Creating a New Healthcare

Welcome to episode #103, Season 4 of Creating a New Healthcare. In this episode we are welcoming back to the podcast Dr. Mandy Cohen, the Secretary for the North Carolina Department of Health & Human Services. Dr. Cohen and her administration have been critical in responding to the current pandemic. Over the past 3 1/2 years, they have also been hard at work, developing and deploying a cutting-edge, state-wide approach to addressing the Social Determinants of Health – a critical national issue whose importance has been magnified by the pandemic. In this episode, we’ll cover: 3 major lessons that the COVID-19 pandemic has taught us: (1) equity, (2) system-ness and (3) care beyond walls. How Dr. Cohen and the NC DHHS adopted “an equity lens” in deploying targeted programs and policies to create a more equitable healthcare system. The progress in “health opportunity” programs such as the NCCARE360 closed-loop referral program. The central importance of Community Health Workers in building a ‘bridge of trust’ to creating better health. For me, there were three profound take-aways from this episode: As we were discussing the importance and necessity of collecting data on racial disparities and inequities in healthcare, Dr. Cohen paraphrased a mutual colleague – Dr. Mark Smith, the founding president and former CEO of the California Health Care Foundation. The lesson she shared is the cautionary note that one should not admire a problem too much at the expense of doing something about it. We should not wait around for perfect or publishable data before taking action. Heeding this advice, she is “full tilt” on deploying resources to assist traditionally marginalized populations – in particular, the Black and Latinx populations. Governor Roy Cooper has been fiercely promoting the importance of Medicaid expansion – which has become even more critically important due to the stressors of the pandemic on factors such as employment. There are currently 2.2 million people on Medicaid in NC, which accounts for about one-fifth of the entire NC population.  1.5 million of those individuals are children, which accounts for one out of every three children in NC.  If we accepted federal funding and expanded Medicaid in NC, it would provide insurance coverage for another 600,000 people – covering COVID-19 testing, behavioral health treatment, early childhood development programs, life-saving medical care and so on. As Dr. Cohen puts it – the fact that we are one of only twelve states in the entire country that has not yet expanded Medicaid is a “black eye” on the NC commonwealth. There was another profound ‘aha’ moment that happened during this interview that I don’t think I’ll ever forget. As we were discussing the ‘community health work’ (CHW) program she and her team are deploying, Dr. Cohen punctuated the key role that community health workers serve in the healthcare ecosystem. It’s well known that Community Health Workers serve to provide navigation and coordination of clinical care, and that they assist with social services and social agency. But, from Dr. Cohen’s perspective, their key core function is really about rebuilding trust. It’s about meeting people where they are, and starting to rebuild a bridge that has been broken. She went on to say that we have to acknowledge that we have a “trust deficit” in communities of historically marginalized people. More explicitly, Black and Latinx communities have been left out and let down by our healthcare system. And, some of the current health inequities are likely due to the fact that people don’t seek healthcare because they don’t believe they will be heard, listened to, and appropriately cared for. The “trust deficit” is based on decades of lived and learned negative experiences, and is supported by decades of published research. Dr. Cohen is a knowledgeable, forward-thinking, empathetic and highly competent public health leader. She has a definite bias to action – deploying programs that achieve measurable positive health outcomes for individuals and communities. Under her leadership, the NC DHHS is keenly focused on addressing the long-standing and systemic ‘dis-trust’ in our healthcare system, which to my mind may be the single most important ‘dis-ease’ we need to tackle if we are to achieve our full potential as a state, and as a nation. Until next time, be safe and be well. Zeev Neuwirth, MD

Dear Friends & Colleagues, Welcome back to the Fall 2020 season of ‘Creating a New Healthcare’.  We are now entering the 4th year of our podcast, with over 250,000 downloads this year to date!  It’s clear that the issue of reframing healthcare has never been more important than it is at this moment.  So, if you find value in listening to the podcast, I would urge you to share it with friends and colleagues. There is so much going on in the world right now. It’s a time of great uncertainty, volatility, distress – and opportunity.   One of the unintended consequences of the sheltering-at-home and social-distancing – necessary to combat COVID-19 – is the devastating isolation, loneliness and despair it has wreaked across the US population.  Research, prior to the pandemic, informs us that somewhere between 40 – 50% of the population experiences social isolation or loneliness.  I strongly suspect that the pandemic has raised those numbers significantly.  We also know that it’s not just the elderly.  The second most affected segment of the population are college age adults.  We desperately need a national solution to address social isolation and loneliness. So, what can NASA teach us about social isolation & loneliness?  And, why is Humana, a major healthcare insurance company, collaborating with NASA to address social isolation? To answer those questions, we’ll be joined today by two distinguished experts in this area – Dr. Will Shrank,  the Chief Medical Officer at Humana; and Dr. Gary Strangman – a psychologist and researcher from the Massachusetts General Hospital (MGH).  Dr. Strangman is the Director of a “Neural Systems Group” at MGH and has also been working closely with NASA over the past 2 decades – currently as the Innovation Specialist for NASA’s Translational Research Institute for Space Health (TRISH). In this interview, we’ll dive into the following: The physiologic and psychologic impact of social isolation on astronauts and the types of solutions NASA is exploring to deal with this. Some of the similarities between space travel & sheltering-at-home in the era of COVID-19. Startling statistics on the impact of social isolation on Humana’s senior members, and the types of initiatives they’ve been deploying to combat it. Next steps for the collaboration between Humana and TRISH. During the interview it becomes abundantly apparent that Gary Strangman and Will Shrank are superstars in their respective fields.  The fact that Humana is collaborating with NASA’s Translational Institute for Space Health speaks volumes about the intense focus, commitment and highly innovative approach Humana is taking to better understand and combat the epidemic of social isolation.  Humana and TRISH are also collaborating, alongside others, in a public health awareness campaign, called ‘Far from Alone’.  This program addresses health-related social needs and promotes understandings of loneliness and social isolation – issues that are exacerbated by the Coronavirus pandemic. I recently read a quote from Atul Gawande that provides a meaningful context to the work that Dr. Shrank and Dr. Strangman, and their respective organizations, are engaged in. “We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival.  But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive.” Until Next Time, Be Safe & Be Well. Zeev Neuwirth MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introductory episode here.  During this series, I interviewed forward-thinking, courageous healthcare leaders and entrepreneurs – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way we’re delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? In order to share the remarkable insights from these timely interviews, we have been releasing episodes as quickly as possible.  Over the past 8 weeks, we’ve posted 20 episodes! Today’s episode is the final interview in this limited podcast series.  In this episode, I’ll be sharing some of my key learnings and lessons from the past few weeks, and the impact I hope it will have on our healthcare system. In this episode, I’m joined by Chitra Ragavan, a nationally recognized journalist and host of her own podcast, When It Mattered.  Chitra will take the mic in this episode and interview me about my perspectives on how COVID-19 is reframing American healthcare.  Chitra is an unusually skilled podcast host in that she brings deep experience in television, radio, and print – including at National Public Radio (NPR) and U.S. News & World Report magazine (U.S. News).  Chitra also is Founder and CEO of Goodstory, a strategic advisory firm helping companies with strategic growth and positioning, using brand architecture, narrative and storytelling.   A preview of the topics we’ll touch on include: The fundamental flaws in the American healthcare system that have been exposed and magnified by this pandemic. The major reframes we MUST deploy post COVID-19 in order to create a new and better healthcare. Why I’m hopeful, energized and enthusiastic about the future of healthcare, and health, in our country. In addition to being the final episode in this limited series, it will also be the final episode of this ‘Creating A New Healthcare’ season.  We’ll take a summer break and kick off the 4th Season in September.  Stay tuned – we have an exciting lineup for the Fall! I’d like to thank the guests who graciously agreed to be interviewed for this limited series.  The stories and stats they shared ran the gamut from enlightening to startling to heart warming to incredibly helpful.  Under normal circumstances, it takes weeks to schedule these interviews; but these incredibly accomplished leaders arranged to participate in a matter of days – out of a shared sense of purpose.  Their insights and profound humanitarianism left me with a deep sense of hope and renewal after each interview. Finally, I would like to take this moment to thank you for listening in and offering your feedback and encouragement via social media and emails.  Please continue to write in and share your thoughts.  And please share the podcast series with your colleagues.  The only way we’re going to create a new healthcare is together. Until next time, Be Safe & Be Well Zeev Neuwirth, MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare.  You can find the introductory episode here.  In this series, I’ve been interviewing visionary, courageous healthcare leaders and entrepreneurs –  asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? In this interview we’ll be speaking with Sami Inkinen, the founder and CEO of Virta Health.  Virta is a completely virtual diabetes clinic whose brand promise is to not only improve type 2 diabetes but, in many instances, to reverse it.  Virta has completely reframed type 2 diabetes care with the physiologic approach they take; the data-driven, digital, AI-enabled technologies they deploy; and the personalized, empathetic and highly responsive care they provide.  Sami is a remarkable person and entrepreneur.  He’s a physicist, turned business and tech guy, turned online real estate entrepreneur, turned healthcare reframer/entrepreneur.  I met Sami about 6 years ago and have had the great privilege of working with him and getting to know him.  And, in full transparency, I have served as an advisor to Virta. Some of the topics we’ll touch upon include: Virta’s approach to type 2 diabetes – which allowed it to be far better prepared to continue delivering exceptional clinical care and outstanding consumer experience during the COVID-19 pandemic. One of the most remarkable statistics I’ve heard during this pandemic – having to do with risk of mortality from the SARS-COV-2 infection in individuals with uncontrolled diabetes. Some of the crippling flaws in the American healthcare system that were exposed and exacerbated by the COVID-19 pandemic. A fundamental misalignment in our healthcare system that represents the most serious impediment to delivering empathetic, value-based care, and superior outcomes. Sami’s top recommendations for what we need to do to create a better healthcare system coming out of this COVID-19 pandemic. Virta Health is an example of what reframed ‘great’ looks like in chronic disease management.  We could spend quite a bit of time breaking down the principles, approaches, processes, technologies, behavioral and relational aspects, payment model, culture, and so on that make Virta so successful.  But the bottom line is that the value proposition, experience and outcomes are far superior to the standard of care across the country.  Virta represents, similarly to others we’ve interviewed in this series, a path to what markedly better healthcare can and should look like.  Sami and his colleagues have paved a path to the future by reframing the care of people with diabetes. One major take-away I’d like to leave you with is one of the key lessons I’ve learned in this limited series.  Organizations – like Virta – that have reframed healthcare, have fared far better during this pandemic than organizations that have not.  This has been a common theme that has come up repeatedly during these in-depth interviews.  It speaks to the fact that our current legacy approaches to healthcare delivery are vulnerable, fragile and simply not oriented, designed or organized around our healthcare needs.  Reframed organizations appear to be much more adaptable, resilient, anti-fragile – and consumer-oriented.  This observation was not lost on me and should not be lost on you. Until next time, be safe and be well. Zeev Neuwirth, MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare.  You can find the introductory episode here.  In this series, I am interviewing future-facing, courageous healthcare leaders and entrepreneurs,  asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? In this interview we’ll be speaking with Dr. Shreya Kangovi about Community Health Workers.  Community Health Workers are individuals who have been hired from their community, and given training and support to provide customized, culturally sensitive, non-clinical care.  Their focus is on the social determinants of health – at the individual level, and delivered in a highly personalized and relationally oriented way.  To my mind, this workforce and approach to care is one of the most untapped opportunities we have to reframe healthcare and create transformative change.  It addresses the overwhelming impact that the Social Determinants of Health (SDOH) have on healthcare outcomes, utilization, costs and the experience of care. The issues of SDOH, chronic disease and disparities of care have been some of the fundamental problems in our healthcare system – problems the COVID-19 pandemic has exposed and exacerbated.  One of the solutions to our present moment and to a better future is the focus of today’s discussion. Dr. Kangovi and her colleagues have pioneered a rigorous, evidence-based approach to building, deploying and measuring the impact of a Community Health Worker (CHW) program.  Dr. Kangovi is the founder & executive director of the Penn Center for Community Health Workers – a national center of excellence dedicated to advancing health in low-income populations through CHW programs. She and her colleagues have spent nearly a decade creating and refining a world-class CHW model called IMPaCT (Individualized Management towards Patient-Centered Targets).  Now, they are offering this program to other institutions to encourage widespread deployment. In this interview, we’ll dive into the following: Six major problems in healthcare – caused and/or exacerbated by the COVID-19 pandemic – that are leading to American deaths. What Dr. Kangovi refers to as the “structural racism” embedded in our healthcare delivery system – and what can be done to reverse it. A detailed description of the Community Health Worker approach to COVID-19 contact tracing, and… The one critical question that drives the highly effective and personalized IMPaCT Community Health Worker approach. The Community Health Worker model is proven to be cost effective, replicable, and complementary. However, in order to implement this model throughout the country, we need a system of care that pays for outcomes, not for procedures or transactions.  Fee-For-Service payment is the “big but” in American healthcare. This has been a common mantra that has emerged in most of the interviews I’ve conducted during this pandemic.  If we shifted to a capitated, value-based payment approach (at least with primary care), we would be able to rapidly and easily deploy effective, humanistic solutions such as Community Health Workers. From my perspective, one of the most important lessons the COVID-19 pandemic has taught us is that Fee-For-Service payment makes both providers and patients vulnerable. It is unsustainable, and frankly harmful to the health of the American public and the American economy.  It’s also not the type of compensation model that fosters meaningful, relationship-enhancing careers for primary care providers as well as specialists. We can talk about a lot of things, but until we fix this one major impediment, we will be propagating an out-dated and misaligned approach to healthcare delivery.  My hope is that this current crisis serves as a catalyst for changing that, and addressing many of the other fundamental flaws in our healthcare system, like disparities in care.  We need courageous leaders to speak up, step up, collaborate across the various stakeholders, and to take directed actions to create a new, and more humanistic, approach to healthcare. Until next time, be safe and be well. Zeev Neuwirth, MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare.  You can find the introductory episode here.  In this series, I am interviewing future-facing, courageous healthcare leaders, entrepreneurs, and practitioners – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? Our focus in this interview is on one of the most critical behind-the-scenes issues that has emerged during this COVID-19 pandemic – provider resilience.  This is not a new issue, but it’s importance has been magnified by the current crisis.  It’s also an issue that will be a high priority for years to come. Our guest this week is Wayne Sotile.  Dr. Sotile is an international thought leader on resilience and work/life balance for health professionals. With 40 years of experience, he has published widely in peer-reviewed medical journals and authored nine books, including his latest two: The Thriving Physician: How to Avoid Burnout by Choosing Resilience Throughout Your Medical Career (2018), and Thriving in Healthcare: A Positive Approach to Reclaim Balance and Avoid Burnout in Your Busy Life (2019).  Dr. Sotile has delivered more than 9,000 talks and workshops, and has provided care and coaching to over 13,000 healthcare providers and their life-mates.  He is the founder of the Sotile Center for Resilience & the Center for Physician Resilience in Davidson, NC. In this interview, we’ll dive into the following: How Dr. Sotile is reframing his own perspective and dispelling widely held misconceptions about provider ‘burnout’, ‘life balance’ and ‘post-traumatic stress’. The attitudes and behaviors we can adopt to optimize our ability to be resilient, and to experience ‘post-traumatic growth’. Dr. Sotile’s recommendations for how healthcare leaders need to reframe the healthcare workplace in order to create a meaningful, resilience-enhancing environment.. Some of the unintended positives of the COVID-19 crisis, and the opportunity we have to carry them forward into the future. The 3 major factors that contribute to resilience; and the one challenge we must overcome to attain emotional health. I’ve had the great pleasure of hearing Dr. Sotile speak a number of times. This was the most inspiring and authentic representation of his wisdom that I’ve heard to date. Throughout our discussion, Dr. Sotile stresses the importance of re-thinking and reframing one’s perspective. And, he is clearly walking the talk here. He describes reframing as a requirement in attaining resilience and renewal. He also stresses the necessity for healthcare leaders to step up to the plate and reframe the work environment in concrete ways – such as redesigning and reorganizing the workplace, and redirecting resources (such as compensation) in order to create a supportive and healthful environment for providers and staff.   This focus on provider resilience and well-being will be a critically important issue for our healthcare system in the post-COVID-19 era.  My favorite teaching from Dr. Sotile is his definition of ‘wonderment’ as “seeing the familiar in unfamiliar ways”, and how he encourages the healthful benefit of practicing wonderment.  I love the way that he normalizes so many behavioral concepts that have been pathologized. I have to say that I found myself experiencing wonderment during this interview, as I listened to him reframe our understanding of resilience and renewal.  Until next time, be safe and be well. Zeev Neuwirth, MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare.  You can find the introductory episode here.  In this series, I am interviewing future-facing, courageous healthcare leaders and entrepreneurs – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare?   (2) How will COVID-19 reframe American healthcare for years to come? In this interview we’ll hear highly strategic, science-based insights regarding the realities of the COVID-19 pandemic, and specific recommendations and illustrations for what we need to be doing in the face of those implications over the next couple of years.  We’ll also be discussing, in some depth, how to create a new and better healthcare, leveraging the learnings and catalyst of this pandemic, as an opportunity to rapidly reframe our approach to chronic disease management and overall healthcare delivery. Our guest this week is Dr. Robert Pearl. Dr. Pearl was the CEO of the Permanente Medical Group & the Mid-Atlantic Permanente Medical Group of Kaiser Permanente, where he was responsible for over 5 million patients’ lives.  He and his colleagues at KP set the bar for what value-based healthcare could and should look like, and the outcomes that can be achieved.  Since leaving his position in 2017, Dr. Pearl has written a book entitled, ‘MisTreated: Why we think we’re getting good healthcare – and why we’re usually wrong’.  He currently teaches healthcare strategy and policy at Stanford Graduate School of Business and has been named one of Modern Healthcare’s 50 most influential physician leaders.  I’ve had the good fortune of speaking with and interviewing Dr. Pearl numerous times over the past couple of years.  You can listen to one of those discussions on Episode #46 of ‘Creating a New Healthcare’. In this interview, we’ll cover a number of topics including: 3 Coronavirus facts Americans should know before returning to work or school.  (Read the article by Dr. Pearl here) Dr. Pearl’s strategic recommendations for how to utilize testing and deploy a safer approach to reducing social distancing. This is a strategy that balances our socioeconomic need to reopen businesses and other social venues (like schools and places of worship) with the need to protect the most vulnerable individuals in our society – what I’m calling a “risk-stratified segmentation” approach to social distancing. The flaws in our healthcare system that the COVID-19 pandemic has exposed, including the fragility and unsustainability of our Fee-For-Service payment model. Robbie’s thoughts about what lessons we should learn from this current crisis to inform how we reframe and reform the American healthcare system moving forward. Dr. Pearl has the incisive thinking and measured approach of a surgeon, combined with the practical experience and insights of a healthcare CEO, combined with the knowledge and nuanced understanding of a healthcare policy expert.  It’s nothing less than awesome to listen to how he utilizes clinical science and evidence-based reasoning to dissect the current pandemic situation.  His prescription for how to go about dealing with the pandemic is hopeful and encouraging.  Robbie is neither an optimist or a pessimist, but instead a realist; and I appreciate his scientific and data driven objectivity. What I appreciate as well is the palpable sense of compassion and empathy that drives his passion for what he is doing – which is informing the lay public and medical field on why and how we must reframe healthcare.  It’s clear that he, like myself, views this current COVID-19 pandemic as a catalytic opportunity for reforming healthcare. What also emerged during the conversation is that Robbie is authoring a 2nd book.  I am looking forward to reading it and learning more from one of the most knowledgable, experienced and discerning healthcare experts of our time. In the meantime, you can access some of Robbie’s writings at www.robertpearlmd.com. Until next time, be safe and be well. Zeev Neuwirth, MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare.  You can find the introductory episode here.  In this series, I am interviewing future-facing, courageous healthcare leaders and entrepreneurs – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare?   (2) How will COVID-19 reframe American healthcare for years to come? Our focus this week will be on the rapid transition, or perhaps immersion, of healthcare into a consumer-centric era.  There are very few people I can think of who have a better understanding of this topic than our guest this week.  Kevan Mabbutt is the Senior Vice President and Chief Consumer Officer at Intermountain Healthcare. Kevan has over 2 decades of experience in consumerism. Prior to joining Intermountain in 2017, he was at The Walt Disney Company, where he served as the Global Head of Consumer Insight.  At Disney, Kevan was responsible for leading large international ventures such as the establishment of the first Disney theme park in mainland China.  He brings world-class, product and service-leading consumer experience to healthcare.  I’ve had the great fortune of speaking with and interviewing Kevan numerous times over the past couple of years. If you haven’t had a chance to hear those interviews, I would urge you to listen to Episodes #45 and #52 on the ‘Creating a New Healthcare’ podcast. In this interview, we’ll cover a number of topics including: Why Kevan believes that consumers are now more in the driver’s seat than they were prior to COVID-19. The increased possibility of healthcare systems being disintermediated in the post-COVID era – by lower cost, more convenient competitors and new entrants. The two-fold strategy that Intermountain is taking to accelerate its consumer positioning and combat disintermediation – which includes leveraging its “holistic, end-to-end” integrated ecosystem of care. Some of the key experience attributes Kevan believes that healthcare consumers are seeking – again, catalyzed by the new healthcare experiences we’ve all been exposed to in the COVID-19 pandemic. The three complementary and elegant modules of the ‘Digital Front Door’ that Intermountain is currently deploying – a set of consumer-centric services that well-situate Intermountain now and into the future. Kevan’s passion and expertise in the domain of consumer experience are inspiring and catalyzing.  I have to say that each time I speak with him I am humbled not only by the depth of his knowledge and experience, but also by the core sense of empathy and humanism that drives his work and directs the strategies and tactics that he and his colleagues at Intermountain are deploying. Kevan continuously reminds us of two fundamental consumers – the patients who will have, and deserve to have, increasing consumer choice and power; and the providers and teams whom we must support in their effort to provide the best care possible.  With both sets of customers, Kevan emphasizes the need to reduce friction and create an optimal human-centered experience.  Kevan also emphasizes the need to nurture the trusting relationship between healthcare consumers, providers and integrated systems of care. I hesitate to impose a brand on anyone, but when I think of Kevan Mabbutt, the qualities that come to mind include: generous, thoughtful, balanced, humble, empathetic, data-informed, outcomes-driven, tech-enabled, and consumer-obsessed.  The one quality that stands out the most for me is Kevan’s deep sense of empathy, and his clear intention and track record of operationalizing humanism into the daily experience for patients and providers.  These are qualities that the COVID-19 pandemic reminds us are important and essential to each and every one of us.  These are, in my opinion, the qualities and branding that should be adopted by our healthcare system at large as we, hopefully, enter a time of COVID-19 recovery. Until next time, be safe and be well. Zeev Neuwirth, MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare.  You can find the introductory episode here.  In this series, I am interviewing future-facing and courageous healthcare leaders and entrepreneurs – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare? (2) How will COVID-19 reframe American healthcare for years to come? The episode this week outlines an approach to designing the healthcare consumer experience that, in my opinion, will become a required standard of care.  Our guest is Lee Becker who currently serves as Solutions Principal at Medallia Inc.  Medallia is a pioneering and leading consumer experience management company.  Prior to joining Medallia, Lee served as the Chief of Staff for the Department of Veterans Affairs ‘Customer Experience Office’ and was responsible for transforming the patient experience there.  Lee is a Navy Veteran and former Chief Hospital Corpsman who served in operational capacities and expeditionary platforms providing care to Marines during the Iraq and Afghanistan wars. This is an incredibly instructive and inspiring dialogue in which we discuss: The “whole person” human-centered reframe the VA introduced in its healthcare consumer experience – and how relevant that is to today’s situation, and moving forward during the post-COVID-19 era. The 3 critical components Lee Becker and his colleagues utilized to deploy this holistic reframe of the healthcare consumer experience. The emerging AI-enabled, ‘signal-capture’ technology that transforms how patients can navigate through the healthcare system – again, so on point to the challenges we are currently facing and will continue to encounter in the post-COVID-19 era. Lee brings a unique set of experiences and expertise to bear.  But, even more than his expertise, wisdom and accomplishments, what impresses me most about Lee Becker is his integrity, his palpable sense of purpose and service, and his down-to-earth practicality.  The approaches he (and Medallia) are deploying are so simple and common sensical; but they are not commonplace.  If we had followed the empathetic, humanistic playbook that Lee Becker outlines, our healthcare system would have been much better prepared for the pandemic, and for the recovery in the post-COVID-19 healthcare era.  These ‘whole-person’ human-centered lessons are particularly salient to our present moment in healthcare history, in which the critical importance of emotional, relational and social health are being demonstrated in spades. As Lee points out, if we are going to fully recover from this pandemic, it will require that we take the time to learn these lessons and make the appropriate shifts – particularly the shift from thinking about healthcare consumers only as ‘clinical’ patients – to understanding, engaging and treating them as ‘whole’ people.  The take home point for me is that we must move beyond words and intentions to actually reframing healthcare, or we will find ourselves repeating history over and over again.  As Lee points out, we must, with methodological rigor – redirect our tactics and resources – and deploy the policies, processes, tools & technologies that can make healthcare more engaging, enabling & empathetic for every member of our society. Until next time, be safe and be well. Zeev Neuwirth, MD

Dear Friends & Colleagues, On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare.  You can find the introductory episode here.  In this series, I am interviewing future-facing, courageous healthcare leaders and entrepreneurs – asking two questions: (1) How is the COVID-19 pandemic immediately changing the way you are delivering healthcare?   (2) How will COVID-19 reframe American healthcare for years to come? The situation is changing rapidly. So, in order to share the remarkable insights from these interviews, as quickly as possible, I’m releasing new episodes as frequently as I can. Our guest this week is Sean Duffy – the co-founder and CEO of Omada Health, one of the leading digital healthcare companies.  I had the good fortune of meeting Sean about 8 years ago, in the early phases of Omada Health.  After a couple of hours of listening to Sean, I was completely enamored with him, his vision and mission, and with the approach he was taking.  It was, and is, breath-taking and brilliant.  Omada Health is based on solid evidence-based medicine. It’s also based on the science of behavior change – which you’ll hear more about in this interview.  I won’t go into any depth providing Sean’s background; but instead, I would urge you to listen to the first interview I posted with Sean on Nov 7, 2017 – I believe is was episode #12 of Creating a New Healthcare.   For those of you who have read my book, Reframing Healthcare, you’ll know that I quote Sean extensively in the book.  Sean and Omada Health have come a long way in the past few years.  Omada Health has come a long way in the past couple of years.  And, as you’ll hear in this interview, Omada has come a long way in the past couple of months during the COVID-19 pandemic. There are numerous critical lessons for the future of US healthcare that emerge from this interview.  The major take home lesson for me is that chronic condition management is more – much more – than a virtual visit or a remote monitoring device.  As Sean points out, it takes a lot of finely tuned and expertly managed instruments, playing all together in sync, from the same symphonic sheet to make meaningful, beautiful and emotionally moving music.  Omada Health has taken a holistic or “whole person” approach, which includes: remote monitoring; 24/7 asynchronous “signal” collection and responsiveness; machine learning and automated responses that enhance customization and personalization of care; expert health coaching and group facilitation; the power of social community to enhance engagement and behavior change; the inclusion of behavioral health monitoring and treatment into its general chronic condition management programs; and advanced motivation and behavior change approaches that include behavioral economic and habit formation techniques. Omada Health has existed in the digital/virtual/remote realm for many years prior to the COVID-19 era.  As a result, they have a vast trove of experience delivering care in this advanced way, and they can innovate at an accelerated pace.  Another major ‘ahah’ for me during this interview was the point Sean made about the data that is being collected.  Omada Health has, for years, been collecting physiologic, emotional and behavioral signals continuously.  As a result, they’re able to, in real time, analyze and understand how the various phases of the pandemic are affecting its clients and the populations they serve.  This has allowed them to rapidly iterate and adjust their care offerings to anticipate and meet their clients’ current and evolving needs during the pandemic.  This capability will contine to serve them and their clients in the post-COVID-19 era.  One example of the “signals” they’ve been able to collect in real time is the marked increase in depression and anxiety, which they’ve  almost immediately responded to by the inclusion of more behavioral health services in their programs. I came away from this interview with a greater appreciation for the work that Omada Health has been doing.  My hope is that healthcare systems across the country take advantage of these ‘representatives from the future’; and collaborate in a way that allows us to collectively leapfrog into a more advanced system of health, that not only delivers better care but also delivers more humanistic care. Until next time, be safe and be well. Zeev Neuwirth, MD