Creating a New Healthcare

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

Friends, Primary care for seniors is different from care for younger patients. Yet, very few providers across the country have a different and distinct strategy to care for their aging senior patients. In this interview, we’ll be introduced to an organization that has made taking care of seniors a priority. The fundamental problems with attempting to apply generic primary care to senior care. The significant investments and thoughtful approaches that Humana has taken to create comprehensive and customized care for seniors, while also addressing inequities in care. The specific value-based care model design and data enablement that Humana has developed to support clinicians in meeting the care needs of senior patients. It’s remarkable to hear Dr. Vivek Garg discuss the multi-year strategy and tremendous commitment that has gone into the CenterWell Brand at Humana. One of the things I appreciate about Dr. Garg is his humility and transparency – about what Humana has achieved as well as what more we ALL need to achieve in order to provide the type of care that the aging senior population requires. As I mention in the closing comments of this interview, we need the type of leadership that Dr. Garg manifests – a leadership focused on outcomes that truly matter to people and communities. Wishing you all the best of health and wellness in the New Year! Zeev Neuwirth, MD

Friends, This interview is one of the most startling I’ve posted to date. In this episode, we discover that pulse oximeters – which measure blood oxygen levels – are not always accurate in people of color. Mounting evidence suggests that they’re far less accurate in people of color than in white people. They can overestimate the amount of oxygen saturation in the blood and miss low oxygen levels. As a result, people of color may be underdiagnosed and undertreated for low blood oxygen – in conditions ranging from pneumonia and flu, to numerous chronic lung conditions, to asthma, and heart failure. The clinical implications are profound. If low oxygen levels are not detected, people may not be provided appropriate monitoring and medical treatment – in their homes, in doctor’s offices, and in emergency departments, hospitals and intensive care units.  As long-time listeners of this podcast know, my approach is not to focus on what’s wrong in American healthcare; but instead, to identify what’s right – so we can adopt, scale and spread positive change. What’s right here is that one solution to this disparity already exists. Our guest, Neil Friedman and his colleagues have developed a pulse oximeter, Circul Pro, that is more accurate in people of color, as well as in white people. It’s been scientifically validated and approved by the FDA. You can learn more about it at www.circul.health.   Another positive development – two days after I recorded this interview, the Center for Devices & Radiological Health (CDRH) within the FDA released a discussion paper for public feedback entitled, “Approach for Improving the Performance Evaluation of Pulse Oximeter Devices Taking Into Consideration Skin Pigmentation, Race and Ethnicity”. They also scheduled a virtual public meeting on Feb 2, 2024 to discuss this issue.  Both announcements can be accessed here.   This interview raises more questions than answers.  For example:   Exactly how inaccurate is pulse oximetry in people of color, and to what extent is it clinically significant? Are clinicians and healthcare executives aware of the pulse oximetry issue?  And if they are, what are they doing about it? Why hasn’t the American public been made more aware of this issue, which has been documented in the medical literature for years? If pulse oximetry is racially biased, what other medical technologies, sensors, algorithms and protocols have racial biases built into them? This is one of those critically important 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, not to lay blame. 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. The paper is well researched and it’s a call-to-action to advance the research – with very specific questions.  I would also urge you to forward this podcast and write up to your clinical colleagues – especially those with expertise in pulmonary, critical care, and sleep medicine.  As always, wishing you the best of health, Zeev Neuwirth, MD

Dr. Neil Wagle, Chief Medical Officer at Devoted Health, discusses the problems with primary care today and how Devoted Health offers an all-in-one solution. They focus on patients' perspectives, achieve incredible outcomes, and have constructed comprehensive clinical service lines. The podcast also explores virtual healthcare services, the importance of technology, working with provider groups and hospital systems, and the need for hope and realignment in the healthcare system.

Friends, In this episode we’re going to discuss the opportunity we have, collectively, to live longer and healthier lives – and the underlying transition that’s required in the healthcare industry to make that a reality over the next few years. The specific topics at hand include: (1) The economic imperative for why the American healthcare industry must move toward wellness; (2) the profound life-saving and cost-saving benefits of such an industry shift; (3) the central role that employers can play in wellness and longevity; and (4) some of the challenges and headwinds in this shift. Our expert guest today is Neal Batra, who is a principal in Deloitte’s Life Sciences and HealthCare practice which is focused on the redesign of business models and commercial operations. He also heads Deloitte’s Life Sciences Strategy & Analytics practice, leading the way on next-gen enterprise strategy, analytics and technology. Neal has more than 15 years of experience advising health care organizations and businesses in biotech, medtech, health insurance, and retail health care. He is the coauthor of Deloitte’s provocative ‘Future of health point-of-view’ – forecasting on the healthcare ecosystem in 2040, and the business models and capabilities that will matter most. He holds an MBA from London Business School and a BBA from the College of William and Mary. In this interview, we’ll discover: The difference between ‘life-span’ and ‘health-span’, and why ‘healthy longevity’ may be more important to us than longevity. How many additional years of life-span and health-span Neal and his colleagues believe Americans can experience by 2040. Why and how employers could be a major channel for enhancing healthy longevity. The amount of annual national healthcare spend we could save if we added well-care to our sick-care system. How this transition must include all Americans – an imperative from the disparities & inequities perspective, as well as the economic perspective. The foundational issue that Neal and his colleagues start off with is that our healthcare system, as amazing as it is – is focused on the ‘break it and fix it’ model.  It is a system that largely waits for disease and illness, and then dedicates tremendous resources and expertise toward dealing with that disease and illness burden. This is what he and many others refer to as a ‘sick-care’ system. This is in stark contrast to a system that is focused on proactive prevention of disease and illness. And Neals points out that this is not an either-or decision. What he recommends is a widening of the aperture – a diversion of some of the current healthcare spend to proactive and preventive well-care.  Neal opens up our discussion with a sobering revelation. For most Americans, the time of life when their health begins to erode corresponds to the time that they’re getting ready to retire. As he puts it, “Your healthiest years went to your employer, and in a time that was meant to be the ‘golden years’, or the years in which you had a financial foundation that allowed you to do different things with your life, your healthspan declines to a point where your quality of life declines.” A second revelation – that Neal and his colleagues have published on – is that if we transitioned to a wellness industry, Americans could add an additional 12 years to their lifespan and nearly 20 years to their healthspan, by 2040. His team has also projected that the American healthcare system could save $3.5 Trillion per year – what he refers to as a whopping ‘well-being dividend’. Neal’s point, not to be missed, is that the cost dilemma in American healthcare will not be solved through cost reduction in a sick-care system, but rather through cost prevention through a well-care system. In his own words, “I’d like to shift to a ‘cost-of-avoidance’ narrative versus a ‘cost-of-care’ narrative. The cost-of-care narrative is a trailing economic measure, and there is no amount of innovation that will ever make it cost-effective to address the population in this break-fix modality. The only way out of the economic death spiral we are in when it comes to healthcare is to jump in front of illness, and invest ferociously on disease avoidance, and early as well as real-time diagnosis.”  A critical finding – that Neal and his colleagues have also published – is that approximately $1Trillion of the $3.5 Trillion in savings will come from the elimination of the disparities and inequities in healthcare. One statistic he mentioned is that white Americans live on average, 78 years, while for black and native Americans, the ages are respectively, 72 years and 68 years. And while these and other disparities are unconscionable in and of themselves, the calculations add an economic imperative to the ethical arguments for eliminating the structural racism in our healthcare system. A third revelation and shocking forecast that Neal shared – which again, his analytics & actuarial team have published – is that, by 2040, 60% of healthcare spend in the US will go to well-care, not the treatment of disease and illness. He and his colleague predict that, by 2040, we are going to witness a “new health economy” with “new business models” which will drive 85% of all healthcare revenue. This new health economy will also be driven by a shift from a ‘rule-of-thumb’ to a ‘rule-of-one’ medicine – that is, the hyper-personalization of care – enabled by the digital and AI revolution in healthcare.  To balance out the dialogue, we did discuss the very real obstacles and headwinds to this sort of healthcare transformation. For starters, wellness care does not align with the current, predominant, industry business models. Neal’s counter-argument is that no industry has ever been transformed by incumbent stakeholders. It’s only through external pressure that the incumbents either respond and change, or they go by the wayside. His point of view is that hospital systems have two options: (1) continue to solely pursue the acute care/sick-care business model, and contract into an acute care focused factory; or (2) engage and expand into wellness care and the corresponding business models.   I don’t want to lose sight of Neal’s ‘both-and’ perspective, which is that it’s not that we have to choose between sick-care and well-care. Instead, we need to create a more balanced healthcare system that includes a significant well-care component. But, as Neal points out, we’ve got a long way to go to reach that balance. “If you held our sick care capabilities constant over the next decade and flowed everything into wellness and wellbeing, I think the yield on the American health system would be enormous economically, as well as from a health outcomes perspective”.  I’ll end with this personal observation. In my career, I’ve seen us accomplish miraculous things – creating space-age interventional cardiac labs, life-saving hemodialysis centers, and tele-stroke units. But here’s the rub. Wouldn’t you rather have the healthcare system focus a significant amount of resources and expertise on you NOT having that heart attack, kidney failure, or stroke in the first place?  I know I would.  Wishing you all the best of health and wellness! Zeev Neuwirth, MD

Glen Tullman, Founder & CEO of Transcarent, discusses the need for a better healthcare system, a consumer-centric approach to digital health, Transcarent's offerings to hospital systems, progress and updates at Transcarent, and the importance of encouraging change and innovation in healthcare.

Friends, The central role that Medicare, and CMS, play in our healthcare system can not be overstated. There are approximately 64 million Americans in the Medicare program, with annual payments of $1 Trillion, comprising over 20% of the healthcare spend in our country.  In addition to its size and scope, CMS, through the Medicare program, is leading the nation in advancing value-based care, and has been deploying landmark historic initiatives at an accelerated pace. This is a unique interview in that we will be hearing directly from the impressive and highly accomplished leader at CMS who is leading Medicare. And, as I promised during the interview, I’ve attached a few links to cms.gov at the end of these notes. Our guest this episode is Dr. Meena Seshamani who currently serves as Deputy Administrator and Director of the Center for Medicare, at the Centers for Medicare & Medicaid Services. Since joining CMS, Dr. Seshamani has led her team of nearly 1,000 through a critical agenda of initiatives to advance health equity; expand access to coverage and care; drive innovation for high-quality, whole-person care; and promote affordability and sustainability of the Medicare program for generations to come. She is the senior official responsible for CMS’s implementation activities under the Inflation Reduction Act, which is the largest change to the Medicare program since the enactment of Part D in 2003. Dr. Seshamani is a Hopkins trained surgeon and an economist, having obtained a doctorate in economics at Oxford. Prior to joining CMS, she served as Vice President of Clinical Care Transformation at MedStar Health – a multi-hospital system – where she developed & implemented population health and value-based care initiatives. She also cared for patients as a head & neck surgeon at MedStar Georgetown University Hospital and at Kaiser Permanente in San Francisco. Dr. Seshamani served on the leadership of the Biden-Harris Transition HHS Agency Review Team. Prior to MedStar Health, she was Director of the Office of Health Reform at the US Department of Health and Human Services, where she drove strategy and led implementation of the Affordable Care Act across the Department, including coverage policy, delivery system reform, and public health policy.   In this interview, we’ll discover: How providers can be aware of the activities at CMS, and how to engage more with CMS.  Some of the most significant recent changes in Medicare that are coming out of the Inflation Reduction Act, as well as other landmark programs.  How CMS is encouraging and supporting providers in joining and advancing their participation in alternative payment models like the Medicare Shared Savings Program – the largest accountable care organization in the country.  How CMS is directly supporting providers in rural America – providers who are caring for tens of millions of Americans. One of the most landmark initiatives we discussed in this interview was the historic ‘Medicare Drug Price Negotiation Program’. This is the first time ever that Medicare will be negotiating directly with pharmaceutical manufacturers for the prices of some of the highest cost drugs in the Medicare program. It’s fascinating to hear Dr. Seshamani describe the thoughtful and thorough preparation, as well as the ongoing research and assessment that is going into architecting the negotiation process. It’s also compelling to hear that CMS is focused not only on optimizing costs but also on evaluating the real-world effectiveness of these medications. In its first year, the program will focus on ten of the highest cost medications, but those numbers will increase rapidly to cover many more high-cost medications. The law will also cap medication costs for any individual Medicare beneficiary to no more than $2,000 per year. Another landmark initiative we discussed is the ‘intensive outpatient program’. As Meena eloquently puts it, “We have made some of the most significant changes in behavioral health in the history of the Medicare program – creating entirely new benefits…”  For example, these new benefits allow licensed marriage & family therapists, mental health counselors, addiction counselors, and care navigators to become billable Medicare providers – so that beneficiaries receive more whole-person, team-based care, radically improving the way that mental healthcare can be delivered. I came away from this interview awed by the sheer number of historic, value-based initiatives that CMS is launching – enhancing affordability and equity of care and advancing care in critical areas such as behavioral health. I was also impressed by the transparency and level of engagement that CMS is enabling with providers and the public at large. Another facet that I have to call out is the focus CMS is placing on studying the effectiveness of their efforts, with an emphasis on actual health outcomes in the real-world setting.  There is so much more happening at CMS that we did not have the time to cover. What CMS is doing, and importantly, how they’re doing it, is a manifestation of their courageous, humanistic, conscious leadership. It’s also a reflection of the capability, commitment and integrity of their teams, and their overall palpable dedication to public service.  I came away from this interview hugely inspired and hopeful about the future of American healthcare. We have extraordinary leaders and sophisticated, dedicated teams at CMS – public servants who are advancing and transforming healthcare delivery in unprecedented ways. Their pace, productivity, and impact is remarkable. Their purpose is exemplary. I hope you come away from this interview as catalyzed to engage with CMS as I am. To that end, please take a moment to click on the cms.gov links below – and join in enhancing CMS’s mission. Until Next Time, Zeev Neuwirth, MD   Proposed CY 2024 Physician Fee Schedule Rule: Press Release: https://www.cms.gov/newsroom/press-releases/cms-physician-payment-rule-advances-health-equity Behavioral Health Blog: https://www.cms.gov/blog/important-new-changes-improve-access-behavioral-health-medicare General Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule Medicare Shared Savings Program Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule  Quality Payment Program Fact Sheet (PDF): https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fqpp-cm-prod-content.s3.amazonaws.com%2Fuploads%2F2483%2F2024%2520QPP%2520Proposed%2520Rule%2520Fact%2520Sheet%2520and%2520Policy%2520Comparison%2520Table.pdf&data=05%7C01%7CDiana.Perez-Rivera%40cms.hhs.gov%7Cc22ffc1b576744bc8a6808db83ec982d%7Cfbdcedc170a9414bbfa5c3063fc3395e%7C0%7C0%7C638248824408723905%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=XIEAjHwFCgW8KZskBift7lQrbZ7HUTJdlvQNKztH7Sw%3D&reserved=0 Proposed Rule: https://www.federalregister.gov/documents/2023/08/07/2023-14624/medicare-and-medicaid-programs-cy-2024-payment-policies-under-the-physician-fee-schedule-and-other Comments due by September 11, 2023   Proposed CY 2024 Outpatient Prospective Payment System Rule: Press Release: https://www.cms.gov/newsroom/press-releases/cms-proposes-policies-expand-behavioral-health-access-and-further-efforts-increase-hospital-price General Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/cy-2024-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center Hospital Price Transparency Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/cy-2024-hospital-outpatient-prospective-payment-system-opps-policy-changes-hospital-price Proposed Rule: https://www.federalregister.gov/documents/2023/07/31/2023-14768/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment Comments due by September 11, 2023   Proposed CY 2024 Home Health Prospective Payment System Rule: Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-home-health-prospective-payment-system-proposed-rule-cms-1780-p Rule: https://www.federalregister.gov/documents/2023/07/10/2023-14044/medicare-program-calendar-year-cy-2024-home-health-hh-prospective-payment-system-rate-update-hh Comments due by August 29, 2023   Proposed CY 2024 End Stage Renal Disease (ESRD) Prospective Payment System Rule: Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-2024-end-stage-renal-disease-esrd-prospective-payment-system-pps-proposed-rule-cms Rule: https://www.federalregister.gov/documents/2023/06/30/2023-13748/medicare-program-end-stage-renal-disease-prospective-payment-system-payment-for-renal-dialysis Comments due by August 25, 2023   Final FY 2024 Inpatient Prospective Payment System Rule: Press Release: https://www.cms.gov/newsroom/press-releases/new-cms-rule-promotes-high-quality-care-and-rewards-hospitals-deliver-high-quality-care-underserved Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fy-2024-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective-0 Rule: https://www.federalregister.gov/public-inspection/2023-16252/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the   Final FY 2024 Inpatient Psychiatric Facility Prospective Payment System Rule: Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2024-medicare-inpatient-psychiatric-facility-prospective-payment-system-and-quality Rule: https://www.federalregister.gov/documents/2023/08/02/2023-16083/medicare-program-fy-2024-inpatient-psychiatric-facilities-prospective-payment-system-rate-update   Final FY 2024 Inpatient Rehabilitation Facility Prospective Payment System Rule: Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2024-inpatient-rehabilitation-facility-prospective-payment-system-final-rule-cms-1781-f Rule: https://www.federalregister.gov/documents/2023/08/02/2023-16050/medicare-program-inpatient-rehabilitation-facility-prospective-payment-system-for-federal-fiscal   Final FY 2024 Skilled Nursing Facility Prospective Payment System Rule: Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2024-skilled-nursing-facility-perspective-payment-system-final-rule-cms-1779-f Rule:  https://www.federalregister.gov/documents/2023/08/07/2023-16249/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities   Final FY 2024 Hospice Payment Rate Update Rule: Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2024-hospice-payment-rate-update-final-rule-cms-1787-f Rule: https://www.federalregister.gov/documents/2023/08/02/2023-16116/medicare-program-fy-2024-hospice-wage-index-and-payment-rate-update-hospice-conditions-of

Friends, There is no question that digital health is a critical part of the future of healthcare delivery. It is what I term ‘the great enabler’.  And in this interview we have the opportunity to speak with a physician leader who is at the tip of that spear: Dr. Eve Cunningham, a physician executive in virtual care & digital health at Providence, one of the largest and most progressive healthcare systems in the country. Dr. Cunningham currently serves as Group Vice President and Chief of Virtual Care and Digital Health for Providence Health. She joined Providence St. Joseph Health in 2017 as the Chief Medical Officer of Providence Medical Group Southwest. Eve is board certified in Obstetrics and Gynecology and has practiced for over 12 years. She earned her medical degree at Saint Louis University School of Medicine and did her postgraduate residency training at Kaiser Los Angeles Medical Center. Eve also obtained a Master’s in Business Administration from the University of Massachusetts Amherst. In this interview, we’ll discover: Why Digital Health is an absolutely critical part of the current and immediate future of healthcare – a must-do can’t-fail for any healthcare system or provider organization. The three major ways that Dr. Cunningham and her teams serve within Providence Health: to promote, develop and support digital health efforts. Some of the amazing virtual services and digital products she and her team have developed and are spreading at a large scale. A few of the critical success factors Dr. Cunningham believes to be essential for the viability of any digital health division and program. I’ve had the privilege of interviewing and speaking with a number of leaders at Providence. Each time I do, I walk away with even more respect for this organization – its mission, its forward-thinking culture, and the level of professionalism, competence and collaboration.  I also walk away with awe at the innovative and transformative services and products they are constantly incubating, scaling and commercializing. This conversation with Dr. Eve Cunningham was no different.   I had heard Dr. Cunningham speak at a symposium a few months prior and I was impressed with her attitude and her approach. She has a unique set of skills – bringing the traditional chief medical officer acumen and experience to bear – the clinical and operational chops. But she also possesses a bold and practical irreverence for traditional approaches that are not future facing. Her ability to meld these two together is quite remarkable and striking. She has no problem in telling it straight, something I deeply admire. In regard to telling it straight, Eve shared some very practical tips in regard to digital health initiatives; chief amongst them were three things. First – being crystal clear about the value proposition, the key performance indicators, and being to demonstrate the value proposition through these metrics.  Second – working very closely with financial colleagues to be able to demonstrate a hard return on investment.  Third – piloting programs that were not only clinically and operationally feasible as well as financially viable, but also programs that are scalable.  She talked about scale on the level of tens of thousands, if not hundreds of thousands of patients.  In regard to some of the exciting programs and innovative products? Well, you’ll have to listen to the interview.  But, I’ll give you a sneak preview. One product we discussed at length is called MedPearl – a digitally-enabled specialty referral system/algorithm that every integrated healthcare provider system or group has been desperately seeking for decades. If you’re a healthcare leader, you will not want to miss this discussion. Another is a set of digitally-enabled surgery support tools which will radically change surgical care forever.  I’ve understood that all healthcare is going to be digitally-enabled in the near future. But it’s leaders like Dr. Eve Cunningham and her colleagues at Providence that are making it a reality. A reality that is going to improve patient access, outcomes, experience, equity and affordability – as well as improve the effectiveness, efficiency and job doability for providers of care. There is no question in my mind that digital is the enabler for humanizing healthcare delivery for all. I’ll leave you with a brief quote from Dr. Cunningham which really captures the essence of the imperative: “I would say that virtual and digital is our way forward into the future, and we have to 10x it!  My goal is 10x what we’re doing in the next five years because that’s what’s going to keep us afloat as an organization.  We have to change. Traditional healthcare delivery is not sustainable in its current state…” Until Next Time, Zeev Neuwirth, MD