Friends,

The number one question I get asked after my presentations and seminars is, “But Zeev, what can I do?”  Making positive humanistic change in healthcare seems daunting, if not impossible. The system is incredibly entrenched. And yet, in this interview we’re going to hear examples of leaders who have used the principle of ‘love’ to create positive, impactful, and measurable change in their healthcare organizations.  

Our two guests in this episode – Dr. Apurv Gupta and Stephanie Feals – have been on a journey to explore and share how ‘love’ is being deployed in healthcare organizations – not just as a vision or mission, but as a tactical operating principle. They co-founded and co-host a wonderful podcast entitled, ‘Making Healthcare Work For You’, which I highly recommend.

In addition, Dr. Gupta – who is VP of Advisory Services at Premier Inc – has been consulting to organizations who are interested in creating a ‘loving’ healthcare organization. I find this to be incredibly encouraging and inspiring – that a publicly held company with the size, stature and reputation of Premier is supporting its people and its clients in working to rehumanize healthcare. 

In this episode, we’ll hear about nationally renowned leaders and organizations who have been deploying love as a leadership principle. There are many pearls of wisdom that Apurv and Stephanie shared.  I’ll briefly mention three:  

I would love to hear your thoughts about this.  If this interview resonates with you, please comment on it and share it with others.

Friends,

One of the most crippling problems in American healthcare is the cost of care through self-insured employers – which is how approximately 40% of all healthcare is paid for in the US. As our guest puts it, “Healthcare is unaffordable for individuals, unaffordable for employers, and unaffordable for the country.” And he’s not exaggerating. There are over 100 million American adults who are in medical debt. And there is abundant evidence that healthcare costs have greatly suppressed wages for decades. There are three important things to note about this. First, employee healthcare costs were largely inflated through decades of mismanagement. Second, due to the Consolidated Appropriations Act (CAA), self-insured employers are now going to be held accountable for the fiduciary responsibility of their employees’ healthcare costs – the recent class action suit against J&J is an example of that. Third, there are solutions out there, including the one we’re going to be talking about today – a highly innovative company called Transcarent. 

Our guest on this episode is Glen Tullman, the CEO of Transcarent. Glen is the former Executive Chairman, CEO & Founder of Livongo Health which was sold to Teladoc. He previously led two other public companies that changed the way health care is delivered – Allscripts and Enterprise Systems. Glen is also a Founding Partner at 7WireVentures, a socially-minded venture capital fund. He is the author of ‘On Our Terms: Empowering the New Health Consumer’; and he has received numerous public recognitions including the Robert F. Kennedy Human Rights Ripple of Hope Award in 2019.

Our discussion will include:

(1) The groundbreaking ‘platform’ approach Transcarent is taking in delivering healthcare to self-insured employers and their employees.

(2) Transcarent’s customized, guided, ‘care-experience’ – a one-stop shop that transcends the one-off, point-solution problem that has plagued digital healthcare. 

(3) The 5 “pillar” offerings or services that Transcarent delivers.

(4) A discussion on Transcarent’s new ‘weight health’ offering.

(5) How Transcarent is a remarkably timed solution for self-insured employers who now have fiduciary responsibility for their employees’ healthcare costs.  

I’ve written about Transcarent numerous times, and for good reason. It’s a brilliant advance in healthcare delivery and it’s incredibly well timed to meet the healthcare needs of self-insured employers. I’ve labeled my previous interviews with Glen Tullman as ‘Master Classes’. This one is exactly that – a ‘Master Class’ for healthcare leaders. But, it’s also a must-listen for CEO’s, CFO’s and CHRO’s of all self-insured employers in the US.

Friends,

Our guest is an incredibly accomplished physician, lawyer and healthcare policy expert – Kameron Leigh Matthews MD, JD, FAAFP. Dr. Matthews is a board-certified Family Medicine physician who has focused her career on marginalized communities. She is an elected member of the National Academy of Medicine where she chairs the Health Policy Fellowship & Leadership Programs Advisory Committee; and is currently a participant in the 6th cohort of the Aspen Institute’s Health Innovators Fellowship. Dr. Matthews received her bachelor’s degree at Duke University, her medical degree at Johns Hopkins University, and her law degree at the University of Chicago. 

What our guest and her colleagues at Cityblock Health are doing to change the status quo is straightforward yet quite remarkable. They are delivering integrated and advanced primary care to marginalized communities – and demonstrating improved outcomes. 

During the course of our interview, Dr. Matthews repeatedly referenced the well-worn definition of insanity – doing more of the same but expecting a different and better result.  When I asked her what Cityblock Health was doing differently, she cited numerous specifics that include: 

(1) providing care for a specific segment of the population – and deploying and customizing the healthcare resources that are needed by that segment; 

(2) utilizing value-based payment in order to sustainably deliver comprehensive services and to invest in innovative care models; 

(3) adopting a “partnership” model of care which includes assigning a “community health partner” (not worker) to each patient; 

(4) “multi-modal” care – delivering care where, when and how patients want it to be delivered – whether in their health “hubs”, in patients’ homes, or virtually; 

(5) a “one-stop-shop” of comprehensive clinical and non-clinical (SDOH) care – which includes a care team of doctors, nurses, and behavioral health experts, as well as partnerships with local healthcare systems and community-based organizations. 

The foundational thesis for Cityblock Health is evidence-based medicine – and the evidence is overwhelmingly clear. The vast majority of our health outcomes are dependent upon non-clinical factors – the so-called ‘social determinants of health’. Cityblock Health has built their model based on this evidence and is deploying a “whole-person”, community-based approach. Another foundational thesis is the principle of segmentation. By focusing on a specific segment of the population, they can more readily create a highly customized, appropriately resourced, and sustainable care model. 

One of the things I admire and respect about Dr. Matthews is that she not only has a prescription in hand, but she is actively delivering on it – with her work at Cityblock, her non-profit ‘Tour for Diversity in Medicine’ (which I recommend you look into), in her advocacy and policy work at the National Academy of Medicine, and more broadly in her national presentations.  

Dr. Kameron’s humanistic leadership and her courageous, intelligent voice is one that I hope we’ll continue to hear more from on the national healthcare scene.  And I hope, for our sake, we have the good sense to listen to it.

Watch out folks! A new day in Creating a New Healthcare is coming…

Creating a New Healthcare has an updated look and an updated focus. Over the past six months, I’ve been speaking with healthcare audiences across the country about my recently published book, ‘Beyond the Walls’, which is about getting beyond our limiting legacy thinking. There are 3 notable gaps that have arisen out of these conversations with providers, administrators, executives and healthcare consumers.

The first gap is a need to refocus our efforts on health – to go beyond healthcare. Our mission is not just to deliver healthcare – it’s to improve health. Somewhere along the way, it seems like we’ve lost that primary focus. We’re spending a lot of time, energy and resources on the healthcare industry rather than on the health care of the American public. In the podcast, we’re going to address that gap and expand the focus to achieving better health. 

The second gap is the inequities in healthcare. And by inequities, I’m referring to the systemic and structural racism, sexism, ageism, ableism, classism and reductionism – the inequitable ‘isms’ in healthcare. What’s clear is that if we’re going to solve the challenges in healthcare, we will need to explicitly address these issues. As such, we will be discussing health equity with a focus on solutions.  

The third gap that we’ll be explicitly addressing is that of leadership. What’s become abundantly clear to me is that if we are going to transform healthcare, we’re going to have to be willing to transform our leadership mindset. In the podcast, we will be focusing on a more generative, inclusive, collaborative and humanistic mindset – what I’m calling a “rebel mindset”. 

Finally, the number one question I’ve been asked as I’ve spoken across the country is, ‘What can I do?’ People are desperate for tangible, do-able, next steps. So, we’re going to add a ‘do-ability’ focus to the podcast and attempt to respond to that question of ”What Can I Do?” in each episode. 

This is a new day in Creating a New Healthcare. To hear more about this new, expanded version of the podcast and my personal journey that has led us here, tune in to today’s podcast, episode 168.

Friends,

Why? Because – when benchmarked against other public and private healthcare systems the VA outperforms on patient experience and consumer trust metrics. 

And, if you want to understand ‘how’ – listen to this interview. I would suggest listening to it more than once – to capture the principles, strategies and tactics that John and his colleagues are deploying to achieve a world-class healthcare experience.  Keep in mind that the VA provides care to over 9 million Veterans annually, at over 150 hospital-based medical centers and over 1400 ambulatory centers.

We cover so many profound topics, but here are a few:

This is one of many interviews I’ve conducted that demonstrates how far ahead the VA system is in so many respects. The VA is a hidden gem in the American healthcare system. 

There are so many pearls of wisdom and sophisticated approaches that are shared in this interview.  My hope is that it reaches the audience that needs to hear them.

Friends,

What’s profoundly disturbing is that this physician’s experience of anguish and burnout reflects that of the majority of clinicians and healthcare staff.

What’s inspiring is that this physician made a decision to turn the dismal dilemma of American healthcare into a positive movement to humanize it. What I also admire is his collaborative approach and the inclusion of patients – coupling his initial effort, Ripple of Change, with Medicine Forward and other advocacy/activism groups.  

One takeaway is that we need to change the narrative and the fundamental construct of our healthcare delivery system. We need a renewed sense of purpose & mission, and actually live it – in our policies and procedures – in our organizations – in our payment – in our daily delivery of healthcare. 

What Todd and others are doing is critical and urgent. Over half of US doctors experience burnout. One quarter of the current nursing workforce are planning to leave the system in the next three years. We aren’t at a tipping point. We’ve already tipped over. 

On a very personal human level, Dr. Otten had to first save himself before he could save others. There’s a profound lesson in there for all of us.

Friends,

This dialogue is a Master Class in Care Transformation – likely owing to our guest’s unique background, which includes preventive medicine, public health, and clinical informatics. It should be required listening for all healthcare executives and managers – both clinical and administrative – as well process/quality improvement professionals. Our guest, Dr. Cole Zanetti is an insightful and brilliant process improvement and care transformation expert. He has a broadly empathetic perspective and a practical humanistic vision that is the foundation for his work and his leadership. 

Dr. Zanetti currently serves as a Senior Advisor for the Veteran Affairs National Center for Care and Payment Innovation – focusing on value-based care delivery and payment innovation pilots as well as emerging technology innovation pilots. He also serves as the Chief Health Informatics Officer for the Ralph H. Johnson VA Medical Center in Charleston South Carolina, and as the Director for Digital Health at Rocky Vista University College of Osteopathic Medicine. Dr. Zanetti was trained in Family Medicine and Leadership Preventive Medicine at Dartmouth Hitchcock Medical Center. He is triple board certified in family medicine, preventive medicine, and clinical informatics – and has a Masters in Public Health from the Dartmouth Institute for Health Policy. He has also served on the National Quality Forum’s Physician Advisory Committee and as a technical expert for the Centers for Medicare & Medicaid Services.  

A few months prior to this interview I heard Dr. Zanetti speak about the cutting-edge, digital-tech innovations being deployed within the VA. My intention going into the interview was to do a deep dive on those care delivery innovations. But, this conversation went in an unexpected direction, which I’m truly grateful for. We ended up exploring the philosophical underpinnings of transformation and the approaches Dr. Zanetti has had to adopt in order to do this work. In short, we discussed the ‘why’ and the ‘how’ of care transformation.  

Some of the areas we covered include:

This interview uncovers another example of how the VA is one of the most innovative and transformational healthcare systems in the country. I continue to be astounded by the “hidden gems” – the forward-thinking, nationally leading expertise and initiatives within the VA, and the unique factors that make the VA ideal for ideating, piloting, deploying and studying care transformation.

Towards the end of our dialogue, I promised that I would follow up with a part 2, which I will – in which we’ll dive into the specific digital tech innovations being deployed in the VA.

In the meantime, I hope you have a chance to glean the wisdom and humanity of Dr. Cole Zanetti.

Until Next Time, Be Well

Friends,

Our guest, the esteemed Dr. Kryger, provides us with his expert perspective on this still emerging situation. In this episode we’ll discover:

This is one of those critically important and urgent issues that we need to learn more about and do more about. As our guest points out, the magnitude of this problem is enormous in that nearly 40% of the people who pulse oximeters are used on are people of color. 

My purpose here is to create awareness and motivate positive action. Along those lines, I would urge you to read and respond to the FDA’s recently released discussion paper (the public is invited to respond up until Jan 16, 2024); as well as attend the FDA’s upcoming virtual public advisory meeting on Feb 2 2024. 

I would also urge you to forward this podcast to your clinical colleagues as well as hospital and healthcare executives. 

Friends,

It’s remarkable to hear Dr. Vivek Garg discuss the multi-year strategy and tremendous commitment that has gone into the CenterWell Brand at Humana. One of the things I appreciate about Dr. Garg is his humility and transparency – about what Humana has achieved as well as what more we ALL need to achieve in order to provide the type of care that the aging senior population requires. As I mention in the closing comments of this interview, we need the type of leadership that Dr. Garg manifests – a leadership focused on outcomes that truly matter to people and communities.

Wishing you all the best of health and wellness in the New Year!

Zeev Neuwirth, MD

Friends,

As long-time listeners of this podcast know, my approach is not to focus on what’s wrong in American healthcare; but instead, to identify what’s right – so we can adopt, scale and spread positive change. What’s right here is that one solution to this disparity already exists. Our guest, Neil Friedman and his colleagues have developed a pulse oximeter, Circul Pro, that is more accurate in people of color, as well as in white people. It’s been scientifically validated and approved by the FDA. You can learn more about it at www.circul.health.  

Another positive development – two days after I recorded this interview, the Center for Devices & Radiological Health (CDRH) within the FDA released a discussion paper for public feedback entitled, “Approach for Improving the Performance Evaluation of Pulse Oximeter Devices Taking Into Consideration Skin Pigmentation, Race and Ethnicity”. They also scheduled a virtual public meeting on Feb 2, 2024 to discuss this issue.  Both announcements can be accessed here.

This interview raises more questions than answers.  For example:

This is one of those critically important issues that we need to learn more about and do more about. As our guest points out, the magnitude of this problem is enormous in that nearly 40% of the people who pulse oximeters are used on are people of color. 

My purpose here is to create awareness and motivate positive action, not to lay blame. Along those lines, I would urge you to read and respond to the FDA’s recently released discussion paper (the public is invited to respond up until Jan 16, 2024); as well as attend the FDA’s upcoming virtual public advisory meeting on Feb 2 2024. The paper is well researched and it’s a call-to-action to advance the research – with very specific questions. 

I would also urge you to forward this podcast and write up to your clinical colleagues – especially those with expertise in pulmonary, critical care, and sleep medicine. 

As always, wishing you the best of health,