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.
Our focus in this episode is on healthcare quality & safety. Quality - its measurement, reporting and accountability - is one of the most significant, impactful and lasting healthcare movements, literally spanning the past four decades. It is a core element of the ubiquitously adopted “Triple Aim”. And yet, it continues to be one of the most challenging problems plaguing healthcare delivery in our country.
Our guest this week is one of the pioneering leaders of the healthcare quality movement. Peggy O’Kane is the Founder and CEO of the National Committee for Quality Assurance (NCQA). She founded the NCQA 29 years ago, at a time when the idea of measuring and reporting standardized quality & safety metrics was largely not accepted by the medical establishment. Through her visionary leadership and her dogged persistence to make healthcare safer and of higher quality, the NCQA has grown to be the largest healthcare quality accreditation organization in the country. The NCQA currently impacts 190 million Americans through its quality measurement and accredits hundreds of organizations. Peggy O’Kane has been named by Modern Healthcare as one of the “100 Most Influential People in Healthcare” 12 times, and one of the “Top 25 Women in Healthcare” 3 times.
In this interview, we’ll discuss:
The core work of the NCQA - identifying quality metrics and creating accountability around those metrics - and the challenges faced in its effort to do so.
Why Peggy believes quality metrics are currently a tremendous burden for providers of care, and how we can change healthcare delivery to make quality reporting more sustainable for providers as well as for healthcare systems.
Which specific mega-trends Peggy thinks are going to fundamentally transform healthcare delivery and how the NCQA is thinking about quality in the context of these seismic changes.
Some of Peggy’s early thoughts regarding the new CMS ‘Primary Care First’ payment models which are set to launch in early 2020.
Listening to Peggy O’Kane is one of those extraordinary opportunities to hear from a visionary healthcare pioneer and entrepreneur. I tried to imagine how 30 years ago, a young female respiratory therapist decides to redirect the entire medical establishment in order to create standardization, transparency and accountability around quality metrics in healthcare. Peggy was clearly part of a larger "movement"; but still, I cannot fathom the enormity of that personal and professional undertaking, and the courage it took.
I also find it of immediate interest that, as Peggy points out, it was the employers and third party stakeholders who initially supported and promoted the launch of the NCQA quality improvement mission. I wondered, during the interview if, indeed, history is repeating itself. There is, I believe, a lesson to be learned from this history. We are in a moment of profound and unprecedented transition in healthcare today and, once again, employers and third party payers are catalyzing transformative change - this time around value-based care. So, it does make me wonder. Do we have the luxury of time (decades) as we had in adopting the triple aim quality mission? Or, is this new era of market-driven, consumer-oriented, value-based care going to demand a much more rapid response, with more negative consequences for those who delay? I’m curious as to how Peggy O’Kane would answer that question, and I’m also very interested in hearing your thoughts.
Until next time, be well.
Zeev Neuwirth, MD
Dear Friends and Colleagues,
These past few weeks have been both exciting and incredibly busy with the recent publication of my book, Reframing Healthcare. As such, I’m taking a very brief hiatus from our typical podcast interviews to focus on sharing the message of the book across the country. So - in this episode, we are going to do something quite different. I was recently interviewed by Gregg Stebben of ForbesBooks Radio about Reframing Healthcare. The goal of ForbesBooks Radio is to “bring the Stories, Passion, and Knowledge of top thought leaders to the world.” I’m incredibly honored to be included in this series. Gregg was also kind enough to allow me to share the interview with you in lieu of our usual podcast this week. I encourage you to listen in as Gregg takes us on a fast-paced exploration of the topic.
We will return to our normal podcast schedule and format on May 16th. We’ll finish out this season with four dynamic interviews that cover everything from the transformation of Quality Improvement with the CEO of the NCQA, to learning about disruptive change from one of the most innovative and disruptive healthcare CEO's.
Finally, and most importantly, please accept my sincere thanks for being such a dedicated audience. Creating a New Healthcare was recently honored as the Healthcare and IT Marketing Community’s (HITMC) 2019 Podcast of the Year. It is entirely due to your support, interest, and engagement that we were able to accept this award, so thank you.
Until next time, be well.
Zeev Neuwirth, MD
This week we’ll be discussing some of the groundbreaking transformations being developed by the North Carolina Department of Health & Human Services (DHHS) under the leadership of Dr. Mandy Cohen.
The North Carolina DHHS is charged with the health and wellness of over 10 million people. This healthcare system, with an annual budget of $20 billion, is one of the largest state healthcare systems in the country. The NC Medicaid program within the DHHS directly serves nearly 2.3 million people - 1 out of every 5 people in North Carolina. It also serves approximately 1.2 million children in North Carolina.
Our guest on this episode is Dr. Mandy Cohen, who was appointed to the role of Secretary of the North Carolina Department of Health & Human Services (DHHS) in January 2017 by Governor Roy Cooper. Before coming to NC, Dr. Cohen served as the Chief Operating Officer and Chief of Staff at the Centers for Medicare & Medicaid Services (CMS). She was responsible for implementing policies for Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and the Federal Health Insurance Marketplace. In February 2019 she was named one of the Top 25 Women Leaders in Healthcare.
In this interview, we’ll talk with Dr. Cohen about:
Why North Carolina is shifting its statewide Medicaid program to Managed Care.
How she is reframing and redefining healthcare within the NC DHHS - from “buying healthcare” to “buying health” services - a progressive shift that is consistent with the direction the healthcare market is heading.
The highly innovative initiatives being launched in the Medicaid Managed Care program, with a particular focus on the social determinants of health, and some illustrative examples of how this is leading to markedly improved health outcomes and lower costs of health.
How DHHS is integrating mental health with physical health - and the advantages of that integration.
North Carolina is one of the last of the large states to transition to Medicaid Managed Care. As a result, it’s also one of the most informed states making this transition. Dr. Cohen and her team have intentionally studied the successes of other state healthcare systems as well as the successes of healthcare systems within NC - attempting to build on those lessons.
As you’ll hear in the interview, the overarching plan is to fundamentally shift from “buying healthcare” to “buying health” - that is to purchase services that cost-effectively advance health outcomes - whether those services be clinical care, behavioral care, or social and community care. Another facet of the plan is to deploy outcomes-based payment models instead of the current volume-based, fee-for-service payment.
The systematic approach of the Medicaid Managed Care program will begin with the screening of individuals’ medical care needs as well as factors related to social determinants of health. The approach also includes rigorous testing of the numerous pilots & initiatives in order to determine which innovations work and which do not. It is a healthcare outcomes analyst’s dream, but more importantly, it’s what we need if we’re to advance the health and well being of North Carolina, as well as the country.
The success of this immense and critically important effort will require a multi-stakeholder approach. To that end, the DHHS has been, over the past couple of years, actively engaging the expertise of numerous physicians and administrators from across the state - drawing from the sophisticated world-class hospital systems and academic medical centers that call North Carolina home, as well as the independent providers and community-based organizations serving both urban and rural communities.
I applaud the legislature and political leaders of North Carolina for initiating this innovative transition to Medicaid Managed Care - for supporting it and funding it; as well as CMS for providing the waiver. As Dr. Cohen points out in this interview, health and well-being is not a partisan issue - it’s an issue that is fundamental to the overall health and well-being of our commonwealth and our nation.
Is there a senior leader in your organization with the sole job of eliminating “customer friction points”? Well, there is at Banner Health. Valerie Monet is the Senior Director of Customer Experience Strategy at Banner Health. This demonstrates a remarkable commitment to the consumerist mindset from one of the largest and most forward-thinking integrated healthcare systems in the country. Banner Health is attempting to improve the patient experience by transforming the customer experience.
Valerie Monet has over a decade of involvement in healthcare customer experience. Prior to joining Banner Health, Valerie spent thirteen years at J.D. Power where her responsibilities included strategic planning, business development, customer experience management and consumer data analytics, as well as qualitative ‘voice-of-the-customer’ data collection. In this role, she worked with dozens of top performing consumer-oriented companies in the U.S. and Canada.
In this interview we’ll discuss:
Why a focus on customer experience has become increasingly important to healthcare systems in differentiating themselves from their competitors.
What strategies Banner Health is deploying to reduce customer friction points and differentiate it’s consumer experience, including their omnipresent patient/customer persona - “Sophia”.
How Valerie and her colleagues utilize both quantitative and qualitative data to understand the customer experience and measure the improvements.
How Valerie understands consumerism to be highly complementary and synergistic with the concept of “patient”.
The similarities and marked differences between the customer experience in healthcare and other industries, and why healthcare experiences tend to be more polarized - either really good or really bad...
At this point in time, Valerie admits that she can’t easily quantify the outcomes of many of her hypothesis, despite dogged efforts to do so. I admire and respect her honesty regarding where she’s at and where she’s trying to get to. Much in keeping with other experts I’ve interviewed, Valerie emphasizes that many of the insights have to be gleaned from qualitative research and field data collection - direct conversations with healthcare consumers. As she puts it, customer experience is a data scientist’s dream; but there’s also an art to it. The measurement of experience is impacted by numerous factors such as patient expectations and the strength of the doctor-patient relationship. Science, as she points out, will only get you so far.
One of the most telling insights Valerie shared was when I asked her to instruct us, in less than 30 seconds, how we might go about setting up an amazing customer experience division. Her immediate answer was, “just start listening to your customers and patients - start getting feedback - find a starting place, sit there and observe and listen - and just start to understand what they feel and what they see and what it’s like to be on the other side.”
In the end, what I repeatedly come back to is that customer experience is about better understanding the people we care for and treat, understanding what they want and need, making it easier for them to manage their healthcare and their health, and creating better experiences and better outcomes - call it what you will...
This was one of the most interesting discussions I’ve had on one of the most important topics in healthcare. It’s clear that Valerie is excited by the intellectual, emotional and purposeful pursuit of customer experience; and she makes it salient and purposeful for those of us who are not experts in this domain. Her curiosity and fascination with this topic are infectious.
Until next time, be well.
William Gibson, the noted science fiction author wrote, "the future is already here, it’s just not widely distributed yet." Our guest this week describes a future revolution in healthcare that is, in fact, already here. Digital health therapeutics are transforming the delivery and experience of medical care and rapidly gaining traction in healthcare delivery.
Anand Iyer, the Chief Strategy Officer for Welldoc, has been engaged in digital health for well over a decade. He is a respected global digital health leader. Anand has a doctorate in computer and electrical engineering as well as a MBA from Carnegie Mellon. Anand and his colleagues are part of a large and growing community of cutting-edge digital entrepreneurs that are building the technologic infrastructure and capabilities to enable a completely different approach to medical care.
In this interview, Anand describes the digital therapeutics that are being used to provide clinical care to patients with chronic diseases such as diabetes and hypertension. To date, Welldoc’s FDA approved digital therapeutic, Blue Star, has been used by tens of thousands of healthcare consumers with diabetes.
In addition, in this episode Anand shares the following:
How digital health software and algorithms are becoming FDA-approved and regulated therapeutics, similar to medications and medical devices.
The three main facets of the Blue Star digital health program - targeted at patients, providers and health systems.
The requirements for the acceptance and adoption of digital health into mainstream clinical delivery.
Why digital health is the only viable option in addressing numerous chronic diseases that are advancing at epidemic proportion.
Why digital health presents a great solution to some of the challenges in providing optimal care to the Medicaid population - addressing some of the existing inequities in quality, accessibility, affordability and engagement.
How different digital health platforms are beginning to coalesce, affording users a singular, non-fragmented, seamless experience.
It is remarkable that Anand and his colleagues understood this potential well over a decade ago - the use of digital apps to treat diabetes, hypertension, depression, heart failure and numerous other chronic diseases. Given their forethought, Anand asks us to imagine what digital technology and advanced analytics will be able to accomplish in the next 5 years. The use of: 24/7 real-time biometric recording and psychosocial/consumer information; coupled with machine learning, artificial intelligence, predictive analytics, voice technologies, natural language processing and avatars; plus new coordinating & integrating operating platforms - will enable unimagined advances in medical care.
Three closing thoughts:
The take-home point is that digital health will almost certainly be a profound (and perhaps unprecedented) enabler in making high-quality healthcare accessible, affordable and sustainable - for everyone.
Digital health will also be a major enabler in engaging healthcare consumers, finally breaking the quality & outcomes barrier we’ve been unable to penetrate over the past couple of decades.
Although digital technology is going to be a game-changing enabler, our purpose should not be to digitize healthcare, but to humanize it.
As always, I am very interested in hearing your thoughts about this exciting domain of creating a new healthcare.
This will be one of a number of upcoming interviews focused on digital health.
Until next time, be well!
Dear Friends & Colleagues,
The phrase, “Last Mile of Healthcare,” is used to describe a number of situations in healthcare. First, it’s been used to describe the value-laden interface between a provider and a patient. Second, it describes patients in the context of their life - as individuals making healthful as well as unhealthful decisions. It is in these so-called ‘last mile of healthcare’ moments that the issue of behavior is paramount - provider behavior and patient behavior. The metaphor has significant ramifications in population health as well as in public health. For example, chronic disease management, which now accounts for the majority of healthcare encounters, as well as costs, is all about behavior change. It’s not so much the advice or treatment as much as the follow-up that really makes the difference. Despite all of our advances, sustained behavior change remains a holy grail of healthcare delivery.
This week’s guest has made it her career ambition to tackle this issue head on. She and her colleagues are consumed by the issue of engagement and behavior change. Their tool box is called ‘behavioral economics’. Karen Horgan is the CEO and a co-founder at VAL Health, which she started with her colleagues Kevin Volpp MD and David Asch. I’ve been a long-time fan of Dr. Volpp’s work and had the wonderful opportunity to interview him on this podcast a while back .
Behavioral Economics provides an evidence-based array of methods to create healthful behavior change. There have been a plethora of recent studies demonstrating how Behavioral Economics can greatly advance how we communicate and engage with patients, as well as with providers. As Karen points out in this interview, these market-tested techniques are used in many other industries, as well as in public health campaigns.
In this interview Karen will share:
The basic underlying principles of Behavioral Economics.
Illustrations of the most powerful Behavioral Economics techniques used to influence healthy patient behaviors as well as value-based provider behaviors.
A number of impressive examples of how Karen and her colleagues at VAL Health are deploying Behavioral Economic initiatives with provider and payer clients.
Why Behavioral Economics isn’t more well known in healthcare; where she’s seeing greater adoption; and how long she believes it’ll take for general adoption to hit that exponential inflection point.
Up until now, in our Fee-For-Service dominated market, patient behavior and follow-up has not really mattered. For the most part, healthcare systems, provider groups and individual clinicians do not get paid, bonused or dis-incented based on outcomes. But, as the market shifts to value-based payment, both provider behavior - in terms of appropriate utilization and quality care - as well as patient behavior, will actually make a huge impact on revenue.
From my perspective, it’s exciting and encouraging. Here we have a scientifically proven approach to influence positive behavior, an approach that does not manipulate behavior or force compliance, but instead makes it easier for people to do the right things to enhance health outcomes. The vision that Karen Horgan paints is a world in which the way we communicate and engage with patients will include Behavioral Economic techniques as a matter of course. It will just be the way we deliver healthcare. I, for one, would like to see us nudge this along a bit faster. But in the meantime, I’ll be closely following the work that these folks are doing to further validate and advance one of the toughest nuts to crack in healthcare - our own behavior!
Until next time, be well!
Zeev Neuwirth, MD
The topic we’re going to cover in this podcast episode may be one of the most disruptive changes in hospital care to come along in over a century. It’s the movement of ‘hospital at home’ - literally shifting hospital-based care to people’s homes. It might sound a bit futuristic, but it’s already an established practice in other countries; and it’s rapidly gaining traction here in the US.
Our guest today is a leading medical director and researcher in this area. David Levine, MD MPH MA, is a practicing general internist and clinician-investigator at Brigham Health and Harvard Medical School. His research is focused on digital health technology, measuring the quality & experience of outpatient care, and optimizing healthcare at home. As assistant medical director of “alternative care pathways” for the Brigham and Women’s Physician Organization, Dr. Levine works to bring acute, hospital-level care to patients’ homes as a substitute to traditional hospitalization.
In this interview, Dr. Levine discusses:
How ‘hospital at home’ actually works and the specific conditions that can be treated in the home instead of in hospitals.
Some of the critical problems that ‘hospital at home’ addresses and solves.
Why and how, when appropriately implemented, ‘hospital at home’ can be a superior substitute for hospital-based care.
Why and how 'hospital at home' is more customized and personalized care.
Some of the positive outcomes that have been demonstrated in research studies with the ‘hospital at home’ approach.
This 'hospital at home' movement is one of those elegant ideas that makes you wonder, “why didn’t someone think of doing this sooner?” And more importantly, “why aren’t we doing more of this, right now?” It addresses some major issues, including access to hospital care, and the rising and uncontrollable costs of healthcare, as well as safety and quality of care.
It was a privilege speaking with Dr. Levine. He brings a deep sense of humanity to his work. It’s clear that his primary goal is not just the advancement of technology, but the advancement of health for patients. He also brings a researcher’s diligence - not wanting to overstate where we are and what we’ve demonstrated to date.
It is incredible to think that nearly 25% of all hospital admissions could safely - perhaps even more safely - be deployed to patient’s homes. And that, at some point in the very near future, that number could be as high as 50%, or more, of all hospital admissions. In addition to being a safer option, 'hospital at home' is more personalized and customer-oriented care as well - for the patient and their family. It’s more accessible, more convenient and more comfortable. It’s not only better medical care; it’s better patient care.
This is one of those single point innovations that could potentially change the face of healthcare delivery forever. And, it’s not a future discussion. It’s an immediately important issue for senior leaders across the country who are, right now, grappling with billion dollar, long-range decisions on how to invest in the infrastructure of healthcare delivery.
As always, I hope you’ve benefited from this interview as much as I have.
Until next time, be well.
Zeev Neuwirth, MD
Dear Friends & Colleagues,
Today’s brief podcast is not our usual bi-weekly interview episode. Instead, I’d like to share some exciting news. It’s regarding the publication of my book, ‘Reframing Healthcare - A Roadmap for Creating Disruptive Change’,
which is now officially available for pre-order on Amazon.com, with a publication date of April 23rd.
In this brief podcast I’ll discuss:
What ‘Reframing Healthcare’ is about
Why I wrote this book & what I’m hoping to see happen as a result
A call-to-action for you
As we get closer to the publication date, I’ll share more details about the contents of the book.
I think it will be of interest to many of you who listen regularly, as the themes we discuss in the podcast series are featured throughout the book.
As always, I appreciate your support, and welcome you to the #reframehealthcare movement.
Stay tuned for a regularly scheduled podcast interview next week.
It’s another real-life example of healthcare leaders who are disrupting and reframing healthcare in profoundly positive and humanistic ways.
Until next time, Be Well.
Zeev Neuwirth, MD
Healthcare consumerism is on everyone’s mind these days. It’s a growing movement being taken up across the industry - from entrepreneurial start-ups, to retail and dig-tech giants, to leading hospital systems and healthcare insurance companies. This is a big shift for an industry that has been woefully behind other sectors in understanding its customers’ needs and expectations. There are numerous challenges to making this shift from patient-centered mindset to a consumer-centric mindset.
Fortunately, there are experts like our guest this week Kevan Mabbutt, who joins us again to assist us in making the transition to a more consumer-oriented era. Kevan Mabbutt is the Senior Vice President and Chief Consumer Officer of Intermountain Healthcare. He was previously at The Walt Disney Company, where he served as the Global Head of Consumer Insight.
We were fortunate to have Kevan first join us back in early Fall 2018, for Episode 45. If you haven’t listened to that episode, I would strongly encourage you to do so. It was the single most downloaded episode of this podcast series, at over 10,000 downloads. During that dialogue, Mr. Mabbutt introduced us to some different ways of understanding the consumerist mindset. And now, 6 months later, we advance the dialogue and delve deeper into how Mr. Mabbutt is bringing his decades of world-class experience to healthcare.
In this episode we’ll discuss:
How Mr. Mabbutt and his colleagues are developing the first phases of the ‘InterMountain Health’ experience.
Their comprehensive end-to-end digital platform which makes it easier to obtain “access to, navigation through, education around, and payment for” healthcare delivery.
How Kevan is reframing patient loyalty in terms of “relevance” and “preference” - a shift that will require not only a different design approach, but also fundamentally different metrics for assessing patient experience.
The approach Mr. Mabbutt took in building Disney theme park experiences, and how he’s applying that to discovering the “friction” or “pain points” in healthcare delivery.
A reorienting focus on how healthcare occupies a ‘space’ in patients’ lives, instead of focusing solely on how patients occupy a ‘space’ in the healthcare delivery system.
There are numerous pearls of wisdom that Mr. Mabbutt shares with us during the course of this interview. But, the most important message, from my perspective, is that consumerism is a sophisticated way to enhance, advance and elevate humanism in healthcare - to support and sustain those of us who are serving in the system; and to enable greater empathy, dignity and connectivity, as well as a safer, more seamless and effective care environment to those who are being served by the system.
Given the current state of healthcare delivery - the frustrations faced by patients, the lack of transparency, the challenges of navigating the system, the plummeting public trust in healthcare, the obstacles providers and staff face daily, as well as the horrendous crisis of provider burnout - who can argue with the consumerist approach that Mr. Mabbutt and his colleagues at Intermountain are taking? The only question in my mind is why isn’t this consumerist approach being deployed at more healthcare institutions?
As always, I hope you get as much out of this interview as I have.
Zeev Neuwirth, MD
There are numerous reasons to focus on caring for our aging population. First, it’s the right thing to do. Second, the utilization of care and medical costs in the older population with more complex and chronic medical conditions are tremendous. For example, the budget for Medicare jumped $300 billion between 2007 and 2017. In fact, Medicare costs are the 2nd largest federal expenditure, next to social security. Third, these costs are continuing to rise. It’s predicted that per capita Medicare expenditures will rise at least 4.6% annually for the next decade. At present there are over 60 million people enrolled in Medicare with an estimated 10,000 more enrolling each day. It’s an unsustainable situation, from a cost perspective. Finally, we know that there are significant opportunities for improvement - in care, outcomes, and cost.
Our guest today represents an organization that is addressing this issue in new and better ways. Sachin Jain is the CEO of CareMore. Founded in 1993, CareMore is a prepaid integrated delivery system and health plan that provides medical care to approximately 150,000 Medicare & Medicaid patients in over 40 clinics across nearly a dozen states.
Dr. Jain brings a remarkable background to leading CareMore. He received an MD, an MBA, and his residency training in Internal Medicine, all within the Harvard system. He has held a number of positions at the Centers for Medicare & Medicaid Services (CMS) and CMMI (the CMS innovation division). He has also published over 100 peer reviewed journal articles.
Some of the major points that Dr. Jain will share in this episode include:
Why we need to move away from a generic primary care model to more customized models of care, such as for the older patient with complex chronic conditions.
The various approaches that CareMore takes to address the Social Determinants of Health such as transportation, nutrition, physical fitness and care in patients homes.
How CareMore reorganized the physical infrastructure of their clinics to address the issue of Social Isolation and Loneliness - what has been termed “an epidemic in plain sight”.
Their industry leading “Togetherness Program” as well as other programs that also address social isolation and loneliness.
CareMore’s method for reducing hospitalizations and readmissions, and how they markedly reduce healthcare costs through their focus on transitions of care.
Throughout this interview, Dr. Jain shares CareMore’s compelling story - what makes their model profoundly different from and better than the generic primary care medical home model. One other theme I found encouraging is the attention CareMore pays to the professional development and sustainment of its providers and staff. The thinking that providers should have an ‘owner’ vs. ‘employee’ mentality speaks to one of the major crises of healthcare today - provider and staff burnout. As Sachin states, if we’re going to save healthcare, we’re going to have to really support the people who are actually providing care.
There are numerous lessons to be gleaned from this interview - from CareMore’s focused segmented approach, to their highly coordinated care model, to their focus on social determinants of health and social connectivity, to their attention to sustaining the professionalism and engagement of their providers. Dr. Jain and his colleagues at CareMore refer to it all as “Radical Common Sense”. And, that's exactly what it is!
As always, I hope you get as much out of this interview as I have.
Zeev Neuwirth, MD
Trust - or the lack of it - is a critically important issue in healthcare these days. This issue has tangible impact on the care of patients and the work life of providers. There is no question that trust in our medical system has declined. The Gallup poll shows a massive drop in public trust of the medical system from 76% in 1977 to 36% in 2018.. Another highly respected index, the Edelman Trust Barometer, suggests that the American public’s trust in healthcare “crashed” in 2018; dropping 25 points. The Edelman survey experts called this an “extreme trust loss”.
In response to this distrust epidemic, the American Board of Internal Medicine (ABIM) Foundation has just launched a campaign to address the issue. It’s called the ‘Trust Practice’ Challenge.
What’s unique about this particular interview is that we’ll not only be introduced to an exciting new venture in healthcare, and talk about it with a world-class expert; but, we'll also have the chance to participate in it!
In this interview Dr. Richard Baron, the CEO of the ABIM and the ABIM Foundation, shares the goals of the Trust Practice Challenge - to elicit “inspiring and best-in-class” examples of practices that cultivate trust from and between individuals, provider groups, departments and institutions within and across healthcare.
The purpose of this campaign is to seek out a community of individuals and organizations who care deeply about rebuilding trust in healthcare, and who are interested in getting better at it. The ultimate goal is to improve healthcare relationships, and the experience and outcomes of medical care.
Some of the topics Dr. Baron touches on include:
The current societal factors that led the ABIM Foundation to select ‘trust’ as the major initiative to address at this point in time and what they’re hoping to accomplish through this initiative.
How trust has been eroded in healthcare - between patients and providers, between the public and the healthcare system, between providers and the healthcare system…
The elements of trust the ABIM Foundation is hoping to address and rebuild in the profession of medicine and in healthcare in general.
“The four simple rules” the ABIM Foundation took in launching the Choosing Wisely campaign and how they are adopting that same approach to creating a network of trust.
A more detailed description of the ABIM “Trust Practice” Challenge and how you can immediately contribute to that campaign and the community of trust.
I applaud the ABIM Foundation for taking on an issue that is so critically important and so ambitious. I am not aware of any other national, systematic effort explicitly focused on rebuilding trust in healthcare. I also have to share my admiration for their co-creative approach. It’s a highly appreciative, collaborative and respectful stance - looking to the expertise and integrity that is abundant in the profession of medicine and the healthcare community at large.
The ABIM Foundation's 'trust practice' initiative is visionary. It has the potential to reframe and reshape how we think about and go about the work of healthcare delivery, as well as how we redesign and reorganize healthcare delivery for the future.
Zeev Neuwirth, MD
Welcome to the first 'Creating a New Healthcare' podcast of 2019!
This is an incredibly timely topic. At the start of each year, most of us resolve to discard bad habits and take up new, healthier ones. We all struggle with the perennial challenge of getting motivated, avoiding frustration; and sustaining new behaviors beyond just a few days or weeks. In this interview we discuss a new approach and health app focused on healthy eating - fresh Tri - which our guest co-developed with Walmart.
Our guest this week - Kyra Bobinet - is a bestselling author and the CEO-founder of engagedIN, a neuroscience behavior design firm that uses neuroscience to make health and wellness products, and communications, more engaging.
Kyra is a physician who received a masters in public health from Harvard. She was the recipient of Harvard’s 2015 Innovator Award. Kyra is the author of A Well Designed Life: 10 Lessons in Brain Science and Design Thinking for a Mindful, Healthy, and Purposeful Life. She and her work have been featured by the Wall Street Journal, New York Times, Huffington Post and NPR. She’s created health startups, blockbuster products, health apps, and evidence-based programs in mind-body & metabolic medicine.
Some of the incredibly relevant issues covered in this episode include:
“The emperor has no clothes.” - Kyra’s assessment of the employer wellness industry
The fundamental differences that make her new app - fresh Tri - unique in the world of healthy habit development
Why the perception of ‘failure’ is actually harmful to our health and is the neurophysiological basis for de-motivation
How to apply the basic principle of design thinking to constantly improve one’s approach to developing healthful habits - and how to side-step failure traps
A rare opportunity to hear an expert describe ‘the anatomy and physiology of behavior design’
The ‘secret sauce’ Kyra discovered and believes to be the single most important factor in sustained behavior change
What’s unique about this interview and the work Dr. Bobinet is doing is that it goes beyond healthcare and physical health. This message of how we perceive failure and success is a fundamental life skill. Kyra’s research can assist us in avoiding the pitfalls of self-defeat in all aspects of our lives. Her underlying motivation - to remove the self-blame and harsh criticism we inflict upon ourselves - is a hopeful and realistic way to begin the new year.
As always, I hope you get as much out of this interview as I have.
Zeev Neuwirth, MD
I promised you a lively interview to close out the year on Creating a New Healthcare, and thanks to the assistance of my colleague, Dr. Lisa Gualtieri, I hope this one won't disappoint.
In this episode, the tables are once again turned - as Lisa interviews me on how my expectations for healthcare in 2018 have played out, and what I see as trends in 2019.
It's a bit anxiety-provoking to be interviewed for your own podcast without knowing the questions in advance; but Lisa did an expert job of keeping the dialogue focused on the major shifts, tensions and emergent trends in healthcare.
To give you a taste of what you'll hear, here are some of the questions posed:
What were the trends you predicted a year ago and how accurate were you?
This year, the podcast focused on topics like the shift to consumerism in healthcare. How do you see that benefiting healthcare and what's on the horizon in 2019?
The social determinants of health have been a theme throughout many of the podcasts. Is that something that will be given a lot more attention in 2019?
Is the issue of physician burnout going to be better addressed in 2019?
What's coming next in 2019 for Creating a New Healthcare?
Towards the end of the podcast, I put out a request to the ‘Creating a New Healthcare’ community.
I’m hoping that you’ll respond in that I very much would like to hear your thoughts and recommendations.
We will be back in 2019, with our first episode planned for January 10th.
I wish you all a happy and healthy holiday season and a joyous New Year.!
And, as always, express my tremendous gratitude for your continued interest and support in creating a new healthcare.
We’re now in the last month of this year. It's the holiday season and the New Year is almost upon us. It’s the time of year when most of us pause to evaluate the past 12 months, to reflect on our accomplishments, and to ponder our hopes and expectations for the future. It’s a wonderful moment to reconsider our values and priorities, and to set new goals for the future. It’s also a perfect time for a podcast on value-based leadership.
There may be no single issue that will have more of an impact on the immediate future of healthcare than leadership. Many previous guests interviewed on this podcast series have talked about a lack of forward-thinking, visionary leadership in healthcare. To this end, our guest this week will help us understand what value-based leadership looks like, and what behaviors are required from our leaders in order to transform healthcare.
In this interview we have the wonderful opportunity to hear from Jeff Thompson, a physician executive who was CEO of Gundersen Health. Jeff served as Gundersen’s Executive Vice President from 1995 to 2001, and CEO from 2001 to 2014. During his tenure, he played a key role in the organization’s governance design, culture development and community focus. Gundersen is an integrated delivery system serving 19 counties in western Wisconsin. It has been designated as a Healthgrades Top 50 hospital system. Jeff continues to serve as Gundersen’s Executive Advisor & CEO Emeritus.
Jeff is also the author of a recently published book, Lead True. He has been featured in and authored numerous articles, book chapters and abstracts on healthcare, leadership and sustainability. Over the past couple of years, he has been lecturing across the globe, advancing this notion of value-based leadership. Jeff is an experienced executive leader who has walked the walk. His personal stories and hard-earned wisdom are directed to leaders at all levels.
What you’ll hear in this interview includes:
What the current moment in healthcare history is ‘demanding’ of our leaders and the specific challenges facing leadership in these tumultuous times.
Three specific steps that leaders can take to address the current challenges in healthcare.
A number of real-life stories of how leaders can encourage their providers and staff to embody their organization’s espoused values, and how leaders can create greater provider and staff engagement.
Jeff’s keystone piece of advice that he offers all current and rising leaders.
In tumultuous times, value-based leadership can easily become subservient to immediate, short-term goals. It's understandable. But, Jeff encourages leaders to avoid being deterred by problems that do not add value. Instead, he urges leaders to focus on steering their teams and organizations toward longer-range solutions that benefit patients and communities.
Jeff’s message is one of identifying and voicing shared core values, and then living those values. It’s an inspiring message of authenticity, courage and discipline.
There is one hope I have for the New Year - that individuals and teams in roles of authority and leadership hear and heed this message.
I would encourage you to share this message with colleagues.
Zeev Neuwirth MD
Thanksgiving is a holiday for sharing all that you're grateful for, so I wanted to take a few brief moments to do just that.
I hope you enjoy this 6-minute episode of Creating a New Healthcare.
Wishing you all a happy and healthy Thanksgiving Holiday!
Welcome to Part II - the continuation of our interview with David Contorno - an expert in employee benefits and employer-based health programs. David is a founding member of Health Rosetta and has over 20 years of experience in the field.
If you haven’t listened to Part I yet, you may want to start there. In the first half of our interview, David described the ‘Stockholm Syndrome’ that exists between employees, employers and payers. He also shared the specific value-based strategies he deploys - interventions that assist employees in avoiding unnecessary tests and procedures; and that steer them toward more cost effective options - using pre-paid, at risk, bundled payment programs.
In Part II, you’ll hear :
A story of an employee with severe back pain whose positive outcomes inspired David to depart from the “benefits-as-usual” approach.
Some of the specific strategies David deploys to manage the significant and rising costs of medications, including his “PBM Last” approach.
David’s scathing critique of Health Savings Accounts (HSA’s) and High Deductible Health Plans (HDHP’s), which he believes lead to a spiraling cycle of unintended adverse outcomes for both employees and employers.
Judging from listeners' responses (on social media) to Part I of the interview, it's clear this is a topic of high importance and high complexity. While many listeners did not agree with everything David said, there was a lot of agreement on his intention and approach.
I came away from this interview inspired and wanting to hear more.
As I thought about David’s recommendations, I tried to come up with reasons why we shouldn’t follow his advice. I couldn’t come up with any.
What is happening in the employer healthcare market is astounding - perhaps revolutionary. Most of the experts I have spoken with agree that it’s the employers who will be the primary disruptors in the healthcare delivery ecosystem. One only need look at Amazon and it’s new collaboration with JPMorgan Chase and Berkshire Hathaway, or Apple or Google or Comcast or General Motors, or hundreds of other innovative employers, and employer coalitions such as the Health Transformation Alliance. These employers are taking their employee’s health into their own hands by partnering with vendors that aggressively work to lower costs, improve outcomes, and elevate the consumer experience.
Our speaker today is an incredibly rare expert & professional in this regard. Contorno has 24 years of experience in the employee health space. He was a highly successful employee health benefits broker - making a sizable salary based on commission. And, then he had an ethical & moral crisis - as he tells it; which drove him to completely change the way he thought about and deployed employee health benefits and programs. As a founding advisor to Health Rosetta, he and the Health Rosetta team have developed methods to assist with the adoption of simple, practical, cost effective employee benefits and healthcare programs. In 2016, Forbes named David as “One of America’s Most Innovative Benefits Leaders.” There is nothing hypothetical about his approach. He is actively and successfully implementing this cost-savings system.
What you’ll hear will include:
David’s “aha” moment that led him to make the change to align his compensation completely with the actual benefit he brought to employees.
The simple and practical programs David has deployed to dramatically reduce healthcare costs while improving access, quality and outcomes.
How primary care is the most broken part of the healthcare delivery model and how he thinks we can fix it.
David’s radically different take on Health Savings Accounts (HSA’s) and why he thinks they’re a scam...
I have to say that I am surprised and impressed with the knowledge and wisdom that David has amassed. While so many employers are struggling to manage these unsustainable costs of care, David and his colleagues at Health Rosetta have laid out a doable and effective plan. What I admire and respect the most is that instead of shifting the responsibility to the employees to make cost effective and clinically effective decisions, which is wholly unrealistic; they put the responsibility back on the employers and benefits advisors, to institute supportive benefits that drive the appropriate utilization of quality clinical programs.
Whether you’re an employer, an employee, a health benefits manager or advisor; or you just want to understand how we can optimally manage what amounts to over one-third of the American healthcare spend, these two episodes (#49 and #50), with David Contorna, will equip you with an in-depth understanding and some specific steps to take.
It’s become increasingly apparent that large employers are rapidly becoming the most disruptive force in American healthcare today. Think Amazon, Berkshire Hathaway, JP Morgan Chase, Apple, Google, Microsoft, Comcast, CVS Health, Walgreens, Walmart, and so on...
The reasons are readily apparent:
Employers are feeling the most pain due to the unsustainable and rising costs of healthcare, the paucity of pricing transparency, and the lack of consumer-oriented service.
Employers are footing over a third of the American healthcare bill, with the knowledge that at least one-third of their spend on healthcare is not leading to improvements in the health of their employees.
Unlike other stakeholders in the healthcare market, employers are less encumbered by political bureaucracy, conflicting incentives, and legacy systems.
They have tremendous capital and scale, as well as cutting-edge, consumer-oriented technologic capabilities to bring to bear.
This episode is as much about healthcare consumerism as it is about employee health - tying in nicely to this season’s earlier podcast episodes with Dr. Robert Pearl, Kevan Mabbutt and Dr. Harold Paz.
Our guest this week - Marcus Osborne, a Harvard Business School alum - is the VP of Health & Wellness Transformation at Walmart. He has years of experience in Walmart’s previous healthcare delivery initiatives - their clinics, pharmaceutical products & pricing, and collaborative efforts with Humana around Medicare part D.
Marcus is a no-nonsense, results-oriented, highly accomplished businessman who is on a mission to build a new and better healthcare system. He makes it abundantly clear why this is critical to Walmart as an employer, and as a retailer serving over 85% of the American public. He does not believe the current healthcare system can be fixed. He does believe that Walmart’s credo to deliver affordable products & services, its capabilities, its size and reach, make it well positioned to create a new healthcare system.
This episode will include:
Marcus’ explanation of why Walmart is formulating a strategic decision to enter the healthcare market.
How Walmart is optimally situated to become one of, if not, the most significant disruptor in the American healthcare delivery market.
Marcus’ scathing critique of how people are treated in our healthcare system; in juxtaposition to Walmart’s “customer-only” approach to serving the American public.
Marcus’ high-level view of what a transformed, consumer-oriented healthcare system might look like.
Discussion about a specific initiative Walmart has been deploying with its over 1 million associates, which is literally reducing its employee healthcare costs by over a billion dollars per year.
While some may find Marcus’ responses a bit in-your-face, I actually found his honesty & directness to be refreshing. At times during the interview, I did find myself feeling defensive - in large part because I am privileged to witness daily the amazing life-saving and life-enhancing work accomplished within the current healthcare system - by bright, passionate and intensely committed individuals, teams and organizations. However, I also found myself aligned with Marcus’ strategic assessment and in complete agreement with his consumer-centric thinking.
During the course of our conversation, it became clear to me that some of the most innovative and disruptive changes coming to healthcare may not be technologic. The understanding I’ve arrived at, after dozens of conversations like this one, is that our primary purpose might not be to digitize healthcare, but instead, to humanize it.
The major theme of this interview is how a traditional healthcare insurance company - Aetna - is redefining what it means to be a payer.
They are reorganizing healthcare delivery to be much more engaging of consumers, and they’re doing it with numerous collaborators, in non-traditional ways.
Our guest this week has an impressive academic and executive background. Dr. Harold Paz is an executive vice president and the chief medical officer for Aetna. He leads clinical strategy and policy at the intersection of all of Aetna’s domestic and global businesses.
Before joining Aetna in 2014, Dr. Paz served as chief executive officer of Penn State Hershey Medical Center & Health System, and dean of its college of medicine. Prior to his appointment to Penn State, he spent 11 years as dean of the Robert Wood Johnson Medical School, and chief executive officer of Robert Wood Johnson University Medical Group, the largest multispecialty group practice in New Jersey.
What you’ll hear in this interview includes:
The "three pillars" of Aetna’s clinical strategy: member engagement, creating a health ecosystem for consumers, and value-based contracting.
The novel and non-traditional ways that Aetna is creating outcomes-based healthcare solutions.
The innovative, highly collaborative and value-enhancing joint ventures that Aetna has entered into with provider groups, pharma & device manufacturers.
Aetna’s Wellness Index - a comprehensive survey that is redefining what health and well-being look like.
Examples of how Aetna is designing and deploying the “third curve” of healthcare personalization and consumerism.
Aetna's approach to combating the opioid epidemic in our country.
This work that Dr. Paz shares with us is a spectacular example of what forward-thinking leaders and leadership teams can do within the traditional legacy system - to redesign and reorganize healthcare delivery. Dr. Paz and his colleagues are clearly breaking the mold of what an insurance company can be, and do.
As I listened to example after example of the innovative initiatives and collaborations Aetna is deploying, I was struck by how they are tearing down the constricting walls of the past, and crossing boundaries in ways that are on point to create a better healthcare system.
Our guest this week - Robert Pearl, MD - has nearly 2 decades of experience leading two of the nation’s largest medical groups.
As CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group of Kaiser Permanente (KP), he was responsible for the healthcare of over 5 million members. He led numerous initiatives with exceptional performance in quality outcomes, patient safety, cost savings and consumer experience. He and his colleagues at KP have set the bar for what value-based healthcare could look like and the outcomes that can be achieved. It’s been said by many experts and authorities that the future of American healthcare should look a lot like Kaiser Permanente.
Since leaving his position in 2017, Dr. Pearl has written a book entitled, ‘MisTreated: Why we think we’re getting good healthcare - and why we’re usually wrong’. He’s also been travelling the globe, sharing the wisdom gleaned over decades of first-hand experience as a practicing surgeon and as a healthcare executive. He currently teaches healthcare strategy and policy at Stanford Graduate School of Business and was recently named one of Modern Healthcare’s 50 most influential physician leaders.
Dr. Pearl is gifted in taking complicated healthcare topics and rendering them in ways that are easy to understand. His point is that if we just execute on what we already know works, we’d be in a completely different, and better place in healthcare delivery. His mantra is one echoed by numerous award-winning coaches - ‘stick to the basics’.
In this interview we’ll discuss:
The personal family experience that led Dr. Pearl to write his book, ‘Mistreated’.
The quality, safety & cost issues that adversely impact millions of individuals each year. The numbers are staggering, but it’s the personal experiences we share that really tell the story.
A number of simple, effective strategies he and his colleagues deployed at Kaiser Permanente that have achieved remarkable outcomes in quality, safety, cost and patient experience.
The 4 Pillars upon which to build a superior healthcare system. You won’t want to miss these!
Dr. Pearl’s predictions of which stakeholder in our country will be the major force for change in the next 3 - 5 years. You might be surprised by what you hear…
What I admire about Dr. Pearl - in addition to his acumen - is his passion. He is at a point in his career where others might take a well-deserved rest. But he is driven by a deep sense of mission and purpose. His enthusiasm and energy are palpable and contagious. What I also admire about Dr. Pearl is his practical, no-hype, data-driven approach to identifying and implementing evidence-based solutions. If you have any doubt that healthcare can and will change for the better, I urge you to listen to this podcast. Regardless of what you think today, by the end of the podcast, I believe you’ll be convinced that positive change in healthcare is coming, and coming soon.
Consumerism - the promotion of consumers' perspectives & interests - is one of the hottest & rapidly emerging topics in healthcare today.
Whether you’re a large healthcare delivery network, hospital system, surgical center, or ambulatory practice - if you’re interested in patient growth and retention, or in optimizing the experience & outcomes of care - you should be very interested in improving your approach to consumerism.
Many factors have contributed to the rapid rise of consumerism in healthcare. First, patients are being presented with an increasing array of care choices. Second, patients are footing a greater percentage of their healthcare bills. Third, people are now used to sophisticated, easy, and elegant customer interactions in other aspects of their lives; and are bringing these expectations to bear on their healthcare experience. And, they’re increasingly voting with their feet and their wallets.
The problem is that while there are lots of opinions; there’s not a whole lot of expertise or experience in healthcare consumerism.
Our guest today is the most experienced and accomplished consumer-oriented expert I’ve encountered in healthcare to date. He's also a delightful, engaging and humble human being. Kevan Mabbutt joined Intermountain Health last year as their Chief Consumer Officer bringing over 25 years of experience in this field. Prior to joining Intermountain, Mr Mabbutt served as the Global Head of Consumer Insight at Walt Disney. In this role, he led consumer experience development and transformation for Disney’s theme park, cruise line, resort, retail, and digital assets in the U.S., Europe, and Asia. He was instrumental in defining and optimizing the guest experience at Disney’s first theme park in mainland China (Shanghai Disney Resort). He also helped drive the expansion of Disney, Pixar, Marvel, and Star Wars brands globally.
In this interview Kevan shares his profound thoughts on the context of consumerism in healthcare. What you’ll hear includes:
How Disney understands consumer-centrism, and how different that perspective is from how we, in healthcare, consider consumerism.
Kevan’s own understanding of consumerism as a deeply humanistic and empathetic endeavour.
The need for consumerism to be inclusive of providers as much as patients, and the reason that's critically important.
A fundamental reorientation of “value” as being defined by the consumer’s subjective experience - whether it be outcomes or affordability, or any other aspect of healthcare.
Some of the challenges that Kevan has encountered in introducing a consumerist mindset into healthcare, and his strong caution that we not equate consumerism with digital technology.
This is one of the most exciting and enlightening interviews I’ve had the pleasure of hosting. If there is a must-do in healthcare, it’s this. As Kevan puts it - consumerism is not a part of the chain; it impacts the entire chain of healthcare delivery. It’s about redefining the core strength and critical element of every link of that chain as being implicitly about value, as defined by the consumer. This will require us to adapt and integrate aspects of consumerism such as human-centered design & personalization, segmentation & customization, transparency, and engagement at a system-wide level - if we aspire to be fully successful in the value-based transformation of healthcare delivery.
Get ready to be challenged and inspired by the notions of consumerism that Kevan Mabbutt brings from his unique experiences at Disney and his 25 years as a leading authority and highly accomplished executive in consumer insights.
Zeev Neuwirth, MD
Friends & Colleagues,
After interviewing more than 50 insightful, courageous and accomplished leaders who are literally creating a new healthcare, we are going to turn the tables in this podcast episode.
In this episode, I've placed myself in the hot seat, and will be interviewed about my reflections from this first year of podcasting, as well as future plans & directions for the series.
At less than 15 minutes, it is much shorter than my usual podcast, and will provide you with insights into what I do, why I do it, and how you can get more involved!
Here are some of the questions I answer in this episode:
What were your expectations and have they been met?
What makes this podcast different from other healthcare podcasts/newscasts?
What were some surprises you encountered?
What are you planning for in the 2nd year of podcasting?
Who are 2 or 3 people you would like to interview?
What one request do you have of listeners?
So, please take a listen! My hope is that you'll be inspired by what you hear.
I sincerely appreciate your continued support and encourage you to invite others to subscribe to ‘Creating a New Healthcare’. This work - to transform healthcare - is so critically important to all of us!
Looking forward to an exciting new season beginning in mid-September.
Until then, Be well!
Zeev Neuwirth, MD
For anyone who doesn’t appreciate the critical importance of healthcare economics in the U.S., consider this: The average price for health insurance in the U.S. for a family of four is $18,500 per year. This is the equivalent of each American family purchasing a car every year. Healthcare currently makes up nearly 20% of the U.S. GDP; and numerous studies have suggested that nearly one-third of that spend is unnecessary, wasteful and even harmful. Given the unfettered rise in healthcare spending, it’s been estimated that Millennials will conservatively spend somewhere between 50 to 75% of their total lifetime earnings paying for healthcare.
These staggering statistics give you a sense of the important role that healthcare economists can play in determining the future of our healthcare system, and the future of our economy. Healthcare economists take an objective, data-driven approach to analyzing the issues of healthcare spending and utilization. We’ll discover, in this fascinating interview with a leading healthcare economist, that many beliefs we hold about healthcare spending are based on incomplete data, and therefore erroneous conclusions.
Dr. Zack Cooper - our guest on this episode of Creating a New Healthcare, trained at the London School of Economics and is an Associate Professor of Health and of Economics at Yale University. He is one of the rising stars on the healthcare economics scene; and represents the nextgen - trained in the most advanced science, analytics & machine learning that can be applied to healthcare spending, utilization & costs. His publications are regularly featured in the New York Times which wrote of Dr. Cooper’s work that it’s “likely to force a rethinking of some conventional wisdom about healthcare”.
In this interview, we’ll cover a broad range of topics including:
What healthcare economists actually do & how they influence policies around healthcare delivery & payment.
How Dr. Cooper’s ground-breaking research on commercial health insurance completely changes our understanding about regional healthcare utilization & costs.
Dr. Cooper’s recent research that challenges our belief that patients can act as informed consumers capable of making price-based decisions, even when they’re provided with straightforward, transparent, comparative pricing.
Evidence-based recommendations for redesigning employee health plans.
I came away from this from this interview with a newfound and enhanced respect for the role that healthcare economists play in creating a new healthcare. We need their powerful problem-solving methods & advanced analytics to help us decide which problems to solve and how to go about solving them. It’s hard to argue against the notion that healthcare needs a new ‘True North’. Perhaps we should take a closer look at the compass that Professor Cooper and his colleagues are constructing.
Social determinants of health (SDOH) represent the largest set of factors in determining healthcare outcomes & utilization. Despite understanding this, a fundamental problem remains: How to motivate & sustain healthful behavior, especially within communities experiencing profound social and economic obstacles such as unemployment, poverty, food insecurity, isolation, unsafe housing, etc. There is a tremendous amount of effective, innovative effort directed at this challenge. But the current “screen & refer” approaches have limitations. As we’ll discover in this podcast, Community Health Worker programs can overcome these limitations and serve as a keystone program in this domain.
Community Health Worker (CHW) programs connect professional and social-service resources with the individuals & communities they are attempting to benefit. It is a unique approach that takes lay individuals from the community and trains them to be a combination of life coach, social worker, and healthcare system liaison. The basic premise relies on the idea that health is social, contextual & communal; and the closer you are to the situation, the more likely you will be to catalyze & sustain behavior change. Like many other good ideas, this one is as much about execution as it is about intention.
Unfortunately, despite good intentions, many CHW programs have floundered and failed. To help us understand what is needed to create an effective and sustainable CHW model, we are fortunate to have with us Dr. Shreya Kangovi. Dr. Kangovi and her colleagues have pioneered a rigorous, evidence-based approach to building, deploying and measuring the impact of a CHW program. Dr. Kangovi is the founder & executive director of the Penn Center for Community Health Workers - a national center of excellence dedicated to advancing health in low-income populations through CHW programs. The Penn Center spent seven years creating and refining an exemplary CHW model called IMPaCT™ (Individualized Management towards Patient-Centered Targets). It’s based on the application of human-centered design principles, implementation science, and robust qualitative & quantitative research methodology.
In this episode, we’ll discuss:
The scope of services a Community Health Worker (CHW) performs, and what makes them effective.
The most critical question each Penn Center CHW client is asked.
The evidence-based clinical, economic and humanistic benefits of an effective CHW program.
The 5 major pitfalls that have undermined the success of CHW programs in the past, and how to turn them into opportunities for success.
The services the Penn Center offers to assist other medical centers in standing up their own CHW program.
From my perspective, CHW programs are a critical - but often absent - piece of the healthcare delivery ecosystem. Because they are treated as ‘soft’ programs, they often lack appropriate operational planning, resource allocation, and rigorous management and measurement.
The Penn CHW program has set the standard for efficiency and sustainability. It is a masterpiece of fiscal responsibility, operational excellence, evidence-based consumer-oriented design, and system integration. If the rest of healthcare operated this way, we would be in a far better place than we are now!
Zeev Neuwirth, MD
Despite the fact that nearly one in five hospitalized patients is discharged to a skilled nursing facility, inpatient rehabilitation service or into a home health care program - the so-called ‘post-acute’ care space remains a largely opaque and overlooked sector of healthcare for most hospital administrators and providers of care. It's also extremely confusing to patients and their families.
Adding to this complexity and confusion is the tremendous unwarranted variation in post-acute care. There is little standardization in how decisions are made as to where patients might be optimally discharged; and there is a staggering amount of harmful and costly variation in how patients are cared for in post-acute care facilities/programs.
But, market forces and CMS-driven payments and penalties have recently brought post-acute care front and center for providers and hospital systems; and have also caught the attention of Wall Street investors, and corporations who are making significant R&D investments in this space. These forces are moving things favorably toward a triple-aim vision for post-acute care - great care & outcomes, outstanding experience & cost effectiveness.
We are fortunate to have an expert on this episode who can clear some of the mist and misunderstanding shrouding this domain of care. Mr. Andy Edeburn is a Principal with Premier, Inc., with nearly 20 years of healthcare consulting experience specializing in acute, post-acute, and senior care services. Mr. Edeburn is a nationally recognized expert who guides organizations through strategic deployment around acute and post-acute partnerships, new programs, and facility and redevelopment efforts - establishing value-based, outcome-oriented relationships as organizations transition from the fee-for-service environment.
In this episode, what you'll discover includes:
The major levers that hospital systems and integrated delivery networks rely upon to positively impact post-acute care.
Which set of interventions have proven to be the most powerful in managing post-acute care spending and outcomes.
Some insights into the profound disruption that is about to occur in the post-acute care industry due to the impending site-neutral, unified payment that CMS is planning to implement.
Which specific area of the post-acute care space has become the darling of Wall Street, as well as the focus of huge investments on the part of vendors such as Phillips and Samsung.
The so-called post-acute care space is likely the next frontier of standardization and systematization in healthcare delivery. It seems that few healthcare systems have ventured into this arena with a deliberate, well-resourced, comprehensive program to optimize care. To my mind, post-acute care, or perhaps what might be termed 'sub-acute' care, represents one of the most significant opportunities we have to improve care and the care experience for one of the most vulnerable and costly moments in the continuum of healthcare delivery. It is also an opportunity to provide direction to providers, so they can bring both health and dignity to patients and their families who require this level of care.
In addition to his broad experience and depth of knowledge, Andy Edeburn - our expert guest and guide in this podcast episode - has the gift of making this highly complex area seem a bit more straightforward and understandable. Andy not only provides us with a better understanding of the problem; he informs us on potential high leverage solutions.
As always, I hope you get as much out of this interview as I have!
Zeev Neuwirth, MD
The rapidly escalating impact of chronic disease is devastating populations, employers, payers & economies - both in the U.S. and across the globe. The World Health Organization (WHO) projects that, by 2025, chronic disease will make up over 70% of all illness. At the present time, preventable chronic disease is responsible for over 40 million of the 56 million annual deaths worldwide. The WHO has also projected that the global costs of healthcare will more than double between 2015 and 2030 - from $8.4 trillion to $18.3 trillion - with an estimated global productivity loss due to chronic disease, in that time frame, of $47 trillion. This is clearly an unsustainable situation.
Our guest this week, Dr. Samir Damani, is trying to solve this problem - of the escalating impact of chronic disease - by using blockchain technology. Dr. Damani brings a depth and breadth to this work by combining his skills as a clinician, researcher, technologist & entrepreneur. He is a board-certified practicing cardiologist with a Masters in Clinical Investigation from the Scripps Research Institute, who also obtained a PharmD from the University of Georgia. In 2011, he founded and served as CEO of ‘MD Revolution’, a technology-enabled service platform for Medicare’s Chronic Care Management program.
Dr. Damani’s most recent endeavor is MintHealth, a decentralized healthcare platform designed to engage patients in committing to healthful behaviors - somewhat similar to current loyalty programs. An individual signs up on the MintHealth platform and accumulates tokens (aka ‘purchasing power’) by demonstrating healthful behaviors - anything from listening to educational material, to demonstrating improvements in diabetes, or high blood pressure, or weight. The tokens (called ‘Vidamints’) can be redeemed for healthful products. The blockchain platform facilitates the loyalty campaign, which is typically sponsored by an individual's employer or insurance company.
Dr. Damani and his collaborators envision that Vidamints will become a defacto healthcare campaign currency and program for organizations or government agencies interested in incenting healthful member behaviors. In addition to the incentive program, the MintHealth platform could serve as a secure and portable, cloud-based personal health record, allowing participants to control and direct their own health data. They also intend for the MintHealth platform to serve as a Health Information Exchange (HIE), allowing for the protected and seamless transfer of personal health information amongst numerous healthcare stakeholders.
In this episode, we discuss how MintHealth is addressing the following issues:
Interoperability - the ability to safely and securely move health data between closed electronic medical record systems.
Sustained behavior change - creation of a behavioral economic approach to engage and empower people in their pursuit of healthful behaviors and optimal health outcomes.
Self-sovereignty - Providing patients with the ability to control and direct their own health data and records.
Economics - Driving down the increasing and unsustainable costs of chronic disease.
Dr. Damani and his colleagues are attempting to create a healthcare marketplace that increases healthcare consumers purchasing power through rewarding healthful behaviors and healthy outcomes. They are attempting to solve one of the most significant and challenging healthcare related problems of our era. To listeners of this podcast it will be clear that Dr. Damani is a passionate, persistent and purpose-driven leader who has his eyes set on winning the long game.
As always, I hope you get as much out of this interview as I have!
It’s been said that our zip codes impact our health more than our genetic codes. How do the social determinants of health -- education, employment, public transportation, safe housing and neighborhoods, access to healthy food... -- so profoundly affect healthcare utilization and health outcomes?
In this interview, you’ll hear an emerging story of how the leadership of a healthcare system in New Jersey is addressing this issue head-on and going right to the root cause. My remarkable guest, Michellene Davis - a lawyer and policy expert - is the Executive Vice President & Chief Corporate Affairs Officer for RWJBarnabas Health - the largest healthcare system and largest non-profit employer in the state of New Jersey. Ms. Davis has been named as New Jersey's top healthcare lobbyist and Modern Healthcare recently recognized her with their 2018 Top 25 Most Influential Minorities in Healthcare Award.
Key topics and stories we’ll explore in this interview include:
RWJBarnabas Health’s rollout of a novel and compelling “anchor” strategy, synergistic with larger economic and cultural revitalization efforts like the ‘Newark 2020 Initiative’ launched by Newark Mayor Ras J. Baraka.
The overall approach and major interventions of the ‘Social Impact & Community Investment Practice’ that focus on education, economic stability, neighborhood and built environments, global health and employee engagement & volunteerism.
Inspiring stories of local entrepreneurs who are growing successful businesses and enriching the local community as part of the “Hire, Buy, Invest” strategy that Ms. Davis is leading on behalf of RWJBarnabas Health.
Ms. Davis emphasizes how her organization’s community-focused initiatives make sense, not only from a healthcare perspective, but also from a business and economic perspective. The approach taken in New Jersey is focused on implementing long-term, expanded and self-sustaining solutions; and is being accomplished through the intentional inclusion of multiple stakeholders who might otherwise be competitors.
Ms. Davis’ initiatives strive to not only be enabling, but also empowering and self-generating. They include providing local communities with access to healthy foods, transportation and safe housing - critically and immediately important efforts! But, they go beyond that - to actually providing employment to local citizens. And even beyond that - to actively supporting local entrepreneurs and small businesses - teaching them how to grow their businesses and become even more entrepreneurial.
Hang onto your seats (or earbuds) folks. Ms. Davis is a powerhouse! All of her talent and energy is highly purpose-driven and laser-focused on “eliminating” the adverse negative impacts of the social determinants of health.
There are numerous lessons to be learned from this interview - lessons that can translate into action. My hope is that you’ll share this interview with your local healthcare systems and local government, and begin to organize similar efforts. And, if you're engaged in similar 'anchor' strategy efforts, I would love to hear about it. From my perspective, this interview is one of the most inspiring and potentially catalyzing dialogues posted on this podcast series to date.
As always, I hope you get as much out of this interview as I have!
Zeev Neuwirth, MD
Friends & colleagues,
The care of patients with chronic medical conditions represents a significant dilemma in healthcare today. How do we optimize cost effectiveness while achieving good health outcomes? In today’s interview, we learn how ChenMed empowers primary care physicians to deploy a VIP concierge experience that delivers affordability and outstanding health outcomes for seniors. My esteemed guest is the CEO of ChenMed, Dr. Chris Chen, a cardiologist & physician executive who has devoted his career to building this premier practice focused on the care of low to moderate income patients with complex, chronic medical & social issues.
In this interview, we’ll explore how ChenMed manifests its vision to: (1) be America’s leading primary care provider; and (2) transform care for those who need it the most - the elderly, the sick and the poor.
Key topics covered include:
· Specific tactics ChenMed uses to deliver outstanding outcomes that mutually and simultaneously benefit patient well-being, provider satisfaction, and payor success.
· How ChenMed’s focus on preventive primary care demonstrably improves health outcomes & reduces the need for downstream “catastrophic” care such as ED visits & hospitalizations.
· The training and development of ChenMed’s incoming physicians - building their readiness for accountability as well as advanced training in service orientation, finance and leadership.
· The holistic approach ChenMed takes in the ‘care’ of people - focusing on lifestyle issues, social supports & behaviors - rather than solely on clinical ‘healthcare’.
Throughout the interview, Chris shares the underlying mission-driven philosophy that differentiates his practice from others. He reveals numerous pearls in the second half of the interview you'll not want to miss. Of note, in addition to the intense focus on person-centered care, Chris also describes how ChenMed creates a supportive, respectful & meaningful environment for physicians and other providers.
If you’d like to understand what outstanding ‘triple-aim’ primary care looks like, this is the ticket. Chris informs us that the three values upon which ChenMed’s strategy & tactics are built are love, accountability & passion. Many organizations use these words. ChenMed clearly makes them part of their daily operation. I always leave my conversations with Chris with a renewed sense of conviction, courage and hope. I suspect you will as well.
As always, I hope you get as much out of this interview as I have!
Zeev Neuwirth, MD
Human behavior is, by far, the single biggest lever we have to impact our health outcomes. Yet, despite the profound impact our behaviors have on health outcomes, as well as on our national & global economic health; we continue to see adherence rates to appropriate treatment and medication taking hover between 40 to 50%! These incredibly low adherence rates exist in chronic issues such as diabetes treatment and blood pressure control; and they also occur even after life-threatening events such as heart attacks. This is, without question, a major health care challenge for patients, providers, payers & employers. In fact, it’s one of the most significant challenges for just about every stakeholder in healthcare, including pharmaceutical companies and pharmacies.
Clearly, behavior change is a tough nut to crack. We all want to do the right things - but behavior change is challenging to initiate, and even more challenging to sustain. Gratefully, there is a discipline called ‘behavioral economics’ - a combination of microeconomics, psychology & neuroscience - that is demonstrating marked success in making it easier for patients, as well as doctors, to repeatedly and more easily perform & sustain desired healthful behaviors.
In this interview, Dr. Kevin Volpp, one of the most highly published and productive physician-scientists in this discipline, shares numerous applications & techniques of behavioral economics - as applied directly to patients’ & providers’ behaviors.
What you’ll hear in this interview includes:
How a large employer-based incentive program tripled the rate of sustained smoking cessation - from 5% to 15%. And,in a smaller subset of employees (~14%) the intervention achieved rates of 50% long term smoking cessation!
How a default electronic medical record intervention increased physicians’ prescribing of generic medications from less than 60% to 99% - leading to savings of approximately $32M in a couple of years time.
How behavioral economics is being deployed to create a new primary care payment system in the Hawaii Medical Services Agency - incenting doctors to deliver high value care.
Toward the end of our dialogue, Dr. Volpp sketches an enlightened picture of the future of healthcare - a tremendous emancipation of value that could occur, if we can begin combining virtual digital technologies with the powerful techniques of behavioral economics
Clayton Christensen, the preeminent Harvard Business School Professor & one of the leading management scholars of our time, wrote in The Innovator’s Prescription: A Disruptive Solution for Health Care, “There are more than 9,000 billing codes for individual procedures and units of care. But there is not a single billing code for patient adherence or improvement, or for helping patients stay well.” In my opinion, Dr. Kevin Volpp’s groundbreaking work in Behavioral Economics addresses Dr. Christensen's keen observation by focusing on creating the procedures & interventions for helping patients stay well, as well as helping physicians and other providers help patients stay well.
I came away from this interview with one lingering question: Given the clear potential for behavioral economics to achieve sustained healthful behaviors, improve our health and the health of our nation, and lower the crippling costs of healthcare - how come we’re not doing more of it? My hope - and intention - is that this interview advances the greater awareness of one of the most significant opportunities we have available to us to improve healthcare.
As always, I do hope you get as much out of this interview as I have!
Zeev Neuwirth, MD
Have you ever wondered what it takes to be a model healthcare system? In this interview, Dr. Mark Briesacher provides us with profound insight into how Intermountain Healthcare consistently maintains its position at the forefront of clinical outcomes, improvement & innovation. Mark informs us that the organization's original charge was to create “a Model Healthcare System.” What you'll discover in this interview is how he and his colleagues have taken that charge to heart.
One manifestation of that charge is the "Clinical Reorganization” being deployed to create a consumer-oriented, community-based model of healthcare. Dr. Briesacher describes a two-part construct - a highly innovative community division focused on long-term health, prevention & wellness; and an acute, episodic-care division composed of specialty surgical/medical centers-of-excellence. Mark discusses the unique contributions of each, and also emphasizes the synergistic intersection between them - which leads to optimal decisions about appropriateness of care as well as world class health outcomes.
Another example of creating 'a Model Healthcare System’ is the innovative insurance product called ‘SelectHealth Share’ - an offering of Intermountain’s embedded SelectHealth Plan. This product creates explicit shared accountability between the Employers/Employees (customer), the SelectHealth Plan & Intermountain Healthcare providers. All of this contributes to what Mark refers to as a “community” of health.
A third illustration of creating 'a Model Healthcare System" is the consumer-oriented, digitally-powered, transformational patient experience that Intermountain Healthcare is building - which, as Mark points out, “… all starts with the digital front door that removes as much friction as possible.”
Toward the end of our interview, Mark shares a number of heartwarming and inspiring stories from his upbringing. Please don't miss this! These snapshots provide us with an understanding of how and why his personal values are so highly aligned with Intermountain’s long-standing culture of excellence, integrity and community service.
Mark is, without question, a highly capable and humble servant leader; and Intermountain Healthcare is the quintessential 'learning organization'. Dr. Briesacher and his colleagues are brilliantly carrying out their charge to create 'a Model Healthcare System’. There are numerous lessons and learnings to be gleaned & emulated from their example!
As always I hope you get as much out of this interview as I have!
Zeev Neuwirth, MD
Al Lewis may be one of the most controversial, and respected, figures in the employee health & wellness industry. His insight and candor have earned him various labels and epithets including, “the founding father” of disease management and alternatively, the “troublemaker-in-chief” of the wellness industry.
Whether you like him or not, I doubt that anyone can challenge his integrity, or the rigorous intellectual approach he takes in analyzing the efficacy of employer-based wellness and care management programs.
By way of introduction - Al Lewis attended Harvard College, where he studied and then taught Economics. He graduated from Harvard Law School, and eventually became a partner at Bain & Company; prior to becoming a nationally recognized expert and consultant in the fields of employee health & care management.
Al has authored a number of critically acclaimed books on employee health & care management, including 'Why Nobody Believes The Numbers', which was named '2012 healthcare book of the year' in Forbes.
In this interview Al Lewis - true to form - dispels numerous myths and radically reorients our thinking on the critically important issue of employee health & wellness.
According to Mr. Lewis, the most significant healthcare cost & health outcomes opportunity for employers is NOT getting employees to “take more steps or eat more broccoli;” but instead to prevent them from having unnecessary screenings, tests and treatments - what he terms “hyper-diagnosis.”
He has, over many years, repeatedly documented and demonstrated that healthcare over-utilization wastes tremendous money and adversely impacts employee health. He also argues that current Health Risk Assessments (HRA’s) are misguided, wasteful and potentially harmful.
What you’ll discover in this interview includes:
1. Why, according to Al Lewis, employee health wellness programs are a waste of money and, more importantly, are potentially harmful to employee's health & wellness. If you’re interested in his online documented expose on the "mis-statements" of the wellness industry, you can learn more on www.theysaidwhat.net.
2. Mr. Lewis’ online program ‘Quizzify’ (available to employers at www.quizzify.com) - which uses games, quizzes and assessments to educate employees on how to better manage their health, healthcare, and healthcare expenditures - and whose basic purpose is to create a culture of healthcare literacy.
3. How employers can provide services that enhance employee health & wellness - what Mr. Lewis terms “wellness done for employees” instead of “wellness done to employees”.
4. Al’s forecast for the future of the wellness industry - an industry which he predicts is going to change dramatically in nine months, as a result of major court rulings.
Mr. Lewis certainly puts his money where his mouth is. If you don’t agree with him, he’s offering a $3 million reward to anyone who can demonstrate that wellness programs actually save money, or if he can’t prove that they don’t save money!
It is refreshing, enlightening and encouraging to have a conscientious industry watchdog with the intellectual rigor, acumen and experience that Al Lewis possesses. For the purpose of this podcast series, it’s not his critique that is most important. What's important is what Al Lewis is creating, and how he is contributing to Creating a New (and better) Healthcare. Again, I did warn you all that he is a controversial and respected authority. If you have any difference in opinion, Al is ready to listen and respond.
As always I hope you get as much out of this interview as I have!
Zeev Neuwirth, MD
Given the rapid, tumultuous, and unprecedented changes in healthcare these days, there are very few things that are as important to a hospital system or integrated delivery network as developing and deploying a sound and forward-thinking strategy.
In this interview we have the amazing good fortune and unusual opportunity of picking the brain of the senior strategy executive for one of the most successful, visionary and pioneering healthcare systems in the world - Geisinger.
Dominic Moffa is a seasoned healthcare executive with a long standing track record of success. He’s also an incredibly humble, generous, practical and fun guy. In this interview he generously shares some of the life lessons and rules of thumb that have contributed to his amazing success, and the success of the organizations he’s been a leader in. It’s clear from his straightforward responses that he not only talks the talk, he walks the walk.
What you’ll learn in this interview includes:
Toward the end of the interview Dominic shares the best piece of advice he was ever given. Folks - this is not to be missed, as it is certainly one of the best we have heard on this podcast series to date!
As always, I hope you get as much out of this interview as I have!
One final note - I would feel remiss if I didn't extend a personal message of sincere appreciation to the entire Geisinger organization - for their many years of being leaders in healthcare, but also being generous in sharing the lessons they've learned. While it's apparent, as Mr. Moffa points out in this interview, that their primary focus is to provide outstanding medical care to their patients and the populations they serve; it's also abundantly clear that they understand, and take seriously, their innovative and pioneering role in helping to advance the American Healthcare System.
Zeev Neuwirth, MD
Friends & colleagues,
This week’s podcast episode is unusual in a number of ways. First, we’re posting a bit earlier in the week than usual - to coincide with the Becker’s Hospital Review 9th Annual Conference. Second, the topics covered are exciting, enlightening and relevant; but definitely different for this podcast series. Third, we have a unique guest on this week’s episode - someone who brings tremendous expertise and success in a broad range of areas inlcuding healthcare law, business, leadership, online media & journalism & world-class symposia planning.
In addition to his own extraordinary accomplishments and contributions to healthcare, Scott Becker has had the unique vantage point and experience of speaking with and learning, first-hand, from world-class leaders and celebrities, as well as renowned healthcare system leaders. In this special interview, Mr. Becker shares with us the wisdom he’s gleaned from over two decades of steering one of the leading, most prolific and influential healthcare media outlets and forums.
Some highlights from this this interview include:
(1) Scott's astute observations of the current healthcare market dynamics; and a discerning assessment of the unprecedented challenges and pressures facing hospital & healthcare system leaders;
(2) a number of profound pearls on leadership, teamwork and business development;
(3) his unique insights into healthcare media, communication & journalism - lessons that have made, and continue to make, the daily Becker’s Reports & conferences so popular and so immensely valuable to healthcare executives, leaders and influencers at all levels, and in all sectors of healthcare.
From my perspective, Scott exemplifies the best qualities of the great leaders he informs us about. In addition to his intelligence, experience, strategic acumen and track record of delivering on great results; he is a generous, forward-thinking, inspiring and empathetic leader. What is also abundantly apparent is that Mr. Scott Becker is keenly focused - first and foremost - on identifying & solving the problems of his customers and consumers.
As always, I hope you get as much out of this interview as I have!
Episode #32 - Reframing How Doctors Make Clinical Decisions - an interview with Dave Slawson MD, Professor of Family Medicine & Internationally Renowned Lecturer in Evidence-Informed Decision Making & Information Mastery.
The literature would suggest that a significant percentage of clinical decision making is not well supported by evidence-based literature. Given the vastness of the emerging literature, combined with how rapidly it changes, it’s nearly impossible for any individual provider to keep up. Compounding this issue is the fact that the physiology-based reasoning we were all taught is no longer adequate. Adding fuel to the fire is the predominant fee-for-service reimbursement system which strongly incentivizes providers to do more rather than less; and a tort reform system which also compels providers to do more rather than less.
Fortunately, Dr. Slawson and his colleague - Allen Shaughnessy PharmD, along with many other informaticists and evidence-based experts, have been working on a solution. In this interview you’ll hear how he and his colleagues have reframed the way physicians and other healthcare providers can and should go about making evidence-based decisions.
Here are some highlights:
The most significant shift required in our clinical reasoning and decision making is to what Dr. Slawson describes as “probabilistic analytics & science”. This quantitative approach disrupts the inherent fallacies of human decision making.
We need to shift from process metrics to outcome metrics. This is a shift from treating the numbers, such as blood glucose, to treating the patient - that is, focusing on the outcomes that matter, such as heart attacks, strokes and deaths.
The shift to consumer-centricity & shared decision making is also of utmost importance. If decisions are, in fact, going to be made about value-based outcomes; and if we agree that patients, as consumers, define the value proposition; then any decision that is made without the patient’s shared input and preferences is going to be flawed.
This approach, far from being a ‘cook-book medicine’ imposition on providers, actually offers immense support and guidance. It will improve the clinical care of patients; and it will provide much needed relief for physicians - allowing them the time and energy to focus their attention on their patients, instead of constantly hunting and foraging for the latest clinical updates.
One of the most meaningful messages that Dr. Slawson leaves us with is a “prescription to say ‘No’." ‘No’ to unnecessary tests, imaging studies and invasive diagnostics. ‘No’ to wasteful and potentially harmful medications & treatments that are not indicated. ‘No’ to making decisions based on outmoded data and antiquated reasoning.
One of the major lessons I came away with from this dialogue is that it’s not only what we do that can make a difference; it’s what we can stop doing that can really make a demonstrable positive difference in improving patient care and health outcomes.
As always, I hope you get as much out of this interview as i have!
The problem we’ll be addressing in this episode - which is of critical national significance - is the unsustainable burden of healthcare costs.
We’ll cover two major issues: (1) tactics employers can take to avoid unnecessary healthcare costs; and (2) an approach to understanding and addressing a long-standing challenge in healthcare delivery - post acute care.
You should listen to this interview if:
You're not overly concerned about these issues, or don’t feel knowledgeable enough to be concerned.
Your provider group is engaged in an Accountable Care Organization, Medicare Shared Savings Program, Medicare Advantage or Bundled Payment Program; or if you’re an employer or payer.
You have a family member that may one day end up hospitalized or in a nursing home.
Our guest this week, Josh Luke, is a nationally recognized expert in the post-acute care space, and on healthcare cost strategies in general. He spent 15 years as a hospital CEO and a senior nursing home administrator - so he has deep knowledge and an insider's perspective.
Since leaving those roles, his mission has been to assist patients and their families in navigating the opaque archipelago of post-acute care; and to assist individuals & employers in learning how to manage the overwhelming costs of medical care.
Josh is a self-described “truth teller”. As you’ll hear in this interview, Dr. Luke does not hold back - and with good reason. He’s got some well defined and thoughtful perspectives, as well as bold practical solutions on how the system needs to change to provide care that is safer, less costly and more dignified.
One example is Josh’s program, ‘Discharge with Dignity’ - an initiative to assure that patients being discharged from hospitals are given a reasonable option to return to their home, instead of being corralled into avoidable, unnecessarily lengthy, and costly post-acute care facility stays. His protocol is being used across the country to train physicians and other providers.
Another example - Josh will discuss the main points of his most recently published book, ‘Health-Wealth: 9 Steps to Financial Recovery’. He’ll share the specific tactics that employers can take to reduce unnecessary costs and optimize their healthcare spend.
From the employee or individual’s perspective, Josh will introduce us all to his “3 P’s” of becoming an “Engaged Healthcare Consumer” (EHC).
If you're still wondering what all of this has to do with 'dignity', here’s what I garnered from listening to Josh. Healthcare with dignity includes: (1) making what we do in healthcare - including prices - transparent, and easily understandable to patients, families & employers; (2) giving patients real choices that take into account their preferences (keep in mind that the AARP has repeatedly documented that over 97% of people want to go home after a hospitalization, and not to a nursing home); and (3) considering the quality, safety & cost factors first, rather than the business imperatives; or more bluntly put, being patient-centered rather than profit-centered.
Dr. Josh Luke's honesty and openness is refreshing and much needed. He sheds a revealing light and a helpful set of approaches to issues that have been hidden and confusing for decades.
He is clearly purpose-driven and passionate; his perspectives are born of wisdom and backed by data; and his recommendations are forward-thinking, consumer-oriented, value-based and practical.
If you still have some doubts as to the importance of this topic, I'll leave you with some stats to consider:
The Medicare Trust Fund is expected to go bust by 2029 - that’s only 10 years from now - important for those of us who are expecting Medicare to pay our healthcare bills.
About 25% of the total costs of Medicare (which make up half of all medical expenditures in the U.S.) are spent on what is termed ‘post acute care’ - nursing homes, inpatient rehabilitation facilities, long term acute care hospitals, home health and hospice care.
It’s predicted that Millenials (currently 20 to 40 year olds) - who make up the largest employee demographic in the country - will spend over 50% of their lifetime earnings on healthcare.
As always, I hope you get as much out of this interview as I have.
How many of us can define ‘well-being’? How many of us understand the factors that enhance it? How many of us think about the issue of ‘well-being’ or do anything about it in the context of ourselves, our employees or the patients that we provide care for?
Dr. O’Day and her multi-disciplinary team have spent years not just defining ‘well-being’, but also learning how to improve it.*
If you have a personal or professional interest in well-being, you’ll be interested in this interview.
What’ll you hear is Dr. O’Day sharing:
5 modifiable factors (domains) that contribute to well-being.
How these 5 domains of well-being impact our health and influence our ability to change behavior.
Specific tactics to positively impact these 5 domains of well-being.
How well-being - as a ‘global determinant of health’ - is a critical component of any successful approach to population health - spanning the continuum of care, from people focused on wellness to those who are dealing with chronic disease management.
How well-being is a highly advantageous, integral part of any employee health program, in terms of its impact on human performance and resilience, as well as its impact on health outcomes.
I have heard Dr. O’Day speak on this topic a number of times; and I learn something new and important each time.
In the second half of the interview she also shares some of the personal experiences, which have shaped her thinking on human behavior, performance and growth.
The conversation then meanders into a deeper discussion on existential issues such as meaning and purpose. It becomes abundantly apparent that this work is highly meaningful to Dr. O’Day, not only as a professional, but also as a fellow human being. It’s clear that she not only talks the talk, but also walks the walk, when it comes to well-being.
As always, I hope you get as much out of this interview as I do.
*The information Dr. O’Day shared, specifically related to 'well-being' research & development performed at Johnson & Johnson, is proprietary, and is the intellectual property of J&J.
If you have not been following the great leap forward that the American Medical Association (AMA) has made over the past 5 years, then you’ve been missing out on something quite spectacular. It’s phenomenal, and phenomenally told to us by the President-elect of the AMA, Dr Barbara McAneny.
What you’ll discover in this interview is that the current AMA is not your father’s or mother’s AMA. This is a bold organization that is attempting to launch the profession into the future. The breathtaking strategic initiatives and dramatic progress you’ll hear about may represent the largest inflection in the AMA’s history since the Flexner Report transformation over a century ago. And, Dr. McAneny is, in her own right, an impressive & inspiring example of leadership. She has distinguished herself many times over as a community-based oncologist, as well as a leader on the national healthcare scene.
Here are a just a few snippets of the many forward thinking trajectories that you’ll hear Dr. McAneny expound upon in this interview:
People want health and are not necessarily interested in healthcare, so the AMA has been focusing on improving health outcomes through the creation of their “innovation ecosystem” network.
Patient outcomes are affected as much by their zip code as by the quality of the healthcare we offer; so it’s critically important to understand, measure and intervene on the social determinants of health.
Medical care is no longer just an individual clinical endeavour, and will require highly collaborative partnering which combines medical science with digital technology, health economics, analytics and an understanding of patient behavior and socioeconomic factors…
In this episode, Dr. McAnaney will also describe three major strategic arcs the AMA is focused on:
First - the AMA’s (moonshot) “innovation ecosystem” network - a broad expanse of initiatives and highly progressive partnerships the AMA has engaged in to radically improve healthcare and health outcomes. It’s astounding to hear the sheer number of highly collaborative partnerships the AMA has formed with start-ups, accelerators, venture capitalists, tech developers & other organizations - in order to bring the physician sensibility to the development of new health technologies & digital technologies. The AMA has begun to act like an innovation convener - proactively partnering with companies such as IBM Watson, GE, Intel, the Scripps Institute, Partners Center for Connected Health, Intermountain Healthcare and Omada Health.
Second - the AMA’s strategy to transform medical education by creating “the medical school of the future”. In this initiative - the ‘Accelerating Change in Medical Education’ Consortium - they’ve funded medical schools to create forward-facing curriculum and training programs. The goal is to create the ‘physician of the future’ - not only knowledgeable in the science & art of medicine, but also steeped in the science & art of management, leadership and systems thinking. At present there are over 30 medical schools involved, collectively representing a quarter of all medical students in this country.
Third - the AMA’s focus on physician burnout and sustainability. Approximately 50% of physicians are burnt out according to numerous studies; and physicians daily spend over an hour on burdensome administrative work for every hour of direct patient contact. Dr. McAnaney emphasizes that it’s hugely wasteful and demoralizing to have the most highly trained and costly human resource in healthcare function as data clerks for hours each day. Of note and underscoring this point, HHS Secretary Alex Azar recently stated, “Its the patients who suffers when a provider spends more time reporting quality measures than delivering quality care”. Dr. McAneny compellingly advocates for the removal of these and other stressors, as a way to reduce physician burnout and improve healthcare.
I came away from this interview with a renewed appreciation and admiration for the AMA and its mission; and with a profound respect and gratitude for the vision, integrity and selfless commitment that Dr. McAneny has manifested throughout her career.
Dr. McAneny shares numerous pearls of wisdom throughout the interview - transformational inflections that you’ll want to listen to - likely, more than once.
As always, I hope you get as much out of this as I have!
Our guest this week, Glenn Steele MD PhD, is one of the most trailblazing, impactful and enduring healthcare leaders of our time. He is a distinguished surgeon, researcher and executive. Dr. Steele served as past Chairman of the American Board of Surgery, past president of the Society of Surgical Oncology, and a member of the National Academy of Medicine. He has been named consecutive times to Modern Healthcare’s Most Powerful Physician Executives in Healthcare, Modern Healthcare’s 100 Most Powerful People in Healthcare & Beckers’ Hospital Review 100 non-profit Health System CEO’s to know list.
Dr. Steele, former President & CEO of Geisinger & currently the Chairman of xG Health Solutions; and his colleague, the current President & CEO of Geisinger, David Feinberg MD recently co-authored a book entitled ProvenCare - How to Deliver Value-Based Healthcare the Geisinger Way. In this interview we will uncover the major components of the ProvenCare model. It’s a great peak under the hood of one of the best healthcare systems in the world.
What you’ll discover in this interview will include:
Dr. Steele’s 3 fundamental approaches to “emancipating value” in healthcare.
Geisinger’s ProvenCare Acute - a protocol so reliable that Geisinger offers money-back guarantees on procedures like coronary artery bypass surgery, and hip and knee replacement surgeries.
Geisinger’s ProvenCare Chronic - an approach to providing consistently high quality, patient-oriented care for chronic conditions such as diabetes, high blood pressure and asthma.
Geisinger’s uniquely bold approach to achieving outstanding outcomes in chronic disease management - one example being their ‘all-or-none’ diabetes bundle.
Geisinger’s ProvenHealth Navigator - a comprehensive approach that includes Primary Care Redesign, Population Health Management, and Medical Neighborhoods.
Geisinger’s ‘sweet spot’ - the integrated vertical alignment of payer/insurer & provider that has allowed them to create a powerful synergistic system for value-based care.
This interview also highlights Dr. Steele’s hard-earned wisdom, which played a critical role in the repeated and sustained successes at Geisinger. He shares a number of memorable pearls during our dialogue. One example is his commentary on how “scaling” innovation is, in his experience, much more challenging than creating the innovation itself. Another related example is, in his own words: "how you do the ‘sociology for change’ is actually even more important than the substance of the change". His explanation of these statements have profound implications for anyone interested in or working on the transformation of healthcare.
You’ll also hear about the groundbreaking work Dr. Steele is doing in his newest role as Vice Chairman and clinical leader at the Health Transformation Alliance (HTA), an alliance of over 40 U.S. Corporations composed of over 6 million employees, with an annual healthcare spend of over $25 billion. In this role, Dr. Steele, and his colleagues at HTA, are demonstrating to employers and employees that they can lower the cost of care by over 25% and decrease the risk of heart attacks, strokes and other end-stage outcomes of chronic disease - by guiding medical care to physicians within the Alliance who are using the ProvenCare model.
The Geisinger ProvenCare story is one of the best in the annals of American Healthcare; and in this interview, it’s told by one of the most proven healthcare leaders.
As always, I hope you get as much out of this interview as I have!
This week’s episode, on employer-based healthcare, deals with one of the most critically important & rapidly advancing issues in American healthcare today.
Our guest this week is Dave Chase. He is a highly successful serial entrepreneur - who, among numerous other accomplishments, played a leadership role in launching Microsoft’s $2B healthcare platform. Dave has been named as one of the most influential people in Digital Health, and is known for the boldness and integrity of his speaking and writing.
A hallmark of Dave’s approach, as you’ll hear in this interview, is his refusal to pull any punches. Over the past few years he has been on a quest to understand and address the impact of the growing costs of healthcare on employers, employees, as well as the deleterious downstream impact on our municipalities and the national economy. Keep in mind that nearly half of all healthcare costs in the U.S. are paid for by employers and increasingly shouldered by employees.
Fortunately, Dave and his colleagues, as well as numerous others around the country, have been working to optimize the effectiveness & enhance the efficiency of healthcare delivery, as well as to very intentionally reduce the significant unnecessary costs of care.
To this end, Dave and his colleagues have formed a non-profit called Health Rosetta, whose purpose is to drive the “adoption of successful strategies and practical tactics to fix the healthcare system through the optimization of employer health benefits programs & healthcare purchasing." It’s essentially an open source education, training and certifying resource for employee health.
In this episode, you'll learn about Health Rosetta’s “7 Habits for highly successful employers" - the proven solutions that Dave has discovered and collected. We’ll also discuss the critical role that “value-based primary care” and “centers of excellence” (high performing provider groups) play in reducing unnecessary healthcare costs for employers. Dave has the refreshing perspective that most of the solutions are already out there - they just need to be identified and deployed effectively. Dave also shares several encouraging examples of employers who have implemented these relatively straightforward initiatives, and reaped huge savings, which return to their bottom line and enhance their ability to extend greater benefits to their employees and their communities.
It's a real treat to hear Dave discuss these topics with sincerity and fact-fueled passion; but, if you'd like more detailed information, I would encourage you to visit the Health Rosetta website and/or download a free digital copy of his book, "The CEO's Guide to Restoring The American Dream - How To Deliver World Class Healthcare to Your Employees at Half the Cost".
Although this interview begins with some stark economic realities and a disturbing vision of a potential future, it ends with a hopeful message. Dave’s call to action is simple - join the value-based movement. Dave is practical, purpose-driven, compassionate healthcare leader who brings fresh perspectives, fearless honesty and a selfless commitment to, as he puts it, “leave the world a better place for my kids than the current trajectory." His work in the domain of employer-based healthcare is a critical endeavor to make a highly opaque and misaligned part of healthcare delivery more transparent and more sensible.
I hope his story and his mission inspires you, as much as it has me.
This week’s interview is an expose in modern medical professionalism and perspectives on what will be required for the next era. Our guest this week, Richard Baron, is a physician grounded in nearly three decades of direct hands-on clinical care and enlightened by his experience of participating on numerous national level workgroups such as at the National Quality Forum, the National Committee on Quality Assurance, the Center for Disease Control, The Commonwealth Fund & The Aspen Institute Health Strategy Group - as well as a couple of years at the Centers for Medicare & Medicaid Innovation Center, leading initiatives in accountable care and primary care redesign. He currently is the CEO of the American Board of Internal Medicine (ABIM), which has had its fair share of controversy.
Richard has a deep and broad perspective on healthcare delivery. But more than that, he’s a remarkably and refreshingly independent-minded thought leader, and a dedicated, passionate public steward for American medical professionalism.
Dr. Baron reminds me of the many dedicated, hard working, thoughtful primary care physician leaders whom I meet regularly. Like these high-integrity physicians, his focus is on the broader continuum of patient care - on patients & patient care, first & foremost; and then secondarily on sustaining providers. His vision is consistent with the "quadruple aim" of better health, better care experience, better value & better support for providers. He is an ardent champion for maintaining and elevating the standards & quality of medical care; and a vocal advocate for the critical central role of primary care in any value based healthcare system.
Richard studied English at Harvard College, and then received his MD degree from Yale. I’m not sure if it’s his liberal arts background that has given him the ability to tease out and integrate complex themes and narratives; but I do admire the new narrative he is attempting to construct at the ABIM. He is currently focusing his efforts on listening to the varied voices and myriad perspectives of the ABIM's physician constituents; and seeking to understand how to recognize, celebrate and reward both the tangible and intangible benefits of the the doctor and the doctor/patient relationship.
He is keenly and realistically aware of the very real tensions of our times, and rather than ignore or polarize, he is seeking to balance. Richard exposes the tension between science & service, between payment and prioritizing value-based patient care, between clinical medicine and community care. He is clearly a defender of the scientific & technological narrative of healthcare - the ABIM’s purpose being to maintain professional knowledge and competence. But, he is also seeking to support the integration of complementary narratives such as the importance of doctor/patient communication, continuous quality improvement, data-driven health management, and the empathetic skill and emotional work that is crucial in healing relationships.
This interview reveals the story of an individual physician, innovator & leader - who is attempting to do what many of us are struggling to do - to infuse & sustain ourselves, our colleagues, our professions, and our institutions with humanism, humility, meaning and purpose; and to do so in an increasingly complex world that is becoming, of necessity, more corporatized, institutionalized and standardized.
Above all else, what comes across in this dialogue is Dr. Baron’s strong sensibility that it is an incredible privilege to be of service to others - to have the gift of being able to alleviate the suffering of our patients and our communities through the practice of the art & science of medicine.
This is a story you shouldn’t miss out on. As always, I hope you gain as much from this interview as I have!
On the surface of it, this week’s podcast is about a new migraine solution. But, the bigger story here is really about reframing how we think about chronic disease management and rethinking the importance of self-reported patient health data. This story is also about the power and elegance of simplicity; the value of customer discovery and agile prototyping; and the absolute primacy of paying attention to the user interface interface/consumer experience.
What’s particularly refreshing about the way this product was created is that it was developed through listening to patients and providers. Listening to patients, who define value; and to providers, who create it - and being open to continuously revamping one's design based on what one is hearing and observing.
This week’s guest is Dr. George McLendon. George has an impressive academic & entrepreneurial background. He’s published over 200 research papers in chemistry, physics & biology; and holds multiple patents, which has led to the founding of several successful life science companies.
George and his colleagues at SensorRX focused on headaches for a number of reasons. Over 40 million people in the U.S. and nearly 1 billion people worldwide suffer from migraine headaches - making it one of the most prevalent chronic medical conditions. The impact on U.S. employers is also profound - reaching tens of billions of dollars a year in medical costs and lost productivity.
The customer discovery process that George and his team took led them to a number of observations and learnings. Here are a few of their discoveries you’ll hear about in this interview:
Physicians made their decision about which migraine medications to use, and the medication dosing based on only 4 or 5 pieces of patient reported symptoms.
Patients grossly under reported their symptoms - more specifically, the frequency and intensity of the headaches they had been experiencing. In their studies, the SensorRX team discovered that well over 50% of patients were under reporting their symptoms!
As a result of this under reporting, providers were under treating the migraine headaches - leading to months and years of prolonged headaches. It was this key pivotal discovery - the critical importance of reliable self-reported patient health data - which became the centerpiece of their solution.
Patients would not use an app that took longer than 15 seconds to record and document their symptoms. People wanted a quick and easy product.
These realizations led the team to construct an app that literally takes 12 - 15 seconds to use each time a patient has a migraine. The app records the necessary pieces of data; and can convey that info to the treating provider in a number of ways that makes it easier for the provider to treat the patients’ headaches more appropriately.
In their unpublished trials to date, the team has witnessed an overall improvement in quality-of-life scores of over 30%, with many patients seeing much greater improvements. This standardized quality-of-life survey - known as MIDAS - measures the negative impact headaches have on one’s work and social life. Clearly, the efficacy has yet to be proven in more rigorous, peer-reviewed studies; but the anecdotal reports to date are compelling.
George and his team are also applying this approach to other conditions - such as asthma, irritable bowel syndrome, epilepsy and emphysema… conditions in which patient reported health data play a critical role in determining how physicians treat their patients.
There is another part of this story here that shouldn’t be lost - Dr. McLendon's intention. One only need listen to his telling of the story of ‘Sally’ and her daughter to appreciate that his overarching mission is to alleviate the avoidable suffering of patients with chronic conditions. This is a trait shared by most of the leaders and innovators interviewed on this podcast series. The lesson here may be that empathetic purpose & intention are key factors in redesigning successful healthcare solutions from the consumer/patient perspective. And, that may be one of the most significant lessons we can derive from this and other episodes of ‘Creating a New Healthcare’.
This week's podcast is about the critically important issue of patient suffering & professional caregiver suffering. This particular episode will speak to you, not only from a professional perspective, but also from a deeply personal one. If you have ever been a hospitalized patient, or a family member of a patient; or, think that you might someday be a hospitalized patient or family member of a patient, you’ll want to listen to this interview.
Our guest this week is Christy Dempsey, the Chief Nursing Officer for Press Ganey Associates, who has recently authored a book entitled, ‘The Antidote to Suffering: How Compassionate Connected Care Can Improve Safety, Quality, and Experience’. Christy has over three decades of experience as a nurse, nurse leader, hospital executive, and a consultant with deep experience in clinical operations, process improvement & patient experience. Her approach is comprehensive and balanced; and her prescriptions are practical, and grounded in the practice of medicine, as well as in the science of process improvement and business management. Her stories range from heart breaking to incredibly hopeful.
In this episode, you’ll learn about the ‘Compassionate Connected Care’ model that Christy has constructed and is deploying in hospitals across the country.
You’ll also come away with some amazing pearls & actionable take aways. Here are a few examples:
There are two types of suffering - inherent & avoidable; and caregivers often, unknowingly, contribute to or worsen the avoidable suffering that patients and their families experience in the hospital.
People from different backgrounds and with different conditions have different susceptibilities to suffering - and knowing the specific painful issues can assist in creating a targeted plan to alleviate that suffering.
It doesn’t take a lot of time to alleviate suffering - caregivers can make a strong personal connection with patients in less than a minute or two - what Christy calls the ‘56 second rule’.
Professional caregivers - similar to patients - experience both inherent and avoidable suffering or distress; and if we want to alleviate patients’ suffering, we’ll need to make the alleviation of caregiver suffering a major part of our plan.
Caregiver resilience is a balance between inherent/added distress and inherent/added reward. Our goal should be to tip the balance in favor of rewards vs distress. Christy also introduces us to the concept of 'Emotional Labor' and its impact on caregiver resilience & patient experience.
Patient distress/suffering is not about professional caregivers being ‘nice’ or creating a ‘wow’ experience. It’s also not about hitting the patient experience metrics on your hospital's scorecard. This is an integral part of clinical care & core to our professional ethic; and closely tied to quality & safety outcomes such as infection rates, hospital length of stay, readmission rates...
Christy is a passionate, highly expert and convincing champion for the cause of alleviating patient & professional caregiver suffering. What I admire most about Christy, and what she's doing, is her courage and commitment in speaking out and doing something about a very sensitive issue that most don't recognize or want to discuss. Christy definitely joins the pantheon of leaders I’ve interviewed who have devoted their careers, and lives, to creating a new healthcare!
As always, I hope you get as much out of this as I have!
This episode is about nothing less than elevating the human condition at the forefront of healthcare delivery. It is about enriching and empowering professional caregivers through real-time written feedback from the patients they care for, so that they can, in turn, create a sustained culture of caring, comfort, compassion, trust and safety for patients and patients’ families.
The solution we’ll discuss this week focuses on directly recognizing & appreciating the professionals and staff who are, all-too-often, the unsung frontline heroes of healthcare delivery.
Our guest this week is Alex Coren - a female entrepreneur, inventor, digital tech wizard & international speaker who was named #1 female student entrepreneur in the U.S. In 2016 she formed a company called Wambi. In 2017, she formed Carepostcard and Humans of Wambi - two other products which elevate humanism in healthcare. Her overarching mission is to catalyze what she has named, ‘The Compassionate Care Movement’.
Alex is an impressive and inspiring leader. She is a powerhouse of purpose, passion & productivity. What she is doing to improve care in the acute and post acute setting is so simple and so ingenious that you’ll wonder why no one has thought about this or done it up until now. Her personal story is equally as compelling, and provides some explanation for what catalyzed her to create such a unique and innovative contribution. Alex grew up with two parents who were chronically ill - constantly in and out of the acute care healthcare settings. Over the course of years, she observed, up close and personal, the essential vulnerability and dependence of being a patient in the hospital setting.
As a result, she developed a tremendous gratitude, respect and deep admiration for those frontline caregivers that worked tirelessly to care for her parents, and for her. It may come as no surprise, that her first job was in an acute care facility, being a manager responsible for patient experience. What she observed in this role - to her surprise - was the widespread depersonalization that frontline providers & staff experienced - literally the sense of ‘not being seen’ or recognized. She also observed the outcomes - which included depersonalized care, lower patient satisfaction, worse outcomes of care, low employee morale, and an extremely high staff turnover rate.
Out of these challenging experiences as a child, her early empathetic professional observations, and her brilliant and bold mind, she created Wambi. Wambi is a patient-driven, healthcare employee performance platform aimed at recognizing and empowering compassionate care. It uniquely addresses patient satisfaction where it starts - with the care providers - through the eyes of patients and their families. It’s a gamified digital platform informed by real-time patient/family feedback, which supports care providers with individualized patient/customer experience data as a means to promote autonomy and inspire sustained behavioral change. This product serves to improve care provider engagement, decrease staff turnover and burnout, and elevate the patient experience. And it works. The hospitals her team have deployed the Wambi platform in have experienced up to a 20% decrease in staff turnover within 5 months times; a 30 to 40% increase in staff engagement, and double digit increases in HCAHPS scores.
Alex Coren and her team come at this serious & long-standing problem in healthcare with a fresh perspective and a new set of solutions. This is an essential ‘must-listen’ podcast interview for any manager and/or leader involved in hospital, post acute care or home healthcare, who wants to create a culture of compassion.
The contents of this interview are compelling enough. But there is more to the story. This dialogue with Alex is a profound lesson in leadership - a lesson in the art of simplicity, gratitude, courage and conviction. Alex’s sense of purpose is palpable. Her bold entrepreneurial spirit, and the humanistic mission she and her team are on, are hugely inspiring. In this interview, I ask her for her secret ‘super-power’. It’s well worth the listen just to hear her response to that question.
I hope you appreciate and benefit from this dialogue as much as I have!
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Kyra Bobinet MD, CEO & founder of engagedIN - a healthcare behavior design firm which uses neuroscience and state-of-the-art design techniques that make products and communications more engaging for consumers. Kyra has an impressive background in developing health apps, blockbuster products, and evidence-based programs in wellness & metabolic medicine. Prior to founding her own company, she served as a physician executive at Aetna, where she designed large-scale population health management and wellness interventions for Fortune 500 companies. In 2015, she authored the ‘Well Designed Life: 10 Lessons in Brain Science and Design Thinking for a Mindful, Healthy, and Purposeful Life’. In addition to her companies work, she also co-teaches patient engagement and health design with Dr. Larry Chu at the Stanford School of Medicine.
This podcast episode is a critically important to anyone interested in patient engagement & behavior change. Kyra has spent years studying and combining the most up-to-date, evidence-based brain science, behavior change and design thinking - and embedding them in healthcare programs and products. You will come away from this interview with a very different understanding of behavior change. As Kyra puts it, “we have learned more about the brain and behavior in the past 5 years than in the previous 5,000 years - offering the potential and power to reach, influence and improve health and well-being at scale”.
There are a number of pivotal learnings to be gained from this interview. Here are a couple.
One of the most compelling advantages of Dr. Bobinet’s approach is the absence of blame, shame or guilt. In this model, there is no sense of personal failure. If there is a failure, it is in the behavior design, not in the provider or patient; because the intent is not in manipulating or psychologizing the individual; but rather in manipulating the design.
Another advantage to this approach is that it’s based on brain science. Kyra describes a part of the brain called the Habenula. It’s purpose is to prevent us from repeating behaviors that might harm us. As Kyra describes, the Habenula is essentially a ‘failure counter’. If we perceive a failure - like in trying to lose weight or starting some new exercise regimen or eating healthier - the Habenula downgrades our motivation. So - not only do we not achieve the intended behavior change, we also feel bad about it, and are demotivated to try something else. The Habenula pathway is literally a physiologic demotivator. Realizing the unintended consequences of this evolutionary neural pathway, the Design approach attempts to side-step the Habenula’s failure mode. If we perceive a design attempt as an externally located learning experience, rather than a personal failure, the Habenula failure counter and cycle of suffering is far less likely to be activated.
The Design approach transforms behavior change from compliance-based to creative-based. And, this is not a theoretical model. It is a practical one that has been deployed in industry and in healthcare. Kyra describes how companies like Facebook use this creative iterative approach. She also shares some of her own projects that have deployed this approach.
There are numerous pearls, parables and personal takeaways that Kyra offers up in this interview. Kyra is, above all else, completely genuine and authentic; and therefore her voice is incredibly compelling. It’s truly a delight and a privilege to share this interview with you.
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Len D’Avolio, CEO and founder of Cyft - an organization that uses data and Artificial Intelligence (AI) I to make value-based care wildly successful. Dr. Len D’Avolio has spent the past 13 years - in government, academia, philanthropy and industry - attempting to transform healthcare into a “learning healthcare system”. He is clearly one of our country's most talented minds and experienced practitioners in the use of predictive analytics and machine learning as applied to healthcare.
His resume and portfolio are impressive - as an academic and an entrepreneur. Len is an assistant professor of medicine at the Brigham & Women’s Hospital and the Harvard School of Medicine. He has worked with superstars like Atul Gawande, deploying global healthcare projects. Len also created the infrastructure for the world’s largest genomic medicine cohort; and embedded the first clinical trial within an electronic medical record system for the Department of Veterans Affairs. He’s a highly sought after and nationally recognized keynote speaker, and serves as an advisor to numerous healthcare start-ups.
If you want to understand AI in healthcare - both the opportunities and the limitations - you’ll want to listen to Dr. D’Avolio’s deep knowledge and honest practical take on things. Len characterizes healthcare largely as treating data as ‘exhaust’, whereas other industries treat data like it’s their oxygen or their life blood. Whereas other industries understand how to use advanced data analytics to inform their daily decisions for the purpose of optimizing performance, healthcare remains years behind.
What we’re talking about here is ‘moneyball’ - using advanced mathematical algorithms embedded in software programs that affords practitioners in any field the ability to make much more informed decisions - whether that field is finance, sports, retail, social media or medicine. The ‘machine learning’ or ‘neural network’ part of it speaks to the capacity of these software programs to create probabilistic inductive hypothesis from enormous amounts of data - clearly something the unaided human mind can not do. This may be the ‘rocket science’ of our era; but it’s not magic. In this interview Len dispels the mystery & myths surrounding AI. He likens it to a tool. A hammer does not build a house - carpenters do; and so-called AI or supervised machine learning does not cure cancer - scientists and physicians do.
According to Dr. D’Avolio - and his expert colleagues, there is no magic to AI. This is not some plug-and-play ‘black box’ that can be let loose to solve all the problems in healthcare. It is not an independent sentient ‘artificial intelligence’ that will somehow supercede and substitute for physicians or physician scientists. To anthropomorphize this technology is fantasy. These tools require tremendous amounts of human expertise & attention - both technical and clinical - to program and manage - hence the term ‘supervised’. Len also dispels the myth that one algorithm can be applied across the board to numerous use-cases. The current reality is that it might require a team weeks, if not months, to create a program for a specific condition or situation.
On the other hand, what these tools can help us accomplish is profound and amazing. There is little doubt that this field will transform healthcare delivery - allowing us to deliver much better care at a much lower cost - optimizing outcomes and customizing medical care. There is little doubt that this field will transform the way medicine is practiced - assisting physicians and other providers in ways unimaginable. And, this is not the future - it’s now. Len shares some examples of these benefits.
This is an enlightening and inspiring interview in which we synthesize and distill the years of Len’s hard-earned practical wisdom into an hour’s time. You will leave the interview with a greater understanding of machine learning, predictive analytics, and AI in healthcare; and will now be aware of and connected to one of the leading figures in the field.
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Roy Rosin, the Chief Innovation Officer at Penn Medicine - the University of Pennsylvania Perelman School of Medicine. Roy distills the “essence” of his two decades of success in customer behavior change & reveals some of the most critical ingredients. He has spent the past 5 years at PennMed - initiating over one hundred new healthcare delivery projects. Prior to entering healthcare, Roy spent 18 years at Intuit (Quicken & TurboTax), where he was an accomplished executive and then Intuit’s first Innovation Officer. Intuit has been widely recognized for its application of innovation to enhance business outcomes, and Roy was clearly instrumental in that.
Roy brings to healthcare a profound acumen in digital technology, human-centered design & super-rapid cycle innovation - which, in and of itself, would have been an interesting topic of discussion. But in this interview, Roy focuses the conversation on what he believes matters most to achieving positive healthcare outcomes - patient engagement & activation. The projects he and his PennMed colleagues have deployed are fascinating - using the techniques of behavioral economics to drive behavior change. And the outcomes are compelling. Roy discusses how PennMed is making improvements in medication adherence, blood pressure control, surgical recovery, hospital follow-ups, cost effective prescribing, readmission rates and ED visit rates. He illustrates the profound impact and leverage that behavior change and patient engagement can have in terms of cost savings as well as life savings.
One surprise that emerges in the dialogue is the realization that high impact does not necessarily mean high tech. Some of the amazing results achieved at PennMed come about through surprisingly low tech solutions. The use of texting, for example; or just creating default settings in the electronic medical record that drives tens of millions of dollars of savings via the use of generic medications. One pearl that Roy drops toward the end of the interview is an innovation heuristic he lives by - “Love the problem, not the solution”. He shares stories of how he and his teams have discovered that the stated problem is often not the actual one - and that landing too quickly on a proposed solution often short changes the desired outcome. Roy also introduces us to a new center at PennMed called the ‘Nudge Unit’ - a unique division designed to directly apply behavioral economics onto healthcare delivery.
It’s abundantly clear throughout the interview that Roy is a humble leader, innovator and mentor. He repeatedly mentions his colleagues and predecessors by name - and credits them for the results and outcomes achieved. It’s also clear that Roy & his colleagues at PennMed are mission-driven and passionate about creating meaningful results. Roy’s is a refreshing and engaging perspective. If you have an interest in understanding and improving patient engagement/behavior change, you’ll want to listen to this dialogue - and probably more than once!
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Mike McSherry, CEO of Xealth. Mike represents a new breed of highly accomplished digital tech entrepreneurs who have spent the past decade or two reshaping the landscape of digital tech; and who are now entering healthcare, ushering in a new era of healthcare delivery - an era that this interview will offer you a glimpse into. Mike’s amazing portfolio of accomplishments includes Swype. It’s an application that is embedded in over a billion android smart phones across the globe; allowing user’s to essentially ‘draw’ words rather than 'tap' them out - enabling faster, easier text input. The point here is that Michael and his colleagues are not only technologic wizards. They are clearly world-class experts in user interface (UI) & user experience (UE) - something that is sorely lacking in healthcare! As you listen to the interview, just imagine what healthcare might look like if there were dozens or even hundreds of similar UI/UE digital experts engaged in healthcare across the country - working collaboratively with clinical colleagues. Now, that's a roadmap for Creating a New Healthcare.
In this interview, Mike introduces us to Xealth - an application he and his long-time colleagues have created - that allows any digitally connected app or service to be placed onto a user-friendly platform. For starters, Xealth is a digital formulary - allowing physicians or other providers to ‘prescribe’ an app or service. Physicians can now decide what digitally connected services & apps they want in this formulary - and just like adding a new medication - a new digital app or service can be added in less than a tenth of the time it traditionally takes. The types of services on Xealth at the time of this interview includes traditional apps, but also includes transportation services, home devices such as glucometers and CPAP machines, and even food delivery and transportation services. (Although not discussed in the intervew, keep in mind that, in the literature on 'social determinants of health', inadequate food and transportation, along with social isolation, are some of the leading causes of poor health outcomes and avoidably higher costs of care.) The Xeatlh platform also offers automatic monitoring of patients' patterns of usage, as well as predictive analytics - keeping track of how often, and in what ways patients are using these apps, as well as guiding the provider to better identify which app or service might work better with a particular patient.
There are numerous pearls in this podcast. Among them, Mike shares the best piece of his advice he has ever been given, which has guided the way he works; and has greatly contributed to the tremendous value and success he and his colleagues have created together. Most importantly, you’ll hear a fresh perspective on how cutting edge thinkers and doers are attempting to augment and leverage the value proposition in the provider/patient relationship. What we find particularly encouraging from interviews with digital tech gurus like Mike is their unabashed support of physicians and other providers of medical care, and a deep respect for the patient/provider relationship. We have heard this theme repeatedly in this podcast series. Far from disrupting that relationship, these digital tools serve to enhance it.
Mike brings an encouraging and inspiring message for providers - a set of support tools that will enhance one’s ability to optimize patient care and augment one’s efficiency. For patients, this should be viewed as healthcare catching up to other industries in terms of customer service, convenience and engagement - making it easier to be healthy. And for payers and healthcare leaders, this represents the emergence of a new paradigm in patient/customer engagement - a novel approach to realize the triple aim of improved healthcare, improved outcomes & more cost effective care.
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Sami Inkinen, founder & CEO of Virta Health. Sami’s story is remarkable, and remarkably disruptive to healthcare. There are actually 3 stories rolled up into this podcast: (1) the story of Sami Inkinen, (2) the story of the ketogenic nutritional approach (low carb/high fat diet), and (3) most importantly, from our perspective, the story of how disrupt-able healthcare delivery is when you combine cutting edge medical science with leading digital technology. Sami, an immigrant from Finland with a physics background and an MBA from Stanford, co-founded, took public, and then sold Trulia, an online real estate marketplace, for $3.4 Billion. He did this before he was 40 years old. Then he discovered that despite being a world-class athlete (literally—he won a world triathlon championship in his age group), he had pre-diabetes. After researching on his own, Sami connected with two highly published, world-class nutritional scientists who had been studying the ketogenic nutirtional approach for decades. One being Steve Phinney, a Stanford-trained physician with a PhD in nutrition from MIT; and the other being Jeff Volek PhD, one of the most highly published researchers in the ketogenic genre, with over 300 peer-reviewed publications. The three decided to merge cutting-edge medical science with Sami's software and technology background. And, Virta Health was born—an online specialty medical clinic that reverses type 2 diabetes, without medication or surgery. Their goal - that is, Virta's corporate mission- is to reverse diabetes in over 100 million people by 2025! There are many remarkable aspects to this story, but just keep in mind that Sami is a guy who had no medical/clinical background, and within a couple of years has a company that is licensed to provide specialty medical care in all 50 states within the U.S. It is our belief that this is not an aberration; but rather an emerging trend that will continue to accelerate as more entrants from the digital technology world make their way into healthcare delivery, and begin to collaborate closely with evidence-based authorities in clinical medicine. [For further evidence of this, you can view podcast episode #16 with Aaron Martin at Providence Health St Joseph; or podcast episode #12 with Sean Duffy at Omada Health; or podcast episode #11 with Eyal Gura at ZebraMed; or podcast episode #6 with Joanna Strober at Kurbo - as other brilliant examples of this trail blazing trend.] Getting back to Sami & Virta Health, the immediate and understandable response to hearing about this might be skepticism. How can you meaningfully connect with patients and treat them effectively via an online service? In this interview Sami shares some early results and outcomes that might surprise you. Virta Health has a Net Promoter Score (broadly used measure of customer satisfaction & loyalty) of 70—on par with Apple, The university-based research studies Virta has conducted to date are showing type 2 diabetes reversal rates of nearly 60%, with adherence of over 80%. It’s still early on, but the results, to date, are promising. And the trail that Sami - and others like him - are blazing, is one that would be very worthwhile listening to and learning from.
Disclosure: Dr. Zeev Neuwirth sits on the Industry Advisory Board for Virta. He has been collaborating (non-paid) with Sami Inkinen and his colleagues, even prior to the launch of Virta - driven by a genuine professional and personal desire to improve the care of people with diabetes. Dr. Neuwirth wasn’t going to post this interview publicly because of concerns related to a perceived conflict of interest; but he felt this story was too important not to share. Dr. Neuwirth holds stock options in Virta; but receives no payment or other remuneration for this podcast episode, or any other discussion of Virta.
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Robert Andrews, CEO of Health Transformation Alliance (HTA). HTA is a non-profit alliance of nearly 45 Corporations who are working to improve the outcomes of healthcare and reduce the costs of medical care. The Alliance includes such names as: IBM, Coca-Cola, 3M, Walgreens, Marriott, Pitney Bowes, Verizon, Dupont, Shell, Prudential and Fedex - to name a few. Rob outlines HTA’s bold mission which is to “fix our broken healthcare system”; to “help companies take better care of the people who take care of them”; and to reverse the perverse incentives of the current Fee-For-Service payment model by paying physicians for value-based preventive care and improved health outcomes. Placing himself in challenging situations in order to serve the public, taking on ambitious goals, and getting them accomplished, is not a new pattern for Mr. Andrews. Prior to his current role at HTA, he served as a Congressman in the U.S. House of Representatives for nearly 24 years. Upon his departure from the House, President Barack Obama praised Rob’s service as “an original author of the Affordable Care Act… and a vital partner in its passage and implementation”. In this interview Rob outlines the three major tactics the HTA is taking in order to accomplish its mission. The first is to lower pharmaceutical spending through appropriately cutting out non-value added costs in the pharmaceutical supply chain. The second is to select provider groups with a demonstrable track record of delivering excellent health outcomes, cost effectively. And the third is to engage employees in becoming proactive participants in their own healthcare. These activities are all informed by IBM Watson Health’s supercomputing analytics. It seems like HTA is well on its way to achieving its goals. They are predicting healthcare savings of hundreds of millions of dollars in the first three years. However, Rob Andrews convincingly argues that HTA's mission is not primarily about cost; but instead, they are focused on improving health outcomes, which will drive costs down - a win for employees and their employers. You’ll be inspired by the conviction, integrity and energy that Mr. Andrews brings to this critically important task at hand.
This is the second of two inspiring interviews featuring the integration of digital health into one of the largest integrated delivery networks in the country. In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Aaron Martin, who came to Providence St. Joseph Health (PSJH) directly from spending nearly a decade at Amazon, where he was an executive - the North American director of Kindle & print-on-demand services. In that role, Aaron led a disruption of the print publishing industry that catalyzed tremendous value for readers as well as writers. What is remarkable about this interview is that, despite being a technical leader in the digital realm, Aaron spends the first few minutes of the interview describing the leadership principles & cultural norms that were critical factors in Amazon’s success. In those first few minutes, what becomes abundantly apparent is that Aaron brings to his work an intense dedication to patients and providers; as well as a unique combination of value-based thinking, authentic leadership, and industry-leading technical capability in healthcare redesign and innovation. In what is an inspiring and refreshing dialogue, Aaron describes the two most important stakeholders in healthcare - the ‘creator’ of value (the provider of care), and the ‘customer’ (the patient or consumer of care) in the healthcare value chain. In this interview, he shares how he views his role as supporting the professional commitment of providers & enabling the ‘sacred moments of care’ between provider & patient. Aaron views digital health & the consumerist approach as integral enablers of medical care, and not as disintermediaries. He also lays out a very clear picture of why and how design thinking, digital health, and a consumerist approach are critical success factors for any organization that expects to thrive in the future healthcare delivery market. With straightforward examples, Aaron demonstrates that, unlike some previous deployments of technology, digital health leads to a markedly better consumer experience for both patients and providers; leverages and enhances the value proposition of providers; improves health outcomes, and solves for major organizational challenges such as access to care, growth and affordability. Aaron and his colleagues hold themselves accountable for producing demonstrable and measurable results - outcomes that matter to patients, providers, and payers.
This is the first of two amazing interviews featuring the topic of Digital Health and its integration into healthcare delivery at Providence St. Joseph Health. In this first interview, Sara Vaezy describes, in no uncertain terms, the ‘Existential Imperative’ that makes digital health an absolute requirement and a critical success factor for any organization contemplating a robust future in healthcare delivery. Sara shares two customer-centric examples of how digital health is transforming healthcare at Providence St. Joseph Health - in their on-demand care services (Express Care); and in their Women’s Health offering (Circle). She points out that, far from being a nice-to-do, the consumer-oriented digital health integration is moving “big needles” in terms of access, consumer satisfaction, growth and revenue. Sara talks about the work she and her colleagues are collaborating on - to create a 10X experience that enhances engagement and improves health outcomes. By 10X, she means a patient/consumer experience that is ten times better than what patients currently experience! When asked to describe the personal leadership characteristics that make this sort of transformation possible, Sara has two answers. First - “resilience... in the face of a non-steady state environment”; and second - an “unwavering commitment to what’s best for our patients”. You’ll not want to miss this authentic and insightful interview with someone who is clearly one of the up and coming leaders in the digital health movement.
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Stuart Levine - one of the most experienced & accomplished physician executives in the realm of value-based care. Dr. Levine has been deeply engaged in providing comprehensive care under global capitation for decades. He brings a clarity and practical wisdom to the complex topic of clinical care & cost stewardship; as well as a deep sense of professional responsibility to high quality, safe & effective patient-centered care. He describes a managed care environment that is both practical and personalized. He also describes a healthcare construct that is rewarding and sustainable for physicians & other providers of medical care. In this in-depth interview, Stuart outlines ‘the six pillars of care’ - a time-tested and proven model for population-based, value-based care. Stuart places a tremendously high premium on spending more upfront & supporting a relationship-based approach to patient care - which he has proven saves both lives & money. He advocates for a human-centered care that is fiscally responsible. The picture that Stuart paints provides us with hope for a better future in healthcare.
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews John Moore, the CEO of Twine Health - a patient engagement & health activation platform. Dr. Moore brings an unusual background to his work. In addition to his medical training and clinical background, he is also an engineer, who spent years, after leaving his medical residency, at the MIT Media Lab; where he became expert in the technology of social media & communications, as well as in the science & art of behavior change. This rare combination of clinical, technologic & behavioral expertise led him to reframe the clinical value proposition & to create the Twine platform - which allows clinical teams, patients and their families to work in a highly collaborative and convenient way. Dr. Moore reframes patient engagement in terms of ‘health activation’, in which health becomes a collaborative team activity. The traditional office visits are augmented with ‘micro-interactions’ in which the patient can access a health coach or someone else on their health team when and where they need it - that is, in the rhythm of their own lives. On the Twine platform, medical advice & recommendations are delivered in small aliquots that are highly effective and efficient. It’s a win/win/win situation - patients get what they need, when they need it, & how they want it - in an easy-to-use and convenient format; health care providers’ time & expertise is leveraged & distilled to be of highest value; and clinical outcomes of care and cost effectiveness are greatly improved. There are numerous lessons to be gleaned in this interview, which can inform anyone who is interested in improving patient care & the customer experience in healthcare delivery.
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Sean Duffy, who is one of the most lauded pioneers in the space of digital health & digital behavioral medicine. Sean and his colleagues at Omada Health are clearly trailblazers in numerous ways. The company has used the foundation of a widely-respected, evidence-based intervention -- the National Diabetes Prevention Program -- and transformed it into a convenient, digital platform that is consumer-oriented, customer-friendly, and that delivers a personalized experience for users. Sean and his team focus their intervention on a specific, clinical population that represents one of our nation's most significant and growing healthcare problems -- those at elevated risk for type diabetes and other obesity-related chronic conditions. While capturing some of the most cutting-edge approaches to behavior change, Omada has incorporated their solution into the mainstream of healthcare delivery, adhering to all regulatory requirements while working to have the intervention coded and paid for like any other billable event. Omada's plan is not to go around the legacy healthcare system, but to become a working part of it. Sean's Omada story is one of courage, conviction & commitment - toward taking patient-centered care, the patient user experience & patient engagement to the 10X realm. It's a story you will definitely want to hear.
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Eyal Gura, co-founder & Chairman of ZebraMed - an Artificial Intelligence (AI) company dedicated to transforming medical imaging. ZebraMed was listed in Fast Company, in February 2017, as one of the top 10 AI companies in the world; and in Fortune Magazine, also in 2017, as one of the top 50 companies leading the AI revolution. In this interview, Eyal describes his company's mission to provide the world with automated, accurate, timely & affordable medical imaging diagnosis. The computer machine-learning algorithms at ZebraMed are already reading CT scans and mammograms; and they are continuing to expand their portfolio of medical images. It’s an exciting vision that Eyal paints - one that you will definitely want to hear. His company is mission driven as well - planning to & already delivering high tech radiologic support to underserved communities & countries. One of the most exciting parts of the interview is Eyal’s announcement of their AI1 (All in One) program; in which ZebraMed is going to offer a flat-rate fee of $1 per scan - no matter what. That’s right - $1 per scan! This revolutionary pricing strategy is, almost certainly, going to transform medical imaging & healthcare delivery, by providing access to high quality, affordable medical care for millions of people around the globe. Eyal and his colleagues at ZebraMed are on a bold, courageous & visionary journey to Create a New Healthcare!
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Don Berwick - widely recognized as one of the most influential & impactful healthcare leaders of our time. His foundational contributions to the quality, safety & reliability movement in healthcare - beginning in the late 1980’s - have led to profound reductions in medical errors in the United States and abroad. Among his numerous contributions, Don co-founded and led the Institute for Healthcare Improvement for 18 years - an organization that has shifted the landscape of healthcare delivery; catalyzed the healthcare quality movement; and whose overall positive impact on domestic & global healthcare is almost immeasurable. He has served numerous key leadership roles such as in the Institute of Medicine (IOM) & the Center for Medicare & Medicaid Services; and has authored and co-authored numerous landmark publications such as the IOM's 'To Err is Human' and ‘Crossing the Quality Chasm’. In this interview, Dr. Berwick provides us with detailed principles for the creation of a “third era of medicine” - an era in which we can more fully realize the goals of the triple aim - better medical care for patients, better health & health outcomes, and lower costs of care; and in which we can support our physicians & other providers of care in performing clinical work that is meaningful and sustainable. Dr. Berwick is an unparalleled physician-scientist-scholar, and a humanitarian leader whose integrity, vision & insights hold practical wisdom and guidance for any leader contemplating the future of healthcare delivery; and whose compelling stories provide us with directed purpose, inspiration & hope.
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Rushika Fernandopulle MD, co-founder and CEO of Iora Health. Rushika and his colleagues have spent the past 15 years building a model of healthcare that is primarily dedicated to optimizing people’s lives through better living - using Primary Care as the foundation. His courageous approach has really set the vision for what Primary Care can and should look like; and numerous other innovative Primary Care redesigns have been built off of the groundbreaking Iora Health model. In this interview, Rushika will unabashedly discuss the critical success factors upon which he will not compromise. He also shares stories which illustrate the simple elegance and amazing potential value of Primary Care. Dr. Fernandopulle ends the conversation with one take-home ‘nugget’: do a team huddle each morning, and talk about your patients, even if it’s only for 5 minutes. Are you up for his challenge?
In this episode of Creating a New Healthcare, Dr. Neuwirth interviews Devin Gross, who very recently left EMMI, after many years of success at the helm, as CEO. What becomes abundantly apparent in this dialogue is that Devin is not only a talented executive, but that he has also garnered tremendous insights into patient engagement during his 14 years at EMMI. Topics covered include: (1) the value proposition and ROI of patient engagement; (2) the essential understanding of the differences between patient education, patient experience & patient engagement; and (3) the two, very different, persona’s of the patient and consumer, and why each must be addressed in order for providers to be successful in a value based market. This is a not-to-be missed episode for anyone who is interested in this most critical topic of patient engagement - potentially the ‘holy grail’ of valued based care.
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Joanna Strober, the CEO of Kurbo. Kurbo is an online program that can be accessed via a digital app that provides motivational coaching and nutritional dietary guidance to children, parents and families who are attempting to improve their nutrition and optimize their weight. Joanna - a long time investor in technology start-ups focused on families and children - was wholly dissatisfied with the options available to her in helping her own son lose weight. As a result, she turned the Stanford Obesity Program into a consumer-oriented, kid-friendly app called Kurbo. Since 2014, Kurbo has helped thousands of children and their parents eat healthier and achieve a healthier weight. In addition to the physical benefits of weight loss, Joanna illustrates the social, emotional and behavioral benefits of these children learning how to eat better and maintaining a healthier weight. One remarkable story that she shares with us is that the Singapore government - after a side-by-side prospective study comparing Kurbo to their own program - has instituted the Kurbo program in its entire school system - as a government benefit for children who are overweight or obese.
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Dr. Par Bolina, Chief Innovation Officer at IKS. Par is a physician & expert in Healthcare Informatics, Electronic Medical Records & Exam Room Ambulatory Workflow. This episode focuses on one of the most critical and under-examined parts of healthcare delivery - the so-called “last mile” - the patient/provider encounter - where the rubber meets the road, and where healthcare value is directly created. To be quite honest - this podcast episode is lengthy; but you won’t want to miss what’s revealed. Dr. Bolina points out that our lack of investigation into and superficial understanding of the provider/patient encounter is what is leading to avoidable care gaps, suboptimal outcomes, inefficiencies, high costs, provider burnout, and less than optimal patient experience. Similar to a Jacque Cousteau, Bolina takes us on a deep dive into this largely unexplored domain, and opens our eyes to the ‘ecosystem of the encounter’ - what might be considered ‘the final frontier’ of healthcare delivery. What Bolina reveals to us is that the provider/patient encounter is filled with real-time data that we could measure and use, to dramatically improve upon healthcare outcomes. Dr. Bolina discusses ‘Scribbles’ - a ‘scribe on steroids’ redesign that he’s developed at IKS. Scribbles is an asynchronous, virtual, off-site physician-scribe/coach who listens to the audio recorded encounters during off-hours, and provides the provider with daily, real-time feedback and recommendations to improve clinical care, documentation & coding.
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Hesky Kutscher, the CEO of CareDox. Hesky is an experienced, bottom line entrepreneur who is also driven by a mission to radically improve the system of healthcare for school children. In this episode, Hesky describes the CareDox digital platform which is a 4-way platform that connects school health to parents, pediatricians & payers. CareDox has developed and is deploying a data-rich, analytic, digital platform to support, integrate and enhance the medical care of schoolchildren. As Hesky describes, the application of this approach will result in improved outcomes of care & lower costs through preventive measures such as assuring vaccinations; alerting school nurses, parents & pediatricians of impending problems; and ultimately, through the reduction of preventable & avoidable emergency room visits & hospitalizations.
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Cathryn Gunther, a seasoned Pharma executive, who discusses her passion and award winning efforts to advance employee health at Merck; and shares a glimpse into Merck's global population health initiatives. We explore the overlap of employee health, community health & population health.; and discover the potential for employee health to serve as a channel for improving population health. Cathryn leaves healthcare leaders with a wonderfully simple directive, "Make the healthy choice, the easy choice..."
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Bob Matthews, CEO of Medisync & VP of Quality at PriMed Physicians. Bob has been engaged in Population Health & Value Based Care since the early 1990’s and brings a practical wisdom, refreshingly honest insights, and ambitious goals to this increasingly important movement within healthcare delivery. He shares how he has, along with his colleagues at PriMed Physicians, constructed a unique approach to chronic disease management that has led to significantly superior and consistent outcomes. This approach, based on the principles of Six Sigma, makes it easier for physicians to practice good medicine and easier for patients to engage in their own care. Bob teaches us the distinction between pathways, algorithms & processes; emphasizing that 'a process is a way to make sure that we do the right thing, every time, for every patient, every day... If you don't have a repeatable process, you don't have crap!". Bob drives home the point that embracing payment-for-value and the practice of outcomes-based medicine is the only viable option if we plan to be able to deliver medical care to all Americans.
In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Tom Charland, CEO of Merchant Medicine and one of the leading experts in the On Demand/Urgent Care industry. Tom reveals the customer oriented and data driven underpinnings that have led to the sky-rocketing growth of the Urgent Care sector. He also explains how this business orientation can lead to consistently superior clinical care, as well as greater convenience and access, compared to offerings of lower acuity/lower complexity Urgent Care within the traditional Primary Care setting. Tom views On-Demand care as complementary rather than competitive to traditional Primary Care, and describes how providers can and are integrating this into their practices and integrated delivery networks.