Creating a New Healthcare

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

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.

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

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.

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

Friends, There is no question that digital health is a critical part of the future of healthcare delivery. It is what I term ‘the great enabler’. And in this interview we have the opportunity to speak with a physician leader who is at the tip of that spear: Dr. Eve Cunningham, a physician executive in virtual care & digital health at Providence, one of the largest and most progressive healthcare systems in the country. Dr. Cunningham currently serves as Group Vice President and Chief of Virtual Care and Digital Health for Providence Health. She joined Providence St. Joseph Health in 2017 as the Chief Medical Officer of Providence Medical Group Southwest. Eve is board certified in Obstetrics and Gynecology and has practiced for over 12 years. She earned her medical degree at Saint Louis University School of Medicine and did her postgraduate residency training at Kaiser Los Angeles Medical Center. Eve also obtained a Master’s in Business Administration from the University of Massachusetts Amherst. In this interview, we’ll discover: Why Digital Health is an absolutely critical part of the current and immediate future of healthcare – a must-do can’t-fail for any healthcare system or provider organization. The three major ways that Dr. Cunningham and her teams serve within Providence Health: to promote, develop and support digital health efforts. Some of the amazing virtual services and digital products she and her team have developed and are spreading at a large scale. A few of the critical success factors Dr. Cunningham believes to be essential for the viability of any digital health division and program. I’ve had the privilege of interviewing and speaking with a number of leaders at Providence. Each time I do, I walk away with even more respect for this organization – its mission, its forward-thinking culture, and the level of professionalism, competence and collaboration. I also walk away with awe at the innovative and transformative services and products they are constantly incubating, scaling and commercializing. This conversation with Dr. Eve Cunningham was no different. I had heard Dr. Cunningham speak at a symposium a few months prior and I was impressed with her attitude and her approach. She has a unique set of skills – bringing the traditional chief medical officer acumen and experience to bear – the clinical and operational chops. But she also possesses a bold and practical irreverence for traditional approaches that are not future facing. Her ability to meld these two together is quite remarkable and striking. She has no problem in telling it straight, something I deeply admire. In regard to telling it straight, Eve shared some very practical tips in regard to digital health initiatives; chief amongst them were three things. First – being crystal clear about the value proposition, the key performance indicators, and being to demonstrate the value proposition through these metrics. Second – working very closely with financial colleagues to be able to demonstrate a hard return on investment. Third – piloting programs that were not only clinically and operationally feasible as well as financially viable, but also programs that are scalable. She talked about scale on the level of tens of thousands, if not hundreds of thousands of patients. In regard to some of the exciting programs and innovative products? Well, you’ll have to listen to the interview. But, I’ll give you a sneak preview. One product we discussed at length is called MedPearl – a digitally-enabled specialty referral system/algorithm that every integrated healthcare provider system or group has been desperately seeking for decades. If you’re a healthcare leader, you will not want to miss this discussion. Another is a set of digitally-enabled surgery support tools which will radically change surgical care forever. I’ve understood that all healthcare is going to be digitally-enabled in the near future. But it’s leaders like Dr. Eve Cunningham and her colleagues at Providence that are making it a reality. A reality that is going to improve patient access, outcomes, experience, equity and affordability – as well as improve the effectiveness, efficiency and job doability for providers of care. There is no question in my mind that digital is the enabler for humanizing healthcare delivery for all. I’ll leave you with a brief quote from Dr. Cunningham which really captures the essence of the imperative: “I would say that virtual and digital is our way forward into the future, and we have to 10x it! My goal is 10x what we’re doing in the next five years because that’s what’s going to keep us afloat as an organization. We have to change. Traditional healthcare delivery is not sustainable in its current state…” Until Next Time, Zeev Neuwirth, MD

Friends, In my upcoming book, Beyond The Walls, I spend an entire chapter discussing how platforms have revolutionized other industries and how they’re about to do the same in healthcare. Over the past couple of years, I’ve had the privilege of interviewing and learning from the experts who have been working with platforms for years. Geoffrey Parker, who wrote the now classic text The Platform Revolution, Vince Kuraitis, and Dr. Randy Williams have been working over the past decade to introduce the platform revolution into healthcare. If you’re interested in really understanding what platforms in healthcare look like and what differentiates them from our more typical business models, I recommend you listen to my podcast interview with Vince and Randy (episode # 149, April 19th 2023) and read chapter 7 in my about to be published book, Beyond The Walls. During that interview, Vince & Randy mentioned an exciting example of a platform business model in healthcare. The company is called KeyCare. It was founded and is being led by physician entrepreneur Dr. Lyle Berkowitz. In this interview we’re going to discover how this novel platform is attempting to solve the issues of access to care, capacity, cost-effectiveness, and burnout amongst providers and their teams. Lyle Berkowitz, MD, is the Founder and CEO of KeyCare, the nation’s only virtual care company built on the Epic platform. He has more than twenty years of experience as a primary care physician, health system executive and informatics expert, and serial entrepreneur. Previous roles include Founder & Chairman of Healthfinch, Chief Medical Officer at MDLIVE and Director of Innovation for Northwestern Medicine in Chicago. Dr. Berkowitz is also Editor-in-Chief for Telehealth and Medicine Today. He’s served on numerous industry boards in the past and is currently a board member for Oneview Healthcare. Lyle has been listed as one of HealthLeader’s Twenty People Who Make Healthcare Better, Healthspottr’s Future Health Top 100, and Modern Healthcare’s Top 25 Clinical Informaticists. He has been elected to Fellowships in both the American College of Physicians (ACP) and the Healthcare Information Management Systems Society (HIMSS). He graduated with a Biomedical Engineering degree from the University of Pennsylvania and is an Associate Professor of Clinical Medicine at the Feinberg School of Medicine at Northwestern University. In this interview, we’ll discover: How KeyCare can address the shortage of primary care physicians in American healthcare. The major differentiating benefits of KeyCare and the variety of use cases for healthcare systems. The three “R’s” and the three “C’s” that are critical for the adoption of KeyCare as well as other virtual services. Throughout the interview Dr. Berkowitz illustrates the numerous ways that healthcare systems as well as other provider groups can utilize and leverage KeyCare. The initial use case, and probably the most challenging to manage, is ‘on-demand’ and ‘urgent care’ – or what might be considered part of the so-called ‘digital front door’. Instead of staffing and managing their own virtual on-demand urgent care services, healthcare systems can rely on KeyCare. Lyle points out that on-demand care is not a differentiating value proposition for healthcare systems. By outsourcing it, systems can focus their efforts and resources on the aspects of care that are differentiating and of higher margin. One sub-category of on-demand urgent care is patient populations in value-based contracts. Lyle suggests that KeyCare could assist healthcare systems in reducing avoidable ED visits and other costly alternatives, thereby lowering the costs of care in these risk-based populations. Another significant use case is primary care. Lyle proposes that KeyCare could become an extension of a PCP’s team, performing a number of functions that enhance efficiency of care, allowing a provider and their on-site teams to perform to the top of their license, and increasing access and capacity, enabling a provider to manage much larger panel sizes. The way this might work would be for KeyCare to manage patients with chronic disease who are relatively stable, to perform routine visits including annual wellness visits, and to do follow up care. This would allow PCP’s to see more complex patients as well as new patients. In risk-based contracts, KeyCare could assist by closing care gaps and updating data points for risk score adjustments, thereby helping to appropriately increase the per member per month (PMPM) payments. In addition to on-demand and primary care, KeyCare can also offer specialty services such as behavioral health. There are a few key benefits to KeyCare (sorry, I couldn’t resist). First, one differentiating benefit is that KeyCare is essentially a virtual provider group that is on an Epic instance. The advantages to healthcare systems who are on the Epic electronic health system are significant in terms of interop

Friends, This week’s interview is nothing less than awesome, and it’s awesome for three reasons. First, Dr. Rishi Sikka is a brilliant and accomplished physician executive with an incredibly diverse professional background. He brings that diversity of thought and vision into his work and into our dialogue. Second, we’re going to discuss some key new leadership competencies that both Dr. Sikka and I believe are critical for the future advancement of healthcare delivery in our country. Third, as I mention in the intro to this interview, I’m about to publish a second book entitled Beyond the Walls. It’s a market-based, three-part strategy for the transformation of American healthcare. What was so confirming to me is that Dr. Sikka’s perspective, as well as his strategic and tactical vision, is fully aligned with what I’ve written in that book. Of note, he has not yet read the book. As you can tell, I’m incredibly excited about this interview, and once you listen, I suspect you’ll be as well. Dr. Rishi Sikka is currently a venture partner at Lifeforce Capital, and a Professor of the Health Services, Policy and Practice at Brown University School of Public Health. His past executive roles include: President of System Enterprises at Sutter Health as well as Senior Vice President of Clinical Operations & President of the Advocate Insurance Segregated Portfolio Company. He earned his bachelor’s in economics at the Wharton School at the University of Pennsylvania and his medical degree from the Mayo Clinic Medical School. He is co-author of the book Leading Healthcare Transformation: A Primer for Clinical Leaders, and has written for the Wall Street Journal and Harvard Business Review. In 2021, he was recognized as a Top 50 Clinical Executive by Modern Healthcare. In this interview, we’ll discuss: Why Dr. Sikka believes that diverse backgrounds and disciplines foster opportunity in healthcare delivery.  Dr. Sikka’s recommendation for how leaders can tactically embed relationship-centered care into daily clinical practice.  The importance of ‘Championing the Trust Agenda’ – both for patients as well as providers.   The issue of provider burnout and demoralization, and a tactical approach to addressing it – an approach that Dr. Sikka has some experience with.  The notion of partnering and collaborating, which is a reframe of the old ‘buy it or build it’ paradigm.   A few new and promising trends in healthcare delivery – based on Dr. Sikka’s VC experience working with a portfolio of entrepreneurial companies.   This conversation with Dr. Rishi Sikka was enlightening, inspiring, encouraging, and quite honestly, fun. He’s a bold thinker and doer, but he shares his point of view in a collaborative and humble way. This interview touches upon a number of really important lessons for a new leadership – what I would label ‘beyond the walls’ leadership. I’ll briefly touch upon a few of these. Seeking diversity of experience and disciplines. Most of us recognize the critical importance of diversity, but do we recognize the importance of diversity of experience, disciplines and thought? Dr. Sikka brings an incredibly broad and diverse background to bear. He was initially an economics major prior to going to medical school. As a medical student, he took off a few months to work as a managed care researcher, learning how to use big data (claims data) to assess quality and outcomes of care. While in medical school he also spent time as a reporter and on-air broadcaster for a local NBC affiliate. In addition, Dr. Sikka is a student of other industries – proactively borrowing and learning the lessons that others have had to learn the hard way. His own healthcare leadership perspective is imbued with these diversities of experience and thought, which he believes is supremely helpful in creating new ideas and opportunities in healthcare delivery.   Deploying Relationship Centered Care. Most of us are familiar with this phrase, but Dr Sikka believes it’s essential to not just voice that sentiment, but also to operationalize it. He provides a number of examples of how to tactically deploy relationship centered care. One that he shares is the notion that, as we leverage AI to increase productivity, we should divert some of that enhanced capacity into time that providers can spend with their patients.   Fostering ‘mastery, autonomy and purpose’. Borrowing from Daniel Pink’s book Drive – The Surprising Truth About What Motivates Us, Dr. Sikka discusses how we can and must leverage mastery, autonomy and purpose in combating provider demoralization and burnout. Once again, he takes this from the strategic level to tactical deployment – sharing his own experience as a physician executive in shared governance organizations, in which physicians are treated not as employees but as true partners.  ‘Championing the Trust Agenda’. Once again, borrowing from ha

[In order to provide accessible content, here is a full transcript of this interview] Friends, The topic this week is caregiving and caregivers – an issue that is so much larger, so much more devastating, and so much more in need of reform than most of us are aware. There are over 50 million family caregivers in the US, and they suffer financially, emotionally, psychologically and physically with negative consequences that persist for the rest of their lives. The solution, according to our expert guest, comes down to funding and policy: to provide the funding through Medicaid’s Long-term services and supports (LTSS) and remove the stringent requirements that grossly limit appropriate access to those funds. During this episode, we’ll dive into the underlying systemic social biases around the elderly and the disabled – a bias that is preventing the policy and funding changes needed to alleviate the heartbreaking suffering of caregivers and their loved ones. In this interview, Professor Laura Mauldin will distill the learnings from her research, as well as from her own personal experience in caregiving. She also provides recommendations for what needs to be done to remedy the situation. Laura Mauldin PhD is a writer and scholar based in Brooklyn, New York. She’s currently an associate professor at the University of Connecticut. Laura’s research focuses on disability care and technology. Her first book, Made to Hear: Cochlear Implants and Raising Deaf Children, documents the structure and culture of the systems we’ve designed to try to make deaf kids hear. Laura is currently writing a book – scheduled to be published in 2025 – on spousal caregiving which weaves together research, memoir and cultural commentary. In this interview, we’ll discover: The major reasons for why the number of family caregivers in the US is rapidly growing.  The various traumas that are inflicted upon caregivers, something that most of us who have not lived this experience are completely unaware of.  An insidious systemic bias in our society toward the disabled, which Professor Mauldin refers to as ‘ableism’.   An explanation of the institutional bias built into Medicaid policy, which greatly limits the access to paid caregiving for over 90% of Americans who want and need it.  How the formal healthcare system – insurance companies, pharmaceutical companies, device manufacturers, and hospital systems – benefits financially at the emotional, physical and financial expense of caregivers. Something I had never considered.   The very specific policies and funding that we need to change in order to remedy this situation and provide the support that family caregivers require.   Professor Mauldin is a remarkable scholar. As a highly trained qualitative researcher, she intentionally decided not to take a neutral stance in her research on caregiving and caregivers. Instead, she infused her work with her own lived experience of being a caregiver. She infused it with a studied understanding of the political and social biases that are root causes for why the situation isn’t being addressed and remedied. She infused it with the power of story and not just with the power of statistics. In this interview, Laura Mauldin shares her own story of caregiving and reveals what most of us have little to no understanding of – a world that is so radically different. She talks about the daily “terror” and “exhaustion”, the “isolation” and a sense of being “invisible”. She also describes a profound “demotion” in her relationship with her partner – a shift from being a “lover” to being a “life support system”. The stories she shares, her own as well as those from the dozens of families she studied, are heartbreaking and informing. Laura points out that the suffering of caregivers isn’t limited to their emotional, psychological and physical health. It also has a profound 3-part impact on their financial health. First, caregivers are largely unpaid for this in this country. Only about 7% of Americans can afford private pay care-giving, which means that well over 90% of caregiving goes unpaid for in the US. Second, if family caregivers have a job, they often see a marked decrease in their earned salaries, due to the time they must spend caregiving. Third, caregivers suffer a marked loss in their retirement savings, in part, as a result of the compounded losses in their job salary over the course of years. One of the most enlightening parts of the dialogue was Professor Mauldin’s articulation of ‘ableism’, which I had never heard of before. I found it to be inspiring and liberating – yes, liberating. This sense of liberation comes from her shining a light on a part of our lives that is hidden from view, a part of our lives that has been cloaked in shame and bias, and a part of our life in which we desperately seek to maintain some semblance of control and independent l

Friends, This is a super interesting and fast paced dialogue about a topic that is poorly understood by most, including healthcare executives and policy experts. The topic is employee health plans. Our guest today, Dave Chase is a remarkable healthcare entrepreneur with decades of experience who has been one of the most brilliant thinkers and activists in reforming employee healthcare benefits. He and his colleagues at Health Rosetta have really unearthed the core underlying problems and are doing something about them. They do, in fact, have a blueprint that is replicable, scalable and sustainable; and they have numerous examples of success. Given that nearly 50 percent of healthcare is paid by employers, this issue has broad impact and significant implications for American healthcare and for the financial welfare of working Americans and their families. In this interview, we’ll discover: To what extent employee health plans have been eroding the wages and retirement funds of working Americans for the past 3 decades. The implications of the Consolidated Appropriations Act of 2021, which requires employers to be fiduciary stewards of their employees’ health plans. The importance of understanding the legal documents of health plans as the untapped lever that can enable us to fix American healthcare. The undisclosed revenue streams and incentives that are contributing to the outsized and unsustainable rising costs of employee health plans. The “open sourcing” in hospitals, and in healthcare in general, that is needed to improve quality, safety and costs. Examples of companies that have successfully redesigned their health benefits resulting in better health outcomes and lower costs for their employees. Of all the opaque and confusing aspects of healthcare delivery, the legal agreements of employee health plans, may top them all. This wouldn’t necessarily be an issue except for the incontrovertible fact that what they’re hiding is literally decades of misaligned incentives that reward increased pricing rather than high quality care, positive health outcomes, cost effective pricing, convenient access and consumer-oriented navigation. What’s hard to comprehend is how many hands there are in the pockets of the American workers, siphoning off decades of hard earned wages and retirement savings. The irony is that these employer health plans benefit the insurance companies, third party administrators, health benefits managers, PBM’s, and hospital systems more than they benefit the employers or employees. And let’s be clear – this is not a minor issue affecting a small percentage of the population. This is a huge issue affecting the majority of working Americans. What we’re talking about is not being able to afford healthcare and having to forego it to pay for housing costs, food, clothing, child care and transportation. What we’re talking about are tens of millions of Americans who can’t afford preventive medical care, medications and much needed medical procedures. Here are some stats that Dave provided – a sobering and alarming perspective on the severity and magnitude of the situation. Over 100 million Americans carry medical debt, which is one of the leading causes of individual and family financial ruin. Over 60% of Americans earn less than $60,000 per year while the cost for a family of four in an employer-sponsored PPO health plan in 2023 is over $30,000. This places healthcare insurance at literally 50% of earnings for the majority of Americans – completely untenable and almost mind boggling. Tens of millions of Americans are what Dave terms “functionally uninsured”. They have health insurance but their life savings are far less than the deductible required. To put some numbers to this, the majority of Americans have less than $1000 in total savings while the deductibles for an individual range from $1800 to $2400; and for a family of four, the deductibles range from $3600 to $4800. What this means is that tens of millions of Americans are literally one ED visit or one hospitalization away from financial ruin. The situation is dire but there is some good news and positive momentum. It’s taken decades but it’s heartening to learn that regulatory policies and laws are finally beginning to protect employees. As Dave informs us, the Consolidated Appropriations Act of 2020/2021 will put the onus on employers as “plan sponsors”, but will also empower them by requiring transparency and prohibiting contract terms that harm employers and employees. The Department of Labor has been charged with enforcing the law and is already demanding documentation from employers. Plan sponsors will be required to prove to the federal government that they are good financial stewards of their employees’ health benefits, and transparently demonstrate to their employees that they are contracting for cost effective, high quality healthcare. From a political perspective this Act is supported by the previous Trump A

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 C

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 &#8

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 prob

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

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 adjace

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

Friends, The problem of inequity in women’s health is a hugely disturbing one, particularly in American healthcare. For example – the disparity in maternal-fetal mortality & outcomes among Black women compared to White women in our country is an egregious example of a long-standing unsolved inequity. To put it plainly, it’s a shocking disparity and one that has to be addressed and eliminated. In this dialogue we are introduced to another shocking inequity in women’s health. The issue is menopause, and I have to admit that I was unaware of the enormity of this unaddressed issue, and its debilitating impact on literally tens of millions of women each year. As always, our main focus here will not be on the problem, but more so on a solution that a courageous group of leaders have deployed to create a new and more humanistic approach to healthcare in our country. Joanna Strober is the CEO of Midi Health. Prior to Midi, Joanna founded Kurbo Health, a digital therapeutic for childhood obesity that she grew to serve tens of thousands of adolescents worldwide and sold to Weight Watchers in 2018. Prior to following her passion for digital health, Joanna spent fifteen years making investments in venture capital and private equity. Joanna is also the co-author of Getting to 50/50, a best selling book written to help parents thrive in the workforce after having children. Joanna received her BA in Political Science from University of Pennsylvania and holds a JD from University of California, Los Angeles where she was UCLA Law Review editor. In this episode, we’ll discover: How Joanna Strober personally discovered one of the great hidden inequities in American healthcare – an issue that is impacting nearly 60 million women. How painful and debilitating menopausal symptoms can be, and how these symptoms can be mis-disagnosed and mis-treated by well-intentioned providers. The impact menopause has on the professional lives of tens of millions of women in our country, and its negative impact on corporate America. The evidence-based, expert-supported, consumer-oriented & hyper-focused model of care that Joanna & her colleagues have created to address the problem of menopause in America. How Midi Health can be a synergistic and collaborative partner with providers and healthcare systems. A number of summary learnings are well worth reviewing:   Nearly 60 million women in the USA are in the menopausal age range. The symptoms are incredibly debilitating and are often missed and misdiagnosed by providers, leading to costly testing as well as inappropriate treatments. It’s not hard to see how these symptoms could be confused for other issues, as they include: migrainous headaches, sleep disturbances, anxiety and depression, heart palpitations, brain fog, memory problems, and a lack of energy. As Joanna states, when these symptoms arise in a women between the ages of 40 to 65, menopause should be on the top of the list of possible causes rather than at the bottom. Women struggle to find appropriate care because the bottom line is that primary care physicians, neurologists, cardiologists, sleep medicine doctors and even gynecologists don’t get significant, if any, formal training in menopause. In addition to the personally debilitating symptoms, menopause also impacts women’s professional lives. Here are some stats Joanna shared with us: Nearly 60% of women have to take time off from work due to menopause. Nearly 20% have to take off more than 4 weeks. In one survey, 60% of women said they did not apply for a promotion or raise because of their menopause symptoms. 25% said they had considered quitting their jobs, and 10% actually quit their jobs as a result of their menopausal symptoms What struck me during this interview was the truly exceptional clinical program that Joanna and her colleagues have built at Midi Health. It is one of the most elegant and sophisticated clinical/operational models of care that I have come across. It’s also supremely consumer oriented. The model is virtual which makes it accessible and convenient. Below is a high-level overview. The major interface women have is with a nurse practitioner who is certified by NAMS – the National Association of Menopause Specialists. In addition to being highly trained and vetted, these nurse practitioners are also following continuously updated, evidence-based protocols that the renowned experts at Midi Health have painstakingly created. If you take a look at their website, you’ll get a sense of the depth of the experts and expertise that Midi has brought to bear. In addition to the NAMS certification and updated protocols, these nurse practitioners receive on-going training by the core team of experts. During the actual patients visits, the nurse practitioners also have real-time, on-demand access to the panel of experts. So they can literally obtain an expert consultation during the virtual visit. And, this is not just general menopau

Friends, Our dialogue this episode centers on one of the most transformative and divergent clinical care models that I have come across. People throw around phrases like relationship-centered, patient-centered, preventive, personalized, and social determinants of health. In the model we’re discussing in this episode, you’ll see all of that actually being integrated into a coordinated ecosystem of care that delivers continuous, comprehensive, cost-effective and dignified VIP care to older, poorer and sicker Americans. People refer to ChenMed as one of the iconic, value-based senior care models or Medicare Advantage care models. It is also one of the best examples of a mission-driven healthcare organization. If you’ve ever wondered how a small group of people can transform the American healthcare system, I would suggest you listen very carefully to this interview. I would also recommend that you read the book that Dr. Chris Chen & Dr. Gordon Chen recently co-authored, The Calling – a Memoir of Family, Faith and the Future of Healthcare. Dr. Chris Chen is CEO & Co-Founder of ChenMed. Since becoming ChenMed’s CEO in 2009, Dr. Chen and his colleagues have built the decades-old, highly successful ChenMed model into a scalable organization with over 100 sites now spanning dozens of cities across numerous states. ChenMed has been named to Newsweek’s “Most Loved Workplaces” list, Fortune Magazine’s “Change the World” list, as well as earning recognition by the White House, the Department of Health and Human Services, and the U.K. National Health Service. ChenMed was recently named by Newsweek as the #1 workplace in healthcare. ChenMed has also been featured in numerous publications including Medical Economics which named ChenMed, “Best Primary Care System in the U.S.” Dr. Chen graduated from the University of Miami’s Honors Program in Medicine. He went on to complete his medical training at Beth Israel Deaconess, a Harvard University teaching hospital, after which he completed a fellowship in cardiology at Cornell University Medical College in New York City. In this episode, we’ll discover: The foundational healthcare vision and mission that this organization adheres to and delivers upon. The pivotal capitation payment model ChenMed has adopted, and how that enables the shift from transactional, volume-driven and reactive care to one that is highly relational, personalized and preventive. The numerous clinical, operational and technologic initiatives and infrastructure ChenMed has launched, which differentiate it from the primary care being deployed in the vast majority of healthcare systems across the country. How ChenMed treats its providers with the same respect, dignity and humanity that it applies to the patients and families it serves. The analytic and technologic sophistication that ChenMed has invested in, which greatly enable providers and their teams. The remarkable business acumen that Chris and his colleagues bring to bear – allowing for a model that is viable, replicable and scalable. I first met Chris Chen over seven years ago, and I’ve been observing the phenomenal maturation and advancement of the ChenMed model ever since. Below are 3 reflections. First, ChenMed is solving a serious and unresolved problem in our country – affordable, effective and dignified healthcare for older, sicker and poorer Americans. Poverty, overall, in the US is decreasing; but it appears to be rebounding for older Americans. A recent NYT article by Lydia DePillis (An Uptick in Elder Poverty: A Blip, or a Sign of Things to Come, Oct 17, 2022) cites that nearly one in ten Americans over the age of 65 live below the poverty line. One in five Hispanic or Black American Women over 65 live below the poverty line. One in four Americans over 65 years of age make less than 150% of the federal poverty line which is, on average, $19,494 for an individual living alone. I was surprised, actually shocked, to learn of the high and rising prevalence of poverty amongst our senior population. At this level of poverty, preventive primary care is unaffordable. The ethical imperative is clear. But, what we also know is that the vast majority of the costs of healthcare are attributed to the older, sicker and poorer population. So, there is an economic imperative as well. Second, what I have come to learn is how poorly understood ChenMed is amongst healthcare leaders. I’ve listened to knowledgeable experts speak without any coherent awareness of the integrated ecosystem ChenMed has built. I’m under no illusion that I fully understand the ChenMed model, but I continue to be an avid student; and continue to be an outspoken champion. Third, one thing I’ve observed over and over again with ChenMed is their divergent thinking and approach to primary care, and healthcare in general. They have reframed the practice of medicine to align with the core principles of our profession. There are literally dozens, if not hundreds, of w

Friends, This is one of a series of interviews I conducted to better understand the role of platforms in healthcare delivery. Our guest today, Dr. Roy Schoenberg, is one of the most significant contributors and most accomplished entrepreneurs in the domain of telehealth & virtual healthcare. He and his colleagues are also pioneers in one of the most significant transformations that will occur in healthcare – platforms. Dr. Roy Schoenberg is President and CEO of Amwell. Since co-founding the company in 2006 with his brother Ido, Amwell has grown to become one of the largest telehealth eco-systems in the world. Amongst numerous accomplishments and recognitions, Roy was appointed to the Federation of State Medical Boards’ Taskforce that issued the landmark guidelines for the “Appropriate Use of Telemedicine in the Practice of Medicine” in 2013. He is the 2014 recipient of the American Telemedicine Association Industry award for leadership in the field, and was named one of Modern Healthcare’s 100 Most Influential People in Healthcare in 2020. Roy holds over 50 issued US Patents in the area of healthcare technology. He speaks frequently in industry and policy forums, and serves on the healthcare advisory board of MIT Sloan School of Business. He holds an MD from the Hebrew University in Israel, and a MPH from the Harvard School of Public Health. In this episode, we’ll discover: What a healthcare delivery platform actually means and what it does.  The revolutionary potential of automation in healthcare delivery and the two requirements of this new generation of technologies.  The role platforms can play in assisting us to achieve the elusive triple, quadruple & quintuple aims.  How platforms can solve the ‘digital dilemma’ that is now confronting every healthcare system attempting to enter into the digital era of healthcare.  How platform technologies will actually humanize patient care by connecting people, connecting data, connecting technologies and connecting services. I’m just going to say that listening to and learning from Roy Schoenberg is a treat not to be missed. I’ve had the privilege of speaking with and interviewing Roy a number of times. But, each and every time I do, it seems like I comprehend his vision and appreciate his wisdom even more than the last time. It took me 3 passes through this interview to actually see – and I mean ‘see’ the vision of the future that Roy was describing. It is incredible. Roy describes the 3 domains of healthcare delivery that will be fully and seamlessly integrated through platforms, and the two requirements of the next generation of automated technologies. He paints a picture of a ‘digital companion’ that is so real and sounds so doable, but at the same time seems almost magical. As I listened to Roy, I was reminded of that quote by science fiction writer, Arthur C Clarke: “Any sufficiently advanced technology will be indistinguishable from magic.” One always wonders about the real-life challenges and timeline of transformational change when speaking about an industry that is as homeostatic as healthcare. In listening to Roy Schoenberg and other leaders like him, I have come to realize that the challenges are not technologic. We have those magical capabilities. The challenge is the limitations of our industry-centric framing, the limitations of our disease-reactive vs health-centric framing, and the limitations imposed by our current payment and profit framing. The sad part of our inertia is two-fold. First, it is the harm we unintentionally impose upon our patients and our providers of care – instead focusing on incremental temporizing measures that are a relic of a reengineering era of improvement. Second, it is that the future of healthcare is going to be so much better than the past, and yet we delay that reality by clinging to a past framework instead of catalyzing a future one. Far from depressing me, these realizations only strengthens my resolve to reframe healthcare. And my hope is that this has the safe effect on you. The incredibly inspiring reality is that we have lots of highly impactful leaders like Roy who are making that better future a reality. I’ll leave you with a few comments by Roy which provide a snippet of his vision and his humanity. “I think that a lot of people still see these technologies as another way to do the same things we’ve always done… like, take the office visit and put it on your phone – same stuff, different place… I think a lot of the market is still married to that easier-to-comprehend notion… versus the logistical power of what these technologies actually bring to the table and our ability to rewrite the healthcare experience through them… we’re going to be able to give people the reassurance that they can be cared for in their own environment… completely rethinking the way care happens.” “Completely rethinking the way care happens…” That’s the reframe in healthcare we all

Friends, Many of us think of Uber as simply a much more convenient and comfortable alternative to taxi cabs, or as another great app on our smartphones. Underlying that reality is a deeper understanding that Uber is actually one of the most sophisticated business & technology platforms to date. Through the use of data, analytics and digital connectivity, it brings customers and vendors together in a way that is much more accessible, convenient, customized, and cost effective, and with just as good if not better outcomes, Uber makes it easier for both customers and vendors. What does Uber and their platform have to do with healthcare? For those of us who are in population health and healthcare quality, what I just wrote about Uber translates into the quadruple aim: better care, better outcomes, lower cost, and improving the experience for providers. That is what I’m referring to when I titled this episode – the ‘uberization of healthcare’. Uber Health has the potential to reframe and powerfully enable us to achieve the very aims that we have been attempting for the past couple of decades; including the quintuple aim goal of healthcare equity – which you’ll hear about early on in our dialogue. Our guests today are both Boston-based and so when I say they’re ‘wicked smart’, you’ll forgive me for the colloquialism. They also happen to be ‘wicked’ accomplished, capable, incredibly articulate and profoundly mission-driven – all of which will become apparent as you listen to this exciting and enlightening interview. I’ve also had the recent opportunity to meet with other members of the Uber Health team and was super impressed with the healthcare acumen they’re bringing to the table: deep knowledge in Medicare, Medicaid, population health, healthcare benefits and so on… Caitlin Donovan is the Global Head of Uber Health. She has held numerous chief operating roles in organizations including MyOrthos, ModivCare – previously called LogistiCare – a specialty benefits manager in non-emergency medical transportation, and CareCentrix, where she focused on home-based care and post acute care. Early in her career, she worked in finance as an investor at Bain Capital, and as a member of the internal consulting group at Summit Partners. She earned a bachelor’s degree in Economics from Harvard University and lives in Dover, Massachusetts with her husband and two sons. Dr. Mike Cantor is a geriatrician and attorney. He is Chief Medical Officer (CMO) of Uber Health and CEO of The Cantor Group. Previously he has held positions as CMO for Bright Health Plan, CMO for CareCentrix, and CMO for the New England Quality Care Alliance (NEQCA). He still makes house calls one day a month in the Boston area, and has practiced for many years – in nursing homes, long term acute care facilities & the hospital setting. He trained in Internal Medicine at Beth Israel Hospital in Boston and completed a geriatrics fellowship at Harvard Medical School. He holds degrees in law and medicine from the University of Illinois. In this interview, we’ll hear: How devastating an issue access to care is in our country, and the incredible health and financial costs that accrue because patients aren’t able to show up to their scheduled appointments. The basic transport services that Uber Health is already offering to patients, healthcare providers, payers & health plans. How Uber has expanded its transport to include providers – think ‘home health nurses’ and community health workers for starters. How Uber is reframing its transport to also include medications, testing, groceries and meals. What Uber is doing in order to enable and engage low income and digitally challenged individuals who may not have access to smartphones, apps or even basic texting capabilities. There are so many amazing discoveries that you’ll encounter in this interview. The initial discovery that struck me is that Uber is a transport enablement platform which is expanding into adjancenies. Initially focused on transporting patients in the traditional service they offer to the public, they are now expanding by curating non-emergency medical transport (NEMT), and also expanding into the transport of groceries, meals, home testing devices and importantly medications. In addition, they’re also transporting healthcare workers and providers of care. What is important to recognize is that Uber health is attempting to solve some of the immediate core challenges facing American healthcare. By focusing on food, medications and home testing, they are directly addressing the non-clinical (or social) determinants of health, which have a much greater impact on outcomes of care than even medical treatment. By focusing on the transport of healthcare workers, they are addressing one of the critical issues we are facing today, which is the frightening shortage of providers as well as other care workers – a problem which is literally plaguing

Friends, Whether you’re 25 years old or 75 years old, when you walk into primary care providers’ offices in most places across the country, the care you’ll receive is pretty much the same. The people in the office are the same; the services are the same; the protocols are the same; the time slots you get are the same. Does that make sense to you? To state the obvious – a 65-year old, 75-year old and 85-year old have much different needs, concerns and issues to deal with than patients in a younger demographic. And yet, the healthcare seniors receive is largely undifferentiated. In this episode, we’ll hear about a segmented, customized, personalized and holistic approach to senior care that is being delivered by a highly innovative pay-vider. Humana has, for years, been a national leader in senior care, home-based care, and the social determinants of health. In this episode, we’ll explore these topics with the incredibly accomplished Dr. William Shrank. Now, I do want to add that there are other organizations who have been segmenting and customizing care for seniors. My three favorite examples are ChenMed, CareMore and Iora Health. ChenMed is, in my opinion, the paragon for VIP care of seniors. A few other examples include Archwell, Oak Street, Patina, Landmark, Lena Health, and Landmark which is now part of Optum. Large hospital/healthcare systems across the country are also beginning to develop similar models of care that are focused on seniors. Dr. William Shrank serves as a Senior Advisor at Humana, after recently stepping down as Chief Medical Officer. His current responsibilities include implementing Humana’s integrated care delivery strategy. He leads Humana’s Care Delivery Organization, clinical operations, and the Bold Goal population health strategy. Dr. Shrank held the position of Chief Medical and Corporate Affairs Officer from July 2019 to July 2021, during which time he also oversaw government affairs. Dr. Shrank joined Humana as Chief Medical Officer in April 2019, having previously been employed by the University of Pittsburgh Medical Center (UPMC) where he served as Chief Medical Officer of their Insurance Services Division from 2016 to 2019. Prior to UPMC, Dr. Shrank served as Senior Vice President, Chief Scientific Officer, and Chief Medical Officer of Provider Innovation at CVS Health. Before joining CVS Health, Dr. Shrank served as Director of the Research and Rapid-Cycle Evaluation Group for the Center for Medicare and Medicaid Innovation, part of the Centers for Medicaid and Medicare Services (CMS). Dr. Shrank began his career as a practicing physician with Brigham and Women’s Hospital in Boston and as an Assistant Professor at Harvard Medical School. He has authored over 250 peer-reviewed publications. Dr. Shrank received his M.D. from Cornell University Medical College. He completed his residency in Internal Medicine at Georgetown University and his fellowship in Health Policy Research at UCLA. He also earned a Master of Science degree in health services from UCLA and a bachelor’s degree from Brown University. In this interview, we’ll hear about: The impressive investments that Humana has made into senior care, home-based care & the social determinants of health. Humana’s national deployment of senior care clinics as well as the larger integrated Centerwell brand that includes home-based care & pharmacy. The incredibly thoughtful divisions they’ve created focusing on digital health, social equity, and clinical solutions. How Dr. Shrank views the relationship between healthcare systems and payers. The significant emphasis that Humana places on being a “rapid learning organization” and their focus on data-driven decisions & evidence-based deployment. I admire so many things about Dr. Shrank. He is a physician, health services researcher, healthcare administrator and visionary leader. He’s also incredibly humble and as much a learner as he is a doer. His background and the years he spent at CMS and CVS have provided him with incredible experience in how to deploy and evaluate large-scale, value-based programs. Along these lines, the emphasis that Humana has placed on scientifically evaluating their initiatives and making data-informed decisions is exemplary. In this episode, Dr. Shrank articulates some of the challenges in systematically and scientifically evaluating whether or not initiatives create patient engagement and deliver on outcomes; as well as their scale-ability. One also has to respect Humana’s forward-thinking focus on social equity and the social determinants of health, which is largely credited to their CEO, Bruce Broussard, who initiated “The Bold Goal” project in 2015. Along these lines, Dr. Shrank discusses the CDC’s self-reported “healthy days” metric that Humana has been pursuing; as well as their perspective, which is to make social determinants of health an integral part of every day care delivery. We go into some depth on why Humana has cre

This is a singularly unusual and unprecedented episode. Aug 17th 2022, which is the day of the posting of this episode, is the 5th anniversary of the ‘Creating a New Healthcare’ podcast. I’m taking this opportunity to spend a few minutes reflecting on the journey – and to share those reflections with you. As always, I am interested in your thoughts as well, so please respond on LinkedIn and Twitter. Initially, I was planning to host this by myself, but then I thought how much more interesting and fun it would be to have someone else to speak with, especially someone who is adept with hosting their own podcast. The first person who came to mind was the amazing Scott Becker, who graciously agreed to interview me for this episode. Scott Becker needs no introduction, but for those who don’t know his history… Scott Becker is the founder & publisher of The Becker’s Healthcare and Becker’s Hospital Review. He is an attorney, a partner at McGuireWoods and a former board member of McGuireWoods. Scott also served as chair of the national health care practice at McGuireWoods for more than 12 years. He is a graduate of Harvard Law School and a CPA. And, as I mentioned before, an amazing podcast host! In this interview, I’ll share: The very real tension that is driving this podcast, as well as its fundamental purpose, which is a bit different from other podcasts. A few critical lessons I’ve learned from our guests over the past 5 years. Some examples of the courageous journeys that we’ve been privy to hearing on this podcast. A couple of favorite quotes from the amazing leaders I’ve interviewed. What continues to energize and inspire me about the podcast journey and some thoughts about what’s next. Without giving away too much, here are a few brief thoughts on this discussion with Scott Becker. First – it was an incredible honor to have Scott Becker interview me. He is one of the most generous individuals I have come across in the healthcare world and I have tremendous respect for what he has built, including the incredible relationships he has fostered. Second – when I reviewed the list of the brilliant leaders who have been on the ‘Creating a New Healthcare’ podcast – over 250 interviews, 137 of which I’ve posted – I was surprised at how many were situated within legacy healthcare organizations: hospital systems, payers… I would have thought that the majority were entrepreneurs in start-ups, but it seemed to be split pretty evenly. The takeaway is that transformational change can and does occur within legacy healthcare systems – hugely hopeful and inspiring! Third – although I’ve conducted hundreds of interviews, there are actually a relatively small number of critical lessons or themes that these leaders all resonate around. I share 3 major lessons in response to a question Scott asks; but there are a few others that are woven throughout the dialogue. And I love that Scott inserts some important takeaways in there as well. Fourth – despite a lot of rhetoric about the demise of our healthcare system, I share an informed and grounded perspective that I have never been more encouraged, hopeful and inspired than I am today. This doesn’t come from an armchair perspective. I work in our healthcare system each and every day, as I have for the past 30 plus years. And, my overall sense is that there has never been a better time for the humanistic transformation of American healthcare. Fifth – My overarching perspective is one of respect and gratitude. There is no question that our healthcare system is in need of some serious fundamental change. But, there is also no question in my mind that the vast majority of the people working within our healthcare system are truly amazing. The doctors, nurses, PA’s and other providers, as well as the administrative leaders and staff who work tirelessly each and every day – week after week, month after month, year after year. No matter what swirls around them, no matter what politics or payments or pandemics, they perform professionally – with compassion and empathy. They hold our system together. My respect, gratitude and hope arise from working with, watching and learning from these truly incredible individuals. Two final thoughts here – I’d like to take a moment to thank all of you out there who have been listening to, commenting on and sharing this podcast with your professional networks. I can’t begin to tell you how important and meaningful your feedback is to me. I hope you enjoy and benefit from listening to this particular podcast episode as much as I did in recording it. Until Next Time, Be Well Zeev Neuwirth, MD

Friends, There is a quiet, maybe not so quiet, revolution happening in healthcare delivery. The transposition of healthcare out of the legacy bricks & mortar sites and into the home. Payers such as Humana and Optum, as well as retailers such as Amazon, Best Buy Health and Walgreens are spending tens of billions of dollars acquiring companies and capabilities to bring medical care into the home. There are hundreds of vendors that are already years into creating a home-based care ecosystem. With the increasingly sophisticated remote monitoring, digital diagnostic equipment, predictive analytics, telemedicine & logistics software capabilities, we are seeing these companies provide more personalized and contextualized care that, in many ways, is not only more convenient, but actually superior to care in the hospitals, ED’s & clinics. We’ll be asking our guest today, Dr. Mark Prather, to share his industry-leading experience and wisdom on all of this. Dr. Prather has an impressive track record in both the clinical and entrepreneurial domains. He practiced as a board-certified emergency medicine physician for more than two decades. He was a founder and served as President of US Acute Care Solutions, an integrated acute care physician staffing organization serving approximately six million patients annually. He has partnered in multiple medical industry startups, including iTriage, an early digital patient navigation tool. Dr. Prather obtained his undergraduate degree in Molecular Biology at Vanderbilt University. He attended medical school at UCLA, where he graduated with honors, and completed residency training in Emergency Medicine at Denver Health where he also served as Chief Resident. He also obtained a Master of Business Administration from the University of Colorado School of Business. In this interview, we’ll hear about: The profound & documented clinical, interpersonal & economic advantages of home-based care compared to traditional brick & mortar hospital based care. How home-based care is much more effective in assessing & addressing social determinants of health. The evolution of Dispatch Health from urgent/emergent care at home to a full service home-based healthcare ecosystem, and why Mark decided to start with urgent/emergent care visits. How Dispatch Health is evolving their payment into the value-based realm & the incredible cost savings they’ve already demonstrated. Some critical comments from Mark regarding how home-based care is actually much safer, far less fragmented, and much more personal than the traditional brick & mortar care being delivered in hospitals, ED’s & doctors’ offices. Why Mark firmly believes that home-based care will disintermediate the brick & mortar landscape of healthcare delivery. There are a few take-aways that I believe are incredibly important for all of us to understand about the home-based care ecosystem. First – Healthcare in the home is not a hypothetical and not some future state. It is happening and in significant numbers. Dispatch Health has already seen hundreds of thousands of patients, over 700,000 in the home, and is seeing hundreds of thousands of patients annually. Second – The acuity or severity of patients being cared for in the ‘Hospital at Home’ are not the mildly sick patients. Mark’s data reveals that the patients cared for in the home are in the top 10% of acuity according to the Charleston Comorbidity Index. Third – the cost savings are real and significant! Dispatch Health is documenting savings of $5000 – $7000 per admission compared to traditional hospital admissions. Mark goes into some detail as to how these cost savings are occurring. What’s remarkable to note is that these savings accrue not because there is less care, but actually because there is more and better care. Fourth – In addition to the concrete clinical & safety benefits, Dispatch Health has an average Net Promoter Score of 95%, with over 700,000 patient home visits & home hospitalizations. Along the lines of patient experience & satisfaction, it seems almost too obvious to mention but this sort of care delivered in the home is infinitely more convenient and comfortable for patients and their families than hospital-based care or traditional ED or even urgent care. Fifth – Care delivered in the home is much more personal, customized and contextual than care delivered in hospitals, ED’s, nursing homes, urgent care centers & doctor’s offices. Mark points out that being in the home really shifts the focus of the clinicians from a limited triage & treat function to a treat & recovery function. Clinicians & staff in the home have purview into the patient’s life – into non-clinical determinants of health like social supports, medications, food security and home safety – that have as much, if not more, of an impact on health outcomes. One great example Mark provides o

Friends, The first interview we conducted with Ben Kligler (see episode #130) was an introduction to a game-changing humanistic inflection in healthcare delivery called ‘Whole Health’. If you haven’t listened to it yet, you must. What the VA is deploying on a national scale may be the largest and most significant positive transformation occurring in the American healthcare system. This interview builds on what we discovered in episode 130, but we get a chance to really discover the essence of this life-saving movement. In the beginning of this interview, Dr. Kligler lays it out plainly, “…we are creating an actual delivery system built on whole health”. His response to the ‘why’ question is also straightforward and rings true. “… we’ve gotten to the limit of what disease-oriented care can do in terms of improving our health and well-being…” He goes on to support this statement with statistics and well reasoned arguments. One stat he cites is that the US continues to rank the lowest on multiple domains of healthcare, including health outcomes, when compared to other high-income countries. In fact, the US ranks 37th in the world when it comes to healthcare outcomes, despite grossly outspending every other country. I think most of us understand the problem at hand, but we may not really understand the ‘whole health’ solution. Ben does a fantastic job of distilling it down for us, “Our theory is that our legacy healthcare approach is not tapping into one of the most powerful sources of health, which is a person’s ability to make changes in their life and move forward, toward what’s important to them; and to address what’s in their way – what’s keeping them from having a healthy life. [Whole health] is also a vehicle for addressing the social and structural determinants of health… It’s really the solution to what’s holding our healthcare system back… because managing disease is simply not enough…” Benjamin Kligler, MD, MPH, is a board-certified family physician who has been working as a clinician, educator, researcher and administrative leader in the field of complementary and integrative medicine for the past 25 years. In May 2016 he was named National Director of the Integrative Health Coordinating Center (IHCC) in the Office of Patient Centered Care and Cultural Transformation (OPCC&CT) as well as Director of Education and Research for Whole Health. In May 2020 Dr. Kligler was named Executive Director of the Office of Patient Centered Care & Cultural Transformation (PCC&CT.) He is a Professor of Family and Community Medicine at Icahn Mount Sinai School of Medicine, and was Vice Chair & Research Director of the Mount Sinai Beth Israel Department of Integrative Medicine. He is currently a core faculty member of the Leadership Program in Integrative Healthcare at Duke University. In this interview, we’ll hear about: The two questions that form the foundation for the ‘whole health’ program. I’ll give you a teaser. The first question is, ‘what in your life most matters to you?’ Can you guess what the second question might be? See below. The specific domains within the “circle of health” which assist providers and patients in identifying what’s most important and most relevant to the context of patients’ lives. How this program is intent on not only identifying the issues, but also providing the tools and support in attaining and maintaining those personal goals. The ‘whole health’ outcomes that the VA is measuring and tracking, and those they’re already beginning to see improvements in. Some of the challenges in studying these outcomes and deploying the program on a national scale, as well as next steps There are a few notable comments from this dialogue with Dr. Kligler that stand out for me. First – a surprising benefit of the VA’s Whole Health approach is that the providers and staff are also benefiting. The VA is observing an improvement in provider & staff work satisfaction as well as a reduction in turnover. Given the significant burnout (~50% amongst doctors and nurses) and the ‘great resignation’ in healthcare, leaders should take note and consider this Whole Health approach. It should come as no surprise that one of the core defining elements of burnout is depersonalization. Second – One of the most surprising and telling stats that Dr. Kligler cites is that people who have a low sense of purpose are two and a half times more likely to die than people who have a high sense of purpose. Based on that research, he goes on to ask the question ‘why isn’t ‘purpose’ a core vital sign?’. Well, in the whole health approach it is one of the main domains on the ‘circle of health’. His point is that ‘sense of purpose’ and other non-clinical factors are, in fact, ‘vital’ signs – determinants of our vitality. We’ve known this for years, with mounds of scientific evidence to support it, and yet, we continue to propagate a system that excludes these ‘vital’ signs. W

Friends, I’ve listened to this podcast multiple times, in preparation for this write-up. Each time I listen, I learn something new and continue to be blown away by what the visionary folks at Laguna Health are doing and building. The bottom line here is that our healthcare system is not designed to identify and address the contextual [life] barriers of care. As a result, patients and their families suffer, health outcomes are worse, and the jobs of providers and their teams are made much more difficult. Laguna Health is reversing that by creating a much more contextualized and personalized healthcare approach. In this interview we distill decades of patient-centered research that Dr. Saul Weiner and Dr. Alan Schwartz have conducted and are now embedding within the Laguna Health approach. It is the most significant and impactful applied research I have ever encountered in terms of understanding how the context of people’s lives impact their healthcare and their health outcomes. And, importantly, how clinicians, clinical teams and healthcare systems can identify barriers to care and address them as an integral part of the healthcare experience. The magic, however, doesn’t stop here. Laguna Health has taken this extraordinarily empathetic approach and combined it with the most advanced digital technologies to create an ecosystem of care that supports the provider-patient relationship and promotes a humanistic form of healthcare. This is in stark contrast to what most patients and providers have to endure – which is an underlying technologic platform and system of care that makes it difficult for providers to really listen to and understand their patients, and makes it very difficult for patients and their families to navigate healthcare within the larger context of their daily lives. The majority of the interview was conducted with Dr. Weiner and Dr. Schwartz, who literally wrote the book on ‘Contextualizing Care’. We were also fortunate to have Dr. Spiro (Chief Medical Officer) as well as Yoni Shtein (co-founder and CEO) on the line to provide some brilliant commentary in what was one of the most engaging and awe-inspiring conversations I’ve had on this podcast. Dr. Weiner is co-founder of the Institute for Practice and Provider Performance Improvement. Dr. Weiner is a professor of medicine, pediatrics and medical education at the University of Illinois at Chicago, and deputy director of the research Center of Innovation for Complex Chronic Health Care at the Veterans Health Administration. He graduated from the Geisel School of Medicine at Dartmouth, completed his residency in Internal Medicine at the University of Chicago and is a former Robert Wood Johnson Foundation Generalist Physician Faculty Scholar. Dr. Schwartz is also a co-founder of the Institute for Practice and Provider Performance Improvement. He is the Michael Reese endowed professor of medical education, and research professor of pediatrics at the University of Illinois at Chicago. Dr. Schwartz received his PhD in cognitive psychology and Masters in business at the University of California, Berkeley. He is currently enrolled in the JD program at the University of Illinois at Chicago School of Law. Dr. Alan Schwartz & Dr. Saul Weiner co-authored the book on contextualized care – Listening for What Matters: Avoiding Contextual Errors in Health Care. In this interview, we’ll hear: What contextualizing care actually means – from the physician and medical researcher who have been studying this topic for over 20 years, and who have taught it to thousands of doctors and healthcare teams. How critically important contextualizing care is in delivering optimal healthcare outcomes, and how frequently it is ignored in clinical practice. The difference between empathetic care and contextualized care. Contextualized care is not the same thing as good bedside manner! The twelve domains of contextualizing care that Dr. Weiner and Dr. Schwartz have discerned from intensely & rigorously studying over 5000 patient-provider encounters. Which one of the twelve barrier domains these experts emphasized as being grossly missed in healthcare delivery. What I love about the Laguna Health story is that these visionary leaders are operationalizing and technologizing – automating – a humanistic form of healthcare delivery that is almost the inverse of mainstream healthcare. They are literally contextualizing care for each and every patient and their families by embedding it in the process and embedding it in the tech platforms. Most providers would agree that the current legacy electronic health records as well as workflows make it more difficult to understand the context of patients’ lives and its impacts on healthcare. What Laguna is building is quite the opposite – creating a tech platform and a system of care that literally has personalized care built into it, at every step of the way – from assisting the provider team

Friends, Our topic today is nothing less than a new standard of care for a vulnerable segment of the population that has been subjected to highly fragmented, uncoordinated and grossly inadequate medical care. For those of us who have experience with older parents as well as for physicians and other providers of care – you understand how challenging, frustrating and heartbreaking this situation can be. Dr. Michael Le, and his colleagues at Landmark Health and Optum’s Home & Community division, have spent decades developing and deploying a remarkably humanistic alternative approach to care for this vulnerable population. He outlines for us a comprehensive, concierge-like, premier home-based care ecosystem for frail seniors and those with complex chronic conditions. Dr. Michael Le is the Chief Medical Officer of Optum Home & Community, as well as the Co-founder & Chief Medical Officer of Landmark Health. He has spent the majority of his career serving high-acuity, frail patients through the development and implementation of innovative care models. Prior to Landmark, Dr. Le served as the Chief Medical Officer of Fidelis SeniorCare, a Medicare Advantage Special Needs Plan. Before that, he was the Senior Medical Officer at CareMore, a Medicare Advantage plan where he ran high-risk clinical programs. Prior to CareMore, Dr. Le was a Regional Lead Hospitalist at HealthCare Partners, a risk-bearing medical group, where he was the physician lead for the company’s high-risk Ambulatory Case Management program. Dr. Le received his MD at UCLA and completed his residency in internal medicine at Cedars-Sinai. In this interview, we’ll hear: The profound problem and tremendous gap in the American healthcare delivery system that Landmark is solving. The various types of home-based care that Landmark offers to frail elderly individuals and seniors with complex chronic conditions. The remarkable outcomes that Landmark has achieved for patients, providers and payers. Where Landmark is going next and some insights into Optum’s Home & Community division. There are some many wonderful aspects to the healthcare approach Dr. Le and his colleagues have created at Landmark Health and are now incorporating as part of Optum’s Home & Community division. The core team is a pod composed of a physician, a NP or PA, a nurse care manager, and a health ambassador/health coach. Surrounding this core team is another team of a pharmacist, a psychiatrist and a social worker. And even beyond that, there is another team of specialists in urgent and emergent care that can be deployed for more complex testing and procedures in the home. It’s nothing less than an entire ecosystem of high quality, comprehensive clinical care that can be delivered in patients’ home – 24/7! Another key differentiator of this new standard of care is that it’s equally focused on the social and behavioral aspects of medical care. In fact, Michael shares with us that over 50% of the calls they receive from patients and family members have to do with psychosocial factors, the social determinants of health and palliative care needs. What I found remarkable is that Landmark trains every one of its providers and team members in a specially designed program around how to discuss and deliver excellent Palliative Care. It’s clear from listening to Michael that they not only talk the talk around Palliative Care and outstandingly respectful and dignified end of life care – they walk the walk. It’s heartwarming to hear how intentionally caring Landmark is in this domain. The proof, of course, is in the pudding and Landmark’s outcomes are remarkable. A 20 plus percentage reduction in hospital admissions; a 20 – 30% improvement in the Medical Loss Ratio; a 43% reduction in emergent dialysis starts. The statistic or outcome that really gripped me was the 26% reduction in mortality. This is astounding – and it really speaks to the holistic care that the Landmark team provides, and their approach to dealing with the real barriers to care in real time. When you listen to Dr. Michael Le speak, you hear a physician who grew up watching his father practice medicine in a small town, carrying a black bag and doing home visits. Michael and his Landmark colleagues have brought the best of the past into the present, and propelled that care into the future with a high tech, high touch holistic approach to care that delivers hospital and ED quality care in the comfort, convenience and safety of the patients home. This type of care would be welcome by all of us, but it’s especially needed and appreciated by those elder patients who are suffering with complex and chronic conditions – issues such as dementia, frailty, and end stage chronic diseases. Landmark Health was acquired by Optum Health and Dr. Le could have easily retired. But instead he has joined Optum Home & Community and launched a whole new chapter in his career and a whole new chapte