Episode #32  – Reframing How Doctors Make Clinical Decisions – an interview with Dave Slawson MD, Professor of Family Medicine & Internationally Renowned Lecturer in Evidence-Informed Decision Making & Information Mastery.

The literature would suggest that a significant percentage of clinical decision making is not well supported by evidence-based literature. Given the vastness of the emerging literature, combined with how rapidly it changes, it’s nearly impossible for any individual provider to keep up. Compounding this issue is the fact that the physiology-based reasoning we were all taught is no longer adequate.  Adding fuel to the fire is the predominant fee-for-service reimbursement system which strongly incentivizes providers to do more rather than less; and a tort reform system which also compels providers to do more rather than less.

Fortunately, Dr. Slawson and his colleague – Allen Shaughnessy PharmD, along with many other informaticists and evidence-based experts, have been working on a solution.  In this interview you’ll hear how he and his colleagues have reframed the way physicians and other healthcare providers can and should go about making evidence-based decisions.

Here are some highlights:

One of the most meaningful messages that Dr. Slawson leaves us with is a “prescription to say ‘No’.”  ‘No’ to unnecessary tests, imaging studies and invasive diagnostics. ‘No’ to wasteful and potentially harmful medications & treatments that are not indicated. ‘No’ to making decisions based on outmoded data and antiquated reasoning.

One of the major lessons I came away with from this dialogue is that it’s not only what we do that can make a difference; it’s what we can stop doing that can really make a demonstrable positive difference in improving patient care and health outcomes.

As always, I hope you get as much out of this interview as i have!

Zeev

Episode #32  - Revolutionizing How Doctors Make Clinical Decisions - an interview with Dave Slawson MD, Professor of Family Medicine & Internationally Renowned Lecturer in Evidence-Informed Decision Making & Information Mastery.

The literature would suggest that, in 2018, a patient is almost as likely to be harmed by a clinical decision as helped!  The reason is that the majority of clinical decisions are not well supported by evidence-based literature. Given the vastness of the emerging literature, combined with how rapidly it changes, it’s nearly impossible for any individual provider to keep up. Compounding this issue is the fact that the physiology-based reasoning we were all taught is no longer adequate.  Adding fuel to the fire is the predominant fee-for-service reimbursement system which strongly incentivizes providers to do more rather than less; and a tort reform system which also compels providers to do more rather than less.

Fortunately, Dr. Slawson and his colleague - Allen Shaughnessy PharmD, along with many other informaticists and evidence-based experts, have been working on a solution.  In this interview you’ll hear how he and his colleagues have reframed the way physicians and other healthcare providers can and should go about making evidence-based decisions.

Here are some highlights:

1. The most significant shift required in our clinical reasoning and decision making is to what Dr. Slawson describes as “probabilistic analytics & science”. This quantitative approach disrupts the inherent fallacies of human decision making.

2. We need to shift from process metrics to outcome metrics. This is a shift from treating the numbers, such as blood glucose, to treating the patient - that is, focusing on the outcomes that matter, such as heart attacks, strokes and deaths.

3. The shift to consumer-centricity & shared decision making is also of utmost importance. If decisions are, in fact, going to be made about value-based outcomes; and if we agree that patients, as consumers, define the value proposition; then any decision that is made without the patient’s shared input and preferences is going to be flawed.

4. This approach, far from being a ‘cook-book medicine’ imposition on providers, actually offers immense support and guidance. It will improve the clinical care of patients; and it will provide much needed relief for physicians  - allowing them the time and energy to focus their attention on their patients, instead of constantly hunting and foraging for the latest clinical updates.

One of the most meaningful messages that Dr. Slawson leaves us with is a “prescription to say ‘No’."  ‘No’ to unnecessary tests, imaging studies and invasive diagnostics. ‘No’ to wasteful and potentially harmful medications & treatments that are not indicated. ‘No’ to making decisions based on outmoded data and antiquated reasoning.  

One of the major lessons I came away with from this dialogue is that it’s not only what we do that can make a difference; it’s what we can stop doing that can really make a demonstrable positive difference in improving patient care and health outcomes.

As always, I hope you get as much out of this interview as i have!

Zeev

The problem we’ll be addressing in this episode – which is of critical national significance – is the unsustainable burden of healthcare costs.

We’ll cover two major issues: (1) tactics employers can take to avoid unnecessary healthcare costs; and (2) an approach to understanding and addressing a long-standing challenge in healthcare delivery – post acute care.

You should listen to this interview if:

Our guest this week, Josh Luke, is a nationally recognized expert in the post-acute care space, and on healthcare cost strategies in general.  He spent 15 years as a hospital CEO and a senior nursing home administrator – so he has deep knowledge and an insider’s perspective.

Since leaving those roles, his mission has been to assist patients and their families in navigating the opaque archipelago of post-acute care; and to assist individuals & employers in learning how to manage the overwhelming costs of medical care.

Josh is a self-described “truth teller”.  As you’ll hear in this interview, Dr. Luke does not hold back – and with good reason.  He’s got some well defined and thoughtful perspectives, as well as bold practical solutions on how the system needs to change to provide care that is safer, less costly and more dignified.

One example is Josh’s program, ‘Discharge with Dignity’ – an initiative to assure that patients being discharged from hospitals are given a reasonable option to return to their home, instead of being corralled into avoidable, unnecessarily lengthy, and costly post-acute care facility stays.  His protocol is being used across the country to train physicians and other providers.

Another example – Josh will discuss the main points of his most recently published book, ‘Health-Wealth: 9 Steps to Financial Recovery’.  He’ll share the specific tactics that employers can take to reduce unnecessary costs and optimize their healthcare spend.

From the employee or individual’s perspective, Josh will introduce us all to his “3 P’s” of becoming an “Engaged Healthcare Consumer” (EHC).

If you’re still wondering what all of this has to do with ‘dignity’, here’s what I garnered from listening to Josh.  Healthcare with dignity includes: (1) making what we do in healthcare – including prices – transparent, and easily understandable to patients, families & employers; (2) giving patients real choices that take into account their preferences (keep in mind that the AARP has repeatedly documented that over 97% of people want to go home after a hospitalization, and not to a nursing home); and (3) considering the quality, safety & cost factors first, rather than the business imperatives; or more bluntly put, being patient-centered rather than profit-centered.

Dr. Josh Luke’s honesty and openness is refreshing and much needed.  He sheds a revealing light and a helpful set of approaches to issues that have been hidden and confusing for decades.

He is clearly purpose-driven and passionate; his perspectives are born of wisdom and backed by data; and his recommendations are forward-thinking, consumer-oriented, value-based and practical.

If you still have some doubts as to the importance of this topic, I’ll leave you with some stats to consider:

As always, I hope you get as much out of this interview as I have.

Zeev

How many of us can define ‘well-being’?  How many of us understand the factors that enhance it?  How many of us think about the issue of ‘well-being’ or do anything about it in the context of ourselves, our employees or the patients that we provide care for?

Dr. O’Day and her multi-disciplinary team have spent years not just defining ‘well-being’, but also learning how to improve it.*

If you have a personal or professional interest in well-being, you’ll be interested in this interview.  

What’ll you hear is Dr. O’Day sharing:

I have heard Dr. O’Day speak on this topic a number of times; and I learn something new and important each time.   

In the second half of the interview she also shares some of the personal experiences, which have shaped her thinking on human behavior, performance and growth.

The conversation then meanders into a deeper discussion on existential issues such as meaning and purpose. It becomes abundantly apparent that this work is highly meaningful to Dr. O’Day, not only as a professional, but also as a fellow human being.  It’s clear that she not only talks the talk, but also walks the walk, when it comes to well-being.

As always, I hope you get as much out of this interview as I do.

Zeev

*The information Dr. O’Day shared, specifically related to ‘well-being’ research & development performed at Johnson & Johnson, is proprietary, and is the intellectual property of J&J.

If you have not been following the great leap forward that the American Medical Association (AMA) has made over the past 5 years, then you’ve been missing out on something quite spectacular.  It’s phenomenal, and phenomenally told to us by the President-elect of the AMA, Dr Barbara McAneny.

What you’ll discover in this interview is that the current AMA is not your father’s or mother’s AMA.  This is a bold organization that is attempting to launch the profession into the future. The breathtaking strategic initiatives and dramatic progress you’ll hear about may represent the largest inflection in the AMA’s history since the Flexner Report transformation over a century ago.  And, Dr. McAneny is, in her own right, an impressive & inspiring example of leadership. She has distinguished herself many times over as a community-based oncologist, as well as a leader on the national healthcare scene.

Here are a just a few snippets of the many forward thinking trajectories that you’ll hear Dr. McAneny expound upon in this interview:

In this episode, Dr. McAnaney will also describe three major strategic arcs the AMA is focused on:

First – the AMA’s (moonshot) “innovation ecosystem” network – a broad expanse of initiatives and highly progressive partnerships the AMA has engaged in to radically improve healthcare and health outcomes.  It’s astounding to hear the sheer number of highly collaborative partnerships the AMA has formed with start-ups, accelerators, venture capitalists, tech developers & other organizations – in order to bring the physician sensibility to the development of new health technologies & digital technologies.  The AMA has begun to act like an innovation convener – proactively partnering with companies such as IBM Watson, GE, Intel, the Scripps Institute, Partners Center for Connected Health, Intermountain Healthcare and Omada Health.

Second – the AMA’s strategy to transform medical education by creating “the medical school of the future”.   In this initiative – the ‘Accelerating Change in Medical Education’ Consortium – they’ve funded medical schools to create forward-facing curriculum and training programs.  The goal is to create the ‘physician of the future’ – not only knowledgeable in the science & art of medicine, but also steeped in the science & art of management, leadership and systems thinking.  At present there are over 30 medical schools involved, collectively representing a quarter of all medical students in this country.

Third – the AMA’s focus on physician burnout and sustainability.  Approximately 50% of physicians are burnt out according to numerous studies; and physicians daily spend over an hour on burdensome administrative work for every hour of direct patient contact.  Dr. McAnaney emphasizes that it’s hugely wasteful and demoralizing to have the most highly trained and costly human resource in healthcare function as data clerks for hours each day. Of note and underscoring this point, HHS Secretary Alex Azar recently stated, “Its the patients who suffers when a provider spends more time reporting quality measures than delivering quality care”. Dr. McAneny compellingly advocates for the removal of these and other stressors, as a way to reduce physician burnout and improve healthcare.  

I came away from this interview with a renewed appreciation and admiration for the AMA and its mission; and with a profound respect and gratitude for the vision, integrity and selfless commitment that Dr. McAneny has manifested throughout her career.

Dr. McAneny shares numerous pearls of wisdom throughout the interview – transformational inflections that you’ll want to listen to – likely, more than once.

As always, I hope you get as much out of this as I have!

Zeev

Our guest this week, Glenn Steele MD PhD, is one of the most trailblazing, impactful and enduring healthcare leaders of our time.  He is a distinguished surgeon, researcher and executive.  Dr. Steele served as past Chairman of the American Board of Surgery, past president of the Society of Surgical Oncology, and a member of the National Academy of Medicine.  He has been named consecutive times to Modern Healthcare’s Most Powerful Physician Executives in Healthcare, Modern Healthcare’s 100 Most Powerful People in Healthcare & Beckers’ Hospital Review 100 non-profit Health System CEO’s to know list.

Dr. Steele, former President & CEO of Geisinger & currently the Chairman of xG Health Solutions; and his colleague, the current President & CEO of Geisinger, David Feinberg MD recently co-authored a book entitled ProvenCare – How to Deliver Value-Based Healthcare the Geisinger Way.  In this interview we will uncover the major components of the ProvenCare model.  It’s a great peak under the hood of one of the best healthcare systems in the world.

What you’ll discover in this interview will include:

This interview also highlights Dr. Steele’s hard-earned wisdom, which played a critical role in the repeated and sustained successes at Geisinger.  He shares a number of memorable pearls during our dialogue.   One example is his commentary on how “scaling” innovation is, in his experience, much more challenging than creating the innovation itself.  Another related example is, in his own words: “how you do the ‘sociology for change’ is actually even more important than the substance of the change”.  His explanation of these statements have profound implications for anyone interested in or working on the transformation of healthcare.

You’ll also hear about the groundbreaking work Dr. Steele is doing in his newest role as Vice Chairman and clinical leader at the Health Transformation Alliance (HTA), an alliance of over 40 U.S. Corporations composed of over 6 million employees, with an annual healthcare spend of over $25 billion.  In this role, Dr. Steele, and his colleagues at HTA, are demonstrating to employers and employees that they can lower the cost of care by over 25% and decrease the risk of heart attacks, strokes and other end-stage outcomes of chronic disease – by guiding medical care to physicians within the Alliance who are using the ProvenCare model.

The Geisinger ProvenCare story is one of the best in the annals of American Healthcare; and in this interview, it’s told by one of the most proven healthcare leaders.

As always, I hope you get as much out of this interview as I have!

Zeev

This week’s episode, on employer-based healthcare, deals with one of the most critically important & rapidly advancing issues in American healthcare today.

Our guest this week is Dave Chase. He is a highly successful serial entrepreneur – who, among numerous other accomplishments, played a leadership role in launching Microsoft’s $2B healthcare platform. Dave has been named as one of the most influential people in Digital Health, and is known for the boldness and integrity of his speaking and writing.

A hallmark of Dave’s approach, as you’ll hear in this interview, is his refusal to pull any punches. Over the past few years he has been on a quest to understand and address the impact of the growing costs of healthcare on employers, employees, as well as the deleterious downstream impact on our municipalities and the national economy. Keep in mind that nearly half of all healthcare costs in the U.S. are paid for by employers and increasingly shouldered by employees.

Fortunately, Dave and his colleagues, as well as numerous others around the country, have been working to optimize the effectiveness & enhance the efficiency of healthcare delivery, as well as to very intentionally reduce the significant unnecessary costs of care.

To this end, Dave and his colleagues have formed a non-profit called Health Rosetta, whose purpose is to drive the “adoption of successful strategies and practical tactics to fix the healthcare system through the optimization of employer health benefits programs & healthcare purchasing.” It’s essentially an open source education, training and certifying resource for employee health.

In this episode, you’ll learn about Health Rosetta’s “7 Habits for highly successful employers” – the proven solutions that Dave has discovered and collected.  We’ll also discuss the critical role that “value-based primary care” and “centers of excellence” (high performing provider groups) play in reducing unnecessary healthcare costs for employers. Dave has the refreshing perspective that most of the solutions are already out there – they just need to be identified and deployed effectively. Dave also shares several encouraging examples of employers who have implemented these relatively straightforward initiatives, and reaped huge savings, which return to their bottom line and enhance their ability to extend greater benefits to their employees and their communities.

It’s a real treat to hear Dave discuss these topics with sincerity and fact-fueled passion; but, if you’d like more detailed information, I would encourage you to visit the Health Rosetta website and/or download a free digital copy of his book, “The CEO’s Guide to Restoring The American Dream – How To Deliver World Class Healthcare to Your Employees at Half the Cost”.

Although this interview begins with some stark economic realities and a disturbing vision of a potential future, it ends with a hopeful message.  Dave’s call to action is simple – join the value-based movement.  Dave is practical, purpose-driven, compassionate healthcare leader who brings fresh perspectives, fearless honesty and a selfless commitment to, as he puts it, “leave the world a better place for my kids than the current trajectory.” His work in the domain of employer-based healthcare is a critical endeavor to make a highly opaque and misaligned part of healthcare delivery more transparent and more sensible.

I hope his story and his mission inspires you, as much as it has me.

Zeev

This week’s interview is an expose in modern medical professionalism and perspectives on what will be required for the next era.  Our guest this week, Richard Baron, is a physician grounded in nearly three decades of direct hands-on clinical care and enlightened by his experience of participating on numerous national level workgroups such as at the National Quality Forum, the National Committee on Quality Assurance, the Center for Disease Control, The Commonwealth Fund & The Aspen Institute Health Strategy Group – as well as a couple of years at the Centers for Medicare & Medicaid Innovation Center, leading initiatives in accountable care and primary care redesign.  He currently is the CEO of the American Board of Internal Medicine (ABIM), which has had its fair share of controversy.

Richard has a deep and broad perspective on healthcare delivery.  But more than that, he’s a remarkably and refreshingly independent-minded thought leader, and a dedicated, passionate public steward for American medical professionalism.  

Dr. Baron reminds me of the many dedicated, hard working, thoughtful primary care physician leaders whom I meet regularly.  Like these high-integrity physicians, his focus is on the broader continuum of patient care – on patients & patient care, first & foremost; and then secondarily on sustaining providers.  His vision is consistent with the “quadruple aim” of better health, better care experience, better value & better support for providers.  He is an ardent champion for maintaining and elevating the standards & quality of medical care; and a vocal advocate for the critical central role of primary care in any value based healthcare system.  

Richard studied English at Harvard College, and then received his MD degree from Yale.  I’m not sure if it’s his liberal arts background that has given him the ability to tease out and integrate complex themes and narratives; but I do admire the new narrative he is attempting to construct at the ABIM.  He is currently focusing his efforts on listening to the varied voices and myriad perspectives of the ABIM’s physician constituents; and seeking to understand how to recognize, celebrate and reward both the tangible and intangible benefits of the the doctor and the doctor/patient relationship.  

He is keenly and realistically aware of the very real tensions of our times, and rather than ignore or polarize, he is seeking to balance.  Richard exposes the tension between science & service, between payment and prioritizing value-based patient care, between clinical medicine and community care.  He is clearly a defender of the scientific & technological narrative of healthcare – the ABIM’s purpose being to maintain professional knowledge and competence.  But, he is also seeking to support the integration of complementary narratives such as the importance of doctor/patient communication, continuous quality improvement, data-driven health management, and the empathetic skill and emotional work that is crucial in healing relationships.  

This interview reveals the story of an individual physician, innovator & leader – who is attempting to do what many of us are struggling to do – to infuse & sustain ourselves, our colleagues, our professions, and our institutions with humanism, humility, meaning and purpose; and to do so in an increasingly complex world that is becoming, of necessity, more corporatized, institutionalized and standardized.  

Above all else, what comes across in this dialogue is Dr. Baron’s strong sensibility that it is an incredible privilege to be of service to others – to have the gift of being able to alleviate the suffering of our patients and our communities through the practice of the art & science of medicine.  

This is a story you shouldn’t miss out on.  As always, I hope you gain as much from this interview as I have!

On the surface of it, this week’s podcast is about a new migraine solution.  But, the bigger story here is really about reframing how we think about chronic disease management and rethinking the importance of self-reported patient health data.  This story is also about the power and elegance of simplicity; the value of customer discovery and agile prototyping; and the absolute primacy of paying attention to the user interface interface/consumer experience.

What’s particularly refreshing about the way this product was created is that it was developed through listening to patients and providers.  Listening to patients, who define value; and to providers, who create it – and being open to continuously revamping one’s design based on what one is hearing and observing.  

This week’s guest is Dr. George McLendon.  George has an impressive academic & entrepreneurial background.  He’s published over 200 research papers in chemistry, physics & biology; and holds multiple patents, which has led to the founding of several successful life science companies.

George and his colleagues at SensorRX focused on headaches for a number of reasons.  Over 40 million people in the U.S. and nearly 1 billion people worldwide suffer from migraine headaches – making it one of the most prevalent chronic medical conditions.  The impact on U.S. employers is also profound – reaching tens of billions of dollars a year in medical costs and lost productivity.  

The customer discovery process that George and his team took led them to a number of observations and learnings. Here are a few of their discoveries you’ll hear about in this interview:

These realizations led the team to construct an app that literally takes 12 – 15 seconds to use each time a patient has a migraine.  The app records the necessary pieces of data; and can convey that info to the treating provider in a number of ways that makes it easier for the provider to treat the patients’ headaches more appropriately.  

In their unpublished trials to date, the team has witnessed an overall improvement in quality-of-life scores of over 30%, with many patients seeing much greater improvements.  This standardized quality-of-life survey – known as MIDAS – measures the negative impact headaches have on one’s work and social life. Clearly, the efficacy has yet to be proven in more rigorous, peer-reviewed studies; but the anecdotal reports to date are compelling.  

George and his team are also applying this approach to other conditions – such as asthma, irritable bowel syndrome, epilepsy and emphysema… conditions in which patient reported health data play a critical role in determining how physicians treat their patients.  

There is another part of this story here that shouldn’t be lost – Dr. McLendon’s intention.  One only need listen to his telling of the story of ‘Sally’ and her daughter to appreciate that his overarching mission is to alleviate the avoidable suffering of patients with chronic conditions. This is a trait shared by most of the leaders and innovators interviewed on this podcast series.  The lesson here may be that empathetic purpose & intention are key factors in redesigning successful healthcare solutions from the consumer/patient perspective.  And, that may be one of the most significant lessons we can derive from this and other episodes of ‘Creating a New Healthcare’.

This week’s podcast is about the critically important issue of patient suffering & professional caregiver suffering.  This particular episode will speak to you, not only from a professional perspective, but also from a deeply personal one.  If you have ever been a hospitalized patient, or a family member of a patient; or, think that you might someday be a hospitalized patient or family member of a patient, you’ll want to listen to this interview.  

Our guest this week is Christy Dempsey, the Chief Nursing Officer for Press Ganey Associates, who has recently authored a book entitled, ‘The Antidote to Suffering: How Compassionate Connected Care Can Improve Safety, Quality, and Experience’.  Christy has over three decades of experience as a nurse, nurse leader, hospital executive, and a consultant with deep experience in clinical operations, process improvement & patient experience.  Her approach is comprehensive and balanced; and her prescriptions are practical, and grounded in the practice of medicine, as well as in the science of process improvement and business management.  Her stories range from heart breaking to incredibly hopeful.  

In this episode, you’ll learn about the ‘Compassionate Connected Care’ model that Christy has constructed and is deploying in hospitals across the country.  

You’ll also come away with some amazing pearls & actionable take aways.  Here are a few examples:

Christy is a passionate, highly expert and convincing champion for the cause of alleviating patient & professional caregiver suffering.  What I admire most about Christy, and what she’s doing, is her courage and commitment in speaking out and doing something about a very sensitive issue that most don’t recognize or want to discuss.  Christy definitely joins the pantheon of leaders I’ve interviewed who have devoted their careers, and lives, to creating a new healthcare!

As always, I hope you get as much out of this as I have!