Medical knowledge is expanding faster than any physician can absorb, and Dan Shields, CEO of digital medicine for New Orleans-based Ochsner Health, sees AI as the way to help them keep pace without taking clinical decisions out of their hands.
“The volume of medical knowledge has been documented as doubling every 20 days. In reality, that’s probably down to about 12 to 15 [days] now,” he said during a Nov. 4 panel at Becker’s CEO + CFO Roundtable. “No human is capable of synthesizing that amount of data as things move forward.”
Much of chronic condition care is “somewhat algorithmic,” Mr. Shields said, which makes it suited to AI agents that surface the best next steps for physicians to weigh.
“It’s not telling the doctor what to do; it’s saying, here are your options, and based on everything we see, here are your best next steps,” he said. The physician still makes the call for that patient. “It has to be options, not telling you what to do.”
Here are four more takeaways from the panel:
1. Primary care needs a bigger team and bigger panels.
Mr. Shields cited research finding that a primary care provider with a 2,000-patient panel would need 27 hours a day to do everything evidence-based medicine recommends. Team-based care cuts that to eight or nine hours, but “we don’t get paid for team-based care,” he said.
Ochsner is building a primary care model that pairs advanced practice providers and pharmacists with ambient listening and its digital medicine program, which handles chronic condition support. The goal is panels of 3,000 to 5,000 patients “without killing the provider.” To fold digital medicine into that model, Ochsner recently stopped commercializing the program, which it had sold to other organizations.
Patients would be sorted by complexity. Requiring every patient to come in for an annual physical, Mr. Shields said, is “chasing RVUs.”
Arshad Rahim, MD, chief medical officer and senior vice president of clinically integrated network and population health at New York City-based Mount Sinai Health System, said New York has lagged on APPs. He endorsed Ochsner’s complexity-based approach.
“When I spend my day seeing annual wellness visits, it’s not a good use of what I trained for,” he said.
2. Ochsner and Mount Sinai are placing greater focus on the middle.
Ochsner once identified 2,000 patients driving a “ridiculous amount of cost” through readmissions, but there was little it could do to change their trajectory, Mr. Shields said.
“The answer was to take the next level down and keep them from getting there,” he said. “The fool’s errand is to focus on the top 5%.”
Dr. Rahim agreed, describing the middle 30% of a health risk pyramid as the “most impactable” group. Mount Sinai finds those patients through the Hopkins ACG risk model, physician referrals and transitions of care, though he said, “I can’t say we’ve really solved that yet.”
3. Claims data is not enough.
Most risk models run on claims data that is limited and three to four months behind, even as systems hold a full medical record for every patient, Mr. Shields said. Ochsner is building its own stratification model from EHR data.
Dr. Rahim said scale makes better tools urgent. Mount Sinai has about 550,000 lives in value-based contracts, but its care management operation can touch about 9,000 longitudinally.
“There’s got to be a different way,” he said, adding that AI “is going to be huge for population health.”
4. Care at home is working for both systems.
In Ochsner’s remote and low-income communities, the digital approach is paying off, Mr. Shields said. Some patients would have to cross the 26-mile bridge spanning Lake Pontchartrain to reach a clinic.
“We see better outcomes from people who manage these conditions at home than from the ones who routinely come in,” he said.
Dr. Rahim pointed to a remote blood pressure monitoring program he built, now at 2,000 to 3,000 patients across all major payer classes. For him, the larger lesson is that population health cannot be a side project.
“It really should be your care philosophy and how you deliver care,” he said. “I really think that will separate the winners and losers in the next 10 years.”
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