Creating a New Healthcare

Friends, The focus of this interview is on a ‘greenfield’ project that was under wraps for the past three years, and has only recently been revealed. Project Fulcrum was launched in the spring of 2018 by the CEO and senior leadership team of AdventHealth – one of the largest healthcare systems in the country. It’s bold purpose – “to disrupt its legacy provider business model with consumer-driven innovation”.   Our guest this week is Nick Archer, the CEO of Project Fulcrum. In this role he leads a cross-functional team from brand experience, banking, retail, and healthcare to build new products and experiences. He has held various leadership positions at AdventHealth in strategy and finance, most recently serving as the VP of Finance for Network Development and Post-Acute Care. He serves on the boards of United Against Poverty and Andrews Memorial Hospital in Kingston, Jamaica. Nick earned a bachelor’s degree in finance from Oakwood University and an MBA from the University of Florida’s Hough Graduate School of Business. In this episode, we’ll discover: The competitive market forces that led AdventHealth’s leadership team to make the decision to disrupt their own business model. The fundamental consumer problems & issues that Nick and his team discovered during their customer discovery work. The consumer innovation initiative that Project Fulcrum has deployed to over 50,000 patients. Some of the early outcomes they’ve achieved, such as a 30% reduction in no-show rates. This interview felt like listening to a superb master class in healthcare consumerism. Although many of us in healthcare use words like ‘empathy’, ‘consumer-focus’ and ‘whole person care’ – Nick and his team, as you’ll hear in this interview, have taken a very different approach to delivering on these concepts. For example – the notion that ‘empathy’ isn’t just identifying your customer’s pain points, but must also include understanding what role they want you to play in solving those problems. Nick’s team discovered that their patients did not want things done to them, but instead were looking for someone to “come alongside, champion and remove barriers”.  Another example – the notion that ‘conversation’ itself has a significant healthcare value proposition. As Nick puts it, “using the medium of conversation as a way to drive value, whereas traditionally the paradigm of communication in medical practice is largely task focused and transactional”.  There are numerous remarkable and unique aspects to Project Fulcrum. The commitment to transformation – made by the AdventHealth senior leadership team – to protect, support and resource a greenfield innovation division. Their relentless pursuit to understand the consumer perspective and make that priority number one. The fact that they intentionally chose to start by creating a more personalized consumer experience. And, their intention to eliminate disparities & inequities in experience and access. As Nick states,“We want to democratize the idea of concierge and make care accessible to everyone.” Project Fulcrum is a bold strategic commitment to investing in the future; to investing in AdventHealth’s differentiation and growth; and to investing in a significant, positive inflection in patient care. As Nick eloquently states during the interview, “The challenges of today can’t prevent us from thinking through and designing the success of the future”.  This initiative is a remarkable example of a disruptive innovation and I suspect numerous case studies will be written about it. For me, however, the most essential theme is the humanistic one. This is a story about leadership that clearly believes that enhancing human connection – empathetic dialogue and healing relationship – is necessary to a successful healthcare delivery system and critical for a thriving healthcare business model. If you want to understand what ‘humanizing healthcare’ can look like, I suggest you listen to this interview with Nicholas Archer, CEO of Project Fulcrum at AdventHealth. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends, You are going to hear a remarkable case study about a successful and sustained philanthropic initiative focused on educating disadvantaged youth. Although outside of the strict domain of healthcare delivery, this initiative is actually about the health & well-being of our communities and our country – education being a significant social determinant of health outcomes. Joining us in this interview are Harris Rosen, President & COO of Rosen Hotels & Resorts, Dr. Chuck Dziuban, and JuaNita Reed.  Dr. Dziuban is the Coordinator of The Harris Rosen Foundation educational programs for the University of Central Florida. He is in charge of maintaining the research and statistics of the Tangelo Park Program.  JuaNita Reed is a recently retired guidance counselor at Dr. Phillips High School. She has mentored the scholarship recipients in the program and continues to lead that aspect of the program in her new role as Scholarship Coordinator of The Harris Rosen Foundation. In this episode, we’ll discover: The key components contributing to the success & 26-year sustainability of the Tangelo Park Program. The profound educational outcomes & remarkable impact it’s had on the community – for example, dropping the crime rate by ~80%! Mr. Rosen’s vision for spreading the Tangelo Park Program to the rest of the country. Since 1994, Harris Rosen and his colleagues have funded a Pre-K program and a full college scholarship in a small, disadvantaged community. Although the solution is simple, the success is startling. Also startling is how this program has not only sustained itself but has activated the youth and catalyzed the parents in the community. Over the years, families have required and requested less of the Rosen funding, as they’ve been acquiring more college scholarships on their own. Another critical point to understand is that this approach is reversing an insidious, self-perpetuating driver of financial disparity & inequity in educational opportunity. If you live in the bottom economic quartile in this country, your chance of graduating from college is 11%. The odds against you are 9:1. The total college debt in the USA is $1.7 Trillion dollars. Most of this college debt is carried by the bottom economic quartile in this country, and by Black youth. It is a compounding problem which perpetuates a cycle of debt and the suppression of upward mobility, largely in the Black & LatinX populations. One of the brilliant things that the Tangelo Park Program does is break this cycle of educational debt and upward social mobility. The evidence for that – well, for starters, the Tangelo Park program has reversed the odds of these kids graduating college, from 9:1 against, to 3:1 in favor!  Further evidence – over 160 Tangelo Park youth have graduated from college. That is 3 times the expected number, which would have been 45. In addition, the program has resulted in 227 degrees, including post-graduate degrees. There’s also a positive economic impact to the community. Lance Lochner, an economist at the University of Western Ontario, recently calculated a 7:1 return to the community. Harris Rosen’s program is catalyzing the tremendous intellectual talents, capabilities and potential in our disadvantaged youth, particularly in Black & LatinX youth. He understands that a college or vocational school education leads to employment, financial stability, and significantly higher life-time earnings. Those are well substantiated facts. At one point in the discussion, Chuck Dziuban refers to a recently published landmark study which has demonstrated that a Preschool (Pre-K) education positively and cumulatively transforms an individual’s entire life, with ripple effects on the lives of their children & grandchildren. I suspect that you will be as moved as I was by this story. But Harris is asking for more. Harris Rosen is calling for action. His vision is that every underserved community in this country be adopted by philanthropists, Boards and C-suites. Toward the end of the interview, Harris implores us, “What I would like to hear and see more of is people who not only say that black lives matter, but people who are inclined to do something about it. Here’s a program with nearly 30 years of extraordinary success. All somebody has to do who cares about Black lives, LatinX lives, the lives of our youth – is ask how we did it.”  If reversing the cycle of educational & economic inequity in our country is important to you, then please share this interview with others – especially those who are in a position to replicate the Tangelo Park Program. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends, The focus of this interview is on a solution created by Yale Economists to address the rising & unsustainable costs of healthcare in our country. Most of us are aware that healthcare costs are a problem, but our guest today argues the cost of healthcare is actually devastating to American workers & families. The approach he and his colleagues are taking to solve this massive problem is unique & I’m excited to explore it with you today. Zack Cooper, PhD is an Associate Professor of Health Policy and Economics at Yale University. Cooper has published his research in leading economics & medical journals and has presented his research at the White House, the Department of Justice, the Federal Trade Commission, & the Department of Health and Human Services. Cooper received his undergraduate degree from the University of Chicago and his PhD from the London School of Economics. In this episode, we’ll discover: The meeting at 10 Downing Street that led this extraordinary Yale Healthcare Economist to come up with the idea for 1% solutions. The specific healthcare issues being addressed by these 1% solutions, such as Surprise Medical Billing & Kidney Transplantation. Why Zack believes employer-based health insurance is contributing to bloated costs that are profoundly harming the health & welfare of working Americans. How the unprecedented drop in American life expectancy and the American epidemic of “deaths of despair” might be linked to healthcare economics. Why the 1% solutions are intentionally focused on incentivizing providers & healthcare organizations rather than attempting to change patient behaviors through cost-sharing and other demand-side interventions. The opportunity cost to the American public and the American future resulting from bloated healthcare costs. This is an extraordinary story of a ‘scholar-activist’ who is battling the insidious mistruths that are guiding policies for an industry that makes up nearly one-fifth of the US GDP.  With this latest 1% project, he’s not only debunking harmful myths, but also using evidence-based, scientific methodology to build solutions to lower the staggering costs of healthcare. Make no mistake about it, the stakes are high. For example, Zack refers to a recent study which demonstrated that a $10 increase in Medicare Part D copays (prescription medications) led to a 33% increase in monthly death rates among seniors. People couldn’t afford their medications and so they simply stopped buying them. Zack is reframing the field of healthcare economics by attempting to accomplish a number of things. First, he is actively recruiting leading scholars to adapt their research to current policy-relevant domains. Second, he is inviting leading scholars to more directly engage with and influence politicians and policy makers. Third, he is catalyzing a movement toward more scientific, peer-reviewed, evidence-based healthcare policy decision-making. Fourth, he is calling for a shift from research that purely critiques to briefs that develop and support tangible solutions to lowering the costs of healthcare. And fifth, he’s influencing the next generation of healthcare scholars to view themselves as ‘scholar activists’. What Zack & his colleagues are attempting is courageous. They are battling on behalf of the plight of the majority of Americans who simply can not afford healthcare. They are battling the status quo of a huge, well-funded, complicated & opaque industrial complex. As Zack points out, there are few other industries as heavily lobbied as healthcare – underscoring the need for independent, peer-reviewed, evidence-based, policy decision-making. At one point in the interview, Zack says that he’s been “coarsened” by what he has discovered. He is, in my opinion, experiencing what many clinicians & others in healthcare have recently been terming ‘moral harm’. One domain of moral harm that is of “gripping” concern for Zack is the economic and healthcare inequities in this country. His current research is focused on how healthcare inefficiencies and costs might actually be contributing to the economic & health inequities, and the growing disparity chasm in our country. What I greatly admire and respect is Zack’s ethical conviction, commitment and persistence to challenging and changing the fundamental policies causing this moral harm. So, while the 1% approach may appear incremental, what Zack and his colleagues are doing is nothing less than transformational. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends, What if I told you that I just learned of a completely doable and replicable approach to reducing the costs of healthcare by 30 – 50% while increasing quality outcomes simultaneously?  In this interview we’ll be speaking with an employer that has been achieving this for years. Corporate America – which pays for 50% of all healthcare costs – has been the “sleeping giant” of healthcare. But these giants are now waking up and they’re not going to put up with the status quo. One particular employer has been awake for decades, and we’re going to hear his story told in some detail. Joining us in this interview are Harris Rosen, President & COO of Rosen Hotels & Resorts; Ashley Bacot, President of Provinsure (the health insurance company that Rosen Hotels formed; and Kenneth Aldridge Jr, RN, BSN, MS-HSA, the Director of Health Services at the Rosen Medical Center and RosenCare. In this episode, we’ll discover: The simple but widely successful approach that Mr. Rosen and his colleagues have taken to achieve the triple aim results of better care, better outcomes & lower costs. Some of the key programs and critical success factors that have contributed to Rosen Hotels having sustained healthcare savings of over 30% for decades. How ProvInsure and the Osceola County School District have replicated the model with remarkable savings and outcomes. Mr. Rosen’s vision for spreading the RosenCare model to the rest of the country. Each podcast interview is an adventure for me. To really listen well, I have to allow myself to be surprised. I have to allow myself to think differently and to experience uncomfortable emotions that my guests elicit. In this interview, I found myself surprised with almost every turn of the dialogue. First, having worked within our overly complicated US healthcare system for decades, I was really knocked back on my heels by the simplicity of Mr. Rosen’s approach to healthcare.  It was almost too simple and too obvious; which led me to the second surprise.  The emotional dialectic I experienced was embarrassment on one side and inspiration on the other.  I was embarrassed and inspired on behalf of the American healthcare system. Here is a guy – Mr. Harris Rosen – with no medical, healthcare or technical background, and he figured it out. I was embarrassed and inspired because here is a leader who did not compromise on what he knew to be the right thing to do for his employees. I was embarrassed and inspired because Harris Rosen had the conviction, commitment and courage to do the things that we all know will radically improve healthcare. I imagine you’re wondering what Harris Rosen and his colleagues have done. There are a number of ways I could explain it. The simplest way is to tell you that he’s inverted the American healthcare system. RosenCare spends the vast majority of its funding on Primary Care, not specialty care; and makes primary care accessible, convenient, affordable and equitable. RosenCare follows its associates throughout the continuum of care to create a more seamless and integrated experience; and promotes and even imposes the principles of public health by making it a requirement to follow certain healthful behaviors.  For example – nicotine use, alcohol consumption affecting “fit for duty” and illegal drug use are not allowable if you’re going to be a Rosen associate. I’ll share one other emotion I felt as I was listening to the RosenCare story. I felt validated. Having practiced primary care for decades and having been a primary care proponent for over 3 decades, the RosenCare story demonstrates what we have known, and what the literature has repeatedly substantiated. Investing in proactive, preventive primary care leads to better care, better outcomes and lower costs. This is a lesson, sadly, that has not been widely supported or manifested within the American healthcare system. One final thought. The RosenCare story reveals the power of a caring, loving community. I didn’t know how to describe it as I was listening, but RosenCare felt a little bit like a ‘tough love’ healthcare community. They haven’t just built an exceptional healthcare benefits program or an outstanding employer healthcare approach. What they’ve done is to reframe the transactional and individualistic medical mindset into one that is relational and community oriented. RosenCare’s fundamental principles are about caring, not coding. Until next time, be safe and be well. Zeev Neuwirth, MD

There aren’t many people who have the breadth of perspective and the depth of accomplishment that this week’s guest brings to the table. Dr. Tony Slonim doesn’t just wear multiple hats. He has lived in multiple healthcare worlds – having earned a nursing degree, a medical degree, a subspecialty board certification, a doctorate in public health; and having served in the public health service as well as in senior executive roles. It is this unique multi-system orientation that enables him to draw distinctions between medical care, public health, community health and population health – distinctions that many of us may not fully appreciate..   In this interview, Dr. Slonim points out that our hospital-based medical healthcare system is not interchangeable with a public health care system. The fallacy that they are interchangeable – and that a public health service is not needed – is a mis-guided national error which has contributed to an American health system which delivers subpar outcomes when compared to other economically developed nations. By way of formal introduction, Dr. Anthony Slonim is president and chief executive officer of Renown Health in Reno, NV. Modern Healthcare has named Dr. Slonim one of the “50 Most Influential Clinical Executives” in 2019. Before joining Renown Health, he served in executive leadership roles at Barnabas Health in NJ, Carillion Clinic in VA and Children’s National Medical Center in DC.  Dr. Slonim holds a diploma in professional nursing. He is a board-certified pediatric intensivist, who also earned a masters and doctorate in public health from George Washington University; and then served four years in the United States Public Health Service in Rockville, MD with the rank of Lieutenant Commander. In this episode, we’ll cover: The difference between the ‘medical mindset’ and the ‘public health mindset’. The reframing of our public health system as an “insurance policy” that our country has not invested in over the past few decades. Some thoughts on how the defunding of our public health system has contributed to the disparities and inequities in healthcare. The “precedent of unkindness” in our society – exacerbated by the stressors of the pandemic and perhaps enabled through social media – that is adding to our psychologic and physiologic strain, and harming the public health. Dr. Slonim is a kind and humanistic leader, but he is also a demanding leader. He is demanding that we reinvest in a diverse healthcare system that works to keep our communities and the American public healthy. What this interview reveals is that the vast majority of us – who have not been trained in public health – don’t understand its significance and its critical role. We don’t understand the differences between public health, population health and medical care. We don’t understand the unique approaches and tools of the public health system. We are not aware that our public health system has been defunded over the past few decades. Nor do we fully appreciate the implications of that defunding, especially in inner cities and rural counties. Many of the healthcare problems we’re experiencing today – including some of the devastating fallout of the COVID-19 pandemic – are due to this lack of a robust public health system. These problems include: unsafe drinking water (think Flint Michigan); unsafe air; climate change; the racial disparities in healthcare in which life expectancy between neighboring zip codes can vary by as much as 15 – 20 years; the worsening opioid epidemic; and the epidemic of mental health and suicide in our country. All of these have one thing in common. They could be greatly mitigated by the presence of a strong local public health system in our communities, our towns, our cities, our counties and our states. The pandemic has taught us many things, not least among them is that we need to rebuild our public health system. One wonders if our political and healthcare leaders have the discernment, conviction and courage to translate this obvious societal need into action by investing not only in the medical system, but also in a public health system. The federal government that the framers created is intentionally organized around checks and balances, informed by multiple perspectives. Our healthcare system needs that same sort of multi-system, multi-perspective reorganization. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends, Our topic this episode may be one of the most misunderstood and challenging issues in healthcare delivery – with significant potential for lowering costs and improving outcomes. The topic is employer-based healthcare; and as many of you know, employers pay for 50% of all the healthcare costs in the US. Escalating healthcare costs over the past few decades have imposed a major strain on corporate America and its employees. The Kaiser Family Foundation reported that in 2018, employers paid approximately $20,000 per year for healthcare for a family of four, $6000 of which the employee paid. They also reported that since 2006, employee healthcare premiums have risen twice as fast as wages. As a result, Corporate America has been increasingly focused on right-sizing healthcare costs – from Apple and Amazon launching their own employee primary care; to Walmart providing ‘centers of excellence’ to its employees; to companies such as Comcast who have partnered with vendors to put alternative healthcare solutions in place for its employees. But, the situation is challenging, as evidenced by the recently failed attempt of Haven, an employer-based healthcare initiative launched by JP Morgan, Berkshire Hathaway and Amazon. It’s a complex ecosystem involving employer-based HR & health benefits managers, employer benefit brokers & benefits consulting companies, insurance companies, provider groups & hospital systems, direct to employer providers, and collaboratives such as the Business Group on Health. Our guest this week is a passionate expert who has a discerning handle on the ecosystem, the fundamental problems, and the proven solutions in employee-based healthcare. Dave Chase founded & leads Health Rosetta, whose goal is to empower community-owned health plans. Health Rosetta has created a blueprint and platform that empowers health plans to deliver high quality, affordable care. Dave has authored a number of insightful books including The CEO’s Guide to Restoring the American Dream: How to deliver world class healthcare to your employees at half the cost. He received the Health Value Awards’ Lifetime Achievement for Health Benefits Innovation at the 2020 World Health Care Congress. Prior to this work, Dave Chase co-founded Avado which was acquired by and integrated into WebMD/Medscape.  He also founded Microsoft’s $2B, 28,000 partner healthcare ecosystem. In this episode, we’ll cover: Dave’s unique perspective on the fundamental problems in the American healthcare system. What Dave describes as epidemic healthcare ‘financial toxicities’ and ‘financial comorbidities’, which is denying the American dream to the majority of employees. Five major solutions that employers can leverage to reset and radically improve their employee health benefits plans. Examples of employers who have saved a significant and sustained percentage of their healthcare costs while improving healthcare outcomes for their employees. Dave makes some amazing claims in terms of dramatically lowering healthcare costs for employers and employees; and he’s got numerous examples to support those claims. There is no question that the solutions he proposes are disruptive to the status quo. But, rather than view them as disruptive, we can learn from these successful models and deploy the proven blueprints that he and his colleagues at Health Rosetta have catalogued and created. One thing is abundantly clear.  The American healthcare system is not working for the vast majority of employed Americans. Dave’s facts and statistics are disturbing. What he reveals is that escalating healthcare costs are levying a hidden tax that is destroying the economic health and well-being of working American families. It’s a striking reframing of the problem that makes it very personal and very real. Once we understand this, one wonders why more employers aren’t adopting the tools and techniques that Dave and his colleagues at Health Rosetta outline so clearly. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends & Colleagues,  There are a few healthcare delivery enablers which will catalyze the transformation of healthcare delivery over the coming years. In our dialogue today, we’ll be focusing on one of them – virtual care. Our guest this week has spent years directly leading the charge in virtual healthcare redesign and deployment. Dr. Tom Hale is the Chief Medical Officer of VirtuSense where he and his colleagues are using virtual care to build value-based services for ACOs, MAs, and other at-risk models. Prior to this role, Dr. Hale pioneered the development of telemedicine and virtual care at Mercy Health. Under his leadership, Mercy telehealth services launched the world’s first virtual care center, Mercy Virtual. Prior to that, he led a 350-member multi-specialty organization as the President of Mercy Medical Group. In this episode, Dr. Hale and I will touch on: Some insights as to how Mercy Health developed its world renown Virtual Care services and the amazing outcomes they achieved. Examples of AI-enabled monitoring technologies that VirtuSense has created, such as one that reduces falls by 50 to 70% in the home and in hospital rooms. Common missteps that healthcare organizations make in deploying virtual care. Tom’s belief that success in virtual care is largely about people and process; requiring more than just an overlay, but instead an overall redesign of clinical and business models. Dr. Hale provides us with a very pragmatic understanding of the benefits of virtual care. He busts the myth that virtual care is merely a video substitute for a supposedly superior in-person visit. He proposes that virtual care redesign is actually far superior to the traditional approach of in-person healthcare encounters. I love his metaphor comparing traditional care to a series of ‘snapshots’ that provide disconnected, infrequent and lagging representations of a patients’ health; which is in sharp contrast to virtual care with its AI-enabled, remote monitoring and rapid responsiveness, which provides a continuous ‘movie’ of the patient’s health –  continuous, connected and contextual. Dr. Hale also points out that virtual care increases access to care; and through standardization and automation, it can reduce harmful variation of care – all leading to improved outcomes and lower total costs.  He backs these claims with data. The reduction of falls was significant, as well as the 60% reduction in healthcare costs that he and his colleagues achieved by placing simple remote monitoring technology and iPad’s into patients’ homes. Another fascinating revelation was how AI-enabled software can detect the onset of sepsis or the worsening of chronic disease long before they become apparent through our current monitoring. An example of this is the increasing variability in heart rate that precedes the onset of heart failure by days, allowing providers to more proactively respond to and prevent ED visits and hospitalizations. I really appreciate Tom’s thoughts regarding the impact of virtual care on the Social Determinants of Health and vulnerable populations: “Virtual care increases access to [proactive preventive] care. It decreases harmful variation. It removes the geographic barriers to care. It brings the best of the best to everybody. How can it not help the poor and underserved populations?” And I hope his final message in this podcast makes it to the ears of policy makers and payers. “Virtual Care will increase access and decrease variation in care, and you’ll get lower costs and higher quality. But, for that to happen, we need you to decrease the regulatory barriers, and prove and support the economics around virtual care that brings value to patients.” Until Next Time, Be Well Zeev Neuwirth, MD

Friends, Welcome to the first ‘Creating a New Healthcare’ podcast episode of 2021. The major themes we’ll explore in this episode are two sides of the same coin: the strategic, market-driven imperative for transformation in healthcare; and the financial and operational challenges of disrupting one’s own healthcare organization. Our expert guest in this interview refers to this phenomena as the “conflicting realities” of transformation and disruption. The situation is challenging. If healthcare systems and provider groups don’t pursue transformation, it’s likely that they will find themselves increasingly less relevant in the future. Yet, at the same time, disrupting oneself is fraught with pitfalls and seemingly insurmountable challenges. Our guest this week has spent years threading this needle, earning the wisdom and the wins that demonstrate his competence and credibility. His message is simple and clear, and worth listening to. He believes that we are up to the challenge, if we grasp the mantle of high integrity, courageous, patient-centered leadership. Dr. Roger Ray is the Chief Physician Executive with The Chartis Group – a well-known and highly respected healthcare consultancy. He has over three decades of service in a variety of leadership positions at major healthcare organizations throughout the eastern United States. Most recently, Dr. Ray served as Executive Vice President/Chief Physician Executive at Atrium Health, where he led a medical group of over 3,000 members and had operational oversight over myriad clinical services & functions. In full disclosure, I had the privilege of working with Dr. Ray for a number of years during his tenure at Atrium Health. In this episode, we’ll cover: The 4 major strategic advancements that Dr. Ray believes every healthcare system needs to be focused on achieving. The increasing and unprecedented importance of physician leadership, and how that is a differentiating factor among healthcare systems. The specific and significant challenge of disrupting one’s healthcare system, coupled with the conflicting need to rapidly adopt technology, generate new business models and transform healthcare delivery. Why becoming expert at ‘fast-following’ and adopting best practices may be a superior strategy vs being a ‘bleeding-edge’ organization. Dr. Ray is a pragmatist and a highly strategic thinker. But, he’s also a highly principled leader. One of my favorite ‘Ray’ quotes is, “Principles matter when they’re inconvenient.” The point being that it’s much harder, much more meaningful, and far more impactful to manifest principles when they inconvenience you. One of the fundamental principles that Dr. Ray has led by include his focus on ‘patient-first’ healthcare delivery. That is, leading with the question of how any decision impacts patients – first and foremost. As an example of this principle in action – when I asked Dr. Ray what he would say if he had a few minutes with President Biden and VP Kamala Harris, he said that he would remind them that healthcare is fundamentally about “people taking care of people” – highly skilled professionals who are earnest and passionate about helping and healing others – providers and staff who sacrifice and give of themselves, and who daily deliver near-miraculous outcomes. Yes, healthcare is a business. But, if we forget what it’s fundamentally about, we will sub-optimize the endeavour and harm patients. Dr. Ray also added that he would remind the President & VP that the current disparities in American healthcare are an embarrassment to our nation. He would encourage them to use the resolution of healthcare disparities as a primary marker and absolute requirement for American healthcare improvement. I’m delighted to see that Dr. Ray is sharing his expertise and wisdom with many other leaders and organizations across the nation. American healthcare needs more leadership with principled pragmatism, and we need leadership that is willing, capable and courageous enough to thread the needle of disruptive transformation. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends & Colleagues,  The focus of this episode is of immediate importance to all of us. It’s especially important right now, in the month before the inauguration of President-elect Biden & VP-elect Kamala Harris. (Of note, this interview was recorded in late August, so we were unaware of the election outcomes). The topic is ‘fixing’ healthcare and our guest today is Dr. Vivian Lee, the President of Health Platforms at Verily. Dr. Lee recently published a book entitled –The Long Fix – Solving America’s Healthcare Crisis with Strategies that work for Everyone – in which she explains the fundamental problems in healthcare and provides practical solutions. The book speaks directly to policy makers, providers, payers & patients. In this interview, we’ll hit the high points of the book and get a sense of the priority Dr. Lee assigns to certain problems. The book is remarkable and so is Dr. Lee. She is a Harvard-Radcliffe College graduate who obtained a doctorate in medical engineering from Oxford University as a Rhodes Scholar and then earned an M.D. with honors from Harvard Medical School. She has also earned an Executive MBA at NYU’s Stern School of Business. Dr. Lee is a radiologist and medical researcher who has authored over 200 peer-reviewed journals. Prior to her current role, Dr. Lee was the Dean & CEO of the University of Utah Health – one of the nation’s leading hospital and academic medical centers. During her tenure, she and her colleagues achieved numerous nationally recognized accomplishments in quality, safety, patient experience, growth and entrepreneurial commercialization. In 2019 she was ranked #11 among the ‘Most Influential People in Healthcare’ by Modern Healthcare.  She has been elected to the National Academy of Medicine. In this episode, Dr. Lee and I will touch on: A broad range of issues ranging from the mind boggling complexities of billing and payment, to the lack of price transparency, to the crippling and uncontrolled costs of medications, to the impact of healthcare costs on suppressing employee wages and retirement funds. The one issue Dr. Lee calls out as the core off-the-charts problem in the American healthcare system. Why Dr. Lee believes that it’s critically important for all citizens to understand how healthcare delivery works and what it would take to make it better. Why universal access to healthcare is not only the right thing to do from an ethical perspective, but also from a public health, productivity and economic point of view. Why Dr. Lee believes we must shift to value-based care in order for universal coverage/access to be optimally effective. I have to say that it was a privilege and a pleasure to speak with Dr. Lee.  Given her remarkable accomplishments, her brilliance, and the enormity of her current position, I was struck by how down-to-earth and humble she is. We didn’t have the opportunity to directly discuss the issue of leadership in healthcare; but an unspoken message that came across is that we need a leadership culture that Dr. Lee embodies – data-driven, humanistic, socially aware, and selfless – leadership that is, first and foremost, for the people.  Dr. Lee wrote this book for the American public – to bring some clarity to our complicated, opaque healthcare system. I applaud her for that.  Most importantly, I applaud her for the explicit intention to deliver solutions that work for everyone. Until Next Time, Be Well Zeev Neuwirth, MD

The COVID-19 pandemic has shone a new light on the deep-rooted disparities and inequities that are built into the fabric of our American healthcare system. Triggered in part by the pandemic, as well as a number of deeply disturbing episodes of racist police brutality, and the Black Lives Matter movement, we’re experiencing a national re-awakening of concern regarding systemic and institutional racism in our society. Our two distinguished guests in this interview, Dr. Alisahah Cole and Michellene Davis, are nationally recognized leaders in the movement to eliminate healthcare disparities. Michellene Davis, Esq. is currently the Executive Vice President and Chief Corporate Affairs Officer at RWJBarnabas Health, the largest academic healthcare system in New Jersey. She is an attorney and has held positions at the senior most tier of government, including as State Treasurer, Chief Policy Counsel to a Governor, and CEO of a state lottery. Dr. Alisahah Cole is currently the System Vice President of Population Health & Policy at CommonSpirit Health, one of the largest integrated healthcare systems in the United States. She is a Family Medicine physician and has held multiple leadership positions including as Chief Community Impact Officer and Academic Chair, implementing novel approaches to improve health equity in vulnerable populations. This interview was recorded last month as a panel discussion during a virtual conference on patient experience. The topic was originally intended to be a discussion on the Social Determinants of Health (SDOH). But we felt that it would be culturally tone-deaf and socially irresponsible to discuss the SDOH without recognizing systemic and institutional racism as a root cause of the inequities and disparities in health care delivery and health outcomes. With that in mind, this panel discussion includes: A passionate discussion on this most recent ‘awakening of awareness’ about the systemic & institutional racism in our society – including the impact of the COVID-19 pandemic. The manifestations of systemic, institutional & interpersonal racism in healthcare. Practical, real-life recommendations regarding a systematic, data-driven approach to identify, understand & eliminate racism in healthcare. In addition to bringing their experience as clinicians and executives, Michellene and Alisahah also share their lived experience as professional Black women. The stories they share are honest, courageous, and at times, unsettling. For example, Michellene shares that, unlike her white colleagues, she does not have the luxury of putting racism aside, even for a moment. Alisahah shares that, as the mother of two teenage Black boys, she worries for their lives, literally, each time they leave home to venture outside. This conversation challenges the very core of our humanity – in our communities, our corporations, our social institutions and our government. One lesson this interview taught me is that the issue of ‘social determinants of health’ needs to be reframed in terms of eliminating the racial disparities and inequities in healthcare and in our broader society. Another is that good intention is not enough – we need to take sustained systemic action. There are so many lessons embedded in this podcast. Lessons about listening and building trust. Lessons about the unhealthful effects of racism on Americans of color. Lessons about the need to fundamentally reorient, redesign, reorganize and appropriately resource healthcare delivery so that it meets the needs of vulnerable populations. And lessons about the need to expand healthcare delivery beyond traditional medical boundaries – to apply a racial equity lens to how we reframe our education system, our criminal justice system, our housing and urban development system, our transportation system, our social services systems, our labor system, and our public health system. This was the most important interview I’ve conducted to date. I say that with Martin Luther King’s words ringing in my ears. Words that, sadly enough, have as much relevance today as they did when he delivered them over five decades ago, during a 1966 speech before the 2nd National Convention of the Medical Committee for Human Rights. Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death. I see no alternative to direct action and creative nonviolence to raise the conscience of the nation. Martin Luther King Until Next Time, Be Well Zeev