Creating a New Healthcare

There are numerous reasons to focus on caring for our aging population.  First, it’s the right thing to do.  Second, the utilization of care and medical costs in the older population with more complex and chronic medical conditions are tremendous.  For example, the budget for Medicare jumped $300 billion between 2007 and 2017.  In fact, Medicare costs are the 2nd largest federal expenditure, next to social security.  Third, these costs are continuing to rise. It’s predicted that per capita Medicare expenditures will rise at least 4.6% annually for the next decade.  At present there are over 60 million people enrolled in Medicare with an estimated 10,000 more enrolling each day.  It’s an unsustainable situation, from a cost perspective.  Finally, we know that there are significant opportunities for improvement – in care, outcomes, and cost. Our guest today represents an organization that is addressing this issue in new and better ways.  Sachin Jain is the CEO of CareMore. Founded in 1993, CareMore is a prepaid integrated delivery system and health plan that provides medical care to approximately 150,000 Medicare & Medicaid patients in over 40 clinics across nearly a dozen states. Dr. Jain brings a remarkable background to leading CareMore. He received an MD, an MBA, and his residency training in Internal Medicine, all within the Harvard system.  He has held a number of positions at the Centers for Medicare & Medicaid Services (CMS) and CMMI (the CMS innovation division).   He has also published over 100 peer reviewed journal articles. Some of the major points that Dr. Jain will share in this episode include: Why we need to move away from a generic primary care model to more customized models of care, such as for the older patient with complex chronic conditions. The various approaches that CareMore takes to address the Social Determinants of Health such as transportation, nutrition, physical fitness and care in patients homes. How CareMore reorganized the physical infrastructure of their clinics to address the issue of Social Isolation and Loneliness – what has been termed “an epidemic in plain sight”. Their industry leading “Togetherness Program” as well as other programs that also address social isolation and loneliness. CareMore’s method for reducing hospitalizations and readmissions, and how they markedly reduce healthcare costs through their focus on transitions of care. Throughout this interview, Dr. Jain shares CareMore’s compelling story – what makes their model profoundly different from and better than the generic primary care medical home model. One other theme I found encouraging is the attention CareMore pays to the professional development and sustainment of its providers and staff.  The thinking that providers should have an ‘owner’ vs. ‘employee’ mentality speaks to one of the major crises of healthcare today – provider and staff burnout.  As Sachin states, if we’re going to save healthcare, we’re going to have to really support the people who are actually providing care. There are numerous lessons to be gleaned from this interview – from CareMore’s focused segmented approach, to their highly coordinated care model, to their focus on social determinants of health and social connectivity, to their attention to sustaining the professionalism and engagement of their providers.  Dr. Jain and his colleagues at CareMore refer to it all as “Radical Common Sense”.  And, that’s exactly what it is! As always, I hope you get as much out of this interview as I have. Zeev Neuwirth, MD

Trust – or the lack of it – is a critically important issue in healthcare these days. This issue has tangible impact on the care of patients and the work life of providers. There is no question that trust in our medical system has declined. The Gallup poll shows a massive drop in public trust of the medical system from 76% in 1977 to 36% in 2018.. Another highly respected index, the Edelman Trust Barometer, suggests that the American public’s trust in healthcare “crashed” in 2018; dropping 25 points. The Edelman survey experts called this an “extreme trust loss”.   In response to this distrust epidemic, the American Board of Internal Medicine (ABIM) Foundation has just launched a campaign to address the issue.  It’s called the ‘Trust Practice’ Challenge. What’s unique about this particular interview is that we’ll not only be introduced to an exciting new venture in healthcare, and talk about it with a world-class expert; but, we’ll also have the chance to participate in it! In this interview Dr. Richard Baron, the CEO of the ABIM and the ABIM Foundation, shares the goals of the Trust Practice Challenge –  to elicit “inspiring and best-in-class” examples of practices that cultivate trust from and between individuals, provider groups, departments and institutions within and across healthcare.  The purpose of this campaign is to seek out a community of individuals and organizations who care deeply about rebuilding trust in healthcare, and who are interested in getting better at it. The ultimate goal is to improve healthcare relationships, and the experience and outcomes of medical care. Some of the topics Dr. Baron touches on include: The current societal factors that led the ABIM Foundation to select ‘trust’ as the major initiative to address at this point in time and what they’re hoping to accomplish through this initiative. How trust has been eroded in healthcare – between patients and providers, between the public and the healthcare system, between providers and the healthcare system… The elements of trust the ABIM Foundation is hoping to address and rebuild in the profession of medicine and in healthcare in general. “The four simple rules”  the ABIM Foundation took in launching the Choosing Wisely campaign and how they are adopting that same approach to creating a network of trust. A more detailed description of the ABIM “Trust Practice” Challenge and how you can immediately contribute to that campaign and the community of trust. I applaud the ABIM Foundation for taking on an issue that is so critically important and so ambitious. I am not aware of any other national, systematic effort explicitly focused on rebuilding trust in healthcare.   I also have to share my admiration for their co-creative approach. It’s a highly appreciative, collaborative and respectful stance – looking to the expertise and integrity that is abundant in the profession of medicine and the healthcare community at large. The ABIM Foundation’s ‘trust practice’ initiative is visionary.  It has the potential to reframe and reshape how we think about and go about the work of healthcare delivery, as well as how we redesign and reorganize healthcare delivery for the future.  I plan to share this campaign with my colleagues.. The online submission form can be accessed here/, or at www.abimfoundation.org. The last day for submissions is Thursday, February 28th 2019. Zeev Neuwirth, MD

Welcome to the first ‘Creating a New Healthcare’ podcast of 2019! This is an incredibly timely topic.  At the start of each year, most of us resolve to discard bad habits and take up new, healthier ones. We all struggle with the perennial challenge of getting motivated, avoiding frustration; and sustaining new behaviors beyond just a few days or weeks.  In this interview we discuss a new approach and health app focused on healthy eating – fresh Tri – which our guest co-developed with Walmart. Our guest this week – Kyra Bobinet – is a bestselling author and the CEO-founder of engagedIN, a neuroscience behavior design firm that uses neuroscience to make health and wellness products, and communications, more engaging. Kyra is a physician who received a masters in public health from Harvard. She was the recipient of Harvard’s 2015 Innovator Award. Kyra is the author of A Well Designed Life: 10 Lessons in Brain Science and Design Thinking for a Mindful, Healthy, and Purposeful Life.  She and her work have been featured by the Wall Street Journal, New York Times, Huffington Post and NPR. She’s created health startups, blockbuster products, health apps, and evidence-based programs in mind-body & metabolic medicine.   Some of the incredibly relevant issues covered in this episode include: “The emperor has no clothes.” – Kyra’s assessment of the employer wellness industry The fundamental differences that make her new app – fresh Tri – unique in the world of healthy habit development Why the perception of ‘failure’ is actually harmful to our health and is the neurophysiological basis for de-motivation How to apply the basic principle of design thinking to constantly improve one’s   approach to developing healthful habits – and how to side-step failure traps A rare opportunity to hear an expert describe  ‘the anatomy and physiology of behavior design’ The ‘secret sauce’ Kyra discovered and believes to be the single most important factor in sustained behavior change What’s unique about this interview and the work Dr. Bobinet is doing is that it goes beyond healthcare and physical health. This message of how we perceive failure and success is a fundamental life skill. Kyra’s research can assist us in avoiding the pitfalls of self-defeat in all aspects of our lives. Her underlying motivation – to remove the self-blame and harsh criticism we inflict upon ourselves – is a hopeful and realistic way to begin the new year.   As always, I hope you get as much out of this interview as I have. Zeev Neuwirth, MD

Dear Listeners, I promised you a lively interview to close out the year on Creating a New Healthcare, and thanks to the assistance of my colleague, Dr. Lisa Gualtieri, I hope this one won’t disappoint. In this episode, the tables are once again turned – as Lisa interviews me on how my expectations for healthcare in 2018 have played out, and what I see as trends in 2019. It’s a bit anxiety-provoking to be interviewed for your own podcast without knowing the questions in advance; but Lisa did an expert job of keeping the dialogue focused on the major shifts, tensions and emergent trends in healthcare. To give you a taste of what you’ll hear, here are some of the questions posed: What were the trends you predicted a year ago and how accurate were you? This year, the podcast focused on topics like the shift to consumerism in healthcare. How do you see that benefiting healthcare and what’s on the horizon in 2019? The social determinants of health have been a theme throughout many of the podcasts. Is that something that will be given a lot more attention in 2019? Is the issue of physician burnout going to be better addressed in 2019? What’s coming next in 2019 for Creating a New Healthcare? Towards the end of the podcast, I put out a request to the ‘Creating a New Healthcare’ community. I’m hoping that you’ll respond in that I very much would like to hear your thoughts and recommendations. We will be back in 2019, with our first episode planned for January 10th. I wish you all a happy and healthy holiday season and a joyous New Year.! And, as always, express my tremendous gratitude for your continued interest and support in creating a new healthcare.   Zeev

We’re now in the last month of this year.  It’s the holiday season and the New Year is almost upon us.  It’s the time of year when most of us pause to evaluate the past 12 months, to reflect on our accomplishments, and to ponder our hopes and expectations for the future.  It’s a wonderful moment to reconsider our values and priorities, and to set new goals for the future.  It’s also a perfect time for a podcast on value-based leadership. There may be no single issue that will have more of an impact on the immediate future of healthcare than leadership.  Many previous guests interviewed on this podcast series have talked about a lack of forward-thinking, visionary leadership in healthcare.  To this end, our guest this week will help us understand what value-based leadership looks like, and what behaviors are required from our leaders in order to transform healthcare.   In this interview we have the wonderful opportunity to hear from Jeff Thompson, a physician executive who was CEO of Gundersen Health.  Jeff served as Gundersen’s Executive Vice President from 1995 to 2001, and CEO from 2001 to 2014.  During his tenure, he played a key role in the organization’s governance design, culture development and community focus.  Gundersen is an integrated delivery system serving 19 counties in western Wisconsin.  It has been designated as a Healthgrades Top 50 hospital system.  Jeff continues to serve as Gundersen’s Executive Advisor & CEO Emeritus. Jeff is also the author of a recently published book, Lead True.  He has been featured in and authored numerous articles, book chapters and abstracts on healthcare, leadership and sustainability.  Over the past couple of years, he has been lecturing across the globe, advancing this notion of value-based leadership. Jeff is an experienced executive leader who has walked the walk.  His personal stories and hard-earned wisdom are directed to leaders at all levels. What you’ll hear in this interview includes: What the current moment in healthcare history is ‘demanding’ of our leaders and the specific challenges facing leadership in these tumultuous times. Three specific steps that leaders can take to address the current challenges in healthcare. A number of real-life stories of how leaders can encourage their providers and staff to embody their organization’s espoused values, and how leaders can create greater provider and staff engagement. Jeff’s keystone piece of advice that he offers all current and rising leaders.   In tumultuous times, value-based leadership can easily become subservient to immediate, short-term goals.  It’s understandable.  But, Jeff encourages leaders to avoid being deterred by problems that do not add value.  Instead, he urges leaders to focus on steering their teams and organizations toward longer-range solutions that benefit patients and communities. Jeff’s message is one of identifying and voicing shared core values, and then living those values.  It’s an inspiring message of authenticity, courage and discipline. There is one hope I have for the New Year – that individuals and teams in roles of authority and leadership hear and heed this message. I would encourage you to share this message with colleagues. Zeev Neuwirth MD

Dear Listeners, Thanksgiving is a holiday for sharing all that you’re grateful for, so I wanted to take a few brief moments to do just that. I hope you enjoy this 6-minute episode of Creating a New Healthcare. Wishing you all a happy and healthy Thanksgiving Holiday!

Dear Listeners, Welcome to Part II – the continuation of our interview with David Contorno – an expert in employee benefits and employer-based health programs. David is a founding member of Health Rosetta and has over 20 years of experience in the field. If you haven’t listened to Part I yet, you may want to start there. In the first half of our interview, David described the ‘Stockholm Syndrome’ that exists between employees, employers and payers. He also shared the specific value-based strategies he deploys – interventions that assist employees in avoiding unnecessary tests and procedures; and that steer them toward more cost effective options – using pre-paid, at risk, bundled payment programs. In Part II, you’ll hear : A story of an employee with severe back pain whose positive outcomes inspired David to depart from the “benefits-as-usual” approach. Some of the specific strategies David deploys to manage the significant and rising costs of medications, including his “PBM Last” approach. David’s scathing critique of Health Savings Accounts (HSA’s) and High Deductible Health Plans (HDHP’s), which he believes lead to a spiraling cycle of unintended adverse outcomes for both employees and employers. Judging from listeners’ responses (on social media) to Part I of the interview, it’s clear this is a topic of high importance and high complexity. While many listeners did not agree with everything David said, there was a lot of agreement on his intention and approach. I came away from this interview inspired and wanting to hear more. As I thought about David’s recommendations, I tried to come up with reasons why we shouldn’t follow his advice. I couldn’t come up with any. Can you? Zeev

What is happening in the employer healthcare market is astounding – perhaps revolutionary.  Most of the experts I have spoken with agree that it’s the employers who will be the primary disruptors in the healthcare delivery ecosystem.  One only need look at Amazon and it’s new collaboration with JPMorgan Chase and Berkshire Hathaway, or Apple or Google or Comcast or General Motors, or hundreds of other innovative employers, and employer coalitions such as the Health Transformation Alliance. These employers are taking their employee’s health into their own hands by partnering with vendors that aggressively work to lower costs, improve outcomes, and elevate the consumer experience.   Our speaker today is an incredibly rare expert & professional in this regard. Contorno has 24 years of experience in the employee health space. He was a highly successful employee health benefits broker – making a sizable salary based on commission. And, then he had an ethical & moral crisis – as he tells it; which drove him to completely change the way he thought about and deployed employee health benefits and programs. As a founding advisor to Health Rosetta, he and the Health Rosetta team have developed methods to assist with the adoption of simple, practical, cost effective employee benefits and healthcare programs. In 2016, Forbes named David as “One of America’s Most Innovative Benefits Leaders.” There is nothing hypothetical about his approach. He is actively and successfully implementing this cost-savings system.    What you’ll hear will include: David’s “aha” moment that led him to make the change to align his compensation completely with the actual benefit he brought to employees. The simple and practical programs David has deployed to dramatically reduce healthcare costs while improving access, quality and outcomes. How primary care is the most broken part of the healthcare delivery model and how he thinks we can fix it. David’s radically different take on Health Savings Accounts (HSA’s) and why he thinks they’re a scam… I have to say that I am surprised and impressed with the knowledge and wisdom that David has amassed. While so many employers are struggling to manage these unsustainable costs of care, David and his colleagues at Health Rosetta have laid out a doable and effective plan.  What I admire and respect the most is that instead of shifting the responsibility to the employees to make cost effective and clinically effective decisions, which is wholly unrealistic; they put the responsibility back on the employers and benefits advisors, to institute supportive benefits that drive the appropriate utilization of quality clinical programs.   Whether you’re an employer, an employee, a health benefits manager or advisor; or you just want to understand how we can optimally manage what amounts to over one-third of the American healthcare spend, these two episodes (#49 and #50), with David Contorna, will equip you with an in-depth understanding and some specific steps to take.

It’s become increasingly apparent that large employers are rapidly becoming the most disruptive force in American healthcare today. Think Amazon, Berkshire Hathaway, JP Morgan Chase, Apple, Google, Microsoft, Comcast, CVS Health, Walgreens, Walmart, and so on… The reasons are readily apparent: Employers are feeling the most pain due to the unsustainable and rising costs of healthcare, the paucity of pricing transparency, and the lack of consumer-oriented service. Employers are footing over a third of the American healthcare bill, with the knowledge that at least one-third of their spend on healthcare is not leading to improvements in the health of their employees. Unlike other stakeholders in the healthcare market, employers are less encumbered by political bureaucracy, conflicting incentives, and legacy systems. They have tremendous capital and scale, as well as cutting-edge, consumer-oriented technologic capabilities to bring to bear. This episode is as much about healthcare consumerism as it is about employee health – tying in nicely to this season’s earlier podcast episodes with Dr. Robert Pearl, Kevan Mabbutt and Dr. Harold Paz. Our guest this week – Marcus Osborne, a Harvard Business School alum – is the VP of Health & Wellness Transformation at Walmart. He has years of experience in Walmart’s previous healthcare delivery initiatives – their clinics, pharmaceutical products & pricing, and collaborative efforts with Humana around Medicare part D. Marcus is a no-nonsense, results-oriented, highly accomplished businessman who is on a mission to build a new and better healthcare system. He makes it abundantly clear why this is critical to Walmart as an employer, and as a retailer serving over 85% of the American public. He does not believe the current healthcare system can be fixed. He does believe that Walmart’s credo to deliver affordable products & services, its capabilities, its size and reach, make it well positioned to create a new healthcare system. This episode will include: Marcus’ explanation of why Walmart is formulating a strategic decision to enter the healthcare market. How Walmart is optimally situated to become one of, if not, the most significant disruptor in the American healthcare delivery market. Marcus’ scathing critique of how people are treated in our healthcare system; in juxtaposition to Walmart’s “customer-only” approach to serving the American public. Marcus’ high-level view of what a transformed, consumer-oriented healthcare system might look like. Discussion about a specific initiative Walmart has been deploying with its over 1 million associates, which is literally reducing its employee healthcare costs by over a billion dollars per year. While some may find Marcus’ responses a bit in-your-face, I actually found his honesty & directness to be refreshing. At times during the interview, I did find myself feeling defensive – in large part because I am privileged to witness daily the amazing life-saving and life-enhancing work accomplished within the current healthcare system – by bright, passionate and intensely committed individuals, teams and organizations. However, I also found myself aligned with Marcus’ strategic assessment and in complete agreement with his consumer-centric thinking. During the course of our conversation, it became clear to me that some of the most innovative and disruptive changes coming to healthcare may not be technologic. The understanding I’ve arrived at, after dozens of conversations like this one, is that our primary purpose might not be to digitize healthcare, but instead, to humanize it.

The major theme of this interview is how a traditional healthcare insurance company – Aetna – is redefining what it means to be a payer. They are reorganizing healthcare delivery to be much more engaging of consumers, and they’re doing it with numerous collaborators, in non-traditional ways. Our guest this week has an impressive academic and executive background. Dr. Harold Paz is an executive vice president and the chief medical officer for Aetna. He leads clinical strategy and policy at the intersection of all of Aetna’s domestic and global businesses. Before joining Aetna in 2014, Dr. Paz served as chief executive officer of Penn State Hershey Medical Center & Health System, and dean of its college of medicine. Prior to his appointment to Penn State, he spent 11 years as dean of the Robert Wood Johnson Medical School, and chief executive officer of Robert Wood Johnson University Medical Group, the largest multispecialty group practice in New Jersey. What you’ll hear in this interview includes: The “three pillars” of Aetna’s clinical strategy: member engagement, creating a health ecosystem for consumers, and value-based contracting. The novel and non-traditional ways that Aetna is creating outcomes-based healthcare solutions. The innovative, highly collaborative and value-enhancing joint ventures that Aetna has entered into with provider groups, pharma & device manufacturers. Aetna’s Wellness Index – a comprehensive survey that is redefining what health and well-being look like. Examples of how Aetna is designing and deploying the “third curve” of healthcare personalization and consumerism. Aetna’s approach to combating the opioid epidemic in our country. This work that Dr. Paz shares with us is a spectacular example of what forward-thinking leaders and leadership teams can do within the traditional legacy system – to redesign and reorganize healthcare delivery. Dr. Paz and his colleagues are clearly breaking the mold of what an insurance company can be, and do. As I listened to example after example of the innovative initiatives and collaborations Aetna is deploying, I was struck by how they are tearing down the constricting walls of the past, and crossing boundaries in ways that are on point to create a better healthcare system.