Healthcare is Hard: A Podcast for Insiders

Robert Musslewhite has viewed healthcare innovation and the lifecycle of a healthcare services company from nearly every angle over the past two decades. He joined The Advisory Board Company because it was a small but fast-growing organization where he felt he could make an impact, and where he ultimately became chairman and CEO. Under his leadership, the company quadrupled in size to serve nearly 300,000 leaders in over 5,500 hospitals, health systems, and universities worldwide. In 2017, Robert led the successful merger of the Advisory Board Company with Optum – while spinning off its education business – and became CEO of OptumInsight. At OptumInsight Robert is focused on a societal need for strong partners and new solutions for a more modern, high performing and simpler health care system.

In this episode of Healthcare is Hard, Robert shares experiences with Keith Figloli that will resonate with both healthcare entrepreneurs and leaders of large healthcare organizations. He provides valuable leadership advice, offers predictions about how the healthcare industry will evolve over the next decade, and recounts his unique vantagepoints over the past twenty years including:

• Building a high growth startup. When he joined The Advisory Board, Robert’s mandate was to find new growth vectors. He approached this challenge with the realization that nearly every business that undergoes major transformation takes something they’re doing well and finds new ways to apply it. For The Advisory Board, this involved leveraging its world-class research and relationships with hospital leaders, and wrapping technology around them. The timing of this endeavor couldn’t have been better – Robert talks about how this occurred right at a massive boom period for healthcare analytics, how his team capitalized, and the lessons he learned in the process.
• Navigating a multi-billion acquisition. Under Robert’s leadership, The Advisory Board expanded its focus beyond healthcare and into education. Ultimately, he orchestrated the sale of both sides of the business at the same time. Robert talks about the process to seek and identify a potential market partner on the healthcare side, and how Optum – building one of the world’s most comprehensive, digital, information and AI-enabled care platforms – was an obvious fit after the first discussion. He saw how Optum’s capabilities would enable The Advisory Board to broaden its reach beyond hospitals into the changing healthcare market, and how The Advisory Board could help channel Optum’s many capabilities to further modernize health care with a focus on lowering cost while improving the experience for providers and their patients.
• Becoming the acquirer. Now, as CEO at a $10 billion business unit of Optum, identifying innovation inside and outside the business is a key part of Robert’s strategy, and traditional M&A is only one avenue to pursue. For example, Robert’s team works closely with Optum Ventures to get more exposure to startups it might otherwise never see, or it might consider taking minority stake in a company to first bridge gaps in expectations and/or prove a value prop in ways that couldn’t be achieved otherwise. Either way, the key is finding opportunities that provide real and rapid value. Real value because all innovation in healthcare has to be focused on expanding access to coverage, reducing the total cost of care and making the health care system simpler. Rapid value because speed to market in health care can and must be radically reduced so the impact of innovation can be realized quickly.

To hear Robert and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

CommonSpirit Health created one of the largest health systems in the nation by merging Dignity Health and Catholic Health Initiatives in early 2019. It now operates 137 hospitals and more than 1,000 care sites across 21 states, with revenues of nearly $29 billion.

Extending its reach into more communities across the country has enabled CommonSpirit to leverage scale as a means to advance its core mission of expanding healthcare access to all, advocating for those who are poor and vulnerable, and innovating how and where healing can happen.

If a person’s personal journey and early years are what guide them to their calling in life, as CommonSpirit CEO Lloyd Dean believes, it’s no wonder why he and SVP and Chief Strategic and Innovation Officer, Rich Roth, are key parts of a leadership team charged with seeing this mission through.

In this episode of Healthcare is Hard, Lloyd tells his inspiring story of growing up the son of a factory worker who experienced racial inequalities firsthand and saw the impact they have on basic healthcare and life expectancy. He shares his personal journey from being the first in his community to attend a university, to becoming the CEO of one of the nation’s largest health systems and how these experiences drive purpose in this role. Rich Roth recounts his first exposure to the healthcare industry cleaning doctors’ offices where his mother worked as a receptionist, his later roles cooking and cleaning at nursing homes, and ultimately his first job out of college stuffing envelopes and answering patient questions in the billing department of a hospital.

With the foundational influence of these experiences, Lloyd and Rich talk to Keith Figlioli about their role in fulfilling CommonSpirit’s healing mission and how it has changed in the wake of COVID-19. They cover a number of topics, including:

• COVID-19 as the great equalizer. Rich explains how certain elements of a health system like home care, pharmacy or community benefit have historically played a secondary role – part of a strategy, but not leading it – and are now starting to be central components of a system’s identity. COVID-19 has revealed the true vulnerabilities in our healthcare system and these are the things CommonSpirit is thinking deeply about to create the next chapter of healthcare delivery. As Lloyd points out, if we don’t see the inequalities now and address them in a demonstrable way, history will chronicle that as one of the greatest missed opportunities the nation has ever seen.
• Personalizing care for individuals. The U.S. health system has done a poor job personalizing primary care to meet individual needs, according to Rich. For example, behavioral health might be the primary need for some people while food or housing is the biggest concern for others. And different groups of people – women, seniors, Latinx, and many more – need more services specific to them too. The next evolution of care must move away from the “one stop shop” and will require services that understand and better serve each person individually.
• Being part of a community, not just “in” a community. Lloyd shares his prediction that care delivery from health systems, hospitals, clinics and other providers that currently occurs IN the community, will transform to be a bigger part OF the community. And providing a robust health infrastructure with broad access to care will not simply be understood as a moral imperative, but as an economic imperative as well.

To hear Lloyd, Rich and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Tal Heppenstall has a dual role at UPMC. He’s been treasurer of the $21 billion dollar health care provider and insurer since 2003, where he’s responsible for the day-to-day cash needs of an organization that integrates 90,000 employees, 40 hospitals, 700 doctors’ offices and outpatient sites, and a 3.9 million-member Insurance Services Division. In addition, Tal is president of UPMC Enterprises, where its mission is to create products and businesses that make life changing medicine happen.

In this episode of Healthcare is Hard: A Podcast for Insiders, Tal talks to Keith Figlioli about the elements that have created this unique, world-class organization and how it will continue to adapt in a post-COVID world. They address topics including:

• A Culture of Risk. According to Tal, one defining factor that sets UPMC apart from other non-profits is its tolerance for risk. It’s a theme he points to throughout the interview, talking about how the organization’s high risk tolerance enabled its success on the payer side, but how it is also an inherent characteristic of an academic medical center. Innovation is why UPMC exists, but Tal believes that without the willingness to take risks, it’s just a word.
• Constant Reinvention. Another important part of being rooted in an academic medical center is the bias towards discovery and reinvention. This has always been core to UPMC, but especially in the current environment as big tech, retail and others enter the market, innovation is not optional. However, Tal is quick to point out that the corporate venture operation under UPMC Enterprises is not a fund. It’s not about short term returns, but rather a reinvestment to make sure the organization is successful in its mission.
• UPMC’s Best Startup Ever. Innovation has resulted in a financial difference at UPMC, but one startup stands out in Tal’s mind – the health plan UPMC created in the late 90s. It’s now the largest medical insurer in western Pennsylvania with revenues of $12 billion. Tal recounts an environment in the market where one payer dominated for years and how competitive rates forced UPMC to do more with less. UPMC in turn became a very efficient organization and, as Tal puts it, is why they chose to do more with less of their own money instead of relying on another payer.
• The Pervasive Impact of COVID-19. Tal and Keith’s discussion reflects the fact that COVID-19 has permeated into every aspect of healthcare and is not a single topic of discussion, but an important part of every topic for the healthcare industry. Throughout the interview Tal shares his thoughts about COVID including how it has accelerated digital health, the challenges it has created for payers and providers, and the role government will continue to play driving change in response.

To hear Tal and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Michael Allen has unique expertise in healthcare finance. He’s been chief financial officer at four different health systems and is national chairman of the Healthcare Financial Management Association (HFMA) where he regularly interacts and shares knowledge with peers in the 56,000-member organization.

Michael calls HFMA his side hustle and is going on his second year of a one-year term since the organization froze its leadership to provide stability during the COVID-19 pandemic. His primary role is CFO at OSF Healthcare, a faith-based health system in Peoria, Illinois with 23,600 Mission Partners in 147 locations, including 14 hospitals.

Since the pandemic started, the Healthcare is Hard podcast has explored how health systems are dealing with it from multiple angles including from the CEO, CIO, regulatory, governance and supply chain perspective. In this episode, Keith Figlioli talks to Michael Allen to learn how finance leaders are supporting the healthcare industry and their organizations through this trying time.

Michael talks about how healthcare has historically not been very agile because realities like fixed costs, reliance on bricks and mortar and steady organic growth meant that it didn’t have to be. But he talks about the new need for agility, how OSF is adapting, and how some steps the organization took before the pandemic put it in a better position to respond. The topics Michael and Keith discuss include:

• Supporting quick decisions. Through its emergency operations center created to navigate the pandemic, Michael says OSF learned how slow the organization had previously been at making decisions. This wasn’t an issue before because it worked, but COVID forced a need for change. Instead of including everyone in every decision, Michael talks about how OSF learned to rely on small groups to make decisions, vet those decisions with the larger group, and then move forward quickly.
• Spending less time in the rear view. Michael is working to flip the traditional model of healthcare finance. Instead of looking backwards and planning based on previous experiences, Michael is directing his team to spend most of their time looking forward. For example, no one in healthcare knows what their future revenue stream will look like as the payer mix shifts and the average payment rate for services is likely to decline. This is why it’s critical for finance teams to spend more time forecasting and ensuring they’re nimble enough to respond to any situation.
• Eliminating the annual budget process. OSF entered its fiscal year starting October 2019 without a traditional budget. Michael and his team still updated their long-term financial plan and set financial targets on an annual basis, but spent less time on individual line items. Instead, they focused more on forecasting and dynamic planning, including measurement and processes for reacting to issues. This proved to be invaluable when the pandemic hit and as the healthcare industry faced rapid change, enabled OSF to quickly gather the information it needed, build forecasts, and move quickly.
• Creating an environment where innovation is inherent. Another area that bolstered OSF’s response to the pandemic is its focus on innovation – something Michael says has always been an integrated part of the organization versus a separate entity. In OSF’s venture arm for example, investments are never solely made for their financial benefits, but must also be doing something positive for the organization and be endorsed by clinical leaders. As the response to COVID-19 placed digital touchpoints first, this gave OSF a running head start in how it adapted.

Hear Michael and Keith dig into these topics and more in this episode of Healthcare is Hard: A Podcast for Insiders.

Cedars-Sinai is a nonprofit academic healthcare organization that serves the diverse Los Angeles community through more than 40 locations, 4,500 physicians and nurses, and 1,500 research projects in motion. Darren Dworkin has been Chief Information Officer at Cedars-Sinai since 2006, where he also founded the Cedars-Sinai Accelerator and serves as managing partner of Cedars-Sinai Health Ventures.

In this episode of Healthcare is Hard, Darren talks to Keith Figlioli about the impact of COVID-19 through a technical lens, offers advice to innovators and entrepreneurs selling to health systems during this difficult time, and shares broad views into the digital transformation of healthcare. Some of the topics they discuss include:

• Enabling Remote Work Through COVID. Many healthcare workers have been bravely carrying out their roles within the hospital setting during the pandemic. But the fact that a large portion of healthcare workers have been asked to work remotely – just like in other industries – hasn’t gotten much attention. Darren points out that in only four days, Cedars-Sinai shifted from having 400 people working remotely to having well over 4,000. He talks about how the health system’s technical infrastructure scaled to handle the demand.
• Lasting Impacts. One of the silver linings Darren sees emerging from the pandemic is how it will advance strategies around helping patients interact with technology in the right ways. While Cedars-Sinai had already been relying on technology for urgent care and primary care visits, he uses the example of post-surgical follow-up as one area where telehealth has, and will likely continue to be very beneficial. As he points out, surgeons prefer to operate, so if they can minimize the time they spend on follow-ups, it’s a win all around.
• Pulling Versus Pushing Technology. Darren recognizes that his role as CIO is to “help engage end users in the tech that we have.” In other words, push technology on the enterprise. But part of the reason he finds the work of the Cedars-Sinai Accelerator so rewarding is that it’s exactly the opposite. Clinical and operational leaders get to choose which companies should be in the accelerator based on their needs and the solutions that will solve their biggest challenges. As an academic medical center, Darren sees innovation and discovery as core to the overall mission at Cedars-Sinai, and its accelerator is a big part of that.
• Advice for Entrepreneurs. Darren’s biggest advice for digital health entrepreneurs is to focus on real savings. Just as we’re approaching a day of reckoning for tech IPOs where companies planned to layer on growth without profitability, the environment for digital health startups is similar: adding improvement without adding bottom line ROI may no longer be sufficient. For example, as companies think about expanding their product, Darren suggests thinking about how to broaden into an adjacent space – versus simply of adding more “bells and whistles” – in order to help health systems eliminate vendors and streamline costs and administration.

To hear Darren and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Over the course of nearly 20 years as Chief Research Officer at The Advisory Board Company, Chas Roades became a trusted advisor for CEOs, leadership teams and boards of directors at health systems across the country. When The Advisory Board was acquired by Optum in 2017, Chas left the company with Chief Medical Officer, Lisa Bielamowicz. Together they founded Gist Healthcare, where they play a similar role, but take an even deeper and more focused look at the issues health systems are facing.

As Chas explains, Gist Healthcare has members from Allentown, Pennsylvania to Beverly Hills, California and everywhere in between. Most of the organizations Gist works with are regional health systems in the $2 to $5 billion range, where Chas and his colleagues become adjunct members of the executive team and board. In this role, Chas is typically hopscotching the country for in-person meetings and strategy sessions, but Covid-19 has brought many changes.

Almost overnight, Chas went from in-depth sessions about long-term five year strategy, to discussions about how health systems will make it through the next six weeks and after that, adapt to the new normal. He spoke to Keith Figlioli about many of the issues impacting these discussions including:

• Corporate Governance – The decisions health systems will be forced to make over the next two to five years are staggeringly big, according to Chas. As a result, Gist is spending a lot of time thinking about governance right now and how to help health systems supercharge governance processes to lay a foundation for making these difficult choices.
• Health Systems Acting Like Systems. As health systems struggle to maintain revenue and margins, they’ll be forced to streamline operations in a way that finally takes advantage of system value. As providers consolidated in recent years, they successfully met the goal of gaining size and negotiating leverage, but paid much less attention to the harder part – controlling cost and creating value. That’s about to change. It will be a lasting impact of Covid-19, and an opportunity for innovators.
• The Telehealth Land Grab. Providers have quickly ramped-up telehealth services as a necessity to survive during lockdowns. But as telehealth plays a larger role in the new standard of care, payers will not sit idly by and are preparing to double-down on their own virtual care capabilities. They’re looking to take over the virtual space and own the digital front door in an effort to gain coveted customer loyalty. Chas talks about how it would be foolish for providers to expect that payers will continue reimburse at high rates or at parity for physical visits.
• The Battleground Over Physicians. This is the other area to watch as payers and providers clash over the hearts and minds of consumers. The years-long trend of physician practices being acquired and rolled-up into larger organizations will significantly accelerate due to Covid-19. The financial pain the pandemic has caused will force some practices out of business and many others looking for an exit. And as health systems deal with their own financial hardships, payers with deep pockets are the more likely suitor.

To hear Chas and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

As the healthcare industry’s largest group purchasing organization (GPO), Vizient manages more than $100 billion in spend for more than half of the nation’s acute care providers. Its members include a diverse group of large community health systems, safety net institutions, children’s hospitals, independent community hospitals and 95% of the country’s academic medical centers. This provides Vizient CEO Byron Jobe and his team exceptional visibility into the healthcare system and yields countless benefits for members of the network – especially during a national and global pandemic such as Covid-19.

 In this episode of Healthcare is Hard, Keith Figlioli talks to Byron about ways Vizient is using its supply-side and clinical data and leveraging the power of its network in the fight against Covid. They explore a number of issues including:

• Cross-Network Collaboration. While GPOs are always recognized for their purchasing power, they bring so much more to their networks. In Vizient’s case, its sheer size and reach allows it to share data, information and best practices across a broad segment of the U.S. healthcare system. Since the beginning of the pandemic, more than a thousand members have been joining weekly Vizient webinars where providers in hot spots share strategies about what’s working to fight the virus. For providers who have not yet experienced a surge, this offers an invaluable opportunity to help them prepare so they can mitigate the impact if and when a spike of cases occurs in their area.
• Predicting PPE Needs. There are many Covid surge calculators on the market, but unique datasets including information about social distancing at a local level enabled Vizient to build one of the most accurate. In fact, revisiting predictions from March and April showed that its models were accurate within 3-5% of actual numbers. Byron talks about how Vizient has now made this calculator available to all providers and is also adapting it to help predict future needs for PPE and other supplies as different parts of the country prepare for future outbreaks.
• Secrets of the Healthcare Supply Chain. Covid-19 has awaken many people to details about the supply chain they may have previously taken for granted – specifically, how much product is produced overseas and how little visibility exists. Byron talks about a Vizient “war room” that’s been running around the clock to globally source products its members need, how they’ve seen an uptick in attempted fraud, and how they vet suppliers to ensure quality, which includes having feet on the ground to inspect product around the world. He talks about how this crisis could motivate changes to the current system and what those changes might look like.
• The Lasting Impact of Covid. Before his role leading Vizient, Byron worked in healthcare finance roles and spent time in the healthtech startup arena. Combining his knowledge from these experiences with the unique visibility he has into the healthcare system at Vizient, he talks to Keith about the long-term impacts of Covid-19. He talks about how providers will be reevaluating capital projects over the next few years, especially those focused on building acute care facilities because of the accelerated adoption of virtual health. While providers have been preparing for virtual health for some time, he says some models predict that adoption rates at the end of this year will reach levels that had previously been predicted for four or five years down the road.

To hear Byron and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

This special episode of Healthcare is Hard: A Podcast for Insiders puts listeners “in the room” for LRVHealth’s annual planning meeting where the firm and its partners from across the health system determine strategic directives for the upcoming year.

But this year was much different than the past. Months of extensive planning for what is typically a two-day event in Boston was thrown completely out the window in response to the Covid-19 crisis. The event quickly became virtual, and perhaps more significantly, the content was entirely refocused to address the new realities that are changing every facet of the healthcare industry.

To lead a discussion about fast-changing healthcare policy directives at a federal level, LRVHealth tapped Blair Childs who, the day before, had been at the White House discussing these very issues with the president, vice president and hospital leaders from across the country. Blair is SVP of public affairs at Premier Inc, a company that unites an alliance of 4,000 hospitals and health systems and more than 175,000 other providers and organizations. As Premier’s primary spokesperson and communications strategist in Washington, Blair serves as liaison to the U.S. Congress, White House, healthcare policymakers and other major bodies involved in healthcare policy and regulation.

During his presentation for LRVHealth’s strategic partners, Blair provided a view inside the beltway and shed light on the biggest issues impacting the healthcare industry including:

• Rapid regulatory changes. In response to the pandemic, the federal government made about 70 different regulatory changes to make it easier for providers to care for patients. And it all happened in about a month – a remarkable pace for such change to occur. But as the public health emergency subsides, the focus will soon turn towards deciding when new regulations should be rolled back, and in many cases, whether they should be rolled back at all. Blair reviews some of the major changes that have occurred so far and offers insight into how some of them – on a range of issues from telehealth to FDA approvals – might fare into the future.
• Election implications and policy predictions. With the general election occurring in November and close contests that could shift power in the White House and both houses of congress, Blair offers his analysis on the different races and how they might impact the healthcare market. He reviews issues such as the shift to retail ambulatory care that has been incentivized by the realities of Covid-19 and how those changes will not be impeded by either party. And he also talks about issues that hang in the balance such as the battle between providers and payers that could swing towards collaboration with Democrats in power, or continue to rely more on market-based solutions under Republican leadership.

To get an inside look at LRVHealth’s annual meeting and hear what Blair Childs shared with the firm’s strategic partners to help them plan for and adapt to major shifts occurring in Washington, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

There’s one major difference between Boston Medical Center (BMC) and the other outstanding health systems in Boston. While being a major part of a city and region that’s renowned for world-class healthcare and innovation, BMC is the safety net institution.

More than half of BMC’s patients live at or below the federal poverty level, defined as annual income less than $20,000 for a family of three, and one-third of medical encounters require translator assistance of some kind. In other words, BMC is a big and divers place. And it encompasses all the pieces of the health system, from an academic medical center, to a network of community health centers, and a Medicaid insurance plan that services 400,000 people in Massachusetts and New Hampshire.

With this and more in one organization, BMC essentially has one payer: Medicaid. So, to fulfill its mission of providing exceptional care without exception, BMC is constantly seeking new and innovative ways to care for the community and produce healthcare services at a price the country can afford.

In this episode of Healthcare is Hard, Keith Figlioli talks to BMC’s president and CEO, Kate Walsh, to learn about how she approaches these challenges. Their conversation covers a number of topics including:

• Coronavirus magnifying public health necessities. During a conversation which took place just at the U.S. began to experience the spread of Covid-19, Kate shares her optimism about preparedness, especially in Massachusetts, where government, academic and health leaders have been collaborating closely. But she also talks about how the pandemic magnifies questions about where healthcare dollars are spent – more often on the episode of illness rather than maintaining the public’s health – and the need to think more comprehensively.
• Strength in academics. As the primary teaching affiliate for Boston University School of Medicine, Kate is extremely encouraged by hundreds of young residents who, every year, bring a drive and ambition to change the world. She also talks about how being a system rooted in academics means that major decisions are led by evidence, an approach that’s just as valuable for tackling both clinical and social challenges. She points to poverty and other social determinants and how they need the same academic focus, rigor and research. For example, one of the newest studies from BMC revealed just how difficult it is to capture the full scope of social determinants through screening.
• Food as medicine. BMC has been ahead of the curve in addressing the impact of food insecurity. Through a partnership with the Greater Boston Food Bank, BMC has been writing prescriptions for food for 15 years and now integrates the process directly into the clinical workflow. Prescriptions for food are included in a patient’s electronic medical record to optimize for dietary needs and, just as importantly, confirm that a patient has picked up their food. Writing a prescription for food has also removed some of the stigma of visiting a food pantry and has developed into a program that now serves 7,000 families per month.
• Partnering on housing. Kate jokes that the last person you want to build housing is a healthcare executive because they can’t do it for less than $1 million a bed. But with that awareness, BMC partners with the right organizations that can direct investments where they help patients most. Kate notes how this is more than simply providing a key: it’s understanding where simple rehabs can help patients safely transition home, to searching for answers about how people fell into homelessness in order to help them get out.

To hear Kate and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Dan Michelson’s recap of the JP Morgan Healthcare Conference in Becker’s Hospital Review has become a must-read over the past few years – whether you attend the conferences or not. Dan’s organization, Strata Decision Technology, works with more than 1,000 hospitals from hundreds of health systems on their financial planning, analytics and performance. And as CEO, he has a unique view across systems that allows him to neatly unpack and bring clarity to the various sessions and conversations that occur throughout the JPM conference.

Dan’s insight is especially welcome when it comes to the conversations that happen in the secluded confines of the thirty-second floor of the Westin St. Francis Hotel during JPM week. That’s where dozens of CEOs and CFOs from the nation’s largest health systems gather to hear presentations from their peers about high-level strategies in this rapidly changing market. 

If you’ve read Dan’s articles and wondered how he got started writing them, or if you’ve wanted to hear directly from him with more context on his thoughts, here is your chance. In this episode of Healthcare is Hard, Keith Figlioli’s conversation with Dan brings his JPM recap to life. This year, based on all the provider presentations and many one-on-one conversations, Dan outlines the 10 questions that health systems should be asking and answering to guide the future of their organizations. He and Keith take a deep dive into these questions, discussing topics including:

• Performance. Looking at whether a leadership team should spend their time focusing on performance or building a budget is one of the important questions Dan outlines for health systems. He explains the choices systems have in more detail, using OSF Healthcare as an example. The Peoria, Illinois-based provider shifted away from traditional budgeting processes in favor of a rolling approach and according to Dan, saved 20,000 hours of leadership time and more than $1 million in spend.
• Market share. Dan says providers need to change their mindset and think differently about how they define market share as healthcare evolves. In addition to the “share of cup” analogy Dan explained in his written recap, he talks about his experience hearing Walmart’s head of healthcare discuss the retail behemoth’s view of the market. While providers believe they own the patient relationship, he points out how only half of Americans say they have a primary care provider and among the other half, two-thirds haven’t visited their primary care provider in years. With that data, what does Walmart have to say about the market and the patient-provider relationship? “Alright, we’ll take the other 84%.”
• The “other five” questions. While Dan’s article framed the ten questions providers should be asking, Keith calls him to task for adding another five at the end of the piece without full explanations. Dan says his point is that the ten specific questions health systems are asking themselves doesn’t really matter; what really matters is that they’re asking tough questions like these at the executive level. However, he explains why he thinks questions about affordability are the ones that leave health systems most exposed right now. 

To hear Dan and Keith’s conversation, listen to this episode of Healthcare is Hard: A Podcast for Insiders.