Relentless Health Value

Rahul Dubey is the founder of Percynal Health Innovations. He’s also the former chief innovation officer at AHIP—that’s America’s Health Insurance Plans. AHIP is a trade group for insurance carriers, health systems, best-in-breed solution providers, and others. Rahul has created what he calls strategic working groups, in which he gets together essential stakeholders within a regional geography to collaborate and figure out innovative best-in-class emerging solutions and approaches. The first thing they do in these strategic working groups is to identify common problems. Since the best solutions solve the best problems for the most stakeholders, this seems like a pretty decent way to start. What are some of the challenges that Rahul has identified with payers and providers and other stakeholders to solve for? Here’s your listicle: Really get to population health management and just population health Operational inefficiencies Information trafficking without getting anything out of it is not gonna work anymore Level up health literacy Here’s a point Rahul makes that I’m continuing to think about. He says that payers should be grade aggregators—aggregators of data, aggregators of solutions that they should be able to distribute to other essential stakeholders. I heard somebody else say the other day that the new payer is more like an entity that provides comprehensive services. You can learn more by connecting with Rahul via email or LinkedIn.  Rahul Dubey is CEO of Percynal Health Innovations and the Founder of America's Health Insurance Plans (AHIP) Innovation Lab. Rahul is currently responsible for collaborating with C-level executives at his health plan. Prior to joining AHIP and launching Percynal Health Innovations, Rahul held a leadership role as a founding employee of a successful digital health care start-up based in Washington, DC. Along with the company’s cofounders, Rahul was instrumental in developing a multifaceted consumer tool as well as leading the company’s “go-to-market strategy,” resulting in successful market penetration and revenue growth for the industry’s first consumer-led shared decision making and treatment selection platform. Rahul was recognized with the Smart Health’s 2018 Excellence in Healthcare Transformation award, was named the American Journal of Health Promotion’s 2017 Innovators and Game Changers, and is featured in Accenture Perspectives: Minds Driving the Future of Business. In 2017, Frost & Sullivan presented Rahul with one of their highest honors, their Global Visionary Innovation Leadership Award. He is a graduate of the University of Michigan–Ross School of Business and lives in Washington, DC, with his son. He invites you to contact him directly—that is, if you’re willing to roll up your sleeves and drive transformation through inflective collaborative. 02:08 The stated needs of payers. 03:24 “Where are the inefficiencies that we can actually cut out of the system?” 05:14 A reverse approach to meeting the needs of payers. 06:35 Information transfer—what this means. 09:42 “Innovation is a team sport.” 13:12 The “optimal solution.” 18:49 “The lines of communication and business model creation … it’s getting very creative right now.” 20:10 Data play and finding key insights. 20:49 “A more definitive risk.” 21:24 Vendors as “solution providers.” 21:33 “The great aggregators”—collaborating optimally. 22:39 Brian Van Winkle and Rishab Shah on NODE.Health’s “Ease of Doing Business.” 25:16 “It’s more relationship innovation and business model innovation than technology.” 27:02 Rahul’s advice to health plan collaborators, like insurance carriers. 29:44 Rahul’s advice on how providers can collaborate better. 30:37 What’s essential to payer success. 30:56 “Who are we trying to serve?” You can learn more by connecting with Rahul via email or LinkedIn.

In this health care podcast, seven thought leaders talk about the areas of promise they see in health care in 2020. Seven thought leaders include: Kimberly Noel, MD, from Stony Brook Medicine Eric Weaver, from Innovista Health Solutions Suzanne Delbanco, from Catalyst for Payment Reform Sue Schade, from StarBridge Advisors Naomi Fried, from Health Innovation Strategies Joe Grundy, from Grundy Consulting Adrian Rubstein, from Merck Just a couple of comments up front here. I don’t want to further my reputation for dropping major spoilers, however, so I’ll keep this short. Many of the thought leaders today talk about AI in various contexts. Are you rolling your eyes right now? If so, let me remind everyone about the Gartner Hype Cycle. The first step is wild-eyed enthusiasm. The next step in the hype cycle is anger, the old trough of disillusionment. I’d suggest that as far as AI is concerned, we are coming out of that trough and AI—be it artificial intelligence or augmented intelligence or machine learning or deep learning or whatever you choose to call it—it is being used, for reals, for various applications. Other corroborations among our thought leaders include the importance of exalting primary care, in the form of what some may call direct primary care and Zeev Neuwirth calls complex-condition care or condition-specific care—a relationship model, if you will. Another idea that comes up in various ways is the idea of breaking down silos and getting everyone with a stake in patient health to the table and focused on achieving better patient outcomes using all the technology and wherewithal available to us in 2020. By all the stakeholders, I mean going beyond the usual suspects of providers and insurance carriers—meaning employers. Also meaning Pharma, in the sense of Pharma taking the opportunity to collaborate more deeply toward outcomes their medications can potentially confer … IRL with RWE. Today’s episode features the following guests: Kimberly Noel, MD, MPH, is a board-certified, preventive medicine physician. She serves as the telehealth director and deputy chief medical information officer of Stony Brook Medicine, where she provides leadership to all telehealth activities of the health system. Dr. Noel is also the chief quality officer of the patient-centered medical home (PCMH) for the family medicine department, working on quality improvement and population health management for National Committee for Quality Assurance (NCQA) designation. She practices occupational medicine clinically and provides digital solutions for employee wellness programs. She is an appointee the New York State Department of Health Regulatory Modernization Initiative Telehealth Advisory Committee and has won many service and innovation awards for health care. In academia, her research areas are in machine learning, risk models, and remote patient monitoring. Dr. Noel has developed several educational curriculums, including a 40-hour telehealth curriculum for the School of Medicine, as well as interprofessional educational curriculums with the School of Health Technology and Management, Nursing, Dentistry, and Social Work. Dr. Noel is a graduate of Duke, George Washington, and Johns Hopkins Universities. She is a proud graduate of the Stony Brook Preventive Medicine program, whereby she is now working collaboratively with the residency program leadership on development of a telehealth preventive medicine service. Eric Weaver, DHA, MHA, is nationally recognized for his work in primary care transformation and value-based care. As a corporate vice president for Innovista Health Solutions, he oversees enterprise strategy and technology adoption for a fast-growing population health management services organization. Dr. Weaver has been recognized for his contribution to the health care industry by receiving the ACHE Robert S. Hudgens Award for Young Healthcare Executive of the Year and the Modern Healthcare “Up & Comers” Award in 2016. Prior to joining the Innovista leadership team in 2015, he was the president and CEO of Austin, Texas–based Integrated ACO—one of the more successful physician-led accountable care organizations in the country. Suzanne Delbanco, PhD, is the executive director of Catalyst for Payment Reform (CPR), an independent, nonprofit corporation working to catalyze employers, public purchasers, and others to implement strategies that produce higher-value health care and improve the functioning of the health care marketplace. In addition to her duties at CPR, Suzanne serves on the advisory board of The Source on Healthcare Price & Competition at the University of California–Hastings and the Blue Cross Blue Shield Institute. Previously, she was the founding CEO of The Leapfrog Group. Suzanne holds a PhD in public policy from the Goldman School of Public Policy and an MPH from the School of Public Health at the University of California–Berkeley. Sue Schade, MBA, is a nationally recognized health IT leader and Principal at StarBridge Advisors providing consulting, coaching, and interim management services. She recently served as the interim chief information officer (CIO) at Stony Brook Medicine in New York. She was a founding advisor at Next Wave Health Advisors and in 2016 served as the interim CIO at University Hospitals in Cleveland, Ohio. Sue previously served as CIO for the University of Michigan Hospitals and Health Centers and, prior to that, as CIO for Brigham and Women’s Hospital in Boston. Her previous experience includes leadership roles at Advocate Health Care in Chicago, Ernst & Young, and a software/outsourcing vendor. Naomi Fried, PhD, is an innovative and digital health thought leader and founder and CEO of the boutique advisory firm, Health Innovation Strategies, which focuses on innovation program design and digital health strategy. Naomi was the first vice president of innovation and external partnerships at Biogen, the first chief innovation officer at Boston Children’s Hospital, and vice president of innovation and advanced technology at Kaiser Permanente. She served on the board of directors of the American Telemedicine Association and the Governor of Massachusetts’ Innovation Council. Joe Grundy has firsthand experience with nearly every aspect of primary care transformation. He has led policy and product development for the American Academy of Family Physicians, led in-the-trenches transformation of a primary care group, and served as national faculty for Medicare’s Comprehensive Primary Care Plus transformation project. He cofounded Grundy Consulting to work with stakeholders across the industry in order to accelerate the rate of effective transformation in primary care. Adrian Rubstein is a medical adviser and innovation manager at Merck KGaA, where he works to bring cutting-edge technologies to improve patients’ lives. He also helps new biotech companies in strategy development, investment, and business analysis.   02:41 Dr. Kimberly Noel and her thoughts on areas of promise. 02:53 Advocacy for inclusive innovation. 04:01 Why inclusive innovation is an area of promise in the advent of artificial intelligence (AI). 04:52 “Who is most likely to be disadvantaged?” 05:27 Eric Weaver’s thoughts on areas of promise. 05:42 Relationship-driven, team-based primary care. 07:14 What investors are focused on right now. 07:34 Where the tipping point is in value-based care. 08:03 AI as another trend that will help improve health care. 08:48 Incorporating social determinants into primary care and the transformative potential of AI. 11:07 Suzanne Delbanco of Catalyst for Payment Reform and her thoughts on areas of promise. 11:26 Employers making the health care space work better for them as an area of promise. 11:52 Employers seeking out high-value health care in nontraditional ways. 13:10 Where to look to seek high-value health care. 14:37 Employers bringing in really good data. 16:15 Sue Schade’s thoughts on areas of promise. 16:32 How leveraging electronic health records is an area of promise. 16:58 Why eliminating clinician burnout is also part of this area of promise. 17:26 Patient engagement and the patient journey as another area of promise. 18:08 “You have to approach all of these from a partnership between digital, IT, and operations.” 18:30 Enterprise resource planning (ERP) as a third area of focus/promise. 19:01 AI as an area of promise and an area of hype. 19:48 Naomi Fried’s thoughts on areas of promise in health care. 20:02 Digital health developments from the pharma perspective. 22:15 The digital health start-up world as another area of interest and promise. 22:37 The importance of data and the importance of validating those data for digital health solutions. 23:02 Personalized medicine and digital health. 24:32 More jobs in digital health within clinical-grade solutions. 25:01 Joe Grundy’s thoughts on areas of promise in health care. 25:06 The direct primary care model as an area of promise. 26:08 “Questioning the very validity of our understanding of ‘quality’ in health care.” 28:01 Adrian Rubstein’s thoughts on areas of promise in health care. 28:08 AI in emergency medicine as an area of promise. 28:53 CRISPR gene editing as an area of promise. 29:59 Virtual reality/augmented reality as another area of promise in health care.

In this health care podcast, I talk with Karl Bilimoria, MD. Dr. Bilimoria is a surgical oncologist and a VP of quality over at Northwestern Medicine. Plus, he is also a John B. Murphy professor of surgery. The second I heard that Dr. Bilimoria and his colleagues had worked on an initiative to “rate the raters” of hospital and physician quality, I reached out to get him on the show. I had just had about four conversations with various people about the difficulties of judging quality. And I had also had a confounding personal experience visiting a patient at a hospital judged a top hospital by a well-known national rating scale. And this “top” hospital had some readily apparent issues, and I am no expert. That got me wondering about the validity of some of these quality raters. Given the importance and the need for health care quality transparency, Dr. Bilimoria and his colleagues set out to fill this gap by undertaking a (as mentioned) Rating the Raters process to evaluate and compare probably the major publicly reported hospital quality rating systems in the United States. These include the CMS (Centers for Medicare and Medicaid) Hospital Compare Overall Star Ratings, Healthgrades Top Hospitals, Leapfrog Safety Grade and Top Hospitals, and the U.S. News & World Report Best Hospitals.  Interestingly, that “top” hospital I was in was scored a top hospital by one of the lowest-rated raters. You can learn more at the New England Journal of Medicine Web site, thesecondtrial.org, and the NEJM Catalyst Web site.  Karl Bilimoria, MD, is a surgical oncologist and a health services, quality improvement, and health policy researcher at Northwestern University’s Feinberg School of Medicine. He is the vice president for quality for the Northwestern Medicine system. He is also the vice chair for quality in the Department of Surgery and the John B. Murphy professor of surgery. His clinical practice is focused on melanoma and sarcoma. Dr. Bilimoria is the director of the Surgical Outcomes and Quality Improvement Center of Northwestern University (SOQIC), a center of 50 faculty and staff focused on national, regional, and local quality improvement research and practical initiatives. He is also the director of the 56-hospital Illinois Surgical Quality Improvement Collaborative (ISQIC).

You know how in JAMA recently it said that 25% or more of health care spending is frittered away wastefully? Some of that wasteful spending comes from unnecessary care. And some of that unnecessary care happens when a patient is misdiagnosed and then, based on that misdiagnosis, gets care for the wrong thing. And “wrong thing” care obviously isn’t going to fix the actual problem because its intention is to fix something else. How do some of these misdiagnoses occur? Considering all of the diagnoses that begin with an MRI or a CT scan or an ultrasound or some other kind of imaging, it’s not hard to gin up thought that if a radiology report or radiology veers into the “not exactly correct” zone, then you have a treatment plan immediately zipping off on a poor-quality and likely wasteful trajectory. That’s what I speak with Ron Vianu about in this health care podcast. Ron, by the way, is the founder and CEO over at Covera Health. We don’t have time (Ron and I) to get into the AI (artificial intelligence) and machine learning in radiology aspect, but (spoiler alert) a follow-up on that is forthcoming. You can learn more at coverahealth.com.  Ron Vianu is the CEO and co-founder of Covera Health and a serial entrepreneur and problem solver by nature. He has spent the last 20+ years founding ventures in the health care, technology, and insurance spaces. Ron studied chemistry and philosophy at NYU.

Dr. Richard Zane is the chief innovation officer at UCHealth. He’s also the executive director of emergency services there. Besides that, he chairs emergency medicine at the medical school and he’s a professor at the business school and at the medical school. At the recent NODE Digital Medicine Conference, I asked Dr. Zane to talk about the 2019 innovations that he is most proud to have rolled out in their hospital system. We talk about three of these innovations, and then we get into the challenges that Dr. Zane and his team faced and overcame in the pursuit of those rollouts. What struck me most is the underlying dependency on data of all three of these innovations. Optimally complete data sets are really needed to make each one of these programs work as well as they possibly could. And as a corollary to that, the necessity of collaboration with payers like insurance carriers and PBMs (pharmacy benefit managers) to even get close to that complete optimal data set. Sidebar (because I can’t help myself): It’s going to be really interesting to see which payers and PBMs are ultimately willing to share data with providers—and, honestly, which providers are willing to share data with other providers—to help their patients get the right treatments in pursuit of better patient outcomes, because that’s kind of a proxy to which ones value better patient care more than, let’s just say, other things. I think the organizations that choose to share and choose to collaborate—you know, which ones self-sort into that category—that information is going to become more and more publicly available, and I wonder when and if that transparency will influence organizational decision making. In this health care podcast, Dr. Zane uses the term ethnographic a couple of times. Call me “out of the loop” but I had not heard that term before. So, just in case you haven’t either, let me reference my go-to for mostly accurate information, otherwise known as Wikipedia. Ethnographic research, says Wikipedia, is a qualitative method where researchers observe and/or interact with a study’s participants in their real-life environment. You can learn more by connecting with Dr. Zane on Twitter at @richardzane. Richard Zane, MD, currently serves as the George B. Boedecker Professor and chair of the department of emergency medicine at the University of Colorado School of Medicine, professor of health administration at the University of Colorado Business School, and chief innovation officer for UCHealth. Dr. Zane completed medical school at Temple University in Philadelphia, followed by residency training in emergency medicine at the Johns Hopkins School of Medicine. Following residency, Dr. Zane joined the faculty at Johns Hopkins as assistant chief of service. In 1998, Dr. Zane joined the faculty at Harvard Medical School and Brigham and Women’s Hospital in Boston.

Everybody knows about evidence-based medicine, especially evidence-based medicine around the use of pharmaceuticals—and especially in oncology. Provider and payer organizations, many of them, strive to standardize care pathways around that evidence-based medicine. Here is the thing: I’ve heard it said that doctors and patients at the point of care are not particularly interested in evidence-based medicine. What they want right then is medicine-based evidence: If this patient takes this medicine, what will the outcome be? Is there a name for this medicine-based evidence? Why, yes there is! It’s otherwise known as patient-reported outcomes, or PROs. And the high demand for meaningful PRO data has been clear across the spectrum of stakeholders but especially when it comes to patients and doctors who are actually making treatment decisions. This demand is really acute for oncology patients and their doctors, where the stakes are high and adverse events are definitely not trivial. PROs can be collected for drugs that are already FDA approved but also for drugs in development. It’s been said that a Pharma these days who skips collecting PROs in cancer drug development does so at its own peril. Here’s something that Dr. Ethan Basch said. He said, “When I sit down with a patient to think about starting a new treatment, almost invariably the first question that they ask is how they will feel with this product.” Dr. Ethan Basch, by the way, I interviewed in EP157. He’s the director of the Cancer Outcomes Research program at the University of North Carolina.  In that interview, you can hear about how Dr. Basch and his colleagues found that by collecting patient-reported outcomes and acting on them, patient survival time improved something like 5 months. So put this in perspective: Those drugs that cost hundreds of thousands of dollars that are coming out … they don’t increase survival time that long. Let’s bring this full circle. How is all of this relevant to evidence-based medicine? It’s relevant because all of those evidence-based pathways that we’re working on these days should lead to not “better patient outcomes.” They should lead to the outcomes that matter for this patient. And what matters is not some kind of universal truth. Patients at different points in their lives with different goals are going to have different ideas of what good looks like to them. We all know that what gets measured gets managed. So, if achieving patient outcomes or being patient-centric is the goal here and we’re not measuring PROs, then we’re not managing them either. In this health care podcast, I speak with Nadine Jackson McCleary, MD, MPH, BSN. Dr. McCleary is an oncologist at Dana-Farber Institute and an assistant professor in medicine at Harvard Medical School. She is currently working on a project to collect patient-reported outcomes and make them actionable. I interviewed Dr. McCleary at the NODE Digital Medicine Conference in New York City recently. You can learn more by connecting with Dr. McCleary on Twitter at @DrNJMcCleary.   Nadine Jackson McCleary, MD, MPH, BSN, is an assistant professor of medicine at Harvard Medical School, senior physician of the Dana-Farber Cancer Institute (DFCI), and medical director for the DFCI Patient-Reported Data Program in the department of informatics and analytics. As an active member of the Gastrointestinal Cancer Center, she specializes in gastrointestinal oncology with a unique clinical focus on those at the extremes of age (younger than 20 and older than 80). She serves as the liaison for the Gastrointestinal Cancer Center to the DFCI satellite and collaborative members.

I was asked by a group of students from Michigan University’s Ross School of Business to identify what I would consider companies or areas of promise in health care. It’s a good question. I’m going to take a stab at the answer in this health care podcast, but let me foreshadow coming up next month, there’ll be a second episode of Relentless Health Value dedicated to this same exact topic. I have asked a panel of people from across the industry to weigh in on this same exact question. So, here’s what I have to say about it, but you can balance my views with theirs upcoming and decide for yourself what advice you wish to take. For more information, go to aventriahealth.com. When not hosting the show, Stacey is co-president of Aventria Health Group, a marketing agency and consultancy. Aventria specializes in helping pharmaceutical, employer, pharmacy, and health system clients improve patient outcomes by creating and leveraging collaborations with other health care organizations. For more than 20 years, Stacey has innovated better-coordinated health solutions benefiting all stakeholders and, most of all, the patient. 01:47 Promise doesn’t mean piling up bills at the expense of patients and taxpayers. 02:47 “These companies won’t change unless there are people working from within to get them on track.” 03:53 Stacey’s three-prong plan to find promising companies within health care. 04:08 “Follow the money.” 05:29 Three things to look for in a health care company or health care area. 06:12 “It’s really hard to integrate with an unknown entity.” 06:50 “Doctors … like to create their own solutions.” 07:34 “The realities [are], people buy what they … create.” 09:48 “The hype cycle is real.” 10:45 All promising areas and companies have one thing in common: They’re innovative. 11:07 Disruptive innovation vs sustaining innovation. 11:45 Clayton Christensen’s The Innovator’s Dilemma.12:23 Zeev Neuwirth’s Reframing Healthcare. 14:48 EP202 with Frazer Buntin. 15:41 “Look for first movers.” 15:56 “Look for disruptive companies that have gotten investments from entrenched players.” 16:23 Who excels at incremental innovation vs disruptive innovation. 17:10 Stacey’s note of caution about transparency and health care businesses. For more information, go to aventriahealth.com. Check out our #healthcarepodcast #inbetweenisode with our host, Stacey Richter, as she talks areas of promise in #healthcare. #podcast #digitalhealth #healthtech #healthcarebusiness What it really means to have promise within #healthcare. Our host, Stacey Richter, discusses. #healthcarepodcast #podcast #digitalhealth #healthtech #healthcarebusiness “These companies won’t change unless there are people working from within to get them on track.” Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness What’s our host Stacey Richter’s three-prong plan for finding promise within #healthcare? Find out in our latest #inbetweenisode #healthcarepodcast #podcast #digitalhealth #healthtech #healthcarebusiness “Follow the money.” Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness “It’s really hard to integrate with an unknown entity.” Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness “Doctors … like to create their own solutions.” Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness “The realities [are], people buy what they … create.” Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness “The hype cycle is real.” Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness All promising areas and companies have one thing in common: They’re innovative. Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness Disruptive innovation vs sustaining innovation. Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness “Look for first movers.” Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness “Look for disruptive companies that have gotten investments from entrenched players.” Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness Who excels at incremental innovation vs disruptive innovation? Our host, Stacey Richter, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebusiness

Right now, I am in the middle of rereading The Innovator’s Dilemma—that seminal work by Clayton Christensen. I’m at the chapter right now where he talks about resources (human and otherwise), processes, and values. These three things are the trifecta that determines what any organization can manage to achieve—or not achieve, as the case may be with disruptive technologies. Here’s where this is relevant to health IT. You can have the most dedicated team who has built out and proven a digital tool that meaningfully improves patient outcomes and that patients embrace. But if the organization surrounding that team does not have the processes and the values that support this team, the effort will, at best, be suboptimal. In this health care podcast, I speak with George Mathew, MD, MBA, FACP, and Chief Medical Officer, Americas, over at DXC Technology. We talk about the why and the how of patient/provider collaborations when it comes to digital tools. We spend some time on the process prong of Clayton Christensen’s trifecta. From there, there’s news you can use, like what’s going on with the FDA pre-cert program. And then we also get into how digital tools are being inserted into clinical workflows to greater or lesser effect. I can probably also claim that we freewheel our way through some resources and some values advice, but at a minimum, we touch on a number of adjacencies to the process of creating and deploying digital tools effectively, including the why of it all. You can learn more at dxc.technology.  George Mathew, MD, MBA, FACP, is the Chief Medical Officer for the North American health care organization for DXC Technology, the entity created by the merger between Hewlett Packard Enterprise Services and Computer Sciences Corporation (CSC). In this role, Dr. Mathew serves as the clinical expert and health care thought leader to our health care clients in the transforming health care marketplace in payer, provider, life sciences, and state and local Medicaid business. His experience includes consulting, technology development, and business development work at GE; Goldman, Sachs and Co.; WebMD; Pfizer; and Aetna. Dr. Mathew brings a strong technology innovation focus to this role, having founded a health care technology start-up earlier in his career, and advises several health care IT start-ups.

Musculoskeletal issues, otherwise known as MSK issues, account for something like 20% of the cost to any given health plan or employer or anyone else who is paying the bill for health care. That’s like one in every five dollars, which is meaningful when you consider million-dollar drugs and diabetes and all the other things that a purchaser of health care can write checks for. MSK is a big cost kahuna. In this health care podcast, I talk with Chad Gray, who is the CEO of IMC, Integrated Musculoskeletal Care. Interestingly, Chad says that the problem with MSK in this country isn’t a cost problem usually. It’s a quality problem. It’s a problem of patients getting a whole lot of care that doesn’t actually relieve their symptoms or underlying condition. This is what MSK care and the 4-minute mile have in common besides the blindingly obvious necessity of healthy bones to run fast. Everybody thought it was impossible for a human to run a 4-minute mile—until somebody did. And once that happened, it was like a dam opened and lots of people began breaking that previously impossible time. It’s conventional wisdom that MSK problems are mostly going to turn into intractable chronic conditions that ultimately result in surgery, which still doesn’t, in many cases, cure the symptoms or underlying problem. Chad Gray and his team over at IMC may have broken the 4-minute mile when it comes to inventing a systemic approach to MSK care that actually works. Prepare for the dam to burst. You can learn more at imcpt.com. Chad Gray, MS, PT, Cert MDT, is cofounder and CEO of Integrated Musculoskeletal Care, Inc (IMC), providing outcomes-accountable musculoskeletal care programs that improve overall health care quality, reduce costs, and improve patient and employee safety. He has over two decades of experience as a clinical practitioner and is a widely recognized entrepreneur, health-benefit design consultant, and concierge practitioner focused on innovations in musculoskeletal triage, health care, and self-care.

I was listening to The #HCBiz Show!, featuring hosts Don Lee and Shahid Shah, earlier this year—specifically, their two-part series entitled “Selling Into Health Systems” [part 1 and part 2]. Besides being co-hosts of The #HCBiz Show!, Don Lee is the founder of Glide Health and VBP Forward [which stands for value-based payments], and Shahid is a serial entrepreneur; one of his companies is Netspective. Shahid can be found doing HIT keynotes all over the country, too. Both of these guys, Don and Shahid, know a whole lot about selling into health systems from both sides of the table. So it is not a surprise that they did a couple of shows on this theme. A lot of what Don and Shahid were talking about in that “Selling Into Health Systems” series dovetailed superiorly with some work that we do over here at Aventria and that we know a lot about. So pretend there’s a drum roll here because I’d like to announce that this is not just an inbetweenisode. We have just driven right off the Relentless Health Value podcast format reservation. With Don and Shahid’s permission, of course, we are going to play some clips that I find particularly relevant from that #HCBiz Show! “Selling Into Health Systems” series. Then Dave Dierk, my co-president over here at Aventria Health Group, and I will discuss said clips. Dave and I are going to talk about how exactly a—let’s just call them—seller needs to prepare its account management team to go into a health system and successfully do all of the things that Shahid and Don talk about. As foreshadowing, a lot of what Dave and I recommend to prepare an account management team for successful selling centers on five links in a chain … and here they are: Account managers need a really firm grasp of (1) market knowledge and (2) customer knowledge. They need (3) collaborative selling skills (the ability to listen and dialog), (4) consultative skills (which should be additive), and lastly, there is a great requirement for (5) strategic ability to think critically around how to make all of the other links in the chain actionable. And you’ll hear these five things woven throughout the conversation I have with Dave in this health care podcast. One last note: I need to mention Brian Van Winkle. This podcast conversation that Shahid and Don had references an article [part 1 and part 2 on The Health Care Blog] that Shahid coauthored with Brian, who is executive director of innovation over at Johns Hopkins. You can learn more at aventriahealth.com/perspectives. Listen to “Selling Into Health Systems” (part 1 and part 2). Dave and Stacey are co-presidents of Aventria Health Group. Stacey specializes in helping employer, pharmaceutical, device, and pharmacy clients by creating partnerships with other health care organizations. For 20 years, Stacey has innovated better-coordinated health solutions benefiting all stakeholders and, most of all, the patient. Dave is a 30-year veteran of managed-markets marketing. After working in consumer marketing with AT&T and health care publishing with Elsevier, Dave made the move to medical advertising and communications at KI Lipton, Inc. Subsequently, he became a cofounder of Pinnacle Health Communications. Dave is an accomplished strategist, providing innovative customer marketing, access, quality, and health intervention solutions for large clients and has directed the development of numerous industry-leading campaigns in primary care and specialty markets. He has supported clients in disease areas that include oncology (Bristol Myers Squibb [BMS], Novartis, Eisai), virology (BMS, Merck & Co.), pharmacy (American Pharmacists Association, Merck, Novartis), and blood disorders (Novo Nordisk), to name a few. Dave has helped more than 15 clients achieve top rankings in their respective categories. He is also an active member of the Pharmacy Quality Alliance. 03:37 Don Lee on understanding problems in health care on a micro level rather than on the whole. 03:55 Focusing on larger entities that are looking to collaborate with a health system rather than innovators and start-ups in health care. 04:52 Looking at innovation and affecting behavioral change more broadly. 05:42 Helping manifest potential value. 06:06 Don Lee on being a proactive innovation guide rather than telling a health system how their system works. 07:39 Learning new skills and putting new infrastructure in place to support new approaches. 09:24 “The value that you bring is the incremental between where they are now and what they could attain.”—Stacey 10:42 “It’s more about you than it is about your customer.”—Stacey 12:41 “All of that is predicated on, ‘What’s your strategy? What’s your plan?’”—Dave 14:54 Don on doing the consulting work. 15:16 Shahid on building business cases for everything you bring into the health system environment. 15:48 Don on the number of perspectives at the table and needing to understand and align your product to this multitude of needs. 17:24 “Once you get to yes, your job is not done.”—Dave 18:55 Shahid on common mistakes on consultative work. 20:35 “If it’s not meaningful to them, relative to other choices, then they might not act on it.”—Dave 21:48 “That challenge is underestimated.”—Stacey 23:21 Collaborative skills vs consultation skills. 24:18 Shahid on how the value of your product changes depending on the organization and clients that you’re working with. 25:42 Shahid on pushing a product before considering the customer’s needs. 28:39 What an account manager needs in order to be successful. 30:22 What a paradigm of success consists of. 32:47 Breaking down barriers and paradigms to get the right approach. 33:35 Being relational, not transactional. You can learn more at aventriahealth.com/perspectives. Listen to “Selling Into Health Systems” (part 1 and part 2).