I am thrilled to introduce a fellow Pemba alumnus, Dr. Michael Fromke, as our guest for this episode of Pemba on Demand.

Dr. Fromke graduated from Pemba in 2022. He is a neurosurgeon at Lee Health in Florida, an organization in which he holds a physician executive role in addition to practicing neurosurgery. He is also a member of the lead professional group at Lee Health.

He joins us today to discuss the improvement project he has been working on, explaining how he applied lessons learned from his MBA program at Pemba to drive value-based care initiatives, supply chain restructuring, cost efficiencies, and standardization in healthcare delivery.

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PEMBA On-Demand

Click here to download the slide from this presentation

Norman A. Chapin, MD MBA:

Norm Chapin on LinkedIn

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Michael Fromke, MD, MBA, FAANS

Michael Fromke on LinkedIn

Lee Health

On today's episode, we have Dr. Nicholas Wells and Dr. Monica Jones, physician leaders from the Erlanger health system in Chattanooga, Tennessee, joining us today. 

Dr. Jones is currently the Chief Medical Officer at Erlanger East Hospital, and Dr. Wells is the Associate Medical Director of the NICU at the Children's Hospital within the Erlanger system.

Dr. Wells earned his MD degree from the Uniformed Services University in 2006. Alongside his work as a neonatologist, he held the position of Chief Medical Officer for the Education Research Training Directorate at the Walter Reed National Military Medical Center for nearly two years. He is also a certified Epic Builder, responsible for the order set to build and EMR implementation in the NICU since 2021. He took on his current role as the Associate Medical Director for the NICU in 2019. Dr. Wells is currently in the Pemba MBA program of 2024. 

Dr. Jones earned her MD from Indiana University School of Medicine in 1980. Following that, she underwent training in anesthesia and completed a fellowship specializing in obstetrical anesthesia. While Dr. Jones was practicing as an anesthesiologist between 1984 and 2019, she also spent six years as the assistant professor of anesthesia at Baylor College of Medicine. In 2019, she transitioned to become the Chief Medical Officer at Erlanger East Hospital in Chattanooga. Dr. Jones obtained her MBA from Pemba in 2011.

Nick Wells and Monica Jones join us today to discuss a project they initiated to improve neonatal and newborn resuscitation in the early stages, focused on enhancing safety in the OR for infants born through C-section.

Links and resources:

Norm Chapin on LinkedIn

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Erlanger East Hospital

The Children’s Hospital at Erlanger

We are delighted to have Dr. James Daniel Moore joining us today to discuss an innovative strategy he pioneered at the University of Kentucky to address hepatitis C, a prevalent infectious disease affecting his local region and community.

Dr. Moore is an Associate Professor at the University of Kentucky Healthcare. He is also the Co-CEO and Chief Financial Officer at Thoroughbred Emergency Physicians. He completed his residency in emergency medicine at the University of Alabama after graduating from the University of Kentucky Medical School in 2011, and he recently obtained his MBA from the University of Tennessee Knoxville.

Dr. Moore’s Career Journey 

Initially, after completing his residency, Dr. Moore had no intention of pursuing an academic career, preferring instead to work in community emergency medicine. However, after seeing the broken healthcare system in Kentucky and feeling compelled to address the issues, he decided to stay and do his best to fix the problems. He saw academia as a means to access resources and infrastructure to improve healthcare delivery. 

Transitioning to a Large Academic Healthcare Organization

Over time, Dr. Moore learned the importance of building credibility and success within projects to have a seat at the table for decision-making. Despite the slow pace of change, he was motivated by his goal to improve patient care and access. 

Becoming a Change Agent

Participating in emergency department management programs sparked Dr. Moore’s interest in operational change within healthcare systems. His introduction to business concepts came from reading literature and implementing strategies to address the challenges of high patient boarding rates and various other issues. His need for credentials and a desire to learn practical skills to navigate complex healthcare systems effectively drove him to pursue an MBA.

Dr. Moore’s Approach to Public Health Emergencies

Dr. Moore’s interest in addressing public health emergencies, particularly hepatitis C, arose from his commitment to providing high-quality care to every patient. His approach involved implementing standardized screening and treatment protocols within emergency departments, leveraging resources from organizations like Gilead Focus to support infrastructure development. Through perseverance and strategic planning, he aimed to implement systemic changes to improve healthcare outcomes for underserved populations.

Annual Screening within High-risk Communities

Dr. Moore emphasizes the importance of annual screening in high-risk communities, particularly in emergency departments. Despite lacking a defined screening cadence, he asserts that the current guidelines advocate for widespread screening, with minimal issues encountered with payers. 

Financial Viability and Return on Investment

Dr. Moore highlights the significant cost savings associated with early intervention and treatment, the economic benefits of proactive healthcare interventions, and the importance of incentivizing healthcare systems to prioritize preventive care initiatives.

Expansion of Screening Initiatives

Dr. Moore highlights the ongoing efforts to expand screening initiatives to other emergency departments and correctional facilities, emphasizing the need for scalable, replicable models of care.

Expansion into Primary Care Offices

While it's too early to assess the full effectiveness of expanding initiatives into primary care offices, initial indicators suggest increased case identification. However, challenges persist, highlighting the need for standardized protocols and a centralized team. Plans are also underway for a system-wide screening program, extending beyond the UK for the first time.

Challenges with Eradicating Hepatitis C Nationally by 2030 

Reflecting on the daunting task of eradicating Hepatitis C nationally by 2030, Dr. Moore highlights the complexities of Medicaid funding, state variations, and legislative challenges. He outlines efforts to establish public-private partnerships, secure state resources, and advocate for policy changes to address funding gaps. 

Physician Buy-in and Evolution of Attitudes

Addressing questions about physician buy-in and resistance, Dr. Moore emphasizes the shift in mindset from traditional emergency care to a broader definition encompassing preventive interventions. Despite initial reluctance, many physicians now view those initiatives as valuable additions to emergency care, contributing to improved patient outcomes.

Conclusion

Dr. Moore underscores the importance of continuous advocacy, collaboration, and education in driving transformative change in healthcare systems.

Links and resources:

Norm Chapin on LinkedIn

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James Daniel Moore, MD, University of Kentucky College of Medicine

University of Kentucky Healthcare

Thoroughbred Emergency Physicians

We are thrilled to have Dr. Bruce Meyer, Executive Vice President and Western Pennsylvania Market President for Highmark Health Network, back on the show today. 

In today's discussion, we focus on graduate and undergraduate levels of medical education, exploring the repercussions of moving from a fee-for-service model to a value-based system and looking into the adaptations needed within medical education to align with this transition.

Acute Care and Disease Management

Despite recent shifts towards integrated curricula for medical education, the fundamental focus remains on acute care and disease management, with limited attention to preventive healthcare and wellness promotion. Bruce highlights the need to expand the curriculum to include preventive measures, mental health awareness, and addressing social determinants of health.

Barriers to Curriculum Modification 

A barrier to curriculum modification is the lack of training and education among current practitioners in value-based care, making it challenging to impart those principles to medical students and residents. Additionally, the economic incentives for practitioners often fail to align with the value-based care model.

Rise of Alternative Practitioners

The rise of alternative healers like naturopaths and holistic practitioners shows a gap in traditional medicine, which mainly deals with treating illnesses rather than overall well-being. The alternative healers approach preventive care holistically, promoting wellness in a way that the traditional model tends to overlook. 

Need for Government and Payer Involvement 

Bruce emphasizes the importance of both governmental and payer involvement in driving the shift toward value-based care in medical education. Government initiatives are essential due to their significant role in healthcare funding, while payers can incentivize practitioners to prioritize preventive care through financial incentives tied to outcomes.

Reforming Medical Education Financing 

The debt burden that medical students and residents carry poses a significant challenge, particularly in specialties with lower earning potential. That financial barrier discourages students from pursuing careers focused on preventive care and wellness.

Addressing Economic Disparities 

Bruce highlights the need to address the economic disparities between procedural and medical specialties because they influence career choices among medical students. Realigning financial incentives to reward practitioners for preventive care and promoting equity in reimbursement for medical services could help mitigate that issue.

Procedural Specialists

Hospitals value procedural specialists more because they bring in higher revenue, leading to higher salaries for those specialties than for primary care. 

Limited Residency Positions 

The proliferation of medical schools and insufficient graduate medical education slots exacerbate the limited residency positions problem. That has resulted in many American medical school graduates not securing residency spots despite promises of guaranteed training opportunities.

Institutions Implementing Curriculum Changes

Two institutions that have begun implementing curriculum changes to address these issues are Jefferson in Philadelphia and Allegheny Health Network. The changes include incorporating healthcare economics and business aspects into their curricula to prepare medical students and residents for the realities of the healthcare system.

In Conclusion

Ongoing attempts to improve medical education and training are crucial, with graduates from programs like Pemba having the potential to spearhead the change. Bruce emphasizes the importance of those graduates in driving transformation within the healthcare system.

Links and resources:

Norm Chapin on LinkedIn

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Highmark Health Network  

We are delighted to have Dr. Bruce Meyer, Executive Vice President and Western Pennsylvania Market President for Highmark Health Network, joining us today to present Care Reimagined: A Healthcare System’s Transformation.

Since joining Highmark Health in 2022, Bruce has been shaping and executing their payer-provider strategy in the Western Pennsylvania market. Before joining Highmark, he served as President of Jefferson Health in Philadelphia and held key executive positions at Thomas Jefferson University and UT Southwestern in Dallas.  

As a respected author, educator, and alumnus of the Physician Executive MBA program at the University of Tennessee, Bruce brings his vast knowledge of clinical services, academic leadership, and healthcare administration to our discussion today.

Obtaining an MBA from the Physician Executive MBA Program at the University of Tennessee 

Recognizing the shift toward capitation in healthcare payment models, Bruce sought a program focused on the business of healthcare. Pemba stood out for its focus on healthcare management, providing him with a sophisticated toolkit for navigating the evolving healthcare landscape. Their reputation instantly elevated his career prospects, opening doors to new opportunities and leadership roles.

Unanticipated Impact of the MBA Program

Organizational development was an unforeseen but critical aspect of Bruce's MBA experience. Through the coursework and its practical application, he gained insights into the importance of developing people within organizations. That realization reshaped his leadership approach, transitioning from a subject matter expert to a team-oriented leader. 

Addressing Unsustainability in Healthcare Economics

The presentation begins by highlighting the unsustainable nature of healthcare economics in the United States, emphasizing the commonalities among developed healthcare systems worldwide, including service providers, innovators, and administrators, each contributing to the functioning and expenditure of the system. 

Challenges in the Current Healthcare Landscape

Bruce outlines the current economic challenges exacerbated by disproportionate growth in government payers like Medicare and Medicaid, which cover nearly 60% of healthcare costs. Shifting the costs onto commercial payers due to funding shortfalls further complicates the landscape. Additionally, the influence of polarized politics and increased government intervention in healthcare exacerbates existing issues, contributing to growing public distrust in the system.

Transitioning Physician Employment and Financial Pressures on Hospitals

There has been a significant shift in physician employment, with over 70% now employed by larger organizations rather than self-employed. This trend, coupled with private equity funding disruptive models, has led to financial hardships for hospitals, with a substantial percentage operating at a loss. Public trust in healthcare is also eroding due to perceived profit-taking by various stakeholders, including pharmaceutical companies, hospitals, and physicians.

Factors Contributing to Escalating Healthcare Costs

Bruce identifies several contributors to escalating healthcare costs in the US, including technological advancements, inflated drug and device development costs, administrative inefficiencies, and end-of-life care expenditures. Moreover, physicians in the US earn significantly higher salaries when compared with their counterparts in other developed countries.

Addressing Waste and Inefficiencies in Healthcare

The considerable waste and inefficiencies within the US healthcare system encompass administrative, clinical, operational, and social determinants of health costs. Issues such as gun violence, obesity, and homelessness disproportionately burden the healthcare system, highlighting the need for a more closely integrated social safety net.

Disparities in Healthcare Spending and Outcomes

A comparison of healthcare spending as a percentage of GDP reveals the disproportionate spending of the US relative to other developed countries. Despite higher expenditures, the US does not consistently achieve better health outcomes, indicating inefficiencies in the system.

Transitioning Towards Value-Based Care

Bruce emphasizes the imperative of transitioning from a fee-for-service model to a value-based care approach. This shift requires bridging the gap between fee-for-service and value-based models, focusing on reducing unnecessary healthcare utilization while maintaining revenue streams. Collaboration between providers and payers, care coordination, patient engagement, and data-driven decision-making are crucial elements in this transition.

Continuum of Payer-Provider Partnerships

In the presentation, Bruce outlines a continuum of payer-provider partnerships, ranging from traditional fee-for-service arrangements to fully integrated models. That highlights the benefits of moving towards alignment and integration, where providers and payers share financial stakes and work towards a singular bottom line.

Case Study: Implementing an Integrated Model

Bruce shares a case study of implementing a fully integrated model, Living Health, to improve outcomes, member experiences, and cost efficiencies. Results indicate improved outcomes, cost savings, and a virtuous cycle of provider efficiency leading to increased insurance sales.

Addressing Incentives and Alignment

The presentation highlights the importance of aligning stakeholder incentives to drive desired outcomes. That involves redesigning workflows, leveraging technology, and shifting incentives away from pure fee-for-service models towards value-based care metrics such as patient experience and total cost of care.

We are delighted to have Dr. Karen Murrell and Dr. Chuck Noon joining us today.

Dr. Murrell is a practicing emergency physician, Director of Care without Delay at Kaiser Permanente, and a LEAN expert and consultant. She is also a fellow of the American College of Emergency Physicians and a faculty member of ASAP Directors Academy. Dr. Murrell received an MBA from the University of Tennessee Pemba Program in 2009 and currently serves as a faculty member for the Institute for Healthcare Improvement, contributing to their hospital operations and emergency medicine courses. 

Dr. Chuck Noon holds a Ph.D. in Industrial and Operations Engineering from the University of Michigan. As a professor at the University of Tennessee’s Haslam College of Business, he leads various executive MBA programs, including their Physician Executive MBA program. He is a LEAN expert and consultant at X32 Healthcare and a faculty member for the Institute of Healthcare Improvement, working toward perfecting their emergency department operations course.

Navigating Leadership Challenges

As Karen advanced in her emergency medicine career, the increasing volume of patients, long wait times, and a community crisis prompted her to seek solutions beyond traditional medical approaches. That led her to leverage LEAN principles and eventually enroll in the MBA program to gain a broader perspective of leadership and operations.

Pursuing an MBA 

Her desire to improve operations and enhance patient care, coupled with all the possibilities presented by LEAN methodologies, drove Karen to delve deeper into business education by pursuing an MBA at Pemba. The focus on physicians, global exposure, and the one-year duration of the program were additional factors that drew her in.

Balancing Clinical and LEAN Work 

Karen’s current career balance involves operating with a 50/50 split between clinical emergency medicine and LEAN work. Despite her demanding workload, she finds it rewarding to make a meaningful difference in patient care and work environments. She feels that her ability to blend clinical expertise with data analytics enhances the effectiveness of her performance improvement projects.

Chuck's Evolution into Healthcare Improvement 

After joining the University of Tennessee, Chuck transitioned from theoretical research to practical problem-solving in 1998, when they introduced their Physician Executive MBA program. His passion for making immediate and tangible improvements in healthcare operations led to his active involvement in LEAN methodologies.

X32 Healthcare 

Chuck co-founded X32 Healthcare in 2008 as a vehicle for LEAN education, analytic modeling, and on-the-ground consulting. Team Health bought the company in 2018 and continues contributing to healthcare improvement initiatives. 

Consulting Engagements and Impact 

Chuck and Karen engage in consulting work, contributing to various projects globally. In addition to working with Chuck, Karen has also visited Qatar three times over the last year to work on an initiative for the Institute for Healthcare Improvement. Chuck focuses on multi-faceted engagements, averaging four to six projects annually. Collaboratively, their approach enhances the effectiveness of LEAN initiatives.

Multi-Pronged Approach to Improvement

Chuck and Karen have collaborated to enhance patient flow and streamline processes in the emergency department of Boston Medical Center. Their comprehensive and multi-pronged approach involved assessments, data analysis, education, and improvement events. Using the example of their engagement with four hospitals in the Ontario province, Chuck emphasizes the importance of understanding barriers, identifying opportunities for improvement, and implementing targeted changes.

The Boston Medical Center Project

The Boston Medical Center project began with an invitation from a former student who suggested holding a LEAN improvement event at the Boston Medical Center. The project focused on addressing challenges in patient flow, particularly in the context of a perceived bed shortage in the emergency department.

Initial Assessment and Education

The team initially assessed the existing processes at the Boston Medical Center. After that, they conducted a two-day LEAN improvement course for a diverse group of ER staff members to lay the groundwork for their subsequent improvements.

The LEAN Improvement Event

Their LEAN improvements spanned three days, with the first two days dedicated to planning and setting up the new process. On the last day, they tested a new process called the Rapid Assessment Zone (RAZ). 

The Rapid Assessment Zone 

The goal of the RAZ was to address challenges in patient flow, particularly for low to mid-acuity patients. The key elements of RAZ included a streamlined patient pathway, vertical patient positioning to minimize bed consumption and efficient communication between doctors and nurses. 

Sustainability and Leadership Engagement 

LEAN improvement events foster continuous improvement. The events instill a flow culture and encourage people to continue engaging with the work. Leadership engagement is essential for sustaining such events. 

A Blueprint for Healthcare Transformation

The Boston Medical Center case demonstrates how LEAN improvements can drive transformative change in healthcare delivery. Along with leadership engagement, the multi-pronged LEAN events present a blueprint for healthcare organizations seeking to enhance efficiency, patient satisfaction, and overall performance. 

Links and resources:

Norm Chapin on LinkedIn

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Karen Murrell on LinkedIn

Charles (Chuck) Noon on LinkedIn

We are delighted to have Dr. Ram Raju, a dedicated leader in the healthcare industry, joining us for today’s discussion. 

Dr. Raju was formerly the Senior Vice President and Chief Community Health Investment Officer at Northwell Health, the largest healthcare provider in New York. Before joining Northwell, he served as the President and CEO of New York City Health and Hospitals and the CEO of Cook County Health in Chicago. 

Dr. Raju is a Pemba alumnus from the class of 2000 and received his CPE from AAPL. He has served on many local, regional, and national organizations. Throughout his career, he has passionately advocated for addressing population health issues, promoting equity in healthcare, and understanding the impact of social determinants on patients. 

The topics we discuss today go far beyond quality in healthcare. We look into healthcare policy and the crucial role of physician leadership, and Dr. Raju shares valuable insights for those aspiring to leadership positions within healthcare organizations. 

Dr. Raju brings a wealth of experience to our conversation today. You will not want to miss this opportunity to gain unique perspectives and recommendations from this recognized physician leader. 

Current State of Healthcare Quality

Dr. Raju explains that healthcare quality has evolved from a marketing tool to a commodity. As a result, he has noticed overall improvement in both quality and safety in the country. He suggests that future differentiation should include factors like cost-effectiveness, efficiency of care, and convenience for patients.

The Definition of Quality 

Quality in healthcare is not only about successful procedures. Dr. Raju advocates for a more comprehensive view of quality within healthcare, explaining that the focus needs to shift from treating diseases to treating individuals while considering the social determinants impacting each patient. That requires an understanding of the socio-economic conditions, living circumstances, and overall well-being of each patient.

Physician Response to Social Determinants 

Addressing the challenge of physicians incorporating social determinants into patient care, Dr. Raju suggests three strategies for improved patient outcomes:

Changing the Landscape of Quality Metrics 

Discussing the evolution of quality metrics, Dr. Raju argues for a shift from disease-focused to patient-based outcomes, considering factors like patient satisfaction and overall well-being. 

Equity in Healthcare and Policy Advocacy

Highlighting the importance of understanding the integral role health policies play in healthcare, Dr. Raju underscores the need for physicians to get involved in advocating for policy changes. He teaches a course on policy and politics at the Roosevelt School of Public Policy, where he emphasizes the link between policy, politics, and achieving equity in healthcare.

Redesigning Healthcare Delivery 

Dr. Raju believes that training incoming doctors to prioritize health over disease management is crucial for the future. He calls for the healthcare delivery system to get redesigned and a shift from disease management to health-focused care. 

Universal Healthcare and Insurance 

Dr. Raju believes everyone should have healthcare insurance because that is an individual responsibility, like insuring cars or homes. He feels that insurance is essential to ensure careful and responsible healthcare consumption.

Challenges and Opportunities in Healthcare Policy 

Dr. Raju discusses the ongoing debates in healthcare policy, focusing on cost containment, maintaining population health, and funding healthcare appropriately. He points out that the challenge lies in managing the increasing demand for healthcare services while addressing the shortage of healthcare providers.

Universal Healthcare and Collaborations 

Dr. Raju challenges the assumption that universal healthcare always leads to a solely governmental approach. He acknowledges the importance of private and public collaborations to ensure everyone has adequate insurance, preventing people from facing bankruptcy due to unaffordable health care costs.

Economic Impact of Health and Productivity 

Looking at the impact of health on productivity and the economy, Dr. Raju explains that investing in healthcare and maintaining a productive workforce can provide economic benefits. He emphasizes the need for a healthy and productive population to sustain economic growth. 

Transition from Clinician to Policy Involvement 

Dr. Raju’s transition from a clinician to a physician engaged in public policy and healthcare policy began with his need to address the economic challenges faced by the hospital he was with at the time. That led to him understanding the significant role played by the government in healthcare through its policies, reimbursement mechanisms, and regulatory approvals.

Physician Leadership and Operational Knowledge 

Dr. Raju explains the importance of operational knowledge for physicians looking to assume leadership roles. He explains that physicians must understand procurement, human resources, financial management, and other aspects of operation to gain credibility and effectively lead healthcare systems.

Intrapreneurship in Healthcare 

Dr. Raju’s vision for the future of healthcare includes incorporating intrapreneurship into the industry and encouraging doctors to challenge the status quo, innovate, and bring new ideas to fruition. He regrets not realizing the importance of entrepreneurship earlier in his career and urges organizations, especially teaching institutions, to focus on teaching future-oriented medicine.

Links and resources:

Norm Chapin on LinkedIn

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Purpose Med Solutions

We are delighted to present an interview featuring Dr. Amit Prasad, the Chief Medical Officer of the Methodist Le Bonheur Hospital system. 

In today’s conversation, Amit discusses his medical background and current responsibilities, and shares his thought-provoking perspective on the potential impact of artificial intelligence in the future of healthcare. 

Join us as we explore the expertise and reflections of this distinguished leader in the medical field.

Transitioning to Chief Medical Officer During COVID

Amit has been the Chief Medical Officer for the Methodist Le Bonheur Hospital system for about two and a half years. He took on that role during the COVID surge, driven by his desire to be at the forefront of patient care, even though he was initially a Health Plan CMO. 

Background as a Health Plan CMO

Before becoming the Chief Medical Officer for the Methodist Le Bonheur Hospital system, Amit served as the Chief Medical Officer for the United Healthcare Mississippi Medicaid program for about three years.

Transition Challenges During COVID

During the early days of the COVID pandemic, Amit Dr. faced some unique setbacks, including limited face-to-face interactions due to mask mandates, making it challenging to establish connections and relationships.

The Resilience of Healthcare Workforce During COVID

Despite all the challenges, Amit acknowledges the resilience of the medical workforce during the pandemic. He is aware of the dedication and commitment of those who remained in healthcare at the time, going above and beyond to care for patients.

Artificial Intelligence in Healthcare

Amit explains that AI has an increasing role in various aspects of medicine, from analyzing data and interpreting physical exam findings to applications in imaging, robotic surgery, and documentation. It is also helpful for reducing variability in care and offering guideline-based recommendations.

Potential Impact of AI on Clinical Decision Support

Looking at the potential impact of AI on clinical decision support, especially in addressing diagnostic errors, Amit explains that AI could help providers, particularly in rural health settings, by offering guidance and guidelines for managing various conditions.

Concerns and Downsides of AI in Healthcare

Amit has some concerns about AI. They include the blind trust in AI tools, the potential for biased algorithms, the risk of data inaccuracy, and the liability implications. He emphasizes the need for clinicians to maintain control over AI and advocates for establishing guardrails and regulations.

The Role of AI in Addressing Physician Shortages and Enhancing Efficiency

AI can help address various challenges in healthcare, like physician shortages and burnout. Amit also sees AI playing a role in streamlining documentation processes, reducing administrative burdens, and improving the accuracy of medical records.

Personal Journey into Leadership Roles

Amit’s journey into leadership roles in healthcare began with a focus on diabetes management and performance improvement. His interest in leadership grew as he recognized the impact he could have on patient outcomes within those roles.

Amit’s Future Aspirations

Amit highlights the importance of focusing on healthcare beyond the hospital walls. While he remains content in his current position as Chief Medical Officer, he would still like to work on transitions of care and the entire continuum of patient care in the future. 

Leadership Lesson: Empowering Teams for Patient Care

Amit shares a leadership lesson. He points out that clinicians genuinely intend to do well for their patients, yet they might lack the tools or face barriers within the processes. He encourages leaders to empower their teams, remove the barriers and challenge their teams to do more for patient well-being.

Links and resources:

Norm Chapin on LinkedIn

Visit our YouTube Channel 

Methodist Le Bonheur Healthcare

We are delighted to share our live stream interview with Dr. Sandy Valino Stock today. Sandy is a family medicine practitioner and founder of a concierge direct primary care practice called EnVogue Med and Wellness.

In our discussion, she shares her inspiring journey of moving through burnout to finding a practice model that reignited her passion for medicine by allowing her to use what she learned in the Pemba program to continue practicing medicine and bringing value and expertise to her patients.

Founding EnVogue Med and Wellness 

Sandy’s lingering desire to create a practice treating patients as consumers motivated her to found EnVogue Med and Wellness. Halfway through the Pemba program, she began to miss the clinical aspect of medicine. That led her to use the knowledge she gained from the program to return confidently to clinical medicine and establish her practice.

Core Services of EnVogue Med and Wellness 

The three core services offered by EnVogue Med and Wellness focus on an elevated patient experience, comprehensive primary care, and personalized medical weight management. Their unique approach involves longer appointments, direct messaging with doctors, and a membership structure covering non-insurance services.

Business Growth and Future Services 

Sandy’s plan for growing EnVogue Med and Wellness includes expanding to multiple Chicagoland locations to address the shortage of primary care providers and improve accessibility to quality healthcare. Future services may also include aesthetics, anti-aging, and personalized genetic medicine.

Comparing Work Environments

When comparing her workweek at EnVogue Med and Wellness with her previous workweeks in a traditional family medicine setting, Sandy says she prefers having the flexibility and varied responsibilities of her current workweek. As an entrepreneur, she wears many hats. That contributes to a more flexible and satisfying work-life balance.

Integrating Lean Six Sigma into Practice Processes 

Sandy explains that the organizational profile of Lean Six Sigma serves as a handbook, saving time and providing guidance. She believes integrating Lean Six into her medical practice will have a positive impact, as that approach helps her stay grounded as an entrepreneur and allows her to remain focused on her mission and vision.

Patient Care and Practice Growth 

As a new practitioner, about half of Sandy’s time involves direct patient care. She feels confident about the potential of the Direct Primary Care model to contribute to the healthcare landscape to eventually have a patient panel of 300 to 350, potentially expanding to 1000 patients.

Insurance Acceptance 

After initially opting out of Medicare, Sandy adapted to market demand and re-enrolled. Incorporating Direct Primary Care into her medical practice involved navigating legal structures to accommodate the different business models within her practice.

Business Model Modifications and Flexibility 

Sandy adopted an iterative approach to modifying her post-presentation business plan, experimenting with fee structures and remaining true to her mission. She highlights the importance of adaptability, employing a lean startup mentality, and continually tweaking the model to align with market needs.

Impacting the Physician Shortage 

Sandy envisions her model decreasing the physician shortage due to burnout by offering a more laid-back and consumer-centric approach. She anticipates it will retain physicians and positively influence the satisfaction of healthcare workers by contributing to a more sustainable and positive work culture.

After-hours services and Patient Retention 

Addressing the management of after-hours calls and services, Sandy includes boundaries and mutual respect in her membership contract. She has had a positive patient response, indicating their understanding and cooperation. 

The Emotional Journey of Transitioning Her Practice 

Driven by a need for a better work-life balance, Sandy shifted from running a not-for-profit organization to starting her practice. Her emotions during the transition were bittersweet because she was leaving an organization she loved but was excited about creating an efficient and patient-focused practice where she could implement changes quickly. 

Advice for Physicians Interested in Direct Primary Care 

When offering advice to physicians interested in DPC or concierge medicine, Sandy emphasizes the importance of following their hearts, staying true to their goals, and actively networking. She stresses the value of seeking mentors, as mentorship can prevent mistakes and significantly increase the chances of success in entrepreneurial ventures.

Links and resources:

Norm Chapin on LinkedIn

Visit our YouTube Channel 

EnVogue Med and Wellness

We are delighted to introduce Dr. Luissa Kiprono as our guest for today’s show. She is a physician leader, an entrepreneur, and the founder of two companies. She is also a motivational speaker and an author. 

Dr. Kiprono is an alumnus of the University of Tennessee's Pemba program, where she graduated in 2020. She is board-certified. She completed her residency and OB-GYN and then did a maternal-fetal medicine fellowship at the University of Mississippi Medical Centre. She founded World Gateway Perinatal Consultants in 2018 and her Tele Med MFM Venture in 2022. She explores self-help and motivation through her recently published book, Push Then Breathe: Trauma, Triumph, and the Making of an American Doctor. 

We are excited to dive into her work in telemedicine and explore how it influences her life and, more importantly, transforms the lives of her patients.

Evolution of Telemed MFM

Telemed MFM is a high-risk pregnancy care practice providing telemedicine solutions and maternal-fetal care access across geographical borders. Through virtual consultations, Dr. Kiprono addresses the current challenges in evaluation, assessment, and treatment delays, particularly in underserved rural areas. Her practice aims to bring high-risk medical care to expectant mothers, irrespective of where they are. Her commitment to consistency, discipline, and effective communication has contributed to her successful telemedicine practice.

Lessons Learned and Empowerment Message

Dr. Kiprono describes founding a telemedicine practice in her 50s as a simultaneously scary and exciting journey, particularly amid the COVID-19 pandemic and the closure of her former practice. She chooses a patient-driven approach over corporate healthcare norms and always encourages her fellow physicians to follow their hearts and pursue their dreams.

Practicing Maternal Fetal Medicine Remotely

In the earlier days, maternal-fetal medicine physicians provided prenatal care to high-risk patients in their offices and delivered the babies after nine months. However, a shift has occurred over the last decade due to the limited number of maternal-fetal medicine specialists (only about 313 out of 100 physicians are practicing full-time and boarded). That has evolved toward a more consultative approach, where physicians like Dr. Kiprono engage in virtual consultations, examine scans, and provide care through encrypted telehealth systems.

Telemedicine MFM and Working with Hospital Systems

Telemed MFM provides high-risk pregnancy care through telemedicine solutions. It also integrates into healthcare and hospital systems, offering services equivalent to an on-site presence. Dr. Kiprono decided to start the integration process into hospital systems by maintaining a full-time partnership with just one hospital system while contemplating the future expansion of her venture. She is currently working full-time with St. Luke's Health System in Kansas City, Missouri.

Navigating Billing and Insurance in Telemedicine

Dr. Kiprono explains that there has been a shift toward more streamlined and niche insurance coverage, making it more accessible and affordable. The hospital manages the billing for surgical and patient services, simplifying the process. Credentialing with various insurance companies is facilitated through the hospital. That also covers Dr. Kiprono’s services. 

Expanding Telemedicine MFM and Future Plans

Dr. Kiprono’s future vision for Telemedicine MFM includes recruiting additional physicians who share her commitment to virtual maternal-fetal medicine. While acknowledging the steep learning curve of telehealth, Dr. Kiprono remains optimistic about finding individuals comfortable with providing excellent medical care through virtual means.

Pursuing an MBA in Physician Leadership

Pursuing an MBA aligned with Dr. Kiprono’s vision for physician leadership. After recognizing the need for physicians to participate actively in decision-making processes, she decided to enhance her business knowledge. Opting for a one-year, physician-focused MBA program, she found a perfect fit with the Physician Executive MBA (Pemba) at the University of Tennessee Knoxville. Dr. Kiprono emphasizes the importance of being user-friendly, time-efficient, and specialized in her decision-making process.

Closing Thoughts on Entrepreneurship and Innovation

Dr. Kiprono encourages aspiring entrepreneurs to seek support, ask questions, and maintain a flexible approach. She stresses the importance of communication and adaptability, the ongoing transformation in healthcare, and the need to embrace change to improve patient care.

Links and resources:

Norm Chapin on LinkedIn

Dr. Luissa Kiprono on LinkedIn

Obtain your CME certificate

Special thanks for their support go to:

Kate Ashley, Executive Director of the Healthcare Division of Graduate and Executive Education at the Haslam College of Business at the University of Tennessee 

Dr. Don Leiter, a professor at the University of Tennessee and Director of the Institute for Healthcare Quality Research and Education 

Tom Brown 

Shiraz, Sriman

Christy Napper