Newsletter
Creating a New Healthcare

Creating a New Healthcare

A podcast series for Primary Care Physician leaders who are looking for fresh perspectives, new solutions and inspiration in their journey to advance value-based care.

Latest From Series

Episode #122: The Home is where Healthcare is Heading, with Raphael Rakowski – Founder & Executive Chairman, Medically Home

Friends,With the onslaught of the Covid-19 pandemic, numerous hospital systems across the country rapidly adopted the hospital at home model in an effort to deal with overcapacity.  Many systems are planning to continue this service - even after the pandemic. The reasoning is simple. It’s a much lower-cost alternative. It’s much more personal and customized care. It’s a lot more convenient and comfortable for patients and their families. And, it’s going to be a major clinical delivery approach in the future; a major source of revenue, as well as a source for patient growth and retention.Our guest today, Raphael Rakowski, is one of the most significant entrepreneurial leaders in this rapidly advancing and transformative trend in healthcare delivery.  In 2010, years before most of us even heard of it, Raphael Rakowski led a team of engineers and clinicians in the creation of Clinically Home, the first commercially scalable model to enable safe hospitalization at home. In 2017, Raphael and his team created a next-gen version called Medically Home and joined forces with Atrius Health (a large multi-specialty medical group in eastern MA) to bring the program to market.  In 2020, after his role as CEO & Founder, Raphael was named Executive Chairman of Medically Home Group, Inc.  Medically Home operates in over 15 states at the time of this interview with a large number of strategic partners, and has most recently partnered with the Mayo Clinic & Kaiser Permanente.  In this episode, we’ll learn about:Why - according to Raphael - the financial and business model for facility-based hospital care is misguided, misaligned and maladapted to the needs and safety of patients and their families.Why the shift to decentralized healthcare is necessary if we are to have a sustainable system, and how it’s consistent with the path that other industries, such as banking and retail have taken.The four operational pillars that allow Medically Home to deliver a much higher acuity level of care in the home than other ‘hospital at home’ models.The superior outcomes that Medically Home is achieving compared to traditional facility-based hospital care.How Medically Home is addressing some of the challenges in delivering high acuity care in the home setting.According to Raphael, the reason facility-based hospital care is suboptimal is that it has been fashioned like an industrial factory. He backs up his statements with powerful observations, compelling data and intelligent reasoning. For example - according to Raphael, 65% of hospital costs are due to the fixed costs of their bricks and mortar infrastructure. This overhead creates a “tax on care”, leaving only 35% for medical care. On the other hand, the cost savings Medically Home is achieving are about 25%.  Patient satisfaction is at or above hospital levels. Mortality and morbidity reductions are 10%, and fall rates and infection rates are dramatically better than facility-based hospitals.Raphael also reframes our notion of acute care and post acute care.  As he puts it, “The point of the Medically Home model is that you’re reliably integrating three things that should never have been siloed - acute care, post-acute care,and population health… There is no such thing as post-acute care. It was invented as an artifact of reimbursement. You should be cared for by the same care team until you’re not sick anymore.  This is one of the reasons for the high readmission rates we see in hospitals across the country…  We combine these together in a single episode called “stay with the patient until they’re well and you understand what it will take for them to stay well…”  At the present moment, the home-based care market in the US is approximately $140B in revenue, and predicted to grow to over $200B within the next 4 to 5 years. One can view this rapidly emerging home-based care market as a threat to hospital systems - or, as an opportunity.  For those hospital systems willing and capable enough to be early entrants - it is a huge opportunity to diversify their business models and revenue stream, and to de-risk the unprecedented market disruption that is almost certain to occur this decade. From a mission-based perspective, it is an opportunity for our healthcare systems to do what we need them to do: improve care and care outcomes, lower costs, and provide a more compassionate and convenient care experience.Until Next Time, Be Well.Zeev Neuwirth, MD
October 6, 2021

Episode #121: A ‘Master Class’ in building a healthcare consumer experience company – with Glen Tullman, Executive Chairman & CEO of Transcarent

Friends,This interview is about an organization that is creating a new healthcare category, and whose purpose is to solve the employer healthcare dilemma. But even more fundamental than that, they’re attempting to solve the core struggles that all healthcare consumers are facing. Glen Tullman is the Executive Chairman and Chief Executive Officer of Transcarent.  Tullman is the former Executive Chairman, Chief Executive Officer, and Founder of Livongo Health  He previously led two other public companies that changed the way health care is delivered - Allscripts and Enterprise Systems. Tullman is also a Founding Partner at 7WireVentures, a socially-minded venture capital fund. He is the author of ‘On Our Terms: Empowering the New Health Consumer’.  Glen was honored in 2019 with a Robert F. Kennedy Human Rights Ripple of Hope Award for his career focused on improving the safety, empathy, and efficiency of our healthcare system. He also serves as a Chancellor to the International Board of the Juvenile Diabetes Research Foundation and as a Board Member and incoming Chairperson of the American Diabetes Association.In this episode, we’ll learn about:The lack of alignment between payers, PBM’s, healthcare systems and employers.  As Glen points out, if employers spend more, payers, PBM’s and healthcare systems make more. How the plethora of digital healthcare companies and apps are contributing to further complexity in healthcare delivery.Why it makes sense for employers to get rid of copays for preventive care and chronic disease management costs.The three things that people want from healthcare and how Transcarent is delivering on those consumer needs.The 5 most common issues/questions that healthcare consumers call Transcarent about.One of the qualities I most admire about Glen is his blunt but eloquent truthfulness. As he puts it - “After 30 years of promises, we have a healthcare system today that is more confusing, more complex and more costly than it’s ever been”. Supporting this statement, he cites the stat that the average self-insured employer must hire 14 different companies to assist in providing healthcare to their employees.  His solution to curtailing the complexity and confusion is to shift from fragmented point solutions to adopting the approach of other industries - which places the consumer in the driver’s seat, provide ease of use, 24/7 access and low cost.Transcarent isn’t just focused on building a ‘digital front door’ or ‘digital consumer experience’.  It is a wholecloth transformation of the healthcare experience. It is a leader in a new category - part navigator, part health coach, part telehealth provider, part center-of-excellence referral source. Glen is so obsessed with providing a best-in-class consumer experience/journey that his brand promise is personalized, convenient, unbiased, virtual access to coaches, navigators, and doctors - within a few minutes, 24 hours a day, 7 days a week!What I respect most about Transcarent is not the technical wizardry or their impressive feat of creating a new market category. What I respect most is the unyielding primacy they place on the care of the consumer. For example - despite their ability to deploy chatbots, Glen insists that there be a live person on the other end of the line. He believes that people who seek healthcare want and deserve a live person speaking with them. Transcarent’s approach is “care over costs”, and while this may seem unsustainable, he points out that providing this type of care ends up greatly lowering the overall costs of care. The key to Transcarent’s approach is the alignment of payment with value based care. Unlike most other healthcare stakeholders, Transcarent does not make its money when healthcare costs and prices increase. Transcarent has completely attached its revenue and business model to cost savings. If your business model is to provide an outstanding consumer experience, deliver markedly improved health outcomes and lower overall total costs - then it makes sense to invest upfront in the way that Transcarent is doing. I truly wish more healthcare organizations would manifest the vision, integrity and courage to implement the business model that Transcarent has. It would save a lot of money for our country, corporate America, our states and towns, our families and our citizens.  But even more importantly, it would save a lot of lives. Until Next Time, Be Well.Zeev Neuwirth, MD 
September 22, 2021

Episode #120: A clarion call to eliminate disparities & inequities in healthcare – with Michellene Davis, CEO of the National Medical Fellowship, Inc.

Friends,Welcome back to the first episode of the 2021 Fall season.  We are embarking upon the 5th year of the ‘Creating a New Healthcare’ podcast - and we have an amazing line-up of courageous, bold, entrepreneurial individuals that we’ll be hearing from this season.  In this episode, we have the privilege of speaking with Michellene Davis. The theme of this interview, which was recorded on Aug 4th 2021, is centered on eliminating the racial disparities & inequities in the healthcare profession, as well as addressing the gross disparities in healthcare delivery and outcomes in the US.Ms. Davis is the new President and Chief Executive Officer of National Medical Fellowships, Inc.  Prior to her current role, Ms Davis served as the Executive Vice President & Chief Corporate Affairs Officer at RWJ Barnabas Health, the largest academic medical center system in New Jersey. Michellene has been named among the Top 25 Most Influential Minority Leaders in Healthcare by Modern Healthcare Magazine. Prior to joining RWJBarnabas Health, Ms. Davis served as Chief Policy Counsel to former New Jersey Governor Jon Corzine, where she was the first African American to serve in this position. She was the first African American and only the second woman to serve as Acting New Jersey State Treasurer, responsible for a state budget of over $30 billion dollars. She began her legal career as a trial litigator. In this episode, we’ll learn about:The National Medical Fellowship Inc - the only private organization solely dedicated to providing scholarships to medical and health professions students underrepresented in healthcare.  The tens of thousands of professional alum that have been supported by the NMF since its inception in 1946, including 2 surgeon generals.The leadership development programs and the unique community of support that the NMF offers medical students and fellows.How the NMF directly addresses the elimination of the disparities & inequities in American healthcare through an evidence-based approach. Michellene’s articulation of the purpose and value of the National Medical Fellowship Inc is enlightening. It’s goal, as I now understand it, is three-fold.  First, to break the cycle of inequity in medical education by providing medical students, residents and subspecialty fellows with financial support. The second goal is to not only increase the percentage of doctors who are Black, LatinX and other under-represented ethnicities in medicine; but also to support these students and trainees in advancing as leaders. The third goal is to eliminate the disparities in healthcare delivery and outcomes in our country.Toward the end of the interview, I ask Michellene why she upended her career to make this recent professional shift. Her response - “At the height of the pandemic I watched no less than 30 of my colleagues perish. And when you look at who perished and who are the most vulnerable in our communities... after that I just realized that I am done dying. I am done watching colleagues and communities suffer and die, at the expense of what others would just consider an inconvenience…  And I just am tired of watching the same community members suffer the same reality, when those who are in power are blind to the entire equation… And for me, what shifted was that on this side of Covid, with whatever amount of time I might have left on this planet…  I needed every second of it to truly matter, to address this one ill, to save even one life, and to change the face of medicine. As a result of that, I came to NMF…”Michellene Davis is a leader of rare integrity, honesty and courage. Michellene’s discernment is a litmus of the insidious fundamental wrongs that need to be righted within our healthcare system. Her professional actions and her career trajectory demonstrate a commitment to doing something about it - not talking about doing something - but actually doing something. In my 30 years in healthcare, I have heard countless mission statements & purpose statements - multiple pronouncements about a new day in healthcare. But I have never heard anything as authentic, as meaningful, as resilient, and as full of selfless conviction and integrity as Michellene’s statement of purpose. Her words will ring in my ears and resonate in my soul for years to come.Until Next Time, Be Well.Zeev Neuwirth, MD
September 8, 2021

Episode #119: Curating the Collaboration between Employers & Providers – with Steven Nelson, President of Contigo

Friends,Our guest this week, Steve Nelson, takes us on a journey into a new category of company that is curating the collaboration between employers and providers. It’s an incredibly exciting adventure - actually a leap into the world of value-based care. The insights that he shares provides a lens into where healthcare is going - empowering patients & payers to navigate to healthcare that is appropriate, high quality and reliable. Into this mix are enabling technologies that contribute to the value proposition. It’s an incredibly enlightening dialogue - not one you’ll want to miss.Steven Nelson leads the Contigo Health team as President. He was one of the leaders who initiated Contigo within Premier, a leading hospital supply chain company. Before joining Premier, he served as Vice President of Strategy and Planning and COO of Anthem’s diversified business group. Prior to joining Anthem, Nelson led strategy, product and marketing at Highmark Blue Cross Blue Shield and helped to build Allegheny Health Network, a provider entity consisting of seven hospitals, 2,000 doctors and various other facilities. In this episode, we’ll discover:The challenge that employers face in understanding and dealing with the staggering costs of healthcare, and how they’re responding.   How the ‘Centers of Excellence’ program and network management - which are foundational to employer-based healthcare - are evolving.  The use of ‘2nd opinion’ interventions in maintaining high standards of quality in employer healthcare navigation offerings.   How Contigo is convening local collaborations between employers, healthcare systems & health plans - and creating vertical ecosystems with numerous other enabling partners.   One of the revealing insights that Steve shares during the interview is that the purpose of Centers of Excellence (COE) is not necessarily to drive costs down; but instead, to drive value up!  For years, I’ve heard the concern that bundled payments are a 'race-to-the-bottom'. Steve reframes them as a 'race-to-the-top'. The value of these COE’s is NOT that they provide a lower unit price for heart surgery or joint replacement. The value is that they don’t perform unnecessary procedures. They provide an overall bundle of care that is of higher quality, safety and legitimacy. I underscore this because we know that a significant percentage of procedures and surgeries performed in this country are unnecessary, thereby subjecting the American public & employees to unnecessary harm & costs. In fact, the Lown Institute just published a report demonstrating that over 60% of hysterectomies and nearly 25% of cardiac arterial stenting procedures were unnecessary. This was a 2-year Medicare study of 3100 hospitals which discovered that older Americans were subjected to over 1,000,000 unnecessary tests & procedures. Within that were 200,000 cardiac stent procedures that fell into the category of ‘overuse’.Core to Contigo’s approach is that they convene and coordinate local collaborations between employers and healthcare systems. Not only are they convening, but they are optimizing care through: (1) standardized, high reliability, bundled pathways in specialty areas; (2) providing physicians with clinical decision support tools, best practice alerts and patient benefits information; (3) assisting employees in navigating to and accessing high quality care; and (4) using both clinical data, claims data, and advanced analytics to identify patients at risk. Contigo is also bringing health plans into this ecosystem, as well as in numerous enabling technology vendors. What I find encouraging is that Contigo is not alone in creating a more integrated, seamless value-based system of care. While many healthcare systems across the country are hedging their bets and responding as if fundamental transformation is not around the corner, this movement of direct-to-employer curators & navigators is leading and catalyzing the transformation to assure that patients receive the right care. In 2020, over two-thirds of large employers were steering, or planning to steer, their employees to Centers of Excellence. There is little doubt that employers will continue to play an increasing role as a major market force pulling us toward value-based payment & care. As healthcare becomes less affordable for the majority of Americans, we are rapidly reaching a tipping point, or perhaps more like a boiling point. This does not seem like the type of bet any healthcare stakeholder should be hedging.Until Next Time, Be Well.Zeev Neuwirth, MD 
June 2, 2021

Episode #118: Creating a Mindset Shift in Healthcare with Dr. Shantanu Nundy

Friends,In this episode, Dr. Shantanu Nundy shares with us his thoughtful reframing of healthcare. His book, Care After Covid, is a practical exposé on the misalignment of healthcare - offering a guideline for how to reframe the healthcare system moving forward. What you’re going to love about this interview (and his book) are the stories that he shares - transporting us from an inner city clinic in Washington DC, to the plains of Africa with community health workers in villages, to the university hospital where he discovered the power of caring relationships.Dr. Shantanu Nundy MD, MBA, is a primary care physician, engineer, technologist, and business leader who serves as Chief Medical Officer for Accolade, which delivers personalized navigation and population health services to companies. Previously, Dr. Nundy served as a senior health specialist at the World Bank Group where he advised developing countries on health innovation & technology. Prior to that, he was Director of the Human Diagnosis Project, a healthcare artificial intelligence startup which he successfully built into a medical project spanning 80 countries. He is also co-inventor of SMS-DMCare, an automated text messaging software for individuals with diabetes, one of the first mobile health interventions to be adopted by the World Health Organization.He attended MIT for undergrad, the Yale School of Medicine & completed his residency in Internal Medicine at the University of Chicago, where he also obtained a MBA.In this episode, we’ll discover:The maladaptive aspects of our healthcare system that the pandemic has exposed and magnified.The 3D model - distributed, digitally-enabled & decentralized - that Dr. Nundy believes can transform healthcareHow Dr. Nundy views ‘connected care’ as being ‘beyond technology’, but also how digitally-enabled care can create greater access, more personalized care, and greater patient engagement.The largely untapped opportunity we have to include patients as part of the healthcare team, and the tremendous potential that has to transform care.Real life stories that demonstrate how providers' professionalism, empathy and overall value proposition are being constrained by our system.Dr. Nundy’s ability to leverage divergent perspectives is remarkable. He shares a story of conducting research on automated reminders for improving medication taking. What he discovered in interviewing patients was that it wasn’t the digital reminder that motivated them to take their pills. Instead, it was the caring research coordinator, Marla, and the relationship that patients had formed with her, that compelled them to take their medications. Plainly put, they didn’t want to let Marla down. The lesson - caring relationships are not just more empathetic care, they’re also more effective care. Another example of Dr. Nundy’s ability to balance divergent perspectives is his notion of decentralized care - that healthcare decisions are best modulated as close to patient care as possible. He shares a poignant story of a patient with heart failure. His patient kept on being admitted to the hospital because she didn’t have a scale to weigh herself. (People with heart failure are susceptible to water retention, which causes their lungs to fail. Having a scale allows them to detect fluid retention and take appropriate medications to reverse it). During one post-hospital visit, Dr. Nundy realized that his patient did not own a scale because she couldn’t afford one. So, he handed her twenty dollars to buy one. She bought the scale and did not have any further hospital admissions after that. It’s important to note that Dr. Nundy was actually breaking rules and regulations in giving her the money to purchase that scale. He did not, as a primary care doctor, have the decentralized decision-making or authority to personalize care and do what was right for his patient. Dr. Nundy’s goal in authoring this book is to create a mindset shift in healthcare delivery. As he states in our dialogue, ‘words create worlds’. So, I’ll conclude by sharing some of his profound words. One phrase that struck me was, “Digitalizing poor care isn’t enough. We need to reinvent care”.  Another, “We need to do population health one patient at a time”. Dr. Nundy envisions a world in which both providers and patients are much more empowered and connected by the healthcare system. I believe that words do create worlds, and I hope this is the case with the words that Dr. Nundy has shared with us.Until next time, be well.Zeev Neuwirth, MD 
May 19, 2021

Episode #117: Transforming the Culture of Healthcare – with Robert Pearl, MD

Friends,Our guest this week, Dr. Robert Pearl, introduces a fundamental reframe in our understanding of healthcare transformation with his second book, 'Uncaring - How the Culture of Medicine Kills Doctors and Patients'. He convincingly argues that addressing the systemic functional challenges in healthcare is not sufficient. For transformation to occur, we also need to address the entrenched culture; and the first step is in understanding that culture. ‘Uncaring’ is the most comprehensive and scholarly book I've come across on the interplay between the legacy culture of medicine and its impact on healthcare delivery and outcomes. Dr. Robert Pearl’s stories are heart-breaking and heart-warming; and the historical facts, medical stats and studies he draws upon are engaging, enlightening and of concern to all of us.  Dr. Robert Pearl is the former CEO of The Permanente Medical Group, which he led from 1999 to 2017, and former president of The Mid-Atlantic Permanente Medical Group, which he led from 2009 to 2017.  In these roles he led 10,000 physicians, 38,000 staff and was responsible for the nationally recognized medical care of 5 million Kaiser Permanente members. He currently serves as clinical professor of plastic surgery at the Stanford University School of Medicine.  He is also on the faculty of the Stanford Graduate School of Business, where he teaches courses on strategy and leadership, as well as lecturing on Information technology & healthcare policy. Dr. Pearl has been named as one of Modern Healthcare’s 50 most influential physicians.  In this episode, we’ll discover:Numerous episodes in the history of American healthcare that demonstrate how the culture of medicine is holding us back from transforming healthcare delivery.Profound examples of how the culture of medicine directly influences how care is delivered and the grossly suboptimal outcomes that are a result of that culture.The only two possible directions American healthcare can take in response to the unsustainable and unaffordable costs of healthcare delivery.A pathway to confront and change the culture of healthcare.It’s been said that if we don’t study history, we’ll be condemned to relive it. This is no more true than in our healthcare system. Dr. Pearl shares a haunting story of an Austrian physician named Dr. Semmelweis who died penniless in the 1860’s, as a result of being shunned by the medical establishment. His heresy was that, through years of rigorous research, he demonstrated that physicians were carrying the source of maternal infections & deaths - on their hands & clothes. His studies revealed that maternal mortality rate could be decreased from 18% down to 2% simply by physicians changing their gowns and washing their hands with antiseptic in between treating patients. One might shrug this off as a historical footnote, except for the fact that today, in 2021, hospital acquired infections are the fourth leading cause of death in the US - leading to over 90,000 deaths per year. The tragic truth is these deaths could largely be prevented by providers washing their hands in between seeing patients. That is the power of culture - “this invisible force” that Dr. Pearl reveals to us. We discuss many other examples, including the story of the ‘Committee on the Costs of Medical Care’, which reveals the powerful influence of the legacy culture of medicine in resisting recommendations that could vastly improve the health and well-being of our nation. Like myself and many of you, Dr. Pearl  is frustrated and deeply troubled by the complexity, opacity and inertia in American healthcare - and how the culture is greatly limiting access, affordability, efficacy and equity.Two silver linings emerge in our discussion. First, the culture of medicine has tremendous strengths as well as wonderful attributes and values. Second, the solution is not that complicated. When I asked Robbie what he would request healthcare leaders do differently, this is how he replied, “To move from fee-for-service to capitation. To work together to improve medical care rather than maximize volume. To embrace technology that makes care more convenient for patients.” Healthcare leadership is struggling to break free of a legacy maladaptive healthcare construct. What I learned from Dr. Pearl is that healthcare leadership must not only create a new system, it must create a new culture: one that aligns our professional values and purpose with the actual daily practice of medicine and delivery of healthcare. Until next time, be safe and be well.Zeev Neuwirth, MD
May 5, 2021

Creating a New Healthcare

A podcast series for Primary Care Physician leaders who are looking for fresh perspectives, new solutions and inspiration in their journey to advance value-based care.
View All Episodes

Host

Zeev Neuwirth, MD

Zeev Neuwirth, MD

Dr. Zeev Neuwirth is the author of “Reframing Healthcare: A Roadmap For Creating Disruptive Change” and produces and hosts the popular podcast series, “Creating a New Healthcare.” He is currently serving as Atrium Health’s Senior Medical Director of Population Health.

Through his book, podcast series, speaking engagements, and executive leadership, Dr. Neuwirth is reorienting the way individuals and organizations think about healthcare, to catalyze movement towards an affordable, accessible, effective and safe healthcare system. His ultimate goal is to humanize healthcare for those who serve within the system, and especially for those who are served by the system.

You may also like

Subscribe to #HPN and never miss new Episodes!

Proudly supported by:

cover
COVID, AI, and the Future of Medicine with Eric Topol Exploring lingering questions about COVID-19 with Eric Topol, the Founder and Director of the Scripps Research Translational Institute.