The Race to Value Podcast

The only way for the health care sector to sustainably contain costs and fulfill its mission is by putting the patient — and the delivery of outcomes that matter to patients — at the center of the industry’s efforts. We must align incentives around the continuous improvement of health outcomes in a cost-effective matter. This is what value-based health care is all about – better health outcomes to patients for the money spent. Contrary to traditional approaches to health system reform that emphasize cost containment, value-based health care shifts the focus to continuous improvement in the outcomes delivered to patients. On the Race to Value this week, we are joined by two of the four authors from the new healthcare book, “The Patient Priority”. With this book, they wrote a practical step-by-step guide for clinicians, payers, policymakers, and other industry stakeholders to lead patient-centered, value-based health care innovation. It presents case studies from leading innovators and provides a roadmap for the comprehensive value-based transformation of national health systems. On the show this week is Stefan Larsson, MD, PhD — an independent advisor in health care and life sciences, and a senior advisor to Boston Consulting Group (BCG).  Joining him is Robert Howard, a former senior editor at Harvard Business Review and MIT Technology Review who collaborates with BCG on the topics of value-based care and health system transformation.   Episode Bookmarks: 01:30 Putting patients first is the only way for the health care sector to sustainably contain costs and fulfill its mission. 02:00 Introduction to Stefan Larsson, MD, PhD and Robert Howard and their new book, “The Patient Priority.” 03:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:30 The Triple Crisis:  There is a Crisis of Value, a Crisis of Evidence, and a Crisis of Purpose in American Healthcare! 05:30 How the vicious cycle of how a continued explosion of medical research knowledge drives higher costs due to anxiety and lack of guidance. 07:00 The crisis of outcomes (e.g. obesity, declining life expectancy) have persisted over a long period of time. 07:30 “The health care crisis will only get worse unless there is a fundamental shift in how we lead, define success, and agree on what good looks like.” 08:00 The criticality of shifting to an outcomes measurement model that values what matters to patients. 08:30 “Outcomes that matter to patients is the essence of the future of health care.” 09:00 Why the value-based care movement should focus more on the system than the individual provider organizations. 09:30 “The only way individual organizations can sustain value-based change is if we transform health systems as a whole – on a regional, national, and even international level.” 10:00 Health care is a complex adaptive system, and you don’t change it through rules-based policy. 11:00 “Measuring outcomes in accordance to what matters to patients should be the key metric to drive change in health care.” 12:30 This importance of clinical registries that collect comprehensive data on health outcomes in a population of patients with the same condition. 13:00 How a fragmented specialty-dominated healthcare system limits our ability to develop consensus standards for measuring outcomes that matter to patients. 15:00 “By measuring the outcomes that matter to patients, we take a holistic view of health care.  We can then integrate all the different professional capabilities in the most ultimate way.” 15:45 The important work of the International Consortium for Health Outcomes Measurement (ICHOM). 16:00 How Sweden is a driving force for the international adoption of patient-centered outcomes measures and clinical registries. 17:30 Why a health care comparison of Sweden to the United States is relevant. (Patient needs are the same!) 18:00 Stefan discusses how his partnership with Michael Porter led to the development of global standards for health outcomes measures through ICHOM. 18:45 A health system’s scientific approach for improving patient outcomes with acute myocardial infarction. 19:30 Outcomes measurement as a holistic approach to team-based, value-based care. 20:00 A decade of ICHOM’s work in leading a global movement for the adoption of standardized patient reported outcome measures. 21:30 “Patient registries are so much more than databases.  They are systems for continuous improvement and accelerate learning for professional communities.” 23:00 How the Cystic Fibrosis Foundation and Kaiser Permanente are excellent examples of how patient registries can be utilized in the U.S for continuous improvement. 24:00 The work that Blue Cross Blue Shield of Michigan is doing to propagate best practices in outcomes measurement. 26:00 Three leading exemplars that have a patient-focused approach to care delivery: Martini Kiinic (Germany), Oak Street Health, and Kaiser Permanente. 27:00 What can value-based care leaders learn from a prostate cancer clinic in Germany? 28:45 How incumbent healthcare organizations can utilize patient segmentation, accountability, and expert consensus in establishing outcome measurement goals. 29:30 Examples of how Cleveland Clinic and the Karolinska University Hospital (Sweden) completely reengineered healthcare delivery around specific patient groups. 30:00 “Defining success in outcomes measurement provides more autonomy to clinical care teams and allows them to organize around patients instead of specialties.” 30:30 Bridging fragmentation by coordinating care delivery along the provider chain. 31:00 How Martini Kiinic (Germany), Oak Street Health, and Kaiser Permanente are different but the same (e.g. focus on population segments, team-based care, data-driven). 33:45 A deeper exploration into patient-focused outcomes measurement and the team-based culture at Oak Street Health. 35:30 How Kaiser Permanente started a bus line to help unemployed patients access transportation so they can find employment. 37:30 Four examples of value-based change management:  Santeon, Erasmus MC (both in the Netherlands), Karolinska University Hospital, Intermountain Healthcare. 38:30 Visionary Leadership in value-based care transformation. 39:00 Martini-Klinik’s founder, Hartwig Huland, made the decision to focus narrowly on one field, prostate surgery, to lead the organization in VBC transformation. 41:30 An example of the transformational leadership of Marc Harrison (former Cleveland Clinic Abu Dhabi and Intermountain CEO). 42:30 Defining the strategy in value-based health care and navigating change management during system transformation. 43:00 Accepting responsibility beyond your own institution to improve the overall health system. 44:00 How Toby Cosgrove led both system-level and national health care transformation. 44:30 “Value-based health care can’t be done in isolation. It can only happen at scale when all stakeholders are aligned. Leaders must transform beyond the borders of their institution.” 46:00 Transformation VBHC can also happen from leadership in the middle of the organization. 50:00 The evolution of value-based payment innovation – from Medicare Advantage in the U.S. to experimentation with bundled payments in health systems around the world. 51:30 What does the transition from volume to value really mean?  (It won’t work unless it is holistic with payment focused on outcomes.) 53:45 The correlation between outcomes measurement reporting and payment models like Medicare Advantage capitation and episode of care bundles. 56:30 “In the U.S., value-based health care is all too often reduced to risk-based contracting.  Our view is that this is an oversimplification.” 57:30 “Medicare Advantage is a stimulus to value-based care innovation, but it still needs to become more connected to systematic outcomes measurement.” 58:30 The testing of payment models by CMMI shows mixed results.  The Innovation Center Strategy Refresh emphasizes an increased focus on outcomes measures. 61:00 Continued challenges in healthcare with data siloing and limited interoperability. 62:00 The need for data sharing to overcome health care complexity necessitates public-private investments in data security. 63:00 Additional investments in interoperability and health care informatics. 64:00 Artificial Intelligence and Machine Learning in patient outcomes for improved population health. 65:00 The ubiquitous use of outcomes measures through digital learning platforms will transform the health of the world. 66:00 CORAL:  Community in Oncology for Rapid Learning (an example of a leading AI-based digital learning platform at a global level). 67:00 The moonshot opportunity for value-based health care is not unlike John F. Kennedy’s 1962 decision to land a man on the moon b the end of the decade. 68:00 “The beauty of a patient-centric and outcomes-focused approach to health care is the alleviation of human suffering for all citizens across the world.” 69:00 The global approach to health care reform is not overly optimistic – it can be achieved. 71:00 COVID-19 has broken down pathways to international collaboration, yet there are countless examples of local innovation. 72:00 Imagining a world where heroic clinicians unite to form a better health care system.

In the universe of value-based care transformation, there has been one disease that represents a metaphorical black hole, where the gravitational pull of fee-for-service is so strong that nothing can escape. These patients experience the fullest depths of pain and despair, and this chasm is so deep and wide that there is only darkness. You may have guessed it, but we are talking about chronic kidney disease, a condition that impacts 37 million people in the U.S. The suffering of those inflicted with CKD is so immense, yet the Medicare reimbursement system is designed to fail this patient population. In fee-for-service medicine, we wait until patients succumb to end-stage kidney disease, where they crash and burn and need costly dialysis to stay alive for a little while longer. Because of this flawed reimbursement model, Medicare pays over $125 billion for people with all stages of renal disease, which is around 20% of all Medicare spending!  Unless we go upstream and start engaging patients prior to kidney failure, success in value-based kidney care will be limited.  We must “give life” to this patient population in the Race to Value! The giving of life and that is what DaVita Kidney Care is doing.  In fact, the name DaVita is an adaptation of the Italian phrase for giving life. In value-based care, DaVita works with healthcare payers and providers to develop and implement care delivery models that focus on improving outcomes and reducing costs for CKD patients. And I am excited to share with our listeners, that our guest this week is Dr. Adam Weinstein, the Chief Medical Information Officer for DaVita. Dr. Weinstein works across numerous lanes helping bridge the intersection of IT, clinical nephrology, and healthcare policy. He is focused on delivering IT tools that take advantage of DaVita’s clinical data and help nephrologist and DaVita teammates deliver the best care possible.  A kidney doctor from Maryland, Dr. Weinstein is passionate about slowing the progression of chronic kidney disease in patients. This was such an outstanding conversation with one of the true innovators in technology and clinical care! Episode Bookmarks: 01:30 The importance of crossing the chasm of chronic kidney disease, a condition that impacts 37 million people in the U.S. 02:30 Introduction to Dr. Adam Weinstein, the Chief Medical Information Officer for DaVita Kidney Care. 03:30 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:30 Dr. Weinstein shares how his lived experiences and positive mindset have shaped his work as a nephrologist, healthcare executive, and technology innovator. 06:45 Treating kidney disease costs Medicare $130B – although CKD patients are 1% of the population, they account for over 7% of all Medicare spending! 08:30 An overview of the DaVita Integrated Kidney Care (IKC) program and how it produces solid results through data enablement and relationship building. 10:30 Integrated Kidney Care accomplished through people working in collaboration, predictive modeling, and population health management. 11:30 Facility versus At-Home Dialysis and the empowerment of patients through education and health literacy. 12:30 An overview of DaVita’s participation in value-based care payment models focused on CKD and ESKD. 14:30 Dr. Weinstein on how to bring scale to value-based payment innovation in kidney care. 16:00 The need for specialist and care team coordination that goes well beyond the office visit. 17:00 Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) Models and how they provide financial and philosophical alignment for integrated care. 18:00 The challenges of including broader specialties and building an advanced data infrastructure in value-based kidney care. 19:00 The “clinical nebulous” that requires a longer runway for value-based payment model innovation to deliver improved patient outcomes. 22:00 The Relative Value Scale Update Committee (RUC) and how it provides recommendations for setting payment amounts for different physician services. 23:30 The challenges of valuing the technical aspects of physician services that reward procedural intensity versus cognitive services that require critical thinking. 24:00 The tension that a Relative Value Unit system provides in a healthcare system evolving to value-based care. 27:00 Black Americans are 3.5X more likely than White Americans to experience kidney failure. (Black Americans are also less likely to do home dialysis or get a kidney transplant.) 28:00 “Value-based care arrangements are one step toward solving health inequities.” 29:00 The need for a culturally sensitive and contextual understanding of health determinants to address disparities in care. 32:30 “The single most important trust building issue in healthcare is the assurance that we have a caring workforce.” 33:00 How DaVita ensures that its facilities are equipped with motivated, engaged, and culturally competent care teams. 34:30 Addressing clinician burnout through the provision of robust talent pipelines. 36:00 The need to focus on early CKD detection so interventions can happen earlier to slow the progression of disease. 37:00 How lab tests to screen kidney function are not always the best diagnostic indicator for early detection of CKD. 38:30 The role of nephrologists in assuring an effective care regimen. 39:00 The use of Artificial Intelligence to help predict the progression of CKD to ESKD or the likelihood of a hospitalization. 41:00 How risk models that predict future likelihood of dialysis can drive crucial conversations with patients. 42:00 The need for clinical experts to interpret AI predictions in a way that can drive meaningful patient interventions. 43:00 Innovation Results at DaVita (e.g. survival rates for dialysis patients, cost improvement in dialysis, increase in home dialysis, lower hospitalizations). 44:30 Dr. Weinstein discusses DaVita’s innovative approach to data and how it informs an enhanced understanding of value-based care as a clinician. 46:30 The development of a CKD-specific EHR system to drive value-based care at a practice level. 47:30 How data integration and HIEs can bring about improved care delivery with independent providers on disparate EHR systems. 47:45 “Chronically ill patients are similar to projects that need their own personalized Gantt Chart to drive care delivery with enhanced outcomes.” 48:45 The importance of patient- and population-level data at the point-of-care, alongside performance benchmarking tools. 51:00 A brief update on Mozarc Medical – the new venture between DaVita and Medtronic established to develop new kidney care technologies and at-home treatments. 52:45 DaVita Venture Group (DVG) invests in companies that are aligned with DaVita’s mission of improving the quality of life for patients with kidney disease. 54:30 Impacting the kidney space at scale through capital investment in innovation. 56:30 Achieving success in value-based kidney care through people, process, and tools. 58:00 Aligning clinicians for the future of value-based care.

Data enablement has the power to transform American Healthcare. It can foster trust between patients and clinicians and make healthcare more accessible, affordable and equitable. This future of an open and connected health ecosystem may seem elusive, but it’s not out of reach. Technology will not hold us back — instead our biggest challenge will be creating a value-based model of care where new innovations can thrive.   This week we our joined by Dr. David Feinberg, the Chairman of Oracle Health. Dr. Feinberg is committed to advancing thought leadership and strategy related to unleashing the healing power of data through an open and connected healthcare ecosystem.  Previously Dr. Feinberg served as president and CEO of Cerner, now Oracle Health, where he led teams delivering tools and technology to improve the patient and caregiver experience. He has also served as the VP of Google Health, and he served as the President and CEO of Geisinger where he led a complex turnaround and guided Geisinger’s transition to value-based care.  Episode Bookmarks: 01:30 Introduction to Dr. David Feinberg, Chairman of Oracle Health. 02:45 The massive generation of data by humankind in the modern day (projected to be 175 Zettabytes by 2025). 03:45 Approximately 80% of healthcare data today is unstructured. 04:30 People are dying unnecessarily and suffering poor outcomes despite the amount of data generated by the healthcare system. 05:30 “Healthcare fundamentally is people caring for people. Data is secondary; the primary aspect of healthcare is trust.” 06:30 Making Electronic Health Records usable is of paramount importance (PCPs Need 27 Hours a Day to Do Their Best Work!) 07:00 Digitizing the medical record has made clinical workflows humanly impossible and compromises trust. 07:30 The vision for an open and connected health data ecosystem. 08:45 The Meaningful Use program did nothing for EHR usability (an example of the Gartner Hype Cycle). 10:00 Dr. Feinberg’s clinical and executive leadership background provided a great lesson in technology adoption. 11:00 Can there be a high level of technology adoption in healthcare like Google dominates the non-healthcare marketplace? 12:30 We have solved for interoperability, but healthcare lacks a level of usability to allow a true longitudinal health record. 14:00 Motivating doctors for high performance ultimately comes down to the data scorecard. 15:00 Knowing the game (volume vs. value) and the promise of data enablement in value-based care. 16:00 The 21st Century Cures Act and the path forward in interoperability. 17:00 Can scalable FHIR-based interoperability and Open APIs eventually reach critical mass in the U.S. to improve population health? 19:45 Dr. Feinberg describes the two points of failure by technology companies trying to disrupt the healthcare ecosystem. 20:30 How Oracle Cerner is designing an intelligent, cloud-enabled platform to change healthcare for the better. 22:00 An example of disruption with Internet Banking and how application of those principles could change the healthcare system. 23:45 Digitization of medical records was a requisite first step. 24:00 Integration and normalization of disparate data sets provides an opportunity to create data intelligence. 25:00 How Larry Ellison’s impatience for healthcare disruption clashes with the realities of the industry. 26:30 Recognizing the “life and death” aspects of healthcare transformation. 27:00 Making incremental progress with a digitized medical record…and then COVID happens to accelerate value-based care! 29:00 Workforce burnout and EHR usability – “Simplicity is the ultimate art of sophistication.” 30:00 “Value-based care is ultimately the best way to address the root cause of burnout in the workforce.” 30:45 The need for UX in the design of EHR applications to optimize physician workflow. 31:30 Results in usability redesign — ex: 19% reduction in nursing time at the terminal, 8M less clicks at one health system. 31:45 “The future of EHRs has to be where everything is voice-enabled. Physicians and nurses should be freed from the terminal.” 32:30 An example of how sophisticated AI can be used to generate EHR documentation in a regular primary care visit. 33:30 Nurses spend half their time at the terminal. (Voice-enabled EHR documentation could double the nursing workforce!) 34:30 The game changing nature of voice-enablement.  This innovation is in our lifetime! 36:00 The historical opportunity to address health inequities. 37:00 The Oracle Cerner Learning Health Network — unlocking the power of data to improve health equity. 38:00 Using clinical trials to build a foundational infrastructure for equity. 39:00 The use of advanced AI and clinical trials to improve diagnostic capabilities and clinical outcomes. 41:00 The movement to precision-based care to personalize treatment (ex: genomics, wearables) 42:00 Geisinger’s population-based precision health model and how it drives patient-specific care pathways. 43:00 Making data understandable and culturally sensitive for patients in order to improve adherence. 44:00 Parting thoughts — the importance of making healthcare understandable, accessible, and affordable. 46:00 Why sharing of best practices is so important for the future of our industry.  The time is now!

Dr. Stephen Klasko is a transformative leader and advocate for a revolution in our systems of health care and higher education. He has been a university president, a dean, a CEO, and an obstetrician, and now pursues his vision for the creative reconstruction of American healthcare by bridging traditional academic centers with entrepreneurs and innovators. His passion is using technology to eliminate health disparities and offers everyone the promise of health assurance. Dr. Klasko is also a lifelong DJ who believes that the message in the music can give us the courage to tackle a broken, fragmented, unfriendly, expensive, and inequitable healthcare system. In this episode, Dr. Klasko merges with his alter ego “Stevie K the DJ” to discuss his new book, “Feeling Alright: How the Message in the Music can Save Healthcare” published by ACHE.  Feelin’ Alright leverages the emotional power of song lyrics to inspire healthcare executives to envision and build a more accessible, high-quality, and equitable healthcare system. Using music as a metaphor,  Dr. Klasko encourages us to examine what is problematic in the existing healthcare model and to take tangible steps toward a more consumer-centered healthcare experience. Infused with the passion inherent in music, this interview motivate healthcare leaders to take the lead in building a better healthcare system! Episode Bookmarks: 01:20     DJ Eric “The Dream” Weaver introduces Dr. Stephen Klasko (aka Stevie K the DJ)! 03:30 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:30 Using the power of music to inspire a more optimistic world. 05:30 Dr. Klasko discusses his prior career as a DJ and how getting fired started him on the path to medicine. 06:30 Using music at Jefferson to inspire his others to find hope in overcoming the pandemic, financial tsunami, and systemic racism. 07:00 “Choice of Colors” by Curtis Mayfield and the Impressions (healing during the George Floyd protests) https://www.youtube.com/watch?v=Zr0SLv9WFr4 07:45 “Courage to Change” by Sia become a theme song for frontline workers and their heroic response to the COVID-19 pandemic. https://www.youtube.com/watch?v=mWQACEqf4QY 10:00 Health care delivery during the pandemic was a war and how music helped to see a brighter day. 10:45 “We have to stop saying we are the best healthcare system in the world.” 11:00 “Medicine’s Dilemmas: Infinite Needs Versus Finite Resources” and the “Iron Triangle” of Healthcare 11:30 The performance of stocks as evidence for flawed thinking around healthcare disruption. 12:30 Kaiser Permanente and Geisinger come together to launch Risant Health and expand access to value-based care. 13:00     Payer-Provider Alignment in Medicare Advantage 13:45 Cityblock Health leveraging capital investment to build a Community Health Worker model for population health. 14:30     Taking population health, social determinants, predictive analytics, and health equity to the mainstream of healthcare. 14:45 “Keep the Customer Satisfied” by Simon & Garfunkel as inspiration for health assurance to rebuild trust and equity in a broken system. https://www.youtube.com/watch?v=qx6_0Do0qGQ 17:00 In healthcare, do we really view the people as the customer? 18:00 The healthcare system is setup to enrich the people in control. 18:30 “The concept behind health assurance is that costly sick care will give away to affordable, personalized, and preemptive care, partly through genomic sensors and AI-based digital therapies.” 19:00 The future of Jefferson as a health system without a location. 20:00 Livongo and Jefferson Health — a strong, sustainable partnership between technology and providers to remake medicine. 21:00 Poor consumer segmentation in American healthcare (viewing patients monolithically). 22:45 Radical change needed! (collaboration, concentration on health disparities, creativity, and portfolio diversification) 24:00 Dr. Klasko’s prediction for the future market landscape of health systems and hospitals. 25:00 “Mr. Roboto” by Styx bemoans the plight of ‘modern man’ oppressed by technology and is a cautionary tale for the use of tech-enabled healthcare. https://www.youtube.com/watch?v=uc6f_2nPSX8 27:30 The interface between technology and humans (“When offline meets online, what happens to the human in the middle?”) 27:45 Elon Musk and Generative AI 28:00 The importance of recognizing change in society when selecting and training medical students. 29:00 How do we create humans that are more human than robots, instead of more robotic than robots? 29:45 Retraining doctors and faculty who “joined a cult” when entering medicine. 30:00 The lies to providers that technology would make their life easier. 31:30 Building a relational bridge between healthcare leaders and generative AI. 32:00 Failure of IBM Watson vs. Success of Aidoc (why it is important to augment – not replace human intelligence). 33:00 “I am Changing” by Jennifer Hudson from the movie Dreamgirls – a theme song for American healthcare delivery in the 2020s. https://www.youtube.com/watch?v=4UfyVZNejSE 35:30 “Hospital CEOs need to think like Target and Walmart trying to compete with Amazon.” 37:45 Why hospital billboard ads and commercials make no sense! 38:30 The new marketing in healthcare is all about consumerism (helping patient navigate, offering convenience, inspiring loyalty). 39:45 “We need to demonstrate value by giving consumers a single point of contact to create a seamless experience across the continuum.” 40:00 The Amazon acquisition of OneMedical is emblematic of a failed primary care model that lacks consumerism. 41:00 The inevitable failure of Chief Marketing and Growth Officers that are aging white men. 41:45 Examples of innovation:  Strongline (staff safety) and Guild (upskilling the workforce) 43:00 Dr. Austin Chang and his incredible work as a Chief Medical Social Media Officer at Jefferson. 44:00 Overcoming the “poor me” mentality (embracing payer-provider alignment, lower costs, consumerism,Jand portfolio diversification). 44:30 “For the Love of Money” by The O’Jays speaks to the destructive impact that a singular focus on money and profit can have on individuals and society at large. https://www.youtube.com/watch?v=GXE_n2q08Yw 44:30 The Maryland All-Payer Model – mandated global budgets for hospitals achieved great success. 46:30 Dr. Klasko discusses the concept of a single payer by state model. 47:45 Fear and greed caused by the flow of money into politics. 48:30 Direct patient marketing of expensive, specialty drugs. 49:00 Spending 4X more for obstetrical care than other countries (with far worse outcomes). 50:00 The dilemma of expecting a system to change when salaries depend on it not changing. 51:00 Our healthcare system does absolutely great! (for plaintiff’s lawyers, specialists, pharma and insurance industries, EMR companies, PBMs, and patients with unlimited resources who have the best insurance) 52:00 The unconscionable deaths of people during the pandemic who died at home when telehealth companies made record profits. 53:00 The need for companies to fail. 54:00 “Born This Way” by Lady Gaga as an anthem for self-acceptance and celebrating diversity. https://www.youtube.com/watch?v=wV1FrqwZyKw 55:30 Dr. Klasko on how zip code and living conditions mean more to life expectancy than one’s genetic code. 56:30 Dr. David Nash and his landmark population health research on Social Determinants of Health. 57:00 “In a practical world, a health system CEO is incentivized to keep their population as healthy as possible.” 57:30 The radical shifts that took place at Jefferson Health to improve health equity. 60:00 Solving for food deserts through bar coding and drone delivery. 61:00 The challenge of focusing on SDOH interventions when fee-for-service revenue declines. 62:00 “The Myth of Trust” by Billy Bragg as a somber reminder that people have lost trust in institutions. https://www.youtube.com/watch?v=evAJlMotrFM 63:00 Lack of trust in the healthcare system (citing the failure of GPS technology to improve health) 64:30 Distrust with genomics testing and the privacy of data. 65:30 Patients being able to monetize their own data when participating in clinical studies. 66:30 Nurses who feel that CEOs do not care about them. 67:00 Reinstating healthcare as a public good with servant leadership at the helm. 68:00 “Don’t Stop Believin’” by Journey https://www.youtube.com/watch?v=1k8craCGpgs 69:00 The future of 3D printing, RPM, and digital medicine in serving humankind alongside compassionate providers 70:00 Dr. Klasko describes a future scenario in 2033 where technology could prevent a global pandemic. 73:00 Optimism for the future of health assurance with currently available technologies. 74:00 “Will it Go Round in Circles” by Billy Preston as reminder that we do not want to reform healthcare 360 degrees! https://www.youtube.com/watch?v=W1TmIhddn0c

In rural communities, the transformation towards value-based care is an ongoing journey rather than a fixed destination. Rural healthcare faces unique challenges such as geographic barriers, limited resources, and reduced access to specialized care. The value journey in these communities involves adapting care models to meet the specific needs of rural populations. It requires innovative solutions to overcome barriers which can bridge the distance between patients and healthcare providers.  It represents a fundamental shift in healthcare delivery, focusing on improving patient outcomes, enhancing the patient experience, and controlling costs. Ultimately, this journey involves continuous adaptation, collaboration, and innovation that is fostered by a mission-driven culture to improve community health and wellbeing. One of this nation’s leading examples of value-based rural health transformation is the Bassett Healthcare Network, and we are joined this week Leonard Lindenmuth, their Vice President of Strategy and Population Health.  Since 2014, he has been leading value-based care transformation throughout Central New York. In this episode you will learn about what it takes to lead a successful value journey through a cultural evolution that increasingly seeks innovation to improve rural health outcomes.  We discuss such topics as risk progression, the use of commercial ACOs as a learning laboratory in value-based care, population health playbook success that focuses on pharmacy optimization and interdisciplinary team-based care, deploying remote patient monitoring to rural populations, how workforce burnout is related to fee-for-service payment, and the importance of SDOH innovation to better serve vulnerable patients in underserved communities.   Episode Bookmarks 01:30 Introduction to Leonard Lindenmuth, DHA – Vice President, Strategy & Population Health, Bassett Healthcare Network 02:00 Bassett Accountable Care Partners, LLC – BHN’s Accountable Care Organization founded in 2014 03:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:30 How a data-enabled value-based care journey changed the culture of the health system. 05:45 “The value journey helped us understand much more about ourselves so we can better care for our rural communities. It has evolved our culture.” 06:00 A calculated progression to downside risk as a rural healthcare provider. 09:00 An increase in Medicare Advantage penetration in the marketplace and how that is impacting value-based care strategy. 10:00 Developing a co-branded regional MA product and the intention to take aggregated risk with a national MA plan. 12:00 Leveraging brand equity of the health system to develop a MA plan in the future. 12:30 Approaching MA risk-readiness of providers through coding education. 13:00 “MA Risk is clearly on the horizon.” 14:45 Leonard describes BHN’s commercial value-based playbook strategy that includes focus on pharmacy spend. 15:30 The Ambulatory Intensive Pharmacotherapeutics (AIP) program to reduce pharmacy costs through lower medication-related adverse events, avoidable hospital admissions and ED visits. 16:00 How the AIP program reduced BHN’s commercial spend on pharmacy through comprehensive medication management. 16:30 1% of the population drives 55% of specialty drug costs. 17:00 Risk progression in a two-sided risk arrangement with Excellus Health Plan (a local Blue Cross affiliate). 18:00 What being in a Commercial ACO has taught BHN about value-based care transformation. 18:30 How a rural health system balances the “two canoes” – volume vs. value. 19:00 “We have to get to a point where value drives the equation, but it is not an overnight transformation.” 19:30 How a healthcare organization performs better – both financially and clinically – under a fully-capitated environment. 21:30 An alarming divergence of health outcomes and life expectancy between urban and rural populations. 22:00 The challenges of improving population health in rural communities that are highly agricultural and farm-based. 23:00 Leveraging remote patient monitoring and other digital devices to better serve rural populations in upstate New York. 24:00 Bridging the digital divide in rural communities where access to broadband access is limited. 24:45 The Bassett Research Institute conducts research to understand and improve the health and well-being of rural populations. 25:00 Leonard describes the rural community of Cooperstown, New York and how their patient population is challenged by SDOH (lack of transportation, housing instability, food insecurity). 26:00 Medicaid expansion in New York fostered partnership and innovation with Community Benefit Organizations (ex: partnership with a local food bank). 28:00 Creating an anchor institution in a community where the health system is an enabler of improvement in social determinants of health. 29:00 Moving the needle on value by moving closer to the premium dollar and building infrastructural capability to manage delegated premiums from payers. 30:00 The maldistribution of premium dollars that disproportionately benefits insurers through excess profits (at the expense of health system investment to improve patient outcomes). 31:30 The imperative to adopt a payment system that supports lower costs and improved population health outcomes. 32:00 The importance of knowing trends in medical claims costs and utilization. 33:00 Being conscious of what you are getting into when it comes to assumption of risk-based payment. 33:45 Lessons learned from building a vertically integrated system and how that informed perspective on opportunities in a risk-based world. 34:45 Referencing prior podcast — Ep 141 – Cultivation of Physician Wellbeing in the Value Journey, with Dr. Dike Drummond, Dr. Moshe Cohn, Dr. Amadeo Cabral 35:00 How capitation can alleviate workforce burnout and moral injury. 36:00 The unsustainable pharmaceutical cost trajectory, with Americans spending an average of over $1,500 per person on prescription drugs, paying much more than comparable nations. 37:00 Leonard discusses the challenges of pharmacy spend and how Comprehensive Medication Management (CMM) has become an important area of focus in their population health playbook. 39:30 Understanding disease-specific use cases for pharmacy optimization and the340B Drug Pricing Program. 40:30 “Increased pharmacy spend is only acceptable if it crowds out medical spending on the inpatient side.” 41:30 The role of pharmacists in interdisciplinary team-based care and how they can meaningfully collaborate with physicians. 43:30 Value-added pharmacy programs that create a win-win-win for patients, providers, and payers. 45:00 The ticking timebomb of the healthcare workforce! 46:30 Alarming rates of nursing turnover resulting in higher costs due to increased reliance on agency nursing. 48:00 “At any given shift, we are down anywhere from 6-16 nurses. We have the demand to fill our beds, but we can’t get them in because of the nursing shortage.” 49:00 How nursing burnout is ultimately related to the dependence on a fee-for-service payment model. 50:45 New York is one of a number of states that is attempting to address the social needs of Medicaid enrollees through Section 1115 waivers with SDOH-related provisions. 53:00 Economic development zones and SDOH networks in New York supported by Section 1115 demonstration projects. 55:00 Examples of innovative SDOH programs (ex: giving patients free air conditioners to prevent acute exacerbations of chronic asthma). 56:30 Tackling disparities in care through VBC will drive community health outcomes (more so than philanthropic support of CBOs). 58:00 Parting comments on the challenges of health equity transformation.

This week is National Nurses Week, and it is a time to honor the contributions and sacrifices of nurses who perform some of the most difficult and heartbreaking tasks in the medical world.  As workers who perform the most essential healthcare tasks, nurses serve as the first point of contact for most patients…and they save lives and restore health in the process.  Yet, nursing is often a thankless profession that is underappreciated and experiences high levels of burnout and moral injury.  There are a multitude of factors related to societal attitudes towards the nursing profession, and many of them result in a lack of recognition and support, inadequate compensation, limited opportunities for career advancement, and ultimately a lack of respect and appreciation for the work they do.  We must begin to think about how to better position the profession to take a leading role in healthcare innovation.  Nurses must become more empowered as we transition to a future of value-based care. This week on the podcast, we are honored to be interviewing Rebecca Love.  She is an experienced nurse executive, the first nurse featured on Ted.com, and part of the first nurse panel at South by Southwest. Rebecca is a regular contributor on the Forbes Business Council, and has been featured in BBC, Fortune, Becker’s, Forbes, Chief Healthcare Executive Magazine and ABC news. Rebecca, was the first Director of Nurse Innovation & Entrepreneurship in the United States at Northeastern School of Nursing – the founding initiative in the Country designed to empower nurses as innovators and entrepreneurs, where she founded the Nurse Hackathon, the movement has led to transformational change in the Nursing Profession. In early 2019, Rebecca, along with a group of leading nurses in the world, founded and is President Emeritus of SONSIEL: The Society of Nurse Scientists, Innovators, Entrepreneurs & Leaders, a non-profit that quickly attained recognition by the United Nations as an Affiliate Member to the UN. Rebecca is a world renowned Nurse Entrepreneur and currently serves as the Chief Clinical Officer of IntelyCare. Click here to learn more Episode Bookmarks: 01:30 National Nurses Week – a time to honor the contributions and sacrifices of nurses who perform some of the most difficult and heartbreaking tasks in the medical world. 02:00 We must better position the nursing profession to take a leading role in healthcare innovation.  Nurses must become more empowered as we transition to a future of value-based care. 02:30 Introduction to Rebecca Love – a nationally-recognized nurse executive and entrepreneur, the first nurse featured on TED.com, and part of the first nurse panel at SXSW. 03:00 Rebecca founded and is President Emeritus of SONSIEL: The Society of Nurse Scientists, Innovators, Entrepreneurs & Leaders and currently serves as the Chief Clinical Officer of IntelyCare. 04:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:30 How do we better position the nursing profession in the value-based care movement? 06:30 “There is going to be no healthcare in the future without nurses leading value-based care.” 07:00 How tracking VBC outcomes by Provider NPI # is a challenge since nurses do not have assigned NPI #’s. 07:45 Nursing costs were rolled into room rates in the 1930’s with the establishment of modern-day insurance models. This occurred due to a male physician-dominated environment. 08:30 Nurses are the only clinical professional in the healthcare environment without a NPI for billing or tracking outcomes! 08:45 “Value-based care cannot fully be amplified or adopted until we address the lack of a NPI number with nurses.” 09:30 The infuriating pay inequity between executives and nurses. (Nonprofit hospital CEOs make on average 10X the rate of nurses!) 10:00 Should we align compensation to both executives and clinicians tied to patient outcomes? 10:45 North Carolina’s seven largest hospital systems reaped billions of dollars in profit from COVID Relief Funding but couldn’t afford to pay nurses!  (Read more hereand here) 12:00 CEO pay doubled over five years in North Carolina, but nursing pay there only increased 12-14% over the last decade! 13:00 The national increase in nurses pay over the last decade was 1.6% per year(less than the increase in cost of living). 13:45 The UK Nurses Strike – the largest labor protest in the history of the nursing profession. 14:00 How the cost allocation methodology for nursing will cause continued exacerbation of the nursing working shortage in the U.S. 14:45 “We have to find a way to unpack nursing overhead from the room rate to make sure our healthcare system stays operational and can support our communities.” 15:30 Inspiration from President John F. Kennedy about recognizing the opportunity in a crisis. 16:00 There is a shortage of 450,000 nurses in the US today, and it is projected that over 1 million registered nurses in the U.S. will leave the workforce by 2030. 16:45 70% of new nursing graduates have left the bedside since last year! 18:00 Rebecca speaks about the compassion and empathy of nurses and how they are suffering due to burnout and moral injury. 19:30 How the healthcare industry treats nurses like an “endless commodity” and does little to address their burnout. 20:00 What if we invested only a quarter of what we spend in healthcare technology on nurses? 20:30 “Nurses have been degraded and relegated to the lowest rung of healthcare delivery today. If we want VBC to be successful, we must stabilize the nursing workforce.” 21:00 “Value-based care will certainly not survive without the nursing workforce at the heart and the center.” 22:00 93% of nurses are experiencing staffing shortages in their hospitals, which is a significant increase from 59% in a 2020 survey. 23:00 Last year over 90,000 qualified nursing applicants to nursing school were turned away due to lack of space! 24:00 We have more nurses today than any other time in American history, but we have a critical shortage because they are unwilling to work in the current healthcare environment. 24:30 The highly controversial RaDonda Vaught Homicide Case where a nurse was found criminally negligent for a self-reported medical error. 26:00 1 in 3 bedside nurses have left the profession since the RaDonda Vaught case! 26:30 Nurses and CNAs being criminally prosecuted for errors in long-term care delivery when not a single owner is held responsible for the unsafe care environment! 27:00 Rebecca speaks about the role of Higher Education in building bridge pathways and ensuring diversity to support the nursing workforce shortage. 30:30 Workforce challenges are now the #1 issue on the mind of hospital CEOs (ACHE Survey) 31:00 Hospitals have turned to travel nurses to ease staffing shortages during the pandemic, contract labor expenses have risen more than 250% over the past three years! 31:30 Annual burnout-related turnover costs are $9 billion for nurses! 32:30 Rebecca speaks about the need to enable more nurses to serve in senior leadership roles and as governing fiduciaries on hospitals boards to redesign care delivery. 33:30 “Innovation is opposite of the definition of insanity.” 34:00 How hackathons can be utilized in the empowerment of a nurse-led innovation movement. 35:30 Investing in technology to improve nurse staffing (e.g. improving float pool and per diem services). 35:45 80% of women nurses do not return full-time after they have a baby! (Could tech solutions provide staffing flexibility to empower nurses to continue working?) 37:00 “Reverse pitch events” – honing frontline innovation to address adverse events in the healthcare setting. 37:45 Applying the UI/UX methodology to the healthcare end user in order to improve care delivery at scale. 40:30 The lack of nursing input when health systems role out new technologies (and how these tech decisions often end up creating more work and administrative complexity). 42:30 The importance of the Chief Nurse Health Informatics Officer. 43:45 The role technology can play in Patient Safety. 46:00 The work of Healing Politics in getting nurses more involved in the political arena to reshape healthcare. 47:00 The lack of business education in nursing programs. 48:00 The need for more nurses holding political positions and why more nursing input is needed in health policy. (Betty Rambur is currently the only nurse on MedPAC.) 49:00 Nurse-led innovation happens when nurses are trying to save lives! 50:00 How the COVID-19 pandemic depended on nurse-led innovation. 51:30 “Why are we not trusting in nurses now – to hear them and trust them – so we can build the system needed to sustain workforce, sustain healthcare, and sustain our communities?” 52:00 How Florence Nightingale forever fundamentally changed the future of science, history, and medicine with the establishment of the nursing profession. 54:30 Rebecca discusses how attending a healthcare hackathon changed her life and led to a career path in nursing innovation! 60:00 What the hackathon taught Rebecca about the importance of the nurses voice and how they can save healthcare. 62:30 Parting thoughts from Rebecca and the life lesson learned from surviving a shipwreck at sea.  (Bet on yourself and believe you can overcome adversity!) 64:00 “Were there none who were discontented with what they have, the world would never reach anything better.” – Florence Nightingale 65:00 2030:  Florence Nightingale’s prediction of a future nursing renaissance.

Guest Jason Rose, expert in medication adherence and its impact on patient outcomes and healthcare costs, talks about the trillion dollar impact of medication non-adherence. The podcast explores the financial, societal, and health consequences of non-adherence, the influence of social determinants of health, challenges faced by individuals with multiple prescriptions, insulin affordability, and the role of data integration and patient-centered platforms in improving healthcare outcomes.

In value-based care, we have both an economic and a moral imperative.  What’s at stake is so much more than saving our healthcare system. It is about ensuring the continued prosperity of our nation to ensure that we leave it better for future generations. The best indicator of whether our country is on the right path is the assurance that healthy mothers can give birth to healthy children. And those children, in turn, must be assured of good care and a sound education that will enable them to face the challenges of a changing world. If we could have but one generation of properly born, educated, and healthy children, many of the insurmountable problems in our country would vanish in our lifetimes. This week on the Race to Value, you are going to hear from a value-based care leader who is boldly moving beyond with a call to action to serve our nation’s youth. Karen Wilding, the Chief Value Officer at Nemours, is on a passionate pursuit of the Quadruple Aim, and her health system is redefining children’s health in our country. Nemours Children’s Health is truly “leaning in” to the promise of population health by transforming the very definition of what it means for children to be healthy. And their value journey reflects a bold vision to create the healthiest generations of children that will take us beyond medicine by ultimately impacting the world. If you are looking for an example of inspirational leadership in value-based care, look no further than Karen Wilding and the Nemours Children’s Health System!   Episode Bookmarks: 01:30 “If we could have but one generation of properly born, educated, and healthy children, many of the insurmountable problems in our country would vanish in our lifetimes.” 02:30 Introduction to Karen Wilding, the Chief Value Officer at Nemours Children’s Health 03:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:45 Karen describes the whole-person care orientation at Nemours and how the mission of “Well Beyond Medicine” guides their value-based care journey. 06:45 Social Determinants of Health (SDOH) screening in underserved populations to expand care network and create community partnerships. 07:45 Driving “macro-system impact” as an anchor institution (e.g. best practice clinical research, cross-sector partnerships, health equity investments) 08:30 Health Equity opportunities in pediatric whole-person care (e.g. teen birth rates, preventative care access, infant mortality rates…and even household income). 09:00 “Well Beyond Medicine is a commitment to not just care for the medical aspects of children – we also care for the larger health ecosystem to create whole-child health and healthier generations.” 11:45 “Payment transformation is foundational to being able to create sustainability in value-based care.” 12:30 Karen explains how the fee-for-service infrastructure does not align incentives for healthy outcomes (e.g. asthma exacerbations with children in Delaware). 13:30 “Investing in children’s health is the single most important thing we can do as a society.” (balancing present-day economics vs. future economics). 14:45 Partnering with payers to pursue health equity transformation and the importance of community-based investments. 16:45 Nemours has been utilizing Community Health Workers to conduct SDOH screenings and individualized interventions through a culturally competent care model. 17:45 Karen explains how the interdisciplinary care team at Nemours works together to capture, assess, and address SDOH barriers. 18:45 The importance of enterprise-level buy-in when launching a SDOH population health strategy. 20:30 Overcoming fears and concerns of families in sharing personal information about their social barriers. 21:00 The creation of a national toolkit on whole-child population health and how Nemours is collaborating with policy stakeholders at the federal level. 23:30 “We want to be where children live, learn, play, and grow.  In order to address health in communities, you need partnerships.” 24:00 The role of virtual care and home health in a community-based ecosystem. 25:00 Karen describes how Nemours provides physical and behavioral health services in partnership with elementary schools. 26:00 Working with CBOs and faith-based organizations to address SDOH barriers in communities. 27:00 Partnering with government agencies (e.g. juvenile justice, CPS) to elevate the health of vulnerable children. 28:30 The focus of Nemours leadership in technology innovation to develop the system’s EHR infrastructure and digital, consumer-centric strategy. 30:45 Karen discusses the importance of technology enablement to drive population health through an omni-channel patient experience. 32:00 EHR optimization to drive clinical decision support at the point-of-care. 32:30 Leveraging analytics to bridge the clinical and claims data experience. 33:00 How the MSSP empowered healthcare organizations through the provision of claims data. (Medicaid data in children’s health is not the same.) 34:00 The need for national data standards to have consistency with all payers in the country. 35:45 1 of 6 children between the ages of 6 and 17 has a treatable mental health disorder, yet only around half ever receive treatment. 36:45 The pandemic created an increase in childhood Emergency Department utilization (25% increase in children 5-11, 30% increase in adolescents 12-17). 37:00 40% of children are living with anxiety and 45% are living with behavioral health disorders. 37:45 How Nemours is handling the pediatric behavioral health crisis through clinical integration, telepsychiatry, and digital mental health tools. 38:45 Behavioral health diagnoses is 17% more prevalent in a Medicaid population. 40:00 Referencing Daniel Dawes (“The Political Determinants of Health”): We would save over $300 billion per year if we were to eliminate American racial health disparities in our healthcare system. 40:30 Black children are 3X more likely to die in infancy than white children, 7X more likely to die from asthma attacks, and more than 3X more likely to die after elective outpatient surgery than white children. 41:00 Disparities in household income based on race and how that contributes to teen birth rates and health inequities. 42:00 Nemours commitment to equity through program development to ensure education and access. 43:00 The Chief Health Equity Officer role supports health equity transformation, community partnerships, and workflow process changes. 45:00 How payment disparities and demographical attributes between Medicaid and commercially-insured pediatric populations may contribute to health disparities (ex: asthma). 45:45 Designing a whole-person care model to ensure every child is given optimal treatment regardless of their health insurance status. 47:00 Integrated behavioral health in the primary care setting needed to make timely interventions. 49:30 Parting thoughts on the meaningful and impactful work of value-based care transformation and how that provides the passion for service-oriented leadership.

Dr. Amy Boutwell, expert in transforming care for high utilizer or multi-visit patients, discusses the MVP Method to end the cycle of care utilization. The podcast explores the challenges of managing high-utilizer patients, the importance of identifying and managing MVPs, and the transformation of care for these patients. It also explores the connection between emergency department utilization and primary care access, and the shift towards a patient-centered approach in value-based care.

Three perfect storms in recent years – the health storm produced by the COVID-19 pandemic; the economic storm that resulted from its disruptions; and the social storm that followed the murder of George Floyd which sparked fresh outrage at longstanding inequities – have sharpened and added important nuances of what health care really means. The goal of health care has always been to reduce suffering, but we must now prioritize transformation in leadership now more than ever. Building trust, eliminating inequities, and ensuring high reliability are of the highest magnitude of importance as we blaze a new path forward. This week, on the Race to Value, we are joined by Thomas H. Lee, M.D., the author of the new book “Healthcare’s Path Forward” to discuss how the healthcare industry is being transformed by deeper knowledge of what suffering means for patients, their families, and healthcare providers themselves. Since healthcare is not working for anyone, Dr. Lee provides wisdom and insights of optimism for where true change can happen in creating new standards for excellence. In addition to being a bestselling author and expert on healthcare transformation, Dr. Lee is the Chief Medical Officer of Press Ganey.  He brings more than three decades of experience in healthcare performance improvement as a practicing physician, leader in provider organizations, researcher, and health policy expert. He’s responsible for developing clinical and operational strategies to help providers across the nation measure and improve the patient experience, with an overarching goal of reducing the suffering of patients as they undergo care and improve the value of their care. Episode Bookmarks: 01:30 Introduction to Thomas H. Lee. M.D. and his new book “Healthcare’s Path Forward” 03:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:00 The six elements of organizational culture that lead to transformation – Excellence, Trust, Respect, Inclusion, Resilience, Reliability 05:00 John Nash (“A Beautiful Mind”) and Non-Cooperative Game Theory 06:00 Optimism for healthcare because how bad things really are! 07:00 Nash Equilibrium states are commonplace in healthcare – it creates inertia and stifles change. 08:30 “Equilibrium states break down when the pain of the status quo exceeds the fear of the unknown for multiple parties.” 09:00 “Healthcare is not working for anyone.  That is where real change can happen and what makes me optimistic.” 09:45 The destabilizing trends of supply chain disruption, social unrest, political divisiveness, consumerism, demographic shifts, workforce drain, and environmental disasters. 11:30 Responding to social justice, climate change, and the need to redesign healthcare – is it too much for us to tackle all at once? 12:00 “Changing the way healthcare is paid for – in absence of other reforms – is grossly inefficient.  There are many other things that have to happen.” 12:30 Michael Porter’s Value Chain and the importance of clarity and differentiation in the creation of value. 13:30 “Payment reform is just one activity of healthcare reform.  We also need trust in the workforce and with patients, an understanding of what safety means, and a response to consumerism.” 15:00 In times of turmoil, healthcare organizations need more than a performance culture; they need a learning culture. 16:30 The most important part of transformational leadership is division of responsibilities and areas of key focus to enact organizational change. 17:30 No one can do everything!  If leaders focus on only three things, they will be successful in strategy execution. 18:30 3 Functions of Governing Boards and Executives: Articulate the Core Values, Develop Strategy, Understand the Value Chain 18:45 “An organization is the lengthened shadow of its leaders.” – Ralph Waldo Emerson 20:30 3 Functions of Managers: Create Social Capital, Bring High Reliability Principles to Life, Eliminate Waste of all Types 21:30     “Social capital is more important than financial capital in the times in which we live.” 22:00 Applying High Reliability to all the dimensions (including patient experience) and refusing to tolerate failure in matters of trust. 23:45 “Culture of No Waste” – includes both time and resources 24:30 3 Functions of Frontline Caregivers: Create a Culture of Respect, Be Full Participants on Great Teams, View Job as Shaping the Memories of Patients and Families 25:30 The healthcare workforce often feels that they are part of a organization that does not respect them. 26:30 “Treating people with respect should be treated in the same way that the industry tackled hand hygiene to improve patient safety.” 27:45 Referencing the TED Talk from Daniel Kahneman: “The Riddle of Experience vs. Memory” 29:00 Frontline caregivers are like Steven Spielberg, i.e. they are the producers and directors of the patient memories. 32:00 “We live in a time where trust is under attack in society.  You can’t take trust for granted in healthcare.” 33:00 Trust goes beyond the clinician encounter – it encompasses the whole episode of care, including the web presence of the provider before the visit. 35:30 The importance of 5-Star Ratings online in building trust. 36:30 “Patients are unnerved from friction, chaos, and any indication that they may not be safe. The pandemic has really heightened their fears.” 38:00 Dr. Lee discusses how Press Ganey has begun surveying patients on their perceptions of patient safety. 39:45 High-reliability and the Anna Karenina Principle (“Happy families are all alike; every unhappy family is unhappy in their own way.”) 41:45 In 2021, the Press Ganey Employee Engagement Indicator declined in every single job category! 43:00 Dr. Lee discusses how building trust with workers coincides with the actions taken to build trust with patients. 44:30 Personal Pride:  Pride in the organization, Pride in what you do for the organization, Pride in what your team does. 45:30 Personal Alignment: Aligning with the cultural beliefs of employees and the need for inclusion. (Lack of DEI creates a 4X greater risk of employee turnover.) 46:00 Personal Resilience: Activation (employee motivation) and Decompression (ability of employees to forget about work when at home). 47:30 Activation is increasing in healthcare, but decompression continues to go down! 50:00 Dr. Lee explains how the pandemic and social unrest has created a deeper understanding of human suffering and how systems create harm. 50:30 Understanding Patient Safety beyond Physical Harm by also considering Emotional Harm (e.g. not feeling safe or financial distress due to healthcare) 51:30 The nuance of perception in Patient Safety (an example of how patients didn’t feel safe when a change when a hospital starting using odorless disinfectant). 53:00 Lack of respect as a safety issue. 53:00 The murder of George Floyd prompting an examination of the impact of inequality throughout society. 54:00 Diversity, Equity, and Inclusion in healthcare as a form of social capital and the pursuit of zero inequity. 55:00 The importance of DEI in health equity is now understood at a deeper level by healthcare leaders following the murder of George Floyd. 56:00 “Zero Inequity should be our goal just like Zero Harm is our patient safety goal.” 56:45 The data from safety net hospitals showing continued challenges in assessing pain with African American patients. 58:00 How organizational mistreatment of patients creates mistreatment of workers (and why lack of patient-centeredness is main reason for employee turnover). 61:00 Dr. Lee touts the virtues of healthcare and why it is such a great industry to work in. 62:00 New Skills for the Era Ahead:  Strategy (Porter’s Value Chain), Social Capital (Teamwork, Leadership), Growth Mindset (read Grit: The Power of Passion and Perseverance!) 64:00 The potential to do great work in medicine and making a difference in the lives of others. 64:30 “This is the best time to be going into healthcare. You can really make a difference in a noble field.” 65:00 How to reach out to Dr. Lee and learn more about his work in healthcare transformation.