Quality Improvement – The Race to Value Podcast™: Recent Episodes
Institute for Advancing Health Value
The only way for the health care sector to sustainably contain costs and fulfill its mission is by putting the patient — and the delivery of outcomes that matter to ...
Three perfect storms in recent years – the health storm produced by the COVID-19 pandemic; the economic storm that resulted from its disruptions; and the social storm that followed the murder of George Floyd which sparked fresh outrage at longstanding inequities – have sharpened and added important nuances of what health care really means. The goal of health care has always been to reduce suffering, but we must now prioritize transformation in leadership now more than ever. Building trust, eliminating inequities, and ensuring high reliability are of the highest magnitude of importance as we blaze a new path forward.
This week, on the Race to Value, we are joined by Thomas H. Lee, M.D., the author of the new book “Healthcare’s Path Forward” to discuss how the healthcare industry is being transformed by deeper knowledge of what suffering means for patients, their families, and healthcare providers themselves. Since healthcare is not working for anyone, Dr. Lee provides wisdom and insights of optimism for where true change can happen in creating new standards for excellence.
In addition to being a bestselling author and expert on healthcare transformation, Dr. Lee is the Chief Medical Officer of Press Ganey. He brings more than three decades of experience in healthcare performance improvement as a practicing physician, leader in provider organizations, researcher, and health policy expert. He’s responsible for developing clinical and operational strategies to help providers across the nation measure and improve the patient experience, with an overarching goal of reducing the suffering of patients as they undergo care and improve the value of their care.
Episode Bookmarks:
01:30 Introduction to Thomas H. Lee. M.D. and his new book “Healthcare’s Path Forward”
03:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
04:00 The six elements of organizational culture that lead to transformation – Excellence, Trust, Respect, Inclusion, Resilience, Reliability
05:00 John Nash (“A Beautiful Mind”) and Non-Cooperative Game Theory
06:00 Optimism for healthcare because how bad things really are!
07:00 Nash Equilibrium states are commonplace in healthcare – it creates inertia and stifles change.
08:30 “Equilibrium states break down when the pain of the status quo exceeds the fear of the unknown for multiple parties.”
09:00 “Healthcare is not working for anyone. That is where real change can happen and what makes me optimistic.”
09:45 The destabilizing trends of supply chain disruption, social unrest, political divisiveness, consumerism, demographic shifts, workforce drain, and environmental disasters.
11:30 Responding to social justice, climate change, and the need to redesign healthcare – is it too much for us to tackle all at once?
12:00 “Changing the way healthcare is paid for – in absence of other reforms – is grossly inefficient. There are many other things that have to happen.”
12:30 Michael Porter’s Value Chain and the importance of clarity and differentiation in the creation of value.
13:30 “Payment reform is just one activity of healthcare reform. We also need trust in the workforce and with patients, an understanding of what safety means, and a response to consumerism.”
15:00 In times of turmoil, healthcare organizations need more than a performance culture; they need a learning culture.
16:30 The most important part of transformational leadership is division of responsibilities and areas of key focus to enact organizational change.
17:30 No one can do everything! If leaders focus on only three things, they will be successful in strategy execution.
18:30 3 Functions of Governing Boards and Executives: Articulate the Core Values, Develop Strategy, Understand the Value Chain
18:45 “An organization is the lengthened shadow of its leaders.” – Ralph Waldo Emerson
20:30 3 Functions of Managers: Create Social Capital, Bring High Reliability Principles to Life, Eliminate Waste of all Types
21:30 “Social capital is more important than financial capital in the times in which we live.”
22:00 Applying High Reliability to all the dimensions (including patient experience) and refusing to tolerate failure in matters of trust.
23:45 “Culture of No Waste” – includes both time and resources
24:30 3 Functions of Frontline Caregivers: Create a Culture of Respect, Be Full Participants on Great Teams, View Job as Shaping the Memories of Patients and Families
25:30 The healthcare workforce often feels that they are part of a organization that does not respect them.
26:30 “Treating people with respect should be treated in the same way that the industry tackled hand hygiene to improve patient safety.”
27:45 Referencing the TED Talk from Daniel Kahneman: “The Riddle of Experience vs. Memory”
29:00 Frontline caregivers are like Steven Spielberg, i.e. they are the producers and directors of the patient memories.
32:00 “We live in a time where trust is under attack in society. You can’t take trust for granted in healthcare.”
33:00 Trust goes beyond the clinician encounter – it encompasses the whole episode of care, including the web presence of the provider before the visit.
35:30 The importance of 5-Star Ratings online in building trust.
36:30 “Patients are unnerved from friction, chaos, and any indication that they may not be safe. The pandemic has really heightened their fears.”
38:00 Dr. Lee discusses how Press Ganey has begun surveying patients on their perceptions of patient safety.
39:45 High-reliability and the Anna Karenina Principle (“Happy families are all alike; every unhappy family is unhappy in their own way.”)
41:45 In 2021, the Press Ganey Employee Engagement Indicator declined in every single job category!
43:00 Dr. Lee discusses how building trust with workers coincides with the actions taken to build trust with patients.
44:30 Personal Pride: Pride in the organization, Pride in what you do for the organization, Pride in what your team does.
45:30 Personal Alignment: Aligning with the cultural beliefs of employees and the need for inclusion. (Lack of DEI creates a 4X greater risk of employee turnover.)
46:00 Personal Resilience: Activation (employee motivation) and Decompression (ability of employees to forget about work when at home).
47:30 Activation is increasing in healthcare, but decompression continues to go down!
50:00 Dr. Lee explains how the pandemic and social unrest has created a deeper understanding of human suffering and how systems create harm.
50:30 Understanding Patient Safety beyond Physical Harm by also considering Emotional Harm (e.g. not feeling safe or financial distress due to healthcare)
51:30 The nuance of perception in Patient Safety (an example of how patients didn’t feel safe when a change when a hospital starting using odorless disinfectant).
53:00 Lack of respect as a safety issue.
53:00 The murder of George Floyd prompting an examination of the impact of inequality throughout society.
54:00 Diversity, Equity, and Inclusion in healthcare as a form of social capital and the pursuit of zero inequity.
55:00 The importance of DEI in health equity is now understood at a deeper level by healthcare leaders following the murder of George Floyd.
56:00 “Zero Inequity should be our goal just like Zero Harm is our patient safety goal.”
56:45 The data from safety net hospitals showing continued challenges in assessing pain with African American patients.
58:00 How organizational mistreatment of patients creates mistreatment of workers (and why lack of patient-centeredness is main reason for employee turnover).
61:00 Dr. Lee touts the virtues of healthcare and why it is such a great industry to work in.
62:00 New Skills for the Era Ahead: Strategy (Porter’s Value Chain), Social Capital (Teamwork, Leadership), Growth Mindset (read Grit: The Power of Passion and Perseverance!)
64:00 The potential to do great work in medicine and making a difference in the lives of others.
64:30 “This is the best time to be going into healthcare. You can really make a difference in a noble field.”
65:00 How to reach out to Dr. Lee and learn more about his work in healthcare transformation.
This week on the Race to Value you will hear from Dr. Neil Wagle, the Chief Medical Officer at Devoted Health. This is a company we have been wanting to profile on the podcast for quite some time! Devoted Health is a healthcare company that designs Medicare Advantage plans for seniors; however, they are so much more than just a MA plan. Devoted Health has built a different model of care that starts with knowing their members on a personal level and earning their trust. By focusing on each member as a person and not as a chart, they are able to provide the best quality care for older Americans through an all-in-one healthcare solution combining the MA plan, access to high quality local providers alongside virtual and in-home care, and full-service guides—with world-class proprietary technology powering it all. This company is a leading innovator in value-based care.
Dr. Neil Wagle knows a thing or two about transforming healthcare. He is an internal-medicine physician by training, spent six years at Partners Healthcare (now Mass General Brigham) leading the health system’s efforts to improve the quality of care for patients. In 2017, he joined Devoted Health, a $12.7 billion health-insurance startup. As its chief medical officer, he’s spearheading the development of a model of care aimed at improving the health of older Americans by getting them the right care at the right time while saving costs for the US healthcare system.
In this episode, we discuss clinician burnout and moral injury, post-pandemic recalibration of the healthcare system, virtual care delivery, the benefits of a fully-integrated technology platform, health equity transformation, creating a virtual “Blue Zone”, patient-reported outcome measures, activation of chronically ill patients, and the importance of company culture in delivering relationship-based care.
Episode Bookmarks:
01:30 Introduction to Dr. Neil Wagle, the Chief Medical Officer at Devoted Health.
03:45 Dr. Wagle provides his background as a “synthesizer between medical-scientific world and the business world.”
04:15 Inspiration and mentorship from Dr. Tom Lee and being a part of Mass General Brigham’s first value-based contract.
04:45 “We’ll probably lose $70m in the first year, but we’re moving to value-based care because it is the right thing for patients.”
05:45 A chance coffee meeting with Ed Park led to the “ridiculously challenging” quest to build a system that could radically transform healthcare!
07:00 Provider burnout and moral injury is one of the major crises in healthcare (along with rising costs and inadequate care for aging Americans).
08:45 Dr. Wagle on how the pandemic has exacerbated moral injury and why we need to return to the altruistic underpinnings of medicine.
09:30 “The ability for physicians to connect with others has been decimated by overbooked 15-minute visits.”
09:45 How documentation requirements in fee-for-service medicine robs providers of “pajama time” with their families.
10:00 The Great Resignation in healthcare is being driven by the perpetuation of the fee-for-service business model.
10:30 Resolving the three crises of healthcare (i.e. Provider burnout, aging population, and rising healthcare costs) through care delivery transformation.
11:00 The good news in VBC: providers want to practice medicine in this way and patients actually have better outcomes with lower costs!
11:45 “You have to be able to monetize fewer hospitalizations. If you can’t, the value-based model of care won’t work financially.”
12:30 The emotional fuel of seeing better patient outcomes in VBC drives continual value-based care transformation.
13:00 The new wave of healthcare consumerism from the pandemic is causing a much-needed recalibration of care delivery.
14:00 “COVID exposed cracks in our fee-for-service model…”
15:45 “Value-based care is actually the ideal home for virtual care services because you don’t have to worry about over-utilization.”
16:00 Dr. Wagle describes how Devoted Health dramatically improves the health and wellbeing of Americans through person-centered care.
16:30 The “all-in-one healthcare” offering of Devoted Health as a virtual in-home medical group and MA plan, enabled by full-service guides and integrated technology.
17:30 Medicare Advantage patients receive this “all-in-one” care for free as part of their enrollment in the health plan.
17:45 Scaling a virtual care model further enhanced Devoted Health’s mission to treat members like family.
19:15 Overcoming the challenges of loss aversion in the perception of patients when adopting a virtual-first care delivery model.
20:00 The benefits of a virtual-first mentality when it comes to organizational scalability and culture.
21:30 Devoted Health has developed an end-to-end data and technology system that choreographs care delivery in a single, vertically integrated, tech-enabled model.
22:00 Dr. Wagle on the well-deserved skepticism of technology as a panacea…but how that is balanced with the practical vision of Ed and Todd Park.
22:45 Building a full-stack technology platform from the ground up was necessary (market-based solutions are based on FFS medicine and are incredibly fragmented).
23:00 Full-stack tech platform at Devoted does everything! (e.g. sales, enrollment, pharmacy, medical claims, prior authorizations, customer service, full EHR)
23:30 “Having a full-stack technology platform with all information in a single place allows us to deliver on the promise of complete, coordinated, and customized care.”
24:00 How human-centered technology design drives targeted population health interventions and personalized care delivery.
27:00 Human connection (relationship-based care) can be fostered with a full-stack technology platform because people don’t have to remember minute details.
28:00 Enabling tech-enabled rapid cycle innovation to deliver improved population health outcomes.
29:00 The challenges of defining “value-based care” and how health equity is changing how we understand value.
30:30 The historical debate about the adjustment of outcome measures to account for demographic factors.
31:00 “The world has moved to a different place where we have put a spotlight on health equity itself, rather than burying it in adjustment methodologies.”
31:45 How “Community Guides” at Devoted Health correlate the overcoming of SDOH with the Maslow Hierarchy of Needs to help members achieve full potential.
32:30 An example of how helping a member successfully enroll for public benefits can give them an extra $ 325/mo.
33:00 The development of a Health Equity Dashboard to measure their impact in closing equity gaps.
34:00 The product goal of Devoted Health is to be the world’s first virtual “blue zone” where people enjoy much longer, healthier lives than average.
35:00 “Longevity is not the ultimate goal. The first task of a health system is to make sure we treat people like family so they are happy and fulfilled.”
36:30 Dr. Wagle on what it really means to create a virtual Blue Zone at Devoted Health.
37:45 Creating the “Devoted Social Club” to help members overcome loneliness and social isolation through human connectedness and resilience tools.
39:30 Dr. Wagle on why the people and the culture is the foundation of Devoted Health.
41:30 “As we go out and look for new team members we look for experience, clinical acumen, and love in your heart.”
43:00 Caring for the clinician workforce so they can cultivate the love in their heart for the caring of others – it is a self-perpetuating phenomenon.
45:00 Keeping the mission as a “prime directive” by closing your eyes and imagining someone you love…than take action.
46:45 How Community Guides cultivate trusting relationships with members and help people overcome their mistrust of the healthcare system.
47:30 Spending time with members as an enabler of trust and empathy (e.g. a 90-minute phone call).
49:00 Trusting relationships are why Devoted Health has such a high net promoter score of 79 (higher than Apple, Netflix, and Amazon).
50:30 Starting with “Patient Priorities Care” in member engagement first…and then moving to data-enabled, rapid-cycle deployment of interventions.
51:30 Dr. Wagle discusses the importance of Patient-Reported Outcome Measures in value-based care.
54:00 6 in 10 adults have a chronic disease, and it is the leading driver of the nation’s $3.8T healthcare spend.
54:30 Dr. Wagle provides examples of how Devoted Health is making an impact in medication adherence and Hgb A1c reduction.
56:00 85% of diabetic members have their blood sugar under control, with an average A1c reduction of 2.3 within 100 days.
56:30 77% of hypertensive members now have their blood pressure under control, with an average reduction in systolic BP of 15.2 within 40 days.
57:00 Reduction of acute events related to Congestive Heart Failure by 50%.
57:45 Dr. Wagle shares an a research example of “learned helplessness” in dogs and how that behavioral pattern relates to most chronically ill patients managing their disease.
60:00 “We must relate clinical outcomes back to patient priorities. Those cycles are what capture momentum.”
61:30 Dr. Wagle discusses company growth and expansion and how Devoted Health is entering eight new states in 2023.
62:15 How will Devoted Health consistently replicate and scale as it enters into new markets at a national level?
64:00 Parting thoughts of appreciation from Dr. Wagle and how gratitude makes dreams come true in value-based care!
64:45 “Value-based care is more than possible…it is coming. The arc of history is bending towards progress, and I am grateful to be a part of that journey.”
Paying it forward begins in the heart. Leaders who use their gifts in the service to others are those who understand that value given is value added.
By every measure of success, Dr. Shawn Griffin has become one of the most impactful physician executives in value-based care transformation. And his story is all about how he recognized his unique gifts and built amazing teams to improve population health outcomes. Additionally, his sharing of best practices and key learnings with others across the country – through peer learning and mentorship – has amplified impact in improving the lives of others. The host of this podcast, Eric Weaver, was one of the people impacted by the mentorship of Dr. Shawn Griffin. His mentorship inspired Eric to make a difference as an evangelist for a better way of delivering care in this country.
In this episode, you will gain access to an in-depth conversation with Dr. Shawn Griffin, the President and CEO of URAC. You will be inspired by his servant leadership in the pursuit of value-based medicine, and you will learn of his career path from rural physician to one of the leading physician executives in the country. We discuss the important of team-based care delivery and primary care transformation. We also cover such important topics as healthcare accreditation, quality improvement, rural health care, pharmacy integration, technology innovation, and genomics-based care.
The truest measure of a leader is whether they are generous, have a big heart, and pay it forward. Dr. Shawn Griffin is the quintessence of this type of servant leadership in the race to value!
Episode Bookmarks:
01:30 Introduction to Dr. Shawn Griffin, the President and CEO at URAC
04:00 Eric shares a personal extension of gratitude to Dr. Griffin for the mentorship he provided years ago.
06:45 Dr. Griffin describes his journey in value-based care, beginning in the early days of practicing rural family medicine.
08:00 The United States is an outlier in that Primary Care is not at the center of medical care delivery.
08:45 A decision to impact more lives by taking on leadership roles in system design and care delivery transformation.
09:30 How love for family and others manifested into a commitment to patient care quality.
10:30 Building an effective Population Health Team at Memorial Hermann ACO during his leadership tenure.
11:00 The importance of effective storytelling and celebrating wins to drive value transformation.
12:00 “One has to decide in life if they are going to use their gifts to help themselves or help others.” (how VBC leadership is Dr. Griffin’s way of paying it forward)
12:45 The impact of constantly changing health policy on ACO success (and how frustration led Dr. Griffin to make a difference at a federal level).
13:30 How mentorship and teaching in value-based medicine can transform care delivery on a national scale.
17:00 Dr. Griffin explains the importance of accreditation programs and how URAC was founded to set standards in healthcare.
19:00 Specialty Pharmacy Services Accreditation as an example of standard setting to drive quality improvement.
20:00 Telehealth Accreditation and how “Telemedicine is more than just a good camera. It is good quality medical care using technology to do it.”
21:00 “Raising the bar and advancing the quality mission as things change is what accreditation should be doing.” (Reference video on revamping telehealth accreditation)
22:00 Why an accredited program (e.g. URAC Gold Star) provides a basis for a patient to validate their trust in the care provided.
23:00 Dr. Griffin discusses how URAC accreditation is driving care delivery redesign across the world (e.g. Egypt and Saudi Arabia).
25:00 The challenges of defining health care quality.
26:30 “Measuring quality is an ongoing unsolved problem in health care.”
27:30 The power of a trusting patient-provider relationship in care quality and how patient definitions differ.
28:30 The limitations of HEDIS measures.
29:30 Quality measurement data capture at the point-of-care is a major contributor to provider burnout (“checking the boxes”)
32:00 “Most of us have better information available on picking a hotel in Paris than we do selecting a high quality primary care provider.”
34:00 Realigning incentives to get more medical students to practice family medicine in rural communities.
35:00 The role of the federal government to ensure adequate access to primary care in rural areas.
36:00 The crushing economic pressures on rural hospitals.
36:30 “We talk about food deserts in cities. We have provider deserts in the country.”
37:30 “If we are concerned about providing electric charging options for someone’s Tesla crossing the country, perhaps a bigger concern is whether you can receive healthcare in rural parts of the country.”
40:00 Dr. Griffin on opportunity for pharmacy integration and team-based care.
41:00 “One of the good things about medicine in the last 40 years is the recognition that a ‘captain of the ship’ model is not sustainable for doctors or patients. Team-based care is the way to go.”
42:30 The role that URAC is playing in Pharmacy Accreditation and Rare Disease Certification.
45:30 Dr. Griffin on the importance of data liquidity and information sharing in value transformation.
47:00 How concerns about HIPAA compliance (a “HIPAA-chondriac”) can contribute to the problem of data siloing.
47:30 “More data is not always better for physicians. Technology will not always make health care better. A relationship will do more for a person’s health.”
49:00 Balancing Population Health Management with Targeted, Individualized Interventions (examples such as Kaiser Permanente, Intermountain, UPMC).
52:30 Dr. Griffin discusses how the pandemic shifted consumer demand for telemedicine and what we should expect for telehealth delivery in the future.
54:00 Behavioral health telemedicine visits are effective. Pre-surgical screening for heart transplants does not work with telemedicine.
55:00 The “Telemedicine Tug-of-War” going on nationally and why we must always consider the most appropriate application of technology.
56:00 Convenience doesn’t trump quality.
57:00 Telemedicine, Remote Patient Monitoring, Wearables, ML/AI – these will not suddenly make healthcare the “Garden of Eden” overnight.
58:30 Parting thoughts on genomics-driven care and individualized-care planning in a population health model.
59:00 A patient’s Walmart receipts are more valuable to a physician than genomic data.
60:00 Screening genomics for hereditary diseases are scaling as costs come down, but we still cannot discount the impact of lifestyle choices on health.
63:00 How to find out more about URAC and the importance of peer learning and sharing of best practices.
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