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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 #126: Advanced Primary Care For All – a Healthcare Moonshot Mission – with Dr. Chris Crow, CEO & Founder of Catalyst Health Network

Friends,The focus of this interview is an approach to primary care that is divergent from the mainstream approach. It’s different in a number of ways and it’s creating outstanding outcomes for patients, payers, and providers. Our guest today, Dr. Chris Crow, has a compelling story to tell. He is an inspiring leader and a bold reframer of healthcare. I’ve had the privilege of speaking with him a number of times, and am impressed by his personal story, as well as what he and his colleagues have accomplished.Christopher Crow M.D. is the CEO and Founder of the Catalyst Health Network.  He is a nationally recognized healthcare innovator with numerous recognitions & awards; but more importantly he has spent the past 20 plus years focused on helping communities thrive through improving the delivery of healthcare.In this episode, we’ll discover:Some of the underlying problems that greatly sub-optimize the performance of our healthcare system.The three major stakeholders in healthcare, which Chris and his colleagues have built their approach around.The “extended care team” approach that Chris and his colleagues have taken to create an ‘Advanced Primary Care’.The critical distinction between ‘Direct Primary Care’ and ‘Advanced Primary Care’.How Chris is organizing a sustainable financial model that can support this enhanced model of primary care.  Early on in our discussion Chris points out that although American consumers demand outstanding customer service, convenience and quality in every other facet of their lives; when it comes to healthcare they have been gripped by what he terms “the tyranny of low expectations”. He goes on to state that the underlying problem is the status quo and inertia of legacy stakeholders, whom he describes as having turned the American health system into a ‘wealth system’ - that is, a system that creates wealth for the few at the expense of the majority of Americans who can not easily access or afford healthcare. One of the major root cause problems is the strong pull to maintain Fee-For-Service payment, which incentivizes volume (visits, procedures, tests, imaging & hospitalizations) over preventive care. Another is the preferential payment afforded to subspecialty and acute-based care over primary care. Chris has been, admittedly, frustrated with the American healthcare system because, as he bluntly states, we know the solution. The “prescription for America” as Chris puts it, is “advanced primary care” - primary care that is accessible, affordable, effective, equitable, and sustainable for both patients and providers.The mechanism behind advanced primary care is through a tech-enabled, virtual, “extended care team” of pharmacists, care managers, social workers and care coordinators. This extended care team is particularly focused on more complex conditions and situations. Some of the services they offer include: (1) medication management and adherence programs; (2) managing formulary-specific medication changes; (3) a referral management and tracking system that maintains network integrity and helps patients and providers navigate to higher value specialists and surgeons; and (4) addressing social determinants of health.In this advanced primary care model, patients derive tremendous benefit in terms of greater connectivity and continuity of care, as well as more preventive care and improved outcomes.  Providers derive benefit through the additional support and the reduced administrative burden, as well as the support they receive in improving clinical quality. Payers derive benefit through more cost effective care and the reduction in total costs of care. There are numerous metrics and stats that demonstrate the outcomes Chris and his colleagues have achieved. One example that Chris shared is around access. The Healthcare Catalyst Network has reduced average waiting times to see a specialist from approximately 28 days down to 4 days. Chris also shares some of the massive cost reductions his network has achieved.The approach that Chris and his colleagues are taking is incredibly mission driven. They consider healthcare to be critical for communities to thrive; and they believe that a value-based, prospective-payment model of primary care is critical in delivering the health outcomes that patients, providers and payers all want. As Chris states, “We’re trying to leave the world a better place and we believe that ‘advanced primary care for all’ in America is the prescription.”Until Next Time, Be Well.Zeev Neuwirth, MD 
December 2, 2021

Episode #125: Building high-quality, cost-effective employer healthcare benefits – with David Contorno, CEO & Founder of E Powered Benefits

Friends,Our topic this week is employer-based healthcare, which accounts for nearly 50% of all the healthcare spend in the US. We’ll kick off the episode dispelling some surprising misconceptions about how healthcare insurance actually works; which explains, in large part, how the costs of care continue to rise way beyond other costs of living. Our guest today, David Contorno is a nationally recognized expert in employee benefits. After nearly 20 years consulting to large national employers, David created E Powered Benefits: a benefits consulting firm whose mission is to deliver fully transparent, value-based benefit services. David has won numerous recognitions & awards, and has been a major contributor to the work and publications that Dave Chase has produced out of Health Rosetta, and the nationally recognized publications of Dr. Marty Makary. He mentors other benefits managers from across the country to transform their business models as well. In this episode, we’ll discover:Some surprising insights into how healthcare insurance companies, insurance brokers and benefits managers are incentivized and bonused - and the conflict-of-interest that is built into the system.The radically different and transparent approach David Contorno takes in creating healthcare benefits programs for employers and employees.How his business model has produced average one-year savings of over 50%, along with substantially reduced out-of-pocket costs for employees - all while improving quality and experience of care.The specific approaches and tactics that David uses, targeted to decrease unnecessary healthcare costs. A real-life example of how David and his colleagues have reduced the costs of a 500 person company by $35 million over the past 5 years. The complexity and lack of transparency in our employer-based healthcare payment and insurance system make it incredibly challenging to understand or do much about - even for the expert employer-based HR benefits managers, whose job is to manage the costs and quality of care for their employees. In an attempt to provide some clarity, I’ll summarize three significant take-home messages I gleaned during this interview:(I) the healthcare stakeholders that employers and employees rely on to manage quality & costs are not, for the most part, financially incentivized to lower costs, raise quality or improve outcomes of care.(II) The majority of healthcare insurance costs are actually medical costs; so the way to fix rising healthcare insurance costs is to address the detailed medical costs..  (III) The specific tactics that David focuses on include:(1) finding surgeons and surgical centers with higher quality outcomes and lower costs - centers that offer fixed-price bundled payments.(2) finding imaging centers that deliver state-of-the-art service at a fraction of the cost of high-priced centers.(3) purchasing medications outside of the traditional pharmacy benefits management (PBM) system - thus avoiding huge mark-ups.(4) providing value-based ‘direct primary care’ for chronic diseases and preventive services. These models allow a physician to spend more time with their patients rather than be driven by Fee-For-Service, RVU-based, high-volume care.(5) Employers passing the savings onto their employees rather than the more typical employer approach of pass-through cost-shifting.What I truly admire about David Contorno is that he’s adopted a radically different approach to the way that he and his company get paid. His compensation and bonus structure are based on lowering costs while assuring high quality care. And, his revenue is completely aligned with employers’ and employees' best interests, not with those of corporate shareholders.Healthcare insurance and medical costs are a crippling problem for a significant and growing percentage of American employees and their families. The goal here is not to lay blame on legacy stakeholders in healthcare. Rather, it’s to lay out for all to see that the fundamental payment structure and incentives in the system are misaligned and grossly maladapted for the purported purpose of healthcare - that is, of keeping employees and their families healthy. David sums it up in this way, “Every entity that an employer trusts to manage healthcare costs benefits [financially] from healthcare costs going up.”  And so, as many have stated, our healthcare system isn’t broken, it’s perfectly designed to deliver the results it delivers. Until Next Time, Be Well.Zeev Neuwirth, MD 
November 18, 2021

Episode #124: Reframing the dialogue from readmissions to recovery, with Yoni Shtein, CEO & Co-Founder of Laguna Health

Friends,This episode is about a domain of healthcare delivery that will undergo a fundamental transformation over the next 3 - 5 years. It is the most precarious and fragmented stage of care - post-hospital discharge and post-acute care transitions. It is a side of healthcare that is ripe for disruption, with the potential to greatly reduce readmissions, reduce total costs of care, and dramatically reduce preventable pain and suffering for patients and their families.Our guest today, Yoni Shtein, is a serial entrepreneur who started his journey as a software engineer at Microsoft. Having completed his MBA at Harvard, Yoni joined RPX Corp as a founding member of the insurance business. After RPX went public, Yoni left to co-found and merge a tech fund into Fortress Investment Group, where he spent six years as an investor. Yoni then moved to Israel and launched Laguna Health, a ‘digital recovery assurance company’, with his longtime friend and colleague from Microsoft, Yael Peled Adam. They also have recently brought Dr. Alan Spiro on as their President and Chief Medical Officer. In this episode, we’ll discover:Why Yoni states that “recovery is everyone’s problem and no one’s job”, and how Laguna is making it their job!Why and how Laguna is focused on the behavioral and contextual aspects of care, even more than the clinical signs and symptoms.The three platforms that Laguna has created to engage patients and guide providers in optimizing transitions of care: their patient-facing app, the Harmony Case/Care Management Platform, and their Clinical Care EngineHow Laguna is customizing care through a “choose your own adventure” approach.The tremendous outcomes Laguna is achieving in readmission reduction.During the interview Yoni states his fundamental thesis: “Laguna is reframing healthcare in changing the dialogue from readmissions and provider penalties to member ‘recovery journeys’ and payer cost drivers.” He points out that the most fundamental problem in transitions of care is the misalignment of incentives. Let’s unpack his statement.The reality is that healthcare systems and provider groups are not financially incentivized to optimize patients’ health after discharge. While there has been an increased focus over the past few years on reducing readmission rates (driven in large part by CMS readmission penalties); the fact is that hospitals’ financials are not aligned to post-hospital care. And, just to be clear, this is not to blame hospital systems. Instead, it’s a commentary on how care is paid for in our country. Given that reality, Yoni and his colleagues are targeting their efforts at entities whose business models are aligned with improving post-discharge care: (1) self-insured employers; (2) Medicare Advantage Health Plans; and (3) payers or healthcare systems that are taking financial risk for their populations' total cost of care.A second reframe that Laguna is introducing is instead of focusing on a metric (i.e. 30-day readmission rate); they are focused on the patient's “recovery journey”. They’re using decades of published research to identify “recovery barriers”, and are designing their products and services to mitigate and eliminate those barriers. A third reframe that Laguna has introduced is that they have designed their care model to address the behavioral and contextual aspects of care.  They’re identifying and solving for the daily barriers that people face in engaging with healthcare and optimizing their health.According to Yoni, over 50% of all readmissions are preventable. That means that the American healthcare system is failing patients and their families one out of every two readmissions. It’s been said that our healthcare system is perfectly designed to deliver the results it delivers. But if we understand how wrong those results are, why aren’t we changing the system more intentionally and more immediately? Why aren’t more healthcare leaders not pushing to create a new healthcare? Far from being discouraged, these questions only strengthen my resolve to seek avenues to create a new and more humanistic healthcare system. And, it also strengthens my belief that we need more leaders like those in Laguna, who are reframing healthcare to be what patients, their families, as well as providers need it to be, and not what ‘the system’ dictates it be. Until Next Time, Be Well.Zeev Neuwirth, MD 
November 3, 2021

Episode #123: A Radical Departure – Transforming Healthcare Delivery into Outcomes via a Value-based Vertical Integration – with Ken Silverstein MD

Friends,There are numerous critical healthcare reframes in this week’s episode. First, what Dr. Silverstein makes abundantly clear is that the senior leadership team at ChristianaCare is fully comitted to accelerating the shift to value based payment. Second, they are committed to greatly expanding the use of virtual care as a  primary mode of care. Third, they are focused on health outcomes vs healthcare delivery. Underlying these three patient-centered goals is another profound reframe, the notion that in order to achieve the quadruple aim, provider organizations must form vertical integrations and create complementary collaborations with other types of stakeholders in healthcare - such as payers and retailers.Our guest today, Ken Silverstein, is the Chief Physician Executive at ChristianaCare. He previously served as chair of ChristianaCare’s Department of Anesthesiology, Medical Director of Perioperative Services and as Chief Medical Officer. He received his undergraduate degree from Brown University, his medical degree from New York University School of Medicine and his MBA from the University of Delaware. Dr. Silverstein was a resident and a fellow in anesthesiology at the Brigham and Women’s Hospital in Boston. He completed his clinical fellowship in anesthesiology at Harvard Medical School. In this episode, we’ll learn about:The 10 year value-based collaborative agreement that ChristianaCare and Highmark have launched together. The 5 major “vehicles” that ChristianaCare & Highmark are planning to deploy within their collaboration. The guiding “partnership principles” that are being used to create a relationship-centered approach to this synergistic collaboration. The fascinating independent spin-off virtual primary care practice that ChristianaCare is building out with Highmark, that greatly improves the efficiency and effectiveness of care. At the beginning of our conversation, Ken states, “we created a new company and the intent is to completely transform healthcare.”  That bold remark speaks volumes about the visionary leadership at ChristianaCare. Another statement which gripped me was the fact that the ChristianaCare leadership team is discussing Clayton Christenen’s ‘dilemma zone’’, which the folks at ChristianaCare have relabelled as the “commitment zone”. The point of the concept is that in order to transition to a value paradigm and realize a long-term gain, leadership must accept a short-term loss. It’s amazing to see hospital leadership thinking and acting in this way. But even more amazing is the fact that their Chief Financial Officer was the one who introduced this concept to the leadership team. In our correspondence prior to the interview, Ken wrote that American healthcare is “facing an apocalyptic forecast…”.  It’s a disconcerting pronouncement from a seasoned physician executive.  But, what was concerning for me was that I had heard this very same comment from two other physician executives in the prior week. During our interview, I asked Ken what he meant by this statement. He went on to discuss issues such as the worsening unaffordability of healthcare, fragmentation of care, and inappropriate overutilization. He also passionately talked about the unacceptable inequities and disparities in healthcare, using Delaware as an example.  In Wilmington, the difference in life expectancy - what Ken referred to as the “death gap” - between white communities and black communities only 2 miles apart is 16 years! He punctuated this statistic by asking how that is acceptable to anyone.The situation may seem dire but I have to say that I have never been more hopeful, more inspired and more encouraged about the future of healthcare than I am today. The reason stems from listening to leaders like those at ChristianaCare who are not just speaking the rhetoric of reframing, but are taking the very concrete steps necessary to create a new and better healthcare. They are making the painful trade-offs required, and are investing in a better future. They are, as Simon Sinek would put it, playing the generative "long game". ChristianaCare is making a demonstrable commitment to creating a value-based future. They are aligning their resources with their rhetoric. They are doing this not because it’s easy or safe. They are doing it, as Ken states, “because it’s the right thing to do, period.” Until Next Time, Be Well.Zeev Neuwirth, MD 
October 21, 2021

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

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.
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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.

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