Creating a New Healthcare

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.

Our guest this week – Robert Pearl, MD – has nearly 2 decades of experience leading two of the nation’s largest medical groups. As CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group of Kaiser Permanente (KP), he was responsible for the healthcare of over 5 million members.  He led numerous initiatives with exceptional performance in quality outcomes, patient safety, cost savings and consumer experience. He and his colleagues at KP have set the bar for what value-based healthcare could look like and the outcomes that can be achieved. It’s been said by many experts and authorities that the future of American healthcare should look a lot like Kaiser Permanente. Since leaving his position in 2017, Dr. Pearl has written a book entitled, ‘MisTreated: Why we think we’re getting good healthcare – and why we’re usually wrong’.  He’s also been travelling the globe, sharing the wisdom gleaned over decades of first-hand experience as a practicing surgeon and as a healthcare executive.  He currently teaches healthcare strategy and policy at Stanford Graduate School of Business and was recently named one of Modern Healthcare’s 50 most influential physician leaders.   Dr. Pearl is gifted in taking complicated healthcare topics and rendering them in ways that are easy to understand.  His point is that if we just execute on what we already know works, we’d be in a completely different, and better place in healthcare delivery. His mantra is one echoed by numerous award-winning coaches – ‘stick to the basics’. In this interview we’ll discuss: The personal family experience that led Dr. Pearl to write his book, ‘Mistreated’. The quality, safety & cost issues that adversely impact millions of individuals each year.  The numbers are staggering, but it’s the personal experiences we share that really tell the story. A number of simple, effective strategies he and his colleagues deployed at Kaiser Permanente that have achieved remarkable outcomes in quality, safety, cost and patient experience. The 4 Pillars upon which to build a superior healthcare system.   You won’t want to miss these! Dr. Pearl’s predictions of which stakeholder in our country will be the major force for change in the next 3 – 5 years. You might be surprised by what you hear… What I admire about Dr. Pearl – in addition to his acumen – is his passion.  He is at a point in his career where others might take a well-deserved rest. But he is driven by a deep sense of mission and purpose.  His enthusiasm and energy are palpable and contagious. What I also admire about Dr. Pearl is his practical, no-hype, data-driven approach to identifying and implementing evidence-based solutions.  If you have any doubt that healthcare can and will change for the better, I urge you to listen to this podcast.  Regardless of what you think today, by the end of the podcast, I believe you’ll be convinced that positive change in healthcare is coming, and coming soon.

Consumerism – the promotion of consumers’ perspectives & interests – is one of the hottest & rapidly emerging topics in healthcare today. Whether you’re a large healthcare delivery network,  hospital system, surgical center, or ambulatory practice – if you’re interested in patient growth and retention, or in optimizing the experience & outcomes of care – you should be very interested in improving your approach to consumerism. Many factors have contributed to the rapid rise of consumerism in healthcare.  First, patients are being presented with an increasing array of care choices. Second, patients are footing a greater percentage of their healthcare bills.  Third, people are now used to sophisticated, easy, and elegant customer interactions in other aspects of their lives; and are bringing these expectations to bear on their healthcare experience.  And, they’re increasingly voting with their feet and their wallets. The problem is that while there are lots of opinions; there’s not a whole lot of expertise or experience in healthcare consumerism. Our guest today is the most experienced and accomplished consumer-oriented expert I’ve encountered in healthcare to date.  He’s also a delightful, engaging and humble human being.  Kevan Mabbutt joined Intermountain Health last year as their Chief Consumer Officer bringing over 25 years of experience in this field.  Prior to joining Intermountain, Mr Mabbutt served as the Global Head of Consumer Insight at Walt Disney. In this role, he led consumer experience development and transformation for Disney’s theme park, cruise line, resort, retail, and digital assets in the U.S., Europe, and Asia.  He was instrumental in defining and optimizing the guest experience at Disney’s first theme park in mainland China (Shanghai Disney Resort).  He also helped drive the expansion of Disney, Pixar, Marvel, and Star Wars brands globally. In this interview Kevan shares his profound thoughts on the context of consumerism in healthcare.  What you’ll hear includes: How Disney understands consumer-centrism, and how different that perspective is from how we, in healthcare, consider consumerism. Kevan’s own understanding of consumerism as a deeply humanistic and empathetic endeavour. The need for consumerism to be inclusive of providers as much as patients, and the reason that’s critically important. A  fundamental reorientation of “value” as being defined by the consumer’s subjective experience  – whether it be outcomes or affordability, or any other aspect of healthcare. Some of the challenges that Kevan has encountered in introducing a consumerist mindset into healthcare, and his strong caution that we not equate consumerism with digital technology. This is one of the most exciting and enlightening interviews I’ve had the pleasure of hosting.  If there is a must-do in healthcare, it’s this.  As Kevan puts it – consumerism is not a part of the chain; it impacts the entire chain of healthcare delivery.  It’s about redefining the core strength and critical element of every link of that chain as being implicitly about value, as defined by the consumer.  This will require us to adapt and integrate aspects of consumerism such as human-centered design & personalization, segmentation & customization, transparency, and engagement at a system-wide level – if we aspire to be fully successful in the value-based transformation of healthcare delivery. Get ready to be challenged and inspired by the notions of consumerism that Kevan Mabbutt brings from his unique experiences at Disney and his 25 years as a leading authority and highly accomplished executive in consumer insights. Zeev Neuwirth, MD

Friends & Colleagues, After interviewing more than 50 insightful, courageous and accomplished leaders who are literally creating a new healthcare, we are going to turn the tables in this podcast episode. In this episode, I’ve placed myself in the hot seat, and will be interviewed about my reflections from this first year of podcasting, as well as future plans & directions for the series. At less than 15 minutes, it is much shorter than my usual podcast, and will provide you with insights into what I do, why I do it, and how you can get more involved! Here are some of the questions I answer in this episode: What were your expectations and have they been met? What makes this podcast different from other healthcare podcasts/newscasts? What were some surprises you encountered? What are you planning for in the 2nd year of podcasting? Who are 2 or 3 people you would like to interview? What one request do you have of listeners? So, please take a listen!  My hope is that you’ll be inspired by what you hear. I sincerely appreciate your continued support and encourage you to invite others to subscribe to ‘Creating a New Healthcare’.  This work – to transform healthcare – is so critically important to all of us! Looking forward to an exciting new season beginning in mid-September. Until then, Be well! Zeev Neuwirth, MD

For anyone who doesn’t appreciate the critical importance of healthcare economics in the U.S., consider this: The average price for health insurance in the U.S. for a family of four is $18,500 per year. This is the equivalent of each American family purchasing a car every year.  Healthcare currently makes up nearly 20% of the U.S. GDP; and numerous studies have suggested that nearly one-third of that spend is unnecessary, wasteful and even harmful.  Given the unfettered rise in healthcare spending, it’s been estimated that Millennials will conservatively spend somewhere between 50 to 75% of their total lifetime earnings paying for healthcare.   These staggering statistics give you a sense of the important role that healthcare economists can play in determining the future of our healthcare system, and the future of our economy. Healthcare economists take an objective, data-driven approach to analyzing the issues of healthcare spending and utilization.  We’ll discover, in this fascinating interview with a leading healthcare economist, that many beliefs we hold about healthcare spending are based on incomplete data, and therefore erroneous conclusions. Dr. Zack Cooper – our guest on this episode of Creating a New Healthcare, trained at the London School of Economics and is an Associate Professor of Health and of Economics at Yale University. He is one of the rising stars on the healthcare economics scene; and represents the nextgen – trained in the most advanced science, analytics & machine learning that can be applied to healthcare spending, utilization & costs. His publications are regularly featured in the New York Times which wrote of Dr. Cooper’s work that it’s “likely to force a rethinking of some conventional wisdom about healthcare”.   In this interview, we’ll cover a broad range of topics including: What healthcare economists actually do & how they influence policies around healthcare delivery & payment. How Dr. Cooper’s ground-breaking research on commercial health insurance completely changes our understanding about regional healthcare utilization & costs.   Dr. Cooper’s recent research that challenges our belief that patients can act as informed consumers capable of making price-based decisions, even when they’re provided with straightforward, transparent, comparative pricing. Evidence-based recommendations for redesigning employee health plans. I came away from this from this interview with a newfound and enhanced respect for the role that healthcare economists play in creating a new healthcare. We need their powerful problem-solving methods & advanced analytics to help us decide which problems to solve and how to go about solving them.  It’s hard to argue against the notion that healthcare needs a new ‘True North’.  Perhaps we should take a closer look at the compass that Professor Cooper and his colleagues are constructing.

Social determinants of health (SDOH) represent the largest set of factors in determining healthcare outcomes & utilization. Despite understanding this, a fundamental problem remains: How to motivate & sustain healthful behavior, especially within communities experiencing profound social and economic obstacles such as unemployment, poverty, food insecurity, isolation, unsafe housing, etc. There is a tremendous amount of effective, innovative effort directed at this challenge.  But the current “screen & refer” approaches have limitations.  As we’ll discover in this podcast, Community Health Worker programs can overcome these limitations and serve as a keystone program in this domain. Community Health Worker (CHW) programs connect professional and social-service resources with the individuals & communities they are attempting to benefit. It is a unique approach that takes lay individuals from the community and trains them to be a combination of life coach, social worker, and healthcare system liaison. The basic premise relies on the idea that health is social, contextual & communal; and the closer you are to the situation, the more likely you will be to catalyze & sustain behavior change. Like many other good ideas, this one is as much about execution as it is about intention. Unfortunately, despite good intentions, many CHW programs have floundered and failed. To help us understand what is needed to create an effective and sustainable CHW model, we are fortunate to have with us Dr. Shreya Kangovi. Dr. Kangovi and her colleagues have pioneered a rigorous, evidence-based approach to building, deploying and measuring the impact of a CHW program.  Dr. Kangovi is the founder & executive director of the Penn Center for Community Health Workers – a national center of excellence dedicated to advancing health in low-income populations through CHW programs. The Penn Center spent seven years creating and refining an exemplary CHW model called IMPaCT (Individualized Management towards Patient-Centered Targets). It’s based on the application of human-centered design principles, implementation science, and robust qualitative & quantitative research methodology. In this episode, we’ll discuss: The scope of services a Community Health Worker (CHW) performs, and what makes them effective. The most critical question each Penn Center CHW client is asked. The evidence-based clinical, economic and humanistic benefits of an effective CHW program. The 5 major pitfalls that have undermined the success of CHW programs in the past, and how to turn them into opportunities for success. The services the Penn Center offers to assist other medical centers in standing up their own CHW program. From my perspective, CHW programs are a critical – but often absent – piece of the healthcare delivery ecosystem. Because they are treated as ‘soft’ programs, they often lack appropriate operational planning, resource allocation, and rigorous management and measurement. The Penn CHW program has set the standard for efficiency and sustainability. It is a masterpiece of fiscal responsibility, operational excellence, evidence-based consumer-oriented design, and system integration. If the rest of healthcare operated this way, we would be in a far better place than we are now! Zeev Neuwirth, MD