Dr. Norma Padron, CEO of EmpiricaLab
Dr. Norma Padron is a health care economist who has taken an interest in the role technology can play in advancing our health care delivery system. She has worked across both academic and health care settings to best understand how new ideas and enabled technology can help us arrive at a healthier future. In this episode, she explores why technology-first solutions are appearing in specialty care first and the challenges facing our current and future workforce.
Norma is a Latina, first-gen, PhD health economist. She has held leadership roles across the healthcare industry including in academia, nonprofit and private sector leading teams that leverage data analytics and technology in the spaces of digital health, population health, value-based care model design and quality and performance measurement and training.
In addition to her work in digital health, Norma has held board positions in education and technology including as Chair of the industry advisory board of the NSF Industry-University Cooperative Research Center, CHOT (Center for Health Organization Transformation); Secretary of the Board for Consilium Bots, a technology company focused on higher education in Latin America, and the Yale Graduate School of Arts and Sciences Alumni Board.
After working with multiple early stage digital health companies for the last few years in her prior role, she came to understand one of the most pressing barriers to scale health tech and data analytics in healthcare is the lack of investment in the development of the healthcare workforce. She recently launched EmpiricaLab to change that. EmpiricaLab is a platform focused on peer learning and last mile training for healthcare teams.
She earned a Ph.D. in health policy and management (economics track) from Yale University, a master's degree in economics from Duke University; a master's degree in public health from Universitat Pompeu Fabra in Barcelona, Spain; and a bachelor's degree in economics and math from the University of Texas, Rio Grande Valley.
Show Notes
Dr. Norma Padron shares her health care background as a health economist and technologist. [03:01]
How will health care efficiency improve in 2049? [05:28]
How is specialty care becoming patient-centric and caregiver-centric with technology? [07:24]
Will technology reduce disparities and increase access to health care? [10:40]
What’s the future of primary care? [14:33]
How can technology and new metrics improve the health care experience? [17:28]
How can the hospital setting evolve in order to remain relevant? [21:13]
What new technologies are empowering physicians? [24:40]
What are the opportunities for improving the health care experience for minorities? [28:33]
Digital health improvements. [31:14]
Transcript
Jason Helgerson 0:00
Hi. I'm Jason Helgerson, and you're listening to Health2049.
Dr. Norma Padron 0:07
I think that in 2049, which isn't that far away, we'll have many more accessible, patient-centric, technical solutions. We'll see so much more care at home. We're already seeing this and so these trends are only going to accelerate and really deliver, hopefully sooner than 2049, this digital enablement of the clinical operations and so labs, pharmacy, home health, those are going to really improve in efficiency and in doing so improving its access.
Jason Helgerson 0:54
Health care economist and a health technologist walk into a bar but they only order one drink. Today's guest Dr. Norma Padron is both a health economist and a health technologist and has worked across the entire healthcare ecosystem to bring to life digitally enabled and digitally delivered products and services that advance key health care goals. Her expertise in behavioral economics and health IT combined with a focus on population health guides her work and enables her to see the future of what is possible for patients. A proud first generation college graduate with multiple advanced degrees from some of the nation's top universities, she brings a multidisciplinary focus to the question, what could and should health care look like in the year 2049. I'm Jason Helgerson, and you're listening to Health2049 and it's my pleasure to welcome Dr. Norma Padron to our program. Norma, welcome.
Dr. Norma Padron 2:53
Thank you for having me.
Jason Helgerson 2:54
Great. Well, let's start as I always like to ask our guest to tell the audience a little bit more about your interesting background.
Dr. Norma Padron 3:01
Yeah, well, you did a great job. But I think that I would add that I was born and grew up in a small town in south Texas, called McAllen, Texas. And I think that a lot of people have read about it. There were a few articles in the New Yorker around issues of how this is a very special part of the country with really high costs of health care, high expenditures on health care, and very little access. And so I did not have health insurance up until I was in my 20s and that really determined a lot of my interests, both on the economics part and the policy and technology side of things that I've had a chance to do.
I did start a trajectory that was very academic. So as you mentioned, I do have a few degrees and started really interested in health services research and in academic work. You and I coincided in New York. When I started my professional trajectory it was an interesting time policy-wise, in the state of New York and through Medicaid expansion of the Affordable Care Act. And I really saw an opportunity and became really eager to be part of the work outside academia.
I had a chance to work at Thomas Jefferson Health System and Mainline Health System in Philadelphia. I started a team from scratch in population health research and then like they say, the rest is history. I left that job. I went later on to the American Hospital Association, where I was Senior Director of Applied Research and Data Analytics. I have to say that I had to kind of restrain myself and learn about data science and data analytics in different ways and working with hospitals in hospital quality and performance improvement through the AHA and took me into the convoluted world of technology and decision support systems. And I was really interested and still am in the technologies that can reach patients and caregivers directly. So that's what I've been working on in the last two years.
Jason Helgerson 5:20
Excellent. So let's look out into the future, roughly 30 years in the future, and what do you think healthcare looks like in the year 2049?
Dr. Norma Padron 5:28
I'm a very optimistic person, so I will start with that caveat. I think that 2049, which isn't that far away, I think that we'll have many more of these accessible, patient-centric, technical solutions. We'll see so much more care at home and care provided and coordinated for caregivers. We're already seeing this and so these trends are only going to accelerate and really deliver, hopefully sooner than 2049, but this digital enablement of the clinical operations and so labs, pharmacy, home health, those are going to really improve in efficiency and in doing so improving its access. I'm going to pause here and am interested in your follow up questions or reactions to my optimistic 2049.
Jason Helgerson 6:28
Fantastic, we're always about not only what it could be, but what it should be. And so we greatly appreciate your optimism for the show. Maybe we can double click a little bit into that, in terms of one of the themes that you talked about was care in the home. And I often think about this in the sense that there was a time, not that many decades ago, when health care came to us, the physician came to our home to provide care to us, and was only in very extreme circumstances that someone would go to a hospital to receive care, but then as technology advanced, it became so the physician couldn't put it in their bag and come to you, we had to start going to it. And that's still pretty much the way it is almost anywhere in the world. And so maybe we can talk a little bit more, about what you think and what will the health care experience be when more services are in the home? What will that feel like and be like maybe from a provider perspective, or from a patient's perspective?
Dr. Norma Padron 7:24
I think that it's important to think about it in terms of both what is happening already in the primary care kind of world, and then in the specialty kind of world. I've had the chance to work with experts in radiation oncology, for example and the use of sensors at home, fall prevention, monitoring at home. And so in some high specialty settings, we're already seeing that it is both viable and patient-centric and caregiver-centric, to deploy this technology at home and there's very intense monitoring of these patient populations. It is a smaller group of population. It's a more targeted type of approach for delivery of care. So I don't want to say we have it covered, but I can see a roadmap where that expands. And again, improving technologies, improving efficiencies around the processes and workflows in the specialty setting.
Where I think it's a little bit harder to imagine, tends to be in the primary care world, because it is so confusing. We have urgent clinics, we have emergency rooms, we have all of these touch points, and none of them seem to be the right entry point. Sometimes we're looking for the right time, the right moment, the right type of provider, and then of course, there's the lack of continuity of care, that is also a challenge. So I think that those would be the areas to hyper focus on, how does it work?
I think I've mentioned this to you before, but it's going to be very geographically determined in some way. Yes, we want this or it would be great if it is digitally delivered, if virtual care access is more broad, but it has to map out to the conditions that the patient is experiencing on the ground for referral, for example, for access to labs, for access to pharmacy. And so I think that's a challenge for sure. I'm not saying that that's an easier one. But I'm optimistic there, as well. Actually people might think the opposite, people might think that the specialty care world is harder, I've actually seen it to be much more advanced and developed. It's a smaller group of services and coordination that is needed.
Jason Helgerson 9:48
Interesting. So what you're saying is that we'll have specialty care moving into the home quicker than primary care, which is definitely an interesting perspective because other guests we've had on the show have been quite bullish on the role that technology can play in primary care, diagnosis and chronic care management. This is great because specialty care is so important. A major driver of costs, major access problem, particularly for lower income individuals on Medicaid and even individuals on Medicare.
Let's talk a little bit about specialty care access and technology. Do you believe that the technology will reduce disparities, increase access, or are you at all worried that these new technologies, new approaches will be too focused on individuals with greater needs?
Dr. Norma Padron 10:40
Yeah, that's a really good question. So I can think of two examples. By the time a patient presents with risks of developing diabetic foot ulcer or already have symptoms of it, there's a number of disparities that this patient went through and access issues and so by the time we see this presentation, it would be naive to say that it just happened. And so I think that I do want to acknowledge that disparities continue to be something that needs a lot of effort, determination and leadership in the US to address and it's across the board.
Where I think the opportunity might be is the exacerbation or the inattention to these types of risks, which again, if you're at risk of diabetic foot ulcer, you're in the specialty world already. And so I see an opportunity to have devices at home, sensors at home. I don't know if I can mention the companies, but there are some companies that I'm very excited about in the space with pads, at home temperature monitoring, and sensors that can deploy resources to home visits or calls for patients that have some symptoms that are not going in the right direction. That's why I'm excited about specialty care, it's more hyper targeted.
Now, of course, I think prevention is better. And so I would love to see this not even be an issue, not even have this presentation. But that's a case where I think that addressing the needs of a patient that might have already been experiencing lack of access and disparities, this is a point where technology can still prevent amputations and further exacerbations. But I do want to emphasize that this should have been prevented much sooner. So that's one thing to think about.
The other example that I was mentioning, I had the chance to work with colleagues in the Jefferson Health System on radiation oncology and I learned a lot through my colleagues on fall prevention and the relevance of having sensors, step counts, just really understanding the patients, how they feel at home. And again, this is a point where I would love it that this is prevented. But if you find that this is something that can improve the therapy and the outcomes for patients, I think that it could be a really good approach.
Your question about access is an interesting one, because I already think that what we do in the specialty world is very incomplete in some ways. And so I see this as it should be accessible, because it's complementing care that was, in some ways incomplete, specialty care provider that is not having a picture of how the patient is performing through therapy and so I see it as something that is complementary. I don't know if this answers your question.
Jason Helgerson 13:50
Absolutely and I think it's interesting to think through on the specialty side, as technology allows for more personalized care that you mentioned, remote patient monitoring technology, which gives you the ability to track patients and have a lot more data on what's going on in their life and how they're responding to treatment. It's potentially very exciting to think about how that information can be used to improve outcomes. Let's move on to primary care and you said it's a challenge, but obviously really important. What does primary care look like in the year 2049?
Dr. Norma Padron 14:33
That's a good point. We've seen an increase in access to health insurance. The trends at least and the number of uninsured individuals over time has improved. I would be interested in your opinion, but I think that the experience still isn't great. I find that interesting, it tells me that this is still a very persistent challenge that even if individuals are becoming insured, even if we have less uninsured individuals in the country, access remains a problem. And it tells me then that we're probably not doing enough when it comes to access in the physical world.
I've seen some really interesting models of virtual primary care, I still always have that puzzling question of, how does it map out to the physical needs of that patient? Continuity of care, for example, referrals, chronic disease management prevention. As a woman, for example, there are still visits that you have to have in person. And so I'm very interested in the connection of the virtual primary care world with the physical networks and in-person care. Maybe this is the only bit where I'm going to be a little bit pessimistic. I haven't been that impressed, yet.
Jason Helgerson 16:06
I agree. I think there's been a lot of progress in getting health insurance cards into people's hands, but health insurance isn't health care. Health care is actually receiving a service that you need, and being able to get that in a timely, effective fashion. And that's very different from having an insurance card. We still have a long way to go to designing a user experience in health care that is what we have come to expect in other aspects of our lives. I would say that it's a heck of a lot easier to buy a sweater than it is to get a health care service. And it shouldn't be that way, but it is for most of us, not just for lower income individuals. It's a common experience for a lot of people. We end up waiting around for service when we can buy almost anything we want online, 24/7 365. So yeah, I agree with you. I'm under impressed.
In 2049 a lot of technology that exists today, we'll have had almost 30 more years to evolve, whether that's artificial intelligence, machine learning, how will those advanced technologies impact health care? Are you excited about what they have in store or concerned or maybe a mixture of both?
Dr. Norma Padron 17:28
I'm interested in how technology and new metrics can come into play, and actually improve the experience. I recently met this entrepreneur here in Austin, and she has this technology for temperature sensing, and we got talking about how it could be a vital sign, again going back to this world of diabetic foot ulcers or other conditions, temperature changes, skin temperature, in the context of inpatient hospital settings, there's pressure ulcers quality metric that gets tracked. It was interesting because she said that it could be a new vital sign. And I thought, when was the last time that a metric as a vital sign was created?
I thought that was very interesting systematically improving on the metrics that we collect, to deliver better care and more personalized care. I think that I fall somewhere in between being a little bit skeptical of anything that comes with AI, or machine learning, in their marketing strategy. I also work in a space where I come into contact and learn about entrepreneurs' work that are doing the frontier of data and technology. And I haven't seen this concerted effort to systematically improve some of the metrics that we have.I've worked in inpatient hospital settings as well, and so in inpatient hospital settings, we continue to track some of the same metrics that have been collected for decades. And what are those new metrics that we could be collecting, and that we're not doing for improving hospital and quality performance?
So I think that that is a huge opportunity, I'd be very excited. I think that there's a lot of people working on this. I would like to see that by 2049 we have more of these new metrics that in an actionable way can improve the patient experience. And it's something that we can benchmark against and improve performance and improve experience. I think there's an opportunity. I see it a lot in the digital health, digital therapeutics, even for virtual primary care, the quality metrics are still being developed today. How do you measure, what are the HEDIS metrics for virtual care? And I think that that's an area of opportunity.
Jason Helgerson 19:56
Yeah, absolutely it's the same metrics for physical care. I do think one of the biggest challenges is that the measures that we use for outcomes are mostly inputs, and not real true outcomes. And process type measures and things like net promoter score or other measures of the patient experience. There's not much money linked yet in health care to payments that go to those measures. So as a result, people aren't paying as close attention to them.
But I'm optimistic, at least I'm sure you're seeing entrepreneurs, new products, new services, that really are embracing the challenge of designing a better user experience. And I think the good news is that the bar is relatively low, that you can offer a new service that's better in that regard. And I hope ultimately, we as patients will vote with our feet to the providers, whether it's virtual or face to face that offers better user experience. So one other area, I wanted to dive into a little bit with you given your hospital experience working for the American Hospital Association, 30 years in the future, what do hospitals look like in the year 2049?
Dr. Norma Padron 21:13
Yeah, so I think that one of the challenges today that needs to be addressed, it's more urgent than gets discussed is the challenges in staffing and in attracting and retaining staff that some parts of the country experience. You've also probably worked with this, but in certain rural areas it's really difficult. And also staff turnover tends to be high, depending on the geography. I'd like to think that there are ways to address this. Hospitals are definitely working towards this. A huge emphasis in training and making the hospital work experience enjoyable for flux working and clinical staff. And this goes beyond doctors, but also clinical staff, nursing staff, admin staff, because I do think that in some parts of the country, this is a high challenge.
As you were speaking, I thought, well, the discoverability of this solution is still a problem, even if we have a lot of virtual solutions, how do patients find out and who's letting them know? I think that also, the hospital setting could be the place where you learn about how to do better monitoring at home, or self managing your chronic condition can be done through virtual tools. But I do think that more training into hospital staff, and then the training that hospitals can do into caregivers and families. I don't think that right now they do a really good job. You get discharged, sent home, you get the checklist, maybe you get a little bit of training into how to take care of your wounds or whatever it is that you went to the hospital for. But I think that there's an opportunity there for more patient and caregiver training on their own health. Isn't it surprising that we don't think of hospitals as a place where you go and learn on how to take care of your health going forward? So I would love to see that by 2049.
Jason Helgerson 23:34
Yeah, interesting. So you're seeing the hospital as a real community asset, a place that provides not just direct service, but education, support to family and caregivers. That's interesting, because my suspicion is that if you look over the last couple of decades, more and more services that used to be provided in hospitals are moving out into the community and powered by technology and gotta expect that trend to continue.
But then you have these buildings, what are we going to use them for? And what services and what role do they play in the community? And that sort of interesting idea there, which is, can we repurpose not just those buildings, but even the people working inside of them to provide a more preventive service as well as a recovery type service. So it's interesting to see the role of the hospital evolve in that way. And then also on this, do you see the physician themselves, do you think technology will fundamentally change the role of the physician? And if so, in what ways?
Dr. Norma Padron 24:40
I go through two different types of thinking around this. I hope that it changes the physician experience for the better. So far, it just hasn't. When I speak to my colleagues, I've had the good fortune of sometimes shadowing some of them and I do think that the current physician experience for delivering care is really bad. And so I think that it probably needs to be acknowledged and there definitely needs to be very concerted efforts on this, because it hasn't been good. And frankly, I think that many will say that it's gotten worse from the physician experience, from their ability to deliver care has been now a couple of decades that they've been mentioning that they have to enter all of this information into the record. And so I think that this is definitely a point where things really need to change.
We have seen some interesting technologies for empowering physicians in different ways. And there's some exciting technologies out there for more empathetic ways of collecting the electronic medical record. There are legacy players, so it's difficult to change some of the status quo. I do think that it has to. I think that that is part of enabling the physician to deliver the best care with technologies and tools that actually make their work enjoyable. I think it's really urgent.
I don't know that the role of the physician will fundamentally change, I'd like to see it enhanced. What I mean by this is that, putting a little bit of the economist hat on here, but the asymmetry of information, its core, and the relationship between patient and provider. And so you go to this medical expert, and you don't know necessarily what's happening, it's a movie that you've never seen before. So you're at a huge disadvantage in making decisions or understanding as a patient what is happening. And so I would like to see technologies that bring some of that relationship into, of course, the physician will continue to be the expert, and there still will be a symmetry of information there. But to bring the conversation and relationship between the patient and the provider to a more level playing field in some way. Because as a Latina woman, I do think that the challenges they experience right now from the providers perspective is bad. They're struggling with technologies and environments that they're not very happy about. But patients also sometimes have this trust in the providers. And so all of this exacerbates the relationship.
There's lack of trust, or there's lack of adherence, and there's a lot of things, maybe people even avoiding going to the doctor because they just don't trust it. And so no one is enjoying the current experience. l would love to see technologies that make the physician enhance their abilities to deliver care. But that's the relationship that I would like to see change–the technologies that enable the patient provider relationship to be one where there's more trust.
Jason Helgerson 28:03
Yeah, absolutely. I couldn't agree with you more, talk a little bit about the future of health and health care for Hispanics in the United States, and maybe talk a little bit about some of the challenges you see, as well as maybe some of the opportunities for what the future could hold if we use the technologies, use the new treatments, use all the new opportunities in ways that actually maybe address some of the chronic disparities that have plagued the country today.
Dr. Norma Padron 28:33
Thank you for asking. I think there are great opportunities right now for improving the experience not only of Hispanics, but minority groups in the US in health care. Obviously lack of access and insurance has been persistent, but then also there are a lot of disparities in the experience, and disparities in outcomes, and those are well documented. There are simple things that I would like to see happening at a more accelerated pace, some of them that are very low technology, appropriately putting the name of a person, things like hyphens and accentuations and whatever it is to the names. I think that that is a simple thing, very vocal about how important it is to the relationship to be able to have your identity, your name be described the way that it is. So there is some low hanging fruit.
What I would like to see as well and this is less low hanging fruit, but really there should be a concerted commitment to it is technologies that acknowledge the experience in the context of Hispanics, for example, access to language services, access to communities that have for so many years just not have had access to health care. I've mentioned this before, but there's an aspect of trust. And there's an aspect of empathy and understanding cultural empathy and understanding that has to be there. When I learn about new tools and technologies, and many of which are interested in social drivers of health, I think that really spending the time and understanding the community needs that you're trying to serve, this is only going to make your technology or your solution better. There's a lot that we could be doing right now. And to be honest, like sometimes it's frustrating that we don't see it as much today. But I think there's a huge opportunity to really improve the empathy and understanding towards again, not only Hispanics, just minorities in underserved populations in the US through technology and otherwise.
Jason Helgerson 30:57
Yeah, absolutely. I couldn't agree with you more. So we always like to end these interviews with one final question, which is to ask the guests to take a step back and say, okay, so if your optimistic vision for 2049 is achieved, how would that make the world a better place?
Dr. Norma Padron 31:14
I think that it makes the world a better place, because what my vision for 2049 is about leveraging some of the improvements we've had up to now and as I mentioned, improvements in the accuracy of labs or better pharmaceutical therapies, better home health devices. And so I think it makes the world a better place because it improves access to the technologies that right now are out there and improving, but we just don't have a concerted effort in improving access to. I say this, and a part of me is like there's a lot of wishful thinking here. But I do think it's an important moment in time and so we do have some very smart, very dedicated people out there working towards this. So I'm going to remain optimistic that this is both achievable, and will make the experience much better.
Jason Helgerson 32:16
Great. Well, we'll end on that optimistic note. And that was Norma Padron's vision for health and health care in the year 2049. As always, thank you for listening to Health2049. If you enjoyed what you just heard, please subscribe to us on Apple Music or Spotify and share this podcast with a friend. Thank you, and see you next time.
