Relentless Health Value

In this episode, Stacey Richter talks with Richard Zane, MD, chief innovation officer at UCHealth, about a short list of hospital innovations rolled out in 2019.

WHAT YOU'LL LEARN

✅ How Dr. Zane and UCHealth define innovation, and the four algorithms behind their 2019 rollouts

✅ Why complete, high-quality data sets are the underlying dependency for every successful innovation

✅ Why collaboration with payers and PBMs on data sharing matters more than most people realize

✅ How evidence-based pathways and feedback loops work together to improve outcomes

✅ Dr. Zane's advice for digital health start-ups and innovators building tools for health systems

WHY THIS MATTERS

Richard Zane walks through three of UCHealth's most meaningful 2019 innovations and the challenges his team overcame to roll them out. A common thread runs through all three: none of them work without optimally complete data, which in turn depends on payers, PBMs, and even other providers being willing to share data. Zane is candid that failure is part of the process — "compassion without competence is crap" — and that innovation succeeds when everyone involved has real skin in the game toward the same outcome.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

03:06 What Dr. Zane is doing as the chief innovation officer at UCHealth.

03:36 How Dr. Zane and UCHealth define innovation.

04:06 Innovation needs within emergency medicine.

04:27 The innovation successes and accomplishments that UCHealth made in 2019.

06:13 The four algorithms UCHealth used in their innovations.

07:36 The "last mile" of innovation.

09:57 The three most meaningful things UCHealth did in 2019.

12:21 Evidence-based pathways, feedback loops, and how these two work together to improve health outcomes.

16:19 What Dr. Zane has learned through the trials of innovation.

17:06 "Failure's fine. It's absolutely fine to fail."

17:30 "It's not just budget; it's also bandwidth."

17:55 The clear pathway that Dr. Zane is looking to in innovation.

18:29 "We are about making better decisions in health care."

18:42 "The first thing we do is evaluate a problem."

20:04 Walking the balance between innovation and change management.

20:25 "Compassion without competence is crap."

21:25 The guiding principles UCHealth uses for innovation.

21:44 Dr. Zane's innovation approach.

23:16 Dr. Zane's advice for digital start-ups, digital therapeutics, and innovators creating digital tools.

26:51 "If we have the same type of skin in the game, we're gonna get to the same place."

In this episode, Stacey Richter talks with Nadine Jackson McCleary, MD, MPH, BSN, oncologist at Dana-Farber Cancer Institute and assistant professor at Harvard Medical School, about how to achieve outcomes that matter to patients.

WHAT YOU'LL LEARN

✅ Why patient-reported outcomes (PROs) matter as much as evidence-based medicine, especially in oncology

✅ Why only about half of patient outcomes are currently being reported by physicians

✅ How collecting and acting on patient-reported symptoms measurably improves survival and quality of life

✅ What Dana-Farber does day to day to collect and act on patient-reported symptoms like insomnia

✅ The cultural shift and barriers involved in making PRO collection standard practice

WHY THIS MATTERS

Nadine Jackson McCleary makes the case that evidence-based medicine alone isn't enough — what patients and doctors actually want at the point of care is medicine-based evidence, i.e., patient-reported outcomes. At Dana-Farber, collecting and acting on these symptoms, like insomnia, has been shown to meaningfully improve survival and quality of life, yet only about half of outcomes get reported today. McCleary walks through the cultural and practical barriers to closing that gap, and warns of a growing inequity in how big data gets leveraged across cancer care.

MENTIONED IN THIS EPISODE

🔗 EP233, with Glenn Sabin

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

03:43 What percentage of patient outcomes are being reported?

04:16 Why only about 50% of outcomes are being reported by the physician.

06:35 Why reporting patient outcomes really does matter.

08:12 How survival and quality of life are significantly improved by patients who report on their symptoms.

08:57 The delta between wanting to collect patient outcomes and actually collecting those patient outcomes.

10:21 What Dana-Farber is actually doing when interacting with patients.

12:14 How long does it take to collect these patient-reported symptoms?

13:42 The cultural shift required to make this change at Dana-Farber.

14:26 How Dana-Farber is working toward using this data collection for population health management.

15:56 How Dana-Farber is improving one of the most reported patient symptoms: insomnia.

17:00 How collecting patient-reported symptoms and using health technology for this is actually eliminating tasks on the provider's plate.

17:51 EP233 with Glenn Sabin.

19:03 How the patients feel about reporting their symptoms.

19:50 Barriers that Dana-Farber has had to overcome in incorporating these patient-reported symptom practices.

21:07 "The evidence is there, the support is there … but we still don't have a clear how."

22:20 "There is … a growing inequity in how big data is leveraged."

In this episode, Stacey Richter answers a question posed by students from the University of Michigan's Ross School of Business: her three-prong plan for finding areas of promise and promising companies in health care.

WHAT YOU'LL LEARN

✅ Why "promise" shouldn't mean piling up bills at the expense of patients and taxpayers

✅ Stacey's three-prong plan for spotting promising health care companies, starting with "follow the money"

✅ Why it's hard to integrate with an unknown entity, and why doctors tend to favor solutions they help create

✅ The difference between disruptive innovation and sustaining innovation

✅ Why looking for first movers and disruptive companies that have attracted investment from entrenched players is a useful signal

WHY THIS MATTERS

Stacey lays out a practical framework for evaluating promise in health care: follow the money to see who actually benefits, look for genuine innovation rather than hype, and distinguish between companies sustaining the status quo and those disrupting it. Drawing on Clayton Christensen's "The Innovator's Dilemma" and Zeev Neuwirth's "Reframing Healthcare," she cautions that hype cycles are real and that transparency remains a critical, if imperfect, signal of which health care businesses are worth watching.

MENTIONED IN THIS EPISODE

🔗 EP202, with Frazer Buntin

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction

01:47 Promise doesn't mean piling up bills at the expense of patients and taxpayers.

02:47 "These companies won't change unless there are people working from within to get them on track."

03:53 Stacey's three-prong plan to find promising companies within health care.

04:08 "Follow the money."

05:29 Three things to look for in a health care company or health care area.

06:12 "It's really hard to integrate with an unknown entity."

06:50 "Doctors … like to create their own solutions."

07:34 "The realities [are], people buy what they … create."

09:48 "The hype cycle is real."

10:45 All promising areas and companies have one thing in common: They're innovative.

11:07 Disruptive innovation vs sustaining innovation.

11:45 Clayton Christensen's "The Innovator's Dilemma."

12:23 Zeev Neuwirth's "Reframing Healthcare."

14:48 EP202 with Frazer Buntin.

15:41 "Look for first movers."

15:56 "Look for disruptive companies that have gotten investments from entrenched players."

16:23 Who excels at incremental innovation vs disruptive innovation.

17:10 Stacey's note of caution about transparency and health care businesses.

In this episode, Stacey Richter talks with George Mathew, MD, MBA, FACP, chief medical officer, Americas, at DXC Technology, about how to use health IT to help patients and providers collaborate.

WHAT YOU'LL LEARN

✅ What the FDA pre-cert program is and why it matters for digital therapeutics

✅ How standards for evaluating digital therapeutics are being developed

✅ Why the technology has always been the easy part — the hard part is workflow change

✅ How cognitive load, not just clicks, shapes whether digital tools actually work in practice

✅ Why hospitals should think of themselves as data companies working on behalf of their patients

WHY THIS MATTERS

George Mathew applies Clayton Christensen's resources-processes-values framework from "The Innovator's Dilemma" to digital health tools: even a brilliant, proven tool fails if the surrounding organization's processes and values don't support it. He walks through the FDA pre-cert program, how digital therapeutics get evaluated, and why getting clinicians and patients to help construct a solution matters more than the underlying technology itself. His closing framing is simple but often skipped: what is the real problem you're trying to solve, and what's the right process to solve it?

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction.

02:27 What the FDA pre-cert program is.

03:46 The cost of drug tests and clinical trials.

04:41 Coming up with standards for evaluating digital therapeutics.

06:45 "The Hives"—the database where all data collected are reviewed.

08:00 The data collected and how they are evaluated.

08:33 The barriers to developing digital therapeutics.

11:43 "The Innovator's Dilemma" by Clayton Christensen.

13:37 "Getting people to help construct the solution."

15:25 Workflows and how digital therapeutics play into this.

17:22 "The technology has always been easy; the hard part is the workflow change."

20:49 How the information appears within these apps.

22:43 The opportunities within digital therapeutics.

23:33 Cognitive load vs clicks.

24:30 How information gets back to patients—or doesn't.

27:29 "Hospitals should become data companies, except … that they work on behalf of their patients."

27:53 DXC Technology and where people can learn more about the work that they do.

29:21 "What is the real problem you're trying to solve, and what's the right process to solve that problem?"

In this episode, Stacey Richter talks with Chad Gray, MS, PT, Cert MDT, cofounder and CEO of Integrated Musculoskeletal Care (IMC), about the not-so-obvious thing that musculoskeletal care and a 4-minute mile have in common.

WHAT YOU'LL LEARN

✅ Why musculoskeletal (MSK) care is roughly 20% of total health care spend

✅ Why MSK care is a quality problem, not a cost problem

✅ How precision diagnosis can be standardized at both the macro and micro level

✅ Why tracking outcomes data throughout diagnosis and treatment is critical to validating results

✅ How connecting standardized MSK care to employer-sponsored plans changes cost and quality outcomes

WHY THIS MATTERS

Chad Gray argues that most MSK problems don't have to become intractable chronic conditions ending in surgery that doesn't even resolve the symptoms. The barrier isn't medical knowledge—it's standardization: getting every clinician to diagnose accurately and consistently, then scaling that accuracy into best practices with a continuous feedback loop. Just like the 4-minute mile, once one system proves it's possible to do MSK care right, Gray believes the "impossible" standard breaks open for everyone else.

MENTIONED IN THIS EPISODE

🔗 EP244, with Lee Lewis

🔗 EP225, with Joe Selby

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction.

02:23 How big is musculoskeletal care in terms of health spend?

03:20 One out of three patients are seeking health care for musculoskeletal issues.

03:52 EP244 with Lee Lewis.

05:13 "We don't really have a cost problem in this domain; … we have … a quality problem."

05:30 The increasing populations of chronic condition categories.

08:19 How to perform precision diagnosis at the macro and micro level.

09:13 Creating a new standard of care.

09:48 Taking accurate diagnosis and scaling that into best practices.

10:43 Ensuring that everyone is diagnosing in the same way.

11:24 EP225 with Joe Selby.

13:50 What precision diagnostic tools look like to patients and clinicians.

16:17 Tracking data throughout the entire diagnosis and treatment process, including patient outcomes data.

17:03 Verifying and validating that patients are progressing better through IMC's system.

19:20 The dramatic shift in quality and cost within this standardized care model.

20:43 "The single most common reason for an opioid prescription … is low-back pain."

21:40 Why we are so behind on improving musculoskeletal care across the country.

23:50 Why there are such huge gaps in capability and understanding within musculoskeletal care.

24:38 "What's broken? Why is it broken? How do we fix it? Once we fix it, what does it look like?"

27:06 IMC—Integrated Musculoskeletal Care—and the system they've developed to standardize musculoskeletal care and create precision diagnosis.

28:18 Identifying outliers.

28:40 IMC's continuous feedback loop to show providers the quality metrics.

29:24 Preventing data pollution.

31:19 Connecting to employer-sponsored plans and other payer/provider organizations.

In this episode, Stacey Richter and Dave Dierk, co-presidents of Aventria Health Group, discuss how to prepare an account management team for successful selling into health systems.

WHAT YOU'LL LEARN

✅ Why sellers need to understand health system problems on a micro level, not just the whole

✅ Why the value you bring is the incremental gap between where a customer is now and what they could attain

✅ The difference between collaborative selling skills and consultative skills

✅ Why getting to "yes" doesn't mean the job is done

✅ The five links in the chain account managers need: market knowledge, customer knowledge, collaborative skills, consultative skills, and strategic ability

WHY THIS MATTERS

Building on The #HCBiz Show!'s "Selling Into Health Systems" series with Don Lee and Shahid Shah, Stacey and Dave lay out what it actually takes to prepare an account management team to sell successfully into a health system. The throughline is that success depends less on pushing a product and more on being relational rather than transactional—understanding the customer's strategy and plan, building real business cases, and recognizing that value changes depending on the organization you're working with.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction

03:37 Don Lee on understanding problems in health care on a micro level rather than on the whole.

03:55 Focusing on larger entities that are looking to collaborate with a health system rather than innovators and start-ups in health care.

04:52 Looking at innovation and affecting behavioral change more broadly.

05:42 Helping manifest potential value.

06:06 Don Lee on being a proactive innovation guide rather than telling a health system how their system works.

07:39 Learning new skills and putting new infrastructure in place to support new approaches.

09:24 "The value that you bring is the incremental between where they are now and what they could attain."—Stacey

10:42 "It's more about you than it is about your customer."—Stacey

12:41 "All of that is predicated on, 'What's your strategy? What's your plan?'"—Dave

14:54 Don on doing the consulting work.

15:16 Shahid on building business cases for everything you bring into the health system environment.

15:48 Don on the number of perspectives at the table and needing to understand and align your product to this multitude of needs.

17:24 "Once you get to yes, your job is not done."—Dave

18:55 Shahid on common mistakes on consultative work.

20:35 "If it's not meaningful to them, relative to other choices, then they might not act on it."—Dave

21:48 "That challenge is underestimated."—Stacey

23:21 Collaborative skills vs consultation skills.

24:18 Shahid on how the value of your product changes depending on the organization and clients that you're working with.

25:42 Shahid on pushing a product before considering the customer's needs.

28:39 What an account manager needs in order to be successful.

30:22 What a paradigm of success consists of.

32:47 Breaking down barriers and paradigms to get the right approach.

33:35 Being relational, not transactional.

In this encore episode, Stacey Richter and Alex Akers talk with Robert Pearl, MD, former CEO of the Permanente Medical Group and author of "Mistreated: Why We Think We're Getting Good Health Care—And Why We're Usually Wrong," about why we think we're getting good health care, when we aren't.

WHAT YOU'LL LEARN

✅ How the US health system lags according to objective, third-party data analysis

✅ How rampant overtreatment adds to the problem

✅ Dr. Pearl's four pillars for fixing American health care: integration, pay-for-value, technology, and physician-led organizations

✅ Why current health care technology is decades behind other industries

✅ Why waiting for disruption to force change is the wrong strategy

WHY THIS MATTERS

Robert Pearl argues that mistreatment in American health care is rampant, not rare—evidenced by paying more than twice as much per patient as other countries for a system that ranks 37th in the world. His prescription rests on four pillars: integration, pay-for-value, modernized technology, and clinician- and physician-led organizations. Pearl's closing message is a warning dressed as advice: disruption is inevitable, and organizations that wait for it rather than leading change will regret the delay.

MENTIONED IN THIS EPISODE

🔗 EP157, with Dr. Ethan Basch

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction

02:26 Dr. Robert Pearl, author of "Mistreated: Why We Think We're Getting Good Health Care—And Why We're Usually Wrong."

02:44 How bad is the problem in American health care?

05:25 How our health system lags in overall health, according to third-party, objective data analysis.

06:02 Rampant overtreatment, and how this adds to the problem.

09:11 How can context improve health care?

09:19 The four pillars of improving health care outcomes.

13:06 Integration as a crucial step to maximizing quality.

13:24 Pay-for-value as the second pillar of improving health outcomes.

17:39 Technology as the third pillar.

17:55 How current health care tech being utilized is 50+ years old.

19:38 Why video isn't utilized more in health care, despite being relatively inexpensive.

21:32 Do doctors hate technology?

22:52 "All of medicine is probability."

23:18 EP157 with Dr. Ethan Basch.

25:12 "We fail to do the things that we know we should do."

27:10 Physician- and clinician-led organizations as the fourth pillar.

29:00 "We don't have a system; we don't have a structure."

29:35 "To do that will require leadership."

29:56 Dr. Pearl's advice for actionable change.

31:10 "This is the time to change; don't wait for disruption to occur."

In this episode, Stacey Richter talks with Kimberly Noel, MD, MPH, telehealth director and deputy chief medical information officer at Stony Brook Medicine, about preventing readmissions and improving patient outcomes with telehealth and other digital tools.

WHAT YOU'LL LEARN

✅ The four pillars that contribute to readmissions: self-management, follow-up, care coordination, and avoiding medical errors

✅ Why telehealth and digital tools can close the gaps between these four pillars

✅ Why age alone doesn't determine a patient's readiness to adopt technology

✅ Why risk stratification is essential and central to effective digital health strategy

✅ Dr. Noel's advice to vendors building digital health solutions

WHY THIS MATTERS

Kimberly Noel frames readmissions as a solvable, structural problem: patients need to be equipped to self-manage and take medications correctly, get timely follow-up, have their care coordinated across settings, and be protected from medical errors. She pushes back on the myth that older patients resist technology, arguing instead that the barrier is usually poor design and lack of collaboration among stakeholders—not patient readiness. Her call to action for vendors and health systems alike is to understand who actually makes the adoption decision and optimize for patient self-efficacy.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter

🫙 Support the podcast with a small donation to the Tip Jar

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction.

02:14 Medical errors and other health barriers that lead to readmissions.

04:24 How to better understand the problem and start synergizing health care.

05:35 "These patients are also ready to adopt technologies."

05:58 Looking at the digital solutions themselves.

06:16 "It's really a call for collaboration for several stakeholders."

06:38 "Some of the problems that we have in health care are not unique to health care."

08:54 "These shouldn't be secrets that we only give to certain patients when they're hospitalized."

11:19 Overcoming myths in health care.

12:02 "Age alone doesn't define."

13:46 Helping patients navigate their disease and optimizing the technology for their treatment needs.

16:38 Looking at risk stratification as essential and central.

20:10 Optimizing patient self-management.

21:46 What other organizations can learn from what Dr. Noel has done.

23:20 The need for participation from the medical community.

23:38 "How do we best engage and optimize that self-efficacy?"

26:37 Dr. Noel's advice to vendors with digital solutions.

28:11 Understanding who makes the decision.

30:03 You can see Dr. Noel speak at the NODE.Health conference in December.

In this episode, Stacey Richter talks with Vicky Tiase, MSN, RN, director of research science at NewYork-Presbyterian Hospital, about how to make patient-collected data actionable for shared decision making.

WHAT YOU'LL LEARN

✅ Why patients, families, and caregivers are increasingly generating their own health data outside the clinical setting

✅ The barriers keeping clinicians from bringing patient-collected data into their workflows

✅ The debate between provider-prescribed apps and patient-chosen apps—and why a trusted framework can bridge both

✅ How the new CMS rule requiring providers to share data back to patients fits into this picture

✅ Why data alone isn't enough—it has to become information, and then knowledge

WHY THIS MATTERS

Vicky Tiase makes the case that the real barrier to using patient-generated data isn't patient willingness—it's a lack of feedback loops, unclear decision needs, and app saturation. She walks through how NewYork-Presbyterian is working to translate raw data into information and then into knowledge clinicians can actually act on, while navigating the tension between letting patients choose their own apps and the practical need for standardization on the back end.

MENTIONED IN THIS EPISODE

🔗 EP157, with Dr. Ethan Basch

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter

🫙 Support the podcast with a small donation to the Tip Jar

📺 Subscribe to our YouTube channel

🎤 Listen on Apple Podcasts

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction.

03:04 What patients are looking for from their provider when they collect their own data.

03:29 The two categories of patients gathering data.

05:27 Patients looking to participate.

06:34 Encouraging a continuation of data collection while learning to use that data.

07:00 The importance of needing a feedback loop in patient data collection.

08:22 Why clinicians are confused about patient data and patient data barriers.

09:59 "It comes down to the data."

11:00 The pieces of patient data that clinicians need to explore.

11:38 Understanding decision needs and understanding which data are going to be most valuable to clinicians.

12:26 Contending with the saturation of health data collection apps.

13:53 Empowering patients to use the app of their choosing, while vetting these apps.

15:13 What the ideal patient data collection looks like.

16:54 "Seamless data sharing."

18:04 Are different patient data solutions necessary for different cohorts of care?

18:55 EP157 with Dr. Ethan Basch.

20:27 "It's not just data that we're looking at, but … data are translated into information, and from information … into knowledge."

25:01 Vicky's advice: Understand your organizational policies.

28:52 The best solutions for patients collecting and wanting to share their data from a variety of apps.

30:01 The need to think about consumer-directed exchange.

30:49 What Vicky's looking forward to at the NODE.Health conference event.

In this episode, Stacey Richter talks with Dale Folwell, CPA, North Carolina State Treasurer, about the war on financial toxicity in North Carolina.

WHAT YOU'LL LEARN

✅ What the Clear Pricing Project is and why North Carolina's State Employees Health Plan proposed it

✅ Why some of North Carolina's largest hospital systems fought back against transparent, network-based pricing

✅ Why price secrecy, not price level alone, is the core problem Folwell is targeting

✅ How the Clear Pricing Project could actually help some rural hospitals make more money

✅ Dale Folwell's advice for other states considering similar price transparency efforts

WHY THIS MATTERS

As the fiduciary for North Carolina's $100 billion pension fund and the State Health Plan covering more than 720,000 people, Dale Folwell argues that a treasurer has a basic right to know what he's spending taxpayer money on—and that hospitals resisting transparent pricing are protecting a business model built on secrecy, not defending patient care. His central point: the only way to pay less for health care is to actually know, and then pay, less for health care.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter

🫙 Support the podcast with a small donation to the Tip Jar

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction.

02:51 The North Carolina state spend on health care.

04:14 "In medical terms, why has this become acute?"

04:53 One week of work for starting North Carolina troopers and teachers out of every four is going to family health care costs.

06:05 The problem of health insurance vs health care.

06:51 "If they can do this to the largest customers in this state … imagine what they can do to them."

07:13 "This is about the industry whose whole business model is based on secrecy."

08:44 "We've already focused on the why, and now we're [focusing] on the how."

09:48 "We're trying to attack a problem. The problem is that none of [them] consume health care; it all consumes them."

13:07 What the Clear Pricing Project aims to do.

13:37 "Why is it that we don't have trust in the people of this … country to actually consume and evaluate the value and cost of things in health care when they are able, very successfully, to evaluate the value and cost of everything else in their life?"

16:31 "We're not trying to be disruptive; we're trying to fix a problem."

18:25 Why the Clear Pricing Project went the self-insured route and how that's worked for them.

23:34 Who's behind the institutions fighting transparent pricing in North Carolina.

24:49 Instances where the Clear Pricing Project could actually stand to help rural hospitals make more money.

27:15 Dale's advice for other states trying to do this.

28:52 Dale's message to health care providers out there who want to see this change to price transparency.