Fixing Healthcare Podcast

In a career that spans three decades, Dr. Zeev Neuwirth has held many roles: primary care physician, medical educator, medical director and physician executive. Over the years, he’s observed one constant: people want and need to be treated better. His new book “Reframing Healthcare: A Roadmap For Creating Disruptive Change” calls for a shift from today’s medical mindset to a “marketing mindset,” which Zeev says will lead to more consumer-centric, empathetic, customized healthcare. On this episode, Zeev guides listeners through his road map for disruptive change and the steps required to create a better healthcare system. Here are a few highlights from Zeev Neuwirth’s Fixing Healthcare interview. On doctors embracing a ‘marketing mindset’ The essence of marketing is all about understanding people, understanding their needs, finding customer segments, customizing solutions for those segments, delivering those solutions, and making sure that you’re engaging your customers and continue to make your solution relevant to them. If you think about it, that actually isn’t all that different from the fundamental principles of medical care. It’s really about knowing your patients, understanding your patients, taking the generic training and evidence-based medicine you’ve been taught, and customizing it to that individual in front of you, and then making sure they understand it, and they can actually use the wisdom and knowledge and skill that you’re bringing to them. On redesigning medicine with the consumer in mind If something is designed well, whether that’s an experience at an amusement park or it’s going to a store or anything else for that matter, it engages you. You’re sucked into it … If things aren’t designed well, they become irrelevant to you. In fact, they become caustic to you. I would argue that healthcare has paid very, very little attention to human-centered design. I think it is one of the fundamental flaws of our so-called legacy medical mindset. On rethinking results from the patient’s perspective No one ever asked (the patient), “What are the results that matter to you in this surgery, or in this procedure, or in this treatment?” For me, the results that matter might be that I want to be able to walk my dog, or walk with my wife five blocks, or go on a walk after dinner without having severe pain in my hip, or I want to be able to bend over and tie my shoes without severe pain. Or, if I’m an athlete, I want to get back to jogging, or going skiing. That focus on what we now call patient-reported outcomes measures or PROMs, is really still very, very fringe in healthcare. I think its core to every other industry. On physician burnout The issue of burnout in healthcare is incredibly serious … It’s an epidemic. When one out of every two doctors is burnt out, that means they’re emotionally exhausted. They feel depersonalized. They’re depressed. They’re demoralized. That’s a public health issue. You don’t want your doctor feeling that way because they’re not going to be on top of their game. Who wants a surgeon standing over them who’s depressed and demoralized? I don’t. On making change happen I think we’re in, what I would call, a phase change … in healthcare. The economy can’t bear the burden of the cost of healthcare and the inefficiencies and ineffectiveness anymore. Employers are just not going to stand for it. Payers are not going to stand for it. I think if you don’t pick up this book, and if you don’t see the reality in front of you, and you put it down for another year or two, I think you’re going to be at a major, major competitive disadvantage. READ: Full transcript of our discussion with Zeev Neuwirth * * * 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 10: Dr. Zeev Neuwirth’s roadmap for disrupting healthcare appeared first on Fixing Healthcare.

Season 2 of Fixing Healthcare welcomes leaders from outside of the medical mainstream to deliver practical solutions for our nation’s deepening healthcare crisis. Elisabeth Rosenthal did not disappoint. She is a physician, author of the 2017 national bestseller “An American Sickness: How Healthcare became Big Business and How You Can Take it Back,” the current editor-in-chief of the Kaiser Health News. Prior to the KHN, she was a The New York Times reporter for 22 years. Through her investigative research, Elisabeth has exposed corrupt healthcare players, fought outrageous medical bills and advocated tirelessly for American patients. On this episode of Fixing Healthcare, Elisabeth recalls some of the most obnoxious medical bills and health insurance denials she has come across in her research. She also offers everyday day patients the tools to advocate on their own behalf, arming them with advice, resources and the courage to push back against the big business of healthcare. Here are some practical suggestions for patients, courtesy of Elisabeth Rosenthal on Episode 9 of Fixing Healthcare: If you leave the hospital and they say, “Do you want some crutches? Do you want a wheelchair? Do you want a breast pump?” Say “no” because the mark up on those things is going to be crazy and you can buy them on Amazon for literally 20% of the price. This sounds like terrible advice to give someone who’s about to have a baby, but … be careful. When someone says, “Do you want the nice nitrous oxide? Do you want the birthing tub? Do you want a private room?” You have to say, “Okay, well how much is that going to cost?” Because the last thing you want as a new parent is to end up with a $10,000 bill you didn’t anticipate. Ask for an itemized bill. See what you’re being charged for. Protest any charge that seems outrageous or unreasonable. I do tell people, also, and this sometimes works, go find out what the Medicare DRG rate is for that same hospitalization and go in armed to the patient ombudsman and say, “You are charging four times what the Medicare approved rate is and I’m not going to pay it. Let’s see if we can do a deal.” Write about (your surprise medical bills). Write to a journalist, write to your local newspaper. Hospitals today are very sensitive about their reputations and they do not want to be shamed by some of these charges. So that is often effective. The problem we have here at Kaiser Health News with our “Bill of the Month” project is there are so many outrageous bills that people are sending us right now that we don’t have the bandwidth to write about even a small fraction of them. I will say the ones we write about, the bills go away. I think we all need to become healthcare voters. I’m here in D.C. now. Many of the politicians, who do they hear from? Their biggest constituent is their local hospital system. They get a lot of campaign donations and lobbying from pharma. They hear from a lot of patient groups that are often connected to pharma, but they don’t hear a lot from average doctors in the trenches and patients who are living this terrible medical system day in day out and I think we really need to have our voices heard. READ: Full transcript of our discussion with Elisabeth Rosenthal * * * 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 9: Elisabeth Rosenthal on how patients can fight the system appeared first on Fixing Healthcare.

As a Stanford business professor and author of four bestselling books, Chip Heath knows a thing or two about what motivates human behavior and organizational change. This month, he’ll put that wisdom to the test and take on the toughest of all tasks: Fixing Healthcare. In Season Two of the podcast, the focus shifts away from searching for the “Leader of American Healthcare” to yet another challenging question. Co-hosts Dr. Robert Pearl and Jeremy Corr are looking for strategists and implementers from outside the medical mainstream to help translate big ideas and disruptive-change theories into real-life healthcare solutions. As a change-management expert, Chip has been sought out by organizations like Google, Gap, The Nature Conservancy and American Heart Association. But can his knowledge and experience in business translate into practical solutions for twenty-first century healthcare? The answer is undeniably yes. Click the play button above to learn:  What American hospitals can learn from Amazon’s one-click ordering. How a simple meeting shaved $500,000 off the cost of caring for a single patient. The allegory of the elephant, the rider and how they, together, can take us on a path to fixing American medicine. Whether a “one-song workout” can help get Americans off the couch and exercising. How Jerry Sternin improved the health of 2 million Vietnamese children on a tight deadline. Why a middle-manager filled a conference room with 424 different pairs of work gloves (and what U.S. surgeons can learn from this surprisingly effective stunt). Why giving inpatients lavender-scented hand cloths and ear plugs at night speaks to “The Power Of Moments.” READ: Full transcript of our discussion with Chip Heath * * * 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 8: Chip Heath on what US healthcare can learn from one-click ordering appeared first on Fixing Healthcare.

Welcome to Season Two of Fixing Healthcare. In this eye-opening episode, Robert Pearl and Jeremy Corr welcome Dr. Devi Shetty, India’s leading heart surgeon and founder of Narayana Health, which offers world-class cardiac surgery for as little as $1,200 a case with clinical outcomes that rival the best in the world. READ: Full transcript of our discussion with Dr. Devi Shetty In a departure from Season One, guests of the show will no longer vie for the fictitious role of “Leader of American Healthcare.” Instead, experts from outside the mainstream of American healthcare will assist with the toughest task of all: figuring out how to translate disruptive-change theories into real-life solutions. Dr. Shetty proved to be the perfect guest to usher in the show’s new format and focus. Here’s a small sampling of his more memorable quotes: On the rising cost of healthcare If the solution is not affordable, it is not a solution. There is no point in me talking about all the advances in heart care or cancer care if 90% of the world’s population cannot afford it. I did my first heart surgery in Kolkata (India) and the patient paid $2,000 for the heart surgery. Thirty years later, we’re doing the same heart surgery for $1,200. Tell me another example of costs coming down in healthcare over the past 30 years. On improving healthcare’s information technologies We have to get the electronic medical records designed for the mobile phone. Today all the billion-dollar electronic medical records you are using in the United States, they’re all designed for the desktop … What you have to realize (is) that doctors look at the desktop only five to 10 times in a day. But doctors look at their mobile phone 200 times in a day. On the price of a human life Most of my patients are little kids, sitting on a mother’s lap. I examine that kid then I tell the mother that her baby has a hole in the heart and she needs to go for an open heart surgery … (The mother) has only one question, “How much it is going to cost?” If I tell her that the heart surgery on her kid costs $800, which she doesn’t have, that is a price tag on that kid’s life. She comes up with $800, I can save her kid. If she doesn’t have $800, she’s going to lose the child. This is what I do from morning ‘til evening, putting price tag on human life. This is what every doctor living in developing countries do from morning ‘til evening, putting price tag on human life. This is totally unacceptable. This can’t go on. On providing mission-driven care Typically, when a new hospital starts by a traditional corporate entity, the CEO of the group will address all the employees and the doctors. He would end the speech saying that, “This is a hospital we have built for the rich people but we have an obligation. We also take care of poor people.” Whereas me or one of my colleagues … commissioning a hospital, we tell our employees that we have built this hospital primarily for the poor people, but we also take care of the rich people. That dramatically changes your attitude. On Health City in the Cayman Islands, Dr. Shetty’s new, world-class facility, just 1-hour by plane from Miami My message to Americans physicians is to visit our Health City in Cayman Islands and experience it themselves. Be our guests and see how the hospital runs. * * * 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 7: India’s top doctor has a message for American healthcare appeared first on Fixing Healthcare.

Season One of the Fixing Healthcare podcast concludes this month, along its search for a candidate worthy of becoming the first-ever “Leader of American Healthcare.” Our sixth and final guest of the season is healthcare futurist and bestselling author Ian Morrison, who brought a welcome combination of humility and humor to the interview. Said Ian, “My definition of futurist is an economist who couldn’t handle the calculus. I’m in a sweeping generalization business and have been for a very long time.” As a self-described Scottish-Canadian-Californian, Ian also brought a uniquely international perspective to this discussion about fixing American healthcare. Here now are five of Ian Morrison’s most memorable quotes from Episode 6: 1. On U.S. healthcare versus systems in other countries “I have come to believe that every healthcare system in the world sucks in its own unique way. They’re all ugly compromises and trade-offs of what I think of as a “value equation” of quality, access, security and benefits, divided by cost. And they all suck. There is no perfect health system.” 2. On the closest thing to perfect for American healthcare “I would say that our best hope moving forward is to migrate American healthcare to a system I would put under the label of “Medicare Advantage for All.” It tries to reconcile these different values with regard to competition and the role of government, but mandates that everybody is in the system and everyone is covered. What that would necessitate is migrating and building on the growth of integrated delivery systems, providing some kind of global budget framework from the top down, setting perhaps targets at the state level for spending not to exceed GDP per capita targets, much as they’ve done in Massachusetts on a voluntary basis.” 3. On America’s declining life expectancy “It is remarkable how poorly we are performing. I think it’s partly our priority setting. We don’t do the things that would lift up the bottom of the life expectancy tables, simple things like universal primary care and access to generic drugs that you would think would be a starting point to bring people up from the bottom. We have this unbelievable oipiod epidemic, which many people, economists and physicians alike, believe is driven by diseases of despair, having to do with the lost Nirvana of the American Dream. I think there are economic and social policy solutions there that are going to be much more effective than medical care.” 4. On physician “burnout” “I’ve done surveys over the years showing that the majority of doctors feel burned out, feel in some senses, alienated and that their work is not valued. So, perhaps ‘burnout’ is not the right term, it might be demoralization. I do think that providing systems with control, where the physicians, as you said in your book, lead the organization. I’m not 100% convinced you have to be a doctor but I think it sure helps if you’re a clinician leading large organizations. I think trying to encourage colleagues to transform in the name of improving care for patients is a professional motivation and these organizations need to be professionally led with that kind of ethos.” 5. On predicting the future of healthcare by understanding the past “We’re at start of 2019. What’s different since 2009? It’s Obamacare, the iPhone and Trump. The question is what’s going to be different within a 10-year time horizon? The reality we’re going to be dealing with 10 years from now is the absolute peak of the Baby Boom moving through the medical care system. Peak of the baby boom, roughly 1957, so do the math. It’s right in that sweet spot of 2029, 2030, when we’re at the maximum demographic effect. We will have done one of two things. We will either have anticipated that better and have a system where we use high technology to keep people aging in place with tremendous support, where we’ve made investments in social determinants of health, where we have a system of universal coverage all the way through, which is sustainable politically and financially because it’s done on a bipartisan basis. We will have a built the kind of delivery we design into our ongoing health system that incorporates new technology effectively and swiftly at scale. That’s the vision that I hope we have. READ: Full transcript of our discussion with Ian Morrison * * * We hoped you enjoyed the final episode of Season One and will participate in a special project we’re launching to make you, the listener, a part of Season Two. We want to know what changes you would make as “Leader of American Healthcare.” Click here for a chance to share your solutions with Fixing Healthcare listeners. A very big thanks to Ian Morrison for helping us wrap up a fantastic first season. Season Two kicks off in February 2019 with a totally different format. Our first guest will be the cardiac surgeon, entrepreneur and disruptor, Dr. Devi Shetty. He is chairman and founder of Narayana Health, a chain of 21 medical centers in India. He has performed over 15,000 heart operations throughout his career and is committed to making healthcare as affordable as possible. Today, he provides cardiac surgery for less than $1,800 per patient, a fraction of what it costs in United States with results that match the best American hospitals. We cannot wait to have him on the show. 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 6: Ian Morrison says every healthcare system ‘sucks in its own unique way’ appeared first on Fixing Healthcare.

This month, co-hosts Robert Pearl and Jeremy Corr agree our nation could learn so much from our next guest, Dr. Don Berwick. Few healthcare leaders have as much global experience, industry respect and applied knowledge as Don. He is the former president and CEO of the Institute for Healthcare Improvement (IHI) and led the organization’s 100,000 Lives Campaign, a nationwide initiative to significantly reduce morbidity and mortality in American healthcare. He’s the former administrator for CMS and has served on the faculty for Harvard Medical School and Harvard School of Public Health. As always, guests are given 10 minutes to present a plan for radically improving the U.S. medical system. As expected, Don made the most of every minute. You won’t want to miss any of Don’s thoughts. Here are five of his most memorable quotes: 1. On the responsibility of becoming “Leader of American Healthcare.” “I decline. This can only be done together. And the most important component of action is that action begin to be consolidated among stakeholders. We have a highly fragmented system in which people are trying to solve problems separately. That is just not going to work. So, the first step I take is to form a table of healthcare leaders and stakeholders who we share a common intent. We’re going to have to fix healthcare together.” 2. On his trademark Triple Aim. “We need a system of three goals: better care for people when they’re in the care system, better health for populations, and lower per capita cost through improvement, not through rationing or withholding. That was the mission I brought to the Centers for Medicare & Medicaid Services when I took over in the Obama administration. The Triple Aim became tattooed on every single person there: better care, better health, and lower costs.” 3. On healthcare as a human right: “Concomitant with the Triple Aim is another goal, which is healthcare as a human right. For some reason that I do not understand, this country has been ambivalent about declaring as an intention what every other civilized democracy in the world has said, which is healthcare is a human right. It’s the same as the right to clean air, to primary education or to food security. 4. On lowering per capita costs in healthcare: “I’m worried about 18% of GDP (being spent on healthcare). I would set an unequivocal goal to be at 15% within the next five to six years. There’s no reason we can’t do it at 15. Every other nation is below 13 or 12. If we get out of fee-for-service payment, if we move toward global population-based budgets, the payment system should get far easier to manage and far lower cost. There’s probably 10% of the total American healthcare bill right there, right in the simplification of payment systems.” 5. On healthcare’s many improvement metrics: “We have made so many stupid rules and those stupid rules have to be stopped. They have to be taken down. Many of the are rules make no sense, metrics that don’t help people at all. We need to put ourselves on a metric diet, a measurement diet. I’ve called for a reduction in the amount of measurement that’s going on in American healthcare by 75% over a four or five year period.” READ: Full transcript of our discussion with Don Berwick * * * We hoped you enjoy this episode of “Fixing Healthcare.” A very big thanks to Dr. Donald Berwick for coming on the show and sharing his extraordinary ideas. Next month, healthcare futurist, Ian Morrison joins the show. Ian is an internationally known author, consultant and futurist, specializing in long-term forecasting and planning with an emphasis on healthcare in today’s changing business environment. He has worked with more than 100 Fortune 500 companies and is president emeritus of the Institute For The Future and chair of its health advisory panel. Ian is the author of the bestselling books “Health Care in The New Millennium: Vision, Values and Leadership,” and “The Second Curve: Managing the Velocity of Change.” We cannot wait to have him on the show. 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 5: Don Berwick brings a global perspective to fixing US healthcare appeared first on Fixing Healthcare.

Fixing Healthcare co-hosts Dr. Robert Pearl and Jeremy Corr thought they new a lot about their latest guest, Dr. Eric Topol. They’d both read his bestselling books and closely followed his groundbreaking work at Scripps Research. And then Dr. Topol opened up about his plan for fixing American healthcare. Each month, a new guest appears on the show to compete for the highly coveted (and totally fictitious) role of “Leader of American Healthcare.” The guest is given 10 minutes to present his plan for radically improving the U.S. medical system and Dr. Topol didn’t waste a second of his time. Here are some of his most memorable quotes: The United States is the only country that does not provide healthcare to all of its citizens. That needs to be fixed. We can’t address the reduction in these critical metrics unless we provide healthcare equitably among all U.S. citizens. That’s step No. 1. At least a third of the $3.6 trillion a year in the U.S. that is spent (on healthcare) is wasteful, unnecessary, and harmful. That has to stop. I view the professional societies as trade guilds. Basically, their role … is largely to preserve the reimbursement of their constituents. They’re not interested in fixing these problems. They don’t have any role—and that goes not just for the AMA but across the board—in dealing with the waste and unnecessary procedures and testing and treatments. That’s a problem. We can’t rely on professional societies to lead the way because they’ve shown us for decades that they are not part of the solution. One of the most absurd aspects of medical care in this country (is) that our electronic health records are proprietary systems (owned) by the likes of Epic and Cerner and Allscripts. They have no real interest in the patient. The problem with electronic health records is that no one in this country has all their data—from being in the womb through the present time—and they all should. They should see their data, they should own their data, and it’s just the opposite of the way we’re set up here. That has to change. My solution there is that we forget the whole idea of the current model. We need to reboot. Every individual should have their medical data. How can we reduce hospital costs, because that’s $1.2-trillion-a-year and rising quickly? The way we can do that is to get rid of hospital rooms. We’re not talking about getting rid of the emergency room or the operating room or the intensive care unit, but the rest of the hospital should be gutted and (patients) should be at home to avoid the 1 in 4 chance of serious harm or error that takes place in the hospital … and the ridiculous cost of a hospital stay in the United States, which is approaching on average $5,000 a day. We have exquisite remote monitoring capabilities now and we should be using that. Just like decades ago when we saw the big shift from inpatient to outpatient, we need to have the shift … from inpatient to home. Seven minutes for an appointment in a clinic is grossly inadequate, and that’s for a return visit. Twelve minutes, on average, for a new patient consult is ridiculous. The gift of time can be achieved by using analytics. That is: deep learning, artificial intelligence, taking data that’s from not just the electronic record, (but also) from sensors, from genomics, from all different sources and being able to process that data and put an investment in making life better. It can make medicine more efficient, improve workflow, and give the gift of time to both clinicians and patients. I’m very much a proponent of telemedicine. I think it’s a welcome addition to the ways that we can connect clinicians and patient. Unfortunately, today we still have most American physicians unwilling to communicate with their patients through email or other electronic means, which is remarkable. If you ask them why don’t they do that, it’s just because we don’t get reimbursed. Everything’s ‘I don’t get reimbursed,’ so we have to fix the model of reimbursement if we’re going to make some headway. We’ve got some real roadblocks there. We know that the doctor who suffers from burnout has twice (the) rate of medical errors. We know there are more than 12 million serious medical errors in the United States every year and that number is not going down, but rather increasing as the rate of burnout increases. We need to make life better for clinicians. We have a lot of genomics today that we’re not using, particularly polygenic risk scores for the most common conditions that include heart disease, breast and prostate cancer, type 2 diabetes. These are probabilistic, but if you have hundreds of variants from a low cost, high throughput genotyping that costs today less than $50, you could go into prevention mode. All these things are actionable, but we’re not using them. Part of this problem is we have a lack of comfort among clinicians using genomics. We hope you enjoyed listening to this episode of “Fixing Healthcare.” Don’t forget, you can also read this episode, as well … READ: Full transcript of our discussion with Dr. Topol Next month, Dr. Donald Berwick joins the podcast to share his plan to transform healthcare. Dr. Berwick is the former president and CEO of the Institute for Healthcare Improvement (IHI) and led the organization’s 100,000 Lives Campaign, a nationwide initiative to significantly reduce morbidity and mortality in American healthcare. He’s the former administrator for CMS and has served on the faculty for Harvard Medical School and Harvard School of Public Health. We’re looking forward to having him on the show. * * * 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 4: Dr. Eric Topol says ‘step one is providing healthcare to all citizens’ appeared first on Fixing Healthcare.

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.