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Creating a New Healthcare
Introduction to Creating a New Healthcare. A podcast series for Primary Care Physician leaders who are looking for fresh perpsectives, new solutions and inspiration in their journey to advance value based care.
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
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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
Dear Listeners, 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. I plan to share this campaign with my colleagues.. The online submission form can be accessed here/, or at www.abimfoundation.org. The last day for submissions is Thursday, February 28th 2019. 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
Dear Listeners, 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. Zeev
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
Dear Listeners, 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!
Dear Listeners, 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. Can you? Zeev
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
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