Colleagues & Friends,
You may not have heard of Renown Health - a moderate-sized healthcare system in northern Nevada - but once you hear how they are reframing healthcare - literally redefining and reorganizing healthcare delivery, I suspect that you’ll not forget them.
Our guest this week is Dr. Anthony Slonim, President and Chief Executive Officer of Renown Health in Reno, NV. Over the last four years, he and his colleagues have created one of the most innovative and progressive health services organizations in the country. Dr. Slonim is a nationally recognized thought leader. Modern Healthcare has named him one of the “50 Most Influential Clinical Executives” of 2019. He has also been named a “Physician Leader to Know” every year, since 2014, on the Becker’s Hospital Review. A board-certified pediatric intensive care doctor by training, Dr. Slonim has authored more than 15 textbooks and published more than 60 academic journal articles. Before joining Renown Health, Dr. Slonim served in executive leadership roles at Barnabas Health in NJ, Carilion Clinic in VA and Children’s National Medical Center in DC. Dr. Slonim currently chairs the American Hospital Association’s Systems Council, representing more than 300 integrated health systems nationwide.
In this episode you’ll hear about:
How Dr. Slonim caught the healthcare industry’s attention by launching the Healthy Nevada Project®, the first population health initiative that combines genetic, environmental, social and clinical data to address individual and community health needs.
The reorganization of the Renown Health system into two major divisions - a ‘health’ division addressing preventive, population-based, public health needs; and a ‘healthcare’ division comprised of acute care facilities and chronic disease management providers and services.
Why Dr. Slonim believes that the doctor’s prescription pad is a metaphor for the constraints of our system and what a better “prescription” for care looks like..
How Dr. Slonim’s background in public health, combined with his own long-term experience as a patient, shaped his perspective and his approach to healthcare delivery.
There are a number of things that stand out about this interview. First, Dr. Slonim brings a great depth of clinical AND public health expertise to the perspective of a healthcare CEO, which is a rarity. Second, his thinking and approach are scientifically based, consumer-oriented, brilliantly logical, and elegantly simple. Third, he is laser focused on the needs of his patients, consumers and community. Dr. Slonim and his leadership team recognize that there are two fundamental, vastly different, value propositions that are required to care for communities. So they set about to restructure their system and redeploy the appropriate resources to deliver on those two value propositions. Their goal is to improve health through proactive community-based prevention, while creating the best healthcare system for those with acute and chronic disease. Once I heard Renown’s strategy and approach, I was left wondering why other hospital systems in the country aren’t immediately following suit.
From my perspective, Dr. Slonim and his colleagues are brilliantly executing the steps of the Reframe Roadmap - reorienting their approach; redefining the problems from the primary perspective of patients and community; rebranding their value proposition to meet those needs; redesigning their healthcare delivery for results that matter to people; reorganizing their healthcare system to optimally deliver on those results; and importantly, redirecting their strategies, tactics and resources to make it all happen.
What resonates the most, however, from this interview is the profound sense of empathy Dr. Slonim has for the people he serves. He shares that the biggest lesson he learned from his own cancer diagnosis and treatment was about the inequities and disparities of healthcare in our country. The lesson he learned wasn’t about himself, but about others. That speaks volumes about how his mind and heart work. His goal and the goal of Renown Health is clearly to humanize healthcare. To make it less complex and less reactive. To make it more convenient, customized and accessible. To make one of its prime purposes the prevention of illness and trauma. To make it what people want and need in order to stay healthy and return to health.
Again, why aren’t more healthcare leadership teams learning from and emulating this approach?
Until Next Time, Be Well.
Zeev Neuwirth, MD
For decades, Geisinger Health has been one of the most innovative healthcare systems in the world. It’s efforts are not only admired but also emulated and replicated throughout healthcare systems across the country. It is a literal mecca for healthcare leaders to come visit and learn. I’ve had the good fortune of visiting Geisinger at least four or five times over the past few years, and I will tell you that the initiatives, accomplishments and outcomes become more fascinating with each visit.
In this interview, we have the great fortune of learning from Dr. Karen Murphy, Executive Vice President and Chief Innovation Officer at Geisinger. Karen brings a tremendous business, policy and innovation background to this role. Before joining Geisinger, she served as Pennsylvania’s Secretary of Health addressing the most significant health issues facing the state, including the opioid epidemic. Dr. Murphy previously served as Director of the ‘State Innovation Models Initiative’ at the Centers for Medicare and Medicaid Services leading a $990 million CMS investment designed to accelerate health care innovation across the United States. Dr. Murphy earned her MBA from Marywood University; her doctorate in business administration from Temple University Fox School of Business; and she also holds a diploma in nursing from the Scranton State Hospital School of Nursing.
In this interview you’ll hear Karen’s take on:
How Geisinger has defined ‘innovation’, and the significant resources they’ve put into their innovation efforts.
The “4 pillars of Innovation” at Geisinger Health, and the specific initiatives within these pillars - including the virtual “Chronic Disease Management Command Center” and their highly successful “Hospital at Home” program.
How Geisinger is using artificial intelligence, machine learning and predictive analytics to proactively prevent disease.
Why and how Geisginer is making heavy investments in Behavioral Economics and Behavior Change technologies.
What Karen believes to be two of the most significant challenges to innovation in healthcare.
There are few healthcare organizations across the country that have the long, broad and brilliant track record of healthcare delivery innovation synonymous with Geisinger. It’s a legacy that is a direct function of the visionary, patient-centered leadership they’ve had - beginning with Dr. Glenn Steele, then Dr. David Feinberg and now Dr. Jaewon Ryu. In this interview Karen Murphy gives us a vivid and comprehensive picture of the innovation landscape at Geisinger. She’s keen to point out that innovation is embedded in the DNA of the organization and exists well beyond the boundaries of the Steele Institute that she leads.
There are numerous lessons to be gleaned from this highly informative dialogue. Karen outlines a highly strategic and practical approach to large-system innovation. In the last few minutes of the interview Karen makes a strong case for why “accelerated innovation” is critical to healthcare these days. She reminds us, first, of the unsustainable costs of our current healthcare system. But she then also points out that while payment reform is critically important, without the advanced clinical models that can deliver value-based care, payment reform and other policy changes will not create the positive outcomes we’re all looking for - from the provider perspective, the payer perspective, and most importantly the patient perspective.
Until Next Time, Be Well.
A lot has been said about the application of Artificial Intelligence (AI) to healthcare. These discussions typically center on AI’s ability to improve diagnostic accuracy, reduce medical errors, lower healthcare costs, enhance productivity, and even replace providers. We will cover some of that ground as well, but our guest’s perspective takes the discussion far beyond those more familiar topics. His firm belief is that the major impact AI could have on healthcare delivery would be to restore “the human bond, the human touch, and the human factor that has been lost.”
This is a unique opinion, but not surprising, given the source. Dr. Eric Topol is a leading global authority on Precision & Personalized Medicine. He is also one of the most outspoken physicians I’ve ever encountered on the issue of patient advocacy, and in his own words, “patient activism.”
Dr. Topol is the Founder and Director of the Scripps Research Translational Institute. Prior to assuming his leadership role at Scripps in 2007, he led the Cleveland Clinic to become the #1 center for heart care in the country. He is a nationally renowned cardiologist and literally a superstar in the world of academic Medicine, being one of the top ten most cited medical researchers. He has been elected to the National Academy of Medicine and was voted the #1 most influential physician leader in the United States by Modern Healthcare. In 2016, Dr. Topol was awarded a $207M grant from the NIH to lead a significant part of the Precision Medicine (All of Us) Initiative - one of the largest NIH grants ever awarded. As if all of this wasn’t enough, he has published 2 bestseller books on the future of medicine: The Creative Destruction of Medicine & The Patient Will See You Now. His most recent book, Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again, was published this year.
The issues we’ll cover in this interview include:
Dr. Topol’s perspective on the “shallow medicine” being practiced today and how it harms patients as well as providers.
The various applications of AI to healthcare, and Dr. Topol’s take on the most mature and proven applications of AI in Medicine today.
The most significant benefit of Artificial Intelligence in healthcare - “the gift of time” and how it can revitalize and rehumanize medical care - for both patients and providers.
The challenges, hurdles, and risks we face in further developing and deploying AI-enabled healthcare.
Dr. Topol’s refreshing perspective on the characteristics of the ideal medical student, and the relational characteristics we should encourage and support in healthcare providers.
What you’ll come away with from this interview is an understanding of how Artificial Intelligence has the potential to elevate the profession of Medicine - not just through the enhancement of diagnostic accuracy, reduction of errors, lowering of costs and a literal leapfrog in efficiency. But, more importantly, through its ability to free up providers’ time and attention, so they can focus on being empathetic experts, guides & teachers. It is this that will restore the human bond that is so sought after in healthcare delivery today. Dr. Topol is keen to point out that this is as much a “gift” to providers as it is to patients.
If you listen carefully, you’ll also hear Dr. Topols ‘call-to-action’. He urges us all to become “patient activists” because the future of healthcare is by no means a certain or secure one. He believes that we collectively have the ability, and the responsibility, to assure that the future of healthcare is a hopeful and healing one.
I read Dr. Topol’s book, Deep Medicine, and I would urge you to as well. It’s an enlightening and important read. Listening to him speak in this interview, however, gave me an even deeper sense of his integrity, his vision and his humanism. Dr. Topol is, to my mind, one of the greatest physicians, medical researchers, scholars and healthcare leaders of our time. But, what makes him even more unique is the fierce and sustained sense of patient advocacy and humanitarianism that he brings to Medicine & healthcare delivery. This interview left me with a renewed sense of responsibility, purpose and hope, and a strong desire to reframe healthcare - from a shallow to a Deep Medicine.
Until next time, Be Well.
Zeev Neuwirth, MD
Colleagues & Friends,
This is the final episode of this exciting Spring 2019 podcast season. I can’t imagine a more engaging interview to conclude with - one that truly exemplifies the purpose of ‘Creating a New Healthcare’.
Our guest this week, Dr. Stephen Klasko, was recently ranked #6 in Modern Healthcare’s Top 50 ‘Most Influential Clinical Executives’. Last year, in 2018, he was ranked #2 in Modern Healthcare’s Top ‘100 Most Influential People in Healthcare’. In 2018 he was also recognized as #21 in Fast Company’s ‘100 Most Creative People in Business’, as well as being awarded Philadelphia Entrepreneur of the Year. Dr. Klasko, an obstetrician who has been the dean of two medical schools, is the President & CEO of Philadelphia-based Thomas Jefferson University and Jefferson Health. In this role, Dr. Klasko leads one of the nation’s fastest growing academic health institutions. His six year tenure has been based on a vision of re-imagining the future.
This interview was, by far, the most fast-paced I’ve experienced. It was a deluge of highly innovative initiatives and programs. A few of the items you’ll hear discussed include:
The consumer segmentation and customization approach that Jefferson Health is taking - moving away from a 'one-size-fits-all' model of medical care experience.
How Dr. Klasko radically introduced telehealth to Jefferson Health in 2013 - making it mandatory in every clinical division.
The innovative way that Jefferson Health is reducing inappropriate ED visits within its own self-insured workforce.
The “Healthcare with No Address” approach that is completely reframing where and how people will receive and experience healthcare at Jefferson.
The digitally-enabled, consumer-oriented initiatives such as the “match.com” app for young women seeking an obstetrician.
The ground-breaking partnerships Jefferson Health has made, including one with the third-leading ‘fashion & design’ university in the country.
Some of the entrepreneurial ventures Jefferson Health is engaged in, including a hemp-based wearable that Dr. Klasko believes will usurp Apple Watch’s biometric monitoring.
Dr. Klasko is one of those courageous leaders who understand that we need to quickly catch up with other industries in terms of treating people like valued customers and respected consumers. I say “courageous” because he not only understands it, he demands it. He also understands that we need to customize care, not by disease or payment, but by patient needs and preferred engagement. He and his colleagues are attempting to wrap healthcare around patients rather than forcing patients to wrap themselves around the healthcare system. He is unapologetic in repeatedly pointing out how the current system is grossly inadequate. And rather than demonize new entrants and disruptors, he embraces them - partnering, learning, emulating and synergizing.
From my perspective, Dr. Klasko is nothing less than a healthcare revolutionary. It is a bit ironic that he is the leader of a healthcare system whose namesake was an American revolutionary and one of the founding fathers - President Thomas Jefferson. I have to think that President Jefferson would have greatly appreciated and approved of the legacy that Klasko is creating. This moment in healthcare history is a revolutionary inflection. As Dr. Klasko states, “It’s important for CEO’s and others to recognize that when an industry is going through a once-in-a lifetime change, the absolute biggest risk is doing things the way you did them before.” I can’t think of a better note or more important call to action on which to end this season.
I hope you’ve enjoyed this remarkable Spring 2019 season of ‘Creating a New Healthcare’. From my perspective it’s been an extraordinary line-up. I would encourage you all to take the next couple of months to catch up on episodes that you might have missed. It’s essentially a Masters Class series in healthcare innovation, entrepreneurship and leadership. We will resume the podcast in early September and have another amazing lineup in store for you!
Until then, Be Well!
Zeev Neuwirth, MD
Dear Friends & Colleagues,
The promise of real-time health information connectivity and coordination of care has been elusive. That is, until now. Jay Desai, co-founder and CEO of a company called ‘Patient Ping’, has created a platform that allows for real-time notification of a patient encounter in any healthcare facility or home care. Even more revolutionary, the platform delivers bi-directional information automatically.
The need for this type of connectivity is obvious to healthcare professionals and organizations that are accountable for the quality, safety, appropriate utilization and cost effectiveness of care delivered. Part of the challenge for providers is that approximately 30 to 50% of healthcare costs incurred by most integrated delivery systems is actually from clinical care delivered outside of the home system. This percentage is higher for independent provider groups and systems in highly competitive markets. That means that even in the best of integrated delivery networks, there is already a 30 to 50% ‘accountability handicap’.
Prior to co-founding PatientPing in 2013, Jay Desai worked at the CMS Innovation Center (CMMI) where he helped develop Accountable Care Organizations (ACO’s), bundled payments and other value-based initiatives. He has an MBA in Healthcare Management from the Wharton School of Business at the University of Pennsylvania, and a BA from the University of Michigan.
Jay's professional passion lies at the intersection of technology, policy and community. He first discovered the need for real-time, cross-institutional connectivity when he was at CMS. Provider groups were asking CMS for some way to ‘know’, in real-time, when and where their patients were receiving clinical care. These systems needed to know so they could intervene and prevent unnecessary, as well as potentially, harmful tests and procedures. They needed to know so they could follow-up when their patients were discharged from another institution. It's a critically important issue for patients and providers - and this is where Jay Desai and PatientPing come in…
In this interview we’ll discuss:
The two major offerings of PatientPing - the “ping” notification that tells you where your patients are; and the “stories” which tell you where your patients have been.
The different ways healthcare systems are utilizing PatientPing to communicate between hospital-based care/case managers, ambulatory care medical homes, emergency departments, nursing homes and home health services.
The remarkable outcomes demonstrated with the PatientPing platform, and how they are achieving those results.
PatientPing’s customizable “consumer grade user-experience”,as well as the enhancements they're making.
PatientPing is designed to not only respond to the needs of accountable providers and organizations. It’s also designed to create healthier ‘communities of care’ – to enhance the complex inter-dependencies of the clinical ecosystem. The data PatientPing is collecting is beginning to demonstrate that avoidable healthcare utilization across communities is decreasing: lower avoidable emergency room visits, hospital admissions and nursing home days - all of which leads to better care at lower costs.
There is more than one value proposition PatientPing offers. The embedded analytics will also reveal care patterns - allowing systems and communities to better understand where patients are going, and allow for more proactive preventive care. Another easily overlooked value proposition is the user experience. The information PatientPing relies on was already there beforehand. They’ve simply made it more accessible to providers of care. As Jay points out, it’s analogous to the situation with Google Maps. The GPS data was already present when companies like Google and Waze made it easily accessible and usable for the consuming public. PatientPing has done something very similar with the data in the Health Information Exchange network and the health information locked up in proprietary electronic medical records. They’ve made this information accessible and consumer-friendly for providers of care - across and between institutions and practices. It may be a simple concept but the impact and value proposition is profound. It’s going to assist providers and patients with better communication, better integration and better coordination of care. It’s going to make healthcare delivery more seamless and safe. And, who wouldn’t want that?
In 1950, medical information doubled every 50 years. It’s been estimated that, in 2020, it will take only 73 days for medical knowledge to double! This is not surprising given that a new biomedical journal article is published every 26 seconds! It is clear that we will need tools to manage and synthesize all of this data, and that’s where the clinical decision support (CDS) comes in.
Our guest today is Dr. Scott Weingarten. Dr. Weingarten recently joined Premier Inc., retaining his role as CEO of Stanson Health - a clinical decision support company he founded approximately 6 years ago. Prior to joining Premier Inc., Scott was the Senior Vice President and Chief Clinical Transformation Officer at Cedars-Sinai Hospital. In addition to his long-standing tenure as a practicing physician and executive, Scott is also a serial entrepreneur and inventor - holding three software patents. Prior to forming Stanson Health, Scott co-founded Zynx Health, a highly successful leader in ‘order sets’ and ‘care plans’ for electronic health records.
In this interview Scott will share:
The demonstrable positive impact of CDS on organizational quality and cost - resulting from marked improvements in appropriate utilization of lab tests, imaging studies and medication prescribing.
The sophistication of today’s CDS technology that results in the provision of real-time, patient-specific, evidence-based recommendations.
The vast breadth of clinical situations and conditions for which Stanson Health has created evidence-based clinical decision supports.
The specific benefits for practicing clinicians: offering providers performance data on how they compare to their colleagues and to evidence-based standards.
The highly sophisticated analytic approach Stanson Health takes to streamline and optimize clinical alerts embedded in the electronic medical record - removing a substantial percentage of “low value alerts” - what Scott calls “pruning the tree”.
I went into this interview understanding CDS as a tool to enhance clinical practice - improving providers’ and organizations’ ability to meet quality goals, as well as optimize utilization of tests and treatments. I came out of this interview believing that CDS is not only a basic necessity if we are going to practice safe, high quality medicine; but, that it's also one of the most profound technologies shaping medical practice - fundamentally changing the way providers & patients will experience clinical encounters in the future.
Imagine when a care provider will be able to dialogue with a patient, supported by natural language processing software and sentiment analysis, feeding the artificial intelligence that will be making real-time, evidence-based, customized recommendations for that individual patient. This reality does not seem that far off, and I suspect Scott and Stanson Health are moving rapidly toward that day. Imagine how liberating and humanizing that would be - allowing providers and patients to really communicate and engage with one another, with technology aiding that human-to-human interaction rather than interfering with it.
The take-home point is that Clinical Decision Support is not just about meeting quality metrics or reducing inappropriate testing and prescribing. CDS is not just about assisting providers in consistently delivering up-to-date, evidence-based medical care. CDS is not just about reducing unnecessary costs of care. The purpose of CDS, as I understand it now, is to make healthcare more accessible, affordable, effective, personalized and relationship-oriented. The highly informed perspective, and the picture that Dr. Scott Weingarten paints for the future of healthcare is, indeed, a bright one. His is a hopeful and realistic message, and one that is well worth listening to.