Creating a New Healthcare

Dear Friends & Colleagues, Last week, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare.  You can find the introduction episode here.  In this series, I’ll be interviewing future-facing healthcare leaders and entrepreneurs – to ask 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 episode, we’ll be interviewing Dr. Paul Offit, an internationally recognized expert and scientific pioneer in the field of virology and immunology; and the leading virology expert in the U.S.  He is the co-inventor of the rotavirus vaccine recommended for universal use in infants by the CDC, which is credited with saving hundreds of childrens’ lives each day. He is a professor in the division of Infectious Diseases at the Children’s Hospital of Philadelphia, and a professor of Vaccinology at the University of Pennsylvania School of Medicine  (See abbreviated Bio below). My dialogue with Dr. Offit was incredibly hopeful, hugely informative and beyond inspiring.  He is clearly a brilliant medical scientist and a courageous humanitarian. We covered a range of topics including: His perspective on the COVID-19 surge curve and social distancing The 3 major lessons (reframes) he believes we need to learn from this current pandemic His expert thoughts regarding the amount of time it will take to develop a COVID-19 vaccine His views regarding the impact of our public health response on the social determinants of health These are unprecedented times, so I hope you find valuable information, guidance, and inspiration in listening to these experts and entrepreneurs share how they are adapting to this pandemic (in real time); and how they’re thinking about and planning for the future. Until next time, be safe and be well, Zeev Neuwirth MD Paul A. Offit, MD, is Director of the Vaccine Education Center and professor of pediatrics in the Division of Infectious Diseases at Children’s Hospital of Philadelphia.  He is the Maurice R. Hilleman Professor of Vaccinology at the Perelman School of Medicine at the University of Pennsylvania.  Dr. Offit has published more than 150 papers in medical and scientific journals in the areas of rotavirus-specific immune responses and vaccine safety. He is also the co-inventor of the rotavirus vaccine, RotaTeq®, recommended for universal use in infants by the CDC. For this achievement, Dr. Offit received the Luigi Mastroianni and William Osler Awards from the University of Pennsylvania School of Medicine, the Charles Mérieux Award from the National Foundation for Infectious Diseases, and was honored by Bill and Melinda Gates during the launch of their Foundation’s Living Proof Project for global health. In 2009, Dr. Offit received the President’s Certificate for Outstanding Service from the American Academy of Pediatrics. In 2011, he received the David E. Rogers Award from the American Association of Medical Colleges, the Odyssey Award from the Center for Medicine in the Public Interest, and was elected to the Institute of Medicine of the National Academy of Sciences. In 2012, Dr. Offit received the Distinguished Medical Achievement Award from the College of Physicians of Philadelphia and the Drexel Medicine Prize in Translational Medicine from the Drexel University College of Medicine. In 2013, he received the Maxwell Finland award for Outstanding Scientific Achievement from the National Foundation for Infectious Diseases, the Distinguished Alumnus award from the University of Maryland School of Medicine, and the Innovators in Health Award from the Group Health Foundation. In 2014, he was elected to the board of trustees at the College of Physicians in Philadelphia, and in 2015, he was elected to the American Association of Physicians and the American Academy of Arts and Sciences as well as being named as a Fellow for the Pediatric Infectious Diseases Society and the American Academy for the Advancement of Science. In 2016, Dr. Offit received the Franklin Founder Award by the City of Philadelphia, The Porter Prize from the University of Pittsburgh School of Public Health, and the Jonathan E. Rhoads Medal for Distinguished Service to Medicine from The American Philosophical Society. In 2017, he received the Defensor Scientiae Award and an Honorary Doctor of Science degree from The University of the Sciences in Philadelphia.

Dear Friends & Colleagues, Last week, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare.  You can find the introduction episode here.  In this series, I’ll be interviewing future-facing healthcare leaders and entrepreneurs – to ask 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 episode, we’ll be interviewing Andrew Parker, the founder & CEO of Papa.  I recently interviewed Andrew and would encourage you to listen to this amazing entrepreneur and amazing new venture.  You can find that dialogue here.  Although I had recently posted that interview, Andrew was one of the first people I thought to reach out to in this limited series because of how critically important and relevant his service is in this time of social distancing, sheltering-in-place, and lockdowns. Papa is  an on-demand service designed to deliver companionship and non-clinical services to seniors and  families. These non-clinical services are delivered through so-called ‘Papa Pals’ who are college age students who assist in a number of ways including household activities, transportation, shopping, filling out forms… Another reason I reached out to Andrew was to learn how Papa had dramatically pivoted its service model to adapt to COVID-19.  It’s such a delight speaking with Andrew. His energy, enthusiasm, and vision; as well as his accomplishments and outcomes with Papa are uplifting, and provide us with tremendous hope for the future. These are unprecedented times, so I hope you find valuable information, guidance, and inspiration in listening to these experts and entrepreneurs share how they are adapting to this pandemic (in real time); and how they’re thinking about and planning for the future. Until next time, be safe and be well, Zeev Neuwirth MD

Dear Friends & Colleagues, Last week, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare.  You can find the introduction episode here.  In this series, I’ll be interviewing future-facing healthcare leaders and entrepreneurs – to ask 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 episode, we’ll be interviewing two digital innovation superstars from Providence – Sara Vaezy & Maryam Gholami.  Providence is one of the most progressive and innovative integrated delivery systems in the country.  As a result of their long-term investments in healthcare transformation, they are incredibly well prepared for the current situation, and also well prepared to be highly adaptive and agile over the next few months and years.  Lots of lessons to learn from this organization! What you’ll hear in this interview will include: A ‘consumer hub’ which includes a chatbot “Grace” that assesses and navigates patients to appropriate care – and how that’s been adapted for COVID-19. How Providence has pivoted the use of their online ‘on-demand’ platform “Express Care”, which includes ‘virtual video visit’ services that have now also been adapted to deliver chronic disease management in addition to the already existent urgent-care visit use. The greater than 10-fold increase in the number of virtual visits that Providence has been able to scale up to in the past few weeks!  (A fact that is highly illustrative of the rapid shift, Providence has conducted more virtual visits in the first 3 weeks of March 2020 than in the entire year of 2019) The accelerated advances Providence is deploying in home-monitoring of higher risk patients; as well as their focus on the behavioral health of patients and providers. How diligently the Providence digital development and marketing teams are listening to the continuously shifting needs and expectations of their healthcare consumers/patients; and how rapidly they are iterating their products and services to accommodate. Providence is a not-for-profit Catholic health system comprising 51 hospitals as well as 1,085 clinics and other health services, with over 119,000 caregivers serving communities across seven states. Sara Vaezy leads the overall development of the digital strategy, digital partnerships, new business commercialization and business development.   Maryam Gholami is the Chief Product Officer for digital innovations. She leads product development, commercialization, and growth of the consumer digital portfolio. She is also responsible for leading the applications of advanced technologies such as AI and machine learning. These are unprecedented times, so I hope you find valuable information, guidance, and inspiration in listening to these experts and entrepreneurs share how they are adapting to this pandemic (in real time); and how they’re thinking about and planning for the future. Until next time, be safe and be well, Zeev Neuwirth MD

Dear Friends & Colleagues, Last week, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare.  You can find the introduction episode here. In this series, I’ll be interviewing future-facing healthcare leaders and entrepreneurs – to ask 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 episode, we’re interviewing Dr. Erik Vanderlip, the Chief Medical Officer of Zoom+Care. Zoom+Care is a pioneering healthcare company based in the Pacific Northwest.  It’s mission is to create an innovative, patient-empowered, on-demand health ecosystem for the 21st Century.  At ZOOM+Care, Dr. Vanderlip & his colleagues are integrating behavioral health, urgent care, primary care, telemedicine and specialty care services that utilize advanced chronic care models to engage patients and promote health behavior change. These are unprecedented times, so I hope you find valuable information, guidance, and inspiration in listening to these experts and entrepreneurs share how they are adapting to this pandemic (in real time); and how they’re thinking about and planning for the future. Until next time, be safe and be well, Zeev Neuwirth MD

Dear friends & colleagues, In the three months since the Chinese government notified the WHO of the emergence of a new viral pneumonia, we appear to be on the rising ‘surge curve’ of a pandemic that threatens to overwhelm our healthcare system’s capacity. Despite the stark realities of the present moment and the unknowns that lie ahead, there has been another surge – a surge of humanitarian mission and innovation, of empathy and hope, of teaming and transformation. I am awestruck by the creativity, ingenuity, dedication and collaboration I’ve been witnessing and am privileged to be a part of. It’s difficult to express the gratitude that I and others have for the frontline providers and staff who are seeing patients in the clinics, emergency rooms and hospitals. As I observe the herculean efforts around me, I feel compelled to contribute and use my podcast platform to shed light on how this pandemic is accelerating the reframing of American healthcare… in real time. To that end, I am launching a limited podcast series entitled,‘How COVID-19 is Reframing Healthcare in America’.  In this series, I reach out to interview future-facing healthcare leaders and entrepreneurs, and ask them two questions: (1) How has the COVID-19 pandemic immediately changed the way you are delivering healthcare? (2) How will COVID-19 reframe healthcare in America for years to come? I am awed and inspired by the responses I’ve gotten in the interviews I’ve already begun recording for this series. I can’t wait to share them with you! Friends – I hope you’ll join me in this historic window of opportunity that’s been thrust upon us. The first episode in this limited series is now available for download on the ‘Creating a New Healthcare‘ podcast. I urge you to listen, share, and please reach out with your response. Until next time, be safe and be well. Zeev Neuwirth MD

Dear Friends & Colleagues, This is a timely podcast.  If you are not already a believer that social media is an integral part of our healthcare system and the larger social narrative on illness and health, then I would strongly urge you to listen to this interview. In this episode, I speak with Lisa Bookwalter, the Director Health – Twitter Client Solutions.  Lisa, who joined Twitter this past September, oversees all health client partnerships as well as Twitter’s market positioning in the health space. Prior to joining Twitter, she was a senior director at Healthline Media where she spent the past 9 years creating innovative ways for advertisers to connect with their consumers and clients. In this interview, you’ll hear: The ways in which individual healthcare consumers are using Twitter, nationally and across the globe. How healthcare providers and the medical community are using Twitter. The role Twitter is playing in public health crises, like the current covid19 pandemic. How and why pharmaceutical & device manufacturers are shifting from static websites to engaging consumers on social media channels. How Twitter differs from other social media platforms; and how Twitter is deploying safeguards for their consumers, particularly in the domain of healthcare and health. I was struck by a number of revelations during this interview. First – I really appreciated how Lisa kept pointing out that Twitter is an open platform for authentic human connectivity. As she put it, Twitter is the place people go to tell strangers the truth about themselves. This rang true to me. Unlike Facebook, Twitter is not about connecting with family & friends, or some specifically defined & circumscribed community. It’s an open, global format focused on enabling the sharing of raw experiences, thoughts and issues. It’s the place you go to connect to issues of immediate and timely concern – issues that are enhanced by diverse outreach & participation. Second – Twitter and other social media platforms are rapidly becoming the ‘go-to’ for brands looking to enhance consumer engagement. There is formal advertising on Twitter, but there are also other more organic forms of consumer engagement. The ability to ‘listen’ and understand consumers on Twitter – to receive authentic feedback on products and services seems to be emerging as superior to legacy forms of marketing such as brand websites. Third – Twitter and other social media platforms are rapidly becoming forums not only for conversation, but also for customer service. I was unaware that some companies are already utilizing Twitter for actual customer transactions. During the interview, Lisa gave the example that airlines are leveraging Twitter to allow customers to change their flights. Prior to speaking with Lisa, I hadn’t realized the extent to which Twitter could be used by healthcare consumers (patients) who were seeking information regarding treatment or referrals; and who were also wanting to connect with others who had been or were going through similar situations. During the interview I remarked to Lisa that Twitter has the potential to be the largest and most facile patient support group. It also has the potential to be a highly effective form of behavior change. Social network theory has demonstrated that one of the most powerful motivators for sustained change is the connection to others who are exhibiting specific behaviors. It might be that Twitter and other social media platforms are the next-gen motivational and behavior change tools in our society. I came away from this interview with a much greater sense of how social media can, at an unprecedented scale, transform the healthcare consumers’ experience and healthcare professionals’ capabilities. Lisa Bookwalter’s fundamental premise is that Twitter is about providing people with authentic, meaningful, real-time human connection, on issues that are of immediate importance. If an underlying principle of healthcare is also about human connection, then there is a synergy here I think few of us have yet to fully comprehend. Until Next Time, Be Well. Zeev Neuwirth MD

Dear Friends & Colleagues, Every day in the US, 11,000 people turn 65 years old. By 2023 it’s estimated that there will be nearly 55 million seniors in the US, and by 2030, seniors will make up over 20% of the US population. The literature informs us that social isolation & loneliness is rampant – affecting over half of seniors. The literature also informs us that social isolation contributes to many unwanted outcomes, including: (1) depression and an overall sense of unhealthiness, (2) poor medication adherence; (3) increases in ED utilization & hospital admissions. This problem is fueled by the fact that there are simply not enough healthcare professionals to provide the care seniors need, especially with growing shortages in primary care and nursing. And even if we had enough trained professionals, the costs would be unmanageable and unsustainable. There needs to be another solution – a reframing of healthcare and the healthcare workforce for senior care. Here is where Papa enters the picture. Papa is an automated, on-demand service that assigns college-age students to spend time with seniors. The students, called Papa Pals, are carefully selected and provide seniors with companionship, non-clinical assistance at home, and transportation to local destinations such as the supermarket, pharmacy, and doctor’s office. And, as you’ll hear, Papa has expanded its services to non-seniors like postpartum women and family caregivers of older adults. Our guest this week is Andrew Parker, the founder & CEO of Papa. He started Papa to support his grandfather, whom he called Papa. Andrew has led Papa to raise over $13M in capital and expanded the service nationwide to support health plans, employers, and health systems. Prior to Papa, Andrew was an early employee at MDLIVE, one of the nation’s largest telehealth companies, where he ran health systems sales and product to bring the solution to over 30 million Americans. In this interview, you’ll hear: The significant problem of social isolation & loneliness, and the negative impact it has on healthcare utilization, costs and overall health and health outcomes. How senior healthcare consumers are actually using Papa services, and why Medicare Advantage insurers are paying for this as a benefit in their products. Some of the specific health metrics and outcomes Papa is measuring and improving. How Andrew conceives of Papa as a new cloud-based healthcare delivery system – what he terms “pre-care”. How Papa has expanded its services from “grandkids-on-demand” to “family-on demand”. I had to listen to this interview a couple of times before I began to understand the enormity of what Andrew Parker is doing with Papa. He is reframing the American healthcare workforce. Prior to Papa, we relied solely on professionals such as nurses, social workers, paramedics, community health workers and care managers to provide in-home services. Papa has increased the healthcare workforce by literally tens of millions of people, simply by tapping college-age individuals. Andrew and his colleagues are creating “a new type of healthcare provider” and leading us to rethink what it means to be a healthcare provider. Papa is a next-gen approach to the triple-aim. It’s a practical & innovative approach to solving for the social-determinants-of-health such as food insecurity and transportation. Parker is, in his own words, creating a new “cloud-based healthcare delivery system”.  This could not be accomplished without cutting-edge, cloud-based, digital technology and analytics. Without “the tech platform”, Papa would remain a local, community-based, largely manual, excel-spreadsheet type of enterprise. With the tech platform, it’s become an enterprise that delivers outstanding care and customer service that is convenient, personalized, highly responsive, cost-effective, and scale-able. Despite the reliance on technology (or maybe because of the reliance on advanced cloud-based technology), the Papa approach is incredibly empathetic and humanistic. It reminds us that healthcare is fundamentally about trusting, healing relationships. Andrew initiated this approach as a way to take care of his own grandfather.  The origin of this company – the authentic and empathetic mission of taking care of Papa – infuses everything Andrew and his colleagues are doing. It’s an inspiring purpose, and a service that is desperately needed in our country and across the globe. Until Next Time, Be Well. Zeev Neuwirth MD

Dear Friends & Colleagues, Today’s episode shares unique insights into one of the most powerful examples of transformation occurring in the American healthcare market. The leadership at CVS Health has been intentionally curating an expansive and comprehensive approach to healthcare delivery – specifically in the arena of chronic disease management, which makes up the vast majority of encounters and dollars spent in healthcare. By way of quick background, CVS Health – previously the CVS Corporation – was renamed in 2014, following a landmark strategic decision to remove cigarettes and other tobacco products from its shelves. Its assets now include: One of the largest payers in the country (Aetna), and its accompanying state-of-the-art consumer analytic and population health analytic capabilities; CVS Minute Clinic, a provider arm which has now been greatly expanded with HealthHubs; CVS Pharmacy, one of the largest retail pharmacy chains, including its Specialty pharmacy; CVS Caremark, one of the largest pharmacy benefits managers in the US. Our guest this week is Dr. Alan Lotvin, who, at the time of this interview was Executive Vice President and Chief Transformation Officer for CVS Health. On Feb 12, 2020, one day prior to the posting of this episode, Dr. Lotvin was appointed President of CVS Caremark, the largest division of CVS Health. This represents a significant opportunity and is a measure of the trust the organization places in him. He will also have oversight of CVS Specialty and CVS Kidney Care. Dr. Lotvin has extensive experience in the pharmaceutical benefit management and specialty pharmacy industries. He began his career as a practicing cardiologist in New Jersey. He holds a master’s degree in Medical Informatics from Columbia University and also holds a US Patent for Circulatory Valve Repair. In this interview, you’ll hear: How CVS Health is constructing a consumer-centric healthcare system – making it easier, affordable and more convenient to stay healthy. The broad swath of chronic diseases that CVS Health plans to manage. CVS Health’s differentiating value proposition and its new positioning in the larger delivery ecosystem. How the vertical assets of CVS Health are enabling it to create and optimize value-based health services. How CVS Health is using its multiple sources of data and it’s powerhouse consumer analytics to improve patient engagement and health outcomes. CVS Health represents one of the most remarkable stories in the annals of American healthcare.  As described in my book on Reframing Healthcare, I consider CVS Health to be one of the poster childs for what a consumer-oriented, value-based healthcare approach should be. What you will hear woven throughout this interview is a story of a purposeful leadership team committed to creating care that is safe, effective, convenient, easy to use and navigate, all while being affordable. It is also a story of leadership that has been forward thinking enough to invest heavily in the most cutting edge analytics to identify patients in need and proactively assist them in accessing the care they need to stay healthy. There is another facet of this story that also needs to be underscored. The CVS Health approach is a collaborative one. Dr. Lotvin refers to “collaborative partnership agreements” and “open platform models” of care. He points out that while healthcare is highly competitive, there is also the opportunity to cooperate – the notion of ‘coopetition’. This understanding also points toward the direction I believe American healthcare should be heading – toward a more open ecosystem of care rather than the closed legacy system models and platforms of the past. The ‘ecosystem economy’ is upon us, and we, in healthcare, have the unique opportunity to actually contribute to creating a more connected, agile and responsive system of healthcare.  I’ll leave you with a quote from Dr. Lotvin which captures this overarching sentiment. “There is so much opportunity for us to do the right thing for patients and consumers, and really improve healthcare… We need to be tenacious and get through all the problems because the opportunity is really there to do important work that will benefit people, benefit society and benefit the people who are able to do it well. It’s the proverbial win for everyone.”  Until Next Time, Be Well. Zeev Neuwirth MD  

Dear Friends & Colleagues, Our guest this week is Samuel Shem.  Many of you will immediately recognize the pseudonym for the author of the classic piece of medical fiction – The House of God.  I grew up in healthcare reading his book over and over again. For those of you who are unfamiliar with that piece of fiction, I would urge you to read it. It is a brutally honest, true-to-life, incredibly humorous depiction of the unjust abuses of medical training in one of the most prestigious and prototypical internship/residency programs in our country. It is also one of the most empathetic gifts anyone has ever offered up to those of us who endured medical training. Now, nearly four decades after the publication of that classic novel, Dr. Shem has published another book, Man’s 4th Best Hospital.  Whereas the House of God chronicled the trauma inflicted on doctors (and nurses) in training, this book provides some unique perspective on the dehumanizing aspects of healthcare delivery for patients and providers. Shem is currently Professor of Medicine in Medical Humanities at the NYU School of Medicine.  He is a novelist, playwright, and, for three decades, a member of the Harvard Medical School faculty. His novels include The House of God, Mount Misery, and Fine. He and his wife, Janet Surrey, co-authored the award-winning Off-Broadway play Bill W. and Dr. Bob, the story of the founding of Alcoholics Anonymous.  Dr. Shem is a graduate of Harvard College and Harvard Medical School; and earned a PhD as a Rhodes Scholar at Oxford. In this interview, you’ll hear: Shem’s understanding of writing as a way to empathetically resist the dehumanization of healthcare delivery. The unique way in which Shem distills and articulates the fundamental problems facing doctors and patients in healthcare today. The “big resist” and the solutions Shem shares to counter the root cause problems facing healthcare delivery today. Some of Shem’s opinions will, no doubt, be controversial, and some may consider his solutions extreme. I found Dr. Shem’s analysis to be thought provoking and disarming in its honesty and simplicity.  And while many of his observations are not earth shattering, he finds a way to say them in new and insightful ways. Whether you agree with him or not, what’s clear is that Shem is coming from a place of tremendous respect and empathy for patients and providers. Shem’s novel and his commentary are incredibly topical and timely.  Many, if not most, would agree that our healthcare delivery system is inadequate, poorly aligned to the healthcare needs of our populations, financially unsustainable, and in need of significant disruption. What I found most compelling about his book and this interview is Dr. Shem’s unrelenting hopefulness. He deeply believes that as long as we are connected with one another in just pursuits; as long as we can all have a voice in honest, open dialogue; as long as we are able to speak truth to power; as long as we can be critical thinkers and creators, and as long as we maintain a mutual empathy and a respectful sense of humor, we can change the world for the better. What his recent critics have misunderstood about Shem is that he is a human rights activist as much as he is an artist. He is not, in my opinion, writing for the purpose of winning awards or critical acclaim, although that may occur. He is here to actively resist the dehumanizing forces in healthcare, to catalyze positive change, and to make the world different and better. We recently honored the memory of Martin Luther King Jr who said, “Our lives begin to end the day we become silent about things that matter.”  Sam Shem, in the tradition of MLK, refuses to be silent. He is calling us to resist silence and become active participants in the creative effort to humanize healthcare for all. Until Next Time, Be Well. Zeev Neuwirth MD

Dear Friends & Colleagues, A common characteristic of the guests I invite on this podcast is their courage in and commitment to creating unprecedented positive change in healthcare. They don’t just do things right, they do the right things. And, while the content in these interviews centers on transforming healthcare, there are also lessons on humanistic leadership woven throughout. That’s not a coincidence because the act of reframing – of creative disruption – requires that type of leadership.  Our guest this week, Secretary David Shulkin, exemplifies courageous, transformational, principled-based leadership. Dr. Shulkin served as a member of President Trumps’ cabinet, as the 9th Secretary of the US Department of Veterans Affairs. Previous to that he served under President Obama as Under-Secretary for Health. In both positions, he was confirmed by a unanimous Senate vote – an unusual testament to his competence and integrity. Prior to entering the government, Secretary Shulkin had a long distinguished career in the private sector. He served as CEO at Beth Israel Hospital in NYC and Morristown Medical Center in Northern NJ; and also held senior leadership positions at distinguished institutions such as the University of Pennsylvania Health System and the Hospital of the University of Pennsylvania. He has been named as one of the Top 100 Physician Leaders by Becker’s Hospital Review and one of the “50 Most Influential Physician Executives in the Country” by Modern Healthcare and Modern Physician. He has also been named by Modern Healthcare as one of the “One Hundred Most Influential People in American Healthcare”. Secretary Shulkin recently published a book entitled, ‘It Shouldn’t Be This Hard To Serve Your Country’, a memoir of his experience serving under two US Presidents.  In this interview, you’ll hear: The important and unique role the VA system serves for military veterans, as well as its contributions to our larger healthcare system. The bold leadership maneuvers that Dr. Shulkin deployed to solve for immediate national VA healthcare crises and to navigate the entrenched culture of a slow moving and highly political bureaucracy. The lessons that Dr. Shulkin believes the US healthcare system can adapt from the VA. How Dr. Shulkin initiated the modernization of the VA system through the single largest electronic medical record (EMR) deployment in history. One of the major reframes that Dr. Shulkin introduced into the VA system, which was a shift from being a “pure provider of care” to becoming the “network coordinator of care”. The remarkable characteristics of Dr. Shulkin’s leadership approach are apparent in this episode. First – he focused on solving specific, patient-facing healthcare problems such as improving access to care and eliminating hepatitis C. Second – he fearlessly made decisions based on principles and evidence, followed with swift action. I say “fearless”because he was acting in a pathologically political environment, and many of the decisions he made were followed by highly publicized personal attacks on his character and integrity. Third – he focused on delivering measurable and meaningful outcomes, with a relentless push to transparency.   For me, the main story here is about a high-integrity, humanistic leadership approach coupled with a results-oriented, outcomes-based management style – singularly focused on creating unprecedented and differentiating value for patients and healthcare consumers. It seems ironic that we find one of the most brilliant examples of ‘consumer-obsessed’ leadership in the government-run VA system. Yet, there it is.  I’d like to conclude these notes with a very personal message of gratitude.  I would like to sincerely and publicly thank our Veterans for their service and their sacrifice. I had the opportunity to spend the first seven years of my medical career providing care to Veterans at the Bronx VA Hospital in NYC. It was an experience that shaped my perspective and professional trajectory, leaving me with an indelible sense of humanistic mission and purpose. Until Next Time, Be Well. Zeev Neuwirth MD