Creating a New Healthcare

Friends, Our topic today is an overview of some of the most serious and consequential challenges facing our healthcare system and our public health, as shared with us by one of the most erudite, accomplished and ethically driven leaders of our era, Dr. Don Berwick. As always, our focus will not be on what’s wrong with American healthcare, but rather on solutions – on what is actually being done to reframe and recreate healthcare. We’ll also get a preview into some of Don’s recent thoughts and a recommendation that he is planning to publish. Donald M. Berwick, MD, MPP, FRCP is President Emeritus and Senior Fellow at the Institute for Healthcare Improvement (IHI), an organization that he co-founded and led as President and CEO for 18 years. An elected member of the Institute of Medicine (IOM), Dr. Berwick served two terms on the IOM’s governing Council, and was a member of the IOM’s Global Health Board. He also served on President Clinton’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry. Dr. Berwick contributed greatly to the landmark 2001 IOM report – Crossing the Quality Chasm; as well as the landmark, To Err is Human report. Dr. Berwick served as vice chair of the U.S. Preventive Services Task Force and chair of the National Advisory Council of the Agency for Healthcare Research and Quality. In July, 2010, President Obama appointed Dr. Berwick to the position of Administrator of the Centers for Medicare and Medicaid Services (CMS), which he held until December 2011. A pediatrician by background, Dr. Berwick has served as Clinical Professor of Pediatrics and Health Care Policy at the Harvard Medical School, Professor of Health Policy and Management at the Harvard School of Public Health, and as a member of the staffs of Boston’s Children’s Hospital Medical Center, Massachusetts General Hospital, and the Brigham and Women’s Hospital. He has co-authored over 160 scientific articles & six books. In 2005, Dr. Berwick was appointed “Honorary Knight Commander of the British Empire” by Queen Elizabeth II, the highest honor awarded by the UK to non-British citizens, in recognition of his work with the British National Health Service. In this interview, we’ll hear: The core issue that Dr. Berwick believes is corrupting American healthcare – imminently threatening public health, public trust in healthcare and the Medicare Trust Fund. A brief on some of the critical threats to public & global health, such as global warming and worsening health disparities. The global and governmental agencies, and governments that are solving issues such as early childhood development and elder care. A recommendation for an interdependent “all government” approach at the Federal level, as well a specific action plan for healthcare system leaders. One of the most revealing exposes on the Medicare Advantage payment model. The fundamental ethical perspective Dr. Berwick holds is that healthcare should be considered a human right and a public good – not an industry controlled and driven by private sector profit. Another fundamental belief is that healthcare should be patient-centered – that all decisions and actions should be in the best interest of the patient and their family, as understood and articulated from their perspective. Another point that Don Berwick elaborates on is that public health, our health, is greatly impacted by broader socio-political and ecological issues. Issues such as climate change, racism, early childhood development, voter rights, and the marginalization of vulnerable segments of the population. In order to tackle these issues, he advocates for an integrated, multi-sector, all of government approach. And while Dr. Berwick opens up this interview with the statement that he’s deeply concerned about the future of healthcare in America, he does not dwell on the problem. Instead, he shares the abundance of potential as well as concrete solutions and efforts that are already in place. In this interview, and throughout his career, Don exhibits the attributes of a master community organizer – moving swiftly from problem to solution to action. Over the last few years, in his published articles and public talks, Dr. Berwick has begun to lay bare some of the ethical and moral hazards within our healthcare system; and to call for the specific, critical actions that must be taken to address them. He writes, speaks and acts with intellectual integrity, originality and rigor; with a powerful sense of collaborative, empathic leadership; and with a practical down-to-earth sensibility – no ego, no ulterior motive and no self-serving agenda. Dr. Berwick has become the truth-bearer of American healthcare as well as, perhaps, its ethical lightning rod. He has transcended to a meta-position of value-based leadership that I can not adequately label or describe. As with all transcendent leaders, it’s a bit unsettling but also compel

Friends, The topic today is one that is near and dear to my heart, and what I spend a fair share of my time working on. We’ll be focusing on the challenges that seniors face in navigating our complex healthcare system. This is a critically relevant issue for all of us in healthcare – now and for the next few decades. The population of Americans over the age of 65 is growing at a much faster rate than the general population. By 2034, there will be more Americans over 65 than under 18 years old. It’s a segment of the population that carries a tremendous amount of chronic disease and is in need of medical attention across the entire continuum of care – from preventive primary care, to specialty care, to surgeries and hospital care, and onto long-term care and more intensive palliative care. Over 75% of seniors have 2 or more chronic diseases, and over 50% have 3 or more chronic diseases. The annual medical expenditures of seniors has surpassed $750B and is expected to double by 2030. Layered on top of this is the epidemic of social isolation & loneliness that seniors experience, and the marked issue of health disparities. In this interview we’re going to hear what our guest, Alex Harb, has discovered about the challenges that seniors face in navigating the healthcare system, and what he has created to address and mitigate those challenges. Alex was born in São Paulo, Brazil and raised in Santa Cruz, Bolivia before immigrating at the age of 9 with his mother. He received degrees in Biochemistry and Economics from the University of Texas at Austin and pursued post-baccalaureate training in software development from UT-Austin; followed by a Digital Health Biodesign Fellowship at Texas Medical Center’s (TMC) Innovation Institute. During his tenure at TMC, he observed, first-hand, some of the challenges that seniors encounter in their healthcare journey. It was from this experience that he launched Lena Health, whose mission is to simplify and improve the patient experience and outcomes for seniors, utilizing a tech-enabled, concierge-like, personal health assistant solution for navigating their health needs. In this interview, we’ll hear: How and why Alex pivoted Lena Health’s focus from social isolation to healthcare navigation. Some really interesting and important understandings Alex and his team have gleaned about what seniors actually need in regard to their healthcare journey, and the communication channels they prefer. The very consumer-oriented, effective and efficient approach that Alex has taken in organizing this concierge-like healthcare navigator solution. The outstanding value-based outcomes Lena Health has produced to date in terms of reducing ED visits, hospitalizations and readmissions, as well as off-loading nearly 20% of nurse navigator time. How Lena Health achieves a Net Promoter Score of 94 and a monthly usage of nearly 90% A dominant theme has been emerging as we continue to explore the home-based healthcare journey. I would characterize the theme in four ways. First, it’s a profoundly consumer-oriented approach. Second, it’s a profoundly contextual approach – actually exploring & uncovering the context of the individual & their family’s health journey – not an industry-centric health journey. Third, it’s an approach that could be labeled ‘whole person’ or ‘whole health’ – pulling in the entire context of a patient’s life as part of the healthcare experience and intervention. Fourth, it builds the technology around the consumers’ needs rather than forcing the consumer (both patient and provider) to bend themselves around onerous technology. In this interview, we’ve discovered another visionary healthcare entrepreneur – Alex Harb – who is reframing and recreating healthcare from this contextual, whole-person perspective. And, as in every interview, Alex Harb shares with us a few really key learnings that he’s gleaned. Over 90% of the requests made by seniors were not clinical and not related to social isolation; but instead were logistical, task-oriented needs around navigating the healthcare system. These care tasks included: (1) care coordination – such as scheduling appointments, referrals, medication prescriptions & refills, insurance & payment issues, and (2) social navigation – such as housing, food insecurity, transportation, access to medical equipment… 80 – 90% of these logistical task-oriented needs could be conducted either through an automated chatbot or through SMS texting with the majority being readily addressed via an AI-enabled automated chatbot channel. Seniors were incredibly comfortable with the ease and convenience of SMS texting. (As a related aside, Alex shared a stat with me – over 80% of seniors do not log onto electronic medical record websites.) When I did some back of the napkin calculations, it appeared that 60 – 70% of the Lena Health interactions are occurring via c

Friends, The focus of this interview is on recognizing and addressing one of the most ubiquitous barriers to healthcare. I’ve heard it labeled as “the last mile of care”. What we’re talking about is where the rubber really meets the road in delivering on the triple aim of healthcare outcomes, costs & experience. Medical encounters, diagnoses, referrals, clinical interventions, care plans and prescriptions – this is where they all make a difference, or not. If you’re wondering where that is or how that happens, then listen to this interview. Our guests today, Dr. Renee Dua & Nick Desai, are serial entrepreneurs and co-founders of two game-changing companies, Heal, and more recently, Hey Renee. They have focused their efforts on seniors, those with complex chronic conditions and the under-served, providing convenient & accessible care in the home and leveraging digital technology to customize and humanize healthcare. And, of note, they are married and have three adorable children. Dr. Renee Dua is a nephrologist who created & co-founded HeyRenee in June 2021. Prior to HeyRenee, she co-founded Heal, where she served as Chief Medical Officer for 7 years – leading the successful delivery of over 300,000 doctor house calls, driving clinical strategy & product development. Nick Desai is the co-Founder and CEO of HeyRenee. He’s an electrical & computer engineer, and a highly accomplished entrepreneur who has created and led four successful start-ups over the past 2 decades. Prior to co-founding HeyRenee, Nick was CEO and co-founder of Heal. In this interview, we’ll hear: Why Dr. Renee Dua & Nick Desai believe that care based in the home is superior to facility-based healthcare delivery. The very personal healthcare-related stories that led this couple to co-found both Heal & HeyRenee The four levels of “knowing” a person that Nick outlines as their Whole Person approach. Why Nick believes that the numerous point digital solutions are leading to further fragmentation of care and how the HeyRenee platform is being designed to coordinate and integrate care across the continuum of care. I have to admit that it took me a couple of listens to this interview before I began to really appreciate the reframed principles and point-of-view that Renee & Nick were sharing. I’ll try to distill them down into a few bullet points and a couple of key quotes that stood out for me. The role of the family and caregiver is critical, and needs to be supported.  Healthcare delivered in the home is far more convenient, safer, more inclusive and engaging of family and caregivers, and more personalized.  Understanding the ‘patient’ as a whole person is central to developing a customized care plan that actually works.  Providers take a radical leap of faith each time they prescribe a medication or dictate a care plan. Patients and their caregivers need more customized care, personalized direction and contextual support in overcoming the barriers to deploying and executing on care plans.   We need to redefine value-based care in terms of improved care & outcomes leading to lower costs, rather than the current approach which is largely about checking boxes and raising risk scores.  Patients need to be enabled, caregivers need to be empowered, and we need to do this without placing extra burdens on physicians and other providers of care.   The family is the basic unit of care; helping families navigate and coordinate care is a fundamental barrier to health that healthcare leaders have not adequately understood or addressed. Renee & Nick do not pull their punches. They believe the current healthcare system is deeply misguided – placing undue stress and burden on providers – and providing sub-optimal, depersonalized care to patients and their caregivers. One stat Nick cites to support this statement is that nearly 75% of seniors lack a coordinated care plan. Their goal, as Renee puts it, is to create a “personalized care concierge platform that delivers whole person care.” She goes on to say, “a platform that supports and enables all of the caretaker functions… is the most critical thing missing in healthcare. The facts substantiate her statement and support her goal. Over 50 million Americans struggle to care for older loved ones in the face of a predicted shortage of 1.2 million home health aides in the next decade. Renee – who has over 15 years of experience as a practicing nephrologist – believes that “there is a disconnect between those in charge and those who are sick”. When I asked what one message she would deliver to healthcare leaders, her recommendation was that healthcare administrators and executives should spend time in a doctor’s exam room, and observe the real-life challenges and barriers imposed upon providers and patients. I’ll leave you with one final quote by Dr. Renee Dua, which I have heard echoed by other visio

Friends, We open up this podcast talking about a yearning on the part of people for a different type of dialogue, interaction & relationship in the delivery of healthcare. In all of the interviews I’ve conducted over the past 5 years – underneath all of the discussions about value-based payment, reframed clinical and business models, advanced analytics and digital enablement, patient/customer experience, health equity and social determinants of health – underneath all of it is a deep yearning to be understood as a whole person. To have our healthcare be guided by the meaning and context of our lives. To be respected, enabled and empowered as autonomous beings. To be healthy – physically, emotionally and relationally – so we can live our best life. Our guest in this podcast dialogue, Dr. Ben Kligler, provides a framing of the fundamental problem that is preventing providers from delivering this type of healthcare, and a reframe that will enable us to experience a more humanistic approach to healthcare delivery. What you’re going to hear in this interview may be the most significant humanistic shift occurring in the American healthcare system. 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 Whole Health System that the Veteran Health Affairs is in the midst of deploying on a national scale. The 1 fundamental reframe and the 2 key questions that are at the core of how the Whole Health movement is changing the conversation in healthcare delivery. How this approach is being digitized and integrated into the electronic medical record. How the Whole Health System is not only improving the health and well-being of patients, but is also creating a ‘best place to work’ for providers and staff in the Veterans Health Affairs (VHA). In this interview with Dr. Ben Kligler, we are witnessing a profound inflection point. Whole person and whole health care has shifted from being a theme or movement to an actual system of care that is being heavily resourced, organized, deployed and integrated into one of the largest healthcare systems in the country: the national Veterans Health Affairs (VHA). For those who are not familiar, the ~350,000 VHA employees provide care to over 6 million actively engaged veterans, across ~140 large medical centers, and over a thousand outpatient clinics. Far from being a strategy in name only, Dr. Kligler and his colleagues have already trained 32,000 people in the Whole Health System and have touched nearly 8% of all Veterans in the country. That’s over half a million Veterans who have experienced the Whole Health System during their care journey. I am impressed not only with the progress being made, but also with the flexible approach that the VHA has taken in deploying and scaling this new approach. For example, they’re not just training providers and staff, they’re having them participate through a portion of the program itself. When I asked Dr. Kligler, if providers and staff might feel like this is just another item on their ‘to-do’ list or another box to check, he shared that the goal is not to add more to the clinical workload, but instead to change the orientation to clinical encounters. He also shared that it was the entire care team being trained to deliver this, not just the primary provider. The whole person/whole health approach reminds us that human beings thrive when they have meaning and purpose in their lives. It reminds us that if we don’t reframe healthcare within the context of what enables people to thrive, we will be treating the superficial symptom rather than the disease itself. There has been a lot of verbiage over the past two or three years around the notion of ‘connected care’. This generally refers to 24/7 omni-channel access to care. The whole health/whole person approach reminds us that truly meaningful access to care will require not only a digitally-enabled, omni-channel platform; but also an intentional, systematic, resourced and integrated platform for relational connectivity. The VHA is on an accelerated path to deploying the Whole Health Sy

Friends, Our guest today, Dr. Roy Schoenberg, is one of the most significant contributors and accomplished entrepreneurs in the domain of telehealth & virtual healthcare. In this episode, he’ll share some unique perspectives he’s gleaned from over 25 years as a trailblazer in telehealth. He’ll also discuss a transformational initiative that he and his colleagues at Amwell are introducing, as well as what he considers to be the next revolution in healthcare delivery. 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 ecosystems in the world. Among numerous accomplishments and recognitions, Roy was appointed in 2013 to the Federation of State Medical Boards Taskforce that issued the landmark guidelines for the “Appropriate Use of Telemedicine in the Practice of Medicine.” He is the 2014 recipient of the American Telemedicine Association Industry Award for leadership in the field, and in 2020 he was named one of Modern Healthcare’s 100 Most Influential People in Healthcare. Roy holds over 50 issued U.S. Patents in the area of healthcare technology. He speaks frequently in industry and policy forums, and serves on the healthcare advisory board of MIT 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 interview Roy shares a number of critically important inflections that reframe our understanding of the virtual and telehealth era. I’ll list the five most significant ones that I gleaned from our dialogue. First – contrary to what most people believe, telehealth encompasses much more than video visits. It is fundamentally a new and emerging multi-channel ecosystem for the distribution of healthcare that engages a broad spectrum of telecom, digital & data analytic capabilities. Second – we are just at the dawn of the telehealth era and its major transformational impact has yet to occur. Listening to Roy, it’s clear that there is no turning back, and we’re not going to return to some pre-pandemic ‘normal’ when it comes to virtual & digital health. Third – telehealth and the digital health movement will transform the way healthcare engages with its consumers. It will shift the provider/patient relationship from being reactive and episodic to being proactive, continuous, contextual and longitudinal. In Roy’s own words, “We are interacting in healthcare within the construct of the ‘visit’ – which is short, hard to get and expensive. That whole notion is going to be thrown out the window because there are so many other ways for us to interact with patients, inside their reality. It will not only change the experience and expectations of consumers, but will also dramatically move the needle on costs because we can much more appropriately use healthcare resources where they’re needed.” Roy goes on to remind us that most of healthcare actually occurs outside of ‘visits’, in what has been referred to as the ‘between-visit’ space. Yet, we have little access to understanding patients in that space, or intervening effectively and efficiently. The emerging telehealth technology will enable us to cost-effectively connect with our patients in this continuous and longitudinal fashion. It is probable that the ‘between-visit’ space can and will become the dominant place of healthcare delivery. As I reflect on our dialogue, it seems to me that we are applying a 20th century mindset to 21st century technology. Fourth – Roy outlines three domains of care delivery in the future. 1) The physical care cluster of services – in hospitals, operating rooms, clinics…. 2) The digital care cluster of services – telehealth, asynchronous communication, messaging, assessments…. 3) A whole new generation of automated interactions – literally a vigilant presence next to the patient – tracking and following patients during the course of their healthcare journeys and lives. As Roy puts it, once we get into the continuous and longitudinal space and apply automated care, there will be so many more dimensions of patients’ lives that we can begin to understand and respond to, offering much more proactive, personalized and contextual care. Fifth – Perhaps the most transformative impact of telehealth and digital health will not be as a communication channel, but instead as a supply-demand management system. As Roy states, “The part that has changed is that we are beginning to look at telehealth and related technologies as more of a logistical infrastructure rather than just as a video conferencing capability.” Similar to the ways that Amazon transformed the retail industry, the platforms being created now, including the Amwell Converge platform, will create an unprecedented ability to connect providers and care to patients and consumers – literally revolutionizing how healthcare is dist

Friends, Just about every major industry, with the exception of healthcare, has moved into the digital era. This is not my opinion alone. It is the collective perspective of the numerous guests that I’ve had on this podcast. And far from being a nice-to-have, these experts argue that in order for us to achieve the quality, cost effectiveness and experience that consumers expect, healthcare systems & providers will need to shift from being so-called digital laggards to being firmly engaged in the digital era of healthcare delivery. What is at stake, they argue, is nothing less than relevance in the market. In this episode, we have the privilege of hearing from Ries Robinson, a physician healthcare executive and serial entrepreneur who, along with his colleagues & partners at Graphite Health, is tackling the significant roadblocks in the digital transformation of healthcare, and doing it in a uniquely collaborative way. Ries Robinson MD, is the CEO at Graphite Health. He is also the Chief Innovation Advisor at Presbyterian Healthcare Services, the largest integrated healthcare delivery system in New Mexico. Prior to joining Presbyterian, Ries founded a number of companies, including: Rodin Scientific LLC, dedicated to creating a heart failure management solution; InLight Solutions Inc. focused on creating non-invasive glucose measurement techniques; VeraLight, which established a non-invasive screening test for type II diabetes; Luminous Medical, an ICU-based continuous glucose monitor; and TruTouch Technologies, which developed a noninvasive alcohol monitor. Ries serves on the American Hospital Association ‘Center for Health Innovation Leadership’ Council. Previously, he served on Presbyterian Healthcare Services’ Board of Directors. Ries graduated from Stanford University, where he received a bachelors and masters degree in mechanical engineering, and he also graduated from the University of New Mexico School of Medicine. In this episode, we’ll discover: The challenges that even large healthcare systems face as they attempt to evaluate and deploy digital solutions. The reasons that becoming digitally-enabled is critical for providers and healthcare systems. The advantages & benefits Graphite Health is bringing to healthcare systems through the creation of a “democratized public utility infrastructure” and “digital health marketplace”. Some of the challenges that Graphite Health will need to overcome in order to achieve its mission. The names of a few of the healthcare systems that have already signed on to be part of the Graphite Health consortium. Many other experts and entrepreneurs have recognized the importance of the digital revolution in healthcare and the transformative transition we are about to make into the digital era. But, there are a number of unique reframes that differentiate the approach Ries and his colleagues are taking. First is the fundamental thesis that the challenge of digital transformation is not one that healthcare systems can solve individually. As he states, “We believe that the challenge of digitally transforming our industry is bigger than any single system can solve alone.” Ries not only states his thesis, but he takes us through the painful journey and the significant challenges that individual provider groups and healthcare systems face in attempting to work with vendors and suppliers in adopting digital solutions. Second, Graphite Health is adopting a “public utilities infrastructure” approach. They are convening and coordinating a healthcare system-led collaborative that will create tremendous economies of scale and achieve efficiencies through standardization and aggregating the tremendous costs of digital transformation across multiple organizations. This consortium will perform numerous tasks such as vetting digital health solutions, contracting, assuring HIPAA standards, creating standards for interoperability and consumer use, and more. When I asked Ries how he would construct an ROI or value proposition argument for healthcare CFO’s, he mentioned lowered costs, fewer resources and people, and accelerated speed to market in digitally-enabled care. He also added “market relevance”, citing the demise of Sears Roebuck as a classic case study of a large, hugely successful company that could not cross-over into the digital era. The third differentiating feature of Graphite Health is its non-stock, non-profit status and approach. Graphite is not venture capital or private equity backed. It is not attempting to enhance its market valuation with a plan to exit in five to seven years. It is member-driven and uniquely mission driven in this respect. Along these lines, Ries is very keen to point out that Graphite Health will not use its patients as products. What he means by this is that Graphite Health – unlike many digital companies – will not sell its customers data, nor will it profit in other ways from its primary customers. Taking a lesson from Civi

Friends, I’ve heard back from a few of you recently about some of the episodes we’ve had around employer health insurance & benefits. In fact, I was just speaking this past week with a physician colleague who listened to episode #125 with David Contorno, and he literally said that it blew his mind. Well, I think you’ll find this episode illuminating and mind-blowing. The system of employee health benefits is one of the most opaque and confusing legacy constructs we have in healthcare. Payment, financial incentives and business models are not aligned with the best interests of healthcare consumers. This is an incredibly timely and relevant topic. In fact, I just read a piece on ACO’s in Health Affairs (Jan 24, 2022) by Michael Chernew discussing ‘why payment reform remains necessary’. We’ve had numerous expert guests who have commented on the problem in employee-based healthcare and the need for major reform, including episode #121 with Glen Tullman, CEO of Transcarent; episode #119 with Steven Nelson, CEO of Contigo; episode #114 with Zack Cooper, a Yale economist; episode #113 with Harris Rosen, CEO of RosenCare; and episode #111 with Dave Chase, just to name a few. In this episode, we have the privilege of hearing from Francois de Brantes. Francois has spent two decades working to transform the U.S. healthcare system by improving incentives for providers and consumers, in order to encourage value-based decisions. He brings the perspective of an economist, but also has hands-on experience deploying numerous real-life programs. François de Brantes serves as Senior Vice President of ‘Episodes of Care’ at Signify Health. He leads customer development of the Medicare Advantage, Self-Insured Employer, and Commercial Payer markets. From 2006 to 2016, he was Executive Director of the Health Care Incentives Improvement Institute (HCI3), a not-for-profit company that designed programs to motivate physicians and hospitals to improve the quality and affordability of healthcare delivery. This organization was responsible for the Bridges to Excellence® (BTE) and PROMETHEUS Payment® programs, which compensate and reward clinicians that focus on ‘episodes of care’ and ‘performance measures’. François holds a master’s degree in Economics & Finance from the University of Paris IX-Dauphine and a MBA from the Tuck School of Business Administration at Dartmouth College. In this episode, we’ll discover: The amazing journey that Francois has been on for the past couple of decades, starting with his being in corporate benefits at GE. The perverse financial incentives and disincentives built into the fee-for-service, employee health benefits contracts that drive payers, providers and patients away from healthful decisions & behaviors. The principles and tactics required for a shift to value-based employee health benefits. Specific examples of programs demonstrating the benefits of shifting to business and clinical models that focus on profits generated through value rather than volume. How ‘episodes of care’ and ‘bundled payments’ make sense from an individual consumer perspective as well as from a clinical and risk perspective. Every once in a while, a leader comes along stating the piercing truths that capture the core challenges of an era. Francois de Brantes makes such a statement, “There is no real competition for value [in the American healthcare system]. There’s competition for revenue, competition for market share, and competition for billboards, but not for value.” He further distills the fatal flaw in our healthcare system, “Fundamentally fee-for-service does not distinguish between high value care, low value care, or even harmful care for that matter”. Pushing the point even more, he shares that physicians and provider groups, for years, have shared with him the appalling reality that they are not paid to improve or optimize chronic conditions, better manage patient care, or reduce harm. In fee-for-service, providers are simply paid for each incremental service offered, regardless of its intrinsic value to patients. Just pause for a moment and let all that sink in. Payment in American healthcare does not incent providers to do the right thing on behalf of patient care, and in many ways, disincents them. And far from blaming clinicians, Francois understands the challenges and hurdles from an economic perspective, “Clinicians are really hit with an onslaught of incentives [throughout their daily practice]… that drives them away from their professional mission…” Given that reality, Francois shares, “…the ingredients for creating competition for value are known, tested and validated: (1) transparent information on price and quality; (2) risk contracts to reduce volume incentives; and (3) benefits design that encourages steerage to value providers and reduces demand for low-value care.” Francois and his colleagues have manifested these three principles, combining them with alternative value-based pay

Friends, The focus of this interview is an approach to primary care that is divergent from the mainstream approach. It’s different in a number of ways and it’s creating outstanding outcomes for patients, payers, and providers. Our guest today, Dr. Chris Crow, has a compelling story to tell. He is an inspiring leader and a bold reframer of healthcare. I’ve had the privilege of speaking with him a number of times, and am impressed by his personal story, as well as what he and his colleagues have accomplished. Christopher Crow M.D. is the CEO and Founder of the Catalyst Health Network. He is a nationally recognized healthcare innovator with numerous recognitions & awards; but more importantly he has spent the past 20 plus years focused on helping communities thrive through improving the delivery of healthcare. In this episode, we’ll discover: Some of the underlying problems that greatly sub-optimize the performance of our healthcare system. The three major stakeholders in healthcare, which Chris and his colleagues have built their approach around. The “extended care team” approach that Chris and his colleagues have taken to create an ‘Advanced Primary Care’. The critical distinction between ‘Direct Primary Care’ and ‘Advanced Primary Care’. How Chris is organizing a sustainable financial model that can support this enhanced model of primary care. Early on in our discussion Chris points out that although American consumers demand outstanding customer service, convenience and quality in every other facet of their lives; when it comes to healthcare they have been gripped by what he terms “the tyranny of low expectations”. He goes on to state that the underlying problem is the status quo and inertia of legacy stakeholders, whom he describes as having turned the American health system into a ‘wealth system’ – that is, a system that creates wealth for the few at the expense of the majority of Americans who can not easily access or afford healthcare. One of the major root cause problems is the strong pull to maintain Fee-For-Service payment, which incentivizes volume (visits, procedures, tests, imaging & hospitalizations) over preventive care. Another is the preferential payment afforded to subspecialty and acute-based care over primary care. Chris has been, admittedly, frustrated with the American healthcare system because, as he bluntly states, we know the solution. The “prescription for America” as Chris puts it, is “advanced primary care” – primary care that is accessible, affordable, effective, equitable, and sustainable for both patients and providers. The mechanism behind advanced primary care is through a tech-enabled, virtual, “extended care team” of pharmacists, care managers, social workers and care coordinators. This extended care team is particularly focused on more complex conditions and situations. Some of the services they offer include: (1) medication management and adherence programs; (2) managing formulary-specific medication changes; (3) a referral management and tracking system that maintains network integrity and helps patients and providers navigate to higher value specialists and surgeons; and (4) addressing social determinants of health. In this advanced primary care model, patients derive tremendous benefit in terms of greater connectivity and continuity of care, as well as more preventive care and improved outcomes. Providers derive benefit through the additional support and the reduced administrative burden, as well as the support they receive in improving clinical quality. Payers derive benefit through more cost effective care and the reduction in total costs of care. There are numerous metrics and stats that demonstrate the outcomes Chris and his colleagues have achieved. One example that Chris shared is around access. The Healthcare Catalyst Network has reduced average waiting times to see a specialist from approximately 28 days down to 4 days. Chris also shares some of the massive cost reductions his network has achieved. The approach that Chris and his colleagues are taking is incredibly mission driven. They consider healthcare to be critical for communities to thrive; and they believe that a value-based, prospective-payment model of primary care is critical in delivering the health outcomes that patients, providers and payers all want. As Chris states, “We’re trying to leave the world a better place and we believe that ‘advanced primary care for all’ in America is the prescription.” Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, Our topic this week is employer-based healthcare, which accounts for nearly 50% of all the healthcare spend in the US. We’ll kick off the episode dispelling some surprising misconceptions about how healthcare insurance actually works; which explains, in large part, how the costs of care continue to rise way beyond other costs of living. Our guest today, David Contorno is a nationally recognized expert in employee benefits. After nearly 20 years consulting to large national employers, David created E Powered Benefits: a benefits consulting firm whose mission is to deliver fully transparent, value-based benefit services. David has won numerous recognitions & awards, and has been a major contributor to the work and publications that Dave Chase has produced out of Health Rosetta, and the nationally recognized publications of Dr. Marty Makary. He mentors other benefits managers from across the country to transform their business models as well. In this episode, we’ll discover: Some surprising insights into how healthcare insurance companies, insurance brokers and benefits managers are incentivized and bonused – and the conflict-of-interest that is built into the system. The radically different and transparent approach David Contorno takes in creating healthcare benefits programs for employers and employees. How his business model has produced average one-year savings of over 50%, along with substantially reduced out-of-pocket costs for employees – all while improving quality and experience of care. The specific approaches and tactics that David uses, targeted to decrease unnecessary healthcare costs. A real-life example of how David and his colleagues have reduced the costs of a 500 person company by $35 million over the past 5 years. The complexity and lack of transparency in our employer-based healthcare payment and insurance system make it incredibly challenging to understand or do much about – even for the expert employer-based HR benefits managers, whose job is to manage the costs and quality of care for their employees. In an attempt to provide some clarity, I’ll summarize three significant take-home messages I gleaned during this interview: (I) the healthcare stakeholders that employers and employees rely on to manage quality & costs are not, for the most part, financially incentivized to lower costs, raise quality or improve outcomes of care. (II) The majority of healthcare insurance costs are actually medical costs; so the way to fix rising healthcare insurance costs is to address the detailed medical costs.. (III) The specific tactics that David focuses on include: (1) finding surgeons and surgical centers with higher quality outcomes and lower costs – centers that offer fixed-price bundled payments. (2) finding imaging centers that deliver state-of-the-art service at a fraction of the cost of high-priced centers. (3) purchasing medications outside of the traditional pharmacy benefits management (PBM) system – thus avoiding huge mark-ups. (4) providing value-based ‘direct primary care’ for chronic diseases and preventive services. These models allow a physician to spend more time with their patients rather than be driven by Fee-For-Service, RVU-based, high-volume care. (5) Employers passing the savings onto their employees rather than the more typical employer approach of pass-through cost-shifting. What I truly admire about David Contorno is that he’s adopted a radically different approach to the way that he and his company get paid. His compensation and bonus structure are based on lowering costs while assuring high quality care. And, his revenue is completely aligned with employers’ and employees’ best interests, not with those of corporate shareholders. Healthcare insurance and medical costs are a crippling problem for a significant and growing percentage of American employees and their families. The goal here is not to lay blame on legacy stakeholders in healthcare. Rather, it’s to lay out for all to see that the fundamental payment structure and incentives in the system are misaligned and grossly maladapted for the purported purpose of healthcare – that is, of keeping employees and their families healthy. David sums it up in this way, “Every entity that an employer trusts to manage healthcare costs benefits [financially] from healthcare costs going up.” And so, as many have stated, our healthcare system isn’t broken, it’s perfectly designed to deliver the results it delivers. Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, This episode is about a domain of healthcare delivery that will undergo a fundamental transformation over the next 3 – 5 years. It is the most precarious and fragmented stage of care – post-hospital discharge and post-acute care transitions. It is a side of healthcare that is ripe for disruption, with the potential to greatly reduce readmissions, reduce total costs of care, and dramatically reduce preventable pain and suffering for patients and their families. Our guest today, Yoni Shtein, is a serial entrepreneur who started his journey as a software engineer at Microsoft. Having completed his MBA at Harvard, Yoni joined RPX Corp as a founding member of the insurance business. After RPX went public, Yoni left to co-found and merge a tech fund into Fortress Investment Group, where he spent six years as an investor. Yoni then moved to Israel and launched Laguna Health, a ‘digital recovery assurance company’, with his longtime friend and colleague from Microsoft, Yael Peled Adam. They also have recently brought Dr. Alan Spiro on as their President and Chief Medical Officer. In this episode, we’ll discover: Why Yoni states that “recovery is everyone’s problem and no one’s job”, and how Laguna is making it their job! Why and how Laguna is focused on the behavioral and contextual aspects of care, even more than the clinical signs and symptoms. The three platforms that Laguna has created to engage patients and guide providers in optimizing transitions of care: their patient-facing app, the Harmony Case/Care Management Platform, and their Clinical Care Engine How Laguna is customizing care through a “choose your own adventure” approach. The tremendous outcomes Laguna is achieving in readmission reduction. During the interview Yoni states his fundamental thesis: “Laguna is reframing healthcare in changing the dialogue from readmissions and provider penalties to member ‘recovery journeys’ and payer cost drivers.” He points out that the most fundamental problem in transitions of care is the misalignment of incentives. Let’s unpack his statement. The reality is that healthcare systems and provider groups are not financially incentivized to optimize patients’ health after discharge. While there has been an increased focus over the past few years on reducing readmission rates (driven in large part by CMS readmission penalties); the fact is that hospitals’ financials are not aligned to post-hospital care. And, just to be clear, this is not to blame hospital systems. Instead, it’s a commentary on how care is paid for in our country. Given that reality, Yoni and his colleagues are targeting their efforts at entities whose business models are aligned with improving post-discharge care: (1) self-insured employers; (2) Medicare Advantage Health Plans; and (3) payers or healthcare systems that are taking financial risk for their populations’ total cost of care. A second reframe that Laguna is introducing is instead of focusing on a metric (i.e. 30-day readmission rate); they are focused on the patient’s “recovery journey”. They’re using decades of published research to identify “recovery barriers”, and are designing their products and services to mitigate and eliminate those barriers. A third reframe that Laguna has introduced is that they have designed their care model to address the behavioral and contextual aspects of care. They’re identifying and solving for the daily barriers that people face in engaging with healthcare and optimizing their health. According to Yoni, over 50% of all readmissions are preventable. That means that the American healthcare system is failing patients and their families one out of every two readmissions. It’s been said that our healthcare system is perfectly designed to deliver the results it delivers. But if we understand how wrong those results are, why aren’t we changing the system more intentionally and more immediately? Why aren’t more healthcare leaders not pushing to create a new healthcare? Far from being discouraged, these questions only strengthen my resolve to seek avenues to create a new and more humanistic healthcare system. And, it also strengthens my belief that we need more leaders like those in Laguna, who are reframing healthcare to be what patients, their families, as well as providers need it to be, and not what ‘the system’ dictates it be. Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, There are numerous critical healthcare reframes in this week’s episode. First, what Dr. Silverstein makes abundantly clear is that the senior leadership team at ChristianaCare is fully comitted to accelerating the shift to value based payment. Second, they are committed to greatly expanding the use of virtual care as a primary mode of care. Third, they are focused on health outcomes vs healthcare delivery. Underlying these three patient-centered goals is another profound reframe, the notion that in order to achieve the quadruple aim, provider organizations must form vertical integrations and create complementary collaborations with other types of stakeholders in healthcare – such as payers and retailers. Our guest today, Ken Silverstein, is the Chief Physician Executive at ChristianaCare. He previously served as chair of ChristianaCare’s Department of Anesthesiology, Medical Director of Perioperative Services and as Chief Medical Officer. He received his undergraduate degree from Brown University, his medical degree from New York University School of Medicine and his MBA from the University of Delaware. Dr. Silverstein was a resident and a fellow in anesthesiology at the Brigham and Women’s Hospital in Boston. He completed his clinical fellowship in anesthesiology at Harvard Medical School. In this episode, we’ll learn about: The 10 year value-based collaborative agreement that ChristianaCare and Highmark have launched together. The 5 major “vehicles” that ChristianaCare & Highmark are planning to deploy within their collaboration. The guiding “partnership principles” that are being used to create a relationship-centered approach to this synergistic collaboration. The fascinating independent spin-off virtual primary care practice that ChristianaCare is building out with Highmark, that greatly improves the efficiency and effectiveness of care. At the beginning of our conversation, Ken states, “we created a new company and the intent is to completely transform healthcare.” That bold remark speaks volumes about the visionary leadership at ChristianaCare. Another statement which gripped me was the fact that the ChristianaCare leadership team is discussing Clayton Christenen’s ‘dilemma zone’’, which the folks at ChristianaCare have relabelled as the “commitment zone”. The point of the concept is that in order to transition to a value paradigm and realize a long-term gain, leadership must accept a short-term loss. It’s amazing to see hospital leadership thinking and acting in this way. But even more amazing is the fact that their Chief Financial Officer was the one who introduced this concept to the leadership team. In our correspondence prior to the interview, Ken wrote that American healthcare is “facing an apocalyptic forecast…”. It’s a disconcerting pronouncement from a seasoned physician executive. But, what was concerning for me was that I had heard this very same comment from two other physician executives in the prior week. During our interview, I asked Ken what he meant by this statement. He went on to discuss issues such as the worsening unaffordability of healthcare, fragmentation of care, and inappropriate overutilization. He also passionately talked about the unacceptable inequities and disparities in healthcare, using Delaware as an example. In Wilmington, the difference in life expectancy – what Ken referred to as the “death gap” – between white communities and black communities only 2 miles apart is 16 years! He punctuated this statistic by asking how that is acceptable to anyone. The situation may seem dire but I have to say that I have never been more hopeful, more inspired and more encouraged about the future of healthcare than I am today. The reason stems from listening to leaders like those at ChristianaCare who are not just speaking the rhetoric of reframing, but are taking the very concrete steps necessary to create a new and better healthcare. They are making the painful trade-offs required, and are investing in a better future. They are, as Simon Sinek would put it, playing the generative “long game”. ChristianaCare is making a demonstrable commitment to creating a value-based future. They are aligning their resources with their rhetoric. They are doing this not because it’s easy or safe. They are doing it, as Ken states, “because it’s the right thing to do, period.” Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, With the onslaught of the Covid-19 pandemic, numerous hospital systems across the country rapidly adopted the hospital at home model in an effort to deal with overcapacity. Many systems are planning to continue this service – even after the pandemic. The reasoning is simple. It’s a much lower-cost alternative. It’s much more personal and customized care. It’s a lot more convenient and comfortable for patients and their families. And, it’s going to be a major clinical delivery approach in the future; a major source of revenue, as well as a source for patient growth and retention. Our guest today, Raphael Rakowski, is one of the most significant entrepreneurial leaders in this rapidly advancing and transformative trend in healthcare delivery. In 2010, years before most of us even heard of it, Raphael Rakowski led a team of engineers and clinicians in the creation of Clinically Home, the first commercially scalable model to enable safe hospitalization at home. In 2017, Raphael and his team created a next-gen version called Medically Home and joined forces with Atrius Health (a large multi-specialty medical group in eastern MA) to bring the program to market. In 2020, after his role as CEO & Founder, Raphael was named Executive Chairman of Medically Home Group, Inc. Medically Home operates in over 15 states at the time of this interview with a large number of strategic partners, and has most recently partnered with the Mayo Clinic & Kaiser Permanente. In this episode, we’ll learn about: Why – according to Raphael – the financial and business model for facility-based hospital care is misguided, misaligned and maladapted to the needs and safety of patients and their families. Why the shift to decentralized healthcare is necessary if we are to have a sustainable system, and how it’s consistent with the path that other industries, such as banking and retail have taken. The four operational pillars that allow Medically Home to deliver a much higher acuity level of care in the home than other ‘hospital at home’ models. The superior outcomes that Medically Home is achieving compared to traditional facility-based hospital care. How Medically Home is addressing some of the challenges in delivering high acuity care in the home setting. According to Raphael, the reason facility-based hospital care is suboptimal is that it has been fashioned like an industrial factory. He backs up his statements with powerful observations, compelling data and intelligent reasoning. For example – according to Raphael, 65% of hospital costs are due to the fixed costs of their bricks and mortar infrastructure. This overhead creates a “tax on care”, leaving only 35% for medical care. On the other hand, the cost savings Medically Home is achieving are about 25%. Patient satisfaction is at or above hospital levels. Mortality and morbidity reductions are 10%, and fall rates and infection rates are dramatically better than facility-based hospitals. Raphael also reframes our notion of acute care and post acute care. As he puts it, “The point of the Medically Home model is that you’re reliably integrating three things that should never have been siloed – acute care, post-acute care,and population health… There is no such thing as post-acute care. It was invented as an artifact of reimbursement. You should be cared for by the same care team until you’re not sick anymore. This is one of the reasons for the high readmission rates we see in hospitals across the country… We combine these together in a single episode called “stay with the patient until they’re well and you understand what it will take for them to stay well…” At the present moment, the home-based care market in the US is approximately $140B in revenue, and predicted to grow to over $200B within the next 4 to 5 years. One can view this rapidly emerging home-based care market as a threat to hospital systems – or, as an opportunity. For those hospital systems willing and capable enough to be early entrants – it is a huge opportunity to diversify their business models and revenue stream, and to de-risk the unprecedented market disruption that is almost certain to occur this decade. From a mission-based perspective, it is an opportunity for our healthcare systems to do what we need them to do: improve care and care outcomes, lower costs, and provide a more compassionate and convenient care experience. Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, This interview is about an organization that is creating a new healthcare category, and whose purpose is to solve the employer healthcare dilemma. But even more fundamental than that, they’re attempting to solve the core struggles that all healthcare consumers are facing. Glen Tullman is the Executive Chairman and Chief Executive Officer of Transcarent. Tullman is the former Executive Chairman, Chief Executive Officer, and Founder of Livongo Health He previously led two other public companies that changed the way health care is delivered – Allscripts and Enterprise Systems. Tullman 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’. 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 Chancellor to the International Board of the Juvenile Diabetes Research Foundation and as a Board Member and incoming Chairperson of the American Diabetes Association. In this episode, we’ll learn about: The lack of alignment between payers, PBM’s, healthcare systems and employers. As Glen points out, if employers spend more, payers, PBM’s and healthcare systems make more. How the plethora of digital healthcare companies and apps are contributing to further complexity in healthcare delivery. Why it makes sense for employers to get rid of copays for preventive care and chronic disease management costs. The three things that people want from healthcare and how Transcarent is delivering on those consumer needs. The 5 most common issues/questions that healthcare consumers call Transcarent about. One of the qualities I most admire about Glen is his blunt but eloquent truthfulness. As he puts it – “After 30 years of promises, we have a healthcare system today that is more confusing, more complex and more costly than it’s ever been”. Supporting this statement, he cites the stat that the average self-insured employer must hire 14 different companies to assist in providing healthcare to their employees. His solution to curtailing the complexity and confusion is to shift from fragmented point solutions to adopting the approach of other industries – which places the consumer in the driver’s seat, provide ease of use, 24/7 access and low cost. Transcarent isn’t just focused on building a ‘digital front door’ or ‘digital consumer experience’. It is a wholecloth transformation of the healthcare experience. It is a leader in a new category – part navigator, part health coach, part telehealth provider, part center-of-excellence referral source. Glen is so obsessed with providing a best-in-class consumer experience/journey that his brand promise is personalized, convenient, unbiased, virtual access to coaches, navigators, and doctors – within a few minutes, 24 hours a day, 7 days a week! What I respect most about Transcarent is not the technical wizardry or their impressive feat of creating a new market category. What I respect most is the unyielding primacy they place on the care of the consumer. For example – despite their ability to deploy chatbots, Glen insists that there be a live person on the other end of the line. He believes that people who seek healthcare want and deserve a live person speaking with them. Transcarent’s approach is “care over costs”, and while this may seem unsustainable, he points out that providing this type of care ends up greatly lowering the overall costs of care. The key to Transcarent’s approach is the alignment of payment with value based care. Unlike most other healthcare stakeholders, Transcarent does not make its money when healthcare costs and prices increase. Transcarent has completely attached its revenue and business model to cost savings. If your business model is to provide an outstanding consumer experience, deliver markedly improved health outcomes and lower overall total costs – then it makes sense to invest upfront in the way that Transcarent is doing. I truly wish more healthcare organizations would manifest the vision, integrity and courage to implement the business model that Transcarent has. It would save a lot of money for our country, corporate America, our states and towns, our families and our citizens. But even more importantly, it would save a lot of lives. Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, Welcome back to the first episode of the 2021 Fall season. We are embarking upon the 5th year of the ‘Creating a New Healthcare’ podcast – and we have an amazing line-up of courageous, bold, entrepreneurial individuals that we’ll be hearing from this season. In this episode, we have the privilege of speaking with Michellene Davis. The theme of this interview, which was recorded on Aug 4th 2021, is centered on eliminating the racial disparities & inequities in the healthcare profession, as well as addressing the gross disparities in healthcare delivery and outcomes in the US. Ms. Davis is the new President and Chief Executive Officer of National Medical Fellowships, Inc. Prior to her current role, Ms Davis served as the Executive Vice President & Chief Corporate Affairs Officer at RWJ Barnabas Health, the largest academic medical center system in New Jersey. Michellene has been named among the Top 25 Most Influential Minority Leaders in Healthcare by Modern Healthcare Magazine. Prior to joining RWJBarnabas Health, Ms. Davis served as Chief Policy Counsel to former New Jersey Governor Jon Corzine, where she was the first African American to serve in this position. She was the first African American and only the second woman to serve as Acting New Jersey State Treasurer, responsible for a state budget of over $30 billion dollars. She began her legal career as a trial litigator. In this episode, we’ll learn about: The National Medical Fellowship Inc – the only private organization solely dedicated to providing scholarships to medical and health professions students underrepresented in healthcare. The tens of thousands of professional alum that have been supported by the NMF since its inception in 1946, including 2 surgeon generals. The leadership development programs and the unique community of support that the NMF offers medical students and fellows. How the NMF directly addresses the elimination of the disparities & inequities in American healthcare through an evidence-based approach. Michellene’s articulation of the purpose and value of the National Medical Fellowship Inc is enlightening. It’s goal, as I now understand it, is three-fold. First, to break the cycle of inequity in medical education by providing medical students, residents and subspecialty fellows with financial support. The second goal is to not only increase the percentage of doctors who are Black, LatinX and other under-represented ethnicities in medicine; but also to support these students and trainees in advancing as leaders. The third goal is to eliminate the disparities in healthcare delivery and outcomes in our country. Toward the end of the interview, I ask Michellene why she upended her career to make this recent professional shift. Her response – “At the height of the pandemic I watched no less than 30 of my colleagues perish. And when you look at who perished and who are the most vulnerable in our communities… after that I just realized that I am done dying. I am done watching colleagues and communities suffer and die, at the expense of what others would just consider an inconvenience… And I just am tired of watching the same community members suffer the same reality, when those who are in power are blind to the entire equation… And for me, what shifted was that on this side of Covid, with whatever amount of time I might have left on this planet… I needed every second of it to truly matter, to address this one ill, to save even one life, and to change the face of medicine. As a result of that, I came to NMF…” Michellene Davis is a leader of rare integrity, honesty and courage. Michellene’s discernment is a litmus of the insidious fundamental wrongs that need to be righted within our healthcare system. Her professional actions and her career trajectory demonstrate a commitment to doing something about it – not talking about doing something – but actually doing something. In my 30 years in healthcare, I have heard countless mission statements & purpose statements – multiple pronouncements about a new day in healthcare. But I have never heard anything as authentic, as meaningful, as resilient, and as full of selfless conviction and integrity as Michellene’s statement of purpose. Her words will ring in my ears and resonate in my soul for years to come. Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, Our guest this week, Steve Nelson, takes us on a journey into a new category of company that is curating the collaboration between employers and providers. It’s an incredibly exciting adventure – actually a leap into the world of value-based care. The insights that he shares provides a lens into where healthcare is going – empowering patients & payers to navigate to healthcare that is appropriate, high quality and reliable. Into this mix are enabling technologies that contribute to the value proposition. It’s an incredibly enlightening dialogue – not one you’ll want to miss. Steven Nelson leads the Contigo Health team as President. He was one of the leaders who initiated Contigo within Premier, a leading hospital supply chain company. Before joining Premier, he served as Vice President of Strategy and Planning and COO of Anthem’s diversified business group. Prior to joining Anthem, Nelson led strategy, product and marketing at Highmark Blue Cross Blue Shield and helped to build Allegheny Health Network, a provider entity consisting of seven hospitals, 2,000 doctors and various other facilities. In this episode, we’ll discover: The challenge that employers face in understanding and dealing with the staggering costs of healthcare, and how they’re responding. How the ‘Centers of Excellence’ program and network management – which are foundational to employer-based healthcare – are evolving. The use of ‘2nd opinion’ interventions in maintaining high standards of quality in employer healthcare navigation offerings. How Contigo is convening local collaborations between employers, healthcare systems & health plans – and creating vertical ecosystems with numerous other enabling partners. One of the revealing insights that Steve shares during the interview is that the purpose of Centers of Excellence (COE) is not necessarily to drive costs down; but instead, to drive value up! For years, I’ve heard the concern that bundled payments are a ‘race-to-the-bottom’. Steve reframes them as a ‘race-to-the-top’. The value of these COE’s is NOT that they provide a lower unit price for heart surgery or joint replacement. The value is that they don’t perform unnecessary procedures. They provide an overall bundle of care that is of higher quality, safety and legitimacy. I underscore this because we know that a significant percentage of procedures and surgeries performed in this country are unnecessary, thereby subjecting the American public & employees to unnecessary harm & costs. In fact, the Lown Institute just published a report demonstrating that over 60% of hysterectomies and nearly 25% of cardiac arterial stenting procedures were unnecessary. This was a 2-year Medicare study of 3100 hospitals which discovered that older Americans were subjected to over 1,000,000 unnecessary tests & procedures. Within that were 200,000 cardiac stent procedures that fell into the category of ‘overuse’. Core to Contigo’s approach is that they convene and coordinate local collaborations between employers and healthcare systems. Not only are they convening, but they are optimizing care through: (1) standardized, high reliability, bundled pathways in specialty areas; (2) providing physicians with clinical decision support tools, best practice alerts and patient benefits information; (3) assisting employees in navigating to and accessing high quality care; and (4) using both clinical data, claims data, and advanced analytics to identify patients at risk. Contigo is also bringing health plans into this ecosystem, as well as in numerous enabling technology vendors. What I find encouraging is that Contigo is not alone in creating a more integrated, seamless value-based system of care. While many healthcare systems across the country are hedging their bets and responding as if fundamental transformation is not around the corner, this movement of direct-to-employer curators & navigators is leading and catalyzing the transformation to assure that patients receive the right care. In 2020, over two-thirds of large employers were steering, or planning to steer, their employees to Centers of Excellence. There is little doubt that employers will continue to play an increasing role as a major market force pulling us toward value-based payment & care. As healthcare becomes less affordable for the majority of Americans, we are rapidly reaching a tipping point, or perhaps more like a boiling point. This does not seem like the type of bet any healthcare stakeholder should be hedging. Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, In this episode, Dr. Shantanu Nundy shares with us his thoughtful reframing of healthcare. His book, Care After Covid, is a practical exposé on the misalignment of healthcare – offering a guideline for how to reframe the healthcare system moving forward. What you’re going to love about this interview (and his book) are the stories that he shares – transporting us from an inner city clinic in Washington DC, to the plains of Africa with community health workers in villages, to the university hospital where he discovered the power of caring relationships. Dr. Shantanu Nundy MD, MBA, is a primary care physician, engineer, technologist, and business leader who serves as Chief Medical Officer for Accolade, which delivers personalized navigation and population health services to companies. Previously, Dr. Nundy served as a senior health specialist at the World Bank Group where he advised developing countries on health innovation & technology. Prior to that, he was Director of the Human Diagnosis Project, a healthcare artificial intelligence startup which he successfully built into a medical project spanning 80 countries. He is also co-inventor of SMS-DMCare, an automated text messaging software for individuals with diabetes, one of the first mobile health interventions to be adopted by the World Health Organization. He attended MIT for undergrad, the Yale School of Medicine & completed his residency in Internal Medicine at the University of Chicago, where he also obtained a MBA. In this episode, we’ll discover: The maladaptive aspects of our healthcare system that the pandemic has exposed and magnified. The 3D model – distributed, digitally-enabled & decentralized – that Dr. Nundy believes can transform healthcare How Dr. Nundy views ‘connected care’ as being ‘beyond technology’, but also how digitally-enabled care can create greater access, more personalized care, and greater patient engagement. The largely untapped opportunity we have to include patients as part of the healthcare team, and the tremendous potential that has to transform care. Real life stories that demonstrate how providers’ professionalism, empathy and overall value proposition are being constrained by our system. Dr. Nundy’s ability to leverage divergent perspectives is remarkable. He shares a story of conducting research on automated reminders for improving medication taking. What he discovered in interviewing patients was that it wasn’t the digital reminder that motivated them to take their pills. Instead, it was the caring research coordinator, Marla, and the relationship that patients had formed with her, that compelled them to take their medications. Plainly put, they didn’t want to let Marla down. The lesson – caring relationships are not just more empathetic care, they’re also more effective care. Another example of Dr. Nundy’s ability to balance divergent perspectives is his notion of decentralized care – that healthcare decisions are best modulated as close to patient care as possible. He shares a poignant story of a patient with heart failure. His patient kept on being admitted to the hospital because she didn’t have a scale to weigh herself. (People with heart failure are susceptible to water retention, which causes their lungs to fail. Having a scale allows them to detect fluid retention and take appropriate medications to reverse it). During one post-hospital visit, Dr. Nundy realized that his patient did not own a scale because she couldn’t afford one. So, he handed her twenty dollars to buy one. She bought the scale and did not have any further hospital admissions after that. It’s important to note that Dr. Nundy was actually breaking rules and regulations in giving her the money to purchase that scale. He did not, as a primary care doctor, have the decentralized decision-making or authority to personalize care and do what was right for his patient. Dr. Nundy’s goal in authoring this book is to create a mindset shift in healthcare delivery. As he states in our dialogue, ‘words create worlds’. So, I’ll conclude by sharing some of his profound words. One phrase that struck me was, “Digitalizing poor care isn’t enough. We need to reinvent care”. Another, “We need to do population health one patient at a time”. Dr. Nundy envisions a world in which both providers and patients are much more empowered and connected by the healthcare system. I believe that words do create worlds, and I hope this is the case with the words that Dr. Nundy has shared with us. Until next time, be well. Zeev Neuwirth, MD

Friends, Our guest this week, Dr. Robert Pearl, introduces a fundamental reframe in our understanding of healthcare transformation with his second book, ‘Uncaring – How the Culture of Medicine Kills Doctors and Patients’. He convincingly argues that addressing the systemic functional challenges in healthcare is not sufficient. For transformation to occur, we also need to address the entrenched culture; and the first step is in understanding that culture. ‘Uncaring’ is the most comprehensive and scholarly book I’ve come across on the interplay between the legacy culture of medicine and its impact on healthcare delivery and outcomes. Dr. Robert Pearl’s stories are heart-breaking and heart-warming; and the historical facts, medical stats and studies he draws upon are engaging, enlightening and of concern to all of us. Dr. Robert Pearl is the former CEO of The Permanente Medical Group, which he led from 1999 to 2017, and former president of The Mid-Atlantic Permanente Medical Group, which he led from 2009 to 2017. In these roles he led 10,000 physicians, 38,000 staff and was responsible for the nationally recognized medical care of 5 million Kaiser Permanente members. He currently serves as clinical professor of plastic surgery at the Stanford University School of Medicine. He is also on the faculty of the Stanford Graduate School of Business, where he teaches courses on strategy and leadership, as well as lecturing on Information technology & healthcare policy. Dr. Pearl has been named as one of Modern Healthcare’s 50 most influential physicians. In this episode, we’ll discover: Numerous episodes in the history of American healthcare that demonstrate how the culture of medicine is holding us back from transforming healthcare delivery. Profound examples of how the culture of medicine directly influences how care is delivered and the grossly suboptimal outcomes that are a result of that culture. The only two possible directions American healthcare can take in response to the unsustainable and unaffordable costs of healthcare delivery. A pathway to confront and change the culture of healthcare. It’s been said that if we don’t study history, we’ll be condemned to relive it. This is no more true than in our healthcare system. Dr. Pearl shares a haunting story of an Austrian physician named Dr. Semmelweis who died penniless in the 1860’s, as a result of being shunned by the medical establishment. His heresy was that, through years of rigorous research, he demonstrated that physicians were carrying the source of maternal infections & deaths – on their hands & clothes. His studies revealed that maternal mortality rate could be decreased from 18% down to 2% simply by physicians changing their gowns and washing their hands with antiseptic in between treating patients. One might shrug this off as a historical footnote, except for the fact that today, in 2021, hospital acquired infections are the fourth leading cause of death in the US – leading to over 90,000 deaths per year. The tragic truth is these deaths could largely be prevented by providers washing their hands in between seeing patients. That is the power of culture – “this invisible force” that Dr. Pearl reveals to us. We discuss many other examples, including the story of the ‘Committee on the Costs of Medical Care’, which reveals the powerful influence of the legacy culture of medicine in resisting recommendations that could vastly improve the health and well-being of our nation. Like myself and many of you, Dr. Pearl is frustrated and deeply troubled by the complexity, opacity and inertia in American healthcare – and how the culture is greatly limiting access, affordability, efficacy and equity. Two silver linings emerge in our discussion. First, the culture of medicine has tremendous strengths as well as wonderful attributes and values. Second, the solution is not that complicated. When I asked Robbie what he would request healthcare leaders do differently, this is how he replied, “To move from fee-for-service to capitation. To work together to improve medical care rather than maximize volume. To embrace technology that makes care more convenient for patients.” Healthcare leadership is struggling to break free of a legacy maladaptive healthcare construct. What I learned from Dr. Pearl is that healthcare leadership must not only create a new system, it must create a new culture: one that aligns our professional values and purpose with the actual daily practice of medicine and delivery of healthcare. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends, The focus of this interview is on a ‘greenfield’ project that was under wraps for the past three years, and has only recently been revealed. Project Fulcrum was launched in the spring of 2018 by the CEO and senior leadership team of AdventHealth – one of the largest healthcare systems in the country. It’s bold purpose – “to disrupt its legacy provider business model with consumer-driven innovation”. Our guest this week is Nick Archer, the CEO of Project Fulcrum. In this role he leads a cross-functional team from brand experience, banking, retail, and healthcare to build new products and experiences. He has held various leadership positions at AdventHealth in strategy and finance, most recently serving as the VP of Finance for Network Development and Post-Acute Care. He serves on the boards of United Against Poverty and Andrews Memorial Hospital in Kingston, Jamaica. Nick earned a bachelor’s degree in finance from Oakwood University and an MBA from the University of Florida’s Hough Graduate School of Business. In this episode, we’ll discover: The competitive market forces that led AdventHealth’s leadership team to make the decision to disrupt their own business model. The fundamental consumer problems & issues that Nick and his team discovered during their customer discovery work. The consumer innovation initiative that Project Fulcrum has deployed to over 50,000 patients. Some of the early outcomes they’ve achieved, such as a 30% reduction in no-show rates. This interview felt like listening to a superb master class in healthcare consumerism. Although many of us in healthcare use words like ‘empathy’, ‘consumer-focus’ and ‘whole person care’ – Nick and his team, as you’ll hear in this interview, have taken a very different approach to delivering on these concepts. For example – the notion that ‘empathy’ isn’t just identifying your customer’s pain points, but must also include understanding what role they want you to play in solving those problems. Nick’s team discovered that their patients did not want things done to them, but instead were looking for someone to “come alongside, champion and remove barriers”. Another example – the notion that ‘conversation’ itself has a significant healthcare value proposition. As Nick puts it, “using the medium of conversation as a way to drive value, whereas traditionally the paradigm of communication in medical practice is largely task focused and transactional”. There are numerous remarkable and unique aspects to Project Fulcrum. The commitment to transformation – made by the AdventHealth senior leadership team – to protect, support and resource a greenfield innovation division. Their relentless pursuit to understand the consumer perspective and make that priority number one. The fact that they intentionally chose to start by creating a more personalized consumer experience. And, their intention to eliminate disparities & inequities in experience and access. As Nick states,“We want to democratize the idea of concierge and make care accessible to everyone.” Project Fulcrum is a bold strategic commitment to investing in the future; to investing in AdventHealth’s differentiation and growth; and to investing in a significant, positive inflection in patient care. As Nick eloquently states during the interview, “The challenges of today can’t prevent us from thinking through and designing the success of the future”. This initiative is a remarkable example of a disruptive innovation and I suspect numerous case studies will be written about it. For me, however, the most essential theme is the humanistic one. This is a story about leadership that clearly believes that enhancing human connection – empathetic dialogue and healing relationship – is necessary to a successful healthcare delivery system and critical for a thriving healthcare business model. If you want to understand what ‘humanizing healthcare’ can look like, I suggest you listen to this interview with Nicholas Archer, CEO of Project Fulcrum at AdventHealth. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends, You are going to hear a remarkable case study about a successful and sustained philanthropic initiative focused on educating disadvantaged youth. Although outside of the strict domain of healthcare delivery, this initiative is actually about the health & well-being of our communities and our country – education being a significant social determinant of health outcomes. Joining us in this interview are Harris Rosen, President & COO of Rosen Hotels & Resorts, Dr. Chuck Dziuban, and JuaNita Reed. Dr. Dziuban is the Coordinator of The Harris Rosen Foundation educational programs for the University of Central Florida. He is in charge of maintaining the research and statistics of the Tangelo Park Program. JuaNita Reed is a recently retired guidance counselor at Dr. Phillips High School. She has mentored the scholarship recipients in the program and continues to lead that aspect of the program in her new role as Scholarship Coordinator of The Harris Rosen Foundation. In this episode, we’ll discover: The key components contributing to the success & 26-year sustainability of the Tangelo Park Program. The profound educational outcomes & remarkable impact it’s had on the community – for example, dropping the crime rate by ~80%! Mr. Rosen’s vision for spreading the Tangelo Park Program to the rest of the country. Since 1994, Harris Rosen and his colleagues have funded a Pre-K program and a full college scholarship in a small, disadvantaged community. Although the solution is simple, the success is startling. Also startling is how this program has not only sustained itself but has activated the youth and catalyzed the parents in the community. Over the years, families have required and requested less of the Rosen funding, as they’ve been acquiring more college scholarships on their own. Another critical point to understand is that this approach is reversing an insidious, self-perpetuating driver of financial disparity & inequity in educational opportunity. If you live in the bottom economic quartile in this country, your chance of graduating from college is 11%. The odds against you are 9:1. The total college debt in the USA is $1.7 Trillion dollars. Most of this college debt is carried by the bottom economic quartile in this country, and by Black youth. It is a compounding problem which perpetuates a cycle of debt and the suppression of upward mobility, largely in the Black & LatinX populations. One of the brilliant things that the Tangelo Park Program does is break this cycle of educational debt and upward social mobility. The evidence for that – well, for starters, the Tangelo Park program has reversed the odds of these kids graduating college, from 9:1 against, to 3:1 in favor! Further evidence – over 160 Tangelo Park youth have graduated from college. That is 3 times the expected number, which would have been 45. In addition, the program has resulted in 227 degrees, including post-graduate degrees. There’s also a positive economic impact to the community. Lance Lochner, an economist at the University of Western Ontario, recently calculated a 7:1 return to the community. Harris Rosen’s program is catalyzing the tremendous intellectual talents, capabilities and potential in our disadvantaged youth, particularly in Black & LatinX youth. He understands that a college or vocational school education leads to employment, financial stability, and significantly higher life-time earnings. Those are well substantiated facts. At one point in the discussion, Chuck Dziuban refers to a recently published landmark study which has demonstrated that a Preschool (Pre-K) education positively and cumulatively transforms an individual’s entire life, with ripple effects on the lives of their children & grandchildren. I suspect that you will be as moved as I was by this story. But Harris is asking for more. Harris Rosen is calling for action. His vision is that every underserved community in this country be adopted by philanthropists, Boards and C-suites. Toward the end of the interview, Harris implores us, “What I would like to hear and see more of is people who not only say that black lives matter, but people who are inclined to do something about it. Here’s a program with nearly 30 years of extraordinary success. All somebody has to do who cares about Black lives, LatinX lives, the lives of our youth – is ask how we did it.” If reversing the cycle of educational & economic inequity in our country is important to you, then please share this interview with others – especially those who are in a position to replicate the Tangelo Park Program. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends, The focus of this interview is on a solution created by Yale Economists to address the rising & unsustainable costs of healthcare in our country. Most of us are aware that healthcare costs are a problem, but our guest today argues the cost of healthcare is actually devastating to American workers & families. The approach he and his colleagues are taking to solve this massive problem is unique & I’m excited to explore it with you today. Zack Cooper, PhD is an Associate Professor of Health Policy and Economics at Yale University. Cooper has published his research in leading economics & medical journals and has presented his research at the White House, the Department of Justice, the Federal Trade Commission, & the Department of Health and Human Services. Cooper received his undergraduate degree from the University of Chicago and his PhD from the London School of Economics. In this episode, we’ll discover: The meeting at 10 Downing Street that led this extraordinary Yale Healthcare Economist to come up with the idea for 1% solutions. The specific healthcare issues being addressed by these 1% solutions, such as Surprise Medical Billing & Kidney Transplantation. Why Zack believes employer-based health insurance is contributing to bloated costs that are profoundly harming the health & welfare of working Americans. How the unprecedented drop in American life expectancy and the American epidemic of “deaths of despair” might be linked to healthcare economics. Why the 1% solutions are intentionally focused on incentivizing providers & healthcare organizations rather than attempting to change patient behaviors through cost-sharing and other demand-side interventions. The opportunity cost to the American public and the American future resulting from bloated healthcare costs. This is an extraordinary story of a ‘scholar-activist’ who is battling the insidious mistruths that are guiding policies for an industry that makes up nearly one-fifth of the US GDP. With this latest 1% project, he’s not only debunking harmful myths, but also using evidence-based, scientific methodology to build solutions to lower the staggering costs of healthcare. Make no mistake about it, the stakes are high. For example, Zack refers to a recent study which demonstrated that a $10 increase in Medicare Part D copays (prescription medications) led to a 33% increase in monthly death rates among seniors. People couldn’t afford their medications and so they simply stopped buying them. Zack is reframing the field of healthcare economics by attempting to accomplish a number of things. First, he is actively recruiting leading scholars to adapt their research to current policy-relevant domains. Second, he is inviting leading scholars to more directly engage with and influence politicians and policy makers. Third, he is catalyzing a movement toward more scientific, peer-reviewed, evidence-based healthcare policy decision-making. Fourth, he is calling for a shift from research that purely critiques to briefs that develop and support tangible solutions to lowering the costs of healthcare. And fifth, he’s influencing the next generation of healthcare scholars to view themselves as ‘scholar activists’. What Zack & his colleagues are attempting is courageous. They are battling on behalf of the plight of the majority of Americans who simply can not afford healthcare. They are battling the status quo of a huge, well-funded, complicated & opaque industrial complex. As Zack points out, there are few other industries as heavily lobbied as healthcare – underscoring the need for independent, peer-reviewed, evidence-based, policy decision-making. At one point in the interview, Zack says that he’s been “coarsened” by what he has discovered. He is, in my opinion, experiencing what many clinicians & others in healthcare have recently been terming ‘moral harm’. One domain of moral harm that is of “gripping” concern for Zack is the economic and healthcare inequities in this country. His current research is focused on how healthcare inefficiencies and costs might actually be contributing to the economic & health inequities, and the growing disparity chasm in our country. What I greatly admire and respect is Zack’s ethical conviction, commitment and persistence to challenging and changing the fundamental policies causing this moral harm. So, while the 1% approach may appear incremental, what Zack and his colleagues are doing is nothing less than transformational. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends, What if I told you that I just learned of a completely doable and replicable approach to reducing the costs of healthcare by 30 – 50% while increasing quality outcomes simultaneously? In this interview we’ll be speaking with an employer that has been achieving this for years. Corporate America – which pays for 50% of all healthcare costs – has been the “sleeping giant” of healthcare. But these giants are now waking up and they’re not going to put up with the status quo. One particular employer has been awake for decades, and we’re going to hear his story told in some detail. Joining us in this interview are Harris Rosen, President & COO of Rosen Hotels & Resorts; Ashley Bacot, President of Provinsure (the health insurance company that Rosen Hotels formed; and Kenneth Aldridge Jr, RN, BSN, MS-HSA, the Director of Health Services at the Rosen Medical Center and RosenCare. In this episode, we’ll discover: The simple but widely successful approach that Mr. Rosen and his colleagues have taken to achieve the triple aim results of better care, better outcomes & lower costs. Some of the key programs and critical success factors that have contributed to Rosen Hotels having sustained healthcare savings of over 30% for decades. How ProvInsure and the Osceola County School District have replicated the model with remarkable savings and outcomes. Mr. Rosen’s vision for spreading the RosenCare model to the rest of the country. Each podcast interview is an adventure for me. To really listen well, I have to allow myself to be surprised. I have to allow myself to think differently and to experience uncomfortable emotions that my guests elicit. In this interview, I found myself surprised with almost every turn of the dialogue. First, having worked within our overly complicated US healthcare system for decades, I was really knocked back on my heels by the simplicity of Mr. Rosen’s approach to healthcare. It was almost too simple and too obvious; which led me to the second surprise. The emotional dialectic I experienced was embarrassment on one side and inspiration on the other. I was embarrassed and inspired on behalf of the American healthcare system. Here is a guy – Mr. Harris Rosen – with no medical, healthcare or technical background, and he figured it out. I was embarrassed and inspired because here is a leader who did not compromise on what he knew to be the right thing to do for his employees. I was embarrassed and inspired because Harris Rosen had the conviction, commitment and courage to do the things that we all know will radically improve healthcare. I imagine you’re wondering what Harris Rosen and his colleagues have done. There are a number of ways I could explain it. The simplest way is to tell you that he’s inverted the American healthcare system. RosenCare spends the vast majority of its funding on Primary Care, not specialty care; and makes primary care accessible, convenient, affordable and equitable. RosenCare follows its associates throughout the continuum of care to create a more seamless and integrated experience; and promotes and even imposes the principles of public health by making it a requirement to follow certain healthful behaviors. For example – nicotine use, alcohol consumption affecting “fit for duty” and illegal drug use are not allowable if you’re going to be a Rosen associate. I’ll share one other emotion I felt as I was listening to the RosenCare story. I felt validated. Having practiced primary care for decades and having been a primary care proponent for over 3 decades, the RosenCare story demonstrates what we have known, and what the literature has repeatedly substantiated. Investing in proactive, preventive primary care leads to better care, better outcomes and lower costs. This is a lesson, sadly, that has not been widely supported or manifested within the American healthcare system. One final thought. The RosenCare story reveals the power of a caring, loving community. I didn’t know how to describe it as I was listening, but RosenCare felt a little bit like a ‘tough love’ healthcare community. They haven’t just built an exceptional healthcare benefits program or an outstanding employer healthcare approach. What they’ve done is to reframe the transactional and individualistic medical mindset into one that is relational and community oriented. RosenCare’s fundamental principles are about caring, not coding. Until next time, be safe and be well. Zeev Neuwirth, MD

There aren’t many people who have the breadth of perspective and the depth of accomplishment that this week’s guest brings to the table. Dr. Tony Slonim doesn’t just wear multiple hats. He has lived in multiple healthcare worlds – having earned a nursing degree, a medical degree, a subspecialty board certification, a doctorate in public health; and having served in the public health service as well as in senior executive roles. It is this unique multi-system orientation that enables him to draw distinctions between medical care, public health, community health and population health – distinctions that many of us may not fully appreciate.. In this interview, Dr. Slonim points out that our hospital-based medical healthcare system is not interchangeable with a public health care system. The fallacy that they are interchangeable – and that a public health service is not needed – is a mis-guided national error which has contributed to an American health system which delivers subpar outcomes when compared to other economically developed nations. By way of formal introduction, Dr. Anthony Slonim is president and chief executive officer of Renown Health in Reno, NV. Modern Healthcare has named Dr. Slonim one of the “50 Most Influential Clinical Executives” in 2019. Before joining Renown Health, he served in executive leadership roles at Barnabas Health in NJ, Carillion Clinic in VA and Children’s National Medical Center in DC. Dr. Slonim holds a diploma in professional nursing. He is a board-certified pediatric intensivist, who also earned a masters and doctorate in public health from George Washington University; and then served four years in the United States Public Health Service in Rockville, MD with the rank of Lieutenant Commander. In this episode, we’ll cover: The difference between the ‘medical mindset’ and the ‘public health mindset’. The reframing of our public health system as an “insurance policy” that our country has not invested in over the past few decades. Some thoughts on how the defunding of our public health system has contributed to the disparities and inequities in healthcare. The “precedent of unkindness” in our society – exacerbated by the stressors of the pandemic and perhaps enabled through social media – that is adding to our psychologic and physiologic strain, and harming the public health. Dr. Slonim is a kind and humanistic leader, but he is also a demanding leader. He is demanding that we reinvest in a diverse healthcare system that works to keep our communities and the American public healthy. What this interview reveals is that the vast majority of us – who have not been trained in public health – don’t understand its significance and its critical role. We don’t understand the differences between public health, population health and medical care. We don’t understand the unique approaches and tools of the public health system. We are not aware that our public health system has been defunded over the past few decades. Nor do we fully appreciate the implications of that defunding, especially in inner cities and rural counties. Many of the healthcare problems we’re experiencing today – including some of the devastating fallout of the COVID-19 pandemic – are due to this lack of a robust public health system. These problems include: unsafe drinking water (think Flint Michigan); unsafe air; climate change; the racial disparities in healthcare in which life expectancy between neighboring zip codes can vary by as much as 15 – 20 years; the worsening opioid epidemic; and the epidemic of mental health and suicide in our country. All of these have one thing in common. They could be greatly mitigated by the presence of a strong local public health system in our communities, our towns, our cities, our counties and our states. The pandemic has taught us many things, not least among them is that we need to rebuild our public health system. One wonders if our political and healthcare leaders have the discernment, conviction and courage to translate this obvious societal need into action by investing not only in the medical system, but also in a public health system. The federal government that the framers created is intentionally organized around checks and balances, informed by multiple perspectives. Our healthcare system needs that same sort of multi-system, multi-perspective reorganization. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends, Our topic this episode may be one of the most misunderstood and challenging issues in healthcare delivery – with significant potential for lowering costs and improving outcomes. The topic is employer-based healthcare; and as many of you know, employers pay for 50% of all the healthcare costs in the US. Escalating healthcare costs over the past few decades have imposed a major strain on corporate America and its employees. The Kaiser Family Foundation reported that in 2018, employers paid approximately $20,000 per year for healthcare for a family of four, $6000 of which the employee paid. They also reported that since 2006, employee healthcare premiums have risen twice as fast as wages. As a result, Corporate America has been increasingly focused on right-sizing healthcare costs – from Apple and Amazon launching their own employee primary care; to Walmart providing ‘centers of excellence’ to its employees; to companies such as Comcast who have partnered with vendors to put alternative healthcare solutions in place for its employees. But, the situation is challenging, as evidenced by the recently failed attempt of Haven, an employer-based healthcare initiative launched by JP Morgan, Berkshire Hathaway and Amazon. It’s a complex ecosystem involving employer-based HR & health benefits managers, employer benefit brokers & benefits consulting companies, insurance companies, provider groups & hospital systems, direct to employer providers, and collaboratives such as the Business Group on Health. Our guest this week is a passionate expert who has a discerning handle on the ecosystem, the fundamental problems, and the proven solutions in employee-based healthcare. Dave Chase founded & leads Health Rosetta, whose goal is to empower community-owned health plans. Health Rosetta has created a blueprint and platform that empowers health plans to deliver high quality, affordable care. Dave has authored a number of insightful books including The CEO’s Guide to Restoring the American Dream: How to deliver world class healthcare to your employees at half the cost. He received the Health Value Awards’ Lifetime Achievement for Health Benefits Innovation at the 2020 World Health Care Congress. Prior to this work, Dave Chase co-founded Avado which was acquired by and integrated into WebMD/Medscape. He also founded Microsoft’s $2B, 28,000 partner healthcare ecosystem. In this episode, we’ll cover: Dave’s unique perspective on the fundamental problems in the American healthcare system. What Dave describes as epidemic healthcare ‘financial toxicities’ and ‘financial comorbidities’, which is denying the American dream to the majority of employees. Five major solutions that employers can leverage to reset and radically improve their employee health benefits plans. Examples of employers who have saved a significant and sustained percentage of their healthcare costs while improving healthcare outcomes for their employees. Dave makes some amazing claims in terms of dramatically lowering healthcare costs for employers and employees; and he’s got numerous examples to support those claims. There is no question that the solutions he proposes are disruptive to the status quo. But, rather than view them as disruptive, we can learn from these successful models and deploy the proven blueprints that he and his colleagues at Health Rosetta have catalogued and created. One thing is abundantly clear. The American healthcare system is not working for the vast majority of employed Americans. Dave’s facts and statistics are disturbing. What he reveals is that escalating healthcare costs are levying a hidden tax that is destroying the economic health and well-being of working American families. It’s a striking reframing of the problem that makes it very personal and very real. Once we understand this, one wonders why more employers aren’t adopting the tools and techniques that Dave and his colleagues at Health Rosetta outline so clearly. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends & Colleagues, There are a few healthcare delivery enablers which will catalyze the transformation of healthcare delivery over the coming years. In our dialogue today, we’ll be focusing on one of them – virtual care. Our guest this week has spent years directly leading the charge in virtual healthcare redesign and deployment. Dr. Tom Hale is the Chief Medical Officer of VirtuSense where he and his colleagues are using virtual care to build value-based services for ACOs, MAs, and other at-risk models. Prior to this role, Dr. Hale pioneered the development of telemedicine and virtual care at Mercy Health. Under his leadership, Mercy telehealth services launched the world’s first virtual care center, Mercy Virtual. Prior to that, he led a 350-member multi-specialty organization as the President of Mercy Medical Group. In this episode, Dr. Hale and I will touch on: Some insights as to how Mercy Health developed its world renown Virtual Care services and the amazing outcomes they achieved. Examples of AI-enabled monitoring technologies that VirtuSense has created, such as one that reduces falls by 50 to 70% in the home and in hospital rooms. Common missteps that healthcare organizations make in deploying virtual care. Tom’s belief that success in virtual care is largely about people and process; requiring more than just an overlay, but instead an overall redesign of clinical and business models. Dr. Hale provides us with a very pragmatic understanding of the benefits of virtual care. He busts the myth that virtual care is merely a video substitute for a supposedly superior in-person visit. He proposes that virtual care redesign is actually far superior to the traditional approach of in-person healthcare encounters. I love his metaphor comparing traditional care to a series of ‘snapshots’ that provide disconnected, infrequent and lagging representations of a patients’ health; which is in sharp contrast to virtual care with its AI-enabled, remote monitoring and rapid responsiveness, which provides a continuous ‘movie’ of the patient’s health – continuous, connected and contextual. Dr. Hale also points out that virtual care increases access to care; and through standardization and automation, it can reduce harmful variation of care – all leading to improved outcomes and lower total costs. He backs these claims with data. The reduction of falls was significant, as well as the 60% reduction in healthcare costs that he and his colleagues achieved by placing simple remote monitoring technology and iPad’s into patients’ homes. Another fascinating revelation was how AI-enabled software can detect the onset of sepsis or the worsening of chronic disease long before they become apparent through our current monitoring. An example of this is the increasing variability in heart rate that precedes the onset of heart failure by days, allowing providers to more proactively respond to and prevent ED visits and hospitalizations. I really appreciate Tom’s thoughts regarding the impact of virtual care on the Social Determinants of Health and vulnerable populations: “Virtual care increases access to [proactive preventive] care. It decreases harmful variation. It removes the geographic barriers to care. It brings the best of the best to everybody. How can it not help the poor and underserved populations?” And I hope his final message in this podcast makes it to the ears of policy makers and payers. “Virtual Care will increase access and decrease variation in care, and you’ll get lower costs and higher quality. But, for that to happen, we need you to decrease the regulatory barriers, and prove and support the economics around virtual care that brings value to patients.” Until Next Time, Be Well Zeev Neuwirth, MD

Friends, Welcome to the first ‘Creating a New Healthcare’ podcast episode of 2021. The major themes we’ll explore in this episode are two sides of the same coin: the strategic, market-driven imperative for transformation in healthcare; and the financial and operational challenges of disrupting one’s own healthcare organization. Our expert guest in this interview refers to this phenomena as the “conflicting realities” of transformation and disruption. The situation is challenging. If healthcare systems and provider groups don’t pursue transformation, it’s likely that they will find themselves increasingly less relevant in the future. Yet, at the same time, disrupting oneself is fraught with pitfalls and seemingly insurmountable challenges. Our guest this week has spent years threading this needle, earning the wisdom and the wins that demonstrate his competence and credibility. His message is simple and clear, and worth listening to. He believes that we are up to the challenge, if we grasp the mantle of high integrity, courageous, patient-centered leadership. Dr. Roger Ray is the Chief Physician Executive with The Chartis Group – a well-known and highly respected healthcare consultancy. He has over three decades of service in a variety of leadership positions at major healthcare organizations throughout the eastern United States. Most recently, Dr. Ray served as Executive Vice President/Chief Physician Executive at Atrium Health, where he led a medical group of over 3,000 members and had operational oversight over myriad clinical services & functions. In full disclosure, I had the privilege of working with Dr. Ray for a number of years during his tenure at Atrium Health. In this episode, we’ll cover: The 4 major strategic advancements that Dr. Ray believes every healthcare system needs to be focused on achieving. The increasing and unprecedented importance of physician leadership, and how that is a differentiating factor among healthcare systems. The specific and significant challenge of disrupting one’s healthcare system, coupled with the conflicting need to rapidly adopt technology, generate new business models and transform healthcare delivery. Why becoming expert at ‘fast-following’ and adopting best practices may be a superior strategy vs being a ‘bleeding-edge’ organization. Dr. Ray is a pragmatist and a highly strategic thinker. But, he’s also a highly principled leader. One of my favorite ‘Ray’ quotes is, “Principles matter when they’re inconvenient.” The point being that it’s much harder, much more meaningful, and far more impactful to manifest principles when they inconvenience you. One of the fundamental principles that Dr. Ray has led by include his focus on ‘patient-first’ healthcare delivery. That is, leading with the question of how any decision impacts patients – first and foremost. As an example of this principle in action – when I asked Dr. Ray what he would say if he had a few minutes with President Biden and VP Kamala Harris, he said that he would remind them that healthcare is fundamentally about “people taking care of people” – highly skilled professionals who are earnest and passionate about helping and healing others – providers and staff who sacrifice and give of themselves, and who daily deliver near-miraculous outcomes. Yes, healthcare is a business. But, if we forget what it’s fundamentally about, we will sub-optimize the endeavour and harm patients. Dr. Ray also added that he would remind the President & VP that the current disparities in American healthcare are an embarrassment to our nation. He would encourage them to use the resolution of healthcare disparities as a primary marker and absolute requirement for American healthcare improvement. I’m delighted to see that Dr. Ray is sharing his expertise and wisdom with many other leaders and organizations across the nation. American healthcare needs more leadership with principled pragmatism, and we need leadership that is willing, capable and courageous enough to thread the needle of disruptive transformation. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends & Colleagues, The focus of this episode is of immediate importance to all of us. It’s especially important right now, in the month before the inauguration of President-elect Biden & VP-elect Kamala Harris. (Of note, this interview was recorded in late August, so we were unaware of the election outcomes). The topic is ‘fixing’ healthcare and our guest today is Dr. Vivian Lee, the President of Health Platforms at Verily. Dr. Lee recently published a book entitled –The Long Fix – Solving America’s Healthcare Crisis with Strategies that work for Everyone – in which she explains the fundamental problems in healthcare and provides practical solutions. The book speaks directly to policy makers, providers, payers & patients. In this interview, we’ll hit the high points of the book and get a sense of the priority Dr. Lee assigns to certain problems. The book is remarkable and so is Dr. Lee. She is a Harvard-Radcliffe College graduate who obtained a doctorate in medical engineering from Oxford University as a Rhodes Scholar and then earned an M.D. with honors from Harvard Medical School. She has also earned an Executive MBA at NYU’s Stern School of Business. Dr. Lee is a radiologist and medical researcher who has authored over 200 peer-reviewed journals. Prior to her current role, Dr. Lee was the Dean & CEO of the University of Utah Health – one of the nation’s leading hospital and academic medical centers. During her tenure, she and her colleagues achieved numerous nationally recognized accomplishments in quality, safety, patient experience, growth and entrepreneurial commercialization. In 2019 she was ranked #11 among the ‘Most Influential People in Healthcare’ by Modern Healthcare. She has been elected to the National Academy of Medicine. In this episode, Dr. Lee and I will touch on: A broad range of issues ranging from the mind boggling complexities of billing and payment, to the lack of price transparency, to the crippling and uncontrolled costs of medications, to the impact of healthcare costs on suppressing employee wages and retirement funds. The one issue Dr. Lee calls out as the core off-the-charts problem in the American healthcare system. Why Dr. Lee believes that it’s critically important for all citizens to understand how healthcare delivery works and what it would take to make it better. Why universal access to healthcare is not only the right thing to do from an ethical perspective, but also from a public health, productivity and economic point of view. Why Dr. Lee believes we must shift to value-based care in order for universal coverage/access to be optimally effective. I have to say that it was a privilege and a pleasure to speak with Dr. Lee. Given her remarkable accomplishments, her brilliance, and the enormity of her current position, I was struck by how down-to-earth and humble she is. We didn’t have the opportunity to directly discuss the issue of leadership in healthcare; but an unspoken message that came across is that we need a leadership culture that Dr. Lee embodies – data-driven, humanistic, socially aware, and selfless – leadership that is, first and foremost, for the people. Dr. Lee wrote this book for the American public – to bring some clarity to our complicated, opaque healthcare system. I applaud her for that. Most importantly, I applaud her for the explicit intention to deliver solutions that work for everyone. Until Next Time, Be Well Zeev Neuwirth, MD

The COVID-19 pandemic has shone a new light on the deep-rooted disparities and inequities that are built into the fabric of our American healthcare system. Triggered in part by the pandemic, as well as a number of deeply disturbing episodes of racist police brutality, and the Black Lives Matter movement, we’re experiencing a national re-awakening of concern regarding systemic and institutional racism in our society. Our two distinguished guests in this interview, Dr. Alisahah Cole and Michellene Davis, are nationally recognized leaders in the movement to eliminate healthcare disparities. Michellene Davis, Esq. is currently the Executive Vice President and Chief Corporate Affairs Officer at RWJBarnabas Health, the largest academic healthcare system in New Jersey. She is an attorney and has held positions at the senior most tier of government, including as State Treasurer, Chief Policy Counsel to a Governor, and CEO of a state lottery. Dr. Alisahah Cole is currently the System Vice President of Population Health & Policy at CommonSpirit Health, one of the largest integrated healthcare systems in the United States. She is a Family Medicine physician and has held multiple leadership positions including as Chief Community Impact Officer and Academic Chair, implementing novel approaches to improve health equity in vulnerable populations. This interview was recorded last month as a panel discussion during a virtual conference on patient experience. The topic was originally intended to be a discussion on the Social Determinants of Health (SDOH). But we felt that it would be culturally tone-deaf and socially irresponsible to discuss the SDOH without recognizing systemic and institutional racism as a root cause of the inequities and disparities in health care delivery and health outcomes. With that in mind, this panel discussion includes: A passionate discussion on this most recent ‘awakening of awareness’ about the systemic & institutional racism in our society – including the impact of the COVID-19 pandemic. The manifestations of systemic, institutional & interpersonal racism in healthcare. Practical, real-life recommendations regarding a systematic, data-driven approach to identify, understand & eliminate racism in healthcare. In addition to bringing their experience as clinicians and executives, Michellene and Alisahah also share their lived experience as professional Black women. The stories they share are honest, courageous, and at times, unsettling. For example, Michellene shares that, unlike her white colleagues, she does not have the luxury of putting racism aside, even for a moment. Alisahah shares that, as the mother of two teenage Black boys, she worries for their lives, literally, each time they leave home to venture outside. This conversation challenges the very core of our humanity – in our communities, our corporations, our social institutions and our government. One lesson this interview taught me is that the issue of ‘social determinants of health’ needs to be reframed in terms of eliminating the racial disparities and inequities in healthcare and in our broader society. Another is that good intention is not enough – we need to take sustained systemic action. There are so many lessons embedded in this podcast. Lessons about listening and building trust. Lessons about the unhealthful effects of racism on Americans of color. Lessons about the need to fundamentally reorient, redesign, reorganize and appropriately resource healthcare delivery so that it meets the needs of vulnerable populations. And lessons about the need to expand healthcare delivery beyond traditional medical boundaries – to apply a racial equity lens to how we reframe our education system, our criminal justice system, our housing and urban development system, our transportation system, our social services systems, our labor system, and our public health system. This was the most important interview I’ve conducted to date. I say that with Martin Luther King’s words ringing in my ears. Words that, sadly enough, have as much relevance today as they did when he delivered them over five decades ago, during a 1966 speech before the 2nd National Convention of the Medical Committee for Human Rights. Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death. I see no alternative to direct action and creative nonviolence to raise the conscience of the nation. Martin Luther King Until Next Time, Be Well Zeev

Dear Friends & Colleagues, Welcome to episode #106 of Creating a New Healthcare. This week has been a historic one for our country. As votes continue to be counted at the time of this writing, I want to turn our attention to what will undoubtedly be a key component of POTUS’ work over the next four years – our national healthcare policy agenda. This is the first time we’ve posted during a presidential election. But, it is not the first time we’ve tackled the POTUS question as it relates to healthcare. For those of you who have been listening to the podcast series this year, you’ll immediately recognize the question I’ve asked every guest this season. In this episode, it’s time for me to tackle this question. It’s Thursday, Jan 21, 2021 – the day after inauguration of the President of the United States; and you find yourself in the oval office, sitting on the opposite couch from the POTUS and VPOTUS. (As an important aside, you are socially distanced; and you are all wearing masks.) POTUS has asked for your opinion – your thoughts, suggestions & recommendations on what this administration should be focusing on in regard to HC policy & policy deployment over the next 4 years. What are you going to say to them? Listen to the podcast to discover the 5 Policy Principles I recommend to POTUS and the specific recommendations toward a solution for each. I hope you’ll listen with a discerning ear and let me know how you would answer this question. Finally – I have a request of you. I need your help. If you find value in this podcast series, please share it with as many colleagues as you can think to. I have heard from so many of you how valuable these episodes are to you; and if that’s the case, then it’s critically important that you spread the word about Creating a New Healthcare. Until Next Time, Be Well Zeev Neuwirth, MD

Welcome to episode #105, Season 4 of Creating a New Healthcare. Today we welcome one of the most prolific and influential healthcare policy experts of our era. Professor Ezekial Emanuel is the Vice Provost for Global Initiatives and Co-Director of the Healthcare Transformation Institute at the University of Pennsylvania. He is also a Special Advisor to the Director General of the World Health Organization. Dr. Emanuel was the founding chair of the Department of Bioethics at the National Institutes of Health. From January 2009 to January 2011 he served as a Special Advisor on Health Policy to the Director of the Office of Management and Budget, and the National Economic Council. He is also a breast oncologist, having earned his MD at Harvard Medical School, completed a residency in Internal Medicine at the Beth Israel Hospital in Boston, and then completed an oncology fellowship at the Dana Farber Cancer Institute, where he was also appointed as faculty. Dr. Emanuel has written and edited 14 books and over 300 articles, and is the world’s most cited bioethicist. He is a frequent contributor to the Atlantic, the New York Times, the Wall Street Journal, and the Washington Post, and regularly appears on television and radio. In this episode, we’ll touch on the following: The fragility of the US employer-based healthcare payment system and how the COVID-19 pandemic is nudging us to a universal payment system. The differences between a universal payment program and a single payer system. An illustration of a capitated primary care trial demonstrating the advantages to providers and patients. What the US can learn from other advanced nations in terms of primary care access and healthcare payment reform. The multi-pronged solutions that Dr. Emanuel recommends to address the insidious institutional racism and the inequities that are embedded in US healthcare delivery I believe it was H.L. Mencken who said that there are often simple solutions to complex problems, and those simple solutions are typically wrong. Dr. Emanuel does not offer simple solutions to the complex problems in our healthcare system. Instead, he offers thoughtful, studied, and ethical solutions that directly and realistically address the fundamental flaws in our healthcare system. These are serious flaws that leave tens of millions of Americans with no or sub-optimal health insurance, limit access to preventive primary and specialty healthcare for tens of millions of Americans, and create perverse and unethical incentives for providers and health systems that greatly inhibit them from delivering the type of healthcare they would like to offer. Dr. Emanuel is one of the most cited healthcare policy scholars and advisors of our era, as well as one of the most prolific researchers and authors. He is one of the finest healthcare educators and thought-leaders our country has ever produced. It is well worth our time to listen to and study the critically important lessons he is teaching us. Until next time, Be safe and be well. Zeev Neuwirth, MD

Welcome to Episode #104 (Season 4) of Creating a New Healthcare. I’m delighted to welcome back to this podcast Dr. Don Berwick – one of the leading authorities on healthcare quality & improvement over the past few decades. Dr. Berwick is President Emeritus and Senior Fellow at the Institute for Healthcare Improvement (IHI), an organization that he co-founded and led as President and CEO for 18 years. In July 2010, President Obama appointed Dr. Berwick to the position of Administrator of the Centers for Medicare and Medicaid Services (CMS), which he held until December 2011. An elected member of the Institute of Medicine (IOM), Dr. Berwick served two terms on the IOM’s governing Council, and was a member of the IOM’s Global Health Board. He served on President Clinton’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry. His body of work & contributions to the field of healthcare quality & safety are unparalleled, including two classics: the 1999 IOM report, ‘To Err is Human’ and the 2001 IOM report, ‘Crossing the Quality Chasm’. In 2005, he was appointed “Honorary Knight Commander of the British Empire” by Queen Elizabeth II, the highest honor awarded by the UK to non-British individuals, in recognition of his work with the British National Health Service. To say that Dr. Berwick brings a seasoned perspective on the current state of our healthcare system and the challenges we face as a nation is, to put it mildly, an understatement. What distinguishes Dr. Berwick even more than his record of accomplishment or his brilliant mind is his tireless reminders of the ethical responsibility we have to attend to the health of the American public – especially for those of us who are providers, administrators, policy makers, health insurance companies, as well as pharmaceutical and device manufacturers. A relevant quote from one of Dr. Berwick’s recent articles underscores this responsibility; “Fate will not create the new normal; choices will.” In this episode, we’ll cover a range of topics, including the following: Dr. Berwick’s recent article, Choices for the “New Normal” – which is a call-to-action and a leadership roadmap outlining crucial choices in six critical domains that will play a significant role in determining the future of healthcare delivery. Inequality and Inequity – the relative lack of social support services provided in the US as compared to other developed nations; which Dr. Berwick describes as “the most notable wake-up call”. An ethical reframing of the social determinants of health, described in his recent article, The Moral Determinants of Health; along with some shocking statistics on inequities related to poverty, hunger, homelessness, social isolation, and the uninsured. The tragic and insidious institutional racism that is embedded in our healthcare delivery system, as well as in other institutions such as our criminal justice system. A critical reframing of healthcare that Dr Berwick refers to as “What Matters to You Medicine”; which he suggests should disrupt and replace the legacy “What’s the Matter With You” paradigm. Dr. Berwick is one of the greatest healthcare humanitarians and transformational leaders of our era. He is the quintessential example of empathic ethical leadership. We need more leaders like this in and around healthcare. Dr. Berwick’s recent publications are seminal. In these articles, he courageously cuts to the stark realities of our healthcare system. He not only lays bare the truth for all to see but also outlines the crucial leadership choices of our time. And even beyond that, he lays out a pathway for positive action. Dr. Berwick writes, speaks & acts with intellectual integrity, academic rigor, and with a disarmingly insightful and honest authenticity – as well as with a powerful voice based in morals and compassion. At times, it’s unsettling, uncomfortable and inconvenient. Make no mistake about it, Dr. Berwick’s message is not an academic treatise. It is a call for ethical action. Until next time, Be safe and be well. Zeev E. Neuwirth, MD

Welcome to episode #103, Season 4 of Creating a New Healthcare. In this episode we are welcoming back to the podcast Dr. Mandy Cohen, the Secretary for the North Carolina Department of Health & Human Services. Dr. Cohen and her administration have been critical in responding to the current pandemic. Over the past 3 1/2 years, they have also been hard at work, developing and deploying a cutting-edge, state-wide approach to addressing the Social Determinants of Health – a critical national issue whose importance has been magnified by the pandemic. In this episode, we’ll cover: 3 major lessons that the COVID-19 pandemic has taught us: (1) equity, (2) system-ness and (3) care beyond walls. How Dr. Cohen and the NC DHHS adopted “an equity lens” in deploying targeted programs and policies to create a more equitable healthcare system. The progress in “health opportunity” programs such as the NCCARE360 closed-loop referral program. The central importance of Community Health Workers in building a ‘bridge of trust’ to creating better health. For me, there were three profound take-aways from this episode: As we were discussing the importance and necessity of collecting data on racial disparities and inequities in healthcare, Dr. Cohen paraphrased a mutual colleague – Dr. Mark Smith, the founding president and former CEO of the California Health Care Foundation. The lesson she shared is the cautionary note that one should not admire a problem too much at the expense of doing something about it. We should not wait around for perfect or publishable data before taking action. Heeding this advice, she is “full tilt” on deploying resources to assist traditionally marginalized populations – in particular, the Black and Latinx populations. Governor Roy Cooper has been fiercely promoting the importance of Medicaid expansion – which has become even more critically important due to the stressors of the pandemic on factors such as employment. There are currently 2.2 million people on Medicaid in NC, which accounts for about one-fifth of the entire NC population. 1.5 million of those individuals are children, which accounts for one out of every three children in NC. If we accepted federal funding and expanded Medicaid in NC, it would provide insurance coverage for another 600,000 people – covering COVID-19 testing, behavioral health treatment, early childhood development programs, life-saving medical care and so on. As Dr. Cohen puts it – the fact that we are one of only twelve states in the entire country that has not yet expanded Medicaid is a “black eye” on the NC commonwealth. There was another profound ‘aha’ moment that happened during this interview that I don’t think I’ll ever forget. As we were discussing the ‘community health work’ (CHW) program she and her team are deploying, Dr. Cohen punctuated the key role that community health workers serve in the healthcare ecosystem. It’s well known that Community Health Workers serve to provide navigation and coordination of clinical care, and that they assist with social services and social agency. But, from Dr. Cohen’s perspective, their key core function is really about rebuilding trust. It’s about meeting people where they are, and starting to rebuild a bridge that has been broken. She went on to say that we have to acknowledge that we have a “trust deficit” in communities of historically marginalized people. More explicitly, Black and Latinx communities have been left out and let down by our healthcare system. And, some of the current health inequities are likely due to the fact that people don’t seek healthcare because they don’t believe they will be heard, listened to, and appropriately cared for. The “trust deficit” is based on decades of lived and learned negative experiences, and is supported by decades of published research. Dr. Cohen is a knowledgeable, forward-thinking, empathetic and highly competent public health leader. She has a definite bias to action – deploying programs that achieve measurable positive health outcomes for individuals and communities. Under her leadership, the NC DHHS is keenly focused on addressing the long-standing and systemic ‘dis-trust’ in our healthcare system, which to my mind may be the single most important ‘dis-ease’ we need to tackle if we are to achieve our full potential as a state, and as a nation. Until next time, be safe and be well. Zeev Neuwirth, MD

Dear Friends & Colleagues, Welcome back to the Fall 2020 season of ‘Creating a New Healthcare’. We are now entering the 4th year of our podcast, with over 250,000 downloads this year to date! It’s clear that the issue of reframing healthcare has never been more important than it is at this moment. So, if you find value in listening to the podcast, I would urge you to share it with friends and colleagues. There is so much going on in the world right now. It’s a time of great uncertainty, volatility, distress – and opportunity. One of the unintended consequences of the sheltering-at-home and social-distancing – necessary to combat COVID-19 – is the devastating isolation, loneliness and despair it has wreaked across the US population. Research, prior to the pandemic, informs us that somewhere between 40 – 50% of the population experiences social isolation or loneliness. I strongly suspect that the pandemic has raised those numbers significantly. We also know that it’s not just the elderly. The second most affected segment of the population are college age adults. We desperately need a national solution to address social isolation and loneliness. So, what can NASA teach us about social isolation & loneliness? And, why is Humana, a major healthcare insurance company, collaborating with NASA to address social isolation? To answer those questions, we’ll be joined today by two distinguished experts in this area – Dr. Will Shrank, the Chief Medical Officer at Humana; and Dr. Gary Strangman – a psychologist and researcher from the Massachusetts General Hospital (MGH). Dr. Strangman is the Director of a “Neural Systems Group” at MGH and has also been working closely with NASA over the past 2 decades – currently as the Innovation Specialist for NASA’s Translational Research Institute for Space Health (TRISH). In this interview, we’ll dive into the following: The physiologic and psychologic impact of social isolation on astronauts and the types of solutions NASA is exploring to deal with this. Some of the similarities between space travel & sheltering-at-home in the era of COVID-19. Startling statistics on the impact of social isolation on Humana’s senior members, and the types of initiatives they’ve been deploying to combat it. Next steps for the collaboration between Humana and TRISH. During the interview it becomes abundantly apparent that Gary Strangman and Will Shrank are superstars in their respective fields. The fact that Humana is collaborating with NASA’s Translational Institute for Space Health speaks volumes about the intense focus, commitment and highly innovative approach Humana is taking to better understand and combat the epidemic of social isolation. Humana and TRISH are also collaborating, alongside others, in a public health awareness campaign, called ‘Far from Alone’. This program addresses health-related social needs and promotes understandings of loneliness and social isolation – issues that are exacerbated by the Coronavirus pandemic. I recently read a quote from Atul Gawande that provides a meaningful context to the work that Dr. Shrank and Dr. Strangman, and their respective organizations, are engaged in. “We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive.” Until Next Time, Be Safe & Be Well. Zeev Neuwirth MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introductory episode here. During this series, I interviewed forward-thinking, courageous healthcare leaders and entrepreneurs – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way we’re delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? In order to share the remarkable insights from these timely interviews, we have been releasing episodes as quickly as possible. Over the past 8 weeks, we’ve posted 20 episodes! Today’s episode is the final interview in this limited podcast series. In this episode, I’ll be sharing some of my key learnings and lessons from the past few weeks, and the impact I hope it will have on our healthcare system. In this episode, I’m joined by Chitra Ragavan, a nationally recognized journalist and host of her own podcast, When It Mattered. Chitra will take the mic in this episode and interview me about my perspectives on how COVID-19 is reframing American healthcare. Chitra is an unusually skilled podcast host in that she brings deep experience in television, radio, and print – including at National Public Radio (NPR) and U.S. News & World Report magazine (U.S. News). Chitra also is Founder and CEO of Goodstory, a strategic advisory firm helping companies with strategic growth and positioning, using brand architecture, narrative and storytelling. A preview of the topics we’ll touch on include: The fundamental flaws in the American healthcare system that have been exposed and magnified by this pandemic. The major reframes we MUST deploy post COVID-19 in order to create a new and better healthcare. Why I’m hopeful, energized and enthusiastic about the future of healthcare, and health, in our country. In addition to being the final episode in this limited series, it will also be the final episode of this ‘Creating A New Healthcare’ season. We’ll take a summer break and kick off the 4th Season in September. Stay tuned – we have an exciting lineup for the Fall! I’d like to thank the guests who graciously agreed to be interviewed for this limited series. The stories and stats they shared ran the gamut from enlightening to startling to heart warming to incredibly helpful. Under normal circumstances, it takes weeks to schedule these interviews; but these incredibly accomplished leaders arranged to participate in a matter of days – out of a shared sense of purpose. Their insights and profound humanitarianism left me with a deep sense of hope and renewal after each interview. Finally, I would like to take this moment to thank you for listening in and offering your feedback and encouragement via social media and emails. Please continue to write in and share your thoughts. And please share the podcast series with your colleagues. The only way we’re going to create a new healthcare is together. Until next time, Be Safe & Be Well Zeev Neuwirth, MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introductory episode here. In this series, I’ve been interviewing visionary, courageous healthcare leaders and entrepreneurs – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? In this interview we’ll be speaking with Sami Inkinen, the founder and CEO of Virta Health. Virta is a completely virtual diabetes clinic whose brand promise is to not only improve type 2 diabetes but, in many instances, to reverse it. Virta has completely reframed type 2 diabetes care with the physiologic approach they take; the data-driven, digital, AI-enabled technologies they deploy; and the personalized, empathetic and highly responsive care they provide. Sami is a remarkable person and entrepreneur. He’s a physicist, turned business and tech guy, turned online real estate entrepreneur, turned healthcare reframer/entrepreneur. I met Sami about 6 years ago and have had the great privilege of working with him and getting to know him. And, in full transparency, I have served as an advisor to Virta. Some of the topics we’ll touch upon include: Virta’s approach to type 2 diabetes – which allowed it to be far better prepared to continue delivering exceptional clinical care and outstanding consumer experience during the COVID-19 pandemic. One of the most remarkable statistics I’ve heard during this pandemic – having to do with risk of mortality from the SARS-COV-2 infection in individuals with uncontrolled diabetes. Some of the crippling flaws in the American healthcare system that were exposed and exacerbated by the COVID-19 pandemic. A fundamental misalignment in our healthcare system that represents the most serious impediment to delivering empathetic, value-based care, and superior outcomes. Sami’s top recommendations for what we need to do to create a better healthcare system coming out of this COVID-19 pandemic. Virta Health is an example of what reframed ‘great’ looks like in chronic disease management. We could spend quite a bit of time breaking down the principles, approaches, processes, technologies, behavioral and relational aspects, payment model, culture, and so on that make Virta so successful. But the bottom line is that the value proposition, experience and outcomes are far superior to the standard of care across the country. Virta represents, similarly to others we’ve interviewed in this series, a path to what markedly better healthcare can and should look like. Sami and his colleagues have paved a path to the future by reframing the care of people with diabetes. One major take-away I’d like to leave you with is one of the key lessons I’ve learned in this limited series. Organizations – like Virta – that have reframed healthcare, have fared far better during this pandemic than organizations that have not. This has been a common theme that has come up repeatedly during these in-depth interviews. It speaks to the fact that our current legacy approaches to healthcare delivery are vulnerable, fragile and simply not oriented, designed or organized around our healthcare needs. Reframed organizations appear to be much more adaptable, resilient, anti-fragile – and consumer-oriented. This observation was not lost on me and should not be lost on you. Until next time, be safe and be well. Zeev Neuwirth, MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introductory episode here. In this series, I am interviewing future-facing, courageous healthcare leaders and entrepreneurs, asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? In this interview we’ll be speaking with Dr. Shreya Kangovi about Community Health Workers. Community Health Workers are individuals who have been hired from their community, and given training and support to provide customized, culturally sensitive, non-clinical care. Their focus is on the social determinants of health – at the individual level, and delivered in a highly personalized and relationally oriented way. To my mind, this workforce and approach to care is one of the most untapped opportunities we have to reframe healthcare and create transformative change. It addresses the overwhelming impact that the Social Determinants of Health (SDOH) have on healthcare outcomes, utilization, costs and the experience of care. The issues of SDOH, chronic disease and disparities of care have been some of the fundamental problems in our healthcare system – problems the COVID-19 pandemic has exposed and exacerbated. One of the solutions to our present moment and to a better future is the focus of today’s discussion. Dr. Kangovi and her colleagues have pioneered a rigorous, evidence-based approach to building, deploying and measuring the impact of a Community Health Worker (CHW) program. Dr. Kangovi is the founder & executive director of the Penn Center for Community Health Workers – a national center of excellence dedicated to advancing health in low-income populations through CHW programs. She and her colleagues have spent nearly a decade creating and refining a world-class CHW model called IMPaCT (Individualized Management towards Patient-Centered Targets). Now, they are offering this program to other institutions to encourage widespread deployment. In this interview, we’ll dive into the following: Six major problems in healthcare – caused and/or exacerbated by the COVID-19 pandemic – that are leading to American deaths. What Dr. Kangovi refers to as the “structural racism” embedded in our healthcare delivery system – and what can be done to reverse it. A detailed description of the Community Health Worker approach to COVID-19 contact tracing, and… The one critical question that drives the highly effective and personalized IMPaCT Community Health Worker approach. The Community Health Worker model is proven to be cost effective, replicable, and complementary. However, in order to implement this model throughout the country, we need a system of care that pays for outcomes, not for procedures or transactions. Fee-For-Service payment is the “big but” in American healthcare. This has been a common mantra that has emerged in most of the interviews I’ve conducted during this pandemic. If we shifted to a capitated, value-based payment approach (at least with primary care), we would be able to rapidly and easily deploy effective, humanistic solutions such as Community Health Workers. From my perspective, one of the most important lessons the COVID-19 pandemic has taught us is that Fee-For-Service payment makes both providers and patients vulnerable. It is unsustainable, and frankly harmful to the health of the American public and the American economy. It’s also not the type of compensation model that fosters meaningful, relationship-enhancing careers for primary care providers as well as specialists. We can talk about a lot of things, but until we fix this one major impediment, we will be propagating an out-dated and misaligned approach to healthcare delivery. My hope is that this current crisis serves as a catalyst for changing that, and addressing many of the other fundamental flaws in our healthcare system, like disparities in care. We need courageous leaders to speak up, step up, collaborate across the various stakeholders, and to take directed actions to create a new, and more humanistic, approach to healthcare. Until next time, be safe and be well. Zeev Neuwirth, MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introductory episode here. In this series, I am interviewing future-facing, courageous healthcare leaders, entrepreneurs, and practitioners – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? Our focus in this interview is on one of the most critical behind-the-scenes issues that has emerged during this COVID-19 pandemic – provider resilience. This is not a new issue, but it’s importance has been magnified by the current crisis. It’s also an issue that will be a high priority for years to come. Our guest this week is Wayne Sotile. Dr. Sotile is an international thought leader on resilience and work/life balance for health professionals. With 40 years of experience, he has published widely in peer-reviewed medical journals and authored nine books, including his latest two: The Thriving Physician: How to Avoid Burnout by Choosing Resilience Throughout Your Medical Career (2018), and Thriving in Healthcare: A Positive Approach to Reclaim Balance and Avoid Burnout in Your Busy Life (2019). Dr. Sotile has delivered more than 9,000 talks and workshops, and has provided care and coaching to over 13,000 healthcare providers and their life-mates. He is the founder of the Sotile Center for Resilience & the Center for Physician Resilience in Davidson, NC. In this interview, we’ll dive into the following: How Dr. Sotile is reframing his own perspective and dispelling widely held misconceptions about provider ‘burnout’, ‘life balance’ and ‘post-traumatic stress’. The attitudes and behaviors we can adopt to optimize our ability to be resilient, and to experience ‘post-traumatic growth’. Dr. Sotile’s recommendations for how healthcare leaders need to reframe the healthcare workplace in order to create a meaningful, resilience-enhancing environment.. Some of the unintended positives of the COVID-19 crisis, and the opportunity we have to carry them forward into the future. The 3 major factors that contribute to resilience; and the one challenge we must overcome to attain emotional health. I’ve had the great pleasure of hearing Dr. Sotile speak a number of times. This was the most inspiring and authentic representation of his wisdom that I’ve heard to date. Throughout our discussion, Dr. Sotile stresses the importance of re-thinking and reframing one’s perspective. And, he is clearly walking the talk here. He describes reframing as a requirement in attaining resilience and renewal. He also stresses the necessity for healthcare leaders to step up to the plate and reframe the work environment in concrete ways – such as redesigning and reorganizing the workplace, and redirecting resources (such as compensation) in order to create a supportive and healthful environment for providers and staff. This focus on provider resilience and well-being will be a critically important issue for our healthcare system in the post-COVID-19 era. My favorite teaching from Dr. Sotile is his definition of ‘wonderment’ as “seeing the familiar in unfamiliar ways”, and how he encourages the healthful benefit of practicing wonderment. I love the way that he normalizes so many behavioral concepts that have been pathologized. I have to say that I found myself experiencing wonderment during this interview, as I listened to him reframe our understanding of resilience and renewal. Until next time, be safe and be well. Zeev Neuwirth, MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introductory episode here. In this series, I am interviewing future-facing, courageous healthcare leaders and entrepreneurs – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? In this interview we’ll hear highly strategic, science-based insights regarding the realities of the COVID-19 pandemic, and specific recommendations and illustrations for what we need to be doing in the face of those implications over the next couple of years. We’ll also be discussing, in some depth, how to create a new and better healthcare, leveraging the learnings and catalyst of this pandemic, as an opportunity to rapidly reframe our approach to chronic disease management and overall healthcare delivery. Our guest this week is Dr. Robert Pearl. Dr. Pearl was the CEO of the Permanente Medical Group & the Mid-Atlantic Permanente Medical Group of Kaiser Permanente, where he was responsible for over 5 million patients’ lives. He and his colleagues at KP set the bar for what value-based healthcare could and should look like, and the outcomes that can be achieved. Since leaving his position in 2017, Dr. Pearl has written a book entitled, ‘MisTreated: Why we think we’re getting good healthcare – and why we’re usually wrong’. He currently teaches healthcare strategy and policy at Stanford Graduate School of Business and has been named one of Modern Healthcare’s 50 most influential physician leaders. I’ve had the good fortune of speaking with and interviewing Dr. Pearl numerous times over the past couple of years. You can listen to one of those discussions on Episode #46 of ‘Creating a New Healthcare’. In this interview, we’ll cover a number of topics including: 3 Coronavirus facts Americans should know before returning to work or school. (Read the article by Dr. Pearl here) Dr. Pearl’s strategic recommendations for how to utilize testing and deploy a safer approach to reducing social distancing. This is a strategy that balances our socioeconomic need to reopen businesses and other social venues (like schools and places of worship) with the need to protect the most vulnerable individuals in our society – what I’m calling a “risk-stratified segmentation” approach to social distancing. The flaws in our healthcare system that the COVID-19 pandemic has exposed, including the fragility and unsustainability of our Fee-For-Service payment model. Robbie’s thoughts about what lessons we should learn from this current crisis to inform how we reframe and reform the American healthcare system moving forward. Dr. Pearl has the incisive thinking and measured approach of a surgeon, combined with the practical experience and insights of a healthcare CEO, combined with the knowledge and nuanced understanding of a healthcare policy expert. It’s nothing less than awesome to listen to how he utilizes clinical science and evidence-based reasoning to dissect the current pandemic situation. His prescription for how to go about dealing with the pandemic is hopeful and encouraging. Robbie is neither an optimist or a pessimist, but instead a realist; and I appreciate his scientific and data driven objectivity. What I appreciate as well is the palpable sense of compassion and empathy that drives his passion for what he is doing – which is informing the lay public and medical field on why and how we must reframe healthcare. It’s clear that he, like myself, views this current COVID-19 pandemic as a catalytic opportunity for reforming healthcare. What also emerged during the conversation is that Robbie is authoring a 2nd book. I am looking forward to reading it and learning more from one of the most knowledgable, experienced and discerning healthcare experts of our time. In the meantime, you can access some of Robbie’s writings at www.robertpearlmd.com. Until next time, be safe and be well. Zeev Neuwirth, MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introductory episode here. In this series, I am interviewing future-facing, courageous healthcare leaders and entrepreneurs – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? Our focus this week will be on the rapid transition, or perhaps immersion, of healthcare into a consumer-centric era. There are very few people I can think of who have a better understanding of this topic than our guest this week. Kevan Mabbutt is the Senior Vice President and Chief Consumer Officer at Intermountain Healthcare. Kevan has over 2 decades of experience in consumerism. Prior to joining Intermountain in 2017, he was at The Walt Disney Company, where he served as the Global Head of Consumer Insight. At Disney, Kevan was responsible for leading large international ventures such as the establishment of the first Disney theme park in mainland China. He brings world-class, product and service-leading consumer experience to healthcare. I’ve had the great fortune of speaking with and interviewing Kevan numerous times over the past couple of years. If you haven’t had a chance to hear those interviews, I would urge you to listen to Episodes #45 and #52 on the ‘Creating a New Healthcare’ podcast. In this interview, we’ll cover a number of topics including: Why Kevan believes that consumers are now more in the driver’s seat than they were prior to COVID-19. The increased possibility of healthcare systems being disintermediated in the post-COVID era – by lower cost, more convenient competitors and new entrants. The two-fold strategy that Intermountain is taking to accelerate its consumer positioning and combat disintermediation – which includes leveraging its “holistic, end-to-end” integrated ecosystem of care. Some of the key experience attributes Kevan believes that healthcare consumers are seeking – again, catalyzed by the new healthcare experiences we’ve all been exposed to in the COVID-19 pandemic. The three complementary and elegant modules of the ‘Digital Front Door’ that Intermountain is currently deploying – a set of consumer-centric services that well-situate Intermountain now and into the future. Kevan’s passion and expertise in the domain of consumer experience are inspiring and catalyzing. I have to say that each time I speak with him I am humbled not only by the depth of his knowledge and experience, but also by the core sense of empathy and humanism that drives his work and directs the strategies and tactics that he and his colleagues at Intermountain are deploying. Kevan continuously reminds us of two fundamental consumers – the patients who will have, and deserve to have, increasing consumer choice and power; and the providers and teams whom we must support in their effort to provide the best care possible. With both sets of customers, Kevan emphasizes the need to reduce friction and create an optimal human-centered experience. Kevan also emphasizes the need to nurture the trusting relationship between healthcare consumers, providers and integrated systems of care. I hesitate to impose a brand on anyone, but when I think of Kevan Mabbutt, the qualities that come to mind include: generous, thoughtful, balanced, humble, empathetic, data-informed, outcomes-driven, tech-enabled, and consumer-obsessed. The one quality that stands out the most for me is Kevan’s deep sense of empathy, and his clear intention and track record of operationalizing humanism into the daily experience for patients and providers. These are qualities that the COVID-19 pandemic reminds us are important and essential to each and every one of us. These are, in my opinion, the qualities and branding that should be adopted by our healthcare system at large as we, hopefully, enter a time of COVID-19 recovery. Until next time, be safe and be well. Zeev Neuwirth, MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introductory episode here. In this series, I am interviewing future-facing and courageous healthcare leaders and entrepreneurs – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? The episode this week outlines an approach to designing the healthcare consumer experience that, in my opinion, will become a required standard of care. Our guest is Lee Becker who currently serves as Solutions Principal at Medallia Inc. Medallia is a pioneering and leading consumer experience management company. Prior to joining Medallia, Lee served as the Chief of Staff for the Department of Veterans Affairs ‘Customer Experience Office’ and was responsible for transforming the patient experience there. Lee is a Navy Veteran and former Chief Hospital Corpsman who served in operational capacities and expeditionary platforms providing care to Marines during the Iraq and Afghanistan wars. This is an incredibly instructive and inspiring dialogue in which we discuss: The “whole person” human-centered reframe the VA introduced in its healthcare consumer experience – and how relevant that is to today’s situation, and moving forward during the post-COVID-19 era. The 3 critical components Lee Becker and his colleagues utilized to deploy this holistic reframe of the healthcare consumer experience. The emerging AI-enabled, ‘signal-capture’ technology that transforms how patients can navigate through the healthcare system – again, so on point to the challenges we are currently facing and will continue to encounter in the post-COVID-19 era. Lee brings a unique set of experiences and expertise to bear. But, even more than his expertise, wisdom and accomplishments, what impresses me most about Lee Becker is his integrity, his palpable sense of purpose and service, and his down-to-earth practicality. The approaches he (and Medallia) are deploying are so simple and common sensical; but they are not commonplace. If we had followed the empathetic, humanistic playbook that Lee Becker outlines, our healthcare system would have been much better prepared for the pandemic, and for the recovery in the post-COVID-19 healthcare era. These ‘whole-person’ human-centered lessons are particularly salient to our present moment in healthcare history, in which the critical importance of emotional, relational and social health are being demonstrated in spades. As Lee points out, if we are going to fully recover from this pandemic, it will require that we take the time to learn these lessons and make the appropriate shifts – particularly the shift from thinking about healthcare consumers only as ‘clinical’ patients – to understanding, engaging and treating them as ‘whole’ people. The take home point for me is that we must move beyond words and intentions to actually reframing healthcare, or we will find ourselves repeating history over and over again. As Lee points out, we must, with methodological rigor – redirect our tactics and resources – and deploy the policies, processes, tools & technologies that can make healthcare more engaging, enabling & empathetic for every member of our society. Until next time, be safe and be well. Zeev Neuwirth, MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introductory episode here. In this series, I am interviewing future-facing, courageous healthcare leaders and entrepreneurs – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? The situation is changing rapidly. So, in order to share the remarkable insights from these interviews, as quickly as possible, I’m releasing new episodes as frequently as I can. Our guest this week is Sean Duffy – the co-founder and CEO of Omada Health, one of the leading digital healthcare companies. I had the good fortune of meeting Sean about 8 years ago, in the early phases of Omada Health. After a couple of hours of listening to Sean, I was completely enamored with him, his vision and mission, and with the approach he was taking. It was, and is, breath-taking and brilliant. Omada Health is based on solid evidence-based medicine. It’s also based on the science of behavior change – which you’ll hear more about in this interview. I won’t go into any depth providing Sean’s background; but instead, I would urge you to listen to the first interview I posted with Sean on Nov 7, 2017 – I believe is was episode #12 of Creating a New Healthcare. For those of you who have read my book, Reframing Healthcare, you’ll know that I quote Sean extensively in the book. Sean and Omada Health have come a long way in the past few years. Omada Health has come a long way in the past couple of years. And, as you’ll hear in this interview, Omada has come a long way in the past couple of months during the COVID-19 pandemic. There are numerous critical lessons for the future of US healthcare that emerge from this interview. The major take home lesson for me is that chronic condition management is more – much more – than a virtual visit or a remote monitoring device. As Sean points out, it takes a lot of finely tuned and expertly managed instruments, playing all together in sync, from the same symphonic sheet to make meaningful, beautiful and emotionally moving music. Omada Health has taken a holistic or “whole person” approach, which includes: remote monitoring; 24/7 asynchronous “signal” collection and responsiveness; machine learning and automated responses that enhance customization and personalization of care; expert health coaching and group facilitation; the power of social community to enhance engagement and behavior change; the inclusion of behavioral health monitoring and treatment into its general chronic condition management programs; and advanced motivation and behavior change approaches that include behavioral economic and habit formation techniques. Omada Health has existed in the digital/virtual/remote realm for many years prior to the COVID-19 era. As a result, they have a vast trove of experience delivering care in this advanced way, and they can innovate at an accelerated pace. Another major ‘ahah’ for me during this interview was the point Sean made about the data that is being collected. Omada Health has, for years, been collecting physiologic, emotional and behavioral signals continuously. As a result, they’re able to, in real time, analyze and understand how the various phases of the pandemic are affecting its clients and the populations they serve. This has allowed them to rapidly iterate and adjust their care offerings to anticipate and meet their clients’ current and evolving needs during the pandemic. This capability will contine to serve them and their clients in the post-COVID-19 era. One example of the “signals” they’ve been able to collect in real time is the marked increase in depression and anxiety, which they’ve almost immediately responded to by the inclusion of more behavioral health services in their programs. I came away from this interview with a greater appreciation for the work that Omada Health has been doing. My hope is that healthcare systems across the country take advantage of these ‘representatives from the future’; and collaborate in a way that allows us to collectively leapfrog into a more advanced system of health, that not only delivers better care but also delivers more humanistic care. Until next time, be safe and be well. Zeev Neuwirth, MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode here. In this series, I’ll be interviewing future-facing, courageous healthcare leaders and entrepreneurs – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you’re delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? Our guest this week is Dr. Jennifer Schneider, the President of Livongo. Dr. Schneider previously served as the company’s Chief Medical Officer and is also the author of “Decoding Health Signals: Silicon Valley’s Consumer-First Approach to a New Era of Health.” Livongo is a cutting-edge digital health company that uses advanced remote patient monitoring and machine-learning technologies to empower people with chronic conditions to live healthier lives. You can hear an initial interview I recorded with Dr. Schneider for episode #72 (Oct 23, 2019) on ‘Creating a New Healthcare’. In this interview, we’ll discuss a number of topics including: The major modalities and approach that Livongo uses to empower patients and providers The specific chronic medical conditions that Livongo is currently managing How Livongo’s approach greatly advances the patient care experience as well as health outcomes – and provides much more customized, personalized care than the current approaches to chronic disease management How Livongo is being deployed to help keep patients with chronic disease safely at home, and away from healthcare facilities during this COVID-19 era Livongo has, for years, been developing a highly sophisticated approach to chronic disease management that has been used by hundreds of healthcare systems and hundreds of thousands of individuals. The unique approach allows patients to receive state-of-the-art chronic disease management without having to be seen in person. What is amazing and elegant about their applications is that it allows for greatly enhanced customization and personalization while also providing immediate responsiveness to remotely monitored biometric signals and personal health needs. So, care is delivered continuously – when and where the patient needs it, as opposed to the reactive and episodic care provided through the current mode of medical office visits and care management programs. Livongo has been on a trajectory to deliver the type of care that is desperately needed at this point in time, during the COVID-19 pandemic. It enables patients with chronic conditions and complex chronic conditions to be cared for at home and in a highly efficient manner that also reduces the amount of provider time required. This is life saving, as patients with pre-existing chronic conditions are most likely to become infected from the SARS-COV-2 virus, and to have greater morbidities, higher risk of hospitalization, and increased mortality. It’s also life saving for the healthcare system, as the need for provider time is greatly reduced through the use of automated, machine learning technologies. The needs of our healthcare system – and the healthcare market – have caught up with the trajectory that Livongo has been on. I suspect that, once providers and healthcare systems begin to appreciate what Livongo has to offer, we will see this, and similar digital health offerings, become ubiquitous and standard of care for individuals with chronic medical conditions. These are unprecedented times, so I hope you find valuable information, guidance, and inspiration in listening to these experts and entrepreneurs share how they are adapting to this pandemic (in real time); and how they’re thinking about and planning for the future. Until next time, be safe and be well, Zeev Neuwirth MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode here. In this series, I interview future-facing, courageous, healthcare leaders and entrepreneurs – to ask two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? In this episode, we’ll be interviewing Jay Desai. Jay is the founder & CEO of PatientPing. PatientPing’s mission is simple: connecting providers to seamlessly coordinate patient care. They provide real-time ADT feeds (Admissions, Discharges & Transfers) to providers so they can provide more coordinated and integrated care to their patients. I have first-hand experience with their service, and can’t say enough good things about PatientPing. In our dialogue, we covered a range of topics focusing largely on the flow of patients across the healthcare continuum, especially in the post acute care space. And, how the infrastructure of the healthcare ecosystem is fundamentally being reframed by the COVID-19 experience. Our discussion included: The impact of COVID-19 on nursing homes and home health services – and the reframing of the so-called ‘post acute care’ domain. How hospitals may become hyper-segmented in the future – the very real possibility of healthcare ‘focus factories’ that have been forecasted by HBS luminaries such as Regina Herzlinger and Clayton Christensen. The reframing of ‘essential services’ including primary care. The radical (overnight) shift from patients being ‘pulled’ into ED’s & hospitals to patients being ‘pushed’ away from hospitals. A major ‘silver-lining’ by-product of this pandemic, which are the rapid regulatory changes coming out of CMS (see link or go to www.cms.gov/newsroom for recent updates) Jay Desai has a brilliant mind and a brilliant heart. He is an empathetic and innovative entrepreneur, and a brilliant observer and commentator on the changes that are happening, as well as those that are coming in healthcare. I hope to have the opportunity to speak with him again some time soon. These are unprecedented times, so I hope you find valuable information, guidance, and inspiration in listening to these experts and entrepreneurs share how they are adapting to this pandemic (in real time); and how they’re thinking about and planning for the future. Until next time, be safe and be well, Zeev Neuwirth MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode here. Our guest this week is Dr. Chris Chen, who is the CEO of ChenMed. Dr. Chen is a board-certified cardiologist and internal medicine physician. HIs professional journey and the story of ChenMed is a remarkable one – a story of the compassionate redesign of healthcare for the older, the poorer and the sicker. You can hear more about their story in a previous interview I recorded with Dr. Chen – Episode #38 (May 17, 2018) on ‘Creating a New Healthcare’. There are a number of critically important implications for US healthcare that emerge from this interview. What’s clear from this conversation is that ChenMed has developed and honed a sophisticated, comprehensive model of care that is allowing it to thrive in the current pandemic – while most other primary and specialty care practices are struggling. What’s also clear is that this model provides a VIP care experience for those with complex medical and psychosocial conditions, and delivers health and cost outcomes that are superior to the vast majority of provider groups and hospital systems across the country. What’s most critical to take away from this conversation, IMO, is the understanding that the capitated payment model that ChenMed has been built upon has allowed it to develop a proactive, preventive, primary care approach that is best-in-class, resilient, remarkably innovative, and most importantly – relationship-centered and humanistic. What’s also critical to take away from this conversation is the understanding that the predominant fee-for-service payment model has: (1) decimated primary care; (2) led to severe disparities; and (3) limited the ability of well-meaning professionals to deliver the type of compassionate, competent care they were trained to and want to deliver. What I realized during the course of this conversation is that you can’t put a CPT code on ‘caring’ – and that is the fundamental flaw with fee-for-service payment in primary care. Another important lesson to be gleaned from this interview is that fee-for-service payment has rendered our system of healthcare fragile, vulnerable, and inequitable – all of which have been revealed and exacerbated by the COVID-19 pandemic. It will be important to translate these understandings into meaningful action. Healthcare leaders must (in the aftermath of the pandemic surge) address this issue of payment; and push for a more rapid conversion to value-based payment models. This will not only serve our patients and our public health; but also allow providers and healthcare systems to be less vulnerable in the future. This is not the only fix, by any means. It’s apparent that there are other reframes that need to occur, such as redesigns in clinical care models – in the use of virtual & digital health technologies; in the use of remote patient monitoring; in the use of data analytics & machine learning; in the deployment of other less costly, more accessible approaches to healthcare; and in the adoption of a consumer-centric mindset. It’s apparent that our business models and operational approaches will require reframing as well. Having said all that, payment is still the fundamental “but” that has prevented us from unleashing the tremendous value locked up in our healthcare system for the past many decades. If this pandemic has taught us nothing else, it’s taught us that we must remove the fee-for-service “but” from our primary care and public healthcare lexicon. In ‘Reframing Healthcare’ I wrote, “It’s clear that the current predominant system of payment – fee-for-service – provides a perverse incentive to do more” [unnecessary, costly and potentially harmful testing, procedures & surgeries]. What’s also now clear to me is that fee-for-service payment provides a perverse incentive to do less – less caring & compassion, less proactive outreach, less prevention, less equitable care, less of all the right things that we would want for ourselves, our families, our communities, and our patients. The need to transition out of fee-for-service should be one of the first lessons discussed, and one of the first set of responses deployed in the post COVID-19 era. Until next time, be safe and be well, Zeev Neuwirth MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode here. In this series, I’ll be interviewing future-facing, courageous healthcare leaders and entrepreneurs – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you’re delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? Our guest this week is Dr. Anthony Slonim, President and Chief Executive Officer of Renown Health in Reno, NV. Over the last four years, he and his colleagues have created one of the most innovative and progressive health services organizations in the country. Dr. Slonim is a nationally recognized thought leader. Modern Healthcare has named him one of the “50 Most Influential Clinical Executives” of 2019. He has also been named a “Physician Leader to Know” every year, since 2014, on the Becker’s Hospital Review. A board-certified pediatric intensive care doctor by training, Dr. Slonim has authored more than 15 textbooks and published more than 60 academic journal articles. Before joining Renown Health, Dr. Slonim served in executive leadership roles at Barnabas Health in NJ, Carilion Clinic in VA and Children’s National Medical Center in DC. Dr. Slonim currently chairs the American Hospital Association’s Systems Council, representing more than 300 integrated health systems nationwide. In this interview, we’ll cover a number of topics including: How the public health mindset/model is augmenting and perhaps superseding the medical mindset/model in the COVID-19 era How the current pandemic is pushing many more Americans into an existence of extreme scarcity, and the economic effect on the social determinants of health and health outcomes How Renown Health’s unique approach and operating structure – which is focused on prevention and health as well as healthcare – have prepared and positioned it to address the current situation. The escalation of behavioral and mental health conditions – a lesser talked about consequence of the pandemic, which can easily overwhelm our healthcare system, unless we find new ways to assist people. How we must use this opportunity to methodically, systematically and cautiously reframe our approach – to be prepared for not only the shock waves of this current crisis; but to be prepared for future such events by focusing on health and establishing a prepared public healthcare system. The importance of leadership at this point in time, especially at a time of widespread uncertainty and anxiety, which can cause individuals and organizations to recede into a vegetatitve mode of self-preservation. Dr. Slonim is an exceptional CEO. In addition to being a seasoned HC executive, he is a seasoned physician and an expert in public health. In a previous interview we conducted I mentioned that we needed more CEO’s with these sorts of credentials. That was true then, but even more so now, in this COVID-19 era. Our interview ended up going into a discourse on the type of intentional leadership that will be required in this time crisis and its aftermath. He has a perspective that I hope others leaders can be inspired by and benefit from. These are unprecedented times, so I hope you find valuable information, guidance, and inspiration in listening to these experts and entrepreneurs share how they are adapting to this pandemic (in real time); and how they’re thinking about and planning for the future. Until next time, be safe and be well, Zeev Neuwirth MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode here. In this series, I’ll be interviewing future-facing, courageous healthcare leaders and entrepreneurs – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you’re delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? In this episode, we’ll be speaking with a colleague of mine, Dr. Ifeyinwa (Ify) Osunkwo, MD, MPH. Dr Ify Osunkwo – or Dr. Ify, as her patients refer to her – is the Director of the Sickle Cell Disease (SCD) Enterprise at Levine Cancer Institute at Atrium Health. She is a Professor of Medicine at Atrium Health and a Clinical Associate Professor of Medicine at UNC Chapel Hill. Dr. Ify earned her MD from the University of Nigeria and a Masters in Public Health from Johns Hopkins University. She completed a pediatric residency at the University of Medicine & Dentistry of NJ, followed by a pediatric hematology-oncology fellowship at Columbia University. She founded the SCD program at Atrium Health. This program has been instrumental in improving the quality of life of persons living with SCD in North & South Carolina; and has also demonstrated positive health outcomes in terms of reduced mortality rates, reduced health care costs and hospital readmission rates, and increased patient engagement and satisfaction with care. Dr Osunkwo has dedicated her career to providing equitable, comprehensive, compassionate and evidence based care for individuals living with SCD. She serves on numerous national committees for the American Society of Hematology and is the Editor-In-Chief of Hematology News. I felt compelled to share this interview because Dr. Ify is offering a number of humanistic approaches to her patients that are especially important in the COVID-19 era. They are important from a provider/patient relationship perspective in that they directly address the issues of social isolation, loneliness and anxiety that people with chronic medical conditions are experiencing. They are important because they address the concrete issue of chronic disease management, which are disproportionately affected by the social distancing and sheltering-in-place public health efforts. There is little doubt that people with chronic medical conditions and people who are socio-economically vulnerable are impacted upon much more severely than others. I’m posting this interview with the intention and hope that providers from across the country will be inspired by Dr. Ify’s example and adopt these and/or other similar offerings for their patients; and that healthcare systems across the country will support these providers with resources. All of this is said with the grateful understanding that so many providers and healthcare systems are focused right now on emergency preparedness for the pandemic surge and on treating patients with COVID-19. What I’m sharing in this interview is what I would call 2nd, 3rd and 4th wave issues – addressing the pandemic’s impact on social determinants of health and on the mental health of patients – which, as Dr. Ify points out, has a significant impact on the course and treatment of chronic disease. But, these are issues that we need to begin to address now, even as we battle the 1st wave of the pandemic. I’ve known Dr. Ify for a number of years. She is a wonderful physician who has a refreshing public health perspective that she applies brilliantly in her practice of medicine. It’s clear that Dr. Ify is incredibly devoted to her patients and is an exemplary role model. Her accomplishments and her positive impact are also a credit to the Levine Cancer Institute and the Atrium Health system that support her in this critically important, meaningful and innovative work. These are unprecedented times, so I hope you find valuable information, guidance, and inspiration in listening to these experts and entrepreneurs share how they are adapting to this pandemic (in real time); and how they’re thinking about and planning for the future. Until next time, be safe and be well, Zeev Neuwirth MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode here. In this series, I’ll be interviewing future-facing, courageous healthcare leaders and entrepreneurs – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you’re delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? In this episode, we’ll be interviewing Michellene Davis, an Executive Vice President at RWJBarnabas Health – the largest healthcare system in New Jersey. Michellene leads Social Impact and Community Investment across RWJBarnabas Healthcare. She oversees the areas of Policy Development, Governmental and External Affairs, Community and Employee Wellness, and Global Health. Ms. Davis is the first woman and first person of color to serve as an Executive Vice President in Barnabas Health system’s history. She is a lawyer and trial litigator who also has extensive experience in senior levels of state government. Michellene is nationally recognized for her contributions to healthcare. In 2018, she received Modern Healthcare’s Top 25 Most Influential Minorities in Healthcare award. This dialogue is filled with more expertise, wisdom, humanity and hope than I could ever begin to describe. It’s also an eye-opening description and depiction of one of the current epi-centers of the COVID-19 pandemic. Michellene shared her incredible experience and expertise on a range of topics, including: The brave work that healthcare providers & staff are doing in our hospital systems The physical & psychological toll of the COVID-19 ‘battlefield’ on healthcare providers & staff The severely negative and disproportionate impact of COVID-19 on the expanding segment of our population who are socio-economically vulnerable – and the impact that will have on everyone in our society A list of recommendations for the work we must immediately begin, in order to mitigate the ‘2nd wave’ of the pandemic tsunami. This is not an infectious disease wave, but a tidal wave of repercussions from the social determinants of health – such as lack of income and food, and the lack of a strong national public health infrastructure. These are unprecedented times, so I hope you find valuable information, guidance, and inspiration in listening to these experts and entrepreneurs share how they are adapting to this pandemic (in real time); and how they’re thinking about and planning for the future. Until next time, be safe and be well, Zeev Neuwirth MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode here. In this series, I’ll be interviewing future-facing, courageous healthcare leaders and entrepreneurs – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you’re delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? In this episode, we’ll be speaking with Dr. David Shulkin. Dr. Shulkin served as the 9th Secretary of the US Department of Veterans Affairs, as a member of President Trumps’ cabinet. Previous to that he served as Under-Secretary for Health, having been appointed by President Obama. Prior to entering the government, Secretary Shulkin was a widely respected healthcare executive. He has been named as one of the Top 100 Physician Leaders by Becker’s Hospital Review and one of the “50 Most Influential Physician Executives in the Country” by Modern Healthcare and Modern Physician. Dr. Shulkin is an amazing leader and it’s always a privilege and pleasure to speak with him as he describes the principled-based, data-driven leadership we’ll need in the COVID-19 and post COVID-19 era. In this dialogue he speaks to a number of issues, including: The renewed recognition of the critical role of government in preparing and maintaining a public health system The need for a more integrated national public healthcare system – that recognizes & addresses the disparities and inequities in healthcare The impact and fall-out of this pandemic on the social determinants of health, which Dr. Shulkin believes could be its most devastating consequence The changes in our daily lives – including some positive ones – such as a sense of kindness and generosity, as well as shared responsibility, adaptiveness and resilience The social awareness and consciousness being raised, especially amongst the younger generations, who may, for years go come, be motivated to enter into public health service These are unprecedented times, so I hope you find valuable information, guidance, and inspiration in listening to these experts and entrepreneurs share how they are adapting to this pandemic (in real time); and how they’re thinking about and planning for the future. Until next time, be safe and be well, Zeev Neuwirth MD

Dear Friends & Colleagues, Last week, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode here. In this series, I’ll be interviewing future-facing healthcare leaders and entrepreneurs – to ask two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? In this episode, we’ll be interviewing Dr. Paul Offit, an internationally recognized expert and scientific pioneer in the field of virology and immunology; and the leading virology expert in the U.S. He is the co-inventor of the rotavirus vaccine recommended for universal use in infants by the CDC, which is credited with saving hundreds of childrens’ lives each day. He is a professor in the division of Infectious Diseases at the Children’s Hospital of Philadelphia, and a professor of Vaccinology at the University of Pennsylvania School of Medicine (See abbreviated Bio below). My dialogue with Dr. Offit was incredibly hopeful, hugely informative and beyond inspiring. He is clearly a brilliant medical scientist and a courageous humanitarian. We covered a range of topics including: His perspective on the COVID-19 surge curve and social distancing The 3 major lessons (reframes) he believes we need to learn from this current pandemic His expert thoughts regarding the amount of time it will take to develop a COVID-19 vaccine His views regarding the impact of our public health response on the social determinants of health These are unprecedented times, so I hope you find valuable information, guidance, and inspiration in listening to these experts and entrepreneurs share how they are adapting to this pandemic (in real time); and how they’re thinking about and planning for the future. Until next time, be safe and be well, Zeev Neuwirth MD Paul A. Offit, MD, is Director of the Vaccine Education Center and professor of pediatrics in the Division of Infectious Diseases at Children’s Hospital of Philadelphia. He is the Maurice R. Hilleman Professor of Vaccinology at the Perelman School of Medicine at the University of Pennsylvania. Dr. Offit has published more than 150 papers in medical and scientific journals in the areas of rotavirus-specific immune responses and vaccine safety. He is also the co-inventor of the rotavirus vaccine, RotaTeq®, recommended for universal use in infants by the CDC. For this achievement, Dr. Offit received the Luigi Mastroianni and William Osler Awards from the University of Pennsylvania School of Medicine, the Charles Mérieux Award from the National Foundation for Infectious Diseases, and was honored by Bill and Melinda Gates during the launch of their Foundation’s Living Proof Project for global health. In 2009, Dr. Offit received the President’s Certificate for Outstanding Service from the American Academy of Pediatrics. In 2011, he received the David E. Rogers Award from the American Association of Medical Colleges, the Odyssey Award from the Center for Medicine in the Public Interest, and was elected to the Institute of Medicine of the National Academy of Sciences. In 2012, Dr. Offit received the Distinguished Medical Achievement Award from the College of Physicians of Philadelphia and the Drexel Medicine Prize in Translational Medicine from the Drexel University College of Medicine. In 2013, he received the Maxwell Finland award for Outstanding Scientific Achievement from the National Foundation for Infectious Diseases, the Distinguished Alumnus award from the University of Maryland School of Medicine, and the Innovators in Health Award from the Group Health Foundation. In 2014, he was elected to the board of trustees at the College of Physicians in Philadelphia, and in 2015, he was elected to the American Association of Physicians and the American Academy of Arts and Sciences as well as being named as a Fellow for the Pediatric Infectious Diseases Society and the American Academy for the Advancement of Science. In 2016, Dr. Offit received the Franklin Founder Award by the City of Philadelphia, The Porter Prize from the University of Pittsburgh School of Public Health, and the Jonathan E. Rhoads Medal for Distinguished Service to Medicine from The American Philosophical Society. In 2017, he received the Defensor Scientiae Award and an Honorary Doctor of Science degree from The University of the Sciences in Philadelphia.

Dear Friends & Colleagues, Last week, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode here. In this series, I’ll be interviewing future-facing healthcare leaders and entrepreneurs – to ask two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? In this episode, we’ll be interviewing Andrew Parker, the founder & CEO of Papa. I recently interviewed Andrew and would encourage you to listen to this amazing entrepreneur and amazing new venture. You can find that dialogue here. Although I had recently posted that interview, Andrew was one of the first people I thought to reach out to in this limited series because of how critically important and relevant his service is in this time of social distancing, sheltering-in-place, and lockdowns. Papa is an on-demand service designed to deliver companionship and non-clinical services to seniors and families. These non-clinical services are delivered through so-called ‘Papa Pals’ who are college age students who assist in a number of ways including household activities, transportation, shopping, filling out forms… Another reason I reached out to Andrew was to learn how Papa had dramatically pivoted its service model to adapt to COVID-19. It’s such a delight speaking with Andrew. His energy, enthusiasm, and vision; as well as his accomplishments and outcomes with Papa are uplifting, and provide us with tremendous hope for the future. These are unprecedented times, so I hope you find valuable information, guidance, and inspiration in listening to these experts and entrepreneurs share how they are adapting to this pandemic (in real time); and how they’re thinking about and planning for the future. Until next time, be safe and be well, Zeev Neuwirth MD

Dear Friends & Colleagues, Last week, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode here. In this series, I’ll be interviewing future-facing healthcare leaders and entrepreneurs – to ask two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? In this episode, we’ll be interviewing two digital innovation superstars from Providence – Sara Vaezy & Maryam Gholami. Providence is one of the most progressive and innovative integrated delivery systems in the country. As a result of their long-term investments in healthcare transformation, they are incredibly well prepared for the current situation, and also well prepared to be highly adaptive and agile over the next few months and years. Lots of lessons to learn from this organization! What you’ll hear in this interview will include: A ‘consumer hub’ which includes a chatbot “Grace” that assesses and navigates patients to appropriate care – and how that’s been adapted for COVID-19. How Providence has pivoted the use of their online ‘on-demand’ platform “Express Care”, which includes ‘virtual video visit’ services that have now also been adapted to deliver chronic disease management in addition to the already existent urgent-care visit use. The greater than 10-fold increase in the number of virtual visits that Providence has been able to scale up to in the past few weeks! (A fact that is highly illustrative of the rapid shift, Providence has conducted more virtual visits in the first 3 weeks of March 2020 than in the entire year of 2019) The accelerated advances Providence is deploying in home-monitoring of higher risk patients; as well as their focus on the behavioral health of patients and providers. How diligently the Providence digital development and marketing teams are listening to the continuously shifting needs and expectations of their healthcare consumers/patients; and how rapidly they are iterating their products and services to accommodate. Providence is a not-for-profit Catholic health system comprising 51 hospitals as well as 1,085 clinics and other health services, with over 119,000 caregivers serving communities across seven states. Sara Vaezy leads the overall development of the digital strategy, digital partnerships, new business commercialization and business development. Maryam Gholami is the Chief Product Officer for digital innovations. She leads product development, commercialization, and growth of the consumer digital portfolio. She is also responsible for leading the applications of advanced technologies such as AI and machine learning. These are unprecedented times, so I hope you find valuable information, guidance, and inspiration in listening to these experts and entrepreneurs share how they are adapting to this pandemic (in real time); and how they’re thinking about and planning for the future. Until next time, be safe and be well, Zeev Neuwirth MD