Creating a New Healthcare

It’s been said that our zip codes impact our health more than our genetic codes.  How do the social determinants of health — education, employment, public transportation, safe housing and neighborhoods, access to healthy food… — so profoundly affect healthcare utilization and health outcomes? In this interview, you’ll hear an emerging story of how the leadership of a healthcare system in New Jersey is addressing this issue head-on and going right to the root cause.  My remarkable guest, Michellene Davis – a lawyer and policy expert – is the Executive Vice President & Chief Corporate Affairs Officer for RWJBarnabas Health – the largest healthcare system and largest non-profit employer in the state of New Jersey.  Ms. Davis has been named as New Jersey’s top healthcare lobbyist and Modern Healthcare recently recognized her with their 2018 Top 25 Most Influential Minorities in Healthcare Award. Key topics and stories we’ll explore in this interview include: RWJBarnabas Health’s rollout of a novel and compelling “anchor” strategy, synergistic with larger economic and cultural revitalization efforts like the ‘Newark 2020 Initiative’ launched by Newark Mayor Ras J. Baraka. The overall approach and major interventions of the ‘Social Impact & Community Investment Practice’ that focus on education, economic stability, neighborhood and built environments, global health and employee engagement & volunteerism. Inspiring stories of local entrepreneurs who are growing successful businesses and enriching the local community as part of the “Hire, Buy, Invest” strategy that Ms. Davis is leading on behalf of RWJBarnabas Health. Ms. Davis emphasizes how her organization’s community-focused initiatives make sense, not only from a healthcare perspective, but also from a business and economic perspective.  The approach taken in New Jersey is focused on implementing long-term, expanded and self-sustaining solutions; and is being accomplished through the intentional inclusion of multiple stakeholders who might otherwise be competitors. Ms. Davis’ initiatives strive to not only be enabling, but also empowering and self-generating.  They include providing local communities with access to healthy foods, transportation and safe housing – critically and immediately important efforts!   But, they go beyond that – to actually providing employment to local citizens.  And even beyond that – to actively supporting local entrepreneurs and small businesses – teaching them how to grow their businesses and become even more entrepreneurial. Hang onto your seats (or earbuds) folks.  Ms. Davis is a powerhouse!  All of her talent and energy is highly purpose-driven and laser-focused on “eliminating” the adverse negative impacts of the social determinants of health. There are numerous lessons to be learned from this interview – lessons that can translate into action.  My hope is that you’ll share this interview with your local healthcare systems and local government, and begin to organize similar efforts.  And, if you’re engaged in similar ‘anchor’ strategy efforts, I would love to hear about it.  From my perspective, this interview is one of the most inspiring and potentially catalyzing dialogues posted on this podcast series to date. As always, I hope you get as much out of this interview as I have! Zeev Neuwirth, MD

Friends & colleagues, The care of patients with chronic medical conditions represents a significant dilemma in healthcare today. How do we optimize cost effectiveness while achieving good health outcomes? In today’s interview, we learn how ChenMed empowers primary care physicians to deploy a VIP concierge experience that delivers affordability and outstanding health outcomes for seniors. My esteemed guest is the CEO of ChenMed, Dr. Chris Chen, a cardiologist & physician executive who has devoted his career to building this premier practice focused on the care of low to moderate income patients with complex, chronic medical & social issues. In this interview, we’ll explore how ChenMed manifests its vision to: (1) be America’s leading primary care provider; and (2) transform care for those who need it the most – the elderly, the sick and the poor. Key topics covered include:      · Specific tactics ChenMed uses to deliver outstanding outcomes that mutually and simultaneously benefit patient well-being, provider satisfaction, and payor success.      · How ChenMed’s focus on preventive primary care demonstrably improves health outcomes & reduces the need for downstream “catastrophic” care such as ED visits & hospitalizations.      · The training and development of ChenMed’s incoming physicians – building their readiness for accountability as well as advanced training in service orientation, finance and leadership.        · The holistic approach ChenMed takes in the ‘care’ of people – focusing on lifestyle issues, social supports & behaviors – rather than solely on clinical ‘healthcare’.   Throughout the interview, Chris shares the underlying mission-driven philosophy that differentiates his practice from others. He reveals numerous pearls in the second half of the interview you’ll not want to miss.  Of note, in addition to the intense focus on person-centered care, Chris also describes how ChenMed creates a supportive, respectful & meaningful environment for physicians and other providers. If you’d like to understand what outstanding ‘triple-aim’ primary care looks like, this is the ticket. Chris informs us that the three values upon which ChenMed’s strategy & tactics are built are love, accountability & passion.  Many organizations use these words.  ChenMed clearly makes them part of their daily operation. I always leave my conversations with Chris with a renewed sense of conviction, courage and hope.  I suspect you will as well. As always, I hope you get as much out of this interview as I have! Zeev Neuwirth, MD

Human behavior is, by far, the single biggest lever we have to impact our health outcomes. Yet, despite the profound impact our behaviors have on health outcomes, as well as on our national & global economic health; we continue to see adherence rates to appropriate treatment and medication taking hover between 40 to 50%!  These incredibly low adherence rates exist in chronic issues such as diabetes treatment and blood pressure control; and they also occur even after life-threatening events such as heart attacks. This is, without question, a major health care challenge for patients, providers, payers & employers.  In fact, it’s one of the most significant challenges for just about every stakeholder in healthcare, including pharmaceutical companies and pharmacies. Clearly, behavior change is a tough nut to crack.  We all want to do the right things – but behavior change is challenging to initiate, and even more challenging to sustain.  Gratefully, there is a discipline called ‘behavioral economics’ – a combination of microeconomics, psychology & neuroscience – that is demonstrating marked success in making it easier for patients, as well as doctors, to repeatedly and more easily perform & sustain desired healthful behaviors. In this interview, Dr. Kevin Volpp, one of the most highly published and productive physician-scientists in this discipline, shares numerous applications & techniques of behavioral economics – as applied directly to patients’ & providers’ behaviors. What you’ll hear in this interview includes: How a large employer-based incentive program tripled the rate of sustained smoking cessation – from 5% to 15%.  And,in a smaller subset of employees (~14%) the intervention achieved rates of 50% long term smoking cessation! How a default electronic medical record intervention increased physicians’ prescribing of generic medications from less than 60% to 99% – leading to savings of approximately $32M in a couple of years time. How behavioral economics is being deployed to create a new primary care payment system in the Hawaii Medical Services Agency – incenting doctors to deliver high value care. Toward the end of our dialogue, Dr. Volpp sketches an enlightened picture of the future of healthcare – a tremendous emancipation of value that could occur, if we can begin combining virtual digital technologies with the powerful techniques of behavioral economics Clayton Christensen, the preeminent Harvard Business School Professor & one of the leading management scholars of our time, wrote in The Innovator’s Prescription: A Disruptive Solution for Health Care, “There are more than 9,000 billing codes for individual procedures and units of care.  But there is not a single billing code for patient adherence or improvement, or for helping patients stay well.”  In my opinion, Dr. Kevin Volpp’s groundbreaking work in Behavioral Economics addresses Dr. Christensen’s keen observation by focusing on creating the procedures & interventions for helping patients stay well, as well as helping physicians and other providers help patients stay well.   I came away from this interview with one lingering question: Given the clear potential for behavioral economics to achieve sustained healthful behaviors, improve our health and the health of our nation, and lower the crippling costs of healthcare – how come we’re not doing more of it?  My hope – and intention – is that this interview advances the greater awareness of one of the most significant opportunities we have available to us to improve healthcare. As always, I do hope you get as much out of this interview as I have! Zeev Neuwirth, MD  

Have you ever wondered what it takes to be a model healthcare system?  In this interview, Dr. Mark Briesacher provides us with profound insight into how Intermountain Healthcare consistently maintains its position at the forefront of clinical outcomes, improvement & innovation.  Mark informs us that the organization’s original charge was to create “a Model Healthcare System.” What you’ll discover in this interview is how he and his colleagues have taken that charge to heart. One manifestation of that charge is the “Clinical Reorganization” being deployed to create a consumer-oriented, community-based model of healthcare.  Dr. Briesacher describes a two-part construct – a highly innovative community division focused on long-term health, prevention & wellness; and an acute, episodic-care division composed of specialty surgical/medical centers-of-excellence.  Mark discusses the unique contributions of each, and also emphasizes the synergistic intersection between them – which leads to optimal decisions about appropriateness of care as well as world class health outcomes. Another example of creating ‘a Model Healthcare System’ is the innovative insurance product called ‘SelectHealth Share’ – an offering of Intermountain’s embedded SelectHealth Plan. This product creates explicit shared accountability between the Employers/Employees (customer), the SelectHealth Plan & Intermountain Healthcare providers.  All of this contributes to what Mark refers to as a “community” of health.   A third illustration of creating ‘a Model Healthcare System” is the consumer-oriented, digitally-powered, transformational patient experience that Intermountain Healthcare is building – which, as Mark points out,  “… all starts with the digital front door that removes as much friction as possible.” Toward the end of our interview, Mark shares a number of heartwarming and inspiring stories from his upbringing.  Please don’t miss this! These snapshots provide us with an understanding of how and why his personal values are so highly aligned with Intermountain’s long-standing culture of excellence, integrity and community service. Mark is, without question, a highly capable and humble servant leader; and Intermountain Healthcare is the quintessential ‘learning organization’.  Dr. Briesacher and his colleagues are brilliantly carrying out their charge to create ‘a Model Healthcare System’.  There are numerous lessons and learnings to be gleaned & emulated from their example! As always I hope you get as much out of this interview as I have! Zeev Neuwirth, MD

Al Lewis may be one of the most controversial, and respected, figures in the employee health & wellness industry.  His insight and candor have earned him various labels and epithets including, “the founding father” of disease management and alternatively, the “troublemaker-in-chief” of the wellness industry. Whether you like him or not, I doubt that anyone can challenge his integrity, or the rigorous intellectual approach he takes in analyzing the efficacy of employer-based wellness and care management programs. By way of introduction – Al Lewis attended Harvard College, where he studied and then taught Economics.  He graduated from Harvard Law School, and eventually became a partner at Bain & Company; prior to becoming a nationally recognized expert and consultant in the fields of employee health & care management. Al has authored a number of critically acclaimed books on employee health & care management, including ‘Why Nobody Believes The Numbers’, which was named ‘2012 healthcare book of the year’ in Forbes. In this interview Al Lewis – true to form – dispels numerous myths and radically reorients our thinking on the critically important issue of employee health & wellness. According to Mr. Lewis, the most significant healthcare cost & health outcomes opportunity for employers is NOT getting employees to “take more steps or eat more broccoli;” but instead to prevent them from having unnecessary screenings, tests and treatments – what he terms “hyper-diagnosis.” He has, over many years, repeatedly documented and demonstrated that healthcare over-utilization wastes tremendous money and adversely impacts employee health. He also argues that current Health Risk Assessments (HRA’s) are misguided, wasteful and potentially harmful. What you’ll discover in this interview includes: 1. Why, according to Al Lewis, employee health wellness programs are a waste of money and, more importantly, are potentially harmful to employee’s health & wellness. If you’re interested in his online documented expose on the “mis-statements” of the wellness industry, you can learn more on www.theysaidwhat.net. 2. Mr. Lewis’ online program ‘Quizzify’ (available to employers at www.quizzify.com) – which uses games, quizzes and assessments to educate employees on how to better manage their health, healthcare, and healthcare expenditures – and whose basic purpose is to create a culture of healthcare literacy. 3. How employers can provide services that enhance employee health & wellness – what Mr. Lewis terms “wellness done for employees” instead of “wellness done to employees”. 4. Al’s forecast for the future of the wellness industry – an industry which he predicts is going to change dramatically in nine months, as a result of major court rulings. Mr. Lewis certainly puts his money where his mouth is. If you don’t agree with him, he’s offering a $3 million reward to anyone who can demonstrate that wellness programs actually save money, or if he can’t prove that they don’t save money! It is refreshing, enlightening and encouraging to have a conscientious industry watchdog with the intellectual rigor, acumen and experience that Al Lewis possesses.  For the purpose of this podcast series, it’s not his critique that is most important.  What’s important is what Al Lewis is creating, and how he is contributing to Creating a New (and better) Healthcare.  Again, I did warn you all that he is a controversial and respected authority.  If you have any difference in opinion, Al is ready to listen and respond. As always I hope you get as much out of this interview as I have! Zeev Neuwirth, MD

Given the rapid, tumultuous, and unprecedented changes in healthcare these days, there are very few things that are as important to a hospital system or integrated delivery network as developing and deploying a sound and forward-thinking strategy. In this interview we have the amazing good fortune and unusual opportunity of picking the brain of the senior strategy executive for one of the most successful, visionary and pioneering healthcare systems in the world – Geisinger.   Dominic Moffa is a seasoned healthcare executive with a long standing track record of success.  He’s also an incredibly humble, generous, practical and fun guy. In this interview he generously shares some of the life lessons and rules of thumb that have contributed to his amazing success, and the success of the organizations he’s been a leader in.  It’s clear from his straightforward responses that he not only talks the talk, he walks the walk. What you’ll learn in this interview includes: The primary market forces that Dominic perceives to be strategic challenges for healthcare systems The three fundamental building blocks of the Geisinger Strategy Dominic’s 3D’s of Strategy Deployment How Geisinger is transforming itself – and healthcare – not from the inside out, but from the outside in How the ‘hospital of the future’ may actually be much more than a hospital The transformative social and community commitments Geisinger is making in its ‘Fresh Food Farmacy’, it’s Genomics initiative, and its Springboard Healthy Scranton Initiative Toward the end of the interview Dominic shares the best piece of advice he was ever given.  Folks – this is not to be missed, as it is certainly one of the best we have heard on this podcast series to date! As always, I hope you get as much out of this interview as I have! One final note – I would feel remiss if I didn’t extend a personal message of sincere appreciation to the entire Geisinger organization – for their many years of being leaders in healthcare, but also being generous in sharing the lessons they’ve learned.  While it’s apparent, as Mr. Moffa points out in this interview, that their primary focus is to provide outstanding medical care to their patients and the populations they serve; it’s also abundantly clear that they understand, and take seriously, their innovative and pioneering role in helping to advance the American Healthcare System.   Zeev Neuwirth, MD

Friends & colleagues, This week’s podcast episode is unusual in a number of ways.  First, we’re posting a bit earlier in the week than usual – to coincide with the Becker’s Hospital Review 9th Annual Conference.  Second, the topics covered are exciting, enlightening and relevant; but definitely different for this podcast series.  Third, we have a unique guest on this week’s episode – someone who brings tremendous expertise and success in a broad range of areas inlcuding healthcare law, business, leadership, online media & journalism & world-class symposia planning. In addition to his own extraordinary accomplishments and contributions to healthcare, Scott Becker has had the unique vantage point and experience of speaking with and learning, first-hand, from world-class leaders and celebrities, as well as renowned healthcare system leaders.  In this special interview, Mr. Becker shares with us the wisdom he’s gleaned from over two decades of steering one of the leading, most prolific and influential healthcare media outlets and forums. Some highlights from this this interview include: (1) Scott’s astute observations of the current healthcare market dynamics; and a discerning assessment of the unprecedented challenges and pressures facing hospital & healthcare system leaders; (2) a number of profound pearls on leadership, teamwork and business development; (3) his unique insights into healthcare media, communication & journalism – lessons that have made, and continue to make, the daily Becker’s Reports & conferences so popular and so immensely valuable to healthcare executives, leaders and influencers at all levels, and in all sectors of healthcare. From my perspective, Scott exemplifies the best qualities of the great leaders he informs us about.  In addition to his intelligence, experience, strategic acumen and track record of delivering on great results; he is a generous, forward-thinking, inspiring and empathetic leader.  What is also abundantly apparent is that Mr. Scott Becker is keenly focused – first and foremost – on identifying & solving the problems of his customers and consumers. As always, I hope you get as much out of this interview as I have! Zeev

Episode #32  – Reframing How Doctors Make Clinical Decisions – an interview with Dave Slawson MD, Professor of Family Medicine & Internationally Renowned Lecturer in Evidence-Informed Decision Making & Information Mastery. The literature would suggest that a significant percentage of clinical decision making is not well supported by evidence-based literature. Given the vastness of the emerging literature, combined with how rapidly it changes, it’s nearly impossible for any individual provider to keep up. Compounding this issue is the fact that the physiology-based reasoning we were all taught is no longer adequate.  Adding fuel to the fire is the predominant fee-for-service reimbursement system which strongly incentivizes providers to do more rather than less; and a tort reform system which also compels providers to do more rather than less. Fortunately, Dr. Slawson and his colleague – Allen Shaughnessy PharmD, along with many other informaticists and evidence-based experts, have been working on a solution.  In this interview you’ll hear how he and his colleagues have reframed the way physicians and other healthcare providers can and should go about making evidence-based decisions. Here are some highlights: The most significant shift required in our clinical reasoning and decision making is to what Dr. Slawson describes as “probabilistic analytics & science”. This quantitative approach disrupts the inherent fallacies of human decision making. We need to shift from process metrics to outcome metrics. This is a shift from treating the numbers, such as blood glucose, to treating the patient – that is, focusing on the outcomes that matter, such as heart attacks, strokes and deaths. The shift to consumer-centricity & shared decision making is also of utmost importance. If decisions are, in fact, going to be made about value-based outcomes; and if we agree that patients, as consumers, define the value proposition; then any decision that is made without the patient’s shared input and preferences is going to be flawed. This approach, far from being a ‘cook-book medicine’ imposition on providers, actually offers immense support and guidance. It will improve the clinical care of patients; and it will provide much needed relief for physicians  – allowing them the time and energy to focus their attention on their patients, instead of constantly hunting and foraging for the latest clinical updates. One of the most meaningful messages that Dr. Slawson leaves us with is a “prescription to say ‘No’.”  ‘No’ to unnecessary tests, imaging studies and invasive diagnostics. ‘No’ to wasteful and potentially harmful medications & treatments that are not indicated. ‘No’ to making decisions based on outmoded data and antiquated reasoning. One of the major lessons I came away with from this dialogue is that it’s not only what we do that can make a difference; it’s what we can stop doing that can really make a demonstrable positive difference in improving patient care and health outcomes. As always, I hope you get as much out of this interview as i have! Zeev

The problem we’ll be addressing in this episode – which is of critical national significance – is the unsustainable burden of healthcare costs. We’ll cover two major issues: (1) tactics employers can take to avoid unnecessary healthcare costs; and (2) an approach to understanding and addressing a long-standing challenge in healthcare delivery – post acute care. You should listen to this interview if: You’re not overly concerned about these issues, or don’t feel knowledgeable enough to be concerned. Your provider group is engaged in an Accountable Care Organization, Medicare Shared Savings Program, Medicare Advantage or Bundled Payment Program; or if you’re an employer or payer. You have a family member that may one day end up hospitalized or in a nursing home. Our guest this week, Josh Luke, is a nationally recognized expert in the post-acute care space, and on healthcare cost strategies in general.  He spent 15 years as a hospital CEO and a senior nursing home administrator – so he has deep knowledge and an insider’s perspective. Since leaving those roles, his mission has been to assist patients and their families in navigating the opaque archipelago of post-acute care; and to assist individuals & employers in learning how to manage the overwhelming costs of medical care. Josh is a self-described “truth teller”.  As you’ll hear in this interview, Dr. Luke does not hold back – and with good reason.  He’s got some well defined and thoughtful perspectives, as well as bold practical solutions on how the system needs to change to provide care that is safer, less costly and more dignified. One example is Josh’s program, ‘Discharge with Dignity’ – an initiative to assure that patients being discharged from hospitals are given a reasonable option to return to their home, instead of being corralled into avoidable, unnecessarily lengthy, and costly post-acute care facility stays.  His protocol is being used across the country to train physicians and other providers. Another example – Josh will discuss the main points of his most recently published book, ‘Health-Wealth: 9 Steps to Financial Recovery’.  He’ll share the specific tactics that employers can take to reduce unnecessary costs and optimize their healthcare spend. From the employee or individual’s perspective, Josh will introduce us all to his “3 P’s” of becoming an “Engaged Healthcare Consumer” (EHC). If you’re still wondering what all of this has to do with ‘dignity’, here’s what I garnered from listening to Josh.  Healthcare with dignity includes: (1) making what we do in healthcare – including prices – transparent, and easily understandable to patients, families & employers; (2) giving patients real choices that take into account their preferences (keep in mind that the AARP has repeatedly documented that over 97% of people want to go home after a hospitalization, and not to a nursing home); and (3) considering the quality, safety & cost factors first, rather than the business imperatives; or more bluntly put, being patient-centered rather than profit-centered. Dr. Josh Luke’s honesty and openness is refreshing and much needed.  He sheds a revealing light and a helpful set of approaches to issues that have been hidden and confusing for decades. He is clearly purpose-driven and passionate; his perspectives are born of wisdom and backed by data; and his recommendations are forward-thinking, consumer-oriented, value-based and practical. If you still have some doubts as to the importance of this topic, I’ll leave you with some stats to consider: The Medicare Trust Fund is expected to go bust by 2029 – that’s only 10 years from now – important for those of us who are expecting Medicare to pay our healthcare bills. About 25% of the total costs of Medicare (which make up half of all medical expenditures in the U.S.) are spent on what is termed ‘post acute care’ – nursing homes, inpatient rehabilitation facilities, long term acute care hospitals, home health and hospice care. It’s predicted that Millenials (currently 20 to 40 year olds) – who make up the largest employee demographic in the country – will spend over 50% of their lifetime earnings on healthcare. As always, I hope you get as much out of this interview as I have. Zeev

How many of us can define ‘well-being’?  How many of us understand the factors that enhance it?  How many of us think about the issue of ‘well-being’ or do anything about it in the context of ourselves, our employees or the patients that we provide care for? Dr. O’Day and her multi-disciplinary team have spent years not just defining ‘well-being’, but also learning how to improve it.* If you have a personal or professional interest in well-being, you’ll be interested in this interview.   What’ll you hear is Dr. O’Day sharing: 5 modifiable factors (domains) that contribute to well-being. How these 5 domains of well-being impact our health and influence our ability to change behavior. Specific tactics to positively impact these 5 domains of well-being. How well-being – as a ‘global determinant of health’ – is a critical component of any successful approach to population health – spanning the continuum of care, from people focused on wellness to those who are dealing with chronic disease management. How well-being is a highly advantageous, integral part of any employee health program, in terms of its impact on human performance and resilience, as well as its impact on health outcomes. I have heard Dr. O’Day speak on this topic a number of times; and I learn something new and important each time.    In the second half of the interview she also shares some of the personal experiences, which have shaped her thinking on human behavior, performance and growth. The conversation then meanders into a deeper discussion on existential issues such as meaning and purpose. It becomes abundantly apparent that this work is highly meaningful to Dr. O’Day, not only as a professional, but also as a fellow human being.  It’s clear that she not only talks the talk, but also walks the walk, when it comes to well-being. As always, I hope you get as much out of this interview as I do. Zeev *The information Dr. O’Day shared, specifically related to ‘well-being’ research & development performed at Johnson & Johnson, is proprietary, and is the intellectual property of J&J.