Dear Friends & Colleagues,
A common characteristic of the guests I invite on this podcast is their courage in and commitment to creating unprecedented positive change in healthcare. They don’t just do things right, they do the right things. And, while the content in these interviews centers on transforming healthcare, there are also lessons on humanistic leadership woven throughout. That’s not a coincidence because the act of reframing - of creative disruption - requires that type of leadership.
Our guest this week, Secretary David Shulkin, exemplifies courageous, transformational, principled-based leadership. Dr. Shulkin served as a member of President Trumps’ cabinet, as the 9th Secretary of the US Department of Veterans Affairs. Previous to that he served under President Obama as Under-Secretary for Health. In both positions, he was confirmed by a unanimous Senate vote - an unusual testament to his competence and integrity. Prior to entering the government, Secretary Shulkin had a long distinguished career in the private sector. He served as CEO at Beth Israel Hospital in NYC and Morristown Medical Center in Northern NJ; and also held senior leadership positions at distinguished institutions such as the University of Pennsylvania Health System and the Hospital of the University of Pennsylvania. He has been named as one of the Top 100 Physician Leaders by Becker’s Hospital Review and one of the “50 Most Influential Physician Executives in the Country” by Modern Healthcare and Modern Physician. He has also been named by Modern Healthcare as one of the “One Hundred Most Influential People in American Healthcare”. Secretary Shulkin recently published a book entitled, ‘It Shouldn’t Be This Hard To Serve Your Country’, a memoir of his experience serving under two US Presidents.
In this interview, you’ll hear:
The important and unique role the VA system serves for military veterans, as well as its contributions to our larger healthcare system.
The bold leadership maneuvers that Dr. Shulkin deployed to solve for immediate national VA healthcare crises and to navigate the entrenched culture of a slow moving and highly political bureaucracy.
The lessons that Dr. Shulkin believes the US healthcare system can adapt from the VA.
How Dr. Shulkin initiated the modernization of the VA system through the single largest electronic medical record (EMR) deployment in history.
One of the major reframes that Dr. Shulkin introduced into the VA system, which was a shift from being a “pure provider of care” to becoming the “network coordinator of care”.
The remarkable characteristics of Dr. Shulkin’s leadership approach are apparent in this episode. First - he focused on solving specific, patient-facing healthcare problems such as improving access to care and eliminating hepatitis C. Second - he fearlessly made decisions based on principles and evidence, followed with swift action. I say “fearless”because he was acting in a pathologically political environment, and many of the decisions he made were followed by highly publicized personal attacks on his character and integrity. Third - he focused on delivering measurable and meaningful outcomes, with a relentless push to transparency.
For me, the main story here is about a high-integrity, humanistic leadership approach coupled with a results-oriented, outcomes-based management style - singularly focused on creating unprecedented and differentiating value for patients and healthcare consumers. It seems ironic that we find one of the most brilliant examples of ‘consumer-obsessed’ leadership in the government-run VA system. Yet, there it is.
I’d like to conclude these notes with a very personal message of gratitude. I would like to sincerely and publicly thank our Veterans for their service and their sacrifice. I had the opportunity to spend the first seven years of my medical career providing care to Veterans at the Bronx VA Hospital in NYC. It was an experience that shaped my perspective and professional trajectory, leaving me with an indelible sense of humanistic mission and purpose.
Until Next Time, Be Well.
Zeev Neuwirth MD
Friends & Colleagues,
As we did last year, we're going to do something a bit different in this final podcast episode of the year. Instead of the regular interview format, I'm going to respond to a few questions that I frequently receive from listeners. I'll be asking and answering these questions (which I discovered is a lot harder than it sounds). This format is also a bit different in that my responses aren't scripted. So, this episode is a bit more informal and unfiltered. And my responses are, by no means, comprehensive.
What we'll cover will include:
The forces and factors that have shaped American healthcare in 2019, and will continue to be the predominant market forces in the next year and in the coming decade.
Some of my healthcare disappointments of 2019, and hopes for the coming year.
A few highlights from our recent podcast episodes this year. The 'must-listen-to' podcasts. (Spoiler alert: They're ALL 'must-listen-to' podcast episodes. Otherwise, I wouldn't post them).
A brief comment on why I'm producing this podcast series and why I wrote and published a book this year, Reframing Healthcare - a Roadmap for Creating Disruptive Change.
A couple of 'best-advice' comments I've heard this year - year-end thoughts...
We will kick-off the 2020 podcast season on Jan 16th. Our first interview is with Secretary David Shulkin MD. Dr. Shulkin served as the Undersecretary of Health within the Obama Administration and then as the 9th Secretary of Veterans Affairs in the Trump cabinet. He recently published an enlightening and engaging book on his experience. Reads a bit like a novel. He's a tremendous healthcare leader and will share his unique insights with us all.
Finally - I want to express my gratitude to you all - for your support & encouragement. Truly appreciate your feedback. Please keep emailing and messaging on LinkedIn and Twitter. And, also, please continue to share the podcast and the book, Reframing Healthcare, with your colleagues.
Wishing you and yours - Happy Holidays and a Happy & Healthy New Year!
Until Next Year, Be Well!
Dear Colleagues & Friends,
Have you ever thought of transportation as an integral part of healthcare?
Have you heard the term “transportation desert” used to describe our inner-city, suburban & rural communities?
Are you aware that the literature demonstrates a direct link between the availability of non-emergency medical transportation (NEMT) and outcomes such as missed appointments, medication adherence, patient safety and healthcare savings?
During the interview with Megan, I was surprised by my own lack of understanding of how important NEMT is as a major contributor to the health outcomes and well-being of our patients and the populations we serve.
Megan herself admits that, prior to joining Lyft, she did not appreciate the profound impact and importance of NEMT, despite having more than 20 years of experience in the healthcare industry. Now, it is her entire focus. Megan Callahan is the VP of Healthcare at Lyft. Prior to her current role at Lyft, Megan served as the Chief Strategy Officer at Change Healthcare. Before that, she served as SVP of corporate strategy and business development for McKesson Technology Solutions, where she oversaw enterprise strategy, business development and M&A for their $3B healthcare IT business. She holds a Masters in Public Health from UCLA.
In this interview you’ll hear:
Why Lyft is in the business of healthcare, and why healthcare is a growing business within Lyft.
How Lyft delivers transportation to patients through health plans & hospital systems - which differs from the commercial approach we’re used to as individual customers.
The negative impact of inadequate transportation on healthcare and health; and the important role Lyft plays in the NEMT ecosystem - in terms of lowering costs, improving safety and providing more personalized care.
The rapidly expanding role of Lyft in state Medicaid programs, commercial Medicare Advantage programs, and in leading integrated healthcare systems across the country.
Here are some key points I came away with from this enlightening conversation with Megan:
First - transportation is one of the cornerstones of the ‘social determinants of health’ which are the major non-clinical drivers of health outcomes, accounting for over 60% of health outcomes in our country. As Megan emphasizes, the lack of transportation in healthcare has negative, even devastating, consequences for patients as well as for healthcare delivery systems.
Second - although transport to medical appointments is the major reason healthcare systems & health plans utilize Lyft’s services, studies have demonstrated that the vast majority of demand and usage by elderly patients are for trips to the pharmacy, grocery store and to community and family social events. This should come as no surprise given that food insecurity and social isolation are two social determinants that are epidemic in our country and across the globe.
Third - in addition to the concrete value proposition Lyft is offering - the transport of people to medical appointments - there is another set of deeper emotional and existential issues that Lyft is solving for. Toward the end of the interview, Megan shares a story of a woman with breast cancer who was immunocompromised due to the chemotherapy she was receiving. This woman was using a traditional shuttle transport to get her to the doctor’s appointments. Because of the ride-sharing, it was taking her two hours each way to get to an appointment! And, because she was being transported with other patients in the shuttle, she was at high risk for infection because of her immunocompromised status. When she was able to obtain a Lyft transport through her health plan, her travel time decreased to just 20 minutes and she was able to secure an individual ride. Megan’s telling of this story is heart-warming and illustrates not only the clinical but also the human and emotional impact that high quality, reliable and customer-oriented NEMT can have on patients and patient care.
I leave you with a bit of a reframe on the work that Lyft is doing. It’s as much about the human touch - about human dignity, decency and empathy, about human connections and relationships - as it is about the new technologies and business models that Lyft is bringing into healthcare. Having spent some time getting to know Megan Callahan I believe she would fully agree with me on that.
Until Next Time, Be Well.
Dear Colleagues & Friends,
I recently heard Adina Friedman, the CEO of NASDAQ, give a talk on what it means to be a free, open and efficient marketplace. Her main message was that a free and open marketplace has two requirements: ‘certainty of product’ and ‘certainty of price’. What struck me about her talk was how healthcare delivery, for the most part, meets neither of those requirements.
Healthcare leaders and economists have repeatedly described how the healthcare delivery system in our country seems ‘perfectly designed’ to be ridden with inefficiencies, frustrations and opacity. Our guest this week, Dr. David Berman, is keenly aware of these realities. He has practiced medicine for over 30 years. Over the past couple of years he has been putting together a start-up company, ‘Slingshot Health’, whose purpose is to reduce the opacity and friction in the healthcare system. As he puts it, the goal is to “create an open, two-sided marketplace in healthcare - where you put the patients and the providers back in control of what they both want.” It’s an ambitious goal, but Dr. Berman brings a very practical solution to the lack of price transparency, affordability and accessibility in healthcare.
Dr. Berman is a gastroenterologist and hepatologist who trained at the University of Pittsburgh Medical Center. He is a highly accomplished physician & has published and spoken extensively on his subspecialized area within hepatology. He is also a savvy and successful entrepreneur - having built a thriving, multi-specialty practice in Manhattan.
What you’ll hear in this interview includes:
The solution Slingshot Health is deploying.
How Slingshot Health adds more provider supply and capacity to healthcare without any increase in cost to the market.
How Slingshot Health solves a major challenge for providers, which is the significant percentage of unfilled appointments that go to waste each day.
Slingshot Health’s rapid and expansive growth.
There are a number of things I deeply appreciate about Dr. Berman, and the approach he and his colleagues are taking. First, he has been in the private practice environment for decades and intimately understands the day-to-day challenges and frustrations of providers and patients. Second, his approach is not a complicated bureaucratic schema; but instead a simple solution to the complex issues of convenient access, cost and price transparency. Third, I love the fact that it’s a win:win for both patients and providers. Patients win because they are able to obtain timely access to medical care, at a reduced cost. The average selected wait-time to appointments for patients who use Slingshot Health is 4 days, compared to the national statistic that it can take, on average, 3 to 4 weeks to obtain a medical appointment. Providers win because they get to fill their unused appointment slots each day. Somewhere between 10 to 20% of provider appointments go unfilled each day, which harms both patients as well as providers.
Slingshot Health is inserting choice and self-determinism back into the healthcare marketplace. It is fulfilling the efficient marketplace requirement of ‘certainty of price’ that I referred to above. Dr. Berman is clearly a mission-driven physician and entrepreneur. But, he’s also a very down-to-earth business person. From my perspective, his company is a wonderful mix of both mission and margin. It is a manifestation of what an open, transparent and efficient market can offer to patients, providers and our healthcare delivery system.
Now, nothing is perfect and I’m not suggesting that Dr. Berman’s start-up is the answer to the larger access, cost and transparency dilemmas plaguing our healthcare delivery system. And I’m not suggesting that it will address the larger issues of disparity and inequity, or the social determinants of health. But, it does solve some very real and specific problems. And it does it in a consumer-oriented, value-enhancing way.
I’ll leave you with a quote from this interview which captures the pragmatic American idealism that Dr. Berman and his colleagues are attempting to manifest in their efforts.
“Slingshot Health is democratizing healthcare - giving the individual back their voice and their vote in their healthcare destiny. No longer do you have to beg for what you need, but now you have direct, no risk access to what you want - at no extra cost.”
Until next time, be well.
Zeev Neuwirth, MD
Colleagues & Friends,
This is, by far, the best discussion I’ve ever had about the value of social media in transforming healthcare. In a time in which we are constantly being reminded in the news about the downsides of social media, this episode highlights the humanizing and democratizing aspects of social media, with platforms such as Twitter and LinkedIn.
Our guest today is Colin Hung. Colin is a healthcare IT professional turned healthcare marketing executive, turned social media guru. His career has been dedicated to using digital technologies, social media platforms and community organizing to improve healthcare. Over the last decade, he has helped numerous companies build and market solutions that improve patient safety, patient-provider communications and the patient experience. Colin has also co-founded one of the most popular healthcare Twitter communities – #hcldr – which brings together patients, clinicians, healthcare administrators and leaders as well as policy & governmental influencers. He has been selected as a HIMSS (Health Information & Management Systems Society) Social Media Ambassador three times and is internationally recognized as one of the top HealthIT Social Media Influencers. His work has been published in medical journals and he writes regularly for Healthcare IT Today and HITMC (Healthcare IT & Marketing Community).
In this interview we'll discuss:
Colin’s discoveries regarding the benefits of social media - from being a source of expert information, to a platform for sharing diverse perspectives, to a powerful form of community building.
Colin’s views on social media as a vehicle for humanizing & democratizing healthcare - for both patients and providers.
The connecting and community organizing phenomena of Twitter chats, particularly the #hcldr twitter chat that Colin and his colleagues hold weekly.
How organizations such as the Mayo Clinic and the Cleveland Clinic are using social media to create clinically-informed, patient-led, open forum communities.
Colin’s understanding of healthcare social media is profound. Although he is an expert in information technology, healthcare marketing and social media, his focus is on the importance and value of connecting - connecting people, connecting ideas, connecting streams of work - and creating synergies through those connections. His work aims to empower and enable the professional development of those attempting to improve, innovate and transform healthcare. His desire is to create empathy. And although these connections and communities lead to concrete progress in the realm of product design and business development, he also sees the inherent value of human connectivity as being a primary goal, in and of itself.
Colin is a remarkable ‘servant leader’ - a guide and mentor who is focused on helping others advance in their personal and professional journeys. The one trait that he emphasizes as being critical to participation in social media is “being open to being changed by the conversations and communities you connect with online”. It’s a lesson in humility, diversity and acceptance. The world of social media allows us to go beyond the confines of our limited, and limiting, social and professional circles. It empowers us with information, expertise and divergent perspectives that we would otherwise not be exposed to. It releases us from the isolation and insularity that we can experience in our day-to-day lives.
My call to action is for you to engage on a social media platform, if you haven’t already. Try just one Tweet or one LinkedIn message this week! Or, if you’re more adventurous, please join a tweet chat like the #hcldr that Colin introduces us to in this interview. It’s at 8:30 PM EST every Tuesday night. Hope to see you there!
Until next time, be well.
Zeev Neuwirth, MD
Colleagues & Friends,
Chronic disease management has become the predominant healthcare issue of our time. The vast majority of medical encounters and healthcare dollars are spent on the diagnosis, treatment, and management of chronic disease. Despite the staggering negative impact, we continue to treat chronic disease within an episodic, reactive, generic and largely ineffectual care model. It’s a reflection of a healthcare delivery approach that is simply out-dated and poorly aligned with the societal and healthcare consumer needs at hand.
Our guest this week, Dr. Jennifer Schneider, and her colleagues at Livongo, are ushering in a “new era” in healthcare delivery. Livongo is a healthcare start-up with cutting-edge digital and machine-learning technology whose mission is to “empower people with chronic conditions to live better and healthier lives.” Dr. Jennifer Schneider is the President of Livongo and previously served as the company’s Chief Medical Officer. Prior to Livongo, she held several key leadership roles at Castlight Health, including as its Chief Medical Officer. Dr. Schneider is also the author of the recently published book, Decoding Health Signals: Silicon Valley’s Consumer-First Approach to a New Era of Health, which explores how companies are using big data analytics and artificial intelligence to reinvent care delivery for people with chronic conditions. Dr. Schneider has a Doctor of Medicine degree from Johns Hopkins School of Medicine and a Master of Science degree in Health Services Research from Stanford University.
In this interview, you’ll hear about:
Applied Health Signals - the new category of chronic condition management Livongo has pioneered - which uses data-driven, machine-learning algorithms to deliver continuous, real-time, actionable, and personalized clinical insights.
Dr. Schneider’s perspective on this new era of “human-first experience” and “whole person” care in which the locus of chronic condition management is shifting from the provider’s exam room to the healthcare consumer’s life.
How Livongo is reducing the “noise” in healthcare delivery - that is, reducing the frustration, friction and complexity of the patient care experience.
Some of the clinical efficacy outcomes that Livongo has demonstrated in peer-reviewed publications.
What I especially appreciate about Jennifer’s perspective and Livongo’s human-centered, consumer-oriented philosophy is the understanding that the primary goal of clinical care is not in deploying technical wizardry, but in solving the ‘pain points’ for individuals with chronic disease. Livongo's focus is on understanding people’s unique needs, preferences and goals, as well as continuously ‘machine-learning’ how to customize communication in order to optimize engagement and motivate healthful behaviors.
Once you hear about Livongo’ s model, I suspect it will become clear that this approach to chronic condition management is far superior to anything offered in our current medical models. The simple fact that Livongo’s technology stack is collecting multiple points of health-related data throughout the day, aggregating and interpreting that information, and then using it to communicate in real-time and in a personalized way, is so far ahead of where we are today in clinical practice.
Livongo is creating and deploying a major reframe of healthcare delivery - humanizing healthcare, by unleashing the profound value of the patient as the most pivotal member of the healthcare team. From a provider’s perspective, I firmly believe that this is a welcome enhancement of the role that physicians and other providers play in the chronic disease management ecosystem. As Dr. Schneider, who has managed her own Type I diabetes for the past 30 years, puts it, “The idea that the doctor or any other healthcare provider is in charge is really erroneous. It’s really the individual person living with that chronic condition, and great doctors understand that!
Until Next Time, Be Well!
Zeev Neuwirth, MD