Healthcare is Hard: A Podcast for Insiders

Julie Barnes has made a career helping health plans, tech vendors, investors and others in the healthcare space decipher health policy. She’s a former Hill staffer who earned her law degree and spent a decade in corporate law serving healthcare clients before moving to policy think tanks, business consulting, and founding Maverick Health Policy. At Maverick, she provides strategic advice on federal health policy to private companies and industry coalitions, with particular focus on health data and value-based care.With the U.S. presidential election less than two months away, Julie is kicking off a series of Healthcare is Hard episodes that will explore the implications of the shifting power structure in Washington. Next year, there will be a new administration and a new makeup of the U.S. Congress – that much is certain. How these changes will impact health policy and healthcare investing in public and private markets is a much bigger question. During the next few episodes, both before and after votes are cast in November, Keith Figlioli will shed light on these topics with an expert panel of guests.A few of the topics Keith and Julie discussed during the first episode of this series include:The alphabet soup of healthcare policy. One of the things that surprises Julie’s clients the most is the myriad of federal agencies that play a role overseeing healthcare – from HHS and CMS, to the FDA, CDC, NIH, FTC, NIST and many others beyond the big, well known organizations. With Healthcare accounting for nearly one quarter of the federal budget, there is a massive public sector infrastructure behind it, which is a big reason why healthcare policy takes so much effort to navigate. Julie offers advice for organizations looking to better understand healthcare policy, and for the people driving it. For example, she says the wonks, lawyers and lobbyists all talk funny. She admits to being part of this group, and says they need to reduce the lingo for the sake of those not so intimately involved.AI changing everything. When discussing the modernization of the healthcare system, Julie talks about artificial intelligence (AI) being the main focus right now. She believes it has the potential to dramatically change everything because of the far-reaching impact it could have on areas ranging from workforce shortages to clinical decision support, user experiences for providers and patients, and more. She says healthcare AI policy can’t be written fast enough because of the speed with which the technology is developing, but there are many problems to navigate. One is that the public sector lacks experts who fundamentally understand this new technology, which will create challenges with ensuring that regulations are thoughtful enough to create a level of trust around AI without grinding innovation to a halt.White House hysteria. While the country is fixated and divided on an historical race for the Presidency and the impacts of the outcome, Julie is quick to point out that changes in healthcare policy will not be fast, and will not be sweeping. There are broad brush policy changes you can expect based on party philosophies, like Democrats being more skeptical about the influence of private money than Republicans. But major legislative changes require bipartisan effort, no matter who controls the White House, Senate, and/or House. But one major area where Julie thinks many people are underestimating the potential for change is the impact of the Supreme Court’s recent decision on the Chevron Doctrine. She talks about how this will open the floodgates on a wave of litigation.To hear Julie and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

OSF HealthCare stands as a model health system for those who want to do innovation right. One of the defining characteristics of the Peoria, Illinois-based system is how it aligns innovation with operations for everyone – all 24,000 employees across 159 locations, including 16 hospitals.Becky Buchen is responsible for driving innovation at OSF HealthCare. As SVP of Innovation Operations she works to engage and educate people on the innovation process, leveraging the eco-system for innovation built at OSF, including simulation, analytics, OSF Ventures, Innovation Studio, Digital Innovation Development and Performance Improvement.Becky’s background in performance improvement has been a major influence in OSF HealthCare’s approach to innovation. Prior to her role leading innovation, she served as VP of Performance Improvement where she focused on implementing methodologies to monitor, assess and improve patient experience, patient outcomes, and overall operations.In this episode of Healthcare is Hard, Becky talked to Keith Figlioli about how OSF HealthCare formalized its vision for innovation more than a decade ago and the thoughtful approach to ensuring that it would be fully integrated – not simply a “bolt on.” The goal was to truly make an impact and transform how care was delivered across the organization, and to do so, OSF HealthCare recognized that it had to apply the same level of rigor for exploring, testing and measuring innovation initiatives as it historically had to performance improvement.In her conversation with Keith, Becky discussed specifics about OSF HealthCare’s approach to innovation that both digital health entrepreneurs and other health systems can learn from. Some of the topics they discussed include:Integrating innovation into culture. Perhaps the most visible example of OSF HealthCare’s commitment to integrating innovation into every aspect of its operations is the physical footprint. At its main campus, OSF HealthCare has an entire building dedicated to innovation, including two floors built for simulation, allowing clinicians to test and understand new approaches in a safe space, two floors housing its healthcare analytics division, and much more.What health systems are getting wrong (and right). To approach innovation successfully, Becky says health systems need to first have a fundamental understanding of the problems they’re trying to solve. She warned of dedicating resources towards solutions that are looking for problems. OSF HealthCare learned to avoid this trap early, but Becky says it’s still an area of caution for some systems. She talked about how critical it is to pick problems that are big enough to make a significant impact when they’re solved in new and different ways.Retooling and reskilling due to artificial intelligence. Becky talked about the healthcare industry being “data rich and information poor,” and described efforts to centralize data and improve data quality as a critical step to driving value from innovation. While tools like those being explored with generative AI will ultimately allow healthcare organizations to operate more efficiently, data quality and proper governance are essential to establish first. And after that, healthcare organizations should be thinking about how they will need to retool and retrain frontline operators and clinicians.To hear Becky and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

With great power comes great responsibility and in healthcare, those words may have never held more meaning than they do with the advent of artificial intelligence. AI most certainly has the power to transform healthcare, and those in the industry working to develop and use it have an immense responsibility to shape principles that ensure these technologies help, not harm.The Coalition for Health AI (CHAI) was created with a mission to be the trusted source of responsible AI in health that serves all. CHAI was founded in early 2021 by a small group of industry stakeholders and has quickly grown to now encompass more than 2,500 participants representing health systems, technology providers, government agencies, advocacy groups and others.Dr. Brian Anderson is one of CHAI’s co-founders and now serves as its first CEO. Before CHAI, Dr. Anderson was the Chief Digital Health Physician at MITRE, a nonprofit corporation that manages federally funded research and development centers (FFRDCs) supporting various U.S. government agencies. At MITRE he led research and development efforts across major strategic initiatives in digital health alongside industry partners and the U. S. Government.Prior to MITRE, Dr. Anderson led the Informatics and Network Medicine Division at athenahealth. He has also served on several national, and international, health information technology committees in partnership with the Office of the National Coordinator (ONC), the National Institutes of Health (NIH) and the Organization for Economic Cooperation and Development (OECD).In this episode of Healthcare is Hard, Keith Figlioli spoke with Dr. Anderson about the origins of CHAI, its intended role ensuring responsible use of AI in healthcare, and the complex issues already emerging as the industry navigates the early stages of AI adoption.Some of the topics they discussed include:Aligning AI with values. Dr. Anderson admits there’s General agreement around principles like transparency, safety, privacy, and reliability when it comes to responsible use of AI. But says the industry needs a clearer definition for what that actually means at a technical level for the people and companies writing code. He says vendors fundamentally can’t do this on their own, which is why independent entities with appropriate skills, tooling, technology, and data are needed.AI assurance. Nearly every other industry has independent organizations that test and evaluate products. From the star rating system for automotive safety, to the stickers validating consumer electronics, we take these rating systems and their existence for granted. Healthcare AI does not yet have a similar system, but that’s what Dr. Anderson eventually wants CHAI to be known for.Giving everyone a voice. Being inclusive is fundamental to CHAI’s mission and Dr. Anderson stresses that everyone’s perspective is legitimate, especially since healthcare AI is such a new space where no one has definitive answers. He recognizes that listening to every perspective is critical in order to build AI that will serve everyone. For example, this includes ensuring that voices from the startup community are represented just as much, if not more than big tech.To hear Dr. Anderson and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Chris Coburn has been driving health system innovation for decades. He is currently chief innovation officer at Mass General Brigham (MGB), the nation’s largest academic research enterprise with over $16 billion in annual revenue, 1.5 million patient visits and more than $2.4 billion in research expenditures. MGB also has a managed care organization, out-patient facilities and community hospitals. 7,000 of its faculty are appointed at Harvard Medical School.As head of innovation, Chris leads a team of nearly 150 people tasked with the worldwide commercial application of the unique capabilities and discoveries of Mass General Brigham’s 85,000 employees. His unit’s business development responsibilities include investing, company creation, international consulting, innovation management, industry collaborations, and licensing. Commercialization revenue exceeds $160 million annually and more than 300 companies have been spun-off from Mass General Brigham in the last decade.Prior to joining Mass General Brigham, Chris was founding director of Cleveland Clinic Innovations and served for 13 years as its executive leader. During his tenure, Cleveland Clinic spun off 57 companies that raised more than $700 million in equity financing. There were none before his arrival.In this special episode of Healthcare is Hard, recorded live at the Digital Health Innovation Summit (DHIS) in Boston, Keith Figlioli led a keynote discussion with Chris about the current state of healthcare innovation. Some of the topics they discussed include:Embracing innovation from inside and outside of MGB. Chris described how his organization is tasked with supporting innovation that will help achieve strategic objectives, regardless of where it originates. With the realization that most health systems are large organizations not known for their nimbleness, he shared advice for innovators looking to partner with or sell to them about how buying decisions are made.Corporate venture capital in healthcare. With a steady growth in the number of health systems creating their own venture arms over the past several years, Chris shared best practices from being in the space for decades. For example, he talked about balancing the commitment to both strategic and financial goals, and how his organization catalogs the unmet needs of MGB’s leading faculty. For entrepreneurs, he suggests getting to know the growing number of people in corporate venture roles, in addition to health system operators.Getting operators to embrace digital innovation. Fielding a question from the live audience, Chris discussed strategies for getting operators to adapt digital health innovation into established workflows, and how important it is to create a culture around innovation to achieve that goal. On one hand, he talked about how part of his organization’s job is to get doctors to proactively and continuously think about new ways for how they might optimize their work. On the other hand, he talked about listening to unmet needs and addressing them directly as a way to ease adoption from the start.To hear Chris and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Optum Rx serves more than 62 million people, processes 1.6 billion prescriptions and generates more than $110 billion of revenue annually. Dr. Patrick Conway, CEO of Optum Rx, is the third and final guest in a series of Healthcare is Hard episodes exploring the transformation of the pharmacy business – following conversations with Mark Cuban and Dr. Troyen Brennan.Dr. Conway brings an expansive view of the healthcare system to this discussion and his role leading one of the most influential organizations in the pharmacy space. He became CEO of Optum Rx in August 2023 and before that, served as CEO of Care Solutions at Optum for more than three years. He was president and CEO of Blue Cross and Blue Shield of North Carolina for two years and spent more than six years at the Centers for Medicare and Medicaid Services where he held several positions including Chief Medical Officer, Director of CMMI, and Deputy Administrator for Innovation and Quality. Before joining CMS, he oversaw clinical operations and quality improvement at Cincinnati Children’s Hospital Medical Center, and he is still a practicing pediatrician in Boston where he occasionally works at an area medical center on weekends.Some of the topics Dr. Conway discussed with Keith Figlioli in this episode of Healthcare is Hard include:VBC – A way or THE way. As someone who has spent a significant portion of his career focused on improving cost and quality in the U.S. healthcare system, Keith starts the interview asking Dr. Conway for his perspective on value-based care. Dr. Conway says we can either figure out VBC, or raise taxes and reduce benefits, noting that the American public would not be happy about the latter. He firmly believes that VBC is THE way through. He discussed the positive impacts he's witnessed from VBC, and how he believes it’s been a major contributor to slowing the growth of healthcare costs over a significant period of time. However, he’s concerned about how the transition to VBC has slowed.Affordable innovation. When discussing the extremely high cost of new specialty drugs, Dr. Conway points out that innovation is useless if it’s unaffordable and inaccessible to people. He shared personal stories contrasting very difficult conversations he’s had with parents in the past about the failing health of their children, and a more recent experience where Optum Rx delivered a new gene therapy to a child with a rare disease who will now live a full life. With therapies like that one costing $3 million, Dr. Conway discussed his views on some of the public and private financing options that could help improve access to life-changing therapies while still rewarding the innovators.Choice and transparency. Dr. Conway explains some of the solutions Optum Rx has brought to market to serve its customers, and areas where the company is exploring new solutions to keep customer satisfaction high. While customers are happy with Optum Rx, he makes it clear that continuously developing new solutions to stay ahead of a fast-evolving market is essential. During this discussion, customer choice – for both patients and the employers who fund their benefits – is a recurring theme and a major focus.To hear Dr. Conway and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

In the first of a series of episodes exploring opportunities for innovation in the pharmacy space, Mark Cuban offered perspective from an outsider intent on disrupting the status quo. In this, the second episode, Dr. Troyen Brennan gives an insider point-of-view from someone who has studied and worked in the space for decades.Dr. Brennan was Chief Medical Officer at CVS Health for nearly 14 years, and before that, Chief Medical Officer at Aetna for two years. He was also a practicing physician at Brigham and Women’s Hospital for 15 years where he was president of Brigham and Women’s Physician Organization. During that time, he was also Professor of Medicine at Harvard Medical School and Professor of Law and Public Health at the Harvard T.H. Chan School of Public Health. He is the former Chair of the American Board of Internal Medicine and has published six books and more than 600 articles offering his insight into the American healthcare system, and his ideas on how to improve it.With extensive knowledge of how the industry has evolved, and an understanding for why many of the complexities in the industry exist, Dr. Brennan offers a unique viewpoint about where and how disruption in the pharmacy space can succeed. In his eyes, the idea of good and bad actors in the pharmacy space is a false narrative. With an historical perspective, he explains how industry processes were all sensible when they were first implemented, and how that viewpoint is critical to understanding and addressing some that may have become seemingly senseless over time. A few of the topics he discussed with Keith Figlioli in this Healthcare is Hard episode include:Six ways PBMs have lowered cost. Dr. Brennan provides a history of pharmacy benefits managers (PBMs), why they were created in the late 1950s and how they have helped the pharmacy industry. He discussed his thoughts on the six things PBMs have done – and are still doing – to help control costs. These include expanding the use of mail order pharmacies, sourcing generic drugs, introducing tiered pricing, implementing prior authorization and utilization management, assembling pharmacy networks, and negotiating rebates.Flexibility of PBMs. When discussing the future role PBMs may or may not play in the industry, Dr. Brennan says he’s confident in the ability for big PBMs to adapt. He believes they’ve proven to be more flexible than other parts of the healthcare system and will continue to have significant influence as regulations evolve and disruptors enter the market. He says that Mark Cuban is having a good influence on the industry overall with Cost Plus Drug Company, but would bet on the ability of PBMs to adapt.The path to greater affordability. With new, life-changing therapeutics being introduced regularly and specialty pharmacy expected to become a significant portion of healthcare spending, Dr. Brennan discusses some of the potential options for ensuring these treatments are affordable. He believes entrepreneurs disrupting the space can help contribute, but regardless of the role they play, says government will ultimately have to step in with price controls. He points to the role government plays controlling the costs of hospital services and says it will eventually have to play a similar role in the pharmacy space.To hear Dr. Brennan and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Mark Cuban built a career disrupting industries and creating new ones. Now, his sights are set on healthcare. There’s no secret ingredient to Mark’s success. As the world sees very publicly on Shark Tank, his style is the opposite of keeping secrets. It’s based on providing respectful, but direct, honest and unvarnished opinions. He’s bringing that style to healthcare in order to inject what he says the industry is lacking most. Trust.To kick-off a series of Healthcare is Hard podcast episodes that will dive deep into all aspects of reinventing the pharmacy space, Keith Figlioli sat down with Mark to discuss his vision and strategy behind Mark Cuban Cost Plus Drug Company, and many other healthcare-related topics.With Cost Plus Drug Company, Mark is bringing radical transparency to what he says is the most opaque industry he’s ever been involved in. He’s doing it by pricing every single product the same way – the cost of a drug, plus 15% markup, plus pharmacy fee (if any), plus shipping – and publishing these details for everyone to see.Through this model, Mark aims reduce costs and improve access to drugs, while rebuilding trust in the industry. With 2,400+ drugs now available, he’s off to a fast start and talked to Keith about other evolving elements of the business including wholesale operations for providers, partnerships with grocery and pharmacy chains, and more.Some of the other topics Keith and Mark discussed include:The Netflix model for specialty drugs. With revolutionary precision medicine coming to market at high costs that can reach millions of dollars per treatment, how will employers and consumers afford them? According to Mark, that’s the wrong question. He’s looking at the challenge through the manufacturer’s lens, asking how much they’ve invested in drug development and at what dollar value can they make reasonable returns. He discussed conversations he’s having with manufacturers about creating subscription services that could cover a wide range of high-cost, specialty drugs.Transparent, direct contracting. Mark now self-insures his employees and their family members, contracts directly with providers on payment rates, and – following the Cost Plus philosophy – publishes everything for the world to see. He shared a personal story that helped lead him to this decision where he paid a provider directly when his son needed an X-ray and realized it was a fraction of the cost of agreed upon rates with his insurance company. He talked about how this decision cuts other costs while improving employee wellness, removing burdens on HR, and ultimately helping providers by removing the risk they take and helping them get paid faster. Millions of AI models. Mark is a big believer that there will be millions of AI models and everyone will have one. He says 100 years from now you’ll be able to ask him questions through a model trained on all his emails and data. But AI in healthcare will be more segmented. He talks about how there’s no way leading research hospitals with respected brands will feed their data into one large language model unless they get paid an extreme amount of money. They may even stop publishing “anything and everything” to prevent their research from being ingested into someone else’s model.To hear Mark and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

In most industries, innovation leads to an improved product or service while ultimately helping to lower cost. Healthcare is the exception. Despite a constant pursuit of new science, technology, operational efficiencies, business models and more, healthcare expenditures in the U.S. have continued to increase for decades with little sign of bending the cost curve downward. What causes this phenomenon in U.S. healthcare, and what can we do about it? In their book, Why Not Better and Cheaper?: Healthcare and Innovation, twin brothers James B. Rebitzer and Robert S. Rebitzer offer answers to those questions.Jim and Bob’s book brings together research on incentives, social norms, and market competition to argue that the healthcare system generates the wrong kinds of innovation. They contend that U.S. healthcare makes it too easy to profit from low-value innovations and too hard to profit from innovations that reduce the costs of care. As a result, we get a system where innovation abounds, but finding ways to deliver increased value at lower cost is remarkably ineffective.In this episode of Healthcare is Hard, Keith Figlioli talked to Jim, a professor at Boston University’s School of Business, and Bob, National Advisor at Manatt Health, for an in-depth discussion about their work. Their conversation explored topics including:Misaligned incentives. Understanding how incentives work inside and between organizations has been a large focus of Jim’s career in economics, and he now applies that work to the complex world of healthcare. As an example of that complexity that’s all too common, Bob shared a story of a scientist and entrepreneur he advised who had developed a quick and inexpensive way to change how people walk in order to reduce pressure on the knee. While this could defer or obviate the need for common and expensive knee replacement surgeries, he discussed how difficult it would be to turn this idea into a profitable business since organizations across the healthcare ecosystem lack proper incentives to pay for it. He discussed why gain sharing would be the solution in every other part of the economy, and why it doesn’t work in healthcare.The fourth vital sign of healthcare. People generally think of the healthcare system as having three vital signs – cost, quality and access. But Jim and Bob see a fourth vital sign that, so far, hasn’t been recognized. In the long sweep of history, they say innovation matters just as much as the other three vital signs and stress that part of a healthy system should be the ability to produce innovations that increase value to patients while lowering costs.Innovation vs. irrational finance. In order to truly unlock innovation does the country’s irrational finance and insurance system need to be fixed first? Bob and Jim share their thinking around this debate and their ultimate conclusion: not necessarily. Bob compares healthcare innovation to walking uphill in a fog… you never know when you’re going to reach the top, but all you can do is place your foot in a somewhat higher place than it was before.To hear Keith, Bob and Jim discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Through its work with more than 41,000 healthcare facilities and the industry’s largest database of patient feedback, Press Ganey gives organizations the data and insights they need to put the human experience at the center of healthcare.Since it was founded nearly 40 years ago by Professors Press and Ganey at the University of Notre Dame, the company has built a reputation for being the prominent source of patient feedback, but it hasn’t stopped there. Its solutions capture the voice of the patient, physician, nurse, and employee to keep healthcare focused on people by enabling organizations to address safety, clinical excellence, patient and member experience, and workforce engagement.Pat Ryan became CEO of Press Ganey in 2012 after more than 30 years working with healthcare leaders and providers, including a dozen years as a Press Ganey client. Pat has served on several health system boards and has worked throughout his career to improve the quality and safety of care while lowering cost and achieving caregiver resilience to deliver truly patient-centered experience.In this episode of Healthcare is Hard, Pat spoke with Keith Figlioli about the increasing focus on human experience in healthcare transformation. Drawing knowledge from his career and from Press Ganey’s unrivaled understanding of patients and the professionals who serve them, Pat shared his perspective on topics including:The link between patient experience and financial success. Pat shared what he says is a little known fact – that health systems across the country with the highest margins also have the highest patient scores. He talked about how the two are linked and how value leads to long term community loyalty. He cited his time on the board of Beth Israel Deaconess Medical Center where they looked at patient data first and financial data second. He says health systems today need a comprehensive view that also includes safety and employee engagement data in order to identify opportunities for improvement.Redesigning healthcare from the outside in. Any consumer business would start with the needs of the customer first and work backwards to design systems that add value. But healthcare wasn’t created that way and was built from the inside-out. Pat discussed the need for healthcare organizations to continue the long journey of recognizing that consumers comes first, and talked about how workforce engagement will be an important component of that as the industry evolves.The trust factor. Pat describes how organization can map trust in order to understand where it breaks down by identifying friction points within the customer journey. He talks about how important it is to build and maintain trust in all relationships – not just a patient or family’s trust in an organization, but also nurse, clinician and employee trust in their organization and leadership. He mentions how important this is for payer organizations that are especially susceptible to unfair or inaccurate perceptions. Opportunities for innovation. When discussing areas where healthcare organizations can improve, and where innovators in the space can help them, Pat’s focus during this conversation was mostly on two issues – home care and the shift towards value. He says figuring out how to care for more people at home is going to be critical and sees opportunity around redesigning the healthcare workforce for the gig economy. He also talks about how slow the movement to value-based contracts has been and how a major break in the system may finally force congress to act if adoption doesn’t pick up.To hear Keith and Pat discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

This is the final episode in a four part series with heads of strategy at providers and payers from across the healthcare ecosystem to explore “the new normal” in a post-COVID operating environment. For this episode Keith Figlioli welcomed Sukanya Soderland, Chief Strategy Officer at Blue Cross Blue Shield of Massachusetts, to explore how a regional payer is adapting. This follows previous episodes that offered a diverse perspective from heads of strategy at:A regional health system, OhioHealth (Episode 58)A national health system, CommonSpirit Health (Episode 59)A national payvider, Humana (Episode 60)To wrap up this series, Sukanya provides a glimpse into the strategy at BCBS MA, the largest health plan in Massachusetts and a mostly commercial-focused payer that serves nearly three million members across New England. Unlike most not-for-profit organizations, BCBS MA pays significant federal, state, and local taxes and assessments. Without soliciting or receiving charitable donations, or benefiting from tax-exempt financing, BCBS MA stays competitive by generating a small margin from operations that it reinvests in its business, people, and technology, and by remaining deeply focuses on the community its serves.In her discussion with Keith, Sukanya shared her outlook on issues including:Shared empathy between operations and innovation. For any head of strategy, serving the immediate needs of an organization is equally as important as anticipating and planning for future demands and market forces. Sukanya discussed how business leaders can sometimes view innovation leaders as out of touch with current realities, while innovation leaders might view business leaders as “dinosaurs.” She talked about the importance of developing a culture of empathy and trust between these groups.Building vs. buying vs. co-designing. To stay competitive against larger, national organizations, regional payers must recognize what they do well and where they should partner with other like-minded entities to augment their capabilities. Sukanya talked about making decisions to partner or co-develop capabilities with others, including sister companies across the Blue Cross Blue Shield Association, as a way of advancing sustainable, non-profit healthcare. She also recognized the challenges with driving meaningful change in affordability, quality and consumer experience without being intimately involved in care delivery, and discussed creative ways of partnering with incumbent health systems or new and innovative care delivery models to make that happen.Changing dynamics in how people access care. One of the biggest changes Sukanya sees occurring over the next decade is the way people access care. She discussed several of the market factors driving this change from the supply and demand of primary care physicians, to Generation Z aging into adulthood. She talked about how healthcare is losing the “quarterback” function as young adults turn to social media, trusted contacts and convenience in place of a strong relationship with a primary provider, and how that impacts strategy.To hear Keith and Sukanya discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.