Fixing Healthcare Podcast

The Fixing Healthcare podcast continued its quest this month for a candidate worthy to fill the highly coveted (and totally fictitious) role of “Leader of American Healthcare.” Dr. David T. Feinberg is president and CEO of Geisinger, one of the nation’s largest health services organizations. He’s also triple-board certified by the American Board of Psychiatry and Neurology in child, adolescent and addiction psychiatry. Prior to joining Geisinger, Feinberg served as CEO of UCLA’s hospitals, associate vice chancellor of UCLA Health Sciences, and president of UCLA Health System. When asked to present his plan for fixing American healthcare, Dr. Feinberg immediately seized the attention of co-hosts Dr. Robert Pearl and Jeremy Corr. “I think your question is actually really easy,” he said. With that, here are some of Dr. Feinberg’s most memorable quotes from the show: Fixing healthcare in America is the simplest thing we can do. The problem is, we’ve been looking at the wrong problem … Really what we need to do is say, “Well, what does drive health, and what does drive mortality?” We probably get 20% of whether we live or die, whether we have life in our years and years in our life, based on going to good doctors and good hospitals. We’re going to put all of our efforts in my plan, or the majority of effort, on all the other stuff, the stuff that really matters: your genetic code, your zip code, your social environment, your access to clean food, your access to transportation, how much loneliness you have or don’t have. I run a health system and we have about 13 or so hospitals and I think my job is to close every one of them. I think a lot of patients, even the ones that you managed well but ended up in the hospital, could be managed better at home. We look at our highest utilizers, our sickest patients. We show up at their house in two cars, because we can’t all fit in one car, and we got a nurse, a palliative care nurse, a community health worker, a pharmacist, a doc. We say, “Hi, sir or ma’am, we’re here to take care of you, and our goal is you never go in the hospital again and we know you’ve been hospitalized 12 times in the last year. Let’s clean out the medicine cabinet. Let’s make sure the house is safe. Oh, you have a bunch of appointments that are hard for you to get to? We’ll do them through telemedicine right now at the kitchen table.” Just completely eliminate the need for those folks to ever go in the hospital again. Why do people have to come to a doctor now? I don’t go to the bookstore anymore. I don’t go to my travel agent anymore. I can actually do so much through my phone, why can’t I tell you here what my symptoms are, and can you hook me up with someone who can help me? If I do need medicines, why don’t you just drone them to my house? Those types of interventions I think are coming and those disruptions are absolutely crucial. When I was born, the chances of me developing type two diabetes was 1 in 100. If I were born today, the chances of me developing type two diabetes is 1 in 3. That’s not a genetic change. Something happened in our food. We spend more on obesity than we spend on defense. Somewhere between 3% and 7% of GDP is spent on obesity, and that’s a new problem. So, if we’re going to fix American healthcare, we’ve got to put aside American healthcare for a second and figure out how come people aren’t exercising? If we look at your genome now, we can find medically actionable conditions that we can prevent in advance. We can find half the people that wouldn’t know they had BRCA based on their family history and intervene early. We can literally save lives based on your genetics, and that’s probably about 10% or 20% of my plan. Eating right, normal BMI, not smoking, alcohol in moderation, not shooting one another, getting preventive screenings will decrease healthcare costs overall by 50% in the United States. 50% of the disorders we’re paying for are lifestyle disorders. So, we’ve now cut healthcare costs in half. We have happy employers. We just decreased hospitalizations by 50%. By definition, there’s going to be less errors because there’s less people going through the hospital. I’m happy to talk more about how can we improve quality and measures, but we’re missing this big picture of understanding people’s genetic code, their zip code, their micro-environment, and really what drives behavior. That’s what’s costing us so much in American healthcare. We hoped you enjoyed this episode of “Fixing Healthcare.” A very big thanks to Dr. David Feinberg for coming on the show and sharing his bold ideas. Next month, our guest will be Dr. Eric Topol, the founder and director of Scripps Research Translational Institute. Dr. Topol is the author of the bestselling books, The Creative Destruction of Medicine and The Patient Will See You Now. He also serves as the chief academic officer for Scripps Health, a professor of genomics at the Scripps Research Institute, a senior consultant at the division of cardiovascular diseases at Scripps Clinic. We’re looking forward to having him on the show. READ: Full transcript of our discussion with Dr. Feinberg * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post Episode 3: Dr. David T. Feinberg says fixing healthcare is ‘the simplest thing we can do’ appeared first on Fixing Healthcare.

The Fixing Healthcare podcast is back with a new candidate for the highly coveted (and totally fictitious) job of “Leader of American Healthcare.” Dr. Halee Fischer-Wright is author the national bestseller Back to Balance: The Art, Science, and Business of Medicine, and president and CEO of Medical Group Management Association (MGMA), the premier membership association for professional administrators and leaders of medical group practices. Dr. Fischer-Wright brings a unique perspective to the role of fixing American medicine. As a former pediatrician, management consultant and chief medical officer, Dr. Fischer-Wright has seen the healthcare industry from practically every angle. As CEO of MGMA, she and her colleagues represent roughly 50% of the healthcare delivered throughout the United States. Dr. Fischer-Wright is a nationally renowned speaker, recipient of numerous awards for leadership in healthcare, and one of Modern Healthcare’s “Top 25 Women in Healthcare.” This month, she joins Fixing Healthcare for what’s being called “The Toughest Job Interview In Healthcare.” The show’s co-hosts and “hiring managers” Dr. Robert Pearl and Jeremy Corr have asked Dr. Fischer-Wright to present a plan to fix healthcare. Here’s what she had to say: I didn’t have one moment where I knew healthcare was broken. Instead, it was a series of personal experiences that brought the deeper problems into the light. The day that I watched my dad get poked again and again for a spinal tap by residents and interns who didn’t speak to him or even look him in the eye. The moment I realized that my husband and I could possibly lose our home because of crushing medical bills after his cancer surgery. The night my mother convinced herself that she had ALS by Googling the symptoms and double checking it with WebMD. The problem with talking about all these underlying problems in healthcare is that we lose sight of what healthcare is. Healthcare is one human trying to help another get and stay healthy. Healthcare is human, personal and intensely local. And yet we take an army of problem solvers and innovators, and prevent them, daily, from making decisions that could dramatically transform healthcare. I’m talking about every provider, leader, clinician, staff member working in a medical practice, and the patients they serve. In my design of the future of healthcare, I’m choosing to ignore everything at the top and start with all the experience and brilliance and passion and, most importantly, the common sense that I see in medical practices every day. In fact, I’m recommending that we do the exact opposite of what we’re currently doing. First, I’d ask: ‘Do we really know what we want out of healthcare?’ While we keep talking about cost, quality and satisfaction—the triple/quadruple aim—is that really what patients want? Meaning, every single one of us. Would that be what I tell you I personally want? Or do we as policymakers and professionals use those as surrogates because we struggle to deliver what patients really want: to be healthy and trust in all of the institutions that are supposed to take care of them. That includes not just the practices and hospitals, but also the insurance companies, the policymakers and every other player in the system. We have to treat the whole person and not just the disease. We have some amazing practices in the country that are pushing really hard for that idea: Iora Health, the Methodist Health System in Nebraska, and the Mayo Care System. They’re succeeding by focusing on outcomes and not just the preconceived notion of all-mighty processes to get to those outcomes. I believe that empowered partnerships, in which the right people have the right amount of control over the right decisions, are crucial to building a culture of excellence in the whole industry. If we all trust that every other player in the industry is making decisions with the same goals in mind, we’ll be more collaborative in decision-making and contributing to that progress, and we’ll be more willing to share ideas far and wide. We need trust, though, and right now we definitely don’t have it. What empowered partnerships can help eliminate is that tendency to hunt for silver bullets, or so-called disruptive ideas. Because when you have excellence, you don’t need disruption. There are so many solvable problems and yet we keep making many of them worse. Two of the biggest are administrative complexity and regulatory burden. Solve them, and you rapidly save hundreds of billions of dollars, reduce burnout, improve frontline satisfaction and free up amazing time and resources that can be used to improve life expectancy and improve the health of people, leading to quality outcomes. Since 2011, just the direct costs for managing claims, billing and collections for primary care practices have increased by 74%, which is ironic since we’re supposedly at a time where technology and electronic transactions are supposed to be making everything more efficient. A journal article put the total cost of billing and claims at $471 billion in 2012. If we saved just 50% of that, that gives us our decrease in cost. A recent AMA survey shows that practices spend 14.6 hours per physician per week on prior authorizations. If I gave any physician back 14.6 hours per week, I guarantee you we would increase life expectancy and improve quality outcomes. The solutions exist and they’re actually right in front of us. With a little collaboration and common sense, they could be executed on in the next 18-24 months. And these simple things that are right in front of us would have dramatic and lasting effects toward better outcomes … READ: Full transcript of our discussion with Dr. Fischer-Wright * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post Episode 2: Dr. Halee Fischer-Wright wants to unify all the healthcare players appeared first on Fixing Healthcare.

The Fixing Healthcare podcast debuted its first episode by welcoming to the show one of healthcare’s most brilliant and entertaining leaders, Dr. Zubin Damania, MD. Dr. Damania is known throughout the digital and social media landscape by his moniker ZDoggMD. He’s also an internist, a hospitalist and the founder of Turntable Health, an innovative primary care startup in Las Vegas that earned the backing of Zappos CEO Tony Hsieh. In addition to his clinical accolades, ZDoggMD performs stand-up comedy, “mercilessly satirizing our dysfunctional healthcare system.” He posts viral videos and hosts an online series, which together have amassed a following of 1.7 million patients and providers worldwide. This week, ZDoggMD became the first-ever applicant for the newly opened position: “Leader of American Healthcare.” According to co-hosts and “hiring managers” Dr. Robert Pearl and Jeremy Corr, Dr. Damania’s first task: Present the American people with a plan to fix healthcare, not minor tweaks or trade-offs among quality, cost and service. Here are the top ZDoggMD highlights from the show 1. On how we pay for healthcare vs. what we’re paying for I think the first thing we need to distinguish if we’re going to address this huge, huge, huge, issue is that there’s this distinction between how to pay for healthcare and what you’re actually paying for. First, we have to fix what you’re actually paying for. So, the first thing we’re going to do is invert healthcare from a sick-care reactive system that puts band aids on problems … to a focus on actual healthcare. And in order to do that, we have to start inverting the problem we have in this country, which is too many specialists, hospitals, and not enough primary-care prevention: OB/GYN, geriatrics, pediatrics, family medicine, internal medicine, etc. 2. On simple steps to improve patient service and convenience Let’s go where the patients need us: telehealth visits, phone, email, Skype. That’s where our patients want us but instead we’re stuck behind a clunky EHR that looks like it was built in the ‘90s or worse. Also, not everybody needs a doctor. Sometimes a health coach, a licensed clinical social worker, the team—the nurses, the respiratory therapists—those are the people on the front lines. So we need to encourage that teamwork where everybody’s practicing at the top of their training. 3. On restructuring the hospital system I’m a hospitalist and what I would say is that, for a single hospital, trying to be everything to everyone is very hard. Toyota would never build cars that way because you’d never be able to isolate failure points in a process that’s so chaotic … So, the first thing you do, is you take everything that has been shown to work and apply it as a standard. Then you break hospitals into bits, so that a surgical hospital that does elective procedures very well should optimize towards that. And it should be geographically accessible to a triage or urgent care center that can send patients to those places, maybe even faster than they could get transferred within one single hospital. And then ultimately realizing that 50% of what we do not only doesn’t work but it causes harm. And so (we should) focus our research and implementation efforts on getting rid of that 50% that doesn’t work. You know what works? Washing our hands, weighing maternity pads to see how much blood is actually lost, etc. And it’s going to take a quality-improvement culture that hasn’t really existed. 4. On keeping patients out of trouble (Turntable Health) was spending more on primary care. Spending three, maybe four times, what insurers spend normally in Las Vegas, you know, $18 per patient per month or something is what United spends on patients for primary care. And they get what they pay for: fragmented, crappy care with lots of specialists. Now, if you had a value network of patients who are a bit empowered, with a little bit of skin in the game, where they have this $2,000 and they’re like ‘I can spend this on a really good primary care doc who will keep me out of trouble, keep me from spending it downstream,’ well, that’s helpful. So (the plan is) having that support structure and the Medicare for all component of it, which is a very high-deductible, catastrophic plan that keeps people from medical bankruptcy. 5. On the ‘moral injury’ that causes physician burnout There’s a moral injury that occurs to (doctors) when we feel like we have to treat patients differently because of their insurance status. When we have to treat an undocumented immigrant differently for dialysis—they can only get it emergent in the ER—than somebody who has insurance … it creates moral injury and therefore ‘burnout’ in our physicians. And that’s not a sustainable thing. I think the difference, what caused (Turntable Health) to fail, is that we didn’t have that structure. We were a little too early with the model. READ: Full transcript of our discussion with ZDoggMD * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post Episode 1: ZDoggMD has a plan to fix American healthcare appeared first on Fixing Healthcare.