In this episode, I was able to sit down with Dr. Neha Vapiwala who is one of my mentors, and overall one of my absolute favorite people at Penn Med. She just began work as the new Assistant Dean of Student Affairs for the Perelman School of Medicine.

We touch on her time at Johns Hopkins where she studied biology and Hispanic studies, and even worked with Dr. Ben Carson! We then discussed her time at Penn Med, the decision to pursue radiation oncology, how she began to take on leadership roles in medicine, and her goals as the new Assistant Dean of Student Affairs.

I really appreciated hearing Dr. Vapiwala share a bit about the areas she had to personally work on in order to be an effective leader. It was also great to hear her talk in depth about what makes her so passionate about oncology and more specifically the field of radiation oncology.

Map

1:50 – Restaurants in Philly that Dr. Vapiwala recommends

4:20 – Coming to the U.S as a child, Ellis Island, and growing up in Jersey

7:40 – Studying Biology and Hispanic Studies at Johns Hopkins – “why do a minor when you can do a major?”

11:20 – Why medicine?

13:40 – Doing research with, and being mentored by Dr. Ben Carson

15:45 – Thoughts on being a woman in medicine – What else did she have to consider? Did she have female mentors in medicine?

21:00 – Choosing radiation oncology – do you have to love physics?

29:50 – What are the current technologies in radiation oncology? Proton Therapy

37:00 – What does the future of radiation oncology look like? What will future researchers and innovators have to solve?

45:00 – When did Dr. Vapiwala begin to take on leadership roles in medicine?

51:30 – How did she learn to be a leader?

55:15 – What is one thing she needed to work on to be a better leader?

57:45 – Her new role as Assistant Dean of Student Affairs at Penn Med - how is she balancing this role with her clinical duties?

1:03:00 – What are some of Dr. Vapiwala’s goals for the next year?

1:05:00 – Advice she would give to her first year Penn Med self

Links

Dr. Vapiwala’s Profile

https://www.pennmedicine.org/providers/profile/neha-vapiwala

Radiation Oncology

https://en.wikipedia.org/wiki/Radiation_oncologist

OncoLink – Dr. Vapiwala’s Scholarly Project while at Penn Med

https://www.oncolink.org/

Proton Therapy

https://en.wikipedia.org/wiki/Proton_therapy

Aaron Bhole is a first year med student at the Thomas Jefferson University Sidney Kimmel Medical College in Philadelphia. He is involved with a group at Jefferson called Physician Executive Leadership – or PEL – which is a HealthX like organization that focuses on developing future physician leaders.

We were able to hit on Aaron’s interest in the intersection of business and medicine, PEL, drug pricing, orphan drugs, and many other topics.

Register for the Penn HealthX conference happening THIS SUNDAY, December 2nd here:

http://pennhealthx.com/events/conference#Registration

Map

3:15 – Aaron’s time at Cornell, the 3+2 Program to get an MBA, and field ecology/cancer research

6:20 – getting interested in the “macro” of healthcare and the value of having an MBA before starting med school

9:30 – Physician Executive Leadership (PEL) at Jefferson Med

11:00 – Why should people care about rising drug prices?

15:40 – Generic Drugs, The Hatch Waxman Act

22:10 – Patent Life (~20 years) vs. Exclusivity (5-7 years, indication specific)

25:00 – How do companies decide how to price a drug?

30:15 – Negotiating drug prices? Would it work in the U.S? Spoiler – probably not

36:00 – Ryan’s thoughts on the patent system in the U.S

39:09 – Aaron’s response – improving how we incentivize “actual innovation” as opposed to marginal innovation

42:10 – Are current price transparency laws any good? (recent California law)

47:40 – Orphan Drugs – what are they? ; The Orphan Drug Act of 1983 – incentivizing the development of orphan drugs (small patient populations)

51:00 – Orphan drugs are expensive and the laws are being taken advantage of – “salami slicing”

56:45 – What is FDA (and Scott Gottlieb) doing now?

61:00 – Last few questions/wrap up

Links

GOP Tax plan may get rid of Orphan Drug R+D tax credit

https://www.npr.org/sections/health-shots/2017/11/03/561805484/house-republicans-aim-to-eliminate-tax-credits-for-orphan-drugs?sc=tw


Airspeed of a Swallow

https://www.youtube.com/watch?v=liIlW-ovx0Y

Physician Executive Leadership (PEL)

http://www.physicianexecutiveleadership.com/

Healthcare Spending Pie Chart (bit outdated)

http://bit.ly/2AEkSrz

Hatch-Waxman Act

https://en.wikipedia.org/wiki/Drug_Price_Competition_and_Patent_Term_Restoration_Act

A Primer of Acronyms and Different Drug Price “Types”

http://www.hivforum.org/storage/documents/2014/Geeneric_ARVs/cross_fchrgenerics_31mar14.pdf

Graphs showing How Much Brand Drug Price decreases with increasing Generic Competition

http://bit.ly/2Aezddo

Articles on How Gilead Chose to Price it’s HepC Drugs

http://bit.ly/2i0uguc

http://bit.ly/2BuHlnN

National Institute for Health and Care Excellence (NICE) – U.K

https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence

ICER (Institute for Clinical and Economic Review) – U.S

https://icer-review.org/

Having Medicare Negotiate Drug Prices Probably Won’t Help (Articles)

http://www.latimes.com/business/hiltzik/la-fi-hiltzik-medicaire-negotiate-20170111-story.html

https://www.statnews.com/2017/06/13/drug-prices-government-negotiation/

Is California’s Drug Price Transparency Law any good? These articles say no

https://www.healthaffairs.org/do/10.1377/hblog20171002.062240/full/

http://www.drugchannels.net/2017/10/thanks-california-sb17-will-trigger.html

Orphan Drug Act of 1983

https://en.wikipedia.org/wiki/Orphan_Drug_Act_of_1983

https://en.wikipedia.org/wiki/Orphan_drug

Orphan Drugs are Big Business

http://wapo.st/2iYgf0H

http://n.pr/2Ak2Esb

FDA Attempting to Get Rid of “Salami Slicing”

http://n.pr/2Bla0v0

Ryan is joined by Dr Saurabh Jha to discuss writing and tweeting as a physician, and how medical students can most effectively ease themselves into that world. We discuss a number of Dr. Jha's articles, touch briefly on the future of radiology, and learn about some of Dr. Jha's favorite writers.

Map

3:15 – coming to the U.S and choosing radiology

7:00 – when and why did he become interested in writing about the healthcare system and his first article on the Breast Density Law

10:30 – why share your thoughts publicly if there is a risk in the modern political climate, and how to even start?

14:00 – Twitter as a platform for building a community and getting information

18:30 – where should med students start? – how to get your news, and who to follow

22:15 – Ryan discusses his article on KevinMD and his concerns about alienating others through expressing political opinions

24:00 – how to deal with political topics knowing full well that medicine is wildly political

30:00 – med students are quite savvy these days, and should be entitled to an opinion

32:45 – Dr. Jha’s article on the hospital “Chargemaster” and costs in healthcare; learning from everyone around you, including cabdrivers

42:45 – the field of radiology – where is it heading? Will radiologists be replaced?

50:00 – what would Dr. Jha do if he was starting in 2017? – hint: still radiology, but through global health

52:00 – Dr. Jha’s most popular blog post and tweet

54:25 – what other writers does he read and respect?

58:10 – last thoughts and advice for future physicians

Links

Dr. Jha’s KevinMD portfolio -

https://www.kevinmd.com/blog/post-author/dr-saurabh-jha

Dr. Jha's first article on the Breast Density Law - https://www.kevinmd.com/blog/2013/11/breast-density-laws-based-anecdote.html

Dr. Jha's twitter account -

https://twitter.com/RogueRad

HealthNewsreview.org -

http://www.healthnewsreview.org/

Ryan's first article on KevinMD – https://www.kevinmd.com/blog/2017/10/want-change-medicine-work-finance.html

Dr. Jha’s KevinMD article on the "chargemaster" - https://www.kevinmd.com/blog/2017/07/chargemaster-health-cares-evil-component.html

The Patient Will See You Now (book) – https://www.amazon.com/Patient-Will-See-You-Now/dp/0465054749

Dr. Jha's most popular blog post – topic of public reporting - https://www.kevinmd.com/blog/2015/07/when-a-bad-surgeon-is-the-one-you-want-propublica-introduces-a-paradox.html

Atul Gawande’s Complications (book) – “required reading” according to Dr. Jha

https://www.amazon.com/Complications-Surgeons-Notes-Imperfect-Science/dp/0312421702

Theodore Dalrymple – one of Dr. Jha’s favorite writers - https://en.wikipedia.org/wiki/Theodore_Dalrymple

Dr. Lisa Rosenbaum Twitter -

https://twitter.com/lisarosenbaum17?lang=en

Dr. Anish Koka -

http://thehealthcareblog.com/blog/tag/anish-koka/

On the most recent episode of the Penn HealthX Podcast, we were able to speak with Dr. Dana Kuhn. Dr. Kuhn shared his heartbreaking story of finding out he was infected with HIV after receiving treatment for hemophilia. He then unknowingly passed the virus on to his wife, who then died of AIDS-related pneumonia a few years later.

While taking time to recuperate with his children, Dr. Kuhn found work as a counselor for patients with chronic illnesses. He then turned to patient advocacy, first working on The Trail of AIDS, and fighting to push legislators to clean up the national blood supply.

Dr. Kuhn then founded Patient Services Inc. (PSI), a non-profit organization that helps patients with chronic and rare diseases pay for their insurance premiums and drug co-pays. Premiums and co-pays have been steadily rising over the last number of years, making the affordability for drugs and coverage out of reach of certain patients who fall on hard times.

PSI was meant to be a "short-term" solution, and I think Dr. Kuhn would agree that it's up to future healthcare leaders to design policy and innovate to ensure that the work of PSI becomes obsolete. It's one of the most important challenges the we face in the future of the U.S healthcare system.

Map

3:16 – Dr. Kuhn’s Story

7:30 – Finding out he was HIV positive and losing his wife to AIDS

11:30 – AIDS phobia in the 80’s

15:45 – getting a job counseling patients with chronic illnesses

17:00 – The Trail of AIDS and advocacy – cleaning up the blood bank

23:30 – The motivation for founding Patient Services Inc.

28:45 – The first step – raising money

32:30 – Where do the donations come from?

35:00 – How do you decide what disease types to fund, and which specific patients?

39:30 – Why design the model this way? – PSI was supposed to be a “short-fix”

45:00 – Are pharmaceutical companies being altruistic, or doing it because there’s something in it for them?

49:00 – The difficulty with getting individuals to donate vs. companies when you aren’t a well-known charity

52:30 – Is PSI fighting a losing battle? Is it sustainable? How can we make it obsolete?

55:50 – Advice for future innovators

Links

Registration for the Penn HealthX Conference - 12/2/17

http://pennhealthx.com/events/conference#Logo

Dr. Dana Kuhn – President and Founder of PSI

http://www.patientservicesinc.org/Who-We-Are/Leadership

https://www.patientservicesinc.org/Our-Story

And the Band Played On Book and Documentary

https://en.wikipedia.org/wiki/And_the_Band_Played_On

Patient Services Inc. Link

https://www.patientservicesinc.org/

Other Co-Pay Charities Supported by Medicare

https://www.medicarerights.org/pdf/copay_charities.pdf

Kaiser Family Foundation – 2017 Employer Health Benefits Survey

https://www.kff.org/health-costs/report/2017-employer-health-benefits-survey/

Past Coverage of the Relationship between Co-Pay Charities and Pharma

http://www.nytimes.com/2013/12/19/business/shake-up-at-big-co-pay-fund-raises-scrutiny-on-similar-charities.html

https://www.bloomberg.com/news/articles/2017-06-29/charity-funded-by-drugmakers-draws-irs-probe-on-tax-exemption

https://www.usatoday.com/story/news/politics/2016/06/08/drug-co-pay-assistance-programs-facing-increasing-state-federal-scrutiny/85547788/

http://www.fiercepharma.com/pharma/irs-probes-whether-patient-charity-acted-as-a-conduit-for-big-pharma

In this episode, Ryan is joined by the three founders of Spectrum Scores - Phil Williams, Naveen Jain, and Jun Jeon. We discuss how they came up with the idea for Spectrum Scores - a website dedicated to helping LGBTQ+ patients find competent healthcare providers who are able to address their unique healthcare needs - and the experience of getting it off the ground.

Map:

3:30 – October 11th – Releasing Spectrum Scores and National Coming Out Day

5:15 – Phil’s Background

7:00 – Naveen’s Background

9:00 – Jun’s Background

12:00 – forming their HealthX Labs team

15:45 – early ideas for their team

17:30 – coming up with the idea for Spectrum Scores

22:00 – where do you even start one you have your idea?

27:00 – HealthX Labs Demo Day presentation, and getting feedback

34:00 – deciding what the purpose of Spectrum Scores is, and pivoting after feedback

37:00 – How does Spectrum Scores rate healthcare providers?

42:30 – dividing up work and deciding roles

46:00 – getting publicity and marketing Spectrum Scores

50:00 – where is Spectrum Scores now, and what are future directions?

55:45 – what have they learned throughout the process?

Links:

HealthX Conference Registration

pennhealthx.com/events/conference#Registration

Spectrum Scores Website

www.spectrumscores.org/

More on The Founders

www.spectrumscores.org/about

Spectrum Scores Fbook Page

www.facebook.com/SpectrumScores/

NBC Article

www.nbcnews.com/feature/nbc-out/m…e-doctors-n793861

In this bonus episode of The Penn HealthX Podcast, we'd like to share a conversation host Ryan O'Keefe had with Nathan Dollinger, the host of The Future of Healthcare Podcast. Ryan and Nathan discuss why they started their podcasts, some of their favorite guests, and riff on some topics in healthcare that they are passionate about. If you enjoy The Penn HealthX Podcast, you'll love The Future of Healthcare. Thanks to Nathan for letting us share.

Rate the podcast!! Find us on iTunes here:

https://itunes.apple.com/us/podcast/the-penn-healthx-podcast/id1271378904?mt=2

Learn how to rate on iTunes and the podcast app below:

https://pennhealthx.blog/2017/09/05/how-to-rate-the-podcast/

Map: (thanks Nathan for putting this together)

- Who is Ryan O’Keefe and why he started his podcast [6:40]

– Why start a podcast? [10:35]

– Interviewing Dr. David Fajgenbaum [15:45]

– discussing healthcare providers and costs [21:30]

– What’s the focus of Penn HealthX [25:40]

– Figuring out his aspiration through the podcast [29:50]

– A blog, Epi-pen, and prices of healthcare [35:30]

– Health Policy research and Ryan's realization [37:50]

– History of health reforms and where we are today in healthcare [42:55]

– Technology and how it affects healthcare [51:02]

– Bad eating habits, addiction, and how it affects the world today [57:35]

– How to truly prevent health conditions (better than drugs) [1:03:40]

– Gamification and getting people addicted [1:06:30]

– Creating a world where being healthy is easy [1:10:00]

– How biohacking plays a role [1:12:00]

– Controversial medicine and pseudoscience [1:13:45]

– Book that influenced Ryan - America's Bitter Pill [1:19:20]

– If Ryan could change anything about our healthcare and fitness space what would that be and why? [1:26:08]

– Ryan’s advice for future health professionals. [1:27:30]

– End of interview [1:31:25]

Links:

The Future of Healthcare website

https://wearethefutureofhealthcare.com/

Nathan's Twitter

https://twitter.com/NathanDollinger

Ryan's Article on Kevin MD

http://www.kevinmd.com/blog/2017/10/want-change-medicine-work-finance.html

New Yorker - How Medicare Was Made (article)

https://www.newyorker.com/news/news-desk/medicare-made

Stephen Down/Tincture (writes for Medium)

https://tincture.io/@stephenjdowns?gi=c4dc56f07a90

America's Bitter Pill by Steven Brill (Ryan's recommendation)

https://www.amazon.com/Americas-Bitter-Pill-Politics-Healthcare-ebook/dp/B00LYXY05S

Hooked by Nir Eyal

https://www.amazon.com/Hooked-How-Build-Habit-Forming-Products/dp/1591847788

Drug Channels - pharmaceutical supply chain blog

http://www.drugchannels.net/

NYTimes Article on Obesity in Developing Countries https://www.nytimes.com/interactive/2017/09/16/health/brazil-obesity-nestle.html?_r=0

Dr. Paul Offit - (addressing pseudoscience and alternative medicines)

http://paul-offit.com/

BA Sillah joins the Penn HealthX Podcast to discuss getting an MBA, and investing in healthcare in Africa.

3:00 – The MBA year at Wharton

7:30 – deciding not to go into residency

15:30 – rising interest in business in medicine

19:00 – working in Africa

26:00 – addressing problems unique to the healthcare systems of emerging countries

33:00 – the downside to charity care

38:40 – working for Excelsior and investing to benefit a community

Links

BA's LinkedIn

https://www.linkedin.com/in/barthalomew-sillah-5433b614/

King's Sierra Leone Partnership

http://kslp.org.uk/

Excelsior Group

http://excelsior-group.com/

Ghana National Health Insurance Website

http://www.nhis.gov.gh/

Eric Heil joins the Penn HealthX Podcast to discuss his career, passion for systems engineering, and experience founding, and eventually exiting, RIghtCare Solutions. RightCare, a company focused on reducing acute care hospital readmissions, was acquired by NaviHealth.

2:45 – growing up in Iowa

4:00 – going to Penn to play basketball

5:45 – playing in the NCAA tournament

7:15 – choosing to study engineering

8:45 – what is systems engineering?

10:15 – why focus on the healthcare space?

11:45 – other jobs Eric took on after graduating from Penn

17:00 – from VC to becoming an entrepreneur

22:00 – the idea to start RightCare

24:45 – rationale for getting an MBA

27:20 – what exactly did RightCare do, and what problems did it solve?

34:45 – challenges of being the leader of a health-tech company

39:45 – exiting RightCare – being bought by NaviHealth (a Cardinal Health company)

41:45 – starting a new project – trying to make lightning strike twice with BehaveCare

44:35 – lessons learned from successfully leading BehaveCare

Links:

Eric’s Linkedin

https://www.linkedin.com/in/eheil/

Kathy Bowles – co-founder of RightCare

https://ldi.upenn.edu/expert/kathryn-h-bowles-phd-rn-faan-facmi

RightCare Solutions Exit (article)

https://medcitynews.com/2015/12/rightcare-solutions-acquisition/

Domain Associates (website)

https://www.domainvc.com/

BehaveCare (website)

https://www.behavecare.us/about-us

A Past Interview with Eric

http://executiveleadersradio.com/heil-eric-4297.aspx

Letters to a Young Entrepreneur by Ricardo B Levy (Book)

https://www.amazon.com/Letters-Young-Entrepreneur-Succeeding-Business/dp/0996670602

JP Morgan Healthcare Conference (old link)

https://www.jpmorgan.com/global/healthcareconference

Tim Carlon joins us to talk about his MBA year, and his interest in value-based care. We touch on ACO's, bundled payments, MACRA, and other fun acronyms like MIPS. If you plan on being a physician, you will undoubtedly be impacted by the shift to value-based care. Take notes.

4:45 – Tim’s interest in IR

6:10 – why get the MD/MBA?

14:45 – becoming interested in value-based care payment models

22:20 – explaining ACO’s

27:00 – how have ACO’s been doing?

30:45 – what can med students and young physicians bring to the table?

32:55 – bundled payments

36:00 – What is MACRA?

45:00 – should doctors be worried?

Links

Tim's LinkedIn

https://www.linkedin.com/in/timothy-carlon/

CMS Page on MACRA, MIPS, and APMS

http://go.cms.gov/1Gb6GDL

CMS Page on ACO's

http://go.cms.gov/2nf9mvC

Penn Bundled Payments Press Release

http://bit.ly/2ivGtZc

Gregg Khodorov and Julia Tartaglia, the co-presidents of the Biomedical Entrepreneurship Network (BEN) at the Rutgers Robert Wood Johnson Medical School, join me to discuss their interests, BEN, and The Scientista Foundation.

Map:

4:00 – Gregg – getting the MBA before med school

7:11 – working for Pfizer

9:45 – undergrad at GW and deciding to go into medicine

12:15 – Julia’s path to medicine – studying human behavior, getting a post-bacc

15:45 – starting the Scientista Foundation

20:05 – barriers she faced, and barriers women face in STEM careers

24:00 – what does the Scientista Foundation do?

28:00 – BEN, the summit, and cross-disciplinary programs

37:00 – integrating business and innovation skills into medical school curriculum

45:00 – things Gregg and Julia are looking forward to in the next year

Links

Gregg's LinkedIn

https://www.linkedin.com/in/greggkhod/

Julia's LinkedIn

https://www.linkedin.com/in/juliatartaglia/

BEN Website

http://benrwj.com/

BEN Facebook

https://www.facebook.com/BENRWJMS/

Scientista Foundation Website

http://www.scientistafoundation.com/

Wharton Business in Healthcare Conference - last year's site

http://www.whcbc.org/conf2017/