Creating a New Healthcare

So, it turns out that how we frame failure is far more important than how we manage success, in determining our motivation and our ability to sustain healthful and positive behavior change.  Our guest today, Dr. Kyra Bobinet, is a long-standing expert, clinician and entrepreneur in the field of behavior change. Her company, Fresh Tri, applies a unique approach to embedding state-of-the-art behavior change techniques into software apps – something she learned at Stanford, in one of the most illustrious behavioral labs in the world.  The approach Kyra offers us is a liberating reversal of the motivational approaches we’ve used for decades – in our organizations, with our patients, and in our own personal efforts to form healthful habits. It’s a shift from the predominant ‘performance-based mindset’ to an ‘iterative mindset’, which essentially prevents demotivation. This iterative approach to sustained behavior change is far more kind and creative, and likely to be far more successful. Since learning about the iterative mindset from Kyra, I’ve begun to use it in my professional and personal life – and it works – which is why I’m excited to read Kyra’s new book on the subject, ‘Unstoppable Brain: The New Neuroscience That Frees Us from Failure, Eases Our Stress, and Creates Lasting Change’ which is available on Amazon. If you’re interested in learning more you can find Kyra’s work here. Zeev Neuwirth, MD

Neal Khosla, co-founder and CEO of Curai Health, has been recognized as one of Time's 100 most influential leaders in AI. He discusses the pressing shortage of primary care providers and how AI can enhance patient engagement and chronic disease management. Khosla describes Curai's innovative text-based, AI-empowered primary care model, emphasizing its accessibility through platforms like Amazon. He also highlights efforts to serve vulnerable populations and community health initiatives, proving that technology can revolutionize healthcare for all.

Friends, I think you’ll all understand this. Every once in a while an issue comes along which has such importance and urgency that you’re compelled to do something about it. In this case, I had a phone call with our expert guest a week ago, and ten minutes into the discussion, I stopped him and said ‘we have to do this podcast interview immediately and get it out there’.   The compelling issue includes: (1) the severe and worsening nursing burnout and subsequent shortage; (2) the overcrowding of Emergency Departments with prolonged ED “boarding” and (3) morbidity and mortality in our hospital systems.  These are indeed critically urgent issues. A recent Becker’s report noted that nursing and staff shortages is the #1 concern for hospital CEO’s. ED overcrowding is a worsening national crisis – well documented in the medical and lay press. In fact, 90% of hospitals report having to keep patients in the ED because of lack of hospital capacity; and this ED “boarding” is associated with significant increases in patient deaths and harm in the hospital.  Our guest today has been studying and addressing this problem for over two decades. Eugene Litvak, PhD is an adjunct professor at the Harvard T.H. Chan School of Public Health who has published dozens of articles in peer-reviewed journals like the NEJM, JAMA, and Health Affairs. He’s also served as an advisor on patient safety and quality to the American Hospital Association as well as within the prestigious Institute of Medicine (now called the National Academy of Medicine). More to the point, Dr. Litvak developed a proven solution that he’s been deploying for years and which is now the focus of a recent book – Hospital Heal Thyself: One Brilliant Mathematician’s Proven Plan for Saving Hospitals, Many Lives, and Billions of Dollars – by Mark Taylor, a veteran healthcare reporter.  So, we’ve had a proven, doable, financially viable solution to the problem of ED and hospital overcrowding, for years. But, for reasons that are unclear to me, most hospitals in the US are either unaware of or have not adopted his solution – which is the motivation for sharing this interview. In this discussion we’ll discover: The true cause of overcrowding in Emergency Departments and hospitals and how it is largely unrelated to the variability in the number of patients coming to the ED. A detailed explanation of the ‘variability methodology’ that Dr. Litvak has developed which addresses the actual problem causing overcrowding.  Published examples of hospital systems that have deployed Dr. Litvak’s method resulting in dramatic improvements in safety and quality, reductions in burnout and turnover amongst nurses, and increased hospital productivity and margin.  Examples of how Dr. Litvak’s approach is being used in federally qualified health centers (FQHC’s) contributing to improved health equity. In addition to improving quality and safety, the operational excellence that Eugene is talking about creates a working environment in which clinicians and staff can demonstrate the empathy, compassion and love that brought them into healthcare in the first place. Operational excellence enables clinicians to manifest their professionalism, to listen and “attend” to their patients, and to build trusting relationships. One thing I realized through this interview is that there are many paths to love – and in this case it’s through mathematical modeling and operations management.  My purpose in putting this podcast out there with some urgency is to create awareness so folks can make their own decision about its validity and importance, and then take positive action. In terms of action – if you’re moved by this interview, my request is that you preorder the book, ‘Hospital Heal Thyself’ on Amazon, check out Dr. Litvak’s website, and share this interview and the book with your colleagues – particularly hospital-based leaders. And if you disagree or have alternative solutions, please let us know. I choose to be an optimistic realist. What continues to fuel that optimism are humanistic leaders like Dr. Litvak. He’s a renowned expert in healthcare operations management who could rest on his laurels. But instead, he’s been out there for over two decades trying to radically improve healthcare – trying to save lives. The integrity, humanitarian purpose, commitment and perseverance he’s demonstrated are beyond inspiring for me. And I think there’s a lesson in there for all of us – not just in what he’s doing, but in who he’s being.   Zeev Neuwirth, MD

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