Creating a New Healthcare

Friends, The digital/data revolution in healthcare is upon us, and amongst other things, it’s recreating public health, population health and health equity. One of the groups at the forefront of this movement is the ‘Data Humanity Lab’ at Finthrive.   In this episode, we’ll hear directly from one of the emerging leaders in the field, Brian Urban – the Director of Innovation & Emerging Markets at Finthrive. Brian and his colleagues are not just advancing health equity and public health – they’re redefining what it means. To achieve this, they’re partnering with hospital systems and provider groups, health plans, device & tech manufacturers, as well as leading universities and academic medical centers. I learned a lot during this interview, including: The radical contribution the Data Humanity Lab is making by providing its exclusive data sets and expert services for free to health equity programs and researchers across the country.  How the ‘Gramm-Leach-Bliley Permissible Use Act’ protects consumers from both intended and unintended harmful use of their personal data. The gaps in public health education that we need to get beyond. The severe limitations of the claims, clinical and outcomes data we’re currently using in allowing us to understand the health-related conditions and needs of people.   How expanded data sets (i.e. consumer marketing data) are being used to greatly improve our ‘whole-person’ understanding of the social determinants of health. Examples of specific projects in which healthcare systems, such as Dartmouth and UPMC, are partnering with the Data Humanity Lab. Many of my colleagues talk about how entrenched the system is. Well, here is an example of how individuals in a visionary organization are not accepting that belief, radically transforming healthcare for the better. What Brian and his colleagues are doing is a wonderful example of an emerging humanistic leadership mindset in American healthcare. You’ll have to listen in to really understand what I’m talking about, but in this interview Brian challenges us all to reframe our business models from a more humanistic lens.  Zeev Neuwirth, MD

Chris Deacon, a distinguished consultant and legal expert in employee health benefits, dives into the complexities of employer-sponsored healthcare. She discusses the systemic issues driving costs and the lack of accountability under ERISA. The conversation highlights the need for employers to reclaim negotiation power to enhance employee care. Chris also unpacks the implications of the Consolidated Appropriations Act, revealing how it introduces new transparency requirements and could lead to significant legal challenges for self-insured employers.

Friends, The number one question I get asked after my presentations and seminars is, “But Zeev, what can I do?”  Making positive humanistic change in healthcare seems daunting, if not impossible. The system is incredibly entrenched. And yet, in this interview we’re going to hear examples of leaders who have used the principle of ‘love’ to create positive, impactful, and measurable change in their healthcare organizations.   Our two guests in this episode – Dr. Apurv Gupta and Stephanie Feals – have been on a journey to explore and share how ‘love’ is being deployed in healthcare organizations – not just as a vision or mission, but as a tactical operating principle. They co-founded and co-host a wonderful podcast entitled, ‘Making Healthcare Work For You’, which I highly recommend. In addition, Dr. Gupta – who is VP of Advisory Services at Premier Inc – has been consulting to organizations who are interested in creating a ‘loving’ healthcare organization. I find this to be incredibly encouraging and inspiring – that a publicly held company with the size, stature and reputation of Premier is supporting its people and its clients in working to rehumanize healthcare.  In this episode, we’ll hear about nationally renowned leaders and organizations who have been deploying love as a leadership principle. There are many pearls of wisdom that Apurv and Stephanie shared.  I’ll briefly mention three:   If we believe ‘love’ to be an important component and principle in healthcare delivery, we need to make it part of our daily narrative. Dr. Gupta puts it this way, “The conversation changes with us. Organizational culture is about conversation. Healthcare relationships are about conversation. If we think ‘love’ is important, we have to include it in the conversation.” The principle of ‘love’ has to become integral to the daily operations of organizations. It has to be manifest in strategic decisions, policies and protocols, and in the daily management approach. Rather than placing the onus on individuals, the focus should be on the organizational infrastructure. Ultimately, ‘love’ is the responsibility of leaders – in creating the conversation, the culture and the infrastructure that supports a loving organization. As Dr. Gupta put it, “… it starts with one person – with that spirit of courage, optimism and hope…” I would love to hear your thoughts about this.  If this interview resonates with you, please comment on it and share it with others. Zeev Neuwirth, MD

Glen Tullman, CEO of Transcarent and former leader of Livongo Health, shares insights on transforming healthcare for self-insured employers. He discusses the staggering burden of medical debt affecting over 100 million Americans and the inflation of employee healthcare costs due to mismanagement. Tullman highlights the need for innovative solutions, like Transcarent's user-friendly platform that integrates various healthcare services. He emphasizes the importance of comprehensive care and strategic partnerships to enhance employee access to benefits.

Friends, What most of us are unaware of is that the health of the American public is worsening in relation to other developed nations – despite having, by far, the costliest and arguably most sophisticated healthcare system in the world. Our life span is decreasing. Inequities in care and disparities in health outcomes are worsening. The Washington Post, in a recent expose on American healthcare wrote that income is no longer the hallmark of inequity in the US – it’s now longevity – life itself. According to our guest today, this all sadly makes sense as we actively refuse to challenge and change the status quo in American healthcare at the necessary pace – to adopt a more practical, evidence-based, consumer-oriented approach – one that gets us beyond what she refers to as our traditional and myopic “clinical tendencies”. Our guest is an incredibly accomplished physician, lawyer and healthcare policy expert – Kameron Leigh Matthews MD, JD, FAAFP. Dr. Matthews is a board-certified Family Medicine physician who has focused her career on marginalized communities. She is an elected member of the National Academy of Medicine where she chairs the Health Policy Fellowship & Leadership Programs Advisory Committee; and is currently a participant in the 6th cohort of the Aspen Institute’s Health Innovators Fellowship. Dr. Matthews received her bachelor’s degree at Duke University, her medical degree at Johns Hopkins University, and her law degree at the University of Chicago.  What our guest and her colleagues at Cityblock Health are doing to change the status quo is straightforward yet quite remarkable. They are delivering integrated and advanced primary care to marginalized communities – and demonstrating improved outcomes.  During the course of our interview, Dr. Matthews repeatedly referenced the well-worn definition of insanity – doing more of the same but expecting a different and better result.  When I asked her what Cityblock Health was doing differently, she cited numerous specifics that include:  (1) providing care for a specific segment of the population – and deploying and customizing the healthcare resources that are needed by that segment;  (2) utilizing value-based payment in order to sustainably deliver comprehensive services and to invest in innovative care models;  (3) adopting a “partnership” model of care which includes assigning a “community health partner” (not worker) to each patient;  (4) “multi-modal” care – delivering care where, when and how patients want it to be delivered – whether in their health “hubs”, in patients’ homes, or virtually;  (5) a “one-stop-shop” of comprehensive clinical and non-clinical (SDOH) care – which includes a care team of doctors, nurses, and behavioral health experts, as well as partnerships with local healthcare systems and community-based organizations.  The foundational thesis for Cityblock Health is evidence-based medicine – and the evidence is overwhelmingly clear. The vast majority of our health outcomes are dependent upon non-clinical factors – the so-called ‘social determinants of health’. Cityblock Health has built their model based on this evidence and is deploying a “whole-person”, community-based approach. Another foundational thesis is the principle of segmentation. By focusing on a specific segment of the population, they can more readily create a highly customized, appropriately resourced, and sustainable care model.  One of the things I admire and respect about Dr. Matthews is that she not only has a prescription in hand, but she is actively delivering on it – with her work at Cityblock, her non-profit ‘Tour for Diversity in Medicine’ (which I recommend you look into), in her advocacy and policy work at the National Academy of Medicine, and more broadly in her national presentations.   Dr. Kameron’s humanistic leadership and her courageous, intelligent voice is one that I hope we’ll continue to hear more from on the national healthcare scene.  And I hope, for our sake, we have the good sense to listen to it. Zeev Neuwirth, MD

Watch out folks! A new day in Creating a New Healthcare is coming…   Creating a New Healthcare has an updated look and an updated focus. Over the past six months, I’ve been speaking with healthcare audiences across the country about my recently published book, ‘Beyond the Walls’, which is about getting beyond our limiting legacy thinking. There are 3 notable gaps that have arisen out of these conversations with providers, administrators, executives and healthcare consumers.   The first gap is a need to refocus our efforts on health – to go beyond healthcare. Our mission is not just to deliver healthcare – it’s to improve health. Somewhere along the way, it seems like we’ve lost that primary focus. We’re spending a lot of time, energy and resources on the healthcare industry rather than on the health care of the American public. In the podcast, we’re going to address that gap and expand the focus to achieving better health.    The second gap is the inequities in healthcare. And by inequities, I’m referring to the systemic and structural racism, sexism, ageism, ableism, classism and reductionism – the inequitable ‘isms’ in healthcare. What’s clear is that if we’re going to solve the challenges in healthcare, we will need to explicitly address these issues. As such, we will be discussing health equity with a focus on solutions.     The third gap that we’ll be explicitly addressing is that of leadership. What’s become abundantly clear to me is that if we are going to transform healthcare, we’re going to have to be willing to transform our leadership mindset. In the podcast, we will be focusing on a more generative, inclusive, collaborative and humanistic mindset – what I’m calling a “rebel mindset”.    Finally, the number one question I’ve been asked as I’ve spoken across the country is, ‘What can I do?’ People are desperate for tangible, do-able, next steps. So, we’re going to add a ‘do-ability’ focus to the podcast and attempt to respond to that question of ”What Can I Do?” in each episode.    This is a new day in Creating a New Healthcare. To hear more about this new, expanded version of the podcast and my personal journey that has led us here, tune in to today’s podcast, episode 168.

Friends, This interview should be required listening for every chief experience officer, every marketing officer, every chief medical officer and every chief executive officer in American healthcare.  Why? Because – when benchmarked against other public and private healthcare systems the VA outperforms on patient experience and consumer trust metrics.  And, if you want to understand ‘how’ – listen to this interview. I would suggest listening to it more than once – to capture the principles, strategies and tactics that John and his colleagues are deploying to achieve a world-class healthcare experience.  Keep in mind that the VA provides care to over 9 million Veterans annually, at over 150 hospital-based medical centers and over 1400 ambulatory centers. We cover so many profound topics, but here are a few: In 2016, the VA instituted a ‘Trust Index’ comprising 3 major domains.  They are one of the few healthcare systems across the country that have focused on restoring trust in American healthcare – and have seen remarkable improvements as a result of this focus. In addition to the Trust Index, they have also constructed a ‘Social-Drivers-of-Health’ framework which identifies these issues at every patient visit; and is also used to construct collaborative solutions with non-VA community-based organizations across the country. The VA Experience Office has collaborated with the VA Whole Health Initiative to define ‘well-being’ from patients’ and employees’ perspective, and to create wellness programs. The VA has engaged in journey mapping, service blueprints, and numerous other qualitative and quantitative research – across dozens of service lines. They use this information to train their employees in delivering a world-class healthcare experience. The emphasis on provider and employee experience is profound. In addition to their quarterly ‘V-signals’ (Veteran) patient experience surveys; they also have quarterly ‘E-signals’ – employee experience surveys.   This is one of many interviews I’ve conducted that demonstrates how far ahead the VA system is in so many respects. The VA is a hidden gem in the American healthcare system.  There are so many pearls of wisdom and sophisticated approaches that are shared in this interview.  My hope is that it reaches the audience that needs to hear them. Zeev Neuwirth, MD

Friends, This is a remarkable journey – of a physician who has gone from burnout to creating positive ‘ripples of change’ in our healthcare system. He went from being a casualty of our healthcare system to being a courageous leader. In listening to Dr. Otten’s story, I was moved from anger to elation, and I suspect you will be as well.  What’s profoundly disturbing is that this physician’s experience of anguish and burnout reflects that of the majority of clinicians and healthcare staff. What’s inspiring is that this physician made a decision to turn the dismal dilemma of American healthcare into a positive movement to humanize it. What I also admire is his collaborative approach and the inclusion of patients – coupling his initial effort, Ripple of Change, with Medicine Forward and other advocacy/activism groups.   One takeaway is that we need to change the narrative and the fundamental construct of our healthcare delivery system. We need a renewed sense of purpose & mission, and actually live it – in our policies and procedures – in our organizations – in our payment – in our daily delivery of healthcare.  What Todd and others are doing is critical and urgent. Over half of US doctors experience burnout. One quarter of the current nursing workforce are planning to leave the system in the next three years. We aren’t at a tipping point. We’ve already tipped over.  On a very personal human level, Dr. Otten had to first save himself before he could save others. There’s a profound lesson in there for all of us. Zeev Neuwirth, MD

Friends,   This dialogue is a Master Class in Care Transformation – likely owing to our guest’s unique background, which includes preventive medicine, public health, and clinical informatics. It should be required listening for all healthcare executives and managers – both clinical and administrative – as well process/quality improvement professionals. Our guest, Dr. Cole Zanetti is an insightful and brilliant process improvement and care transformation expert. He has a broadly empathetic perspective and a practical humanistic vision that is the foundation for his work and his leadership.  Dr. Zanetti currently serves as a Senior Advisor for the Veteran Affairs National Center for Care and Payment Innovation – focusing on value-based care delivery and payment innovation pilots as well as emerging technology innovation pilots. He also serves as the Chief Health Informatics Officer for the Ralph H. Johnson VA Medical Center in Charleston South Carolina, and as the Director for Digital Health at Rocky Vista University College of Osteopathic Medicine. Dr. Zanetti was trained in Family Medicine and Leadership Preventive Medicine at Dartmouth Hitchcock Medical Center. He is triple board certified in family medicine, preventive medicine, and clinical informatics – and has a Masters in Public Health from the Dartmouth Institute for Health Policy. He has also served on the National Quality Forum’s Physician Advisory Committee and as a technical expert for the Centers for Medicare & Medicaid Services.   A few months prior to this interview I heard Dr. Zanetti speak about the cutting-edge, digital-tech innovations being deployed within the VA. My intention going into the interview was to do a deep dive on those care delivery innovations. But, this conversation went in an unexpected direction, which I’m truly grateful for. We ended up exploring the philosophical underpinnings of transformation and the approaches Dr. Zanetti has had to adopt in order to do this work. In short, we discussed the ‘why’ and the ‘how’ of care transformation.   Some of the areas we covered include:   Why Dr. Zanetti firmly believes that a serious commitment to and more significant resourcing of care transformation and digital transformation is critical – for patients, for providers and their staff, and for the survival of the mission of Medicine.  How the VA is uniquely positioned to be a transformation center – a “test kitchen” for care delivery – not only for Vets but for the entire American healthcare system.  The approaches that Dr. Zanetti has learned and adopted as a leader in care transformation – with a particular focus on inquiry and positive deviance. This interview uncovers another example of how the VA is one of the most innovative and transformational healthcare systems in the country. I continue to be astounded by the “hidden gems” – the forward-thinking, nationally leading expertise and initiatives within the VA, and the unique factors that make the VA ideal for ideating, piloting, deploying and studying care transformation. Towards the end of our dialogue, I promised that I would follow up with a part 2, which I will – in which we’ll dive into the specific digital tech innovations being deployed in the VA. In the meantime, I hope you have a chance to glean the wisdom and humanity of Dr. Cole Zanetti. Until Next Time, Be Well Zeev Neuwirth, MD

Friends, This is Part 2 of an interview that is one of the most startling I’ve posted over the past 8 years. The revelation here is that the pulse oximeters we’ve been using for decades, to measure oxygen in the blood, are not always accurate in people of color. They may overestimate the amount of oxygen in the blood and miss low oxygen levels – potentially leading to delayed treatment and adverse outcomes. What’s shocking to me is that this has been documented in the medical literature for nearly two decades and little to no action has been taken. The implications are profound, especially given the disparity in deaths we witnessed along racial lines during the Covid pandemic, and the on-going widespread utilization of pulse oximetry in the post pandemic era. Our guest, the esteemed Dr. Kryger, provides us with his expert perspective on this still emerging situation. In this episode we’ll discover: Why Dr. Kryger believes it’s taken so long – decades – for some action to be taken to address the inaccuracies in pulse oximetry. Dr. Kryger’s perspective on the impact that inaccurate pulse oximetry measurements had during the Covid pandemic and its impact in the post-pandemic period. What Dr. Kryger believes that professionals, as well as the American public, should be aware of – in regard to pulse oximetry measurement – and what actions can be taken right now. This is one of those critically important and urgent issues that we need to learn more about and do more about. As our guest points out, the magnitude of this problem is enormous in that nearly 40% of the people who pulse oximeters are used on are people of color.  My purpose here is to create awareness and motivate positive action. Along those lines, I would urge you to read and respond to the FDA’s recently released discussion paper (the public is invited to respond up until Jan 16, 2024); as well as attend the FDA’s upcoming virtual public advisory meeting on Feb 2 2024.  I would also urge you to forward this podcast to your clinical colleagues as well as hospital and healthcare executives.  Zeev Neuwirth, MD