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. 

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.