Glen Tullman, former CEO of Livongo Health and current Executive Chairman & CEO of Transcarent, discusses the lack of alignment between payers, healthcare systems, and employers. He also explores the impact of digital healthcare companies on healthcare delivery. Tullman emphasizes the importance of empowering individuals and transforming the healthcare system. The chapter also introduces Transcarent, a healthcare consumer experience company, and discusses the concept of Transcaring and the key components of their offering. They also discuss the benefits of technology in rehab and physical therapy, lowering pharmacy costs, and creating a curated package and ecosystem for healthcare solutions.

Friends, Welcome back to the first episode of the 2021 Fall season.  We are embarking upon the 5th year of the ‘Creating a New Healthcare’ podcast – and we have an amazing line-up of courageous, bold, entrepreneurial individuals that we’ll be hearing from this season. In this episode, we have the privilege of speaking with Michellene Davis. The theme of this interview, which was recorded on Aug 4th 2021, is centered on eliminating the racial disparities & inequities in the healthcare profession, as well as addressing the gross disparities in healthcare delivery and outcomes in the US. Ms. Davis is the new President and Chief Executive Officer of National Medical Fellowships, Inc.  Prior to her current role, Ms Davis served as the Executive Vice President & Chief Corporate Affairs Officer at RWJ Barnabas Health, the largest academic medical center system in New Jersey. Michellene has been named among the Top 25 Most Influential Minority Leaders in Healthcare by Modern Healthcare Magazine. Prior to joining RWJBarnabas Health, Ms. Davis served as Chief Policy Counsel to former New Jersey Governor Jon Corzine, where she was the first African American to serve in this position. She was the first African American and only the second woman to serve as Acting New Jersey State Treasurer, responsible for a state budget of over $30 billion dollars. She began her legal career as a trial litigator. In this episode, we’ll learn about: The National Medical Fellowship Inc – the only private organization solely dedicated to providing scholarships to medical and health professions students underrepresented in healthcare. The tens of thousands of professional alum that have been supported by the NMF since its inception in 1946, including 2 surgeon generals. The leadership development programs and the unique community of support that the NMF offers medical students and fellows. How the NMF directly addresses the elimination of the disparities & inequities in American healthcare through an evidence-based approach. Michellene’s articulation of the purpose and value of the National Medical Fellowship Inc is enlightening. It’s goal, as I now understand it, is three-fold.  First, to break the cycle of inequity in medical education by providing medical students, residents and subspecialty fellows with financial support. The second goal is to not only increase the percentage of doctors who are Black, LatinX and other under-represented ethnicities in medicine; but also to support these students and trainees in advancing as leaders. The third goal is to eliminate the disparities in healthcare delivery and outcomes in our country. Toward the end of the interview, I ask Michellene why she upended her career to make this recent professional shift. Her response – “At the height of the pandemic I watched no less than 30 of my colleagues perish. And when you look at who perished and who are the most vulnerable in our communities… after that I just realized that I am done dying. I am done watching colleagues and communities suffer and die, at the expense of what others would just consider an inconvenience…  And I just am tired of watching the same community members suffer the same reality, when those who are in power are blind to the entire equation… And for me, what shifted was that on this side of Covid, with whatever amount of time I might have left on this planet…  I needed every second of it to truly matter, to address this one ill, to save even one life, and to change the face of medicine. As a result of that, I came to NMF…” Michellene Davis is a leader of rare integrity, honesty and courage. Michellene’s discernment is a litmus of the insidious fundamental wrongs that need to be righted within our healthcare system. Her professional actions and her career trajectory demonstrate a commitment to doing something about it – not talking about doing something – but actually doing something. In my 30 years in healthcare, I have heard countless mission statements & purpose statements – multiple pronouncements about a new day in healthcare. But I have never heard anything as authentic, as meaningful, as resilient, and as full of selfless conviction and integrity as Michellene’s statement of purpose. Her words will ring in my ears and resonate in my soul for years to come. Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, Our guest this week, Steve Nelson, takes us on a journey into a new category of company that is curating the collaboration between employers and providers. It’s an incredibly exciting adventure – actually a leap into the world of value-based care. The insights that he shares provides a lens into where healthcare is going – empowering patients & payers to navigate to healthcare that is appropriate, high quality and reliable. Into this mix are enabling technologies that contribute to the value proposition. It’s an incredibly enlightening dialogue – not one you’ll want to miss. Steven Nelson leads the Contigo Health team as President. He was one of the leaders who initiated Contigo within Premier, a leading hospital supply chain company. Before joining Premier, he served as Vice President of Strategy and Planning and COO of Anthem’s diversified business group. Prior to joining Anthem, Nelson led strategy, product and marketing at Highmark Blue Cross Blue Shield and helped to build Allegheny Health Network, a provider entity consisting of seven hospitals, 2,000 doctors and various other facilities. In this episode, we’ll discover: The challenge that employers face in understanding and dealing with the staggering costs of healthcare, and how they’re responding. How the ‘Centers of Excellence’ program and network management – which are foundational to employer-based healthcare – are evolving. The use of ‘2nd opinion’ interventions in maintaining high standards of quality in employer healthcare navigation offerings. How Contigo is convening local collaborations between employers, healthcare systems & health plans – and creating vertical ecosystems with numerous other enabling partners. One of the revealing insights that Steve shares during the interview is that the purpose of Centers of Excellence (COE) is not necessarily to drive costs down; but instead, to drive value up!  For years, I’ve heard the concern that bundled payments are a ‘race-to-the-bottom’. Steve reframes them as a ‘race-to-the-top’. The value of these COE’s is NOT that they provide a lower unit price for heart surgery or joint replacement. The value is that they don’t perform unnecessary procedures. They provide an overall bundle of care that is of higher quality, safety and legitimacy. I underscore this because we know that a significant percentage of procedures and surgeries performed in this country are unnecessary, thereby subjecting the American public & employees to unnecessary harm & costs. In fact, the Lown Institute just published a report demonstrating that over 60% of hysterectomies and nearly 25% of cardiac arterial stenting procedures were unnecessary. This was a 2-year Medicare study of 3100 hospitals which discovered that older Americans were subjected to over 1,000,000 unnecessary tests & procedures. Within that were 200,000 cardiac stent procedures that fell into the category of ‘overuse’. Core to Contigo’s approach is that they convene and coordinate local collaborations between employers and healthcare systems. Not only are they convening, but they are optimizing care through: (1) standardized, high reliability, bundled pathways in specialty areas; (2) providing physicians with clinical decision support tools, best practice alerts and patient benefits information; (3) assisting employees in navigating to and accessing high quality care; and (4) using both clinical data, claims data, and advanced analytics to identify patients at risk. Contigo is also bringing health plans into this ecosystem, as well as in numerous enabling technology vendors. What I find encouraging is that Contigo is not alone in creating a more integrated, seamless value-based system of care. While many healthcare systems across the country are hedging their bets and responding as if fundamental transformation is not around the corner, this movement of direct-to-employer curators & navigators is leading and catalyzing the transformation to assure that patients receive the right care. In 2020, over two-thirds of large employers were steering, or planning to steer, their employees to Centers of Excellence. There is little doubt that employers will continue to play an increasing role as a major market force pulling us toward value-based payment & care. As healthcare becomes less affordable for the majority of Americans, we are rapidly reaching a tipping point, or perhaps more like a boiling point. This does not seem like the type of bet any healthcare stakeholder should be hedging. Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, In this episode, Dr. Shantanu Nundy shares with us his thoughtful reframing of healthcare. His book, Care After Covid, is a practical exposé on the misalignment of healthcare – offering a guideline for how to reframe the healthcare system moving forward. What you’re going to love about this interview (and his book) are the stories that he shares – transporting us from an inner city clinic in Washington DC, to the plains of Africa with community health workers in villages, to the university hospital where he discovered the power of caring relationships. Dr. Shantanu Nundy MD, MBA, is a primary care physician, engineer, technologist, and business leader who serves as Chief Medical Officer for Accolade, which delivers personalized navigation and population health services to companies. Previously, Dr. Nundy served as a senior health specialist at the World Bank Group where he advised developing countries on health innovation & technology. Prior to that, he was Director of the Human Diagnosis Project, a healthcare artificial intelligence startup which he successfully built into a medical project spanning 80 countries. He is also co-inventor of SMS-DMCare, an automated text messaging software for individuals with diabetes, one of the first mobile health interventions to be adopted by the World Health Organization. He attended MIT for undergrad, the Yale School of Medicine & completed his residency in Internal Medicine at the University of Chicago, where he also obtained a MBA. In this episode, we’ll discover: The maladaptive aspects of our healthcare system that the pandemic has exposed and magnified. The 3D model – distributed, digitally-enabled & decentralized – that Dr. Nundy believes can transform healthcare How Dr. Nundy views ‘connected care’ as being ‘beyond technology’, but also how digitally-enabled care can create greater access, more personalized care, and greater patient engagement. The largely untapped opportunity we have to include patients as part of the healthcare team, and the tremendous potential that has to transform care. Real life stories that demonstrate how providers’ professionalism, empathy and overall value proposition are being constrained by our system. Dr. Nundy’s ability to leverage divergent perspectives is remarkable. He shares a story of conducting research on automated reminders for improving medication taking. What he discovered in interviewing patients was that it wasn’t the digital reminder that motivated them to take their pills. Instead, it was the caring research coordinator, Marla, and the relationship that patients had formed with her, that compelled them to take their medications. Plainly put, they didn’t want to let Marla down. The lesson – caring relationships are not just more empathetic care, they’re also more effective care. Another example of Dr. Nundy’s ability to balance divergent perspectives is his notion of decentralized care – that healthcare decisions are best modulated as close to patient care as possible. He shares a poignant story of a patient with heart failure. His patient kept on being admitted to the hospital because she didn’t have a scale to weigh herself. (People with heart failure are susceptible to water retention, which causes their lungs to fail. Having a scale allows them to detect fluid retention and take appropriate medications to reverse it). During one post-hospital visit, Dr. Nundy realized that his patient did not own a scale because she couldn’t afford one. So, he handed her twenty dollars to buy one. She bought the scale and did not have any further hospital admissions after that. It’s important to note that Dr. Nundy was actually breaking rules and regulations in giving her the money to purchase that scale. He did not, as a primary care doctor, have the decentralized decision-making or authority to personalize care and do what was right for his patient. Dr. Nundy’s goal in authoring this book is to create a mindset shift in healthcare delivery. As he states in our dialogue, ‘words create worlds’. So, I’ll conclude by sharing some of his profound words. One phrase that struck me was, “Digitalizing poor care isn’t enough. We need to reinvent care”.  Another, “We need to do population health one patient at a time”. Dr. Nundy envisions a world in which both providers and patients are much more empowered and connected by the healthcare system. I believe that words do create worlds, and I hope this is the case with the words that Dr. Nundy has shared with us. Until next time, be well. Zeev Neuwirth, MD

Friends, Our guest this week, Dr. Robert Pearl, introduces a fundamental reframe in our understanding of healthcare transformation with his second book, ‘Uncaring – How the Culture of Medicine Kills Doctors and Patients’. He convincingly argues that addressing the systemic functional challenges in healthcare is not sufficient. For transformation to occur, we also need to address the entrenched culture; and the first step is in understanding that culture. ‘Uncaring’ is the most comprehensive and scholarly book I’ve come across on the interplay between the legacy culture of medicine and its impact on healthcare delivery and outcomes. Dr. Robert Pearl’s stories are heart-breaking and heart-warming; and the historical facts, medical stats and studies he draws upon are engaging, enlightening and of concern to all of us. Dr. Robert Pearl is the former CEO of The Permanente Medical Group, which he led from 1999 to 2017, and former president of The Mid-Atlantic Permanente Medical Group, which he led from 2009 to 2017.  In these roles he led 10,000 physicians, 38,000 staff and was responsible for the nationally recognized medical care of 5 million Kaiser Permanente members. He currently serves as clinical professor of plastic surgery at the Stanford University School of Medicine.  He is also on the faculty of the Stanford Graduate School of Business, where he teaches courses on strategy and leadership, as well as lecturing on Information technology & healthcare policy. Dr. Pearl has been named as one of Modern Healthcare’s 50 most influential physicians. In this episode, we’ll discover: Numerous episodes in the history of American healthcare that demonstrate how the culture of medicine is holding us back from transforming healthcare delivery. Profound examples of how the culture of medicine directly influences how care is delivered and the grossly suboptimal outcomes that are a result of that culture. The only two possible directions American healthcare can take in response to the unsustainable and unaffordable costs of healthcare delivery. A pathway to confront and change the culture of healthcare. It’s been said that if we don’t study history, we’ll be condemned to relive it. This is no more true than in our healthcare system. Dr. Pearl shares a haunting story of an Austrian physician named Dr. Semmelweis who died penniless in the 1860’s, as a result of being shunned by the medical establishment. His heresy was that, through years of rigorous research, he demonstrated that physicians were carrying the source of maternal infections & deaths – on their hands & clothes. His studies revealed that maternal mortality rate could be decreased from 18% down to 2% simply by physicians changing their gowns and washing their hands with antiseptic in between treating patients. One might shrug this off as a historical footnote, except for the fact that today, in 2021, hospital acquired infections are the fourth leading cause of death in the US – leading to over 90,000 deaths per year. The tragic truth is these deaths could largely be prevented by providers washing their hands in between seeing patients. That is the power of culture – “this invisible force” that Dr. Pearl reveals to us. We discuss many other examples, including the story of the ‘Committee on the Costs of Medical Care’, which reveals the powerful influence of the legacy culture of medicine in resisting recommendations that could vastly improve the health and well-being of our nation. Like myself and many of you, Dr. Pearl  is frustrated and deeply troubled by the complexity, opacity and inertia in American healthcare – and how the culture is greatly limiting access, affordability, efficacy and equity. Two silver linings emerge in our discussion. First, the culture of medicine has tremendous strengths as well as wonderful attributes and values. Second, the solution is not that complicated. When I asked Robbie what he would request healthcare leaders do differently, this is how he replied, “To move from fee-for-service to capitation. To work together to improve medical care rather than maximize volume. To embrace technology that makes care more convenient for patients.” Healthcare leadership is struggling to break free of a legacy maladaptive healthcare construct. What I learned from Dr. Pearl is that healthcare leadership must not only create a new system, it must create a new culture: one that aligns our professional values and purpose with the actual daily practice of medicine and delivery of healthcare. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends, The focus of this interview is on a ‘greenfield’ project that was under wraps for the past three years, and has only recently been revealed. Project Fulcrum was launched in the spring of 2018 by the CEO and senior leadership team of AdventHealth – one of the largest healthcare systems in the country. It’s bold purpose – “to disrupt its legacy provider business model with consumer-driven innovation”.   Our guest this week is Nick Archer, the CEO of Project Fulcrum. In this role he leads a cross-functional team from brand experience, banking, retail, and healthcare to build new products and experiences. He has held various leadership positions at AdventHealth in strategy and finance, most recently serving as the VP of Finance for Network Development and Post-Acute Care. He serves on the boards of United Against Poverty and Andrews Memorial Hospital in Kingston, Jamaica. Nick earned a bachelor’s degree in finance from Oakwood University and an MBA from the University of Florida’s Hough Graduate School of Business. In this episode, we’ll discover: The competitive market forces that led AdventHealth’s leadership team to make the decision to disrupt their own business model. The fundamental consumer problems & issues that Nick and his team discovered during their customer discovery work. The consumer innovation initiative that Project Fulcrum has deployed to over 50,000 patients. Some of the early outcomes they’ve achieved, such as a 30% reduction in no-show rates. This interview felt like listening to a superb master class in healthcare consumerism. Although many of us in healthcare use words like ‘empathy’, ‘consumer-focus’ and ‘whole person care’ – Nick and his team, as you’ll hear in this interview, have taken a very different approach to delivering on these concepts. For example – the notion that ‘empathy’ isn’t just identifying your customer’s pain points, but must also include understanding what role they want you to play in solving those problems. Nick’s team discovered that their patients did not want things done to them, but instead were looking for someone to “come alongside, champion and remove barriers”.  Another example – the notion that ‘conversation’ itself has a significant healthcare value proposition. As Nick puts it, “using the medium of conversation as a way to drive value, whereas traditionally the paradigm of communication in medical practice is largely task focused and transactional”.  There are numerous remarkable and unique aspects to Project Fulcrum. The commitment to transformation – made by the AdventHealth senior leadership team – to protect, support and resource a greenfield innovation division. Their relentless pursuit to understand the consumer perspective and make that priority number one. The fact that they intentionally chose to start by creating a more personalized consumer experience. And, their intention to eliminate disparities & inequities in experience and access. As Nick states,“We want to democratize the idea of concierge and make care accessible to everyone.” Project Fulcrum is a bold strategic commitment to investing in the future; to investing in AdventHealth’s differentiation and growth; and to investing in a significant, positive inflection in patient care. As Nick eloquently states during the interview, “The challenges of today can’t prevent us from thinking through and designing the success of the future”.  This initiative is a remarkable example of a disruptive innovation and I suspect numerous case studies will be written about it. For me, however, the most essential theme is the humanistic one. This is a story about leadership that clearly believes that enhancing human connection – empathetic dialogue and healing relationship – is necessary to a successful healthcare delivery system and critical for a thriving healthcare business model. If you want to understand what ‘humanizing healthcare’ can look like, I suggest you listen to this interview with Nicholas Archer, CEO of Project Fulcrum at AdventHealth. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends, You are going to hear a remarkable case study about a successful and sustained philanthropic initiative focused on educating disadvantaged youth. Although outside of the strict domain of healthcare delivery, this initiative is actually about the health & well-being of our communities and our country – education being a significant social determinant of health outcomes. Joining us in this interview are Harris Rosen, President & COO of Rosen Hotels & Resorts, Dr. Chuck Dziuban, and JuaNita Reed.  Dr. Dziuban is the Coordinator of The Harris Rosen Foundation educational programs for the University of Central Florida. He is in charge of maintaining the research and statistics of the Tangelo Park Program.  JuaNita Reed is a recently retired guidance counselor at Dr. Phillips High School. She has mentored the scholarship recipients in the program and continues to lead that aspect of the program in her new role as Scholarship Coordinator of The Harris Rosen Foundation. In this episode, we’ll discover: The key components contributing to the success & 26-year sustainability of the Tangelo Park Program. The profound educational outcomes & remarkable impact it’s had on the community – for example, dropping the crime rate by ~80%! Mr. Rosen’s vision for spreading the Tangelo Park Program to the rest of the country. Since 1994, Harris Rosen and his colleagues have funded a Pre-K program and a full college scholarship in a small, disadvantaged community. Although the solution is simple, the success is startling. Also startling is how this program has not only sustained itself but has activated the youth and catalyzed the parents in the community. Over the years, families have required and requested less of the Rosen funding, as they’ve been acquiring more college scholarships on their own. Another critical point to understand is that this approach is reversing an insidious, self-perpetuating driver of financial disparity & inequity in educational opportunity. If you live in the bottom economic quartile in this country, your chance of graduating from college is 11%. The odds against you are 9:1. The total college debt in the USA is $1.7 Trillion dollars. Most of this college debt is carried by the bottom economic quartile in this country, and by Black youth. It is a compounding problem which perpetuates a cycle of debt and the suppression of upward mobility, largely in the Black & LatinX populations. One of the brilliant things that the Tangelo Park Program does is break this cycle of educational debt and upward social mobility. The evidence for that – well, for starters, the Tangelo Park program has reversed the odds of these kids graduating college, from 9:1 against, to 3:1 in favor!  Further evidence – over 160 Tangelo Park youth have graduated from college. That is 3 times the expected number, which would have been 45. In addition, the program has resulted in 227 degrees, including post-graduate degrees. There’s also a positive economic impact to the community. Lance Lochner, an economist at the University of Western Ontario, recently calculated a 7:1 return to the community. Harris Rosen’s program is catalyzing the tremendous intellectual talents, capabilities and potential in our disadvantaged youth, particularly in Black & LatinX youth. He understands that a college or vocational school education leads to employment, financial stability, and significantly higher life-time earnings. Those are well substantiated facts. At one point in the discussion, Chuck Dziuban refers to a recently published landmark study which has demonstrated that a Preschool (Pre-K) education positively and cumulatively transforms an individual’s entire life, with ripple effects on the lives of their children & grandchildren. I suspect that you will be as moved as I was by this story. But Harris is asking for more. Harris Rosen is calling for action. His vision is that every underserved community in this country be adopted by philanthropists, Boards and C-suites. Toward the end of the interview, Harris implores us, “What I would like to hear and see more of is people who not only say that black lives matter, but people who are inclined to do something about it. Here’s a program with nearly 30 years of extraordinary success. All somebody has to do who cares about Black lives, LatinX lives, the lives of our youth – is ask how we did it.”  If reversing the cycle of educational & economic inequity in our country is important to you, then please share this interview with others – especially those who are in a position to replicate the Tangelo Park Program. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends, The focus of this interview is on a solution created by Yale Economists to address the rising & unsustainable costs of healthcare in our country. Most of us are aware that healthcare costs are a problem, but our guest today argues the cost of healthcare is actually devastating to American workers & families. The approach he and his colleagues are taking to solve this massive problem is unique & I’m excited to explore it with you today. Zack Cooper, PhD is an Associate Professor of Health Policy and Economics at Yale University. Cooper has published his research in leading economics & medical journals and has presented his research at the White House, the Department of Justice, the Federal Trade Commission, & the Department of Health and Human Services. Cooper received his undergraduate degree from the University of Chicago and his PhD from the London School of Economics. In this episode, we’ll discover: The meeting at 10 Downing Street that led this extraordinary Yale Healthcare Economist to come up with the idea for 1% solutions. The specific healthcare issues being addressed by these 1% solutions, such as Surprise Medical Billing & Kidney Transplantation. Why Zack believes employer-based health insurance is contributing to bloated costs that are profoundly harming the health & welfare of working Americans. How the unprecedented drop in American life expectancy and the American epidemic of “deaths of despair” might be linked to healthcare economics. Why the 1% solutions are intentionally focused on incentivizing providers & healthcare organizations rather than attempting to change patient behaviors through cost-sharing and other demand-side interventions. The opportunity cost to the American public and the American future resulting from bloated healthcare costs. This is an extraordinary story of a ‘scholar-activist’ who is battling the insidious mistruths that are guiding policies for an industry that makes up nearly one-fifth of the US GDP.  With this latest 1% project, he’s not only debunking harmful myths, but also using evidence-based, scientific methodology to build solutions to lower the staggering costs of healthcare. Make no mistake about it, the stakes are high. For example, Zack refers to a recent study which demonstrated that a $10 increase in Medicare Part D copays (prescription medications) led to a 33% increase in monthly death rates among seniors. People couldn’t afford their medications and so they simply stopped buying them. Zack is reframing the field of healthcare economics by attempting to accomplish a number of things. First, he is actively recruiting leading scholars to adapt their research to current policy-relevant domains. Second, he is inviting leading scholars to more directly engage with and influence politicians and policy makers. Third, he is catalyzing a movement toward more scientific, peer-reviewed, evidence-based healthcare policy decision-making. Fourth, he is calling for a shift from research that purely critiques to briefs that develop and support tangible solutions to lowering the costs of healthcare. And fifth, he’s influencing the next generation of healthcare scholars to view themselves as ‘scholar activists’. What Zack & his colleagues are attempting is courageous. They are battling on behalf of the plight of the majority of Americans who simply can not afford healthcare. They are battling the status quo of a huge, well-funded, complicated & opaque industrial complex. As Zack points out, there are few other industries as heavily lobbied as healthcare – underscoring the need for independent, peer-reviewed, evidence-based, policy decision-making. At one point in the interview, Zack says that he’s been “coarsened” by what he has discovered. He is, in my opinion, experiencing what many clinicians & others in healthcare have recently been terming ‘moral harm’. One domain of moral harm that is of “gripping” concern for Zack is the economic and healthcare inequities in this country. His current research is focused on how healthcare inefficiencies and costs might actually be contributing to the economic & health inequities, and the growing disparity chasm in our country. What I greatly admire and respect is Zack’s ethical conviction, commitment and persistence to challenging and changing the fundamental policies causing this moral harm. So, while the 1% approach may appear incremental, what Zack and his colleagues are doing is nothing less than transformational. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends, What if I told you that I just learned of a completely doable and replicable approach to reducing the costs of healthcare by 30 – 50% while increasing quality outcomes simultaneously?  In this interview we’ll be speaking with an employer that has been achieving this for years. Corporate America – which pays for 50% of all healthcare costs – has been the “sleeping giant” of healthcare. But these giants are now waking up and they’re not going to put up with the status quo. One particular employer has been awake for decades, and we’re going to hear his story told in some detail. Joining us in this interview are Harris Rosen, President & COO of Rosen Hotels & Resorts; Ashley Bacot, President of Provinsure (the health insurance company that Rosen Hotels formed; and Kenneth Aldridge Jr, RN, BSN, MS-HSA, the Director of Health Services at the Rosen Medical Center and RosenCare. In this episode, we’ll discover: The simple but widely successful approach that Mr. Rosen and his colleagues have taken to achieve the triple aim results of better care, better outcomes & lower costs. Some of the key programs and critical success factors that have contributed to Rosen Hotels having sustained healthcare savings of over 30% for decades. How ProvInsure and the Osceola County School District have replicated the model with remarkable savings and outcomes. Mr. Rosen’s vision for spreading the RosenCare model to the rest of the country. Each podcast interview is an adventure for me. To really listen well, I have to allow myself to be surprised. I have to allow myself to think differently and to experience uncomfortable emotions that my guests elicit. In this interview, I found myself surprised with almost every turn of the dialogue. First, having worked within our overly complicated US healthcare system for decades, I was really knocked back on my heels by the simplicity of Mr. Rosen’s approach to healthcare.  It was almost too simple and too obvious; which led me to the second surprise.  The emotional dialectic I experienced was embarrassment on one side and inspiration on the other.  I was embarrassed and inspired on behalf of the American healthcare system. Here is a guy – Mr. Harris Rosen – with no medical, healthcare or technical background, and he figured it out. I was embarrassed and inspired because here is a leader who did not compromise on what he knew to be the right thing to do for his employees. I was embarrassed and inspired because Harris Rosen had the conviction, commitment and courage to do the things that we all know will radically improve healthcare. I imagine you’re wondering what Harris Rosen and his colleagues have done. There are a number of ways I could explain it. The simplest way is to tell you that he’s inverted the American healthcare system. RosenCare spends the vast majority of its funding on Primary Care, not specialty care; and makes primary care accessible, convenient, affordable and equitable. RosenCare follows its associates throughout the continuum of care to create a more seamless and integrated experience; and promotes and even imposes the principles of public health by making it a requirement to follow certain healthful behaviors.  For example – nicotine use, alcohol consumption affecting “fit for duty” and illegal drug use are not allowable if you’re going to be a Rosen associate. I’ll share one other emotion I felt as I was listening to the RosenCare story. I felt validated. Having practiced primary care for decades and having been a primary care proponent for over 3 decades, the RosenCare story demonstrates what we have known, and what the literature has repeatedly substantiated. Investing in proactive, preventive primary care leads to better care, better outcomes and lower costs. This is a lesson, sadly, that has not been widely supported or manifested within the American healthcare system. One final thought. The RosenCare story reveals the power of a caring, loving community. I didn’t know how to describe it as I was listening, but RosenCare felt a little bit like a ‘tough love’ healthcare community. They haven’t just built an exceptional healthcare benefits program or an outstanding employer healthcare approach. What they’ve done is to reframe the transactional and individualistic medical mindset into one that is relational and community oriented. RosenCare’s fundamental principles are about caring, not coding. Until next time, be safe and be well. Zeev Neuwirth, MD

There aren’t many people who have the breadth of perspective and the depth of accomplishment that this week’s guest brings to the table. Dr. Tony Slonim doesn’t just wear multiple hats. He has lived in multiple healthcare worlds – having earned a nursing degree, a medical degree, a subspecialty board certification, a doctorate in public health; and having served in the public health service as well as in senior executive roles. It is this unique multi-system orientation that enables him to draw distinctions between medical care, public health, community health and population health – distinctions that many of us may not fully appreciate..   In this interview, Dr. Slonim points out that our hospital-based medical healthcare system is not interchangeable with a public health care system. The fallacy that they are interchangeable – and that a public health service is not needed – is a mis-guided national error which has contributed to an American health system which delivers subpar outcomes when compared to other economically developed nations. By way of formal introduction, Dr. Anthony Slonim is president and chief executive officer of Renown Health in Reno, NV. Modern Healthcare has named Dr. Slonim one of the “50 Most Influential Clinical Executives” in 2019. Before joining Renown Health, he served in executive leadership roles at Barnabas Health in NJ, Carillion Clinic in VA and Children’s National Medical Center in DC.  Dr. Slonim holds a diploma in professional nursing. He is a board-certified pediatric intensivist, who also earned a masters and doctorate in public health from George Washington University; and then served four years in the United States Public Health Service in Rockville, MD with the rank of Lieutenant Commander. In this episode, we’ll cover: The difference between the ‘medical mindset’ and the ‘public health mindset’. The reframing of our public health system as an “insurance policy” that our country has not invested in over the past few decades. Some thoughts on how the defunding of our public health system has contributed to the disparities and inequities in healthcare. The “precedent of unkindness” in our society – exacerbated by the stressors of the pandemic and perhaps enabled through social media – that is adding to our psychologic and physiologic strain, and harming the public health. Dr. Slonim is a kind and humanistic leader, but he is also a demanding leader. He is demanding that we reinvest in a diverse healthcare system that works to keep our communities and the American public healthy. What this interview reveals is that the vast majority of us – who have not been trained in public health – don’t understand its significance and its critical role. We don’t understand the differences between public health, population health and medical care. We don’t understand the unique approaches and tools of the public health system. We are not aware that our public health system has been defunded over the past few decades. Nor do we fully appreciate the implications of that defunding, especially in inner cities and rural counties. Many of the healthcare problems we’re experiencing today – including some of the devastating fallout of the COVID-19 pandemic – are due to this lack of a robust public health system. These problems include: unsafe drinking water (think Flint Michigan); unsafe air; climate change; the racial disparities in healthcare in which life expectancy between neighboring zip codes can vary by as much as 15 – 20 years; the worsening opioid epidemic; and the epidemic of mental health and suicide in our country. All of these have one thing in common. They could be greatly mitigated by the presence of a strong local public health system in our communities, our towns, our cities, our counties and our states. The pandemic has taught us many things, not least among them is that we need to rebuild our public health system. One wonders if our political and healthcare leaders have the discernment, conviction and courage to translate this obvious societal need into action by investing not only in the medical system, but also in a public health system. The federal government that the framers created is intentionally organized around checks and balances, informed by multiple perspectives. Our healthcare system needs that same sort of multi-system, multi-perspective reorganization. Until next time, be safe and be well. Zeev Neuwirth, MD