Healthcare is Hard: A Podcast for Insiders

When Terry Shaw’s wife was the victim of a car accident in 2016, it completely changed his outlook on care delivery. Even as president and CEO of AdventHealth, one of the nation’s largest faith-based health systems with 50 hospitals across nine states, Terry had a difficult time navigating his wife’s recovery. He spent six months calling in favors to find the right physicians and coordinate care in the out-patient setting. And that’s with a lifetime of healthcare knowledge and the connections to match.If the road was so steep for Terry and his family, how is the average person supposed to handle similar circumstances? That question hit home and continues to be a key catalyst for improvements in care delivery that AdventHealth is pioneering under Terry’s leadership. He understands that 95% of contact with patients takes place in the out-patient setting, but knows from first-hand experience just how disaggregated, complex, and difficult to navigate it can be for patients.In this episode of the Healthcare Is Hard: A Podcast for Insiders, Terry recounts the expansion and evolution of AdventHealth, including its growth from a $2 billion to a $12 billion system over the past 20 years. He also talks to Keith Figlioli about the initiatives underway at AdventHealth to revolutionize the future of patient care, including:Reinventing the Consumer Experience – In most other industries, it’s been essential to build a business around customers, but according to Terry, healthcare is just on the cusp of being required to figure out how to design care around the consumer. This includes processes for making sure people have the right care at the right time – especially after a patient is discharged – and making out-patient care just as efficient as in-patient care. It involves rethinking the whole care process, including the social determinants of health, and putting people in the right environment so that mentally, physically, spiritually and socially they have a better opportunity in life than they had before.Focusing on “Never” Events. As part of its initiative to rethink the consumer experience, AdventHealth has defined 20 “never events” – situations that it’s working hard to help patients avoid. For example, a patient should never be unable to tell how much a procedure will cost, and should never have to work hard to find care. If they want to make an appointment with their doctor, have someone come to their home, stop by a clinic, or seek care on an iPad, those events may not be traditional primary care, but should be recognized and recorded as such if it works for the individual. To support this, AdventHealth is in the process of rolling out a new app that will enable patients to text their doctor, schedule appointments, access their health records and take a number of other actions that allow them to direct their healthcare in a way that’s convenient for them.Looking at Patients as More Than a Diagnoses. Do you have someone at home who loves you? Do you have a sense of peace today? Do you have a source of joy in your life? AdventHealth now asks these questions when patients enter their facilities. If the answers are not what a physician would expect to hear, they’ll work to understand what is going on and refer the patient for additional treatment, therapy and/or care. Terry talks a lot about how a person is more than the sum of their diagnoses, but rather should be looked at as a sum of their thoughts, feelings, and beliefs. As a faith-based organization, engaging patients in this way is extremely important to AdventHeal

In this episode, Keith Figlioli of LRV Health sits down with Joe Randolph, president and CEO of the Innovation Institute, a highly successful joint effort between several healthcare systems in Southern California. The Innovation Institute helps hospitals look within for new ideas while creating a sustainable model for innovation by delivering key services and securing outside partnerships.

Hurricane Katrina was an extremely destructive and deadly storm that shut down communities along the Gulf Coast for months and even years. While the scope and scale of this catastrophe are undeniable, it also opened up doors to help move towards a system that unites social care and clinical care, allowing medical professionals to practice great medicine while also addressing the non-medical drivers of health. Dr. Karen DeSalvo was on the front lines of Katrina disaster relief and she vividly remembers these doorways opening. Delivering healthcare from atop ice chests and card tables in the streets of New Orleans, Karen came to three major realizations: 1)     As important as medicine was, there were a lot of other factors that mattered that she and other healthcare professionals had to prioritize as leaders in the community who people turned to for help.2)    The most effective moments of care delivery came when people who didn’t typically interact – nurses, social workers, pharmacists, and others – united and worked together as a well-aligned team. 3)    Health systems should be created with a community, not for a community. Instead of creating a system around buildings and doctors, it’s more important to listen to what the community and the people in it want to prioritize.

Twenty years ago, no one really understood how to run an integrated health system. That’s because no executives at the time grew up in, or were trained to lead a health system. They were all trained to run hospitals. In this episode of Healthcare is Hard: A Podcast for Insiders, Keith Figlioli talks to Gary Bisbee, who cofounded the Health Management Academy to provide peer learning opportunities and guide health system executives through this new vision of healthcare.

Prioritizing “Whole Person Care,” putting human relationships first and considering all dimensions of a person’s health is part of the fabric at Allina Health. As Penny Wheeler and Ric Magnuson explain on Healthcare is Hard: A Podcast for Insiders, remembering who you’re serving, why, and how you can make their lives better can produce better outcomes at a lower cost.

Mark Keroack, MD, MPH, has been in and around the healthcare industry for most of his life – long before he became President and CEO of Baystate Health, a not-for-profit, integrated healthcare system that serves over 800,000 people in western New England.Most people don’t know that medicine has always been a family business for Dr. Keroack – his mother was a nurse, his father was an “old-fashioned” doctor with an office right in their home, all five Keroack brothers ended up becoming doctors, and he even met his wife in medical school.With this lifelong immersion in healthcare as a foundation, Dr. Keroack has been on the front lines of innovation and digital transformation in the industry. One example is TechSpring, The Baystate Health Technology Innovation Center, which launched under his leadership at BayState in 2014 to bridge the gap between technology innovators and healthcare professionals. As Dr. Keroack describes it, TechSpring lets entrepreneurs get behind the firewall to work with real clinical and claims data, and gives them an opportunity to work collaboratively with physicians to identify and target specific problem areas. Baystate Health is already using a number of innovations that hatched through TechSpring and a few have also gone commercial.In this episode of Healthcare is Hard: A Podcast for Insiders, Keith Figlioli talks to Dr. Keroack about the major shifts occurring in healthcare and how health systems can and are using innovation to adapt. Dr. Keroack offers his insider perspective on a wide range of topics, including:The Importance of “Disciplined Innovation” – there are a lot of ideas being explored to improve healthcare, but where most systems fall down, according to Dr. Keroack, is in their failure to focus and capitalize on the ones that are proven to work. To him, disciplined innovation means going “all in” on the proven ideas and scaling them quickly. Focusing intently on the ideas that work can also help ensure a balanced approach to managing the dichotomy between people in a healthcare organization struggling with change and those who want to adopt new processes and technology as fast as they can. One example Dr. Keroack cites is BayState’s partnership with DispatchHealth, a startup that provides an on-demand, mobile emergency room. DispatchHealth has already made 700 visits around Springfield, Massachusetts and 80 percent of them helped divert patients from making ER visits. With a net promoter score of 95 – a higher NPS than even Apple, Dr. Keroack points out – BayState is working to scale its use of DispatchHealth quickly.The Double-Edged Sword of Integrated Delivery – Private practices are becoming more and more rare, and other than boutique primary care practices in wealthy areas or more niche specialties such as ophthalmology or urology that have a better chance of surviving on their own, that trend will continue according to Dr. Keroack. Some things can get lost in this new reality, such as the entrepreneurial spirit and the intimate, personal touch you get from a small office. But there are also many positive gains. Obsessing about how to design systems of care across specialties and across regions often yields better outcomes, or at least less variable outcomes. To Dr. Keroack, this is one of the great motivations of building an integrated delivery network.   Narrowing the Gap to Consumer-Friendly, Tech-Enabled Healthcare. Productive paranoia is a good thing, and amidst new market entrants like Optum, CVS/Aetna, Walmart, Humana and others, Dr. Keroack says he wouldn’t be doing his job without it. These companies have tremendous resources and sophisticated consumer instincts and technology that they’re using to target – and become the front door to healthcare for – a narrow niche of the continuum that traditional systems manage. If they’re successful, it could leave

Don Berwick and Maureen Bisognano lived and breathed different sides of the healthcare industry before starting the Institute for Healthcare Improvement (IHI) – a $60 million not-for-profit organization with 150 employees across more than 70 countries that drives results in health and healthcare improvement worldwide.What most people don’t know is that Don and Maureen hatched the idea for IHI while working together – Don as a research and quality guide physician and pediatrician, and Maureen as a nurse and hospital CEO. They would discuss each other’s work problems in-depth from very different perspectives, but in a way that helped facilitate actionable improvements.In the mid-1980s, Don, Maureen, and a larger group started meeting people from outside healthcare who understood how to improve things systematically, without having to rely on incentives. They began teaching people around them what they were learning from different industries, and quickly understood that it’s unfair to send a “changed” person back to an unchanged organization. It became quickly apparent to them that it would take a new breed of leaders, as well as people on the front lines, to create long-term change in healthcare.IHI was born with an aggressive goal, literally written on the back of an envelope. Don and Maureen set out to solve six problems in US healthcare, and engaged 2,000 hospitals and saved 100,000 lives. With the guidance of their children who fortunately had political campaign experience, they started their own campaign to change healthcare. Originally supported by the John. A. Hartford Foundation, the IHI became a reality in 1991 – and the rest is history.In this episode of Healthcare is Hard: A Podcast for Insiders, Don and Maureen draw upon their extensive industry experience to cover a number of pressing topics with host Keith Figlioli, including: Achieving the “Triple Aim” in Healthcare – the Triple Aim is the trifecta of achieving better care for individuals, better health outcomes, and lower per capita costs. Don and Maureen saw this happening in other industries and in healthcare markets across the world. They talk about how they took this aim and created a leadership alliance within IHI where 40 organizations came together with a common goal of achieving the Triple Aim. Healthcare’s Defects in Areas that Other Industries Don’t Tolerate – among these areas are safety issues, effectiveness, reliability, patient focus, coordination, waste and delay, and most importantly, equity. Don and Maureen discuss how they understood that people were aware of this in the mid-1980s, but no one had a way to deal with it directly at the time. The Will for Change in Healthcare – who needs this inspiration and how can the will for change be built? As Maureen explains, painting the story of a patient can help build such inspiration, especially for senior-level executives who may be a little further removed. It doesn’t matter whether it’s a good or bad story; it’s about providing a background for these ideas to grow.The Next Big Things in Healthcare – telemedicine, telehealth, global budgeting, and healthcare for millennials are just some of the innovations Don and Maureen are excited about.  To hear Don Berwick and Maureen Bisognano talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders. 

Susan DeVore has been in and around the healthcare industry for most of her life – long before she became president and CEO of Premier Inc., a company that unites an alliance of more than 4,000 hospitals and health systems and approximately 165,000 other providers and organizations to transform healthcare.It’s a little-known fact that Susan’s roots at Premier date back to her childhood when her father, a biomedical engineer, worked for a predecessor to the company. After working at Ernst & Young – including time as a partner and senior healthcare industry management practice leader, among other roles – she got the call to interview at Premier.No one was aware of Susan’s company legacy at that time, but after she joined, there were longtime employees who remembered her attending the company picnic or other gatherings as a young teenager.Susan’s lifelong focus on improving the healthcare system and her current role at Premier – driven by insight from such a vast network of care delivery organizations – combine to give her an incredibly valuable perspective for solving healthcare’s biggest challenges. Premier’s network enables it to maintain a dataset that encompasses roughly 45% of patients in the US. Those data inform Susan’s leadership and the decisions the company makes to help solve cost and quality challenges and develop a unique model of care delivery.At the HIMSS Global Conference & Exhibition in February Susan will be delivering a keynote session titled, “Healing from Within: Leading Change, Inspiring Action.” But you can hear her first on this episode of Healthcare is Hard: A Podcast for Insiders. Susan’s conversation with Keith Figlioli covers a number of pressing topics including: Reducing Waste in the System – Susan talks about how there’s still 30% waste in the system and three times unwanted variation in care delivery, and how these challenges can’t be solved by insurance companies or the government. She believes the only way to tackle them is head-on, from within the system, and shares her thoughts about how data, technology, and influence within healthcare systems are all critical to driving transformation. Changing the Social System – the decades-old social system that the healthcare industry is built upon is one that’s difficult to change. But it’s starting to change in experimental ways, driven by innovators and early adopters who recognize that it’s unsustainable for healthcare costs to grow at twice the rate of the economy, and who want to do something about it. Susan talks about how and why it’s easy to stay in a fee-for-service world and shares her thoughts on the main barriers to change. The Path to Alternative Payments – as Susan sees it, the big thing that’s holding health systems back from adopting alternative payment models is uncertainty. If providers that haven’t adopted or are only experimenting in alternative payments think there’s a chance that fee-for-service might last longer, it’s much harder for them to make the leap. However, she talks about her view of federal regulations and how the “training wheels are coming off” to force change more quickly. The Next Big Thing: Making Big Data Small – while increasing access to healthcare data is playing an important role in transforming the industry, one big challenge right now is the sheer volume of data that exists. Susan talks about how the next big thing on the horizon will be figuring out ways to make vast amounts of data more usable. She talks about how to get “small data” into the workflow so it’s available for physicians and patients to use in making informed decisions that change the care being delivered.To hear Susan DeVore talk about these topics and more, listen to this episode of Healthcare is Hard:

Changing our complex healthcare system from within is a difficult proposition, but one that Glenn Steele, MD, has embraced in multiple capacities over a decades-long career. As a practicing clinician treating patients for 24 years, to leading one of the nation’s most innovative health systems as CEO for 14 years, he personifies what it means to be a healthcare insider. In the second episode of Healthcare is Hard: A Podcast for Insiders, LRVHealth’s Keith Figlioli shares his conversation with Dr. Steele to offer an insider perspective on a wide range of topics including:What’s the Game Plan for Balancing Clinical and Financial Risks?Where Do We Start Aligning Value?How Do You Build the Foundation for Innovation?Will Amazon, JP Morgan, and Berkshire Change Employer Influence? 

There’s only one health system in the country that has an “Aa1” rating from Moody’s Investors Service – it’s Intermountain Healthcare. Hear Intermountain’s CFO talk about how a focus on innovation and quality care contributes to outstanding financial health.