff better understand organizing process. I think that’s a great call. Let’s go to the wearables though, because I live on my apple watch. I kid you not, I think I’ve just glued it to the surface of my skin and then put a little charger underneath it. I sleep with it every night. I get my oxygen levels. I look at my heart, I’m a runner, right. And I run eight miles every day, every day. And so I’m my own little platform out there. Is that good? I mean, is the fact that people are wearing, I mean, certainly there’s people wearing medical devices because it’s required to maintain their health. Right? As you point out. Folks that are looking to understand what their glucose levels are, so they don’t go into shock. Right? That’s one spectrum, on the other spectrum are crazy people like me who are just a walking platform for themselves. Where do you see the world going on that? Are we gonna become more and more dependent on these devices as we move on or what?

Tammy Siragusano: [23:16]

I think technology has a huge role in the future. These wearables they’re just going to get better and better. Look at people that are wear them that have the heart rate monitors on them now, and didn’t even realize that anxious feeling that they had was actually AFib. And so, they call their doctor and say I got this thing and it’s telling me something’s crazy with my heart. And so, the doctor says, yeah, we just avoided a major future problem you could have had. And so now, they’ve got something on the radar that wasn’t on the radar before, and I know you’ve done some, I’ve read some of your work and you’ve done some research as well in looking at chronic kidney and breast cancer. You’ve had some great ideas. That is what has brought me to your stage to begin with, because I’ve been so impressed with some of the work that you’ve done.

Dr. Jerry Smith: [24:12]

Well, one of the most interesting projects I did early on as a really young data scientist. I think I learned that data scientists was capitalized at that particular spot, that’s when I kind of grew up, it was actually a noun and not just words in a sentence. We were looking at how do you help people who have epilepsy drive again? I didn’t know this at the time. We had a woman in the office, she went into epileptic shock. She fell backwards, hit her head, pulled her skull cap off. And I had to triage her at the time and I saved her life. And after that we became friends and I found out all sorts of things like a. in California, if you were an epileptic, you couldn’t drive for obvious reasons. And then that begged the question to me, which is, can we predict when you’re going to go into epileptic seizure? Right? Cause if we can predict it, you can pull over and in theory, be treated and then move on with your life. And we looked at that and we were looking at wearables, at the time taking a look at all the various devices that we can pull in. And then, early days of neural networks, this is early days. And it was amazing to find that there was a set of technologies that could be personalized, albeit, at that day and age, there was no apple watch right? These were massive machines that we were trying to use that we knew over time would reduce down and do some stuff. And so today I think you’re right. I think the wearables will really change our world and help those who are currently restricted in their abilities because of a disease or characteristic of their body augmented a system in preventing them from going into those states. I think you’re right. What about prescriptions? Let’s think about this. So you have a disease, we talked about this, you got these wearables now that are out there. What are about on the flip side? Now, that you’ve been diagnosed now that you’ve got a doctor saying, okay, we understand what’s going on with you, Tammy. Here’s the deal, you need to take this medication. You need to do these things for some time. What about that area? Right? I mean, how many times have we heard somebody say, well, I’ve heard this in my own family. Did you take your medicine? I forgot. What about prescription monitoring and adherence? Is that an opportunity?

Tammy Siragusano: [26:30]

Yeah, absolutely. A lot of insurance payers right now take the pharmacy claims and they’re monitoring their prescription refills. And they’re looking for adherence, they’re trying to make sure that these patients are staying on their medication. And if they’re seeing a little lag time in maybe a couple days to begin with then rolls into four or five days, maybe works into two weeks later past when their refill date were, they’re starting some outreach programs to talk to them about their prescriptions and how important it is to stay on track with their medications. And the biggest thing is, is to have those conversations and find out what the barriers are. Maybe they didn’t have a ride to the pharmacy. And when you find out that that’s the only reason why they missed their meds for two weeks and maybe ended up in the hospital, was just because they didn’t have a ride to the pharmacy. Then you start setting them up automatically on mail order plans and things like that, or find a pharmacy form that has delivery, maybe get a home health nurse in there to help them get back on track. Those kind of things, the quicker you can find out what’s going on in that home, the better off you’ll be.

Dr. Jerry Smith: [27:45]

Those social determinants of health really play a huge impact. Especially, when it impacts your ability to attain and continue your treatment programs. I think you’re right there. Well, let’s start to wrap this thing up. Where do we go from here? So, we’re here. We covered quite a bit about healthcare, some of the challenges, some of the opportunities. I like the call center one. I’m going to really think about that one. I don’t think a lot of people have thought about that. And now, we’re sitting here going, all right. We have some folks out there that are sitting on an X, right? And they’re wondering whether they take a step or do they wait. Where do we go from here?

Tammy Siragusano: [28:26]

Well, the key is, remember what I said about cms.gov, do your homework. Government’s looking to back some really great ideas. And they’re looking for creativity from the AI world. They’re looking for new technology and they’re just put your ideas out there. There’s so many of us that have sat over the years and said, boy, I wish I’d have just put that down on paper, because it was a great idea. And I would’ve been rich and famous and everything else, but these are things that are going to help all of us, they help your parents, they’ll help your kids. And, it’s good for the environment. It’s good for the world.

Dr.

Dr. Jerry Smith: [29:49]

Well, thank you, Tammy. Thanks for being our first guest, our very first guest here at AI Live and Unbiased.

Tammy Siragusano: [29:56]

Thank you.

Dr. Jerry Smith: [29:58]

Well, that’s it for the show. How did we do? Please send me a note about what you found interesting and how we can make our time together better. The team is working to develop a new content for future shows. We intend to produce about one show a week. So please stay tuned. Please give us a try over the next few weeks and let us know how we’re doing. So, this is Dr. Jerry, your host, your AI Uber driver, asking you to change the world, not just observe it. Until next time.

Outro:[30:35]

This has been the AI Live and Unbiased podcast brought to you by AgileThought. The views, opinions and information expressed in this podcast are solely those of the hosts and the guests, and do not necessarily represent those of AgileThought. Get the show notes and other helpful tips for this episode and other episodes at agilethought.com/podcast.

Agile Podcast: AI Live Unbiased