Creating a New Healthcare: Recent Episodes
Zeev Neuwirth
Introduction to Creating a New Healthcare. A podcast series for healthcare leaders who are looking for fresh perpsectives, bold solutions and inspiration in their journey to advance value based care.
Our expert guest on this episode is Brian Esterly, who was appointed CEO of TimeDoc Health in August 2023. Brian brings more than 25 years of healthcare leadership experience to this role. Prior to this he served as the Chief Growth and Strategy officer at Centria Healthcare.
Working with healthcare systems, primary care providers, FQHC’s and Medicare Advantage plans, TimeDoc Health provides virtual care management services primarily targeting the Medicare population. Their three main services include:
- Chronic Care Management
- Remote patient monitoring
- Behavioral health integration
During our discussion, Brian made it clear that TimeDoc Health serves as a seamless extension of the primary care provider and their team. In that role, however, they can help address some major challenges within our healthcare system. Brian shares some examples of how they provide chronic care management and behavioral healthcare services in between provider appointments, relieving the provider group from having to manage that in-between visit care. Additionally, by screening for and addressing quality care gaps and social determinants of health gaps, their services improve patient care outcomes. Finally, their outcome data suggests utilization of TimeDoc reduces ED visits and readmissions, thereby improving quality scores, and providing health insurers and Medicare Advantage plans with the opportunity to improve their STARS ratings.
From a patient care perspective, chronic disease management, particularly for our older Americans, is a growing challenge, especially as the number of primary care providers continues to decline. Services like TimeDoc Health could literally be a lifeline to address some of the most common and insipid conditions plaguing Seniors.
To find out more about TimeDoc’s services, please visit their website at https://timedochealth.com/.
Ann Somers is the Director of Health Care at the Clayton Christensen Institute. Her research focuses on drivers of health (a.k.a. social determinants of health), maternal health, and the pathways to improve them. Ann Somers holds an MSPH in Health Policy and Management from UNC-Chapel Hill and a BS in Commerce from the University of Virginia.
Last year, she authored a report for the Clayton Christensen Institute on the state of maternal health in the United States. The full report can be found here.
In our discussion today, Ann Somers talks about the alarming findings from that report including the systemic barriers that are contributing to poor maternal health outcomes. She explains the need for a shift from viewing maternal health as an individual problem to a systemic issue that requires collective solutions, rather than relying on individual self-care or asking for help.
Our focus with this podcast is both to bring awareness to important topics like this, but also to offer tangible, real ways that we can address the problem. So what can we do? Ann Somers explains the potential for employers to play a significant role in creating supportive systems and policies for working mothers, such as flexible work hours, shortened work weeks, and on-site childcare. But more globally, she impresses on us that we must catalyze a societal shift towards a culture of respect for caregiving that will push the implementation and standardization of policies that support working mothers and other caregivers.
Mothers are the backbone of our families, communities, and societies. And yet, we are not putting our money, resources, or attention towards supporting them. This issue needs to be discussed broadly, and the solutions Ann Somers shares need to be funded and deployed.
Addition: Recently, the U.S. Surgeon General published a report entitled Parents Under Pressure talking about the Mental Health and Well-Being of parents in the United States. We asked Ann Somers to comment on their findings and recommendations. Her thoughts are also included in this episode. A full version of the report can be found here.
Resources:
Moms First
Chamber of Mothers
Piali De, PhD is a talented physicist who started her career developing artificial intelligence systems for the United States defense departments. In 2010, Dr. De founded Senscio Systems, a digital health company redefining chronic care management with the nation’s first AI-powered home-to-clinic digital therapeutics platform called Ibis. Senscio’s Ibis platform is being used by leading ACO’s and was named one of the “10 Most Promising Population Health Management Solution Providers – 2017” by “Healthcare Tech Outlook” magazine.
In this interview, we discuss the personal journey that motivated Dr. De to launch Senscio Systems and how she adapted her AI expertise inr defense systems to healthcare with the creation of Ibis. Highlights from this episode include:
- A description of Sensio Systems’ AI-powered platform that empowers patients with complex chronic conditions to better manage their health at home by utilizing AI to identify problems early and provide personalized care plans.
- Through the introduction of Ibis, Senscio is focused on making healthcare more patient-centric, shifting the paradigm from clinician-driven care to patient-driven care. The platform aims to help patients maintain dignity, control, and independence as they age.
- The platform has demonstrated significant positive outcomes, including over 40% reductions in hospitalizations and over 70% reductions in inpatient days for populations like the dually eligible (Medicare and Medicaid). That’s right…70% reduction!!
To learn more about Senscio Systems and Ibis, please visit www.sensciosystems.com.
Money. Not always the most inspiring or sexiest topic in healthcare, but one that is critical if we are going to change the system for the better. Today on the podcast, we welcome David Kirshner, Managing Partner at LogicSource, to talk about their approach to helping health systems improve efficiency and decrease costs so they can redirect funds where it’s needed most…clinical care. David’s background is impressive. As the former CFO of several major healthcare systems, David is credited with engineering the remarkable financial turnaround for Boston Children’s Hospital, the primary pediatric teaching affiliate of Harvard Medical School, where he spent nearly fifteen years as the Senior Vice President, Treasurer, and Chief Financial Officer.
In this conversation, we discuss:
- The need to balance the business aspects of healthcare with the mission-driven focus on providing care and how adopting more efficient business practices from other industries can help.
- LogicSource’s commitment to collaboration and trust-building through their “doing with” approach, where they collaborate closely with the CFO and supply-chain leadership to build trust and understanding.
- How LogicSource brings data and expertise from outside healthcare to help CFO’s identify savings opportunities in non-clinical spend areas that the healthcare organization may have overlooked.
- Helping CFO’s gain support for these practices by being able to quantify the actual savings, which is routinely in the range of double digits millions of dollars.
This may seem like a nuts and bolts episode to those in direct clinical care, but David and LogicSource’s focus on building trust and delivering measurable financial impact is an important example of how humanistic change is needed on every level of the health organization.
Joe Machiote spent the first decade of his career in the hotel and dining operations industry and has nearly 30 years of experience working in the fields of HR, Diversity & Inclusion. He currently serves as Chief Diversity and Inclusion Officer for Premier, Inc.We’re airing this interview on the podcast as a means of introducing you to the type of conversations you can hear over on the #HRL, our new membership platform. To learn more, go to zeevhealth.com/membership.
We’re excited to share this discussion with Megan Morris, PhD, MPH in the first episode of the 8th season of Creating a New Healthcare! Dr. Morris is currently an Associate Professor in the Division of General Internal Medicine in the Department of Medicine at the University of Colorado, Anschutz. In her work, she focuses on provider-level and organizational factors that affect the quality of care delivered to patients with disabilities.
In this episode, Dr. Morris shares her personal experience of caring for an uncle with a disability and the challenges that led her to dedicate her career to research and advocacy for this community. This story was also captured in a 2023 NEJM article she published.
In this interview, you’ll hear Dr. Morris address the prevalent biases and misconceptions surrounding the 27% of Americans living with some form of disability. She points out major shortcomings in our healthcare delivery system which focuses on fixing the individual rather than addressing the barriers people with disabilities face. She also shares some specific ways in which healthcare delivery can better accommodate patients with disabilities.
To try and address the paucity of information and available resources, Dr. Morris and her colleagues created the Disability Equity Collaborative. Coming soon to this site are implementation guides for things like starting an accessibility program at your organization.
Our discussion is personal, eye opening and largely based on the research that Dr. Morris and others have conducted. Her life’s work is beyond inspiring. I encourage you to visit the Disability Equity Collaborative website to learn more!
In his recently published book, Just One Heart, Dr. Fisher draws upon the vast body of scientific literature on positive psychology and wellness, as well as the teachings of mindfulness and stoicism which have withstood the test of time for over two and half millenia. A major take home point is that the ability to manage our thoughts and emotions impacts our physical, mental and social health as much, if not more than, any medication, healthy food or physical exercise routine.
As you listen to this interview, I suspect you’ll be grabbing your pen to capture the many practical techniques Jonathan shares. Near the beginning of the interview Jonathan lists the emotions that he calls ‘heart breakers’ and goes on to share the ‘heart waker’ emotions that have been demonstrated to help people heal their heart and pursue happiness. Later, he offers us a daily routine that’s distilled in the acronym, ‘BESTLIFE’, designed to assist in manifesting positive emotions at the start of each day. He shares another technique, composed of three brief questions, that empower us to rapidly shift from a pessimistic to optimistic mindset in our daily interactions. One thing I love about Jonathan’s approach is his focus on translating the concepts of mindfulness into daily practices and techniques that “are super simple and …easy to remember”.
Our dialogue is content rich but also deeply personal and touching. What makes it so is that Jonathan has not only grounded his perspective in scientific literature and numerous interviews with experts; he’s also integrated it into his personal life and professional practice – with patients, clients and organizations. Jonathan’s personal pursuit of self-compassion and his transparency, integrity and generosity provide a wonderful example of lived mindfulness.
Dr. Fisher is a unique cardiologist in that his practice includes not only the care of the cardiovascular system, but also tending to the metaphysical heart. I wonder how different healthcare might be if more doctors, nurses and other clinicians were trained in the ways that Jonathan has trained himself – to “think differently about the heart”.
You can learn more about Dr. Fisher and his work through his website and his book, Just One Heart: A Cardiologist’s Guide to Healing, Health, and Happiness, available for purchase now on Amazon.
Dr. Robert Pearl has recently published a 3rd book entitled ‘ChatGPT MD’. His ‘co-author’, as he calls it, was ChatGPT itself. With this book, Robbie brings his unique perspectives as a practicing surgeon, an accomplished CEO, an author of numerous publications and books, a Stanford Graduate Business School and Medical School Professor, and one of the most forward-thinking healthcare leaders in the country.
In this interview we’ll discuss the numerous potential benefits of AI in healthcare, including some real-life illustrations of how AI is already saving lives and limbs. Beyond these illustrations, we discuss a number of critically important take-home messages for the medical community and healthcare leadership. These include:
- Generative AI is markedly different from other forms of AI.
- While generative AI may not be ready for prime time clinical care, it is ready for rapid and immediate experimentation and study.
- Generative AI is improving at an unprecedented rate, so we should focus on its future capabilities and reliability, and not just on what it can do today.
- Why we should think of generative AI as an assistant rather than a tool.
- Generative AI has the potential – if we study and deploy it well – to be the transformative catalyst that we’ve been waiting for.
Robbie’s major point is this – let’s not let fear, hubris or inertia get in the way of what may be the most impactful transformation ever to hit healthcare. And instead of waiting, let’s all jump in by trying it and testing it out. As usual, Dr. Pearl is embodying his own advice. In ‘co-authoring’ a book with this technology, he is setting an example for the rest of us.
If you’re interested in learning more about Dr. Pearl’s work, please check out his website and his most recent book, ChatGPTMD.
If you’ve ever wondered, ‘But what can I do? – please listen to this episode. Dr. Stella Safo, a Harvard-educated, Ghanaian-American physician, provides us all with her wisdom, experience and courageous efforts in addressing that question.
In this interview we’ll cover:
- Some shocking and saddening stats on healthcare inequities & disparities in the US
- The enabling power of community and civic engagement
- The importance of sharing our ‘inexpert knowledge’
- Understanding and confronting our own internal ‘othering’
- Why Diversity, Equity & Inclusion is critical in healthcare delivery
- The origin and creation of the “Green Book survival guide” for healthcare that Dr. Safo and her colleagues are creating
- AfterShock – the 2022 documentary about two young healthy black women who died after childbirth from preventable causes.
- An introduction to the ‘Wake Up Everybody’ community.
- The major lessons I learned from Dr. Safo – challenging our assumptions about ourselves and about our relationship to ‘the system’.
Dr. Stella Safo is a practicing primary care physician, public health advocate, and the founder of ‘Just Equity for Health’. She is an assistant professor at the Mount Sinai Health System in NYC and has served as the Chief Clinical Transformation Officer at Premier. Dr. Safo is a founding member of several organizations dedicated to gender, racial equity and civic engagement in medicine – including ‘Equity Now’ at Mount Sinai, ‘Civic Health Alliance’ and the ‘Coalition to Advance Antiracism in Medicine’.
If you’re interested in learning more about her work, follow her on LinkedIn or check out Just Equity for Health and Thriving in the Last Mile.
So, it turns out that how we frame failure is far more important than how we manage success, in determining our motivation and our ability to sustain healthful and positive behavior change.
Our guest today, Dr. Kyra Bobinet, is a long-standing expert, clinician and entrepreneur in the field of behavior change. Her company, Fresh Tri, applies a unique approach to embedding state-of-the-art behavior change techniques into software apps – something she learned at Stanford, in one of the most illustrious behavioral labs in the world.
The approach Kyra offers us is a liberating reversal of the motivational approaches we’ve used for decades – in our organizations, with our patients, and in our own personal efforts to form healthful habits. It’s a shift from the predominant ‘performance-based mindset’ to an ‘iterative mindset’, which essentially prevents demotivation. This iterative approach to sustained behavior change is far more kind and creative, and likely to be far more successful.
Since learning about the iterative mindset from Kyra, I’ve begun to use it in my professional and personal life – and it works – which is why I’m excited to read Kyra’s new book on the subject, ‘Unstoppable Brain: The New Neuroscience That Frees Us from Failure, Eases Our Stress, and Creates Lasting Change’ which is available on Amazon. If you’re interested in learning more you can find Kyra’s work here.
Zeev Neuwirth, MD
Friends,
The very first question I asked our guest today, Neal Khosla, was, “If AI is the solution, what’s the problem?” His response was disarmingly true. We don’t have enough Primary Care providers and they don’t have enough time.
When I asked Neal to define AI, he didn’t go into the usual tech jargon. Instead, he described the specific needs patients have – needs that are not being met – like convenient access to affordable care, preventive care, assistance with medication adherence and lifestyle changes, chronic disease management, and timely, consistent follow-up. We then spent most of the interview with him illustrating how AI is assisting providers in actually meeting those needs.
Three quick takeaways from this interview:
- Neal actually knows what he’s talking about. He’s been named one of Time’s Magazine 100 most influential leaders in AI and featured in publications like CNBC and Forbes. Prior to co-founding Curai Health in 2017, Khosla was a machine learning researcher at Google and Stanford. He received a Bachelor’s degree in Computer Science & Mathematics from Stanford University, and a Master’s degree in Computer Science with a concentration in Artificial Intelligence.
- Neal isn’t talking about some potential future, He’s talking about current services offered by Curai Health – a text-based, AI-empowered, omni-channel primary care model – which is available direct-to-consumer through Amazon, to employees through their employer-sponsored health plans, and to health systems.
- One of the things that surprised me was how inexpensive the monthly cost is for this primary care service. The payment is subscription-based, so customers can use the service as much as they like without repetitive co-payments or additional fees. Another surprise was learning that Curai is now being offered to homeless people in Los Angeles – which is incredibly humanistic and feasible through the AI-enabled primary care model.
In Beyond The Walls, I make the point that humanism has to be enabled by the digital revolution and business model transformation. Neal and his colleagues at Curai are one of the most profound exemplars of humanistic rebel leaders who are transforming healthcare – not by making things more efficient or effective, but by redefining what it means to be effective.
Throughout this interview, Neal refers to “in your world” and “in our world” when he distinguishes between legacy models of care delivery and the AI-enabled approach he’s created and is rapidly evolving. By the end of this interview I suspect you’re going to want to get your healthcare in his world – which you can check out at www.curaihealth.com.
Zeev Neuwirth, MD
Friends,
I think you’ll all understand this. Every once in a while an issue comes along which has such importance and urgency that you’re compelled to do something about it. In this case, I had a phone call with our expert guest a week ago, and ten minutes into the discussion, I stopped him and said ‘we have to do this podcast interview immediately and get it out there’.
The compelling issue includes: (1) the severe and worsening nursing burnout and subsequent shortage; (2) the overcrowding of Emergency Departments with prolonged ED “boarding” and (3) morbidity and mortality in our hospital systems.
These are indeed critically urgent issues. A recent Becker’s report noted that nursing and staff shortages is the #1 concern for hospital CEO’s. ED overcrowding is a worsening national crisis – well documented in the medical and lay press. In fact, 90% of hospitals report having to keep patients in the ED because of lack of hospital capacity; and this ED “boarding” is associated with significant increases in patient deaths and harm in the hospital.
Our guest today has been studying and addressing this problem for over two decades. Eugene Litvak, PhD is an adjunct professor at the Harvard T.H. Chan School of Public Health who has published dozens of articles in peer-reviewed journals like the NEJM, JAMA, and Health Affairs. He’s also served as an advisor on patient safety and quality to the American Hospital Association as well as within the prestigious Institute of Medicine (now called the National Academy of Medicine). More to the point, Dr. Litvak developed a proven solution that he’s been deploying for years and which is now the focus of a recent book – Hospital Heal Thyself: One Brilliant Mathematician’s Proven Plan for Saving Hospitals, Many Lives, and Billions of Dollars – by Mark Taylor, a veteran healthcare reporter.
So, we’ve had a proven, doable, financially viable solution to the problem of ED and hospital overcrowding, for years. But, for reasons that are unclear to me, most hospitals in the US are either unaware of or have not adopted his solution – which is the motivation for sharing this interview.
In this discussion we’ll discover:
- The true cause of overcrowding in Emergency Departments and hospitals and how it is largely unrelated to the variability in the number of patients coming to the ED.
- A detailed explanation of the ‘variability methodology’ that Dr. Litvak has developed which addresses the actual problem causing overcrowding.
- Published examples of hospital systems that have deployed Dr. Litvak’s method resulting in dramatic improvements in safety and quality, reductions in burnout and turnover amongst nurses, and increased hospital productivity and margin.
- Examples of how Dr. Litvak’s approach is being used in federally qualified health centers (FQHC’s) contributing to improved health equity.
In addition to improving quality and safety, the operational excellence that Eugene is talking about creates a working environment in which clinicians and staff can demonstrate the empathy, compassion and love that brought them into healthcare in the first place. Operational excellence enables clinicians to manifest their professionalism, to listen and “attend” to their patients, and to build trusting relationships. One thing I realized through this interview is that there are many paths to love – and in this case it’s through mathematical modeling and operations management.
My purpose in putting this podcast out there with some urgency is to create awareness so folks can make their own decision about its validity and importance, and then take positive action. In terms of action – if you’re moved by this interview, my request is that you preorder the book, ‘Hospital Heal Thyself’ on Amazon, check out Dr. Litvak’s website, and share this interview and the book with your colleagues – particularly hospital-based leaders. And if you disagree or have alternative solutions, please let us know.
I choose to be an optimistic realist. What continues to fuel that optimism are humanistic leaders like Dr. Litvak. He’s a renowned expert in healthcare operations management who could rest on his laurels. But instead, he’s been out there for over two decades trying to radically improve healthcare – trying to save lives. The integrity, humanitarian purpose, commitment and perseverance he’s demonstrated are beyond inspiring for me. And I think there’s a lesson in there for all of us – not just in what he’s doing, but in who he’s being.
Zeev Neuwirth, MD
Friends,
The digital/data revolution in healthcare is upon us, and amongst other things, it’s recreating public health, population health and health equity. One of the groups at the forefront of this movement is the ‘Data Humanity Lab’ at Finthrive.
In this episode, we’ll hear directly from one of the emerging leaders in the field, Brian Urban – the Director of Innovation & Emerging Markets at Finthrive. Brian and his colleagues are not just advancing health equity and public health – they’re redefining what it means. To achieve this, they’re partnering with hospital systems and provider groups, health plans, device & tech manufacturers, as well as leading universities and academic medical centers.
I learned a lot during this interview, including:
- The radical contribution the Data Humanity Lab is making by providing its exclusive data sets and expert services for free to health equity programs and researchers across the country.
- How the ‘Gramm-Leach-Bliley Permissible Use Act’ protects consumers from both intended and unintended harmful use of their personal data.
- The gaps in public health education that we need to get beyond.
- The severe limitations of the claims, clinical and outcomes data we’re currently using in allowing us to understand the health-related conditions and needs of people.
- How expanded data sets (i.e. consumer marketing data) are being used to greatly improve our ‘whole-person’ understanding of the social determinants of health.
- Examples of specific projects in which healthcare systems, such as Dartmouth and UPMC, are partnering with the Data Humanity Lab.
Many of my colleagues talk about how entrenched the system is. Well, here is an example of how individuals in a visionary organization are not accepting that belief, radically transforming healthcare for the better. What Brian and his colleagues are doing is a wonderful example of an emerging humanistic leadership mindset in American healthcare. You’ll have to listen in to really understand what I’m talking about, but in this interview Brian challenges us all to reframe our business models from a more humanistic lens.
Zeev Neuwirth, MD
Friends,
There are over 160 million Americans who get their health benefits through their employers. Nearly 40% of all healthcare expenditures in the U.S. is paid for by self-insured employers. For decades, these benefits have been mismanaged – contributing to unsustainable costs and suboptimal health outcomes; and leading to a prolonged wage stagnation and suppression for working Americans and their families.
Our guest on this episode is Chris Deacon – a distinguished consultant and legal expert in employer-sponsored healthcare. Chris has dedicated her career to advocating for cost-effective strategies that benefit employers and employees. Her leadership at VerSan Consulting, LLC is marked by innovative solutions that have significantly reduced healthcare expenditures. Deacon’s tenure at the New Jersey Department of Treasury was notable for implementing healthcare cost-saving measures exceeding $3 billion. Chris honed her legal and regulatory expertise as Deputy Attorney General and as Special Counsel to NJ Governor Christie. Deacon is a Rutgers Law School graduate with a BA in International Affairs from The George Washington University.
Under ERISA (the Employee Retirement Income Security Act of 1974), self-insured employers have had a fiduciary responsibility to optimally manage healthcare benefits on behalf of their employees. However, there was limited transparency and enforcement, which made this regulation insufficient to protect employees. The Consolidated Appropriations Act of 2021 (CAA) created greater accountability and more specific obligations targeted at self-insured employers that gives us some hope that things could be changing. Chris points out two important parts of the CAA:
- Broker/consultant compensation disclosure will require that benefits brokers and consultants disclose all the direct and indirect compensation they derive from their employer clients.
- The requirement that employers attest that they’re not a party to any contracts that limit their access to their own health plan data.
Learning about these provisions may cause you to ask what type of direct and indirect compensation have health benefits brokers and consultants been receiving? We’ll hear more about that in the interview. I suspect you’ll be surprised to discover, as Chris puts it, “… the way that employers have been purchasing healthcare absolutely rewards brokers and consultants when the [healthcare] spend goes up.”
As one discovers more about how healthcare benefits have historically worked and the negative impact it’s had on working Americans and their families, it’s easy to recede into despair.
The CAA of 2021 brings cautious optimism to the situation. Its goal is to assure us that self-insured employers will be held accountable for protecting their employees health benefits. We’re already beginning to see this accountability play itself out with a number of legal actions, including a large class action suit brought against J&J.
What we’re beginning to witness here is similar to the legal tidal wave of reform that swept across the country transforming the responsibility employers have for their employees’ retirement funds. It was a bitter battle, but in the end, working Americans won. I am hopeful that we will see the same resolution this time around – rewarding employees and their dependents (aka American families) with affordable health benefits.
Zeev Neuwirth, MD
Friends,
The number one question I get asked after my presentations and seminars is, “But Zeev, what can I do?” Making positive humanistic change in healthcare seems daunting, if not impossible. The system is incredibly entrenched. And yet, in this interview we’re going to hear examples of leaders who have used the principle of ‘love’ to create positive, impactful, and measurable change in their healthcare organizations.
Our two guests in this episode – Dr. Apurv Gupta and Stephanie Feals – have been on a journey to explore and share how ‘love’ is being deployed in healthcare organizations – not just as a vision or mission, but as a tactical operating principle. They co-founded and co-host a wonderful podcast entitled, ‘Making Healthcare Work For You’, which I highly recommend.
In addition, Dr. Gupta – who is VP of Advisory Services at Premier Inc – has been consulting to organizations who are interested in creating a ‘loving’ healthcare organization. I find this to be incredibly encouraging and inspiring – that a publicly held company with the size, stature and reputation of Premier is supporting its people and its clients in working to rehumanize healthcare.
In this episode, we’ll hear about nationally renowned leaders and organizations who have been deploying love as a leadership principle. There are many pearls of wisdom that Apurv and Stephanie shared. I’ll briefly mention three:
- If we believe ‘love’ to be an important component and principle in healthcare delivery, we need to make it part of our daily narrative. Dr. Gupta puts it this way, “The conversation changes with us. Organizational culture is about conversation. Healthcare relationships are about conversation. If we think ‘love’ is important, we have to include it in the conversation.”
- The principle of ‘love’ has to become integral to the daily operations of organizations. It has to be manifest in strategic decisions, policies and protocols, and in the daily management approach. Rather than placing the onus on individuals, the focus should be on the organizational infrastructure.
- Ultimately, ‘love’ is the responsibility of leaders – in creating the conversation, the culture and the infrastructure that supports a loving organization. As Dr. Gupta put it, “… it starts with one person – with that spirit of courage, optimism and hope…”
I would love to hear your thoughts about this. If this interview resonates with you, please comment on it and share it with others.
Zeev Neuwirth, MD
Friends,
This episode is a must-listen, not only for healthcare leaders, but for CEO’s, CFO’s and CHRO’s of every self-insured employer in the US.
One of the most crippling problems in American healthcare is the cost of care through self-insured employers – which is how approximately 40% of all healthcare is paid for in the US. As our guest puts it, “Healthcare is unaffordable for individuals, unaffordable for employers, and unaffordable for the country.” And he’s not exaggerating. There are over 100 million American adults who are in medical debt. And there is abundant evidence that healthcare costs have greatly suppressed wages for decades. There are three important things to note about this. First, employee healthcare costs were largely inflated through decades of mismanagement. Second, due to the Consolidated Appropriations Act (CAA), self-insured employers are now going to be held accountable for the fiduciary responsibility of their employees’ healthcare costs – the recent class action suit against J&J is an example of that. Third, there are solutions out there, including the one we’re going to be talking about today – a highly innovative company called Transcarent.
Our guest on this episode is Glen Tullman, the CEO of Transcarent. Glen is the former Executive Chairman, CEO & Founder of Livongo Health which was sold to Teladoc. He previously led two other public companies that changed the way health care is delivered – Allscripts and Enterprise Systems. Glen is also a Founding Partner at 7WireVentures, a socially-minded venture capital fund. He is the author of ‘On Our Terms: Empowering the New Health Consumer’; and he has received numerous public recognitions including the Robert F. Kennedy Human Rights Ripple of Hope Award in 2019.
Our discussion will include:
(1) The groundbreaking ‘platform’ approach Transcarent is taking in delivering healthcare to self-insured employers and their employees.
(2) Transcarent’s customized, guided, ‘care-experience’ – a one-stop shop that transcends the one-off, point-solution problem that has plagued digital healthcare.
(3) The 5 “pillar” offerings or services that Transcarent delivers.
(4) A discussion on Transcarent’s new ‘weight health’ offering.
(5) How Transcarent is a remarkably timed solution for self-insured employers who now have fiduciary responsibility for their employees’ healthcare costs.
I’ve written about Transcarent numerous times, and for good reason. It’s a brilliant advance in healthcare delivery and it’s incredibly well timed to meet the healthcare needs of self-insured employers. I’ve labeled my previous interviews with Glen Tullman as ‘Master Classes’. This one is exactly that – a ‘Master Class’ for healthcare leaders. But, it’s also a must-listen for CEO’s, CFO’s and CHRO’s of all self-insured employers in the US.
Zeev Neuwirth, MD
Friends,
What most of us are unaware of is that the health of the American public is worsening in relation to other developed nations – despite having, by far, the costliest and arguably most sophisticated healthcare system in the world. Our life span is decreasing. Inequities in care and disparities in health outcomes are worsening. The Washington Post, in a recent expose on American healthcare wrote that income is no longer the hallmark of inequity in the US – it’s now longevity – life itself. According to our guest today, this all sadly makes sense as we actively refuse to challenge and change the status quo in American healthcare at the necessary pace – to adopt a more practical, evidence-based, consumer-oriented approach – one that gets us beyond what she refers to as our traditional and myopic “clinical tendencies”.
Our guest is an incredibly accomplished physician, lawyer and healthcare policy expert – Kameron Leigh Matthews MD, JD, FAAFP. Dr. Matthews is a board-certified Family Medicine physician who has focused her career on marginalized communities. She is an elected member of the National Academy of Medicine where she chairs the Health Policy Fellowship & Leadership Programs Advisory Committee; and is currently a participant in the 6th cohort of the Aspen Institute’s Health Innovators Fellowship. Dr. Matthews received her bachelor’s degree at Duke University, her medical degree at Johns Hopkins University, and her law degree at the University of Chicago.
What our guest and her colleagues at Cityblock Health are doing to change the status quo is straightforward yet quite remarkable. They are delivering integrated and advanced primary care to marginalized communities – and demonstrating improved outcomes.
During the course of our interview, Dr. Matthews repeatedly referenced the well-worn definition of insanity – doing more of the same but expecting a different and better result. When I asked her what Cityblock Health was doing differently, she cited numerous specifics that include:
(1) providing care for a specific segment of the population – and deploying and customizing the healthcare resources that are needed by that segment;
(2) utilizing value-based payment in order to sustainably deliver comprehensive services and to invest in innovative care models;
(3) adopting a “partnership” model of care which includes assigning a “community health partner” (not worker) to each patient;
(4) “multi-modal” care – delivering care where, when and how patients want it to be delivered – whether in their health “hubs”, in patients’ homes, or virtually;
(5) a “one-stop-shop” of comprehensive clinical and non-clinical (SDOH) care – which includes a care team of doctors, nurses, and behavioral health experts, as well as partnerships with local healthcare systems and community-based organizations.
The foundational thesis for Cityblock Health is evidence-based medicine – and the evidence is overwhelmingly clear. The vast majority of our health outcomes are dependent upon non-clinical factors – the so-called ‘social determinants of health’. Cityblock Health has built their model based on this evidence and is deploying a “whole-person”, community-based approach. Another foundational thesis is the principle of segmentation. By focusing on a specific segment of the population, they can more readily create a highly customized, appropriately resourced, and sustainable care model.
One of the things I admire and respect about Dr. Matthews is that she not only has a prescription in hand, but she is actively delivering on it – with her work at Cityblock, her non-profit ‘Tour for Diversity in Medicine’ (which I recommend you look into), in her advocacy and policy work at the National Academy of Medicine, and more broadly in her national presentations.
Dr. Kameron’s humanistic leadership and her courageous, intelligent voice is one that I hope we’ll continue to hear more from on the national healthcare scene. And I hope, for our sake, we have the good sense to listen to it.
Zeev Neuwirth, MD
Watch out folks! A new day in Creating a New Healthcare is coming…
Creating a New Healthcare has an updated look and an updated focus. Over the past six months, I’ve been speaking with healthcare audiences across the country about my recently published book, ‘Beyond the Walls’, which is about getting beyond our limiting legacy thinking. There are 3 notable gaps that have arisen out of these conversations with providers, administrators, executives and healthcare consumers.
The first gap is a need to refocus our efforts on health – to go beyond healthcare. Our mission is not just to deliver healthcare – it’s to improve health. Somewhere along the way, it seems like we’ve lost that primary focus. We’re spending a lot of time, energy and resources on the healthcare industry rather than on the health care of the American public. In the podcast, we’re going to address that gap and expand the focus to achieving better health.
The second gap is the inequities in healthcare. And by inequities, I’m referring to the systemic and structural racism, sexism, ageism, ableism, classism and reductionism – the inequitable ‘isms’ in healthcare. What’s clear is that if we’re going to solve the challenges in healthcare, we will need to explicitly address these issues. As such, we will be discussing health equity with a focus on solutions.
The third gap that we’ll be explicitly addressing is that of leadership. What’s become abundantly clear to me is that if we are going to transform healthcare, we’re going to have to be willing to transform our leadership mindset. In the podcast, we will be focusing on a more generative, inclusive, collaborative and humanistic mindset – what I’m calling a “rebel mindset”.
Finally, the number one question I’ve been asked as I’ve spoken across the country is, ‘What can I do?’ People are desperate for tangible, do-able, next steps. So, we’re going to add a ‘do-ability’ focus to the podcast and attempt to respond to that question of ”What Can I Do?” in each episode.
This is a new day in Creating a New Healthcare. To hear more about this new, expanded version of the podcast and my personal journey that has led us here, tune in to today’s podcast, episode 168.
Friends,
This interview should be required listening for every chief experience officer, every marketing officer, every chief medical officer and every chief executive officer in American healthcare.
Why? Because – when benchmarked against other public and private healthcare systems the VA outperforms on patient experience and consumer trust metrics.
And, if you want to understand ‘how’ – listen to this interview. I would suggest listening to it more than once – to capture the principles, strategies and tactics that John and his colleagues are deploying to achieve a world-class healthcare experience. Keep in mind that the VA provides care to over 9 million Veterans annually, at over 150 hospital-based medical centers and over 1400 ambulatory centers.
We cover so many profound topics, but here are a few:
- In 2016, the VA instituted a ‘Trust Index’ comprising 3 major domains. They are one of the few healthcare systems across the country that have focused on restoring trust in American healthcare – and have seen remarkable improvements as a result of this focus.
- In addition to the Trust Index, they have also constructed a ‘Social-Drivers-of-Health’ framework which identifies these issues at every patient visit; and is also used to construct collaborative solutions with non-VA community-based organizations across the country.
- The VA Experience Office has collaborated with the VA Whole Health Initiative to define ‘well-being’ from patients’ and employees’ perspective, and to create wellness programs.
- The VA has engaged in journey mapping, service blueprints, and numerous other qualitative and quantitative research – across dozens of service lines. They use this information to train their employees in delivering a world-class healthcare experience.
- The emphasis on provider and employee experience is profound. In addition to their quarterly ‘V-signals’ (Veteran) patient experience surveys; they also have quarterly ‘E-signals’ – employee experience surveys.
This is one of many interviews I’ve conducted that demonstrates how far ahead the VA system is in so many respects. The VA is a hidden gem in the American healthcare system.
There are so many pearls of wisdom and sophisticated approaches that are shared in this interview. My hope is that it reaches the audience that needs to hear them.
Zeev Neuwirth, MD
Friends,
This is a remarkable journey – of a physician who has gone from burnout to creating positive ‘ripples of change’ in our healthcare system. He went from being a casualty of our healthcare system to being a courageous leader. In listening to Dr. Otten’s story, I was moved from anger to elation, and I suspect you will be as well.
What’s profoundly disturbing is that this physician’s experience of anguish and burnout reflects that of the majority of clinicians and healthcare staff.
What’s inspiring is that this physician made a decision to turn the dismal dilemma of American healthcare into a positive movement to humanize it. What I also admire is his collaborative approach and the inclusion of patients – coupling his initial effort, Ripple of Change, with Medicine Forward and other advocacy/activism groups.
One takeaway is that we need to change the narrative and the fundamental construct of our healthcare delivery system. We need a renewed sense of purpose & mission, and actually live it – in our policies and procedures – in our organizations – in our payment – in our daily delivery of healthcare.
What Todd and others are doing is critical and urgent. Over half of US doctors experience burnout. One quarter of the current nursing workforce are planning to leave the system in the next three years. We aren’t at a tipping point. We’ve already tipped over.
On a very personal human level, Dr. Otten had to first save himself before he could save others. There’s a profound lesson in there for all of us.
Zeev Neuwirth, MD
Friends,
This dialogue is a Master Class in Care Transformation – likely owing to our guest’s unique background, which includes preventive medicine, public health, and clinical informatics. It should be required listening for all healthcare executives and managers – both clinical and administrative – as well process/quality improvement professionals. Our guest, Dr. Cole Zanetti is an insightful and brilliant process improvement and care transformation expert. He has a broadly empathetic perspective and a practical humanistic vision that is the foundation for his work and his leadership.
Dr. Zanetti currently serves as a Senior Advisor for the Veteran Affairs National Center for Care and Payment Innovation – focusing on value-based care delivery and payment innovation pilots as well as emerging technology innovation pilots. He also serves as the Chief Health Informatics Officer for the Ralph H. Johnson VA Medical Center in Charleston South Carolina, and as the Director for Digital Health at Rocky Vista University College of Osteopathic Medicine. Dr. Zanetti was trained in Family Medicine and Leadership Preventive Medicine at Dartmouth Hitchcock Medical Center. He is triple board certified in family medicine, preventive medicine, and clinical informatics – and has a Masters in Public Health from the Dartmouth Institute for Health Policy. He has also served on the National Quality Forum’s Physician Advisory Committee and as a technical expert for the Centers for Medicare & Medicaid Services.
A few months prior to this interview I heard Dr. Zanetti speak about the cutting-edge, digital-tech innovations being deployed within the VA. My intention going into the interview was to do a deep dive on those care delivery innovations. But, this conversation went in an unexpected direction, which I’m truly grateful for. We ended up exploring the philosophical underpinnings of transformation and the approaches Dr. Zanetti has had to adopt in order to do this work. In short, we discussed the ‘why’ and the ‘how’ of care transformation.
Some of the areas we covered include:
- Why Dr. Zanetti firmly believes that a serious commitment to and more significant resourcing of care transformation and digital transformation is critical – for patients, for providers and their staff, and for the survival of the mission of Medicine.
- How the VA is uniquely positioned to be a transformation center – a “test kitchen” for care delivery – not only for Vets but for the entire American healthcare system.
- The approaches that Dr. Zanetti has learned and adopted as a leader in care transformation – with a particular focus on inquiry and positive deviance.
This interview uncovers another example of how the VA is one of the most innovative and transformational healthcare systems in the country. I continue to be astounded by the “hidden gems” – the forward-thinking, nationally leading expertise and initiatives within the VA, and the unique factors that make the VA ideal for ideating, piloting, deploying and studying care transformation.
Towards the end of our dialogue, I promised that I would follow up with a part 2, which I will – in which we’ll dive into the specific digital tech innovations being deployed in the VA.
In the meantime, I hope you have a chance to glean the wisdom and humanity of Dr. Cole Zanetti.
Until Next Time, Be Well
Zeev Neuwirth, MD
Friends,
This is Part 2 of an interview that is one of the most startling I’ve posted over the past 8 years. The revelation here is that the pulse oximeters we’ve been using for decades, to measure oxygen in the blood, are not always accurate in people of color. They may overestimate the amount of oxygen in the blood and miss low oxygen levels – potentially leading to delayed treatment and adverse outcomes. What’s shocking to me is that this has been documented in the medical literature for nearly two decades and little to no action has been taken. The implications are profound, especially given the disparity in deaths we witnessed along racial lines during the Covid pandemic, and the on-going widespread utilization of pulse oximetry in the post pandemic era.
Our guest, the esteemed Dr. Kryger, provides us with his expert perspective on this still emerging situation. In this episode we’ll discover:
- Why Dr. Kryger believes it’s taken so long – decades – for some action to be taken to address the inaccuracies in pulse oximetry.
- Dr. Kryger’s perspective on the impact that inaccurate pulse oximetry measurements had during the Covid pandemic and its impact in the post-pandemic period.
- What Dr. Kryger believes that professionals, as well as the American public, should be aware of – in regard to pulse oximetry measurement – and what actions can be taken right now.
This is one of those critically important and urgent issues that we need to learn more about and do more about. As our guest points out, the magnitude of this problem is enormous in that nearly 40% of the people who pulse oximeters are used on are people of color.
My purpose here is to create awareness and motivate positive action. Along those lines, I would urge you to read and respond to the FDA’s recently released discussion paper (the public is invited to respond up until Jan 16, 2024); as well as attend the FDA’s upcoming virtual public advisory meeting on Feb 2 2024.
I would also urge you to forward this podcast to your clinical colleagues as well as hospital and healthcare executives.
Zeev Neuwirth, MD
Friends,
Primary care for seniors is different from care for younger patients. Yet, very few providers across the country have a different and distinct strategy to care for their aging senior patients. In this interview, we’ll be introduced to an organization that has made taking care of seniors a priority.
- The fundamental problems with attempting to apply generic primary care to senior care.
- The significant investments and thoughtful approaches that Humana has taken to create comprehensive and customized care for seniors, while also addressing inequities in care.
- The specific value-based care model design and data enablement that Humana has developed to support clinicians in meeting the care needs of senior patients.
It’s remarkable to hear Dr. Vivek Garg discuss the multi-year strategy and tremendous commitment that has gone into the CenterWell Brand at Humana. One of the things I appreciate about Dr. Garg is his humility and transparency – about what Humana has achieved as well as what more we ALL need to achieve in order to provide the type of care that the aging senior population requires. As I mention in the closing comments of this interview, we need the type of leadership that Dr. Garg manifests – a leadership focused on outcomes that truly matter to people and communities.
Wishing you all the best of health and wellness in the New Year!
Zeev Neuwirth, MD
Friends,
This interview is one of the most startling I’ve posted to date. In this episode, we discover that pulse oximeters – which measure blood oxygen levels – are not always accurate in people of color. Mounting evidence suggests that they’re far less accurate in people of color than in white people. They can overestimate the amount of oxygen saturation in the blood and miss low oxygen levels. As a result, people of color may be underdiagnosed and undertreated for low blood oxygen – in conditions ranging from pneumonia and flu, to numerous chronic lung conditions, to asthma, and heart failure. The clinical implications are profound. If low oxygen levels are not detected, people may not be provided appropriate monitoring and medical treatment – in their homes, in doctor’s offices, and in emergency departments, hospitals and intensive care units.
As long-time listeners of this podcast know, my approach is not to focus on what’s wrong in American healthcare; but instead, to identify what’s right – so we can adopt, scale and spread positive change. What’s right here is that one solution to this disparity already exists. Our guest, Neil Friedman and his colleagues have developed a pulse oximeter, Circul Pro, that is more accurate in people of color, as well as in white people. It’s been scientifically validated and approved by the FDA. You can learn more about it at www.circul.health.
Another positive development – two days after I recorded this interview, the Center for Devices & Radiological Health (CDRH) within the FDA released a discussion paper for public feedback entitled, “Approach for Improving the Performance Evaluation of Pulse Oximeter Devices Taking Into Consideration Skin Pigmentation, Race and Ethnicity”. They also scheduled a virtual public meeting on Feb 2, 2024 to discuss this issue. Both announcements can be accessed here.
This interview raises more questions than answers. For example:
- Exactly how inaccurate is pulse oximetry in people of color, and to what extent is it clinically significant?
- Are clinicians and healthcare executives aware of the pulse oximetry issue? And if they are, what are they doing about it?
- Why hasn’t the American public been made more aware of this issue, which has been documented in the medical literature for years?
- If pulse oximetry is racially biased, what other medical technologies, sensors, algorithms and protocols have racial biases built into them?
This is one of those critically important issues that we need to learn more about and do more about. As our guest points out, the magnitude of this problem is enormous in that nearly 40% of the people who pulse oximeters are used on are people of color.
My purpose here is to create awareness and motivate positive action, not to lay blame. Along those lines, I would urge you to read and respond to the FDA’s recently released discussion paper (the public is invited to respond up until Jan 16, 2024); as well as attend the FDA’s upcoming virtual public advisory meeting on Feb 2 2024. The paper is well researched and it’s a call-to-action to advance the research – with very specific questions.
I would also urge you to forward this podcast and write up to your clinical colleagues – especially those with expertise in pulmonary, critical care, and sleep medicine.
As always, wishing you the best of health,
Zeev Neuwirth, MD
Friends,
As we’ve described and discussed before in this podcast, Primary Care in the US is on life-support and the prognosis does not look good. The implications for all of us is dire – as we look at what is nothing less than the demise of primary preventive care in our country. Our guest today has devoted his career to trying to revive and save primary care. And in this episode we’ll discover what he and his colleagues are doing.
Our guest today, Dr. Neil Wagle, earned his MD at Harvard Medical School and his MBA at Harvard Business School. He trained in Primary Care Medicine at the Brigham & Women’s Hospital. As the Chief Medical Officer at Devoted Health, Neil has led the build of an advanced primary care model that complements the traditional care that people receive from their primary care providers.
In this interview, we’ll discover:
- The fundamental problem with Primary Care as it’s being structured and organized today, and Devoted Health’s ”all-in-one” solution.
- The comprehensive clinical service lines Devoted Health has constructed in its advanced primary care model as well as the 5 major organizational components supporting their clinical care and health plan.
- How the providers at Devoted Health are “flipping the script” – focusing on patients’ perspectives and priorities.
- The incredible outcomes that Devoted Health is achieving.
Neil is one of the emerging superstars in our healthcare system. It’s inspiring to hear his humanistic leadership principles and the consumer-centric, service-oriented culture that he and his colleagues have created at Devoted Health. This episode is a masters class in advanced primary care and another not-to-be-missed dialogue.
Wishing you all the best of health and wellness!
Zeev Neuwirth, MD
Friends,
In this episode we’re going to discuss the opportunity we have, collectively, to live longer and healthier lives – and the underlying transition that’s required in the healthcare industry to make that a reality over the next few years.
The specific topics at hand include: (1) The economic imperative for why the American healthcare industry must move toward wellness; (2) the profound life-saving and cost-saving benefits of such an industry shift; (3) the central role that employers can play in wellness and longevity; and (4) some of the challenges and headwinds in this shift.
Our expert guest today is Neal Batra, who is a principal in Deloitte’s Life Sciences and HealthCare practice which is focused on the redesign of business models and commercial operations. He also heads Deloitte’s Life Sciences Strategy & Analytics practice, leading the way on next-gen enterprise strategy, analytics and technology. Neal has more than 15 years of experience advising health care organizations and businesses in biotech, medtech, health insurance, and retail health care. He is the coauthor of Deloitte’s provocative ‘Future of health point-of-view’ – forecasting on the healthcare ecosystem in 2040, and the business models and capabilities that will matter most. He holds an MBA from London Business School and a BBA from the College of William and Mary.
In this interview, we’ll discover:
- The difference between ‘life-span’ and ‘health-span’, and why ‘healthy longevity’ may be more important to us than longevity.
- How many additional years of life-span and health-span Neal and his colleagues believe Americans can experience by 2040.
- Why and how employers could be a major channel for enhancing healthy longevity.
- The amount of annual national healthcare spend we could save if we added well-care to our sick-care system.
- How this transition must include all Americans – an imperative from the disparities & inequities perspective, as well as the economic perspective.
The foundational issue that Neal and his colleagues start off with is that our healthcare system, as amazing as it is – is focused on the ‘break it and fix it’ model. It is a system that largely waits for disease and illness, and then dedicates tremendous resources and expertise toward dealing with that disease and illness burden. This is what he and many others refer to as a ‘sick-care’ system. This is in stark contrast to a system that is focused on proactive prevention of disease and illness. And Neals points out that this is not an either-or decision. What he recommends is a widening of the aperture – a diversion of some of the current healthcare spend to proactive and preventive well-care.
Neal opens up our discussion with a sobering revelation. For most Americans, the time of life when their health begins to erode corresponds to the time that they’re getting ready to retire. As he puts it, “Your healthiest years went to your employer, and in a time that was meant to be the ‘golden years’, or the years in which you had a financial foundation that allowed you to do different things with your life, your healthspan declines to a point where your quality of life declines.”
A second revelation – that Neal and his colleagues have published on – is that if we transitioned to a wellness industry, Americans could add an additional 12 years to their lifespan and nearly 20 years to their healthspan, by 2040. His team has also projected that the American healthcare system could save $3.5 Trillion per year – what he refers to as a whopping ‘well-being dividend’. Neal’s point, not to be missed, is that the cost dilemma in American healthcare will not be solved through cost reduction in a sick-care system, but rather through cost prevention through a well-care system. In his own words, “I’d like to shift to a ‘cost-of-avoidance’ narrative versus a ‘cost-of-care’ narrative. The cost-of-care narrative is a trailing economic measure, and there is no amount of innovation that will ever make it cost-effective to address the population in this break-fix modality. The only way out of the economic death spiral we are in when it comes to healthcare is to jump in front of illness, and invest ferociously on disease avoidance, and early as well as real-time diagnosis.”
A critical finding – that Neal and his colleagues have also published – is that approximately $1Trillion of the $3.5 Trillion in savings will come from the elimination of the disparities and inequities in healthcare. One statistic he mentioned is that white Americans live on average, 78 years, while for black and native Americans, the ages are respectively, 72 years and 68 years. And while these and other disparities are unconscionable in and of themselves, the calculations add an economic imperative to the ethical arguments for eliminating the structural racism in our healthcare system.
A third revelation and shocking forecast that Neal shared – which again, his analytics & actuarial team have published – is that, by 2040, 60% of healthcare spend in the US will go to well-care, not the treatment of disease and illness. He and his colleague predict that, by 2040, we are going to witness a “new health economy” with “new business models” which will drive 85% of all healthcare revenue. This new health economy will also be driven by a shift from a ‘rule-of-thumb’ to a ‘rule-of-one’ medicine – that is, the hyper-personalization of care – enabled by the digital and AI revolution in healthcare.
To balance out the dialogue, we did discuss the very real obstacles and headwinds to this sort of healthcare transformation. For starters, wellness care does not align with the current, predominant, industry business models. Neal’s counter-argument is that no industry has ever been transformed by incumbent stakeholders. It’s only through external pressure that the incumbents either respond and change, or they go by the wayside. His point of view is that hospital systems have two options: (1) continue to solely pursue the acute care/sick-care business model, and contract into an acute care focused factory; or (2) engage and expand into wellness care and the corresponding business models.
I don’t want to lose sight of Neal’s ‘both-and’ perspective, which is that it’s not that we have to choose between sick-care and well-care. Instead, we need to create a more balanced healthcare system that includes a significant well-care component. But, as Neal points out, we’ve got a long way to go to reach that balance. “If you held our sick care capabilities constant over the next decade and flowed everything into wellness and wellbeing, I think the yield on the American health system would be enormous economically, as well as from a health outcomes perspective”.
I’ll end with this personal observation. In my career, I’ve seen us accomplish miraculous things – creating space-age interventional cardiac labs, life-saving hemodialysis centers, and tele-stroke units. But here’s the rub. Wouldn’t you rather have the healthcare system focus a significant amount of resources and expertise on you NOT having that heart attack, kidney failure, or stroke in the first place? I know I would.
Wishing you all the best of health and wellness!
Zeev Neuwirth, MD
Friends,
I’ve had the great privilege of interviewing and interacting with Glen Tullman a number of times over the past few years. The last time we spoke in a formal interview was episode #121, which was posted on Sept 22, 2021. That episode was entitled, “A master class in building a healthcare consumer experience company”. And it was exactly that – a master class. My experience is that this episode is a continuation of that master class in humanizing healthcare and in achieving markedly improved health outcomes.
Glen Tullman is the Chief Executive Officer of Transcarent and the former Executive Chairman, Chief Executive Officer, and Founder of Livongo Health. He previously ran two other public companies. During his time as
Chief Executive Officer of Allscripts, the Company was the leading provider of electronic prescribing, practice management, and electronic health records for physician practices. Prior to Allscripts, he was Chief Executive Officer of Enterprise Systems, the leading resource management systems for hospitals, which he also took public and then sold to McKesson/HBOC. Glen is also one of two Founding Partners at 7wireVentures, one of the highest- returning venture capital funds in Illinois. He is the author of On Our Terms: Empowering the New Health Consumer, in which he proposes new solutions to address the chronic condition epidemic facing our country. A strong proponent of philanthropy, Glen was honored in 2019 with a Robert F. Kennedy Human Rights ‘Ripple of Hope’ Award for his career focused on improving the safety, empathy, and efficiency of our healthcare system. He also serves as a Life Director of the Illinois Chapter of JDRF, the leading organization advancing life-changing breakthroughs for Type 1 Diabetes. Glen has three amazing children and a new granddaughter who inspire him every day.
In this interview, we’ll discover:
- Glen’s honest perspective on the current state of our healthcare system, and the core existential problems we must solve for.
- Glen’s unique and generative perspective on a reimagined humanistic and consumer-oriented future for healthcare.
- An in-depth explanation of the value propositions that his new company, Transcarent, is bringing to the market and to healthcare – and some of the great progress they’ve already made in working direct-to-employer – providing an alternative for self-insured employers who have relied solely on the large TPA (third party administrator) insurance companies.
- What a platform business model is and how platforms are revolutionizing healthcare delivery and the healthcare market.
- How Trancarent has built upon the traditional platform models (such as Amazon and Uber), but expanded it into a new (and uniquely healthcare) model that Glen calls “convener plus”.
Before we go any further, it’s important to briefly point out that Transcarent is inserting itself into the employer healthcare space as an alternative to the large BUCAH insurance companies that are acting as third party administrators (TPA’s) for self-insured employers – large, mid-sized and even relatively small employers. Transcarent is in what we refer to as the ‘direct-to-employer’ market. For those who are unfamiliar with the acronym, BUCAH stands for Blue Cross, United Healthcare, Cigna, Aetna (now CVS Health), and Humana.
This episode is a master class in humanistic consumer-oriented care. In the previous podcast we recorded, Glen outlined 3 major needs people have when it comes to healthcare delivery. Briefly stated, these are: unbiased information, unbiased referrals, and support navigating the system. In this podcast he expands upon those to articulate five major value propositions that Transcarent is offering. These 5 are all embedded within the Transcarent app, and include:
- Easy access to care (EveryDay Care)
24/7 access, with almost instantaneous access to physicians and others who can assist in answering questions and navigating the system. - Low-cost pharmaceutical care – (Pharmacy Marketplace)
Transcarent is working with alternative medication suppliers such as GoodRx, Mark Cuban’s Cost Plus Drug Company, Walmart and others to provide the lowest cost medication options for any given person. - Care@Home
Transcarent is partnering with home health companies, such as Dispatch Health, to deliver care into the home or directly to the individual via telehealth and digital options.
- Surgeries
Transcarent is partnering with the Cleveland Clinic in offering literally world-class 2nd opinions when an individual has been recommended to have surgery. The reason being that a significant percentage of recommended surgeries are unnecessary and potentially harmful. And once the 2nd opinion is rendered, Transcarent can provide options for the best surgeons and hundreds of sites across the country to have the procedure. One thing to note here is that Transcarent is working with employers to provide surgical care without any payment or co-payment to employees. The way this works from a financial perspective is that by reducing inappropriate surgeries and suboptimal outcomes, Transcarent plans to save employers enough money to provide the needed and appropriate surgeries for free.
- Cancer Care
Glen quotes a stat that nearly one quarter of all cancer diagnoses and cancer care in this country is being done without the latest information or being provided at the lowest cost high quality sites. Transcarent’s platform approach utilizes state-of-the-art information and expertise to assist employees in obtaining the best care and the best value option.
Transcarent is utilizing a relatively new business/tech model, which is called a platform. Examples of well known platforms include Amazon, Uber and Airbnb. The model is different from the typical business model in that the platform doesn’t necessarily build, create or produce products and services. Instead, it hosts or convenes them in one place and provides highly consumer-oriented services to make them accessible to the consumer. Platforms are, essentially, virtual digital marketplaces, but they provide customized and personalized information and convenient access that isn’t available in brick & mortar market places. For example, the well-known, “people like you bought” or “people who bought this also bought…” The customers on the Transcarent platform are self-insured employers, with the ultimate consumer being employees. The vendors supplying the products and services would include healthcare systems, provider practices, and digital health companies.
One of the lessons I’ve learned from this conversation with Glen is that Transcarent is not only a platform but it’s a platform plus, or what Glen calls a “convener plus”. Glen explains that unlike Amazon, Transcarent not only provides the product or service, but it assists the customer in navigating through the experience. As he eloquently puts it,
“It’s not just to, it’s through”. For example, Transcarent not only provides a 2nd opinion of whether to have a specific surgery, the platform will also recommend the highest quality, highest value option, and it will also make the referral. Not only that, it will follow up in the surgical as well as post-surgical care.
And, one advantage of this platform approach is that the services that any given employer is looking for can be accessed on the platform without having to purchase the entire bundle of services. It’s a truly ‘choose your own journey’ type of business model – highly customized for any given employer customer. Another related advantage of the platform model is that if an employer has a product or service they like, Transcarent can place that on the platform instead of forcing the employer to switch. As Glen states, most vendors require that you “rip out and replace” the current product or service you’re using. Transcarent’s platform and approach avoids that.
What I’d like to conclude with is an issue that is, in my opinion, the most root cause in healthcare today. In Glen’s own words:
“What I’m looking for in healthcare is more leadership – that’s what we need… And, when I think about leadership, I think about creating systems that put the healthcare consumer front & center – improving the quality and experience of care, and reducing costs.”
I’ve written extensively about Glen and about Transcarent in my recent book – Beyond The Walls – and for good reason. Glen is one of the most accomplished healthcare leaders in the world. But, even more than that, he is a humanistically disruptive and consumer-obsessed healthcare leader. There are very few leaders I’ve met who possess his unrelenting focus on the actual experience of care from the point of view of the individual healthcare consumer. Glen is brutally straightforward on his take of the American healthcare experience. He calls it like it is. As he states so clearly – “healthcare is more confusing, more complex, and more costly than it’s ever been before… [and the situation] is getting worse, not better”. He also makes the point that a major cause is “maximizing profits over care”. It’s Glen’s objectively truthful sensibilities and his integrity which has fueled his incredibly disruptive and positively advancing achievements.
When I asked Glen what message he would want to share with healthcare leaders and employer leadership, he responded with two questions. First – what are you doing now that is really different and better – actually innovating rather than incrementally improving? Second – why would you not at least try this new approach – given the reality that the current approaches we’ve been rehashing for decades is clearly not working and in fact, is making things worse?
I’ll leave you all to ponder and respond to those two questions.
Until Next Time,
Zeev Neuwirth, MD
Friends,
The central role that Medicare, and CMS, play in our healthcare system can not be overstated. There are approximately 64 million Americans in the Medicare program, with annual payments of $1 Trillion, comprising over 20% of the healthcare spend in our country. In addition to its size and scope, CMS, through the Medicare program, is leading the nation in advancing value-based care, and has been deploying landmark historic initiatives at an accelerated pace. This is a unique interview in that we will be hearing directly from the impressive and highly accomplished leader at CMS who is leading Medicare. And, as I promised during the interview, I’ve attached a few links to cms.gov at the end of these notes.
Our guest this episode is Dr. Meena Seshamani who currently serves as Deputy Administrator and Director of the Center for Medicare, at the Centers for Medicare & Medicaid Services. Since joining CMS, Dr. Seshamani has led her team of nearly 1,000 through a critical agenda of initiatives to advance health equity; expand access to coverage and care; drive innovation for high-quality, whole-person care; and promote affordability and sustainability of the Medicare program for generations to come. She is the senior official responsible for CMS’s implementation activities under the Inflation Reduction Act, which is the largest change to the Medicare program since the enactment of Part D in 2003. Dr. Seshamani is a Hopkins trained surgeon and an economist, having obtained a doctorate in economics at Oxford. Prior to joining CMS, she served as Vice President of Clinical Care Transformation at MedStar Health – a multi-hospital system – where she developed & implemented population health and value-based care initiatives. She also cared for patients as a head & neck surgeon at MedStar Georgetown University Hospital and at Kaiser Permanente in San Francisco. Dr. Seshamani served on the leadership of the Biden-Harris Transition HHS Agency Review Team. Prior to MedStar Health, she was Director of the Office of Health Reform at the US Department of Health and Human Services, where she drove strategy and led implementation of the Affordable Care Act across the Department, including coverage policy, delivery system reform, and public health policy.
In this interview, we’ll discover:
- How providers can be aware of the activities at CMS, and how to engage more with CMS.
- Some of the most significant recent changes in Medicare that are coming out of the Inflation Reduction Act, as well as other landmark programs.
- How CMS is encouraging and supporting providers in joining and advancing their participation in alternative payment models like the Medicare Shared Savings Program – the largest accountable care organization in the country.
- How CMS is directly supporting providers in rural America – providers who are caring for tens of millions of Americans.
One of the most landmark initiatives we discussed in this interview was the historic ‘Medicare Drug Price Negotiation Program’. This is the first time ever that Medicare will be negotiating directly with pharmaceutical manufacturers for the prices of some of the highest cost drugs in the Medicare program. It’s fascinating to hear Dr. Seshamani describe the thoughtful and thorough preparation, as well as the ongoing research and assessment that is going into architecting the negotiation process. It’s also compelling to hear that CMS is focused not only on optimizing costs but also on evaluating the real-world effectiveness of these medications. In its first year, the program will focus on ten of the highest cost medications, but those numbers will increase rapidly to cover many more high-cost medications. The law will also cap medication costs for any individual Medicare beneficiary to no more than $2,000 per year.
Another landmark initiative we discussed is the ‘intensive outpatient program’. As Meena eloquently puts it, “We have made some of the most significant changes in behavioral health in the history of the Medicare program – creating entirely new benefits…” For example, these new benefits allow licensed marriage & family therapists, mental health counselors, addiction counselors, and care navigators to become billable Medicare providers – so that beneficiaries receive more whole-person, team-based care, radically improving the way that mental healthcare can be delivered.
I came away from this interview awed by the sheer number of historic, value-based initiatives that CMS is launching – enhancing affordability and equity of care and advancing care in critical areas such as behavioral health. I was also impressed by the transparency and level of engagement that CMS is enabling with providers and the public at large. Another facet that I have to call out is the focus CMS is placing on studying the effectiveness of their efforts, with an emphasis on actual health outcomes in the real-world setting.
There is so much more happening at CMS that we did not have the time to cover. What CMS is doing, and importantly, how they’re doing it, is a manifestation of their courageous, humanistic, conscious leadership. It’s also a reflection of the capability, commitment and integrity of their teams, and their overall palpable dedication to public service.
I came away from this interview hugely inspired and hopeful about the future of American healthcare. We have extraordinary leaders and sophisticated, dedicated teams at CMS – public servants who are advancing and transforming healthcare delivery in unprecedented ways. Their pace, productivity, and impact is remarkable. Their purpose is exemplary. I hope you come away from this interview as catalyzed to engage with CMS as I am. To that end, please take a moment to click on the cms.gov links below – and join in enhancing CMS’s mission.
Until Next Time,
Zeev Neuwirth, MD
- Proposed CY 2024 Physician Fee Schedule Rule:
- Press Release: https://www.cms.gov/newsroom/press-releases/cms-physician-payment-rule-advances-health-equity
- Behavioral Health Blog: https://www.cms.gov/blog/important-new-changes-improve-access-behavioral-health-medicare
- General Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule
- Medicare Shared Savings Program Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule
- Quality Payment Program Fact Sheet (PDF): https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fqpp-cm-prod-content.s3.amazonaws.com%2Fuploads%2F2483%2F2024%2520QPP%2520Proposed%2520Rule%2520Fact%2520Sheet%2520and%2520Policy%2520Comparison%2520Table.pdf&data=05%7C01%7CDiana.Perez-Rivera%40cms.hhs.gov%7Cc22ffc1b576744bc8a6808db83ec982d%7Cfbdcedc170a9414bbfa5c3063fc3395e%7C0%7C0%7C638248824408723905%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=XIEAjHwFCgW8KZskBift7lQrbZ7HUTJdlvQNKztH7Sw%3D&reserved=0
- Proposed Rule: https://www.federalregister.gov/documents/2023/08/07/2023-14624/medicare-and-medicaid-programs-cy-2024-payment-policies-under-the-physician-fee-schedule-and-other
- Comments due by September 11, 2023
- Proposed CY 2024 Outpatient Prospective Payment System Rule:
- Press Release: https://www.cms.gov/newsroom/press-releases/cms-proposes-policies-expand-behavioral-health-access-and-further-efforts-increase-hospital-price
- General Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/cy-2024-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center
- Hospital Price Transparency Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/cy-2024-hospital-outpatient-prospective-payment-system-opps-policy-changes-hospital-price
- Proposed Rule: https://www.federalregister.gov/documents/2023/07/31/2023-14768/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment
- Comments due by September 11, 2023
- Proposed CY 2024 Home Health Prospective Payment System Rule:
- Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-home-health-prospective-payment-system-proposed-rule-cms-1780-p
- Rule: https://www.federalregister.gov/documents/2023/07/10/2023-14044/medicare-program-calendar-year-cy-2024-home-health-hh-prospective-payment-system-rate-update-hh
- Comments due by August 29, 2023
- Proposed CY 2024 End Stage Renal Disease (ESRD) Prospective Payment System Rule:
- Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-2024-end-stage-renal-disease-esrd-prospective-payment-system-pps-proposed-rule-cms
- Rule: https://www.federalregister.gov/documents/2023/06/30/2023-13748/medicare-program-end-stage-renal-disease-prospective-payment-system-payment-for-renal-dialysis
- Comments due by August 25, 2023
- Final FY 2024 Inpatient Prospective Payment System Rule:
- Press Release: https://www.cms.gov/newsroom/press-releases/new-cms-rule-promotes-high-quality-care-and-rewards-hospitals-deliver-high-quality-care-underserved
- Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fy-2024-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective-0
- Rule: https://www.federalregister.gov/public-inspection/2023-16252/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the
- Final FY 2024 Inpatient Psychiatric Facility Prospective Payment System Rule:
- Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2024-medicare-inpatient-psychiatric-facility-prospective-payment-system-and-quality
- Rule: https://www.federalregister.gov/documents/2023/08/02/2023-16083/medicare-program-fy-2024-inpatient-psychiatric-facilities-prospective-payment-system-rate-update
- Final FY 2024 Inpatient Rehabilitation Facility Prospective Payment System Rule:
- Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2024-inpatient-rehabilitation-facility-prospective-payment-system-final-rule-cms-1781-f
- Rule: https://www.federalregister.gov/documents/2023/08/02/2023-16050/medicare-program-inpatient-rehabilitation-facility-prospective-payment-system-for-federal-fiscal
- Final FY 2024 Skilled Nursing Facility Prospective Payment System Rule:
- Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2024-skilled-nursing-facility-perspective-payment-system-final-rule-cms-1779-f
- Rule: https://www.federalregister.gov/documents/2023/08/07/2023-16249/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities
- Final FY 2024 Hospice Payment Rate Update Rule:
- Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2024-hospice-payment-rate-update-final-rule-cms-1787-f
- Rule: https://www.federalregister.gov/documents/2023/08/02/2023-16116/medicare-program-fy-2024-hospice-wage-index-and-payment-rate-update-hospice-conditions-of
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Friends,
I began this interview in a fairly calm state of mind, but I was shaken by the end. Throughout our dialogue, I could not help repeating the word ‘startling’ as our two expert guests shared stats on the state of primary care in their home state of Massachusetts and across the country. For example, were you aware that only about 5% of the total healthcare spend in the U.S. is in primary care? That is startling given that the literature repeatedly demonstrates primary care to be the keystone in any effective healthcare system. It is troubling in that this is a far smaller percentage compared to other developed nations. And, it is of national concern given that the health outcomes in the U.S. continue to lag every other developed nation. In fact, a recent presentation at a NCQA forum #qualitytalks2023 (data derived from the KFF) showed a major dip in life expectancy in the U.S. whereas other developed nations continued to show improvement. Early on in the interview, I asked Dr. Gergen Barnett how she would assess Primary Care, if it were a patient of hers. Her response, “It’s on life support”.
They say you can’t fix what you can’t measure. To that end, we’ll also learn about a critical new step the Massachusetts Health Quality Partners (MHQP) and the Center for Health Information and Analysis (CHIA) have taken in beginning to measure the health of Primary Care through an annual dashboard of ‘vital signs’. What gives me some hope are expert champions, like our guests this episode, who are dedicating their careers and their keen skills to solving the primary care crisis in our country.
Barbra Rabson has led Massachusetts Health Quality Partners (MHQP) since 1998. Under her leadership, MHQP has become a national leader in the measurement and public reporting of healthcare information, with a particular focus on measuring and improving patients’ experiences of care. She serves on numerous state committees and boards including within the MA Dept of HHS, the Massachusetts Health Equity Data Standards Technical Advisory Committee, the Betsy Lehman Center Task Force on Measurement and Transparency. She also serves on the Board of the Massachusetts Health Data Consortium. Ms. Rabson received her Master’s degree in Public Health from Yale University and her undergraduate degree from Brandeis University.
Dr. Katherine Gergen Barnett is the Vice Chair of Primary Care Innovation and Transformation in the Department of Family Medicine at Boston Medical Center (BMC).She’s a Clinical Associate Professor at Boston University School of Medicine, an Associate at Harvard’s Center for Primary Care, and a Health Innovators Fellow at the Aspen Institute. Prior to joining BMC in 2009, Dr. Gergen Barnett attended Yale University School of Medicine and worked at the National Institutes of Health. She is a practicing physician, an active researcher, a medical educator and is involved in local and state health policy. She is also a regular contributor to The Boston Globe and Boston Public Radio.
In this interview, we’ll discover:
- Why primary care is critical to our public health and the viability of our healthcare system.
- The extreme lack of investment that has been crippling the field of Primary Care, and the challenges imposed by the predominant Fee-For-Service payment model.
- The novel ‘vital signs’ dashboard that the MHQP, in partnership with the Center for Health Information and Analysis (CHIA), has constructed to measure and monitor the health of primary care in Massachusetts.
- A number of startling stats in the domains of Primary Care Finances, Capacity, Performance and Equity.
- A few encouraging solutions that Dr. Gergen Barnett and her colleagues have been working on.
Some important points I took away from this interview.
It is well known that primary care is the keystone for a viable and sustainable healthcare system. Without it, the system crumbles under its own weight. There have been numerous studies and reports verifying this, including a seminal report last year from the National Academy of Science Engineering & Medicine which stated, “Primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes.” Another conclusion from that report, “… primary care in the United States is fragile and weakening… [it is]… not configured to provide… comprehensive, preventive and chronic care needs…”
By all accounts, our primary care system is in bad shape and getting worse. It’s not a stable situation. You can get a sense of this by going onto the MHQP/CHIA website and reviewing the Primary Care Dashboard they’ve constructed. There are also some additional links at the bottom of these show notes, provided by our two experts.
Despite the failing state of Primary Care, we are continuing to see gross underinvestment and a relative lack of research. I was shocked to discover that only 0.2% of all NIH funding goes toward Primary Care research. Research is always the first step to a better future. This stat demonstrates that we’re stepping backwards, not forward when it comes to the state of primary care in the U.S.
While MHQP, CHIA and others, such as the Milbank Fund, are measuring and monitoring the state of affairs, it does not appear that political leaders at the state and federal level are aware of the looming crisis and its ramifications.
We all need to do more to raise that awareness, or face the consequences. And time is of the essence. From my perspective, we are heading into a perfect storm – an increased need and demand, a decreased supply, and rising costs and inequities of care that will leave a majority of Americans without access to care. To that end, I’ve included a number of links to further inform you and catalyze action.
Final thought – there are two scenarios – two situations we might find ourselves in a few years from now.
One scenario is a crisis – and I suspect that we’ll be looking at one another and wondering why we didn’t act, especially when the facts were so apparent.
The other scenario is a crisis abated – and I suspect we’ll be looking at one another with gratitude that we did act.
Which one of those two scenarios we find ourselves in is a direct function of what our leadership – our healthcare leaders and our political leaders – do today. It’s a function of what we do today. I left this interview dumbfounded, frustrated and inspired to speak out even more. I’m curious how it leaves you. And even more curious about what you’re going to do about it.
For starters – please share this podcast with anyone and everyone you know, including your congressional representatives. It is nothing less than a matter of life and death.
Until Next Time,
Zeev Neuwirth, MD
Friends,
The day after we recorded this interview, I picked up the May 2nd 2023 issue of JAMA and discovered that one of the leading research studies was about the rising trend in mental health-related ED visits among youth. https://jamanetwork.com/journals/jama/article-abstract/2804326
The stats were shocking and of serious concern. Between 2011 and 2020, the percentage of pediatric ED visits attributed to mental health issues had risen from 7.7% to 13.1% – and the annual absolute numbers had risen from 4.8M to 7.5M – an average annual increase of 8%! Even more startling was the 5-fold increase in suicide-related pediatric ED visits, which had leapt from 0.9% to 4.2% of all pediatric ED visits. Think about it. One out of every 25 pediatric ED visits are due to suicidality, and one out of every 7 pediatric ED visits are related to mental health!
The study authors stated that “these findings underscore an urgent need to improve crisis and emergency mental health service capacity for young people…” This study was timely – but more to the point, this episode of Creating a New Healthcare’ was timely – in that we’re going to discover and hear about a company that has created an evidence-based, highly effective and accessible solution to the “urgent need” and “crisis” of acute mental health issues amongst youth in the U.S.
Our guest today is Carter Barnhart. Carter is the co-founder and CEO of Charlie Health, the largest virtual provider of high acuity mental health treatment for youth in crisis. You’ll hear much more about Carter’s background and the reason she founded Charlie Health during the interview. Prior to Charlie Health, Carter was in the C-suite at Newport Academy, a teen residential treatment program.
In this interview, we’ll hear about:
- Some other startling statistics on the dramatic rise of life-threatening mental health challenges amongst teens in our country.
- The overcrowding of ED’s and the profound lack of access to effective care for teens who are experiencing acute mental health crises.
- A highly effective, evidence-based solution for acute mental health crisis called Intensive Outpatient Programming (IOP), which has existed for some time.
- How Charlie Health has virtualized this highly effective Intensive Outpatient Programming (IOP), and made it more personalized and more accessible to youth across the country.
- The “uphill” battle Charlie Health has been fighting to ensure Intensive Outpatient Programming (IOP) continues to be available and accessible to young people in need.
Some important points to note about Charlie Health:
First – When Carter and others refer to IOP as “Intensive” Outpatient Programming, they mean it. The Charlie Health treatment experience is customized to the needs of the individual client, and it’s comprehensive. Charlie Health’s virtual IOP includes 9-11 hours of evidence-based care weekly, via support group sessions, individual therapy, and family therapy. In addition, they have 24/7 emergency crisis care available to their clients and families.
Second – Carter and her colleagues have been incredibly diligent in implementing measurement-based care practices and outcomes transparency – both of which the behavioral health industry has been slow to adopt. They frequently partner with academic medical centers to study and publish peer-reviewed articles that demonstrate the efficacy of their program and track patient outcomes. What we know is that we now have an evidence-based program that is highly effective.
Third – Not only is the program effective, but it’s accessible in an unprecedented way to youth across the country, due to its being a virtual-first program rather than a place-based IOP. As Carter states during the interview, over 95% of the people in this country do not have access to mental health treatment. Charlie Health has solved that problem of accessibility for those struggling most acutely – not discounting the fact that internet connectivity is still a problem for many Americans.
Fourth – One of the profound advantages – and secret sauces – is that the virtual access enables Charlie Health to match the client with a therapist and a group of peers that are more like them – which Carter shares is a well known and critical success factor for sustaining engagement and achieving positive outcomes. Place-based brick and mortar programs have a far more limited selection of therapists and clients to match from.
FIfth – Another profound advantage of Charlie Health is that they partner with hospitals and emergency departments. This sort of integrated care is absolutely critical if we are going to solve the mental health crisis. Patients do have the ability and opportunity to access Charlie Health directly if they are experiencing a mental health crisis, but they can also be transitioned to Charlie Health in a timely way from an ED or from an inpatient hospital-based unit.
Finally – Charlie Health is a multi-faceted organization. In addition to its robust multi-modal IOP, they have a significant research arm, and they offer a “Charlie University” – on-going CEU training to their own therapists as well as for therapists outside of Charlie Health. One final significant activity is that they are constantly advocating for payment codes for IOP – what Carter refers to as an “uphill battle”, but one they seem to be winning as they are now live in 23 states!
The problem of acute mental health crises amongst youth in our country is alarming, and continuing to worsen. As I said multiple times during the interview, it’s nothing less than heartbreaking. The problem is compounded by the lack of access to care, and even more than that, by the lack of access to care that actually works and helps these young people. Charlie Health has taken a proven highly effective treatment approach – Intensive Outpatient Programming (IOP) – and made it much more accessible, more customized, and I would suggest, more effective. The work Carter and her colleagues are doing to obtain payment codes for IOP is also life saving.
I’m overwhelmed by the magnitude of this heart-breaking problem, but even more overwhelmed by the empathy and effectiveness of the solution that Charlie Health has developed at scale. We need Charlie Health, and other virtually-enabled programs like it, deployed at many more hospital systems and ED’s across the country – as soon as possible.
Until Next Time,
Be Well
Zeev Neuwirth, MD
Friends,
This was the most challenging interview I’ve conducted and posted, in the nearly 6 years that I’ve been hosting the ‘Creating a New Healthcare’ podcast. I spent weeks listening to the audio file – trying to figure out how to understand it, what to do with it, and how to present it to you. In the end, I believe it’s important to share it and to broaden this specific dialogue.
The conversation you’ll be listening to this episode is a conversation about an article that Dr. Don Berwick published earlier this year, in JAMA – the Journal of the American Medical Association. Its title: Salve Lucrum: The Existential Threat of Greed in US Health Care. I’ll save you the bother of looking up what ‘Salve Lucrum’ means. Here’s what chatgpt says:
“Salve Lucrum” is a Latin phrase that translates to “Hail Profit” or “Greetings Profit” in English. The phrase has its origins in ancient Rome, where it was commonly used as a greeting among merchants and traders. It expressed the hope for a successful and profitable transaction, as well as the desire for financial gain. In addition to its use in ancient Rome, “Salve Lucrum” has also been used in various other contexts throughout history, including in medieval Europe and in modern times. It remains a popular phrase among businesspeople and investors who are focused on maximizing their profits.
Per chatgpt, “It remains a popular phrase among businesspeople and investors who are focused on maximizing their profits.” Dr. Berwick’s thesis in the JAMA article, and in our conversation, is that “the immoderate pursuit of profit” has superseded the mission of patient care and public health. In the interview he states that it “has shifted the focus from people to money”, and that, “no sector of US healthcare is immune… neither drug companies, nor insurers, nor hospitals, nor investors, nor physician practices.”
I suspect that, for many of you who are employed in one of those sectors, this topic will be incredibly uncomfortable. I know it is for me. But, I also believe it’s a serious issue that deserves broader dialogue and attention. One might argue with some of the specifics and even the underlying premise that greed is the core problem. But, there is no question that the issues Dr. Berwick points out are real and are negatively impacting the health of Americans. One example of that reality comes from President Biden’s recent state of the union address in which he chides the pharmaceutical industry for the exorbitant, unethical and unnecessary pricing of medications. President Biden shared the example of pharmaceutical companies charging over $250 for a vial of insulin that costs $10 – $15 to produce. What makes this a public health agenda is that a significant percentage of the over 30 million Americans with diabetes can’t afford their insulin. Another recent and timely example is the actions that Congress and the President are taking to curtail some of the profiteering in the insurance industry sector in regard to Medicare Advantage risk adjustments and payments.
In this dialogue, Dr. Berwick walks us through each sector of the U.S. health industry, pointing out the perverse behaviors and implications of this “immoderate pursuit of profit”. One important point to keep in mind. Dr. Berwick makes it abundantly clear that he is not speaking about individuals, but about the system. As he puts it, “I’m not pointing a finger at individuals at all. I’m saying you are trapped in a system which is making you act in ways you don’t want to…” Having said that, he’s also unabashedly stating that “profiteering, storing money away, getting the most you can, has become… the dominant behavior, the dominant agenda of too many organizations in the country.”
Toward the end of the interview, we shifted the conversation from critique to action. Dr. Berwick outlines three or four actions we can take to address this issue – whether from the perspective of patient, provider, caregiver, policy maker or administrator. None of them are easy, but all are necessary.
After a few weeks of thinking about our conversation, I’m not sure that greed is the issue at all. I think a more fundamental problem is the one that Dr. Berwick has raised before and points out in this conversation. That issue being the commoditization of healthcare – having healthcare as a consumer good instead of a public good. As he states, “I have come to believe… we got this thing set up really wrong, that health and healthcare are important social goods. We all depend on it. We all need it. It’s like clean air, not like automobiles… A market for automobiles makes sense to me. A market for consumer goods makes sense to me. But not a market for clean air, and not a market for health. We’ve used market theory, profit theory, capitalist theory where it shouldn’t apply.”
There is no doubt in my mind that Dr Berwick is identifying and articulating a problem of titanic proportion – a problem that is eroding the health and financial welfare for the majority of Americans. It is, as he suggests, an existential issue that is contributing greatly to the unsustainability of our current system of healthcare. Having said that, I’m still uncertain of what we can actually do about it. What I am certain about is that there are few other individuals in the healthcare industry with greater intelligence, integrity, courage and a track record of commitment to patient care and public health than Dr. Berwick. His message comes from a set of principles that are unadulterated and unfiltered. His authority is not one of power or position, but one of profound patient-centered and public health purpose. Dr. Berwick – his career and his leadership – is an exemplar of what we need more leaders to strive toward.
I’ll wrap up this commentary with a goal that Dr. Berwick stated, and which also expresses my overarching goal in this interview and on this podcast. “My hope is that by speaking out and having others speak out, we can begin to create a sense of agency where we say, ‘we can change this and we will’…”
Until Next Time,
Wishing you Purpose and Agency
Zeev Neuwirth, MD
Brief Bio on Dr. Donald M. Berwick:
Donald M. Berwick, MD, MPP, FRCP is President Emeritus and Senior Fellow at the Institute for Healthcare Improvement (IHI), an organization that he co-founded and led as President and CEO for 18 years. An elected member of the Institute of Medicine (IOM), Dr. Berwick served two terms on the IOM’s governing Council, and was a member of the IOM’s Global Health Board. He also served on President Clinton’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry. Dr. Berwick contributed greatly to the landmark 2001 IOM report – Crossing the Quality Chasm; as well as the landmark, To Err is Human report. Dr. Berwick served as vice chair of the U.S. Preventive Services Task Force and chair of the National Advisory Council of the Agency for Healthcare Research and Quality. In July, 2010, President Obama appointed Dr. Berwick to the position of Administrator of the Centers for Medicare and Medicaid Services (CMS), which he held until December 2011. A pediatrician by background, Dr. Berwick has served as Clinical Professor of Pediatrics and Health Care Policy at the Harvard Medical School, Professor of Health Policy and Management at the Harvard School of Public Health, and as a member of the staffs of Boston’s Children’s Hospital Medical Center, Massachusetts General Hospital, and the Brigham and Women’s Hospital. He has co-authored over 160 scientific articles & six books. In 2005, Dr. Berwick was appointed “Honorary Knight Commander of the British Empire” by Queen Elizabeth II, the highest honor awarded by the UK to non-British citizens, in recognition of his work with the British National Health Service.
Friends,
The topic of this episode is about an emerging healthcare marketplace transformation, which is the introduction of platforms into healthcare. What surprised me about this movement is how many years it’s been developing. For example, last July I attended the 2022 MIT Platform Strategy Summit. Turns out it was their 10th annual symposium on this topic. The first day was dedicated to healthcare and entitled, ‘The Platform Revolution Comes to Healthcare’. The opening presentation was entitled, Healthcare Platform Megatrends: Discovering the Power of Network Effects. Our two podcast guests delivered that presentation. It was the most lucid and engaging explanation I’ve ever heard on the topic. Not surprising, given that they’ve been studying platforms for over a decade, have written blogs, spoken at prestigious institutions, launched their own podcast, and are writing a book.
Dr. Randy Williams is an experienced physician, healthcare executive, digital health pioneer and serial entrepreneur. He is the managing director of Digital Care Advisors, a healthcare strategic consulting and advisory firm. Following his medical training as a heart failure & transplant cardiologist at Johns Hopkins, he was recruited to Northwestern University where he built one of the first nationally recognized chronic care programs in heart failure and care management. Dr. Williams has testified in the US Senate and advised the Congressional Budget Office in both the George W. Bush and Barack Obama administrations on issues related to healthcare reform.
Vince Kuraitis is Principal and Founder of Better Health Technologies, LLC – developing strategy, partnerships and business models with a unique focus on platform strategy. His experience includes: President, Health Choice (medical call center), VP of Corporate Development & Specialty Operations at Saint Alphonsus Regional Medical Center; Regional Director of Marketing of National Medical Enterprises (hospital chain with 100 facilities). Vince holds both an MBA and a JD from UCLA. He is on the editorial advisory boards of Accountable Care News and Population Health News.
In this interview, we’ll discover:
- A platform does not only refer to a digital technology infrastructure, but is also a function of a novel business model.
- Examples of mega platforms in other industries – some of which have already entered the healthcare market.
- The opportunities platforms provide, as well as the strategic threat, especially if legacy stakeholders ignore them.
- What the ‘network effect’ means, as well as other characteristics that define a platform.
- The underlying market forces that are propelling platforms as a dominant component of healthcare delivery.
Some important takeaways from this interview.
First, platforms will be a foundational component of healthcare delivery in the near future. They already are in many other industries. Think Amazon in retail, Uber in travel, AirBnB in the hotel industry, and Netflix in streaming entertainment.
Second, platforms will revolutionize healthcare delivery, similar to the ways they’ve improved other industries such as banking, retail, travel and communications – making it more convenient, more consumer-oriented, more more accessible, more cost effective, and replete with more choices.
Third, platforms are not a ‘nice to have’, and they’re not a futuristic phenomena. In fact, I first heard about platforms from the CEO of the Mayo Clinic, Dr. Enrico Ferrugia, during a talk he gave at the 2021 HLTH conference. He described the emphasis Mayo was going to place on platforms and some of the strategic advantages. As Dr. Randy Williams put it during the interview,
“Every executive in healthcare needs to become familiar with what platform thinking is all about because they don’t want to fall asleep at the switch. This is coming to a neighborhood near you.”
Until Next Time,
Be Well
Zeev Neuwirth, MD
Folks,
We recorded this interview in February – the dead of winter – and I have to admit that I needed some sunshine and positivity. Steve Sell supplied it with his enthusiasm, his can-do spirit and the fantastic advancements that Agilon is making in allowing providers to practice primary care medicine with more time, more resources and more support while improving the care, care experience and outcomes for patients, and more specifically for Seniors.
How important is this? Well, we all know that primary care is a withering specialty in American healthcare with dire consequences for the American public in terms of health outcomes and costs of care. But don’t take my word for it. The National Academy of Science, Engineering & Medicine – in an extensive report published in May 2021 wrote, “…primary care in the US is fragile and weakening… it’s not configured to provide… comprehensive, preventive & chronic care needs…”. The Centers for Medicare & Medicaid – also responding to this reality – literally has had two major refreshes of its strategy in the past year. Folks, the topic you’re going to be listening about in this episode is an existential issue for American healthcare. So, when you hear the enthusiasm and excitement in my own voice during this dialogue, you’ll understand why.
Our guest this episode, Steve Sell, has served as the Chief Executive Officer and President of Agilon Health since June 2020. Prior to his current role, Steve served as President, CEO and Chairman of Health Net, Centene’s largest subsidiary, and has held a number of executive roles prior to that. Steve received his B.A. from Swarthmore College and holds an MBA from the Stanford Graduate School of Business.
In this episode, we’ll hear about:
- The challenges that primary care providers endure on a daily basis, and how Agilon is solving these daily frustrations and impediments.
- How Agilon is literally converting traditional fee-for-service ecosystems into value-based Medicare Advantage ecosystems.
- The incredible and much needed resources and supports that Agilon is providing to primary care physicians and their practices.
- The multi-disciplinary, team-based approach that Agilon is taking which directly and intentionally addresses the social determinants of health and health disparities – with demonstrable improvements in patient experience, care quality outcomes and cost reductions.
- The business model that mitigates the risk for primary care providers while enhancing their income as they transition from a perverse fee-for-service model to value-based payment.
Friends – here’s the rub – the bottom line, so to speak. In the US, we spend way less than 10% of all healthcare expenditures on primary care – far less than most other developed nations. Despite the fact that decades of research demonstrate that the more primary care you have in a region, the better health outcomes you have and the lower costs you have. So, what we have is a perverse inversion of what we need from our healthcare system and in clinical care. The other perverse situation is that we’ve put primary care on a volume-driven, transactional payment and incentive model. The point of primary care is to prevent, and prevention takes time. It takes getting to know the individual and their family, the context of their life and their health habits, and then orchestrate care around their needs. It is a completely different value proposition than procedural care or even specialty care, and yet, we have ignored that and subjected both patients and providers to what many are now calling a ‘moral injury’.
What I don’t understand is how healthcare leaders across the country, who must know this, are choosing to ignore it. What I also don’t understand is how CMS is not studying models like this, emulating them and spreading them. This is not a hypothetical model of care. This is a model of care that has been replicated in numerous regions with numerous stakeholders. It is a model that has been applied to lower income populations. And most importantly, it is a model that has demonstrated improvements in patient experience and outcomes of care, as well as reductions in avoidable care and costs. What are the leaders and experts waiting for??
And again, this is why I truly appreciate and applaud what Agilon – and other similar companies – are doing. They are taking the high road by infusing primary care with the resources and support to make it what it should be for patients, and providers and their teams. They are making the transition to value-based payment rapidly – not a ten year, fifteen-year or never-year plan – but now.
I won’t get into the specifics of how they’re doing all of this, but it’s all incredibly practical and all about the daily practice of medicine. It’s all about where the rubber hits the road – removing the hundreds of daily roadblocks and incredibly frustrating, time-wasting hurdles that primary care providers are subjected to just to deliver good care. I would encourage you to listen to the podcast episode. It’s a truly elegant business model that removes the risk of transitioning from the primary care providers and allows them to practice medicine the way they know they should and the way they want to – the right way for their patients. It also allows primary care providers to do this while not suffering any loss in income. In fact, what surprised me is how much primary care providers can increase their income – which is frankly important if we are to have physicians, PA’s, and nurses go into primary care versus the much higher paying specialties.
I’m truly interested in hearing your thoughts and questions about what Agilon is doing. Please post on LinkedIn or Twitter. This is a dialogue we must have in order to drive the much needed changes in American healthcare.
Until Next Time, Be Well.
Zeev Neuwirth, MD
Friends,
Let’s start with a statistic. I suspect that many of you consider rural healthcare a somewhat esoteric or niche market. Let’s correct that misconception right up front. There are over 60 million Americans who live in rural settings and they tend to be older and have more medical conditions than the general population. Just for comparison’s sake, there are 30 million Americans with diabetes – that’s half the number who live in rural America. Point being, the topic we’re talking about in this episode addresses about one fifth of all Americans and according to this week’s guest, “there’s definitely a misperception around the size and the crisis that’s happening in rural America.” And if you’re wondering what makes this a crisis, hit ‘play’ and listen to this enlightening dialogue with a healthcare leader who, along with her colleagues, is attempting to make a positive difference in the lives of nearly one out of every 5 Americans.
Our guest this week, Dr. Jennifer Schneider, is the co-founder & CEO of Homeward Health. Prior to this, she served as Chief Medical Officer of Livongo and then as its President, where she led the company’s strategic clinical product vision, data science & clinical trials. As many of you are aware, Livongo was acquired by Teladoc in the largest digital health acquisition to date. Prior to Livongo, Dr. Schneider held several key leadership roles at Castlight Health, including as its Chief Medical Officer. Earlier in her career, she was a health outcomes researcher and Chief Resident at Stanford University, and has practiced as an attending physician at Stanford University and Kaiser Permanente. She is the author of Decoding Health Signals: Silicon Valley’s Consumer-First Approach to a New Era of Health, which explores how companies are using big data analytics and artificial intelligence to reinvent care delivery for people with chronic conditions.
In this episode, we’ll hear about:
- The unique challenges of providing and receiving healthcare in rural America
- Some startling statistics about the lack of providers and access to care in rural America.
- The 3 differentiating ways in which Homeward Health is tackling the problem of rural healthcare.
- A unique partnership that Homeward Health has formed with Rite Aid.
- Some of the amazing state-of-the-art, tech-enabled approaches that Homeward Health is bringing to an antiquated system of care for the elderly in rural America.
This mission is very personal for Dr. Jenny Schneider, as was her last venture at Livongo. Jenny was diagnosed with type 1 diabetes as a child, and her treatment was delayed for weeks because she was living in rural America and did not have access to the healthcare she needed. So, in a very real sense, she has come home. With Livongo and now with Homeward, Jenny – one of the leading physician healthcare entrepreneurs in our country – is addressing medical conditions and healthcare challenges that she and her family have great personal familiarity with. It’s a profoundly purposeful story.
While the technologic and digital sophistication that Homeward Health uses is amazing, the real differentiation is that they are tackling the very practical challenges in a 3 part fashion.
First, the shift to a viable economic model: value-based payment. They’re focused on the senior segment and are leveraging Medicare Advantage payments. Let’s be clear, there is no way that Fee-For-Service (FFS) aligns with the care of the elderly. Older people require a relational approach to healthcare, not a transactional approach, and the FFS payment model incentivizes transactional volume, not relational preventive care.
Second, Homeward is able to replicate and scale its services because of the state-of-the-art tech-enabling platform. Folks – there is no way around this. The brick & mortar, centralized care delivery model is not financially viable. What is needed now – for so many reasons – is the ability to utilize remote patient monitoring, virtualized care, and home-based care delivery.
Third, the key differentiator is building credibility, trust and synergistic impact through partnering with local healthcare systems. I love the fact that Homeward is partnering with hospital systems in a way that benefits the healthcare system, the local communities and most importantly, patients and their families. We’ve heard this theme of partnership from other forward thinking healthcare entrepreneurs. It may be the key to unlocking the future of healthcare delivery.
The partnership with Rite aid is particularly interesting. As I understand it, Homeward is using mobile health units and literally parking itself in Rite Aid parking lots. This does at least two things. First, it brings medical care closer to people’s homes in rural America; and second, it provides tremendous convenience by enabling folks to obtain their prescriptions and other medical equipment simply by walking right into the adjacent Rite Aid store. Keep in mind that we’re talking about older patients in which medications are not only critical but a major challenge – in terms of appropriate dosing and polypharmacy. Being next to Rite Aid, with immediate access to pharmacists and pharmacy tech’s is the right way to deliver healthcare for the senior population.
The specifics of the care model that Jenny and her colleagues have created is incredibly elegant and supremely patient-focused, with much of it actually being accomplished within patients’ homes – both virtually and in person. I hope you appreciate learning about it as much as I did; and please let me know what you think.
Until Next Time, Be Well.
Zeev Neuwirth, MD
Friends,
I have to tell you that each time I have the opportunity to speak with Dr. Patrick Conway, it’s a treat. He is an erudite and accomplished healthcare executive – having served as the CEO of Blue Cross Blue Shield of North Carolina and previous to that as the deputy administrator for innovation and quality at the Center for Medicare and Medicaid Services, as well as the agency’s Chief Medical Officer. He also brings an incredibly grounded perspective from his many years of clinical practice as a pediatric hospitalist (which he continues to do), and in his previous role overseeing clinical operations and quality improvement at Cincinnati Children’s Hospital. Of note, at one point he also practiced in a federally qualified healthcare center, serving the most undeserved families in our healthcare system.
I’m not at all surprised at the accolades he’s received – being elected to the National Academy of Medicine in 2014 and receiving the President’s Senior Executive Distinguished Service Award. But, what impresses me the most about Dr. Conway is his never ending pursuit to create better healthcare – better healthcare for children, for the elderly, for individuals on Medicaid and dual eligible patients with disabilities and complex chronic conditions, and for those suffering with mental illness. I could have easily titled our conversation, ‘Caring for the underserved in American healthcare’. Patrick is a highly experienced and practical executive who can quote stats, facts, policies and payment models with the best of them; but what he can also do is share with you the real life stories of patients he’s seen and continues to see – stories that reveal the critical need to transform American healthcare.
In this episode, we’ll hear about:
- The vast portfolio of care solutions that Dr. Conway oversees which includes home and community care, post-acute care, mental and behavioral health, specialty care, complex chronic care, senior care, and federal health services.
- A dive into the behavioral health “crisis” and what Optum Healthcare is doing to address it.
- A discussion on the challenges of rural health and senior care, with examples of the solutions and partnerships that Optum is assembling, including a recent partnership with Walmart.
- A couple of recommendations Dr. Conway has for hospital system leaders.
- Some reflections regarding the impact CMS and CMMI has and are continuing to have on American healthcare.
The scope and scale of what Dr. Conway and his colleagues are building is remarkable, and yet, he will be the first to admit that his organization is not flawless and they are still figuring it out. He’ll also be the first to point out the awesome potential for good and the possibilities at scale they are striving for. What inspires me the most about Patrick are the underlying values he brings to this work. In this interview he notes that competition is a fact of life; but, we can and should be more collaborative. He is an ardent, long-time champion for the accelerated transition to value-based care. And finally, he talks about the selfless risks that leaders must be willing to take in order to manifest their mission – financial risks, cultural risks and leadership risks.
I expect that there will be some listeners and readers who will be critical of my lauding Optum. Look, while there are valid criticisms that can be directed at UnitedHealth Group and its insurer arm, UnitedHealthcare, I don’t know many stakeholder groups in American healthcare that are immune from serious critique and in need of significant reformation. Folks, my purpose in this podcast is not to critique, but to discover positive transformative change and to share that with others – to learn from, to emulate and to collaborate with positive deviance, so that we can humanize our healthcare system.
The reality is that we can’t continue on the path and trajectory we’ve been on for the past few decades. We are at numerous existential crossroads in healthcare, and in the health and welfare of our public. We need to figure out how to reframe, redesign and reorganize our healthcare system so that it delivers what we all want and need for our families, our communities and our country. And that means we’ll have to figure out how to relate to one another differently.
So, I hope you perceive this dialogue in the way it was intended: as an inspiring message about possibilities. The message I hope you hear is one that transcends what you think of payers or retailers or big tech or any other stakeholder in the healthcare industry. The message I hope you hear is a shared collective mission. And, my friends, we must rally around that mission, if not for our sake, then for the sake of the generations that follow us.
Until Next Time, Be Well.
Zeev Neuwirth, MD
Friends,
It’s always enlightening and inspiring to hear from Dr. Robert Pearl, our guest this episode. He tackles critical issues in healthcare head on and with unabashed honesty and unfiltered integrity. The topics you’ll be hearing about this episode include what Dr. Pearl refers to as “the middleman mentality”, which he argues is “killing American medicine” and limiting the potential of healthcare leadership, leading to an incrementalist approach. We’ll also hear his insightful perspective on how large disruptors like Amazon, CVS & Walmart are playing what he calls “healthcare’s long game”, and the impact that could have on legacy healthcare systems and providers.
Dr. Robert Pearl was the CEO of The Permanente Medical Group (Kaiser Permanente) from 1999-2017. In this role he led 12,000 physicians, 42,000 staff and was responsible for the nationally recognized medical care of over 5 million Kaiser Permanente members on both the west and east coasts.
Named one of Modern Healthcare’s 50 most influential physician leaders, Dr. Pearl serves as a clinical professor of plastic surgery at Stanford University School of Medicine and is on the faculty of the Stanford Graduate School of Business. He is the author of two books, Mistreated: Why we think we’re getting good healthcare – and why we’re usually wrong, and Uncaring: How the culture of medicine kills doctors and patients. He is also a podcast host and a regular contributor to Forbes.
In this episode, we’ll hear about:
- The incrementalist “middleman” mindset and the type of transformative leadership that will be required for healthcare systems to thrive.
- The short, middle and long game that large retailers are playing, and the impact this will have on hospital systems & provider groups.
- A strong argument for why healthcare must move to capitation, and why it has to be embedded at the healthcare delivery level.
Dr. Pearl is not speaking from an idealistic or ivory tower perspective. He is speaking from decades of delivering some of the highest quality, most accessible, and most cost effective care we’ve witnessed in our country – at scale! He does not sugarcoat the challenge that healthcare systems face in transitioning from an out-moded fee-for-service (FFS) business model to value-based payment. But, at the same time, he holds no punches in articulating how damaging the FFS based healthcare system is for patients, for providers, and for our communities. He also makes the point that the current system is actively being disrupted. Given those realities, the argument for incrementalism seems indefensible; and yet, that is where we find ourselves today. The solution, according to Dr. Pearl, is leadership. The type of forward-thinking leadership that is willing to make the tough decisions and willing to take the courageous steps to transform healthcare delivery.
Until Next Time, Be Well.
Zeev Neuwirth, MD
Friends,
In this episode, we have the unique opportunity of being introduced to two critical components in the future of healthcare delivery: platforms and flywheels. We also have the great fortune of being introduced to one of the national leaders in digital healthcare, Sara Vaezy. Our guest will share why and how platforms and flywheels are necessary for healthcare systems to remain competitive in the digital era, and why they’re important now.
Sara Vaezy is the recently appointed Chief Digital Officer for Providence where she is responsible for digital strategy, product innovation, marketing, digital experience, and commercialization for the integrated delivery network which includes 52 hospitals and over 1000 clinics serving over 5 million unique patients. In addition to her work at Providence, Sara serves as the NCQA Board Director, as a member of inaugural class of the Frist Cressey Ventures Collective, a Health Evolution Forum Fellow, a World 50 Digital 50 member, and a Forbes Business Council Member. She has won numerous awards and recognitions that include a Becker’s Rising Star in Health IT (2020) and a Becker’s Women to Watch in Health IT (2020 & 2022). Sara holds an MHA and an MPH in Health Policy from the University of Washington School of Public Health and BA’s in Physics and Philosophy from the University of California, Berkeley.
In this episode, we’ll discuss:
- Why platforms and flywheels are vital for the mission and viability of healthcare systems.
- Examples of platforms and flywheels outside of healthcare and how they enhance consumer acquisition, engagement and retention.
- Why platforms are a prerequisite for healthcare systems to compete effectively in the digital era.
- How flywheels can also support the transition to value-based care
- The ‘know me, care for me, and ease my way’ promise that Providence Health makes to its patients, and how that directs their digital health strategy and deployment.
There are numerous lessons to be learned from Sara Vaezy in this dialogue – lessons about healthcare consumerism, digital healthcare, the competitive landscape and value-based care. Speaking with Sara is always a privilege, a pleasure and a deeply inspiring experience.
Until Next Time, Be Well.
Zeev Neuwirth, MD
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Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introductory episode ...
Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introductory episode ...
Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introductory episode ...
Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introductory episode ...
Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introductory episode ...
Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introductory episode ...
Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introductory episode ...
Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode here. ...
Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode ...
Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode ...
Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode ...
Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode ...
Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode ...
Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode ...
Dear Friends & Colleagues, Last week, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode here. In this ...
Dear Friends & Colleagues, Last week, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode here. In this ...
Dear Friends & Colleagues, Last week, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode here. In this ...
Dear Friends & Colleagues, Last week, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode here. In this ...
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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, ...
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 ...
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. ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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, ...
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 ...
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 ...
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, ...
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 ...
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, ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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. ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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. ...
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 ...
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 ...
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 ...
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 ...
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 ...
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. ...
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 ...
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 ...
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. ...
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. ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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. ...