Creating a New Healthcare

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

Friends, Our topic this episode may be one of the most misunderstood and challenging issues in healthcare delivery – with significant potential for lowering costs and improving outcomes. The topic is employer-based healthcare; and as many of you know, employers pay for 50% of all the healthcare costs in the US. Escalating healthcare costs over the past few decades have imposed a major strain on corporate America and its employees. The Kaiser Family Foundation reported that in 2018, employers paid approximately $20,000 per year for healthcare for a family of four, $6000 of which the employee paid. They also reported that since 2006, employee healthcare premiums have risen twice as fast as wages. As a result, Corporate America has been increasingly focused on right-sizing healthcare costs – from Apple and Amazon launching their own employee primary care; to Walmart providing ‘centers of excellence’ to its employees; to companies such as Comcast who have partnered with vendors to put alternative healthcare solutions in place for its employees. But, the situation is challenging, as evidenced by the recently failed attempt of Haven, an employer-based healthcare initiative launched by JP Morgan, Berkshire Hathaway and Amazon. It’s a complex ecosystem involving employer-based HR & health benefits managers, employer benefit brokers & benefits consulting companies, insurance companies, provider groups & hospital systems, direct to employer providers, and collaboratives such as the Business Group on Health. Our guest this week is a passionate expert who has a discerning handle on the ecosystem, the fundamental problems, and the proven solutions in employee-based healthcare. Dave Chase founded & leads Health Rosetta, whose goal is to empower community-owned health plans. Health Rosetta has created a blueprint and platform that empowers health plans to deliver high quality, affordable care. Dave has authored a number of insightful books including The CEO’s Guide to Restoring the American Dream: How to deliver world class healthcare to your employees at half the cost. He received the Health Value Awards’ Lifetime Achievement for Health Benefits Innovation at the 2020 World Health Care Congress. Prior to this work, Dave Chase co-founded Avado which was acquired by and integrated into WebMD/Medscape.  He also founded Microsoft’s $2B, 28,000 partner healthcare ecosystem. In this episode, we’ll cover: Dave’s unique perspective on the fundamental problems in the American healthcare system. What Dave describes as epidemic healthcare ‘financial toxicities’ and ‘financial comorbidities’, which is denying the American dream to the majority of employees. Five major solutions that employers can leverage to reset and radically improve their employee health benefits plans. Examples of employers who have saved a significant and sustained percentage of their healthcare costs while improving healthcare outcomes for their employees. Dave makes some amazing claims in terms of dramatically lowering healthcare costs for employers and employees; and he’s got numerous examples to support those claims. There is no question that the solutions he proposes are disruptive to the status quo. But, rather than view them as disruptive, we can learn from these successful models and deploy the proven blueprints that he and his colleagues at Health Rosetta have catalogued and created. One thing is abundantly clear.  The American healthcare system is not working for the vast majority of employed Americans. Dave’s facts and statistics are disturbing. What he reveals is that escalating healthcare costs are levying a hidden tax that is destroying the economic health and well-being of working American families. It’s a striking reframing of the problem that makes it very personal and very real. Once we understand this, one wonders why more employers aren’t adopting the tools and techniques that Dave and his colleagues at Health Rosetta outline so clearly. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends & Colleagues,  There are a few healthcare delivery enablers which will catalyze the transformation of healthcare delivery over the coming years. In our dialogue today, we’ll be focusing on one of them – virtual care. Our guest this week has spent years directly leading the charge in virtual healthcare redesign and deployment. Dr. Tom Hale is the Chief Medical Officer of VirtuSense where he and his colleagues are using virtual care to build value-based services for ACOs, MAs, and other at-risk models. Prior to this role, Dr. Hale pioneered the development of telemedicine and virtual care at Mercy Health. Under his leadership, Mercy telehealth services launched the world’s first virtual care center, Mercy Virtual. Prior to that, he led a 350-member multi-specialty organization as the President of Mercy Medical Group. In this episode, Dr. Hale and I will touch on: Some insights as to how Mercy Health developed its world renown Virtual Care services and the amazing outcomes they achieved. Examples of AI-enabled monitoring technologies that VirtuSense has created, such as one that reduces falls by 50 to 70% in the home and in hospital rooms. Common missteps that healthcare organizations make in deploying virtual care. Tom’s belief that success in virtual care is largely about people and process; requiring more than just an overlay, but instead an overall redesign of clinical and business models. Dr. Hale provides us with a very pragmatic understanding of the benefits of virtual care. He busts the myth that virtual care is merely a video substitute for a supposedly superior in-person visit. He proposes that virtual care redesign is actually far superior to the traditional approach of in-person healthcare encounters. I love his metaphor comparing traditional care to a series of ‘snapshots’ that provide disconnected, infrequent and lagging representations of a patients’ health; which is in sharp contrast to virtual care with its AI-enabled, remote monitoring and rapid responsiveness, which provides a continuous ‘movie’ of the patient’s health –  continuous, connected and contextual. Dr. Hale also points out that virtual care increases access to care; and through standardization and automation, it can reduce harmful variation of care – all leading to improved outcomes and lower total costs.  He backs these claims with data. The reduction of falls was significant, as well as the 60% reduction in healthcare costs that he and his colleagues achieved by placing simple remote monitoring technology and iPad’s into patients’ homes. Another fascinating revelation was how AI-enabled software can detect the onset of sepsis or the worsening of chronic disease long before they become apparent through our current monitoring. An example of this is the increasing variability in heart rate that precedes the onset of heart failure by days, allowing providers to more proactively respond to and prevent ED visits and hospitalizations. I really appreciate Tom’s thoughts regarding the impact of virtual care on the Social Determinants of Health and vulnerable populations: “Virtual care increases access to [proactive preventive] care. It decreases harmful variation. It removes the geographic barriers to care. It brings the best of the best to everybody. How can it not help the poor and underserved populations?” And I hope his final message in this podcast makes it to the ears of policy makers and payers. “Virtual Care will increase access and decrease variation in care, and you’ll get lower costs and higher quality. But, for that to happen, we need you to decrease the regulatory barriers, and prove and support the economics around virtual care that brings value to patients.” Until Next Time, Be Well Zeev Neuwirth, MD

Friends, Welcome to the first ‘Creating a New Healthcare’ podcast episode of 2021. The major themes we’ll explore in this episode are two sides of the same coin: the strategic, market-driven imperative for transformation in healthcare; and the financial and operational challenges of disrupting one’s own healthcare organization. Our expert guest in this interview refers to this phenomena as the “conflicting realities” of transformation and disruption. The situation is challenging. If healthcare systems and provider groups don’t pursue transformation, it’s likely that they will find themselves increasingly less relevant in the future. Yet, at the same time, disrupting oneself is fraught with pitfalls and seemingly insurmountable challenges. Our guest this week has spent years threading this needle, earning the wisdom and the wins that demonstrate his competence and credibility. His message is simple and clear, and worth listening to. He believes that we are up to the challenge, if we grasp the mantle of high integrity, courageous, patient-centered leadership. Dr. Roger Ray is the Chief Physician Executive with The Chartis Group – a well-known and highly respected healthcare consultancy. He has over three decades of service in a variety of leadership positions at major healthcare organizations throughout the eastern United States. Most recently, Dr. Ray served as Executive Vice President/Chief Physician Executive at Atrium Health, where he led a medical group of over 3,000 members and had operational oversight over myriad clinical services & functions. In full disclosure, I had the privilege of working with Dr. Ray for a number of years during his tenure at Atrium Health. In this episode, we’ll cover: The 4 major strategic advancements that Dr. Ray believes every healthcare system needs to be focused on achieving. The increasing and unprecedented importance of physician leadership, and how that is a differentiating factor among healthcare systems. The specific and significant challenge of disrupting one’s healthcare system, coupled with the conflicting need to rapidly adopt technology, generate new business models and transform healthcare delivery. Why becoming expert at ‘fast-following’ and adopting best practices may be a superior strategy vs being a ‘bleeding-edge’ organization. Dr. Ray is a pragmatist and a highly strategic thinker. But, he’s also a highly principled leader. One of my favorite ‘Ray’ quotes is, “Principles matter when they’re inconvenient.” The point being that it’s much harder, much more meaningful, and far more impactful to manifest principles when they inconvenience you. One of the fundamental principles that Dr. Ray has led by include his focus on ‘patient-first’ healthcare delivery. That is, leading with the question of how any decision impacts patients – first and foremost. As an example of this principle in action – when I asked Dr. Ray what he would say if he had a few minutes with President Biden and VP Kamala Harris, he said that he would remind them that healthcare is fundamentally about “people taking care of people” – highly skilled professionals who are earnest and passionate about helping and healing others – providers and staff who sacrifice and give of themselves, and who daily deliver near-miraculous outcomes. Yes, healthcare is a business. But, if we forget what it’s fundamentally about, we will sub-optimize the endeavour and harm patients. Dr. Ray also added that he would remind the President & VP that the current disparities in American healthcare are an embarrassment to our nation. He would encourage them to use the resolution of healthcare disparities as a primary marker and absolute requirement for American healthcare improvement. I’m delighted to see that Dr. Ray is sharing his expertise and wisdom with many other leaders and organizations across the nation. American healthcare needs more leadership with principled pragmatism, and we need leadership that is willing, capable and courageous enough to thread the needle of disruptive transformation. Until next time, be safe and be well. Zeev Neuwirth, MD

Friends & Colleagues,  The focus of this episode is of immediate importance to all of us. It’s especially important right now, in the month before the inauguration of President-elect Biden & VP-elect Kamala Harris. (Of note, this interview was recorded in late August, so we were unaware of the election outcomes). The topic is ‘fixing’ healthcare and our guest today is Dr. Vivian Lee, the President of Health Platforms at Verily. Dr. Lee recently published a book entitled –The Long Fix – Solving America’s Healthcare Crisis with Strategies that work for Everyone – in which she explains the fundamental problems in healthcare and provides practical solutions. The book speaks directly to policy makers, providers, payers & patients. In this interview, we’ll hit the high points of the book and get a sense of the priority Dr. Lee assigns to certain problems. The book is remarkable and so is Dr. Lee. She is a Harvard-Radcliffe College graduate who obtained a doctorate in medical engineering from Oxford University as a Rhodes Scholar and then earned an M.D. with honors from Harvard Medical School. She has also earned an Executive MBA at NYU’s Stern School of Business. Dr. Lee is a radiologist and medical researcher who has authored over 200 peer-reviewed journals. Prior to her current role, Dr. Lee was the Dean & CEO of the University of Utah Health – one of the nation’s leading hospital and academic medical centers. During her tenure, she and her colleagues achieved numerous nationally recognized accomplishments in quality, safety, patient experience, growth and entrepreneurial commercialization. In 2019 she was ranked #11 among the ‘Most Influential People in Healthcare’ by Modern Healthcare.  She has been elected to the National Academy of Medicine. In this episode, Dr. Lee and I will touch on: A broad range of issues ranging from the mind boggling complexities of billing and payment, to the lack of price transparency, to the crippling and uncontrolled costs of medications, to the impact of healthcare costs on suppressing employee wages and retirement funds. The one issue Dr. Lee calls out as the core off-the-charts problem in the American healthcare system. Why Dr. Lee believes that it’s critically important for all citizens to understand how healthcare delivery works and what it would take to make it better. Why universal access to healthcare is not only the right thing to do from an ethical perspective, but also from a public health, productivity and economic point of view. Why Dr. Lee believes we must shift to value-based care in order for universal coverage/access to be optimally effective. I have to say that it was a privilege and a pleasure to speak with Dr. Lee.  Given her remarkable accomplishments, her brilliance, and the enormity of her current position, I was struck by how down-to-earth and humble she is. We didn’t have the opportunity to directly discuss the issue of leadership in healthcare; but an unspoken message that came across is that we need a leadership culture that Dr. Lee embodies – data-driven, humanistic, socially aware, and selfless – leadership that is, first and foremost, for the people.  Dr. Lee wrote this book for the American public – to bring some clarity to our complicated, opaque healthcare system. I applaud her for that.  Most importantly, I applaud her for the explicit intention to deliver solutions that work for everyone. Until Next Time, Be Well Zeev Neuwirth, MD

The COVID-19 pandemic has shone a new light on the deep-rooted disparities and inequities that are built into the fabric of our American healthcare system. Triggered in part by the pandemic, as well as a number of deeply disturbing episodes of racist police brutality, and the Black Lives Matter movement, we’re experiencing a national re-awakening of concern regarding systemic and institutional racism in our society. Our two distinguished guests in this interview, Dr. Alisahah Cole and Michellene Davis, are nationally recognized leaders in the movement to eliminate healthcare disparities. Michellene Davis, Esq. is currently the Executive Vice President and Chief Corporate Affairs Officer at RWJBarnabas Health, the largest academic healthcare system in New Jersey. She is an attorney and has held positions at the senior most tier of government, including as State Treasurer, Chief Policy Counsel to a Governor, and CEO of a state lottery. Dr. Alisahah Cole is currently the System Vice President of Population Health & Policy at CommonSpirit Health, one of the largest integrated healthcare systems in the United States. She is a Family Medicine physician and has held multiple leadership positions including as Chief Community Impact Officer and Academic Chair, implementing novel approaches to improve health equity in vulnerable populations. This interview was recorded last month as a panel discussion during a virtual conference on patient experience. The topic was originally intended to be a discussion on the Social Determinants of Health (SDOH). But we felt that it would be culturally tone-deaf and socially irresponsible to discuss the SDOH without recognizing systemic and institutional racism as a root cause of the inequities and disparities in health care delivery and health outcomes. With that in mind, this panel discussion includes: A passionate discussion on this most recent ‘awakening of awareness’ about the systemic & institutional racism in our society – including the impact of the COVID-19 pandemic. The manifestations of systemic, institutional & interpersonal racism in healthcare. Practical, real-life recommendations regarding a systematic, data-driven approach to identify, understand & eliminate racism in healthcare. In addition to bringing their experience as clinicians and executives, Michellene and Alisahah also share their lived experience as professional Black women. The stories they share are honest, courageous, and at times, unsettling. For example, Michellene shares that, unlike her white colleagues, she does not have the luxury of putting racism aside, even for a moment. Alisahah shares that, as the mother of two teenage Black boys, she worries for their lives, literally, each time they leave home to venture outside. This conversation challenges the very core of our humanity – in our communities, our corporations, our social institutions and our government. One lesson this interview taught me is that the issue of ‘social determinants of health’ needs to be reframed in terms of eliminating the racial disparities and inequities in healthcare and in our broader society. Another is that good intention is not enough – we need to take sustained systemic action. There are so many lessons embedded in this podcast. Lessons about listening and building trust. Lessons about the unhealthful effects of racism on Americans of color. Lessons about the need to fundamentally reorient, redesign, reorganize and appropriately resource healthcare delivery so that it meets the needs of vulnerable populations. And lessons about the need to expand healthcare delivery beyond traditional medical boundaries – to apply a racial equity lens to how we reframe our education system, our criminal justice system, our housing and urban development system, our transportation system, our social services systems, our labor system, and our public health system. This was the most important interview I’ve conducted to date. I say that with Martin Luther King’s words ringing in my ears. Words that, sadly enough, have as much relevance today as they did when he delivered them over five decades ago, during a 1966 speech before the 2nd National Convention of the Medical Committee for Human Rights. Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death. I see no alternative to direct action and creative nonviolence to raise the conscience of the nation. Martin Luther King Until Next Time, Be Well Zeev

Dear Friends & Colleagues, Welcome to episode #106 of Creating a New Healthcare. This week has been a historic one for our country. As votes continue to be counted at the time of this writing, I want to turn our attention to what will undoubtedly be a key component of POTUS’ work over the next four years – our national healthcare policy agenda. This is the first time we’ve posted during a presidential election. But, it is not the first time we’ve tackled the POTUS question as it relates to healthcare. For those of you who have been listening to the podcast series this year, you’ll immediately recognize the question I’ve asked every guest this season. In this episode, it’s time for me to tackle this question. It’s Thursday, Jan 21, 2021 – the day after inauguration of the President of the United States; and you find yourself in the oval office, sitting on the opposite couch from the POTUS and VPOTUS. (As an important aside, you are socially distanced; and you are all wearing masks.) POTUS has asked for your opinion – your thoughts, suggestions & recommendations on what this administration should be focusing on in regard to HC policy & policy deployment over the next 4 years. What are you going to say to them? Listen to the podcast to discover the 5 Policy Principles I recommend to POTUS and the specific recommendations toward a solution for each. I hope you’ll listen with a discerning ear and let me know how you would answer this question. Finally – I have a request of you. I need your help. If you find value in this podcast series, please share it with as many colleagues as you can think to. I have heard from so many of you how valuable these episodes are to you; and if that’s the case, then it’s critically important that you spread the word about Creating a New Healthcare. Until Next Time, Be Well Zeev Neuwirth, MD

Welcome to episode #105, Season 4 of Creating a New Healthcare. Today we welcome one of the most prolific and influential healthcare policy experts of our era. Professor Ezekial Emanuel is the Vice Provost for Global Initiatives and Co-Director of the Healthcare Transformation Institute at the University of Pennsylvania. He is also a Special Advisor to the Director General of the World Health Organization. Dr. Emanuel was the founding chair of the Department of Bioethics at the National Institutes of Health. From January 2009 to January 2011 he served as a Special Advisor on Health Policy to the Director of the Office of Management and Budget, and the National Economic Council. He is also a breast oncologist, having earned his MD at Harvard Medical School, completed a residency in Internal Medicine at the Beth Israel Hospital in Boston, and then completed an oncology fellowship at the Dana Farber Cancer Institute, where he was also appointed as faculty. Dr. Emanuel has written and edited 14 books and over 300 articles, and is the world’s most cited bioethicist. He is a frequent contributor to the Atlantic, the New York Times, the Wall Street Journal, and the Washington Post, and regularly appears on television and radio. In this episode, we’ll touch on the following: The fragility of the US employer-based healthcare payment system and how the COVID-19 pandemic is nudging us to a universal payment system. The differences between a universal payment program and a single payer system. An illustration of a capitated primary care trial demonstrating the advantages to providers and patients. What the US can learn from other advanced nations in terms of primary care access and healthcare payment reform. The multi-pronged solutions that Dr. Emanuel recommends to address the insidious institutional racism and the inequities that are embedded in US healthcare delivery I believe it was H.L. Mencken who said that there are often simple solutions to complex problems, and those simple solutions are typically wrong. Dr. Emanuel does not offer simple solutions to the complex problems in our healthcare system. Instead, he offers thoughtful, studied, and ethical solutions that directly and realistically address the fundamental flaws in our healthcare system. These are serious flaws that leave tens of millions of Americans with no or sub-optimal health insurance, limit access to preventive primary and specialty healthcare for tens of millions of Americans, and create perverse and unethical incentives for providers and health systems that greatly inhibit them from delivering the type of healthcare they would like to offer. Dr. Emanuel is one of the most cited healthcare policy scholars and advisors of our era, as well as one of the most prolific researchers and authors. He is one of the finest healthcare educators and thought-leaders our country has ever produced. It is well worth our time to listen to and study the critically important lessons he is teaching us. Until next time, Be safe and be well. Zeev Neuwirth, MD

Welcome to Episode #104 (Season 4) of Creating a New Healthcare. I’m delighted to welcome back to this podcast Dr. Don Berwick – one of the leading authorities on healthcare quality & improvement over the past few decades.   Dr. Berwick is President Emeritus and Senior Fellow at the Institute for Healthcare Improvement (IHI), an organization that he co-founded and led as President and CEO for 18 years. In July 2010, President Obama appointed Dr. Berwick to the position of Administrator of the Centers for Medicare and Medicaid Services (CMS), which he held until December 2011. An elected member of the Institute of Medicine (IOM), Dr. Berwick served two terms on the IOM’s governing Council, and was a member of the IOM’s Global Health Board. He served on President Clinton’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry. His body of work & contributions to the field of healthcare quality & safety are unparalleled, including two classics: the 1999 IOM report, ‘To Err is Human’ and the 2001 IOM report, ‘Crossing the Quality Chasm’. In 2005, he was appointed “Honorary Knight Commander of the British Empire” by Queen Elizabeth II, the highest honor awarded by the UK to non-British individuals, in recognition of his work with the British National Health Service. To say that Dr. Berwick brings a seasoned perspective on the current state of our healthcare system and the challenges we face as a nation is, to put it mildly, an understatement. What distinguishes Dr. Berwick even more than his record of accomplishment or his brilliant mind is his tireless reminders of the ethical responsibility we have to attend to the health of the American public – especially for those of us who are providers, administrators, policy makers, health insurance companies, as well as pharmaceutical and device manufacturers. A relevant quote from one of Dr. Berwick’s recent articles underscores this responsibility;  “Fate will not create the new normal; choices will.” In this episode, we’ll cover a range of topics, including the following: Dr. Berwick’s recent article, Choices for the “New Normal” – which is a call-to-action and a leadership roadmap outlining crucial choices in six critical domains that will play a significant role in determining the future of healthcare delivery. Inequality and Inequity –  the relative lack of social support services provided in the US as compared to other developed nations; which Dr. Berwick describes as “the most notable wake-up call”. An ethical reframing of the social determinants of health, described in his recent article, The Moral Determinants of Health; along with some shocking statistics on inequities related to poverty, hunger, homelessness, social isolation, and the uninsured. The tragic and insidious institutional racism that is embedded in our healthcare delivery system, as well as in other institutions such as our criminal justice system. A critical reframing of healthcare that Dr Berwick refers to as “What Matters to You Medicine”; which he suggests should disrupt and replace the legacy “What’s the Matter With You” paradigm. Dr. Berwick is one of the greatest healthcare humanitarians and transformational leaders of our era. He is the quintessential example of empathic ethical leadership. We need more leaders like this in and around healthcare. Dr. Berwick’s recent publications are seminal. In these articles, he courageously cuts to the stark realities of our healthcare system. He not only lays bare the truth for all to see but also outlines the crucial leadership choices of our time. And even beyond that, he lays out a pathway for positive action. Dr. Berwick writes, speaks & acts with intellectual integrity, academic rigor, and with a disarmingly insightful and honest authenticity – as well as with a powerful voice based in morals and compassion. At times, it’s unsettling, uncomfortable and inconvenient. Make no mistake about it, Dr. Berwick’s message is not an academic treatise. It is a call for ethical action. Until next time, Be safe and be well. Zeev E. Neuwirth, MD