Healthcare is Hard: A Podcast for Insiders

Cedars-Sinai is a nonprofit academic healthcare organization that serves the diverse Los Angeles community through more than 40 locations, 4,500 physicians and nurses, and 1,500 research projects in motion. Darren Dworkin has been Chief Information Officer at Cedars-Sinai since 2006, where he also founded the Cedars-Sinai Accelerator and serves as managing partner of Cedars-Sinai Health Ventures.In this episode of Healthcare is Hard, Darren talks to Keith Figlioli about the impact of COVID-19 through a technical lens, offers advice to innovators and entrepreneurs selling to health systems during this difficult time, and shares broad views into the digital transformation of healthcare. Some of the topics they discuss include:Enabling Remote Work Through COVID. Many healthcare workers have been bravely carrying out their roles within the hospital setting during the pandemic. But the fact that a large portion of healthcare workers have been asked to work remotely – just like in other industries – hasn’t gotten much attention. Darren points out that in only four days, Cedars-Sinai shifted from having 400 people working remotely to having well over 4,000. He talks about how the health system’s technical infrastructure scaled to handle the demand.Lasting Impacts. One of the silver linings Darren sees emerging from the pandemic is how it will advance strategies around helping patients interact with technology in the right ways. While Cedars-Sinai had already been relying on technology for urgent care and primary care visits, he uses the example of post-surgical follow-up as one area where telehealth has, and will likely continue to be very beneficial. As he points out, surgeons prefer to operate, so if they can minimize the time they spend on follow-ups, it’s a win all around.Pulling Versus Pushing Technology. Darren recognizes that his role as CIO is to “help engage end users in the tech that we have.” In other words, push technology on the enterprise. But part of the reason he finds the work of the Cedars-Sinai Accelerator so rewarding is that it’s exactly the opposite. Clinical and operational leaders get to choose which companies should be in the accelerator based on their needs and the solutions that will solve their biggest challenges. As an academic medical center, Darren sees innovation and discovery as core to the overall mission at Cedars-Sinai, and its accelerator is a big part of that.Advice for Entrepreneurs. Darren’s biggest advice for digital health entrepreneurs is to focus on real savings. Just as we’re approaching a day of reckoning for tech IPOs where companies planned to layer on growth without profitability, the environment for digital health startups is similar: adding improvement without adding bottom line ROI may no longer be sufficient. For example, as companies think about expanding their product, Darren suggests thinking about how to broaden into an adjacent space – versus simply of adding more “bells and whistles” – in order to help health systems eliminate vendors and streamline costs and administration.To hear Darren and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Over the course of nearly 20 years as Chief Research Officer at The Advisory Board Company, Chas Roades became a trusted advisor for CEOs, leadership teams and boards of directors at health systems across the country. When The Advisory Board was acquired by Optum in 2017, Chas left the company with Chief Medical Officer, Lisa Bielamowicz. Together they founded Gist Healthcare, where they play a similar role, but take an even deeper and more focused look at the issues health systems are facing.As Chas explains, Gist Healthcare has members from Allentown, Pennsylvania to Beverly Hills, California and everywhere in between. Most of the organizations Gist works with are regional health systems in the $2 to $5 billion range, where Chas and his colleagues become adjunct members of the executive team and board. In this role, Chas is typically hopscotching the country for in-person meetings and strategy sessions, but Covid-19 has brought many changes.Almost overnight, Chas went from in-depth sessions about long-term five year strategy, to discussions about how health systems will make it through the next six weeks and after that, adapt to the new normal. He spoke to Keith Figlioli about many of the issues impacting these discussions including:Corporate Governance – The decisions health systems will be forced to make over the next two to five years are staggeringly big, according to Chas. As a result, Gist is spending a lot of time thinking about governance right now and how to help health systems supercharge governance processes to lay a foundation for making these difficult choices.Health Systems Acting Like Systems. As health systems struggle to maintain revenue and margins, they’ll be forced to streamline operations in a way that finally takes advantage of system value. As providers consolidated in recent years, they successfully met the goal of gaining size and negotiating leverage, but paid much less attention to the harder part – controlling cost and creating value. That’s about to change. It will be a lasting impact of Covid-19, and an opportunity for innovators.The Telehealth Land Grab. Providers have quickly ramped-up telehealth services as a necessity to survive during lockdowns. But as telehealth plays a larger role in the new standard of care, payers will not sit idly by and are preparing to double-down on their own virtual care capabilities. They’re looking to take over the virtual space and own the digital front door in an effort to gain coveted customer loyalty. Chas talks about how it would be foolish for providers to expect that payers will continue reimburse at high rates or at parity for physical visits.The Battleground Over Physicians. This is the other area to watch as payers and providers clash over the hearts and minds of consumers. The years-long trend of physician practices being acquired and rolled-up into larger organizations will significantly accelerate due to Covid-19. The financial pain the pandemic has caused will force some practices out of business and many others looking for an exit. And as health systems deal with their own financial hardships, payers with deep pockets are the more likely suitor.To hear Chas and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

As the healthcare industry’s largest group purchasing organization (GPO), Vizient manages more than $100 billion in spend for more than half of the nation’s acute care providers. Its members include a diverse group of large community health systems, safety net institutions, children’s hospitals, independent community hospitals and 95% of the country’s academic medical centers. This provides Vizient CEO Byron Jobe and his team exceptional visibility into the healthcare system and yields countless benefits for members of the network – especially during a national and global pandemic such as Covid-19. In this episode of Healthcare is Hard, Keith Figlioli talks to Byron about ways Vizient is using its supply-side and clinical data and leveraging the power of its network in the fight against Covid. They explore a number of issues including:Cross-Network Collaboration. While GPOs are always recognized for their purchasing power, they bring so much more to their networks. In Vizient’s case, its sheer size and reach allows it to share data, information and best practices across a broad segment of the U.S. healthcare system. Since the beginning of the pandemic, more than a thousand members have been joining weekly Vizient webinars where providers in hot spots share strategies about what’s working to fight the virus. For providers who have not yet experienced a surge, this offers an invaluable opportunity to help them prepare so they can mitigate the impact if and when a spike of cases occurs in their area.Predicting PPE Needs. There are many Covid surge calculators on the market, but unique datasets including information about social distancing at a local level enabled Vizient to build one of the most accurate. In fact, revisiting predictions from March and April showed that its models were accurate within 3-5% of actual numbers. Byron talks about how Vizient has now made this calculator available to all providers and is also adapting it to help predict future needs for PPE and other supplies as different parts of the country prepare for future outbreaks.Secrets of the Healthcare Supply Chain. Covid-19 has awaken many people to details about the supply chain they may have previously taken for granted – specifically, how much product is produced overseas and how little visibility exists. Byron talks about a Vizient “war room” that’s been running around the clock to globally source products its members need, how they’ve seen an uptick in attempted fraud, and how they vet suppliers to ensure quality, which includes having feet on the ground to inspect product around the world. He talks about how this crisis could motivate changes to the current system and what those changes might look like.The Lasting Impact of Covid. Before his role leading Vizient, Byron worked in healthcare finance roles and spent time in the healthtech startup arena. Combining his knowledge from these experiences with the unique visibility he has into the healthcare system at Vizient, he talks to Keith about the long-term impacts of Covid-19. He talks about how providers will be reevaluating capital projects over the next few years, especially those focused on building acute care facilities because of the accelerated adoption of virtual health. While providers have been preparing for virtual health for some time, he says some models predict that adoption rates at the end of this year will reach levels that had previously been predicted for four or five years down the road.To hear Byron and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

This special episode of Healthcare is Hard: A Podcast for Insiders puts listeners “in the room” for LRVHealth’s annual planning meeting where the firm and its partners from across the health system determine strategic directives for the upcoming year.But this year was much different than the past. Months of extensive planning for what is typically a two-day event in Boston was thrown completely out the window in response to the Covid-19 crisis. The event quickly became virtual, and perhaps more significantly, the content was entirely refocused to address the new realities that are changing every facet of the healthcare industry.To lead a discussion about fast-changing healthcare policy directives at a federal level, LRVHealth tapped Blair Childs who, the day before, had been at the White House discussing these very issues with the president, vice president and hospital leaders from across the country. Blair is SVP of public affairs at Premier Inc, a company that unites an alliance of 4,000 hospitals and health systems and more than 175,000 other providers and organizations. As Premier’s primary spokesperson and communications strategist in Washington, Blair serves as liaison to the U.S. Congress, White House, healthcare policymakers and other major bodies involved in healthcare policy and regulation.During his presentation for LRVHealth’s strategic partners, Blair provided a view inside the beltway and shed light on the biggest issues impacting the healthcare industry including:Rapid regulatory changes. In response to the pandemic, the federal government made about 70 different regulatory changes to make it easier for providers to care for patients. And it all happened in about a month – a remarkable pace for such change to occur. But as the public health emergency subsides, the focus will soon turn towards deciding when new regulations should be rolled back, and in many cases, whether they should be rolled back at all. Blair reviews some of the major changes that have occurred so far and offers insight into how some of them – on a range of issues from telehealth to FDA approvals – might fare into the future.Election implications and policy predictions. With the general election occurring in November and close contests that could shift power in the White House and both houses of congress, Blair offers his analysis on the different races and how they might impact the healthcare market. He reviews issues such as the shift to retail ambulatory care that has been incentivized by the realities of Covid-19 and how those changes will not be impeded by either party. And he also talks about issues that hang in the balance such as the battle between providers and payers that could swing towards collaboration with Democrats in power, or continue to rely more on market-based solutions under Republican leadership.To get an inside look at LRVHealth’s annual meeting and hear what Blair Childs shared with the firm’s strategic partners to help them plan for and adapt to major shifts occurring in Washington, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

There’s one major difference between Boston Medical Center (BMC) and the other outstanding health systems in Boston. While being a major part of a city and region that’s renowned for world-class healthcare and innovation, BMC is the safety net institution.More than half of BMC’s patients live at or below the federal poverty level, defined as annual income less than $20,000 for a family of three, and one-third of medical encounters require translator assistance of some kind. In other words, BMC is a big and divers place. And it encompasses all the pieces of the health system, from an academic medical center, to a network of community health centers, and a Medicaid insurance plan that services 400,000 people in Massachusetts and New Hampshire.With this and more in one organization, BMC essentially has one payer: Medicaid. So, to fulfill its mission of providing exceptional care without exception, BMC is constantly seeking new and innovative ways to care for the community and produce healthcare services at a price the country can afford.In this episode of Healthcare is Hard, Keith Figlioli talks to BMC’s president and CEO, Kate Walsh, to learn about how she approaches these challenges. Their conversation covers a number of topics including:Coronavirus magnifying public health necessities. During a conversation which took place just at the U.S. began to experience the spread of Covid-19, Kate shares her optimism about preparedness, especially in Massachusetts, where government, academic and health leaders have been collaborating closely. But she also talks about how the pandemic magnifies questions about where healthcare dollars are spent – more often on the episode of illness rather than maintaining the public’s health – and the need to think more comprehensively.Strength in academics. As the primary teaching affiliate for Boston University School of Medicine, Kate is extremely encouraged by hundreds of young residents who, every year, bring a drive and ambition to change the world. She also talks about how being a system rooted in academics means that major decisions are led by evidence, an approach that’s just as valuable for tackling both clinical and social challenges. She points to poverty and other social determinants and how they need the same academic focus, rigor and research. For example, one of the newest studies from BMC revealed just how difficult it is to capture the full scope of social determinants through screening.Food as medicine. BMC has been ahead of the curve in addressing the impact of food insecurity. Through a partnership with the Greater Boston Food Bank, BMC has been writing prescriptions for food for 15 years and now integrates the process directly into the clinical workflow. Prescriptions for food are included in a patient’s electronic medical record to optimize for dietary needs and, just as importantly, confirm that a patient has picked up their food. Writing a prescription for food has also removed some of the stigma of visiting a food pantry and has developed into a program that now serves 7,000 families per month.Partnering on housing. Kate jokes that the last person you want to build housing is a healthcare executive because they can’t do it for less than $1 million a bed. But with that awareness, BMC partners with the right organizations that can direct investments where they help patients most. Kate notes how this is more than simply providing a key: it’s understanding where simple rehabs can help patients safely transition home, to searching for answers about how people fell into homelessness in order to help them get out.To hear Kate and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Dan Michelson’s recap of the JP Morgan Healthcare Conference in Becker’s Hospital Review has become a must-read over the past few years – whether you attend the conferences or not. Dan’s organization, Strata Decision Technology, works with more than 1,000 hospitals from hundreds of health systems on their financial planning, analytics and performance. And as CEO, he has a unique view across systems that allows him to neatly unpack and bring clarity to the various sessions and conversations that occur throughout the JPM conference.Dan’s insight is especially welcome when it comes to the conversations that happen in the secluded confines of the thirty-second floor of the Westin St. Francis Hotel during JPM week. That’s where dozens of CEOs and CFOs from the nation’s largest health systems gather to hear presentations from their peers about high-level strategies in this rapidly changing market. If you’ve read Dan’s articles and wondered how he got started writing them, or if you’ve wanted to hear directly from him with more context on his thoughts, here is your chance. In this episode of Healthcare is Hard, Keith Figlioli’s conversation with Dan brings his JPM recap to life. This year, based on all the provider presentations and many one-on-one conversations, Dan outlines the 10 questions that health systems should be asking and answering to guide the future of their organizations. He and Keith take a deep dive into these questions, discussing topics including:Performance. Looking at whether a leadership team should spend their time focusing on performance or building a budget is one of the important questions Dan outlines for health systems. He explains the choices systems have in more detail, using OSF Healthcare as an example. The Peoria, Illinois-based provider shifted away from traditional budgeting processes in favor of a rolling approach and according to Dan, saved 20,000 hours of leadership time and more than $1 million in spend.Market share. Dan says providers need to change their mindset and think differently about how they define market share as healthcare evolves. In addition to the “share of cup” analogy Dan explained in his written recap, he talks about his experience hearing Walmart’s head of healthcare discuss the retail behemoth’s view of the market. While providers believe they own the patient relationship, he points out how only half of Americans say they have a primary care provider and among the other half, two-thirds haven’t visited their primary care provider in years. With that data, what does Walmart have to say about the market and the patient-provider relationship? “Alright, we’ll take the other 84%.”The “other five” questions. While Dan’s article framed the ten questions providers should be asking, Keith calls him to task for adding another five at the end of the piece without full explanations. Dan says his point is that the ten specific questions health systems are asking themselves doesn’t really matter; what really matters is that they’re asking tough questions like these at the executive level. However, he explains why he thinks questions about affordability are the ones that leave health systems most exposed right now. To hear Dan and Keith’s conversation, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

In 1856, the Sisters of Providence began establishing hospitals, schools and orphanages across the Northwest, and that humble beginning planted the seed of what is now one of the largest and most innovative health systems in the country. Providence brings together more than 119,000 caregivers across seven states, 51 hospitals, 829 physician clinics, and many other health and educational services.Being headquartered outside Seattle – with the access to tech talent that location affords – is just one element that has allowed Providence to flourish amid the rapidly shifting healthcare landscape and the pervasiveness of digital transformation. The organization’s foresight to get ahead of this shift was honed under the leadership of Dr. Rod Hochman as CEO and extended through a number of strategic hires, including the addition of former Amazon executive Aaron Martin as Chief Digital Officer.In this episode of Healthcare is Hard, Keith Figlioli talks to Rod and Aaron about the longstanding values and evolving strategies that have kept Providence at the forefront of U.S. healthcare for so long, and how they plan to build on that history. Their conversation touched upon a wide range of topics including:Partnering inside and outside the industry. As more organizations enter the healthcare market to force disruption, Rod goes beyond recognizing the potential of partnerships and points back to a document from the health system’s founding sisters that calls for seeking partnerships.He describes the document as a constitution that remains relevant today as a means to inspire the organization with the values that inspired its founding sisters nearly 175 years ago. In that spirit, Aaron describes later in the conversation how Providence works extremely closely with other health systems and has had more than 120 visit over the past two years to work collaboratively on the challenges they face.The roadmap for new entrants. Thinking back to his days at Amazon, Aaron talks about how he couldn’t imagine a conversation with Jeff Bezos suggesting an opportunity in a low-margin business that’s very complicated, fraught with legal, brand and other risk, where life and death is actually at stake. For these reasons, Aaron is doubtful that tech companies entering the market will get into care provisioning in a big and meaningful way and believes that partnerships between health systems and companies like Amazon and Microsoft will be critical.A focus on SDOH before it existed. One unique piece of trivia Rod shares about Providence involves its continued investment in areas such as housing and education. The system runs an 85-year old liberal arts college in Great Falls, Montana, a high school in Burbank, California and manages public housing for seniors and low income populations in multiple states. In other words, Providence was invested in social determinants of health long before others were thinking about them, providing a high degree of knowledge and experience to address these increasing challenges.Diversifying revenue. In the future, Providence will not be able to exist on patient care revenue alone, according to Rod. That’s why he’s set a goal to create $1 billion in revenue with a 20% EBITA from things other than patient care within the next three years. He talks about the need to become a services company in order to achieve this goal, and gives examples of what that involves.To hear Rod and Aaron talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Dr. Kevin Tabb fell into medicine through his training as a medic in the Israel Defense Forces, and after medical school and a five year residency, he soon entered the world of healthcare IT. As president & CEO of the newly-formed Beth Israel Lahey Health system, this diverse background gives him a unique perspective to navigate the constantly-changing healthcare landscape where technology continues to play an increasing role.Dr. Tabb now has a prominent position in the greater Boston area’s storied history of driving healthcare innovation. He’s leading the region’s second-largest health system – including 4,000 physicians and 35,000 employees across academic medical centers, community, and specialty hospitals – formed by the March 2019 merger of the Beth Israel Deaconess and Lahey Health systems, along with Anna Jaques, Mount Auburn and New England Baptist Hospitals.Creating a single and cohesive point of care will be one of the most important attributes of a successful health system in the future, according to Dr. Tabb. The dynamics of delivering on this promise are especially acute as health systems across the country merge, and it’s a key focus at Beth Israel Lahey Health.During this episode of Healthcare Is Hard, recorded live on stage at the Digital Health Innovation Summit, Dr. Tabb talks to Keith Figlioli about a number of issues critical to delivering on his vision for a successful, modern health system, including:The Build vs. Buy Debate. When it comes to partnerships with new entrants in the healthcare market, new technologies, or other aspects of running a next gen health system, working with third-parties and bringing everything together makes it more difficult to create a cohesive organization. That’s why Dr. Tabb’s preference is to explore internal development first, a luxury large and growing health systems are more likely to have the resources to accomplish. But he recognizes the reality, knowing when and how to investigate if a third party brings something unique that would be too complex to develop in-house.Solutions Looking for Problems. With a background in health IT, Dr. Tabb is approached almost daily by various companies and investors and says the majority of what he sees comes from people offering niche solutions to small problems. Unless a solution is focused on the larger challenges associated with helping the different aspects of a health system come together and operate more cohesively, he’s much less likely to be interested.Evolving Access Points for Care. The way people access care is rapidly changing. Dr. Tabb compares this shift to the emergence of digital photos and Kodak’s failure to adapt because revenues from film and chemicals weren’t impacted at first. Kodak failed to realize soon enough that pictures can be made in many different ways. And to avoid a similar fate, traditional health systems need to quickly recognize the many different ways and different places care can and should be delivered. They need to adapt and deliver the seamless and unified experience that patients are starting to demand.Differences Between the U.S. and Europe. As someone who grew up in California, but served in the military, went to medical school, and did his residency in Israel, Dr. Tabb is frequently asked for his opinion on the biggest differences between U.S. and European healthcare. He points to the lack of a single system of care, and talks about how critical it is to figure out a new approach so people don’t fall through the cracks – especially when they’re sick and most vulnerable.To hear Dr. Tabb talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders. 

The Healthcare is Hard podcast exists for a single purpose – to help listeners get inside the minds of people who understand the complexities of the health system best, and are pushing it towards change and innovation. In the past year, guests have included 5 current or former CEOs of major health systems, 2 current or former CFOs and leaders of organizations like The Health Management Academy, The Institute for Healthcare Improvement, and Premier, Inc. that are working deep inside the industry to drive change and innovation.In these far-reaching discussion with industry leaders, there were three recurring topics that stood out the most: the shift to value-based care, a growing focus on social determinants of health, and the impact of new entrants into the market.Here are a few of the highlights from the first twelve months of Healthcare is Hard that we’ve cultivated for this look back. To hear more insightful comments like this and Keith Figlioli’s takeaway’s from his many conversations, listen to the one year anniversary episode of Healthcare is Hard: A Podcast for Insiders. 

Atrius Health is way ahead of the curve when it comes to risk-based reimbursement models. With 715 doctors providing care to approximately 745,000 patients, Atrius Health has quickly grown to become the largest independent physician group in the northeast. But what really makes Atrius Health unique is that nearly 80% of its revenue now derives from full-risk contracts in which the organization is accountable for the quality, experience and total cost of patient care.  With value-based care (VBC) at its core, Atrius Health focuses on prevention, population health management and creating full alignment with patients and patient care needs. In this episode of Healthcare Is Hard: A Podcast for Insiders, Keith Figlioli talks to Atrius Health CEO Dr. Steven Strongwater about the challenges of moving to risk-based reimbursement, the successes Atrius Health has seen thus far, and next steps in the organization’s journey.Topics they explore include:The value of partnerships. Being a health system that is not hospital-based provides Atrius Health with a number of advantages in the way it partners with other organizations to deliver the right care. For example, Atrius Health has partnerships with numerous hospitals that include interoperability of electronic medical records to ensure that patient hand-off is extremely tight and coordinated. Among other things, this ensures that there is no waste or frustration as a result of repetitive testing while ultimately lowering cost and improving care. Balancing the books with a high level of risk-based payments. One of the main difference in the financials of a value-based organization is that it requires significant reserves to balance the difficult years, according to Dr. Strongwater. For example, there are certain trend adjustments that an organization can make from year-to-year, but there can also be years where unexpected (and expensive) medical breakthroughs, such as new drugs, are introduced. Dr. Strongwater talks about the need for good contracts, decent reserves, and situational awareness – from both an actuarial and clinical perspective – in order to successfully navigate these occurrences.National trends between independent and owned practices. Independent physician practices are essential to the future of medicine and continue to drive transitions of change. Organizations such as Atrius Health are the ones working harder to avoid hospitalization and to always do what’s right for the patient and the total cost of care. In the process, they’re committed to addressing the country-wide epidemic of physician burnout and figuring out what’s doable for not just physicians, but nurses, nurse practitioners and others. They’re in a great position to do so because of an ecosystem that truly connects with patients – even in their home – and allows for experimentation. But as Dr. Strongwater points out, size matters and only large independent networks have the scale to experiment and the depth of resources to make changes. The driving source of change towards VBC. High-deductible health plans are deterring many Americans from going to a provider for care, but growing consumer pressure is what will ultimately push more organizations towards value-based arrangements, such as the one underway at Atrius Health. This offers the best of both worlds: helping a patient make good choices for their overall health – through preventative programs and otherwise – while driving down costs. Dr. Strongwater reiterates that value-based care isn’t about disrupting primary care, but that this model is one that should be implemented through life’s full continuum of care, from birth to death. To hear Dr. Strongwater talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.