Creating a New Healthcare

A lot has been said about the application of Artificial Intelligence (AI) to healthcare. These discussions typically center on AI’s ability to improve diagnostic accuracy, reduce medical errors, lower healthcare costs, enhance productivity, and even replace providers. We will cover some of that ground as well, but our guest’s perspective takes the discussion far beyond those more familiar topics. His firm belief is that the major impact AI could have on healthcare delivery would be to restore “the human bond, the human touch, and the human factor that has been lost.” This is a unique opinion, but not surprising, given the source. Dr. Eric Topol is a leading global authority on Precision & Personalized Medicine. He is also one of the most outspoken physicians I’ve ever encountered on the issue of patient advocacy, and in his own words, “patient activism.” Dr. Topol is the Founder and Director of the Scripps Research Translational Institute. Prior to assuming his leadership role at Scripps in 2007, he led the Cleveland Clinic to become the #1 center for heart care in the country.  He is a nationally renowned cardiologist and literally a superstar in the world of academic Medicine, being one of the top ten most cited medical researchers. He has been elected to the National Academy of Medicine and was voted the #1 most influential physician leader in the United States by Modern Healthcare. In 2016, Dr. Topol was awarded a $207M grant from the NIH to lead a significant part of the Precision Medicine (All of Us) Initiative – one of the largest NIH grants ever awarded.  As if all of this wasn’t enough, he has published 2 bestseller books on the future of medicine: The Creative Destruction of Medicine & The Patient Will See You Now.  His most recent book, Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again, was published this year. The issues we’ll cover in this interview include: Dr. Topol’s perspective on the “shallow medicine” being practiced today and how it harms patients as well as providers. The various applications of AI to healthcare, and Dr. Topol’s take on the most mature and proven applications of AI in Medicine today. The most significant benefit of Artificial Intelligence in healthcare – “the gift of time” and how it can revitalize and rehumanize medical care – for both patients and providers. The challenges, hurdles, and risks we face in further developing and deploying AI-enabled healthcare. Dr. Topol’s refreshing perspective on the characteristics of the ideal medical student, and the relational characteristics we should encourage and support in healthcare providers. What you’ll come away with from this interview is an understanding of how Artificial Intelligence has the potential to elevate the profession of Medicine – not just through the enhancement of diagnostic accuracy, reduction of errors, lowering of costs and a literal leapfrog in efficiency. But, more importantly, through its ability to free up providers’ time and attention, so they can focus on being empathetic experts, guides & teachers. It is this that will restore the human bond that is so sought after in healthcare delivery today. Dr. Topol is keen to point out that this is as much a “gift” to providers as it is to patients. If you listen carefully, you’ll also hear Dr. Topols ‘call-to-action’. He urges us all to become “patient activists” because the future of healthcare is by no means a certain or secure one. He believes that we collectively have the ability, and the responsibility, to assure that the future of healthcare is a hopeful and healing one. I read Dr. Topol’s book, Deep Medicine, and I would urge you to as well. It’s an enlightening and important read. Listening to him speak in this interview, however, gave me an even deeper sense of his integrity, his vision and his humanism. Dr. Topol is, to my mind, one of the greatest physicians, medical researchers, scholars and healthcare leaders of our time. But, what makes him even more unique is the fierce and sustained sense of patient advocacy and humanitarianism that he brings to Medicine & healthcare delivery. This interview left me with a renewed sense of responsibility, purpose and hope, and a strong desire to reframe healthcare – from a shallow to a Deep Medicine. Until next time, Be Well. Zeev Neuwirth, MD

Colleagues & Friends, This is the final episode of this exciting Spring 2019 podcast season.  I can’t imagine a more engaging interview to conclude with – one that truly exemplifies the purpose of ‘Creating a New Healthcare’. Our guest this week, Dr. Stephen Klasko, was recently ranked #6 in Modern Healthcare’s Top 50 ‘Most Influential Clinical Executives’. Last year, in 2018, he was ranked #2 in Modern Healthcare’s Top ‘100 Most Influential People in Healthcare’.  In 2018 he was also recognized as #21 in Fast Company’s ‘100 Most Creative People in Business’, as well as being awarded Philadelphia Entrepreneur of the Year.  Dr. Klasko, an obstetrician who has been the dean of two medical schools, is the President & CEO of Philadelphia-based Thomas Jefferson University and Jefferson Health. In this role, Dr. Klasko leads one of the nation’s fastest growing academic health institutions. His six year tenure has been based on a vision of re-imagining the future. This interview was, by far, the most fast-paced I’ve experienced. It was a deluge of highly innovative initiatives and programs. A few of the items you’ll hear discussed include: The consumer segmentation and customization approach that Jefferson Health is taking – moving away from a ‘one-size-fits-all’ model of medical care experience. How Dr. Klasko radically introduced telehealth to Jefferson Health in 2013 – making it mandatory in every clinical division. The innovative way that Jefferson Health is reducing inappropriate ED visits within its own self-insured workforce. The “Healthcare with No Address” approach that is completely reframing where and how people will receive and experience healthcare at Jefferson. The digitally-enabled, consumer-oriented initiatives such as the “match.com” app for young women seeking an obstetrician. The ground-breaking partnerships Jefferson Health has made, including one with the third-leading ‘fashion & design’ university in the country. Some of the entrepreneurial ventures Jefferson Health is engaged in, including a hemp-based wearable that Dr. Klasko believes will usurp Apple Watch’s biometric monitoring. Dr. Klasko is one of those courageous leaders who understand that we need to quickly catch up with other industries in terms of treating people like valued customers and respected consumers. I say “courageous” because he not only understands it, he demands it. He also understands that we need to customize care, not by disease or payment, but by patient needs and preferred engagement. He and his colleagues are attempting to wrap healthcare around patients rather than forcing patients to wrap themselves around the healthcare system. He is unapologetic in repeatedly pointing out how the current system is grossly inadequate. And rather than demonize new entrants and disruptors, he embraces them – partnering, learning, emulating and synergizing. From my perspective, Dr. Klasko is nothing less than a healthcare revolutionary. It is a bit ironic that he is the leader of a healthcare system whose namesake was an American revolutionary and one of the founding fathers – President Thomas Jefferson. I have to think that President Jefferson would have greatly appreciated and approved of the legacy that Klasko is creating. This moment in healthcare history is a revolutionary inflection. As Dr. Klasko states, “It’s important for CEO’s and others to recognize that when an industry is going through a once-in-a lifetime change, the absolute biggest risk is doing things the way you did them before.” I can’t think of a better note or more important call to action on which to end this season. I hope you’ve enjoyed this remarkable Spring 2019 season of ‘Creating a New Healthcare’.  From my perspective it’s been an extraordinary line-up. I would encourage you all to take the next couple of months to catch up on episodes that you might have missed. It’s essentially a Masters Class series in healthcare innovation, entrepreneurship and leadership. We will resume the podcast in early September and have another amazing lineup in store for you! Until then, Be Well! Zeev Neuwirth, MD

Dear Friends & Colleagues, The promise of real-time health information connectivity and coordination of care has been elusive. That is, until now. Jay Desai, co-founder and CEO of a company called ‘Patient Ping’, has created a platform that allows for real-time notification of a patient encounter in any healthcare facility or home care. Even more revolutionary, the platform delivers bi-directional information automatically. The need for this type of connectivity is obvious to healthcare professionals and organizations that are accountable for the quality, safety, appropriate utilization and cost effectiveness of care delivered. Part of the challenge for providers is that approximately 30 to 50% of healthcare costs incurred by most integrated delivery systems is actually from clinical care delivered outside of the home system. This percentage is higher for independent provider groups and systems in highly competitive markets. That means that even in the best of integrated delivery networks, there is already a 30 to 50% ‘accountability handicap’. Prior to co-founding PatientPing in 2013, Jay Desai worked at the CMS Innovation Center (CMMI) where he helped develop Accountable Care Organizations (ACO’s), bundled payments and other value-based initiatives. He has an MBA in Healthcare Management from the Wharton School of Business at the University of Pennsylvania, and a BA from the University of Michigan. Jay’s professional passion lies at the intersection of technology, policy and community. He first discovered the need for real-time, cross-institutional connectivity when he was at CMS. Provider groups were asking CMS for some way to ‘know’, in real-time, when and where their patients were receiving clinical care. These systems needed to know so they could intervene and prevent unnecessary, as well as potentially, harmful tests and procedures. They needed to know so they could follow-up when their patients were discharged from another institution. It’s a critically important issue for patients and providers – and this is where Jay Desai and PatientPing come in… In this interview we’ll discuss: The two major offerings of PatientPing – the “ping” notification that tells you where your patients are; and the “stories” which tell you where your patients have been. The different ways healthcare systems are utilizing PatientPing to communicate between hospital-based care/case managers, ambulatory care medical homes, emergency departments, nursing homes and home health services. The remarkable outcomes demonstrated with the PatientPing platform, and how they are achieving those results. PatientPing’s customizable “consumer grade user-experience”,as well as the enhancements they’re making. PatientPing is designed to not only respond to the needs of accountable providers and organizations. It’s also designed to create healthier ‘communities of care’ – to enhance the complex inter-dependencies of the clinical ecosystem. The data PatientPing is collecting is beginning to demonstrate that avoidable healthcare utilization across communities is decreasing: lower avoidable emergency room visits, hospital admissions and nursing home days – all of which leads to better care at lower costs. There is more than one value proposition PatientPing offers. The embedded analytics will also reveal care patterns – allowing systems and communities to better understand where patients are going, and allow for more proactive preventive care. Another easily overlooked value proposition is the user experience. The information PatientPing relies on was already there beforehand. They’ve simply made it more accessible to providers of care. As Jay points out, it’s analogous to the situation with Google Maps. The GPS data was already present when companies like Google and Waze made it easily accessible and usable for the consuming public. PatientPing has done something very similar with the data in the Health Information Exchange network and the health information locked up in proprietary electronic medical records. They’ve made this information accessible and consumer-friendly for providers of care – across and between institutions and practices. It may be a simple concept but the impact and value proposition is profound. It’s going to assist providers and patients with better communication, better integration and better coordination of care. It’s going to make healthcare delivery more seamless and safe. And, who wouldn’t want that? ReplyForward

In 1950, medical information doubled every 50 years.  It’s been estimated that, in 2020, it will take only 73 days for medical knowledge to double!  This is not surprising given that a new biomedical journal article is published every 26 seconds!  It is clear that we will need tools to manage and synthesize all of this data, and that’s where the clinical decision support (CDS) comes in. Our guest today is Dr. Scott Weingarten.  Dr. Weingarten recently joined Premier Inc., retaining his role as CEO of Stanson Health – a clinical decision support company he founded approximately 6 years ago.  Prior to joining Premier Inc., Scott was the Senior Vice President and Chief Clinical Transformation Officer at Cedars-Sinai Hospital.  In addition to his long-standing tenure as a practicing physician and executive, Scott is also a serial entrepreneur and inventor – holding three software patents.  Prior to forming Stanson Health, Scott co-founded Zynx Health, a highly successful leader in ‘order sets’ and ‘care plans’ for electronic health records. In this interview Scott will share: The demonstrable positive impact of CDS on organizational quality and cost – resulting from marked improvements in appropriate utilization of lab tests, imaging studies and medication prescribing. The sophistication of today’s CDS technology that results in the provision of real-time, patient-specific, evidence-based recommendations. The vast breadth of clinical situations and conditions for which Stanson Health has created evidence-based clinical decision supports. The specific benefits for practicing clinicians: offering providers performance data on how they compare to their colleagues and to evidence-based standards. The highly sophisticated analytic approach Stanson Health takes to streamline and optimize clinical alerts embedded in the electronic medical record – removing a substantial percentage of “low value alerts” – what Scott calls “pruning the tree”. I went into this interview understanding CDS as a tool to enhance clinical practice – improving providers’ and organizations’ ability to meet quality goals, as well as optimize utilization of tests and treatments.  I came out of this interview believing that CDS is not only a basic necessity if we are going to practice safe, high quality medicine; but, that it’s also one of the most profound technologies shaping medical practice – fundamentally changing the way providers & patients will experience clinical encounters in the future.   Imagine when a care provider will be able to dialogue with a patient, supported by natural language processing software and sentiment analysis, feeding the artificial intelligence that will be making real-time, evidence-based, customized recommendations for that individual patient.  This reality does not seem that far off, and I suspect Scott and Stanson Health are moving rapidly toward that day.  Imagine how liberating and humanizing that would be – allowing providers and patients to really communicate and engage with one another, with technology aiding that human-to-human interaction rather than interfering with it.   The take-home point is that Clinical Decision Support is not just about meeting quality metrics or reducing inappropriate testing and prescribing.  CDS is not just about assisting providers in consistently delivering up-to-date, evidence-based medical care.  CDS is not just about reducing unnecessary costs of care.  The purpose of CDS, as I understand it now, is to make healthcare more accessible, affordable, effective, personalized and relationship-oriented.  The highly informed perspective, and the picture that Dr. Scott Weingarten paints for the future of healthcare is, indeed, a bright one.  His is a hopeful and realistic message, and one that is well worth listening to. 

Our focus in this episode is on healthcare quality & safety.  Quality – its measurement, reporting and accountability – is one of the most significant, impactful and lasting healthcare movements, literally spanning the past four decades.  It is a core element of the ubiquitously adopted “Triple Aim”. And yet, it continues to be one of the most challenging problems plaguing healthcare delivery in our country. Our guest this week is one of the pioneering leaders of the healthcare quality movement.  Peggy O’Kane is the Founder and CEO of the National Committee for Quality Assurance (NCQA).  She founded the NCQA 29 years ago, at a time when the idea of measuring and reporting standardized quality & safety metrics was largely not accepted by the medical establishment. Through her visionary leadership and her dogged persistence to make healthcare safer and of higher quality, the NCQA has grown to be the largest healthcare quality accreditation organization in the country.  The NCQA currently impacts 190 million Americans through its quality measurement and accredits hundreds of organizations. Peggy O’Kane has been named by Modern Healthcare as one of the “100 Most Influential People in Healthcare” 12 times, and one of the “Top 25 Women in Healthcare” 3 times. In this interview, we’ll discuss: The core work of the NCQA –  identifying quality metrics and creating accountability around those metrics – and the challenges faced in its effort to do so. Why Peggy believes quality metrics are currently a tremendous burden for providers of care, and how we can change healthcare delivery to make quality reporting more sustainable for providers as well as for healthcare systems. Which specific mega-trends Peggy thinks are going to fundamentally transform healthcare delivery and how the NCQA is thinking about quality in the context of these seismic changes. Some of Peggy’s early thoughts regarding the new CMS ‘Primary Care First’ payment models which are set to launch in early 2020.   Listening to Peggy O’Kane is one of those extraordinary opportunities to hear from a visionary healthcare pioneer and entrepreneur.  I tried to imagine how 30 years ago, a young female respiratory therapist decides to redirect the entire medical establishment in order to create standardization, transparency and accountability around quality metrics in healthcare. Peggy was clearly part of a larger “movement”; but still, I cannot fathom the enormity of that personal and professional undertaking, and the courage it took. I also find it of immediate interest that, as Peggy points out, it was the employers and third party stakeholders who initially supported and promoted the launch of the NCQA quality improvement mission. I wondered, during the interview if, indeed, history is repeating itself. There is, I believe, a lesson to be learned from this history.  We are in a moment of profound and unprecedented transition in healthcare today and, once again, employers and third party payers are catalyzing transformative change – this time around value-based care. So, it does make me wonder. Do we have the luxury of time (decades) as we had in adopting the triple aim quality mission?  Or, is this new era of market-driven, consumer-oriented, value-based care going to demand a much more rapid response, with more negative consequences for those who delay? I’m curious as to how Peggy O’Kane would answer that question, and I’m also very interested in hearing your thoughts. Until next time, be well. Zeev Neuwirth, MD

Dear Friends and Colleagues, These past few weeks have been both exciting and incredibly busy with the recent publication of my book, Reframing Healthcare.  As such, I’m taking a very brief hiatus from our typical podcast interviews to focus on sharing the message of the book across the country.  So – in this episode, we are going to do something quite different.  I was recently interviewed by Gregg Stebben of ForbesBooks Radio about Reframing Healthcare.  The goal of ForbesBooks Radio is to “bring the Stories, Passion, and Knowledge of top thought leaders to the world.”  I’m incredibly honored to be included in this series. Gregg was also kind enough to allow me to share the interview with you in lieu of our usual podcast this week.  I encourage you to listen in as Gregg takes us on a fast-paced exploration of the topic.  We will return to our normal podcast schedule and format on May 16th. We’ll finish out this season with four dynamic interviews that cover everything from the transformation of Quality Improvement with the CEO of the NCQA, to learning about disruptive change from one of the most innovative and disruptive healthcare CEO’s. Finally, and most importantly, please accept my sincere thanks for being such a dedicated audience. Creating a New Healthcare was recently honored as the Healthcare and IT Marketing Community’s (HITMC) 2019 Podcast of the Year. It is entirely due to your support, interest, and engagement that we were able to accept this award, so thank you. Until next time, be well. Zeev Neuwirth, MD

This week we’ll be discussing some of the groundbreaking transformations being developed by the North Carolina Department of Health & Human Services (DHHS) under the leadership of Dr. Mandy Cohen.   The North Carolina DHHS is charged with the health and wellness of over 10 million people. This healthcare system, with an annual budget of $20 billion, is one of the largest state healthcare systems in the country.  The NC Medicaid program within the DHHS directly serves nearly 2.3 million people – 1 out of every 5 people in North Carolina.  It also serves approximately 1.2 million children in North Carolina. Our guest on this episode is Dr. Mandy Cohen, who was appointed to the role of Secretary of the North Carolina Department of Health & Human Services (DHHS) in January 2017 by Governor Roy Cooper.  Before coming to NC, Dr. Cohen served as the Chief Operating Officer and Chief of Staff at the Centers for Medicare & Medicaid Services (CMS). She was responsible for implementing policies for Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and the Federal Health Insurance Marketplace.  In February 2019 she was named one of the Top 25 Women Leaders in Healthcare.  In this interview, we’ll talk with Dr. Cohen about: Why North Carolina is shifting its statewide Medicaid program to Managed Care. How she is reframing and redefining healthcare within the NC DHHS – from “buying healthcare” to “buying health” services – a progressive shift that is consistent with the direction the healthcare market is heading. The highly innovative initiatives being launched in the Medicaid Managed Care program, with a particular focus on the social determinants of health, and some illustrative examples of how this is leading to markedly improved health outcomes and lower costs of health. How DHHS is integrating mental health with physical health – and the advantages of that integration. North Carolina is one of the last of the large states to transition to Medicaid Managed Care.  As a result, it’s also one of the most informed states making this transition. Dr. Cohen and her team have intentionally studied the successes of other state healthcare systems as well as the successes of healthcare systems within NC – attempting to build on those lessons.   As you’ll hear in the interview, the overarching plan is to fundamentally shift from “buying healthcare” to “buying health” – that is to purchase services that cost-effectively advance health outcomes – whether those services be clinical care, behavioral care, or social and community care.  Another facet of the plan is to deploy outcomes-based payment models instead of the current volume-based, fee-for-service payment. The systematic approach of the Medicaid Managed Care program will begin with the screening of individuals’ medical care needs as well as factors related to social determinants of health.  The approach also includes rigorous testing of the numerous pilots & initiatives in order to determine which innovations work and which do not.  It is a healthcare outcomes analyst’s dream, but more importantly, it’s what we need if we’re to advance the health and well being of North Carolina, as well as the country.   The success of this immense and critically important effort will require a multi-stakeholder approach. To that end, the DHHS has been, over the past couple of years, actively engaging the expertise of numerous physicians and administrators from across the state – drawing from the sophisticated world-class hospital systems and academic medical centers that call North Carolina home, as well as the independent providers and community-based organizations serving both urban and rural communities.   I applaud the legislature and political leaders of North Carolina for initiating this innovative transition to Medicaid Managed Care – for supporting it and funding it; as well as CMS for providing the waiver.  As Dr. Cohen points out in this interview, health and well-being is not a partisan issue – it’s an issue that is fundamental to the overall health and well-being of our commonwealth and our nation.

Is there a senior leader in your organization with the sole job of eliminating “customer friction points”?  Well, there is at Banner Health.  Valerie Monet is the Senior Director of Customer Experience Strategy at Banner Health.  This demonstrates a remarkable commitment to the consumerist mindset from one of the largest and most forward-thinking integrated healthcare systems in the country.  Banner Health is attempting to improve the patient experience by transforming the customer experience. Valerie Monet has over a decade of involvement  in healthcare customer experience. Prior to joining Banner Health, Valerie spent thirteen years at J.D. Power where her responsibilities included strategic planning, business development, customer experience management and consumer data analytics, as well as qualitative ‘voice-of-the-customer’ data collection.  In this role, she worked with dozens of top performing consumer-oriented companies in the U.S. and Canada. In this interview we’ll discuss: Why a focus on customer experience has become increasingly important to healthcare systems in differentiating themselves from their competitors. What strategies Banner Health is deploying to reduce customer friction points and differentiate it’s consumer experience, including their omnipresent patient/customer persona – “Sophia”. How Valerie and her colleagues utilize both quantitative and qualitative data to understand the customer experience and measure the improvements. How Valerie understands consumerism to be highly complementary and synergistic with the concept of “patient”. The similarities and marked differences between the customer experience in healthcare and other industries, and why healthcare experiences tend to be more polarized – either really good or really bad… At this point in time, Valerie admits that she can’t easily quantify the outcomes of many of her hypothesis, despite dogged efforts to do so.  I admire and respect her honesty regarding where she’s at and where she’s trying to get to.  Much in keeping with other experts I’ve interviewed, Valerie emphasizes that many of the insights have to be gleaned from qualitative research and field data collection – direct conversations with healthcare consumers.  As she puts it, customer experience is a data scientist’s dream; but there’s also an art to it.  The measurement of experience is impacted by numerous factors such as patient expectations and the strength of the doctor-patient relationship.  Science, as she points out, will only get you so far. One of the most telling insights Valerie shared was when I asked her to instruct us, in less than 30 seconds, how we might go about setting up an amazing customer experience division.  Her immediate answer was, “just start listening to your customers and patients – start getting feedback – find a starting place, sit there and observe and listen – and just start to understand what they feel and what they see and what it’s like to be on the other side.” In the end, what I repeatedly come back to is that customer experience is about better understanding the people we care for and treat, understanding what they want and need, making it easier for them to manage their healthcare and their health, and creating better experiences and better outcomes – call it what you will… This was one of the most interesting discussions I’ve had on one of the most important topics in healthcare.  It’s clear that Valerie is excited by the intellectual, emotional and purposeful pursuit of customer experience; and she makes it salient and purposeful for those of us who are not experts in this domain.  Her curiosity and fascination with this topic are infectious. Until next time, be well. Zeev

William Gibson, the noted science fiction author wrote, “the future is already here, it’s just not widely distributed yet.”  Our guest this week describes a future revolution in healthcare that is, in fact, already here.  Digital health therapeutics are transforming the delivery and experience of medical care and rapidly gaining traction in healthcare delivery. Anand Iyer, the Chief Strategy Officer for Welldoc, has been engaged in digital health for well over a decade.  He is a respected global digital health leader.  Anand has a doctorate in computer and electrical engineering as well as a MBA from Carnegie Mellon.  Anand and his colleagues are part of a large and growing community of cutting-edge digital entrepreneurs that are building the technologic infrastructure and capabilities to enable a completely different approach to medical care. In this interview, Anand describes the digital therapeutics that are being used to provide clinical care to patients with chronic diseases such as diabetes and hypertension.  To date, Welldoc’s FDA approved digital therapeutic, Blue Star, has been used by tens of thousands of healthcare consumers with diabetes. In addition, in this episode Anand shares the following: How digital health software and algorithms are becoming FDA-approved and regulated therapeutics, similar to medications and medical devices. The three main facets of the Blue Star digital health program – targeted at patients, providers and health systems. The requirements for the acceptance and adoption of digital health into mainstream clinical delivery. Why digital health is the only viable option in addressing numerous chronic diseases that are advancing at epidemic proportion. Why digital health presents a great solution to some of the challenges in providing optimal care to the Medicaid population – addressing some of the existing inequities in quality, accessibility, affordability and engagement. How different digital health platforms are beginning to coalesce, affording users a singular, non-fragmented, seamless experience. It is remarkable that Anand and his colleagues understood this potential well over a decade ago – the use of digital apps to treat diabetes, hypertension, depression, heart failure and numerous other chronic diseases.  Given their forethought, Anand asks us to imagine what digital technology and advanced analytics will be able to accomplish in the next 5 years. The use of: 24/7 real-time biometric recording and psychosocial/consumer information; coupled with machine learning, artificial intelligence, predictive analytics, voice technologies, natural language processing and avatars; plus new coordinating & integrating operating platforms – will enable unimagined advances in medical care.   Three closing thoughts: The take-home point is that digital health will almost certainly be a profound (and perhaps unprecedented) enabler in making high-quality healthcare accessible, affordable and sustainable – for everyone. Digital health will also be a major enabler in engaging healthcare consumers, finally breaking the quality & outcomes barrier we’ve been unable to penetrate over the past couple of decades. Although digital technology is going to be a game-changing enabler, our purpose should not be to digitize healthcare, but to humanize it. As always, I am very interested in hearing your thoughts about this exciting domain of creating a new healthcare. This will be one of a number of upcoming interviews focused on digital health. Until next time, be well! Zeev

Dear Friends & Colleagues, The phrase, “Last Mile of Healthcare,” is used to describe a number of situations in healthcare.  First, it’s been used to describe the value-laden interface between a provider and a patient.  Second, it describes patients in the context of their life – as individuals making healthful as well as unhealthful decisions.  It is in these so-called ‘last mile of healthcare’ moments that the issue of behavior is paramount – provider behavior and patient behavior.  The metaphor has significant ramifications in population health as well as in public health.  For example, chronic disease management, which now accounts for the majority of healthcare encounters, as well as costs, is all about behavior change.  It’s not so much the advice or treatment as much as the follow-up that really makes the difference.  Despite all of our advances, sustained behavior change remains a holy grail of healthcare delivery. This week’s guest has made it her career ambition to tackle this issue head on.  She and her colleagues are consumed by the issue of engagement and behavior change.  Their tool box is called ‘behavioral economics’.  Karen Horgan is the CEO and a co-founder at VAL Health, which she started with her colleagues Kevin Volpp MD and David Asch.  I’ve been a long-time fan of Dr. Volpp’s work and had the wonderful opportunity to interview him on this podcast a while back . Behavioral Economics provides an evidence-based array of methods to create healthful behavior change. There have been a plethora of recent studies demonstrating how Behavioral Economics can greatly advance how we communicate and engage with patients, as well as with providers.  As Karen points out in this interview, these market-tested techniques are used in many other industries, as well as in public health campaigns. In this interview Karen will share: The basic underlying principles of Behavioral Economics. Illustrations of the most powerful Behavioral Economics techniques used to influence healthy patient behaviors as well as value-based provider behaviors. A number of impressive examples of how Karen and her colleagues at VAL Health are deploying Behavioral Economic initiatives with provider and payer clients. Why Behavioral Economics isn’t more well known in healthcare; where she’s seeing greater adoption; and how long she believes it’ll take for general adoption to hit that exponential inflection point. Up until now, in our Fee-For-Service dominated market, patient behavior and follow-up has not really mattered.  For the most part, healthcare systems, provider groups and individual clinicians do not get paid, bonused or dis-incented based on outcomes.  But, as the market shifts to value-based payment, both provider behavior – in terms of appropriate utilization and quality care – as well as patient behavior, will actually make a huge impact on revenue. From my perspective, it’s exciting and encouraging.  Here we have a scientifically proven approach to influence positive behavior, an approach that does not manipulate behavior or force compliance, but instead makes it easier for people to do the right things to enhance health outcomes.  The vision that Karen Horgan paints is a world in which the way we communicate and engage with patients will include Behavioral Economic techniques as a matter of course. It will just be the way we deliver healthcare. I, for one, would like to see us nudge this along a bit faster.  But in the meantime, I’ll be closely following the work that these folks are doing to further validate and advance one of the toughest nuts to crack in healthcare – our own behavior! Until next time, be well! Zeev Neuwirth, MD