Creating a New Healthcare

Friends, The problem of inequity in women’s health is a hugely disturbing one, particularly in American healthcare. For example – the disparity in maternal-fetal mortality & outcomes among Black women compared to White women in our country is an egregious example of a long-standing unsolved inequity. To put it plainly, it’s a shocking disparity and one that has to be addressed and eliminated.   In this dialogue we are introduced to another shocking inequity in women’s health. The issue is menopause, and I have to admit that I was unaware of the enormity of this unaddressed issue, and its debilitating impact on literally tens of millions of women each year. As always, our main focus here will not be on the problem, but more so on a solution that a courageous group of leaders have deployed to create a new and more humanistic approach to healthcare in our country.   Joanna Strober is the CEO of Midi Health.  Prior to Midi, Joanna founded Kurbo Health, a digital therapeutic for childhood obesity that she grew to serve tens of thousands of adolescents worldwide and sold to Weight Watchers in 2018. Prior to following her passion for digital health, Joanna spent fifteen years making investments in venture capital and private equity. Joanna is also the co-author of Getting to 50/50, a best selling book written to help parents thrive in the workforce after having children. Joanna received her BA in Political Science from University of Pennsylvania and holds a JD from University of California, Los Angeles where she was UCLA Law Review editor. In this episode, we’ll discover: How Joanna Strober personally discovered one of the great hidden inequities in American healthcare – an issue that is impacting nearly 60 million women. How painful and debilitating menopausal symptoms can be, and how these symptoms can be mis-disagnosed and mis-treated by well-intentioned providers. The impact menopause has on the professional lives of tens of millions of women in our country, and its negative impact on corporate America. The evidence-based, expert-supported, consumer-oriented & hyper-focused model of care that Joanna & her colleagues have created to address the problem of menopause in America. How Midi Health can be a synergistic and collaborative partner with providers and healthcare systems. A number of summary learnings are well worth reviewing:   Nearly 60 million women in the USA are in the menopausal age range. The symptoms are incredibly debilitating and are often missed and misdiagnosed by providers, leading to costly testing as well as inappropriate treatments. It’s not hard to see how these symptoms could be confused for other issues, as they include: migrainous headaches, sleep disturbances, anxiety and depression, heart palpitations, brain fog, memory problems, and a lack of energy.  As Joanna states, when these symptoms arise in a women between the ages of 40 to 65, menopause should be on the top of the list of possible causes rather than at the bottom. Women struggle to find appropriate care because the bottom line is that primary care physicians, neurologists, cardiologists, sleep medicine doctors and even gynecologists don’t get significant, if any, formal training in menopause. In addition to the personally debilitating symptoms, menopause also impacts women’s professional lives. Here are some stats Joanna shared with us:  Nearly 60% of women have to take time off from work due to menopause. Nearly 20% have to take off more than 4 weeks. In one survey, 60% of women said they did not apply for a promotion or raise because of their menopause symptoms. 25% said they had considered quitting their jobs, and 10% actually quit their jobs as a result of their menopausal symptoms What struck me during this interview was the truly exceptional clinical program that Joanna and her colleagues have built at Midi Health. It is one of the most elegant and sophisticated clinical/operational models of care that I have come across. It’s also supremely consumer oriented. The model is virtual which makes it accessible and convenient. Below is a high-level overview. The major interface women have is with a nurse practitioner who is certified by NAMS – the National Association of Menopause Specialists. In addition to being highly trained and vetted, these nurse practitioners are also following continuously updated, evidence-based protocols that the renowned experts at Midi Health have painstakingly created. If you take a look at their website, you’ll get a sense of the depth of the experts and expertise that Midi has brought to bear.   In addition to the NAMS certification and updated protocols, these nurse practitioners receive on-going training by the core team of experts. During the actual patients visits, the nurse practitioners also have real-time, on-demand access to the panel of experts. So they can literally obtain an expert consultation during the virtual visit.  And, this is not just general menopausal experts; but it’s specific sub-specialized expertise such as for breast cancer or osteoporosis or mental health or for naturopathic treatment alternatives.   Prior to the initial virtual visit, women complete a comprehensive pre-visit assessment which allows the Midi providers to be highly focused and to customize the visit.  The NP’s, working in conjunction with the women’s providers, can order tests. Once a treatment plan is decided upon they can prescribe the appropriate hormonal or naturopathic treatment.  Joanna shares that it usually takes a few follow-up virtual visits to adjust and correctly titrate the right dosing, and then these women are followed up as needed or annually.   What’s important to point out is that the Midi model is one that is complementary to provider groups and health systems. Midi NP’s will refer back to the women’s PCP or ObGyn for testing and for more clinically complex situations such as bone fragility or bleeding. I was pleasantly surprised to discover that it is a collaborative and not a competitive model of care. As Joanna states during the interview, “Our women are getting mammograms and they’re finding out that they have breast cancer.  We are diagnosing a lot of osteoporosis.  We want to partner with hospital systems because we’ll be sending a lot of patients to them.  We don’t view it as competitive.  Instead, we think our goal is to be this initial screen, to do this initial care and then refer into the hospital’s systems for what they do best, which is the more specialized care and more specialized procedures.” Menopause has been a hidden giant of a problem that women have suffered with, and it’s breathtaking to see how Midi Health is solving for it. One of the core underlying reframes here is the segmental focus that Midi has taken. The team at Midi has developed a highly focused, highly customized solution that addresses a very specific – but large – gap in American healthcare.  I think there’s a lesson here that can and should be transposed onto other conditions. I believe that Midi, and others in this genre are creating a whole new category and categorization of healthcare.   As you may have noted, Midi Health provides care for women with commercial health insurance. While we did not explore this topic, one would hope and expect that the solution will be made available to women who are uninsured, under-insured, as well as those on Medicaid. Midi is charting a bold new direction in healthcare and they are differentiating themselves in numerous ways.  First, they are differentiating themselves as a highly credible and reputable healthcare company, not as a product company.  Second, they are creating a virtual platform with the ability to scale, as opposed to the more typical brick and mortar clinics that are much more costly and geographically limited. This model will be able to treat women across the country and across the globe.  Third, due to the virtual visits and their digital tech platform, they will be able to collect significant amounts of data that can be analyzed and used to improve and further personalize care.  And finally, they are creating a collaborative model of care that can be integrated with providers and healthcare systems.  I truly admire and respect what these folks have done. It’s awe inspiring.  I believe that we will be seeing and hearing a lot more from the tremendous leaders and team at Midi Health.   Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, Our dialogue this episode centers on one of the most transformative and divergent clinical care models that I have come across. People throw around phrases like relationship-centered, patient-centered, preventive, personalized, and social determinants of health. In the model we’re discussing in this episode, you’ll see all of that actually being integrated into a coordinated ecosystem of care that delivers continuous, comprehensive, cost-effective and dignified VIP care to older, poorer and sicker Americans. People refer to ChenMed as one of the iconic, value-based senior care models or Medicare Advantage care models. It is also one of the best examples of a mission-driven healthcare organization. If you’ve ever wondered how a small group of people can transform the American healthcare system, I would suggest you listen very carefully to this interview. I would also recommend that you read the book that Dr. Chris Chen & Dr. Gordon Chen recently co-authored, The Calling – a Memoir of Family, Faith and the Future of Healthcare. Dr. Chris Chen is CEO & Co-Founder of ChenMed. Since becoming ChenMed’s CEO in 2009, Dr. Chen and his colleagues have built the decades-old, highly successful ChenMed model into a scalable organization with over 100 sites now spanning dozens of cities across numerous states.  ChenMed has been named to Newsweek’s “Most Loved Workplaces” list, Fortune Magazine’s “Change the World” list, as well as earning recognition by the White House, the Department of Health and Human Services, and the U.K. National Health Service. ChenMed was recently named by Newsweek as the #1 workplace in healthcare. ChenMed has also been featured in numerous publications including Medical Economics which named ChenMed, “Best Primary Care System in the U.S.”  Dr. Chen graduated from the University of Miami’s Honors Program in Medicine. He went on to complete his medical training at Beth Israel Deaconess, a Harvard University teaching hospital, after which he completed a fellowship in cardiology at Cornell University Medical College in New York City. In this episode, we’ll discover: The foundational healthcare vision and mission that this organization adheres to and delivers upon.  The pivotal capitation payment model ChenMed has adopted, and how that enables the shift from transactional, volume-driven and reactive care to one that is highly relational, personalized and preventive.   The numerous clinical, operational and technologic initiatives and infrastructure ChenMed has launched, which differentiate it from the primary care being deployed in the vast majority of healthcare systems across the country. How ChenMed treats its providers with the same respect, dignity and humanity that it applies to the patients and families it serves. The analytic and technologic sophistication that ChenMed has invested in, which greatly enable providers and their teams. The remarkable business acumen that Chris and his colleagues bring to bear – allowing for a model that is viable, replicable and scalable. I first met Chris Chen over seven years ago, and I’ve been observing the phenomenal maturation and advancement of the ChenMed model ever since.  Below are 3 reflections.  First, ChenMed is solving a serious and unresolved problem in our country – affordable, effective and dignified healthcare for older, sicker and poorer Americans. Poverty, overall, in the US is decreasing; but it appears to be rebounding for older Americans. A recent NYT article by Lydia DePillis (An Uptick in Elder Poverty: A Blip, or a Sign of Things to Come, Oct 17, 2022) cites that nearly one in ten Americans over the age of 65 live below the poverty line. One in five Hispanic or Black American Women over 65 live below the poverty line. One in four Americans over 65 years of age make less than 150% of the federal poverty line which is, on average, $19,494 for an individual living alone.  I was surprised, actually shocked, to learn of the high and rising prevalence of poverty amongst our senior population. At this level of poverty, preventive primary care is unaffordable. The ethical imperative is clear. But, what we also know is that the vast majority of the costs of healthcare are attributed to the older, sicker and poorer population. So, there is an economic imperative as well.   Second, what I have come to learn is how poorly understood ChenMed is amongst healthcare leaders. I’ve listened to knowledgeable experts speak without any coherent awareness of the integrated ecosystem ChenMed has built. I’m under no illusion that I fully understand the ChenMed model, but I continue to be an avid student; and continue to be an outspoken champion. Third, one thing I’ve observed over and over again with ChenMed is their divergent thinking and approach to primary care, and healthcare in general. They have reframed the practice of medicine to align with the core principles of our profession. There are literally dozens, if not hundreds, of ways that this manifests in their clinical, operational and technological infrastructures; in their processes and protocols; and most importantly, in their outcomes. Chris highlights a few of these differentiating elements in our dialogue.  I’ll share an example below. Most primary care across the country is based on a volume-driven, RVU-based, transactional framework that does not recognize that some patients require a very different approach. The wisdom, humanity and integrity of the senior Dr. James Chen and his sons is their firm belief that primary care is about establishing a healing and healthful relationship, not about being a visit vendor. They have understood that in order to create healthful relationships in older and sicker patients, visits must be more frequent, longer, supported by a team, and intensely focused on contextual factors, non-clinical determinants of health and lifestyle modifications. They have understood that this requires much greater investment in primary care, sophisticated protocols and technology that is built specifically for this purpose, and ultimately an approach that they characterize as love. They have also understood that top-down, centralized and generic approaches to population health are blunt instruments. So instead, they’ve empowered, deputized and resourced their physicians to essentially be the population health managers of their patients. Another related example is that they’ve reduced the number of patients each provider cares for to 400.  Contrast that to the typical primary care doctor in the US who carries a panel size between 1500 – 2000 patients. This profound decrease in panel size enables ChenMed physicians and their teams to provide the holistic, comprehensive, continuous and personalized care that is required for this segment of the population. It allows them to spend the attention and time that is required to keep these patients healthy, and out of the ED and hospital. ChenMed is a humanistic inversion of the American healthcare system. It’s approach is an anomaly that, in my opinion, should be studied and applied more broadly across our country. The Chens and their colleagues are missionaries bringing care to the underserved populations in our country: to seniors, to those who have less means and less money, and to those who have more complex and challenging clinical and psychosocial situations. What’s incredible is that the care, experience and outcomes they’re bringing are far superior to the primary care that the vast majority of older Americans receive, and it is far more cost effective. The ChenMed approach and others that are similarly rehumanizing healthcare are incredibly inspiring and compelling. Over the past few years I’ve been pondering the question of why healthcare systems around the country aren’t adopting or emulating these models of primary care, at least for the underserved populations and communities they serve?  I am sincerely interested in how those of us in leadership roles in healthcare can see models like this and not become immediate advocates and champions. I’m sincerely interested in your thoughts and questions. Until Next Time, Be Well. Zeev Neuwirth, MD  

Friends, This is one of a series of interviews I conducted to better understand the role of platforms in healthcare delivery. Our guest today, Dr. Roy Schoenberg, is one of the most significant contributors and most accomplished entrepreneurs in the domain of telehealth & virtual healthcare. He and his colleagues are also pioneers in one of the most significant transformations that will occur in healthcare – platforms.  Dr. Roy Schoenberg is President and CEO of Amwell.  Since co-founding the company in 2006 with his brother Ido, Amwell has grown to become one of the largest telehealth eco-systems in the world. Amongst numerous accomplishments and recognitions, Roy was appointed to the Federation of State Medical Boards’ Taskforce that issued the landmark guidelines for the “Appropriate Use of Telemedicine in the Practice of Medicine” in 2013.  He is the 2014 recipient of the American Telemedicine Association Industry award for leadership in the field, and was named one of Modern Healthcare’s 100 Most Influential People in Healthcare in 2020. Roy holds over 50 issued US Patents in the area of healthcare technology. He speaks frequently in industry and policy forums, and serves on the healthcare advisory board of MIT Sloan School of Business. He holds an MD from the Hebrew University in Israel, and a MPH from the Harvard School of Public Health.  In this episode, we’ll discover: What a healthcare delivery platform actually means and what it does.  The revolutionary potential of automation in healthcare delivery and the two requirements of this new generation of technologies.  The role platforms can play in assisting us to achieve the elusive triple, quadruple & quintuple aims.  How platforms can solve the ‘digital dilemma’ that is now confronting every healthcare system attempting to enter into the digital era of healthcare.  How platform technologies will actually humanize patient care by connecting people, connecting data, connecting technologies and connecting services. I’m just going to say that listening to and learning from Roy Schoenberg is a treat not to be missed. I’ve had the privilege of speaking with and interviewing Roy a number of times. But, each and every time I do, it seems like I comprehend his vision and appreciate his wisdom even more than the last time. It took me 3 passes through this interview to actually see – and I mean ‘see’ the vision of the future that Roy was describing. It is incredible. Roy describes the 3 domains of healthcare delivery that will be fully and seamlessly integrated through platforms, and the two requirements of the next generation of automated technologies. He paints a picture of a ‘digital companion’ that is so real and sounds so doable, but at the same time seems almost magical. As I listened to Roy, I was reminded of that quote by science fiction writer, Arthur C Clarke: “Any sufficiently advanced technology will be indistinguishable from magic.”   One always wonders about the real-life challenges and timeline of transformational change when speaking about an industry that is as homeostatic as healthcare. In listening to Roy Schoenberg and other leaders like him, I have come to realize that the challenges are not technologic. We have those magical capabilities. The challenge is the limitations of our industry-centric framing, the limitations of our disease-reactive vs health-centric framing, and the limitations imposed by our current payment and profit framing.  The sad part of our inertia is two-fold. First, it is the harm we unintentionally impose upon our patients and our providers of care – instead focusing on incremental temporizing measures that are a relic of a reengineering era of improvement.  Second, it is that the future of healthcare is going to be so much better than the past, and yet we delay that reality by clinging to a past framework instead of catalyzing a future one. Far from depressing me, these realizations only strengthens my resolve to reframe healthcare. And my hope is that this has the safe effect on you. The incredibly inspiring reality is that we have lots of highly impactful leaders like Roy who are making that better future a reality.  I’ll leave you with a few comments by Roy which provide a snippet of his vision and his humanity. “I think that a lot of people still see these technologies as another way to do the same things we’ve always done…  like, take the office visit and put it on your phone – same stuff, different place… I think a lot of the market is still married to that easier-to-comprehend notion… versus the logistical power of what these technologies actually bring to the table and our ability to rewrite the healthcare experience through them…  we’re going to be able to give people the reassurance that they can be cared for in their own environment… completely rethinking the way care happens.” “Completely rethinking the way care happens…”  That’s the reframe in healthcare we all need and all desire. So, let’s do it! Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, Many of us think of Uber as simply a much more convenient and comfortable alternative to taxi cabs, or as another great app on our smartphones. Underlying that reality is a deeper understanding that Uber is actually one of the most sophisticated business & technology platforms to date. Through the use of data, analytics and digital connectivity, it brings customers and vendors together in a way that is much more accessible, convenient, customized, and cost effective, and with just as good if not better outcomes, Uber makes it easier for both customers and vendors.   What does Uber and their platform have to do with healthcare?  For those of us who are in population health and healthcare quality, what I just wrote about Uber translates into the quadruple aim: better care, better outcomes, lower cost, and improving the experience for providers. That is what I’m referring to when I titled this episode – the ‘uberization of healthcare’. Uber Health has the potential to reframe and powerfully enable us to achieve the very aims that we have been attempting for the past couple of decades; including the quintuple aim goal of healthcare equity – which you’ll hear about early on in our dialogue. Our guests today are both Boston-based and so when I say they’re ‘wicked smart’, you’ll forgive me for the colloquialism. They also happen to be ‘wicked’ accomplished, capable, incredibly articulate and profoundly mission-driven – all of which will become apparent as you listen to this exciting and enlightening interview.  I’ve also had the recent opportunity to meet with other members of the Uber Health team and was super impressed with the healthcare acumen they’re bringing to the table: deep knowledge in Medicare, Medicaid, population health, healthcare benefits and so on…   Caitlin Donovan is the Global Head of Uber Health. She has held numerous chief operating roles in organizations including MyOrthos, ModivCare – previously called LogistiCare – a specialty benefits manager in non-emergency medical transportation, and CareCentrix, where she focused on home-based care and post acute care.  Early in her career, she worked in finance as an investor at Bain Capital, and as a member of the internal consulting group at Summit Partners.  She earned a bachelor’s degree in Economics from Harvard University and lives in Dover, Massachusetts with her husband and two sons.  Dr. Mike Cantor is a geriatrician and attorney. He is Chief Medical Officer (CMO) of Uber Health and CEO of The Cantor Group. Previously he has held positions as CMO for Bright Health Plan, CMO for CareCentrix, and CMO for the New England Quality Care Alliance (NEQCA). He still makes house calls one day a month in the Boston area, and has practiced for many years – in nursing homes, long term acute care facilities & the hospital setting. He trained in Internal Medicine at Beth Israel Hospital in Boston and completed a geriatrics fellowship at Harvard Medical School. He holds degrees in law and medicine from the University of Illinois. In this interview, we’ll hear: How devastating an issue access to care is in our country, and the incredible health and financial costs that accrue because patients aren’t able to show up to their scheduled appointments. The basic transport services that Uber Health is already offering to patients, healthcare providers, payers & health plans.  How Uber has expanded its transport to include providers – think ‘home health nurses’ and community health workers for starters. How Uber is reframing its transport to also include medications, testing, groceries and meals.  What Uber is doing in order to enable and engage low income and digitally challenged individuals who may not have access to smartphones, apps or even basic texting capabilities.  There are so many amazing discoveries that you’ll encounter in this interview.   The initial discovery that struck me is that Uber is a transport enablement platform which is expanding into adjancenies. Initially focused on transporting patients in the traditional service they offer to the public, they are now expanding by curating non-emergency medical transport (NEMT), and also expanding into the transport of groceries, meals, home testing devices and importantly medications.  In addition, they’re also transporting healthcare workers and providers of care. What is important to recognize is that Uber health is attempting to solve some of the immediate core challenges facing American healthcare. By focusing on food, medications and home testing, they are directly addressing the non-clinical (or social) determinants of health, which have a much greater impact on outcomes of care than even medical treatment.  By focusing on the transport of healthcare workers, they are addressing one of the critical issues we are facing today, which is the frightening shortage of providers as well as other care workers – a problem which is literally plaguing healthcare systems and communities across the country.  And, they are addressing the issue of healthcare burnout – again, a growing dis-ease within healthcare. By focusing on the transport of patients, soon to include NEMT, they are addressing a problem that has yet to be solved in American healthcare: access to care. During our dialogue, Caitlin states, “the number we often cite is that there’s $150 billion of loss annually in our healthcare system because of missed appointments.”  Leading up to that statement, she shares that a lot of the focus of Uber Health is on helping patients get to high frequency, high cost, high risk, high ‘no show’ appointments such as radiation treatments, chemotherapy and hemodialysis. This issue has a devastating impact on patients and their families, and represents a tremendous loss in terms of productivity, revenue and capacity for healthcare systems – all of which can never be reclaimed or recaptured.  A second discovery you’ll encounter in this interview is the digital enablement that Uber Health is bringing to the healthcare system. Up until this point, transportation has been a manual, mom-and-pop business. Provider practices and even large healthcare systems and health plans rely on local vendors to transport patients. All of this is conducted manually, often with antiquated technology. One of the major challenges in transport relates to patients’ benefits and eligibility.  In order to access transport, a patient has to have the insurance benefits and meet eligibility requirements. In a busy medical practice, having a nurse, care coordinator or medical assistant take the time to check a patient’s healthcare plan, their transport benefits and the specific eligibility they currently have, can literally bring the practice to a grinding halt. With its digital platform, Uber is attempting to make all of that happen automatically and at the speed of electrons. Imagine if an appointment was scheduled and the Uber platform automatically checked every patients’ benefits & eligibility and was able to schedule the pick up and drop off. That’s the magic of platforms and that’s the magic that Uber is attempting to embed into healthcare delivery. Keep in mind that these are not naive explorations. Caitlin spent years working in the domain of healthcare benefits and eligibility, so she knows, firsthand, what she’s talking about.  The other side of the platform effect is the ability to make it easier, not only for providers but also for patients. Uber Health has been automatically scheduling drop offs and pick ups for patients, removing the need for patients to schedule their own transport. And, to make it more accessible and convenient, they are sending either text or phone reminders to patients, thus removing as many barriers as possible for individuals.   A third discovery I’ll share in this brief is the mission-driven focus Uber Health is placing on health equity.  By removing the need to have a smartphone, internet connectivity, the ability to download apps and even texting capabilities, Uber is democratizing transportation and access to healthcare.  By automatically scheduling transport for patients and including reminders, they are making it possible for low income and technologically-challenged individuals to obtain care.   One example of their health equity focus is the Rise for Moms program piloted in Washington DC. In this program, Uber offered transportation to low-income, pregnant women who were obtaining care at two federally qualified health centers. About 60% of these women were high-risk pregnancies and most had to spend 30 to 60 minutes in public transport getting to their healthcare centers. 68% of these women reported major challenges in finding transportation to their appointments. 76% said it would have been far more difficult to make their appointments had they not had Uber. The results of this pilot demonstrated a marked decrease in no-shows. The implications here are profound in terms of reducing healthcare disparities and reducing the human and financial costs of high risk pregnancies. As we all know, the maternal/fetal rate for black women and their infants in the US is significantly higher than for white women – a shameful national statistic that has to be remedied. Imagine how many lives and how much cost would be saved if the Rise for Moms program was deployed at a national scale!   Never before in my career would I have thought to be so enthusiastic about the possibility of a transportation platform solving some of the core challenges in American healthcare. This speaks to the point that health care is much larger than the traditional health care we have all been trained to believe in. It speaks to the point that the transformation of American healthcare will require the integration of numerous disciplines and industries, as well as social and political sectors that have not been considered a formal part of our healthcare system.  It speaks to the fundamental point that we will not solve the American healthcare dilemma unless we allow ourselves to be open to reframing healthcare. Until next time, be well. Zeev Neuwirth, MD

Friends, Whether you’re 25 years old or 75 years old, when you walk into primary care providers’ offices in most places across the country, the care you’ll receive is pretty much the same. The people in the office are the same; the services are the same; the protocols are the same; the time slots you get are the same. Does that make sense to you? To state the obvious – a 65-year old, 75-year old and 85-year old have much different needs, concerns and issues to deal with than patients in a younger demographic. And yet, the healthcare seniors receive is largely undifferentiated. In this episode, we’ll hear about a segmented, customized, personalized and holistic approach to senior care that is being delivered by a highly innovative pay-vider. Humana has, for years, been a national leader in senior care, home-based care, and the social determinants of health. In this episode, we’ll explore these topics with the incredibly accomplished Dr. William Shrank. Now, I do want to add that there are other organizations who have been segmenting and customizing care for seniors. My three favorite examples are ChenMed, CareMore and Iora Health. ChenMed is, in my opinion, the paragon for VIP care of seniors.  A few other examples include Archwell, Oak Street, Patina, Landmark, Lena Health, and Landmark which is now part of Optum. Large hospital/healthcare systems across the country are also beginning to develop similar models of care that are focused on seniors. Dr. William Shrank serves as a Senior Advisor at Humana, after recently stepping down as Chief Medical Officer. His current responsibilities include implementing Humana’s integrated care delivery strategy. He leads Humana’s Care Delivery Organization, clinical operations, and the Bold Goal population health strategy. Dr. Shrank held the position of Chief Medical and Corporate Affairs Officer from July 2019 to July 2021, during which time he also oversaw government affairs. Dr. Shrank joined Humana as Chief Medical Officer in April 2019, having previously been employed by the University of Pittsburgh Medical Center (UPMC) where he served as Chief Medical Officer of their Insurance Services Division from 2016 to 2019. Prior to UPMC, Dr. Shrank served as Senior Vice President, Chief Scientific Officer, and Chief Medical Officer of Provider Innovation at CVS Health. Before joining CVS Health, Dr. Shrank served as Director of the Research and Rapid-Cycle Evaluation Group for the Center for Medicare and Medicaid Innovation, part of the Centers for Medicaid and Medicare Services (CMS). Dr. Shrank began his career as a practicing physician with Brigham and Women’s Hospital in Boston and as an Assistant Professor at Harvard Medical School. He has authored over 250 peer-reviewed publications. Dr. Shrank received his M.D. from Cornell University Medical College. He completed his residency in Internal Medicine at Georgetown University and his fellowship in Health Policy Research at UCLA. He also earned a Master of Science degree in health services from UCLA and a bachelor’s degree from Brown University. In this interview, we’ll hear about: The impressive investments that Humana has made into senior care, home-based care & the social determinants of health. Humana’s national deployment of senior care clinics as well as the larger integrated Centerwell brand that includes home-based care & pharmacy. The incredibly thoughtful divisions they’ve created focusing on digital health, social equity, and clinical solutions.  How Dr. Shrank views the relationship between healthcare systems and payers. The significant emphasis that Humana places on being a “rapid learning organization” and their focus on data-driven decisions & evidence-based deployment. I admire so many things about Dr. Shrank. He is a physician, health services researcher, healthcare administrator and visionary leader. He’s also incredibly humble and as much a learner as he is a doer. His background and the years he spent at CMS and CVS have provided him with incredible experience in how to deploy and evaluate large-scale, value-based programs.  Along these lines, the emphasis that Humana has placed on scientifically evaluating their initiatives and making data-informed decisions is exemplary. In this episode, Dr. Shrank articulates some of the challenges in systematically and scientifically evaluating whether or not initiatives create patient engagement and deliver on outcomes; as well as their scale-ability.  One also has to respect Humana’s forward-thinking focus on social equity and the social determinants of health, which is largely credited to their CEO, Bruce Broussard, who initiated “The Bold Goal” project in 2015. Along these lines, Dr. Shrank discusses the CDC’s self-reported “healthy days” metric that Humana has been pursuing; as well as their perspective, which is to make social determinants of health an integral part of every day care delivery.  We go into some depth on why Humana has created a segmented and customized care model focused on seniors, and what differentiates this value-based model from the generic primary care medical home. Dr. Shrank is very firm in his belief that in order to deliver seamless, personalized care and optimal outcomes for the senior segment of our population, we need to create a very different primary care model. He also makes the point that data and analytics is the key to understanding patients’ needs, and that these understandings will contribute more to personalized care than genomics.  In the final moments of the interview, I asked Dr. Shrank what message he had for healthcare system C-suites.  His response was one word, “partner”.  He makes the point that healthcare is too complex for any one system or stakeholder to get it right; and in the best interest of our patients and our communities, we need to become better partners with one another.  When I asked him what message he had for the leaders at HHS & CMS, his response was to put outcomes over ideology; which is no small task given the current polarized political climate.  Dr. Shrank didn’t use this term, but it was apparent to me that throughout our dialogue he was painting a picture of a ‘whole health’ model of care. His point of view is laser focused on what matters most to patients, especially those that are part of more vulnerable populations. One saving grace of our healthcare system is that we have humanitarian leaders like Dr. Shrank and his colleagues at Humana who not only talk the talk but also walk the walk – leaders who are committed to a value-based system of care that places personalized health outcomes as their KPI. Until next time, be well. Zeev Neuwirth, MD

This is a singularly unusual and unprecedented episode. Aug 17th 2022, which is the day of the posting of this episode, is the 5th anniversary of the ‘Creating a New Healthcare’ podcast. I’m taking this opportunity to spend a few minutes reflecting on the journey – and to share those reflections with you. As always, I am interested in your thoughts as well, so please respond on LinkedIn and Twitter. Initially, I was planning to host this by myself, but then I thought how much more interesting and fun it would be to have someone else to speak with, especially someone who is adept with hosting their own podcast. The first person who came to mind was the amazing Scott Becker, who graciously agreed to interview me for this episode. Scott Becker needs no introduction, but for those who don’t know his history… Scott Becker is the founder & publisher of The Becker’s Healthcare and Becker’s Hospital Review. He is an attorney, a partner at McGuireWoods and a former board member of McGuireWoods.   Scott also served as chair of the national health care practice at McGuireWoods for more than 12 years.  He is a graduate of Harvard Law School and a CPA.  And, as I mentioned before, an amazing podcast host! In this interview, I’ll share: The very real tension that is driving this podcast, as well as its fundamental purpose, which is a bit different from other podcasts. A few critical lessons I’ve learned from our guests over the past 5 years. Some examples of the courageous journeys that we’ve been privy to hearing on this podcast. A couple of favorite quotes from the amazing leaders I’ve interviewed. What continues to energize and inspire me about the podcast journey and some thoughts about what’s next. Without giving away too much, here are a few brief thoughts on this discussion with Scott Becker.   First – it was an incredible honor to have Scott Becker interview me. He is one of the most generous individuals I have come across in the healthcare world and I have tremendous respect for what he has built, including the incredible relationships he has fostered.   Second – when I reviewed the list of the brilliant leaders who have been on the ‘Creating a New Healthcare’ podcast – over 250 interviews, 137 of which I’ve posted – I was surprised at how many were situated within legacy healthcare organizations: hospital systems, payers… I would have thought that the majority were entrepreneurs in start-ups, but it seemed to be split pretty evenly. The takeaway is that transformational change can and does occur within legacy healthcare systems – hugely hopeful and inspiring! Third – although I’ve conducted hundreds of interviews, there are actually a relatively small number of critical lessons or themes that these leaders all resonate around. I share 3 major lessons in response to a question Scott asks; but there are a few others that are woven throughout the dialogue. And I love that Scott inserts some important takeaways in there as well.     Fourth – despite a lot of rhetoric about the demise of our healthcare system, I share an informed and grounded perspective that I have never been more encouraged, hopeful and inspired than I am today. This doesn’t come from an armchair perspective. I work in our healthcare system each and every day, as I have for the past 30 plus years. And, my overall sense is that there has never been a better time for the humanistic transformation of American healthcare.    Fifth – My overarching perspective is one of respect and gratitude. There is no question that our healthcare system is in need of some serious fundamental change.  But, there is also no question in my mind that the vast majority of the people working within our healthcare system are truly amazing. The doctors, nurses, PA’s and other providers, as well as the administrative leaders and staff who work tirelessly each and every day – week after week, month after month, year after year.  No matter what swirls around them, no matter what politics or payments or pandemics, they perform professionally – with compassion and empathy. They hold our system together. My respect, gratitude and hope arise from working with, watching and learning from these truly incredible individuals. Two final thoughts here –  I’d like to take a moment to thank all of you out there who have been listening to, commenting on and sharing this podcast with your professional networks. I can’t begin to tell you how important and meaningful your feedback is to me.   I hope you enjoy and benefit from listening to this particular podcast episode as much as I did in recording it. Until Next Time, Be Well Zeev Neuwirth, MD

Friends, There is a quiet, maybe not so quiet, revolution happening in healthcare delivery. The transposition of healthcare out of the legacy bricks & mortar sites and into the home. Payers such as Humana and Optum, as well as retailers such as Amazon, Best Buy Health and Walgreens are spending tens of billions of dollars acquiring companies and capabilities to bring medical care into the home. There are hundreds of vendors that are already years into creating a home-based care ecosystem. With the increasingly sophisticated remote monitoring, digital diagnostic equipment, predictive analytics, telemedicine & logistics software capabilities, we are seeing these companies provide more personalized and contextualized care that, in many ways, is not only more convenient, but actually superior to care in the hospitals, ED’s & clinics. We’ll be asking our guest today, Dr. Mark Prather, to share his industry-leading experience and wisdom on all of this. Dr. Prather has an impressive track record in both the clinical and entrepreneurial domains. He practiced as a board-certified emergency medicine physician for more than two decades. He was a founder and served as President of US Acute Care Solutions, an integrated acute care physician staffing organization serving approximately six million patients annually. He has partnered in multiple medical industry startups, including iTriage, an early digital patient navigation tool. Dr. Prather obtained his undergraduate degree in Molecular Biology at Vanderbilt University. He attended medical school at UCLA, where he graduated with honors, and completed residency training in Emergency Medicine at Denver Health where he also served as Chief Resident. He also obtained a Master of Business Administration from the University of Colorado School of Business. In this interview, we’ll hear about: The profound & documented clinical, interpersonal & economic advantages of home-based care compared to traditional brick & mortar hospital based care. How home-based care is much more effective in assessing & addressing social determinants of health. The evolution of Dispatch Health from urgent/emergent care at home to a full service home-based healthcare ecosystem, and why Mark decided to start with urgent/emergent care visits. How Dispatch Health is evolving their payment into the value-based realm & the incredible cost savings they’ve already demonstrated. Some critical comments from Mark regarding how home-based care is actually much safer, far less fragmented, and much more personal than the traditional brick & mortar care being delivered in hospitals, ED’s & doctors’ offices. Why Mark firmly believes that home-based care will disintermediate the brick & mortar landscape of healthcare delivery. There are a few take-aways that I believe are incredibly important for all of us to understand about the home-based care ecosystem. First – Healthcare in the home is not a hypothetical and not some future state. It is happening and in significant numbers. Dispatch Health has already seen hundreds of thousands of patients, over 700,000 in the home, and is seeing hundreds of thousands of patients annually. Second – The acuity or severity of patients being cared for in the ‘Hospital at Home’ are not the mildly sick patients. Mark’s data reveals that the patients cared for in the home are in the top 10% of acuity according to the Charleston Comorbidity Index. Third – the cost savings are real and significant! Dispatch Health is documenting savings of $5000 – $7000 per admission compared to traditional hospital admissions. Mark goes into some detail as to how these cost savings are occurring. What’s remarkable to note is that these savings accrue not because there is less care, but actually because there is more and better care. Fourth – In addition to the concrete clinical & safety benefits, Dispatch Health has an average Net Promoter Score of 95%, with over 700,000 patient home visits & home hospitalizations. Along the lines of patient experience & satisfaction, it seems almost too obvious to mention but this sort of care delivered in the home is infinitely more convenient and comfortable for patients and their families than hospital-based care or traditional ED or even urgent care. Fifth – Care delivered in the home is much more personal, customized and contextual than care delivered in hospitals, ED’s, nursing homes, urgent care centers & doctor’s offices. Mark points out that being in the home really shifts the focus of the clinicians from a limited triage & treat function to a treat & recovery function. Clinicians & staff in the home have purview into the patient’s life – into non-clinical determinants of health like social supports, medications, food security and home safety – that have as much, if not more, of an impact on health outcomes. One great example Mark provides of how home-based is more humanistic is around end-of-life conversations. These sorts of conversations are challenging in the ED & hospital setting. But, in the home care setting, they become much more personalized and comfortable for patients and their families. Sixth – The clinical benefits are myriad including:(1) far lower risk of hospital acquired infections and other dangerous conditions; (2) lower risk of delirium and falls; (3) lower risk of malnutrition; (4) lower risk of readmission and/or the need for post acute care nursing facilities; and (5) lower risk of mortality – Mark quotes a 20% reduction in mortality. Seventh – the advantage of the patient being initially evaluated at home. Once a patient enters a brick & mortar Emergency Department, their chance of being referred to ‘hospital at home’ is about 35%. Mark attributes this largely to the pressure ED docs face in getting people out of the ED and into a hospital bed. But, if the patient is initially evaluated in the home, their chance of staying in the home (aka – being referred into the ‘hospital at home’ service) is 97%. Two final lessons – one of the key reframes I’ve learned from Dr. Prather as well as other leaders in the home-based care space is that the notions of Urgent Care, Emergency Care, Hospital Care, Post Acute Care – are all arbitrary legacy concepts that have little bearing in the home-based care ecosystem. As Mark and other leaders put it, ‘care is care’. If a patient needs medical/clinical care in the home, it’s simply that – whether it’s urgent, emergency, hospital level, post-acute hospital care and so on. The difference is just a matter of how much and how intense that care is. But the point is that it doesn’t make sense to label it based on legacy brick & mortar concepts. The other related lesson is how much more seamless and safe home-based care is, as compared to traditional brick & mortar hospital-based care. For example – when a patient is discharged from a 5 – 7 day hospital stay, they typically get transitioned to a nursing or rehab facility, or they get transferred back home. What most people don’t understand is that this requires numerous hand-offs which introduce tremendous opportunities for safety errors, and typically leads to a readmission back into the hospital about 20% of the time. If the patient is discharged home, there is also a bit of a leap of faith, because as much as case managers and care managers can inquire about, they don’t have an in-person understanding of what the home environment looks like. What I found fascinating about the Dispatch health ‘hospital at home’ model is that the patient is actually not discharged. The intensity of their care may be reduced after 5 – 7 days, but they are actually followed for up to 30 days. And because there are no artificial hand-offs and because the clinicians and staff are in the home, there is far less risk involved in the transitions of care. I suspect that the vast majority of clinicians and healthcare leaders are unaware of this particularly important point. Dr. Prather is, as he modestly puts it, “an old hospital systems guy”. But he has spent the past decade intensely studying, innovating and now building an incredibly robust home-based ecosystem of care. Mark is not an academic physician or researcher. He is a seasoned clinician and clinical leader, and a highly experienced and successful healthcare entrepreneur, who had to be convinced that the clinical model and business model for home based care worked better than the traditional hospital and ED based model. He’s convinced. How about you? Until Next Time, Be Well Zeev Neuwirth, MD

Friends, The first interview we conducted with Ben Kligler (see episode #130) was an introduction to a game-changing humanistic inflection in healthcare delivery called ‘Whole Health’.  If you haven’t listened to it yet, you must. What the VA is deploying on a national scale may be the largest and most significant positive transformation occurring in the American healthcare system. This interview builds on what we discovered in episode 130, but we get a chance to really discover the essence of this life-saving movement.  In the beginning of this interview, Dr. Kligler lays it out plainly, “…we are creating an actual delivery system built on whole health”.  His response to the ‘why’ question is also straightforward and rings true. “… we’ve gotten to the limit of what disease-oriented care can do in terms of improving our health and well-being…” He goes on to support this statement with statistics and well reasoned arguments. One stat he cites is that the US continues to rank the lowest on multiple domains of healthcare, including health outcomes, when compared to other high-income countries. In fact, the US ranks 37th in the world when it comes to healthcare outcomes, despite grossly outspending every other country.   I think most of us understand the problem at hand, but we may not really understand the ‘whole health’ solution. Ben does a fantastic job of distilling it down for us, “Our theory is that our legacy healthcare approach is not tapping into one of the most powerful sources of health, which is a person’s ability to make changes in their life and move forward, toward what’s important to them; and to address what’s in their way – what’s keeping them from having a healthy life.  [Whole health] is also a vehicle for addressing the social and structural determinants of health… It’s really the solution to what’s holding our healthcare system back… because managing disease is simply not enough…” Benjamin Kligler, MD, MPH, is a board-certified family physician who has been working as a clinician, educator, researcher and administrative leader in the field of complementary and integrative medicine for the past 25 years. In May 2016 he was named National Director of the Integrative Health Coordinating Center (IHCC) in the Office of Patient Centered Care and Cultural Transformation (OPCC&CT) as well as Director of Education and Research for Whole Health. In May 2020 Dr. Kligler was named Executive Director of the Office of Patient Centered Care & Cultural Transformation (PCC&CT.) He is a Professor of Family and Community Medicine at Icahn Mount Sinai School of Medicine, and was Vice Chair & Research Director of the Mount Sinai Beth Israel Department of Integrative Medicine. He is currently a core faculty member of the Leadership Program in Integrative Healthcare at Duke University. In this interview, we’ll hear about: The two questions that form the foundation for the ‘whole health’ program.  I’ll give you a teaser. The first question is, ‘what in your life most matters to you?’ Can you guess what the second question might be?  See below.  The specific domains within the “circle of health” which assist providers and patients in identifying what’s most important and most relevant to the context of patients’ lives. How this program is intent on not only identifying the issues, but also providing the tools and support in attaining and maintaining those personal goals.   The ‘whole health’ outcomes that the VA is measuring and tracking, and those they’re already beginning to see improvements in.   Some of the challenges in studying these outcomes and deploying the program on a national scale, as well as next steps  There are a few notable comments from this dialogue with Dr. Kligler that stand out for me.   First – a surprising benefit of the VA’s Whole Health approach is that the providers and staff are also benefiting. The VA is observing an improvement in provider & staff work satisfaction as well as a reduction in turnover. Given the significant burnout (~50% amongst doctors and nurses) and the ‘great resignation’ in healthcare, leaders should take note and consider this Whole Health approach. It should come as no surprise that one of the core defining elements of burnout is depersonalization.  Second – One of the most surprising and telling stats that Dr. Kligler cites is that people who have a low sense of purpose are two and a half times more likely to die than people who have a high sense of purpose.  Based on that research, he goes on to ask the question ‘why isn’t ‘purpose’ a core vital sign?’.  Well, in the whole health approach it is one of the main domains on the ‘circle of health’. His point is that ‘sense of purpose’ and other non-clinical factors are, in fact, ‘vital’ signs – determinants of our vitality. We’ve known this for years, with mounds of scientific evidence to support it, and yet, we continue to propagate a system that excludes these ‘vital’ signs. Why is that?  Third – Dr. Kligler points out the critical reason why the VA can pursue a Whole Health contextualized/personalized approach to healthcare, while most other healthcare systems can not. It has to do with payment & compensation. The VA is essentially a value-based, capitated-payment provider – a so-called payvider. What this means is that if the VA prevents a bad outcome, it gets to keep the savings, which it uses to re-invest in its healthcare delivery system. So, in the VA system, prevention has a positive return-on-investment and is consistent with the business model. On the other hand, the overwhelming majority of payment in this country (outside of the VA) is fee-for-service (FFS). You get paid for what you do rather than what you prevent, which makes it financially more difficult to invest in proactive, personalized, preventive care. As he puts it, the VA is not ‘conflicted’ or ‘confused’ by a FFS payment model in which contextual factors of care have little to no return on investment.  For those of you who listen to this podcast regularly, this is a recurrent theme.    Fourth – Despite the challenges and conflicting incentives of our FFS-based healthcare system, I was very encouraged to hear that others across the country are also developing a ‘whole health’ or ‘whole person’ approach.  Dr. Kligler shares that the National Academy of Medicine (NAM) is planning to publish a report some time next year, providing an inventory and summary of the whole health movement.  On a final note – I’m writing this on a hot and humid afternoon of July 4, 2022.  I share this with you because Independence Day reminds all of us of the soldiers and veterans who established our independence and continue to defend it. The fact that the Veterans Administration is spearheading the ‘whole health’ approach – rehumanizing healthcare for our veterans – is particularly poignant and special on this day.  Another connection of Whole Health with this day has to do with the concept of liberty. “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”   We cherish our liberties in this country because they enable us to express ourselves, to pursue our dreams and goals, to achieve and manifest what matters most to us, to be the best we can be, and to live the best life we can.  I view Whole Health as a public health movement that is based on the principle of liberty – enabling and empowering us to attain what matters most to us. I salute Dr. Ben Kligler and his colleagues, and the brilliantly humanistic leadership of the Veterans Administration for creating and supporting the whole health revolution.   Wishing you Whole Health Until Next Time, Be Well Zeev Neuwirth, MD

Friends, I’ve listened to this podcast multiple times, in preparation for this write-up.  Each time I listen, I learn something new and continue to be blown away by what the visionary folks at Laguna Health are doing and building. The bottom line here is that our healthcare system is not designed to identify and address the contextual [life] barriers of care. As a result, patients and their families suffer, health outcomes are worse, and the jobs of providers and their teams are made much more difficult. Laguna Health is reversing that by creating a much more contextualized and personalized healthcare approach.  In this interview we distill decades of patient-centered research that Dr. Saul Weiner and Dr. Alan Schwartz have conducted and are now embedding within the Laguna Health approach. It is the most significant and impactful applied research I have ever encountered in terms of understanding how the context of people’s lives impact their healthcare and their health outcomes. And, importantly, how clinicians, clinical teams and healthcare systems can identify barriers to care and address them as an integral part of the healthcare experience.  The magic, however, doesn’t stop here.  Laguna Health has taken this extraordinarily empathetic approach and combined it with the most advanced digital technologies to create an ecosystem of care that supports the provider-patient relationship and promotes a humanistic form of healthcare. This is in stark contrast to what most patients and providers have to endure – which is an underlying technologic platform and system of care that makes it difficult for providers to really listen to and understand their patients, and makes it very difficult for patients and their families to navigate healthcare within the larger context of their daily lives.  The majority of the interview was conducted with Dr. Weiner and Dr. Schwartz, who literally wrote the book on ‘Contextualizing Care’. We were also fortunate to have Dr. Spiro (Chief Medical Officer) as well as Yoni Shtein (co-founder and CEO) on the line to provide some brilliant commentary in what was one of the most engaging and awe-inspiring conversations I’ve had on this podcast.  Dr. Weiner is co-founder of the Institute for Practice and Provider Performance Improvement. Dr. Weiner is a professor of medicine, pediatrics and medical education at the University of Illinois at Chicago, and deputy director of the research Center of Innovation for Complex Chronic Health Care at the Veterans Health Administration. He graduated from the Geisel School of Medicine at Dartmouth, completed his residency in Internal Medicine at the University of Chicago and is a former Robert Wood Johnson Foundation Generalist Physician Faculty Scholar. Dr. Schwartz is also a co-founder of the Institute for Practice and Provider Performance Improvement. He is the Michael Reese endowed professor of medical education, and research professor of pediatrics at the University of Illinois at Chicago. Dr. Schwartz received his PhD in cognitive psychology and Masters in business at the University of California, Berkeley. He is currently enrolled in the JD program at the University of Illinois at Chicago School of Law. Dr. Alan Schwartz & Dr. Saul Weiner co-authored the book on contextualized care – Listening for What Matters: Avoiding Contextual Errors in Health Care.    In this interview, we’ll hear: What contextualizing care actually means – from the physician and medical researcher who have been studying this topic for over 20 years, and who have taught it to thousands of doctors and healthcare teams. How critically important contextualizing care is in delivering optimal healthcare outcomes, and how frequently it is ignored in clinical practice. The difference between empathetic care and contextualized care. Contextualized care is not the same thing as good bedside manner! The twelve domains of contextualizing care that Dr. Weiner and Dr. Schwartz have discerned from intensely & rigorously studying over 5000 patient-provider encounters. Which one of the twelve barrier domains these experts emphasized as being grossly missed in healthcare delivery.   What I love about the Laguna Health story is that these visionary leaders are operationalizing and technologizing – automating – a humanistic form of healthcare delivery that is almost the inverse of mainstream healthcare. They are literally contextualizing care for each and every patient and their families by embedding it in the process and embedding it in the tech platforms.  Most providers would agree that the current legacy electronic health records as well as workflows make it more difficult to understand the context of patients’ lives and its impacts on healthcare. What Laguna is building is quite the opposite – creating a tech platform and a system of care that literally has personalized care built into it, at every step of the way – from assisting the provider teams in identifying barriers to healthcare, to supporting their inquiry of those barriers, to eliciting actionable responses from patients, to identifying and implementing a plan of action to overcome these contextual barriers.   The team at Laguna Health is taking Dr. Weiner and Dr. Schwart’s profound work and putting it on steroids, enabling it with state-of-the-art data analytics and machine learning, natural language processing and voice analytic technologies, as well as embedding it within their team structure, their training and their workflows.  I could literally feel the energy and enthusiasm in speaking with Dr. Weiner and Dr. Schwartz – the realization that their decades of research and teaching were being taken to a whole different level.  As I listened to these leaders from Laguna Health, I could not help but realize that they are, in fact, creating a new, better and more humanistic healthcare system. I also could not help but think that they are doing nothing less than creating a new standard of care. It is breathtaking and inspiring – and I encourage you to listen to this episode more than once. You will be better for it.  Until Next Time, Be Well Zeev Neuwirth, MD

Friends, Our topic today is nothing less than a new standard of care for a vulnerable segment of the population that has been subjected to highly fragmented, uncoordinated and grossly inadequate medical care. For those of us who have experience with older parents as well as for physicians and other providers of care – you understand how challenging, frustrating and heartbreaking this situation can be. Dr. Michael Le, and his colleagues at Landmark Health and Optum’s Home & Community division, have spent decades developing and deploying a remarkably humanistic alternative approach to care for this vulnerable population.  He outlines for us a comprehensive, concierge-like, premier home-based care ecosystem for frail seniors and those with complex chronic conditions. Dr. Michael Le is the Chief Medical Officer of Optum Home & Community, as well as the Co-founder & Chief Medical Officer of Landmark Health. He has spent the majority of his career serving high-acuity, frail patients through the development and implementation of innovative care models.  Prior to Landmark, Dr. Le served as the Chief Medical Officer of Fidelis SeniorCare, a Medicare Advantage Special Needs Plan.  Before that, he was the Senior Medical Officer at CareMore, a Medicare Advantage plan where he ran high-risk clinical programs. Prior to CareMore, Dr. Le was a Regional Lead Hospitalist at HealthCare Partners, a risk-bearing medical group, where he was the physician lead for the company’s high-risk Ambulatory Case Management program. Dr. Le received his MD at UCLA and completed his residency in internal medicine at Cedars-Sinai.  In this interview, we’ll hear: The profound problem and tremendous gap in the American healthcare delivery system that Landmark is solving. The various types of home-based care that Landmark offers to frail elderly individuals and seniors with complex chronic conditions. The remarkable outcomes that Landmark has achieved for patients, providers and payers. Where Landmark is going next and some insights into Optum’s Home & Community division. There are some many wonderful aspects to the healthcare approach Dr. Le and his colleagues have created at Landmark Health and are now incorporating as part of Optum’s Home & Community division. The core team is a pod composed of a physician, a NP or PA, a nurse care manager, and a health ambassador/health coach.  Surrounding this core team is another team of a pharmacist, a psychiatrist and a social worker.  And even beyond that, there is another team of specialists in urgent and emergent care that can be deployed for more complex testing and procedures in the home.  It’s nothing less than an entire ecosystem of high quality, comprehensive clinical care that can be delivered in patients’ home – 24/7!   Another key differentiator of this new standard of care is that it’s equally focused on the social and behavioral aspects of medical care.  In fact, Michael shares with us that over 50% of the calls they receive from patients and family members have to do with psychosocial factors, the social determinants of health and palliative care needs.  What I found remarkable is that Landmark trains every one of its providers and team members in a specially designed program around how to discuss and deliver excellent Palliative Care. It’s clear from listening to Michael that they not only talk the talk around Palliative Care and outstandingly respectful and dignified end of life care – they walk the walk.  It’s heartwarming to hear how intentionally caring Landmark is in this domain. The proof, of course, is in the pudding and Landmark’s outcomes are remarkable. A 20 plus percentage reduction in hospital admissions; a 20 – 30% improvement in the Medical Loss Ratio; a 43% reduction in emergent dialysis starts. The statistic or outcome that really gripped me was the 26% reduction in mortality.  This is astounding – and it really speaks to the holistic care that the Landmark team provides, and their approach to dealing with the real barriers to care in real time.   When you listen to Dr. Michael Le speak, you hear a physician who grew up watching his father practice medicine in a small town, carrying a black bag and doing home visits.  Michael and his Landmark colleagues have brought the best of the past into the present, and propelled that care into the future with a high tech, high touch holistic approach to care that delivers hospital and ED quality care in the comfort, convenience and safety of the patients home.  This type of care would be welcome by all of us, but it’s especially needed and appreciated by those elder patients who are suffering with complex and chronic conditions – issues such as dementia, frailty, and end stage chronic diseases.  Landmark Health was acquired by Optum Health and Dr. Le could have easily retired.  But instead he has joined Optum Home & Community and launched a whole new chapter in his career and a whole new chapter in the field of home-based care.  As he puts it, “The vision at Optum Home & Community is to break down silos and improve collaboration – to give patients a seamless care experience across their entire continuum of needs”.  He and his colleagues at Optum have united numerous companies under the umbrella of home-based care, and their goal is to scale it across the country.  It’s a breath-takingly bold and brilliant vision – and one that will contribute to improving the care for some of the most needy and vulnerable seniors.  I have so much respect and admiration for Dr. Michael Le and his colleagues.  We need more leaders like this in healthcare: focused on what truly matters and what truly makes a difference in patients’ lives – in all of our lives! Until Next Time, Be Well Zeev Neuwirth, MD