Creating a New Healthcare

Friends, There are numerous critical healthcare reframes in this week’s episode. First, what Dr. Silverstein makes abundantly clear is that the senior leadership team at ChristianaCare is fully comitted to accelerating the shift to value based payment. Second, they are committed to greatly expanding the use of virtual care as a  primary mode of care. Third, they are focused on health outcomes vs healthcare delivery. Underlying these three patient-centered goals is another profound reframe, the notion that in order to achieve the quadruple aim, provider organizations must form vertical integrations and create complementary collaborations with other types of stakeholders in healthcare – such as payers and retailers. Our guest today, Ken Silverstein, is the Chief Physician Executive at ChristianaCare. He previously served as chair of ChristianaCare’s Department of Anesthesiology, Medical Director of Perioperative Services and as Chief Medical Officer. He received his undergraduate degree from Brown University, his medical degree from New York University School of Medicine and his MBA from the University of Delaware. Dr. Silverstein was a resident and a fellow in anesthesiology at the Brigham and Women’s Hospital in Boston. He completed his clinical fellowship in anesthesiology at Harvard Medical School. In this episode, we’ll learn about: The 10 year value-based collaborative agreement that ChristianaCare and Highmark have launched together. The 5 major “vehicles” that ChristianaCare & Highmark are planning to deploy within their collaboration. The guiding “partnership principles” that are being used to create a relationship-centered approach to this synergistic collaboration. The fascinating independent spin-off virtual primary care practice that ChristianaCare is building out with Highmark, that greatly improves the efficiency and effectiveness of care. At the beginning of our conversation, Ken states, “we created a new company and the intent is to completely transform healthcare.”  That bold remark speaks volumes about the visionary leadership at ChristianaCare. Another statement which gripped me was the fact that the ChristianaCare leadership team is discussing Clayton Christenen’s ‘dilemma zone’’, which the folks at ChristianaCare have relabelled as the “commitment zone”. The point of the concept is that in order to transition to a value paradigm and realize a long-term gain, leadership must accept a short-term loss. It’s amazing to see hospital leadership thinking and acting in this way. But even more amazing is the fact that their Chief Financial Officer was the one who introduced this concept to the leadership team. In our correspondence prior to the interview, Ken wrote that American healthcare is “facing an apocalyptic forecast…”.  It’s a disconcerting pronouncement from a seasoned physician executive.  But, what was concerning for me was that I had heard this very same comment from two other physician executives in the prior week. During our interview, I asked Ken what he meant by this statement. He went on to discuss issues such as the worsening unaffordability of healthcare, fragmentation of care, and inappropriate overutilization. He also passionately talked about the unacceptable inequities and disparities in healthcare, using Delaware as an example.  In Wilmington, the difference in life expectancy – what Ken referred to as the “death gap” – between white communities and black communities only 2 miles apart is 16 years! He punctuated this statistic by asking how that is acceptable to anyone. The situation may seem dire but I have to say that I have never been more hopeful, more inspired and more encouraged about the future of healthcare than I am today. The reason stems from listening to leaders like those at ChristianaCare who are not just speaking the rhetoric of reframing, but are taking the very concrete steps necessary to create a new and better healthcare. They are making the painful trade-offs required, and are investing in a better future. They are, as Simon Sinek would put it, playing the generative “long game”. ChristianaCare is making a demonstrable commitment to creating a value-based future. They are aligning their resources with their rhetoric. They are doing this not because it’s easy or safe. They are doing it, as Ken states, “because it’s the right thing to do, period.” Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, With the onslaught of the Covid-19 pandemic, numerous hospital systems across the country rapidly adopted the hospital at home model in an effort to deal with overcapacity.  Many systems are planning to continue this service – even after the pandemic. The reasoning is simple. It’s a much lower-cost alternative. It’s much more personal and customized care. It’s a lot more convenient and comfortable for patients and their families. And, it’s going to be a major clinical delivery approach in the future; a major source of revenue, as well as a source for patient growth and retention. Our guest today, Raphael Rakowski, is one of the most significant entrepreneurial leaders in this rapidly advancing and transformative trend in healthcare delivery.  In 2010, years before most of us even heard of it, Raphael Rakowski led a team of engineers and clinicians in the creation of Clinically Home, the first commercially scalable model to enable safe hospitalization at home. In 2017, Raphael and his team created a next-gen version called Medically Home and joined forces with Atrius Health (a large multi-specialty medical group in eastern MA) to bring the program to market.  In 2020, after his role as CEO & Founder, Raphael was named Executive Chairman of Medically Home Group, Inc.  Medically Home operates in over 15 states at the time of this interview with a large number of strategic partners, and has most recently partnered with the Mayo Clinic & Kaiser Permanente. In this episode, we’ll learn about: Why – according to Raphael – the financial and business model for facility-based hospital care is misguided, misaligned and maladapted to the needs and safety of patients and their families. Why the shift to decentralized healthcare is necessary if we are to have a sustainable system, and how it’s consistent with the path that other industries, such as banking and retail have taken. The four operational pillars that allow Medically Home to deliver a much higher acuity level of care in the home than other ‘hospital at home’ models. The superior outcomes that Medically Home is achieving compared to traditional facility-based hospital care. How Medically Home is addressing some of the challenges in delivering high acuity care in the home setting. According to Raphael, the reason facility-based hospital care is suboptimal is that it has been fashioned like an industrial factory. He backs up his statements with powerful observations, compelling data and intelligent reasoning. For example – according to Raphael, 65% of hospital costs are due to the fixed costs of their bricks and mortar infrastructure. This overhead creates a “tax on care”, leaving only 35% for medical care. On the other hand, the cost savings Medically Home is achieving are about 25%.  Patient satisfaction is at or above hospital levels. Mortality and morbidity reductions are 10%, and fall rates and infection rates are dramatically better than facility-based hospitals. Raphael also reframes our notion of acute care and post acute care.  As he puts it, “The point of the Medically Home model is that you’re reliably integrating three things that should never have been siloed – acute care, post-acute care,and population health… There is no such thing as post-acute care. It was invented as an artifact of reimbursement. You should be cared for by the same care team until you’re not sick anymore.  This is one of the reasons for the high readmission rates we see in hospitals across the country…  We combine these together in a single episode called “stay with the patient until they’re well and you understand what it will take for them to stay well…”   At the present moment, the home-based care market in the US is approximately $140B in revenue, and predicted to grow to over $200B within the next 4 to 5 years. One can view this rapidly emerging home-based care market as a threat to hospital systems – or, as an opportunity.  For those hospital systems willing and capable enough to be early entrants – it is a huge opportunity to diversify their business models and revenue stream, and to de-risk the unprecedented market disruption that is almost certain to occur this decade. From a mission-based perspective, it is an opportunity for our healthcare systems to do what we need them to do: improve care and care outcomes, lower costs, and provide a more compassionate and convenient care experience. Until Next Time, Be Well. Zeev Neuwirth, MD

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