Innovation in the Boondocks

Discover how a small town in Hernando County, overcame its limitations to become a hub of healthcare innovation. Dr. Singh shares their journey of self-discovery, transparency, and leveraging strengths to create a culture of excellence in health IT.

Can innovation happen in the Boondocks? This is the question we have grappled with over the last five years.

We live in Spring Hill, Hernando County, which is about 50 miles north of Tampa, known more for its mermaids locally than anything else. We are a small town, an urban city, which is a bedroom community for Tampa, truly a sleepy town. Our largest employers are Walmart supercenters (three of them), Publix, and three community hospitals with a population of 170,000. Our majority is above 50 years of age. We have minimal infrastructure in electronic highways, and no major commercial hubs or business centers. Even our malls are mini-malls. Transportation is poor with no real railway or bus services. Our only highways are 589 and 75, which connect us to Tampa and allow us to be a transit locale.

We have no major academic centers with pools of talent, teams, consultants, connections, relationships, mentors, experience, funds, and philanthropic endowments supporting the community. We now have had a state college for the last three years.

Our restaurants shut down at 8 p.m. Roads go quiet by 9. We do not have a Silicon Valley or Koremangalam nearby. We do not have entrepreneurs hanging out in cafeterias working out startups on the back of paper napkins, with money pouring in from private equity or large investors from New York or California. We are collectively resigned to the fact that others will pave the way and we will follow.

We have no military establishments or industries. We were known a dozen or so years ago as cow country. We are not a center for Google or Zappos. Amazon does not have a huge warehouse here. We have mom-and-pop stores which are slowly being replaced by bigger corporate entities.

Creating an innovation center in Spring Hill, Hernando County, might seem like an implausible dream. But against the odds, we began our journey of innovation, a group of healthcare professionals striving to bring innovation to the fields of healthcare and health IT.

In 2004, we laid the foundation for Optimum Health Care, the first Health Maintenance Organization based in Hernando County. Today, it stands as one of Florida’s largest HMOs and one of the select few to achieve a 5-Star rating in the state. Access Health Care subsequently introduced various innovations in healthcare, including robust compliance programs, a quality initiative that secured a 5-star rating for Optimum Health Care, and a care management program that placed case managers among hospitalists and SNFists. We have reached a point where we perform compliance testing not only for ourselves but for health plans as well, achieving a remarkable 100% compliance score on an audit for all our managed care patients and Medicare fee-for-service billing in 2017. Such achievements are almost unheard of in our domain.

Along the way, we were entrusted with providing credentialing services to two Fortune 100 companies, a recognition we hold with immense pride. We established Hernando County’s first home-grown Third-Party Administrator in 2011 and its first Accountable Care Organization in 2013, followed by the first Level 3 Patient-Centered Medical Home in 2015. We deliberately used local talent rather than outsourcing to external consultants.

In recent years, we have constructed a SOC 2-certified data center and developed our audio/video studio. Here, our subject matter experts record their knowledge to be shared globally via our Learning Management System. The recording and editing processes were executed entirely by local community artists.

We delved into software development, creating state-of-the-art architecture and software modules to enhance our services and push us toward excellence. Our custom-built utilization management software is actively used for our Humana patients, adhering to the stringent requirements of CMS.

We even programmed our own claims gateway, responsible for processing thousands of claims daily, reducing an error rate of 30% to less than 0.1%. Our claims adjudication software is poised to disrupt the market, alongside our credentialing services, revenue cycle management, and a universal platform that seamlessly integrates diverse data feeds and disparate software applications.

Today, we dare to dream of cutting-edge healthcare, one that places the utmost emphasis on compliance, quality, and evidence-based medicine, supported by the most advanced health IT. We manage to accomplish all this and more with limited resources, all while facing skepticism, even from some of our most dedicated leadership.

And we execute all these and more, with limited means, and wide skepticism even amongst our most fervent and committed leadership. We embarked on creating an innovation center in Spring Hill three years ago and were successful in doing so.

We unearthed talent that we never knew existed within our community. We harnessed expertise from across the country and around the globe, flying in experts and upskilling our knowledge in IT, video production, educational course creation, and information systems, as well as obtaining technical certifications and licenses.

We stretched ourselves to the limit, pushing our resources to the brink to break through with innovative solutions, bridging two seemingly disparate fields and domains. In such a short time, we achieved so much. We realized that Spring Hill, Hernando County, had the potential to become a hub for health IT innovation, defying the limitations of technology and connectivity in our region.

Here are some of the critical lessons we’ve learned along the way:

Lessons Learned: Our Explorations

1. Self-Discovery

As we began leveraging our hidden strengths (and one always has some without realizing them) we began understanding who we were and what each team member’s most secret aspirations were. For example, we realized we were wasting our Chief Information Officer’s talents and passion. He wanted to be an inventor while he was spending his time with functions that a help desk normally would do, like answering phones fixing computers for providers, or working on phone lines and fiber cables. Our first mission was to free him of sundry activities that did not optimize his time, knowledge, drive, and experience. As we hired more IT professionals to free him, we brought him closer to the role he had in his previous life; he had been a software developer for Microsoft. Today, he handles a team of nearly 125 developers in India and 20 IT professionals in our backwaters. 

We also realized while chatting with our Chief Quality Officer that her work was of interest to her only because it helped her make money while using her clinical skillset to assist the company. When I asked her what she wanted to do, her answer was simple, “I want to build sets and stage plays.” My response was, “I can’t help you with that.” But we could. And did. Today, she leads our Edutainment Division, which creates creative educational programs for our employees, patients, and affiliate providers. Now, she has all the time to create stories, set stages and interviews, and allows her creativity a license to be as crazy and outlandish as possible (within allowable limits, of course). The journey of self-discovery is a long and continuous process. One just needs to be open to it constantly.

2. Understanding Innovation

We realized that innovation is not only the creation of new software or to be like Google and Amazon. Innovation is creating something new, or rather, being new. That means that creativity can flower not only in producing new technology but also in improving processes or structures or even goals and mindsets. Innovation is not just Einsteinian mental leaps but could also deal with down-to-earth designs of office space and workflows or in the creation of an enrichment center for our patients. It is about belief and faith in oneself and about questioning the status quo. Not taking anything for granted and rejecting authority without breaking industry regulations. 

This implies that innovation is non-hierarchical and is not the monopoly of a single individual or department. The key is to question constantly and challenge our attitudes and complacency. Not being satisfied with what we do or who we are, is the desire to compete not with others but with ourselves, to improve constantly, and to become free and child-like in our workspace. To make of work a play without losing the seriousness of our responsibilities. 

3. Radical Transparency

We realized how utterly opaque we were to criticism, how we were encrusted with habit and with the past. As we probed deeper into how we interacted with each other and how we had become siloed and compartmentalized, the awareness of realizing that this was only a function of ego and self-importance began to dawn on us. 

In our experience with creating a culture of compliance, we found out that compliance has to become a part of everyone’s blood and DNA. For that to happen, each employee had to be empowered to raise red flags challenge assumptions, and be willing to share with anyone or everyone if they thought that something and anything was not in compliance with our operations. A culture of rewarding such a sharing of serious concerns had slowly become a part of our normal work atmosphere. Here, we had to continue the same processes, first at the level of top leadership and then, slowly, at the level of the middle managers. Creating a conscious corporation has become our goal since innovation is no longer the end of the journey, but its very inception and the journey itself. 

4. Commitment and Relationships

The fish rots from the head as an ancient Japanese proverb tells us. But enlightenment too begins from there. At the top levels of leadership, there came a growing realization that the company only reflected the values we held, believed in, and lived. That the world outside was only a reflection of what we are within. Such an exploration necessitates a clear and simple trust in our relationships and communications with one another.

Over the last decade, we have pursued relationship management as one of the bedrock of our organization. To keep things harmonious whenever there were strong disagreements whether at the professional or personal level. We were fortunate to have focused strongly right from the beginning on a culture that brought everyone together by creating harmony, improving discourse, and allowing each other the benefit of the doubt whenever things soured amongst us. This helped us stay cohesive despite the disparate tendencies and personalities, and work together with respect and cohesiveness. Listening to each other, allowing strong opinions, and still being able to enjoy each other can create sparks of fresh thoughts and ideas. This was our experience. 

5. Leveraging the Core

We realized that our hidden strength was our deep expertise in healthcare. That made us unique in what we tried to do despite our obvious handicap in technology and financing. We had people who had spent more than two to three decades in their domains, e.g., case management coding and billing or compliance or risk management. Our goal was to hire the best in these fields and then push each other to make our processes better. Our focused implementation plan was conceived together and made everyone in the leadership a stakeholder. We then followed up on the progress of our execution and we excelled and beat our targets. 

Realizing that we are subject matter experts in healthcare allowed us to tie up with IT professionals and create a synergy with them. The challenges of working with specialists from an entirely different field were many and extremely painful and disruptive. Yet we persisted and slowly learned the aspects of IT that pertain to software development. We learned their language what they needed and how they thought and worked. Developing strong bonds with our IT professionals proved to be a catalyst in creating new healthcare modules that captured our granular requirements and niche specifications. When IT professionals created healthcare modules they did so out of a very superficial knowledge of our domain. When we partnered with them and kept beating them (nicely), we were able to create products that fulfilled an essential need in the industry and had immediate use for us. 

6. Leveraging Our Deficiencies

This sounds like a paradox but is so true. It is well known that experts get blinded by their paradigms and are unable to challenge their models. But those who do not know what is not possible can dream the impossible. We realized that in attempting to remove all our pain points we were taking on a huge enterprise approach to software in healthcare. Normally, we see vendors pedaling one module, which they have developed over decades to catch up on old architectures.  We were able to dream of things that normally would not be attempted by a regular health IT company, e.g., trying to create a claims adjudication system in five months or a whole ecosystem of healthcare modules tackling multiple dimensions of each specialty. 

While we did not know what we did not know, our lack of fixed information freed us up to dream big and work with a small budget, without the need for investors or marketing research. This allowed us to create freely what we needed for ourselves. Once we addressed our unique needs, we realized that this uniqueness itself created a universal application (pun intended). 

Our journey of innovation in Spring Hill, Hernando County, has been a testament to the power of determination, self-discovery, and embracing our deficiencies as strengths. By nurturing innovation in our community, we’ve unlocked talents, pushed the boundaries of what’s possible, and created something valuable. As we continue to challenge ourselves, we believe that Spring Hill can indeed become a center for health IT innovation, proving that innovation knows no bounds.

In the tranquil corners of Spring Hill, innovation is thriving, and it’s just the beginning of our journey.

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