The Quality Improvement and Cost Reduction Challenge with David Williams, President of Health Business Group
: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez
Saul Marquez: [00:00:18] Outcomes rocket listeners welcome back once again to the Outcomes Rocket where we chat with today's most successful and inspiring healthcare leaders. Hey I want to invite you to go to outcomesrocket.health/reviews rate and review what you thought about today's podcast. And without further ado I want to welcome our amazing guest. His name is David Williams. He's the president of health care business group member of Board of Directors at Clerio vision and he's got a track record of success in health care. Among those things a blog that he's been writing for the last 12 years and other companies that he's been involved with but wanted to extend the invitation to David to fill in any of the gaps in that introduction. David. welcome to the podcast.
David Williams: [00:01:03] Hey thanks, it's good to be here. I'm not often called amazing so I assume that setting up some zinger questions for later when she soften me up but you handled it pretty well in the health business group is a strategy consulting firm been around for for quite a while it worked throughout healthcare and life sciences. I write a blog I am on the board of the clerio of vision as you mentioned and also a couple of other companies very Cradd and Madugalle and so keep them busy.
Saul Marquez: [00:01:27] Awesome. Now you definitely have reason to be. And you know just your leadership track record in this field and thought leadership as well. So David what is it that got you into health care to begin with.
David Williams: [00:01:38] I something I always had an interest in even growing up my father worked in public health as highway safety researcher and I did have a summer job one year at a V.A. hospital programming a mini computer. So I had some some practice of programming in that clinical decision support. Way back when in the early 80s so it was that was I guess how I got into it. And that's pretty cool yeah. And then when I was in business school I came out of there in 94 and so it was just after Hillary Care had fallen by the wayside. But the private sector had gotten the message that it better innovate and try to do some new and different things. So when I went to Boston Consulting Group even though it was a general firm I did a lot of work in the health care practice there.
Saul Marquez: [00:02:20] Awesome. So really all roads lead to health care for you and you just stayed strong with it.
David Williams: [00:02:24] I mean I guess you know what I was at BCG I did some other things too including work in the automotive space and paper and all that and it was kind of fun but I thought health care was really interesting and also socially redeeming so it's really at the end of the day impacting life and death which is different than in some of the other field. So when I left Boston Consulting Group pictures back in 2001 I just decided to continue in that field and never left.
Saul Marquez: [00:02:49] Love it. DAVID And what would you say. There's a lot going on in healthcare today out of all the things that are going on right now in your perspective. David what would you say. Hot topic that every leader needs to be focused on.
David Williams: [00:03:01] As you say it's a little hard to pin it down so I'll give you a broad one which is just overall costs. The costs are just totally unsustainable. We sometimes forget about how the high costs of health care are driving out other spending priorities both on the public side and the private side. So you see that things like education and infrastructure are really driven out by Medicare and Medicaid spending from a government level and then on the private side it's much the same people trying to figure out how they can afford their copays on their medication even if they are insured. So cost is really the biggest area I would say.
Saul Marquez: [00:03:35] And David as we as we think about costs. No doubt it's you know three point two trillion dollars 20 percent of GDP. It's a big issue like how do we tackle that like what would you say. As far as say health care leaders right. What do we need to be thinking about as it relates to costs. And maybe if you can drive down the main pillars of provider industry and payer.
David Williams: [00:03:58] Well I think that there are a couple of approaches I would take to it. One is to look at the overall level of value based care. So that's something that certainly had been introduced probably during the Obama administration even before then things like pay for performance and that really does bring everybody together including the providers including the payers including the patient. And I would say that at the end of the day you have to have a value based system that's rewarding you know value over volume the same time. Under the current administration a lot of that work has has slowed down quite a bit and those that felt that they needed to make the jump from volume to value and we're trying to figure it out and we're sort of ready to roll with it have decided. Well I think we're going to step back for a bit because the fee for service era is going to continue for a while and certainly the first HHS secretary in this administration Dr. Price was focused on pink Yucie for service was just great. So I think eventually we need to reaccelerate that value based approach. And I think that we will. So that's happe while that's happening or while it's not happening. There are some other things that can be done and some of those are a little bit more specific. So thinking about how in other industries technologies are used to reduce costs while improving quality there's actually no contradict in between cost and quality. From that from that standpoint and a couple of the companies that I've been involved with that I can talk about publicly like cardiac technologies which was just sold to ARCI earlier in December and clarity of vision both due that they are improving quality but they're also reducing costs by an order of magnitude in many cases both in the areas of clinical trial core laboratories and then in vision correction. So some of those technologies can come in as well. One problem you do see in healthcare is that you'll have something that may look like it's a lower cost and it might be on a unit basis like going to a retail clinic instead of going to the emergency room. But if you go to the retail clinic instead of staying home and you still go to the emergency room when you go to the emergency room it's just additive. So that's one of the tricky things in health care.
Saul Marquez: [00:06:04] That's really interesting. And so the examples that you provided are both industry and just from the perspective of the folks listening it just seems like as a provider just with the changes. Just hard to get to that point of value based care. We are in a value base fee for service based system and it seems like maybe a lot of the onus is getting put on companies to own that.
David Williams: [00:06:27] Well what happened before is that Medicare is such a big elephant that you really have to pay attention to Medicare so I remember back 15 years or so ago Harvard Pilgrim Health Care was trying to do some innovative things related to you know what at the time would've been called Pay for performance or some alternative payment models and what they found is that the hospitals they were dealing with even though Harvard program was supposedly the top health insurer in the country they didn't have that much influence over the hospitals the hospital would take whatever they did and just convert it into Medicare equivalents and they lost all the incentives and that behavior change they were trying to get as a result. So with Medicare setting the tone with things like a CEOs and bundled payments it provides private health plans at least with the opportunity to sort of follow in their footsteps and so I think what you're seeing now is that even if the feds are backing off from some of that the private health plans the commercial plans Medicare Advantage plans are still continuing down that path and they can continue to make progress as long as Medicare doesn't completely undercut them.
Saul Marquez: [00:07:34] Yeah that's a really interesting perspective. I think it's a good good way of framing it and really the way that it's ticking. So if you had to say your group David had to focus on one thing. What is 2018 looking like for health care.
David Williams: [00:07:48] I think that 2018 unfortunately might be looking like 2017. So that's a little bit of a grim prospect. So I do think what will happen is that.
Saul Marquez: [00:07:57] What you mean by that. What was 2017 like are you just saying there's not many changes coming.
David Williams: [00:08:01] I'm saying that from a healthcare policy perspective which is where I spend some of my time not a lot really happened. It was more about undermining things that were already there. Slinging totally and arrows trying to undermine or repeal as opposed to building anything new even one area that you might have thought was going to get some attention which was drug pricing really didn't. So I mean from a health care policy perspective I don't see a lot of great things happening. And I also think that with the tax bill it may shortly become law that's likely to sort of take money out of the system without making a lot of good impact. You'll see more organizations that are suffering financially. So that's kind of what I expect in 2018. I think especially as an election year we can't really expect any bipartisanship to occur. So I don't have high hopes on the policy side. My hopes are more that we're going to see things like analytics and big data that have been brewing for a while you know start to make a practical impact. That's what I would point to. You'll see things like that. Nothing from a policy standpoint.
Saul Marquez: [00:09:03] For sure. Yeah. Thanks for sharing that. It just seems to be that consistent thing that nags at all these companies that have amazing ideas that wanna move move the industry forward policy just can't seem to keep up with the innovations kind of like with Amazon. You know they want to get their drones up there but our antiquated air space policies don't allow us to get there.
David Williams: [00:09:25] I think you're going to see Amazon you pointed them for another reason. But certainly that's an organization that is starting to enter health care and could have some impacts as soon as 2018. You already see impacts on it in that it's it's driving others to take action like the CBS Aetna merger proposal. I would put in that category of the defense against Amazon.
Saul Marquez: [00:09:45] Yeah really interesting. So let's shift here. David can you share with the listeners a time or an example of you guys have done a lot and you guys have done a lot of really good things so out of the many that you have in mind a story when you guys improved outcomes for a client that you've worked with.
David Williams: [00:10:02] Maybe I'll take something a little bit off the beaten track so you know we work with businesses mostly but we also work with nonprofit organizations and I don't mean just nonprofit hospitals which is just another way of not paying taxes but there are effectively businesses that are being but we do know like it is coming.
Saul Marquez: [00:10:21] I love it.
David Williams: [00:10:21] Exactly so we work with some major philanthropic foundations and we often help them on what they call sustainability for some of their multistakeholder nonprofit organizations some in the area of regional health improvement collaboratives and sustainability really means how can they survive without having being completely grant supported. So what we do differently is we bring a real business perspective to it. So we say even though you're a you're a not for profit and you're a collaborative group. You still need to think about things like your value proposition customer service return on investment and bikes getting some of those business concepts across without undermining the soul of the organizations. We've been able to help some of these regional centres really get on their feet and be successful and sustainable for the long term.
Saul Marquez: [00:11:08] And I think that's really great. You know just supporting the people that have a really strong mission and are in it for the greater good. That's maybe the path that your father laid out for you and you continue to carry it forward as a public servant. So kudos to you guys for doing that.
David Williams: [00:11:24] So I don't want to take it too far I'll give you another example that's a little bit more mercenary. So what the other thing that I do as a board member of privately owned companies is try to incorporate the grand perspective but also be able to navigate between their private equity investors who are very financially driven and the company executives who often focus heavily on the on the day to day. So sometimes it's about uniting two companies that may have kind of suspicious of one another but actually are very complimentary and that's something that I worked on recently with two clinical trial core lab companies that I was involved with and they and they came together in a way that I think is going to be very strong and powerful for the customers and the market.
Saul Marquez: [00:12:05] So let's dive into that a little bit deeper David because I do believe that this happens too often we're oftentimes in a position where we consider another group potentially a foe when in reality they're a partner. In the end it hurts us it hurts the organization and it hurts the people that we serve in health care. Can you give us an example of how you help people bridge that and how you get them to work together.
David Williams: [00:12:28] Well you're pointing to something that I think is is important which is that people that are very you know kind of close rivals may actually have more in common and be able to work together. So I guess I saw this most exhibited actually by my younger brothers who are identical twins. They used to beat the heck out of each other in the house they just paulownia each other day it day and night and they both actually pretty good wrestlers but what you got. And that's I think the ultimate example of somebody that is very close to another one an identical twin. When they got out in the world if anybody would poke one or the other of them or bother me even as their older brother they would be just completely bonded and working together so in a very strong way that would make somebody regret having picked on one of them because they're definitely getting getting two of them. That's something that maybe I learned at home not from my father but from my dad my brothers and help companies to think not exactly in those terms but to say you know you're such major rivals and you're always going up against one another. You know what are ways that you can potentially come together and be even stronger now.
Saul Marquez: [00:13:26] And I love that idea. And the analogy is wonderful if you had to pull out one thing what recommendation do you give people. What we're looking to do that better.
David Williams: [00:13:35] I would say first of all you know take a deep breath and listen to somebody that is more of an observer of the industry or you than a customer or an investor and try to understand their perspective and look at it fresh and you know even forget the name of the other organization that you're dealing with for a minute while you while you do that.
Saul Marquez: [00:13:52] I love it. What a great tip and listeners too often. We're all guilty of this. We get stuck in our head about what we believe about what we say we know. But truly what our perspective of the situation a person or group is and let's heed David's advice. You know let's let's step away from it and get some fresh perspective because we may be missing some amazing opportunities of collaboration and even just a bigger way to fulfill our mission that we're all in here for which is improving outcomes and being able to do it profitably. David you know you're sharing some really great tips. Really appreciate it. What would you say to date in the decades that you've been in health care is one of your proudest moments.
David Williams: [00:14:33] Well I would say One example is things that are not done. You know we talk about doing business strategy and strategy of course is about what you are going to do. But it's also about what you're not going to do. Yes. Well so we do a lot of work with companies that are making acquisitions and oftentimes somebody will really fall in love with an acquisition and they're hiring advisers. But you know they've got a bias toward doing the deal and you tell them it isn't good you know you're not going to be that popular. So we're working with one company and the chairman of that company was very hot on a particular acquisition opportunity really thought up with it and he was also described to me as a very mercurial and forceful type of guy mercurial I'd say it was an understatement if that's possible for that to be an understatement. And he put out that allow I'll give you an example that he put a lot of pressure on the management team and specifically on me I remember when we started to sort of question the deal he he threatened that not only was he not going to pay our bill he was going to send us a bill which I thought was which is really something so we stood our ground and recommended against the deal and eventually it didn't happen. And a few months later it was sold for about 40 percent less than what a client was prepared to pay for it and that it actually went downhill from there after it was acquired. So I heard later from. Yeah I heard later from the CFO of that client that that was all the things we'd done with that company which we've worked with for you know several years that this was the most valuable one because it really helped them avoid a disaster. So I guess I'm proud of something that we did we didn't do that we couldn't somebody else not to do.
Saul Marquez: [00:16:03] I think that's so awesome. So congratulations on standing your ground. You know a lot of times it's tough to do that especially when somebody threatens you like that. And so that speaks to your courage and to your vision. And then secondly the message to the listeners strategy is not always about what you're going to do it's what you're not going to do as well. So let's consider that let's take this example of this lesson that David shared with us and this potentially catastrophic financial decision that could have been made was avoided because of courage and because I've seen that. So a really wonderful example. David thanks for sharing that. Sure. So tell us about an exciting project that you're working on today.
David Williams: [00:16:43] Well one of the things I love about my work is really work only on exciting projects so.
Saul Marquez: [00:16:50] So everything.
David Williams: [00:16:51] Everything is everything everything is wonderful you know from the from the Lego movie right. That's one thing that I would say that we see a lot of that seems to be a theme right now is clients of ours that have some sort of technology our software That are interested in trying to expand into services. And it's both a way for the customers. It's a business in and of itself when you're looking to accelerate growth but it's also a way for the customers to get value out of the products that they are that they're purchasing. You find that you have a product that has a great return on investment and yet how come you're not getting that type of growth that the penetration of the price realization that you would expect. And a lot of that can be remedied actually with services so that's sort of a generally exciting one. I would say if you asked me for a very specific one that we're working right now with a company that has it does clinical trials and they've got a particular medical device they use in the trials that they spent a lot of effort on the device and now what they're finding is that those who are leading the clinical trials are saying hey this would be great to have in my everyday medical practice. So we're evaluating whether this can be used in more routine health care settings as well. I can't be too specific about it but that's that would be the one that's most exciting.
Saul Marquez: [00:18:04] I get it. Yeah that's pretty interesting just putting the lens on seeing the applications and the other example that you gave established companies looking to just get additional growth services tend to be that way to do it. And so if you are a company executive listening to this I definitely encourage you to check out the show notes David will be able to share his company info contact info and potentially reach out to him because he's definitely got some pretty good wins under his belt as it relates to helping companies diversify and increase their penetration in the market. So David let's dive into this part of the episode. You and I are building a medical leadership course on what it takes to be successful in medicine today. It is the 101 or the ABC of David Williams And so we're going to write a syllabus here four questions lightning round style and then we'll follow it up with a book that you recommend to the listeners ready.
David Williams: [00:19:02] I have as ready as I'm going to be I think.
Saul Marquez: [00:19:05] I love it you're quick on your feet so I know this will go well. What's the best way to improve health care outcomes.
David Williams: [00:19:11] Oddly I think it's actually to encourage people to stay away from the doctor and take good care of themselves both from sort of a preventive and wellness basis and then even when something's happening to them that is medically necessary they should be thinking and not just become passive within the system.
Saul Marquez: [00:19:26] Love it. What is the biggest mistake or pitfall to avoid.
David Williams: [00:19:29] What I think is really about trying too heavily on medications to the you know every medication is going to have some side effects. Now certainly people may need medications. Nothing wrong with that but sort of the idea of a pill for every ill and physicians that may look at things that way not always working in the favor of the patient. And I think in particular try to avoid getting addicted to opioids which is all too common unfortunately.
Saul Marquez: [00:19:52] And that's for sure and this is definitely a hot topic for me too David. Just being able to understand that a pill only takes care of a symptom and oftentimes not the actual problems are diving into what is the actual problem rather than just masking it with a pill. Love that. How do you stay relevant as an organization despite constant change.
David Williams: [00:20:12] Yeah that is a hard one. We have a very seasoned team which is a better way than saying that we're all tottering but that's one reason we're not doing the video here. But we really tout our experience. We know we're doing we've seen a lot of things. And so the biggest danger is really about staying open to new ideas. And there's a couple of ways that we do it. One I've already mentioned serving on boards of companies that are doing really innovative and exciting things. A lot of those are run by younger innovators people really taking some interesting risks and really pushing the envelope. And the second way is as you do I write a blog and do podcasts with entrepreneurs so I'm always being pitched ideas about new companies and speaking with CEOs entrepreneurs who are doing something that's interesting so try to be open to these ideas but also put myself in a place where I'm going to be confronted with new ideas new companies new approaches.
Saul Marquez: [00:21:07] Great tip and what's the one area of focus that should drive everything else in your organization.
David Williams: [00:21:12] I mean in our own organization we have an insistence on trying to do really great and nearly perfect work. So I'd say you know they say don't let the perfect be the enemy of the good. We don't let the perfect be the enemy of the good but we do let it be the enemy of major growth and expansion we like to keep a very tight focus on what we're doing and know most of the people that work at health business group have been working here for 10 or more years so that's how we do it.
Saul Marquez: [00:21:37] It speaks to the culture. People don't stay a decade or more. If the culture does not fit I know this wasn't one of the questions but what would you say a tip you'd give to the leaders listening to this show on building culture.
David Williams: [00:21:49] Certainly you know things start from the top and just as in raising children if you're going to behave a certain way you can't expect people all of a sudden to behave in a different manner so they're setting the example of being consistent. Those are important things and then you kind of build it from there.
Saul Marquez: [00:22:06] Love it. What book would you recommend to the listeners here on the syllabus. David.
David Williams: [00:22:09] Well at the risk of dating myself a little bit. One of my favorite classics and one that people don't always know about is called up Parkinson's Law and the subtitle is other studies and administration. You might have Parkinson's Law be familiar with Parkinson's blood cells. So Parkinson's Law as work expands solaced is still the time available for its completion. And this book is really full of pithy observations on administration and about how organizations become dysfunctional as they grow and evolve so they have chapters on things like directors and councils. The annual general meeting how people are selected and I would say just one word of caution that there's no bad words in there but some of the modern readers may find it a bit offensive that it's coming from including some uncensored social observations from a 1950s British perspective. But there's there's some amazing principles to be derived especially about how large organizations work.
Saul Marquez: [00:23:00] Love it. Love it. Yeah. And you know I have found this to be so true. David if you give yourself six months to do it you'll take six months or so two months somehow you'll figure out how to get it in two months.
David Williams: [00:23:13] It was telling him that yeah that's it. So now you know doing something finally you didn't expect to learn anything from this process.
Saul Marquez: [00:23:19] I every time every time especially for you David so I'm glad you recommended that book to us and listeners don't worry about jotting that down just go to outcomesrocket/davidw. That's David Williams. David W. and you're going to find all the show notes as well as this mini syllabus that we just got put together for you links to the book links to his company and his blog and all the things that he's up to David. Time flies when you're having fun. We're here to the end. So if you can please just share a closing thought with the listeners and then the best place where they can get a hold of you.
David Williams: [00:23:51] Ok well a closing thought is that despite what I said about 2018 not looking that rosy is real life is what you make of it so let's say everybody out there listen and prove me wrong by making it great. A good way to find me is that healthbusinessgroup.com or if you like Twitter I'm @healthbizblog and you can also look at the health business blog. Those are all ways that you'll get to me and with the common name of David Williams. You'll find a lot of us out there so make sure you're looking at the one that's involved in healthcare.
Saul Marquez: [00:24:18] David it's been such a pleasure listeners. Be sure to reach out to David stay in touch with them. Follow him. He's up to some really amazing things. David just want to say thanks again for making the time to be with us.
David Williams: [00:24:29] Saul. it's my pleasure.
: [00:24:33] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.
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