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Building for The Future: Physician and Clinical Leadership with Anish Mahajan, Chief Medical Officer, Harbor-UCLA Medical Center was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2019.
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Saul Marquez:
Welcome back to the podcast. Today I have the privilege of speaking with Dr. Anish Mahajan. He’s a Chief Medical Officer at Harbor UCLA Medical Center, Associate Dean at the David Geffen School of Medicine at UCLA. He’s an accomplished and driven physician and health care executive with the clinical, strategic, data, analytic and communication skills to motivate policy and practice change in the government and private sector. With over 10 years of experience in Vanguard policy and health care organizations, including 5 years leading successful initiatives at the intersection of health policy and system change. He served one year as a special advisor on health policy at the White House Office of Management and Budget during the formulation of the Affordable Care Act. His work, as well as the bed practice that he’s had, really will offer a lot of insight to everybody listening today. And so with that, it’s a true privilege to have Anish on the podcast and looking forward to the discussion. Anish, welcome.
Anish Mahajan:
Thank you very much.
Saul Marquez:
It’s a privilege to have you here. And I want to know, did I leave anything out in the intro that you’d like to share with listeners?
Anish Mahajan:
No, I don’t think so. Is a very nice introduction. I appreciate.
Saul Marquez:
Sure. So tell me, what is it that got you interested in health care?
Anish Mahajan:
Well, you know, for me, early on, you know, I had a drive and a passion to try and be of use in service for underserved communities. And that really came inspired by my grandfather, who was a public servant in India where my parents are from. And that really drove me. And, you know, how did it become serving the public and the underserved in health? Quite simply, it’s that I am of Indian American origin. There are no doctors in my family. And my parents had a very strong hope that somebody would become a doctor. And of course, I felt that pressure and I thought, oh, I can make the best of being a doctor because at least I can also serve in the area of health for underserved people.
Saul Marquez:
Well, I think that’s fantastic. Dr. Mahajan And so you you’ve done wonderful work and you’ve covered so many, so many, as you call that, different angles of the elephant. Right. Taking a look at it. And it is a big elephant healthcare. So, you know, I’m just curious what you believe is and should be at the forefront of health leaders agendas and how are you and in the work you do approaching it?
Anish Mahajan:
Yeah. You know, I guess I’ll start by saying that, you know, my experience has taken me from the bedside where, you know, I am an internist. I practice in the hospital setting on the inpatient side. And mostly I practice now half a day week as a primary care provider. And I learned clinical medicine, but I quickly moved into health services or implementation science research and became a research faculty member after my training and residency at UCLA and was fortunate to gain skills and analytics and research and studying health systems and trying to understand what are the possible way in which we could create interventions and policy environments to improve the system. Of course, in doing that, I also understood that academia and the production of knowledge is extraordinarily important, but certainly not nearly enough to actually implement and get to the goal of actually improving health outcomes. And so I was fortunate to have the opportunity to go and work as a special advisor on health policy, as a White House fellow in the lead up to the Affordable Care Act in the first year of President Obama’s presidency. And that was a moment where I could. I thought in going to Washington that I could take my understandings and my ability to understand research insights and the medical literature. What we what is written in the Journal of American Medical Association and doing journal. Could we bring those insights to bear on policy and what the new health care reform, which eventually we ended up calling the Affordable Care Act would do? And I was quickly shown how complicated I had a front row seat and how complicated it is to use the best available evidence and translate it into meaningful and policy. And we got what we got and I believe the Affordable Care Act was a big step or but certainly not the entire step in. And so that was somewhat humbling for me about the nature of how research and academia can impact change thereafter. I know in my own career, as I thought about it, I was in my mid thirties at the time after the Affordable Care Act was passed. I had opportunities to stick around in Washington and continue to contribute as a political appointee at CNS or HHS or at OMB where I was. But I made a very deliberate decision, thinking that it would be quite a privilege to continue to work at a policy level. But I felt the same way I felt in academia that, gosh, how are we going to actually translate what we’re doing here into actual impact and change for how Americans access and utilize and benefit from health care? And so I made a decision to walk away from great opportunities after my year in Washington in the Obama administration and returned to Los Angeles to seek an opportunity to be a health system leader and to try and understand what it means to lead as an executive and implement both insights from the literature and opportunities in policy to the system change. I was very fortunate to have an opportunity to be a deputy director of the second largest public health care system in the US and L.A. here. And from there I really understood that gosh, there is a whole another layer to actually improving health care. And that was that was related to how you lead teams, how you build a culture at the level of health care delivery organization that could actually harness the opportunities of policy and the insights of research. And so in my journey so far, I’ve been humbled in every arena I’ve worked in. But I’ve also sort of understood or feel like because I have a global view from multiple sort of silos, as it were, that I can see places where there is opportunity and also places where, gosh, we have a lot more work to do in a collaborative fashion.
Saul Marquez:
Now, some rich experience you’ve had there an Asian and fascinating to hear that you’ve done all this really during such a young phase of your career. So kudos for you for being able to have done that and contributed so early on. And now as a system executive, putting things in the practice that make a difference. Can you give an example of something that you’ve done or things that have been implemented at your facility that have improved outcomes by doing things differently?
Anish Mahajan:
Sure. We one of the big changes that the Affordable Care Act enabled was coverage expansion for people who were traditionally uninsured and with coverage expansion in California where I work, the governor at the time, Jerry Brown, decided that coverage expansion would occur in a managed care fashion. And so Medicaid insurance of Medicare in California, it was decided that anybody who gained new insurance in California, which there were going to be hundreds of thousands in L.A. County, the areas that we serve would have to be managed care members of the health plan. And this was a sea change in how low income people in Los Angeles would access care. And the theory, as as I worked on it and promulgated in Washington and as I understood it in the academic setting, is that if we made provider groups accountable per member per month style capitation for the lives of patients, we are likely to improve the delivery of the care and ultimately the outcomes of care for those patients as compared to fee for service. And that’s the grand experiment we’ve been on in California since the implementation of the Affordable Care Act for low income people. And so in our health system, which is a safety net health system. We suddenly had to get our patients to understand that they were going to have a primary care physician that they could call their own. They could identify that person, that they had a place to go for clinic. They did not have to go to urgent care or the emergency room as their starting point of care. And yet in the first year or two, our patient satisfaction scores were not very good. Not surprisingly so in the outpatient setting. And so we as a team using Toyota production. System principles, lean management approach created a state court, multi disciplinary stakeholder team of nursing administrators and physicians in our primary care practices to figure out how can we do better. You know in one intervention that was something that people said would never, could never be possible before we created collaborative teams using lean methodology was that we ought to have open access appointments. Our patients should be able to call their doctor and be seen that day or the next day in our scheduling template should allow it before we management approach. No chance of doing that because we did the hard work of doing that. We implemented it and we saw our scores skyrocket. We saw patient experience improve dramatically among the low income population. And that was something that everybody in my facility should be very proud of.
Saul Marquez:
Well, that’s that’s amazing. And also a very ambitious project. It’s difficult to do. What would you say was the reason you guys are able to execute on that? In particular, I’m referring to the just in time method for appointments. I mean, that’s that’s not easy.
Anish Mahajan:
Yeah, well, I appreciate the question so much because, you know, it isn’t because we did lean it wasn’t a terminal or it wasn’t that only that we were able to throw together the people who do the schedule, the I.T. folks who control the electronic health record and the physicians and some patient and input. It wasn’t you know, those were necessary, but not sufficient, really. What made this possible was a very long set of engagements and conversations at all levels of our organization about who we are, what really is our mission. And can we articulate together what we call our true north? And what we did articulate, I think, was ended up being very powerful and that we articulated that two years prior to achieving this game, which was that even though we provide care to low income people, we should be providing care at a level that we would bring our own loved ones to our facilities. And with that sort of powerful notion, it became very easy in the face of big challenges for people to feel inspired and say, well, you know, when I need to bring my mother and or myself or if I have a problem, I’m able to get into my own doctor’s office within a day or two. It shouldn’t be different for our patients. And so people rolled their sleeves up and did what was hard. And lo and behold, they figured it out.
Saul Marquez:
Love it. Yeah. And, you know, it’s a testament to the culture like you alluded to and being serious about the true north. And there is also some inspiration there, I think, brought by you and the leadership team. Dr. Mahajan, to be able to knock this out. So kudos to you guys for doing this. Give us an example of of a project that didn’t work and something that you guys learned from that that has made you better.
Anish Mahajan:
Gosh, there are so many projects that continue not to work. So, guys, what should I pick? I would just give a very operational example of managing our Kerry operative process from patients who are screened for their risk of the preoperative risk all the way through to having their operation and their post op care. We run a level one trauma center. We provide everything, all kinds of procedures and surgeries, including robotic surgery. So insofar as we do that, we have you know, we have over 70 surgeons on staff across multiple departments. And it becomes a very complex situation in terms of managing the operations, effectively managing our costs. How do we decide which supplies are absolutely needed in the operating room? How do we budget for it? And to date, you know, we’ve had very strong clinical department chair leaders who continue to be very strong, but they work somewhat autonomously. And we still we did not and we continue to work on trying to manage the entire perioperative process in our trauma center in a way that is more efficient, more collaborative and ensures that we have the right skill sets applied for every problem. So how did we try to address this? You know, I thought we ought to change how we govern decision making in the perioperative care service line. And I ask that we create a perioperative leadership team that involves the senior nursing leader, the senior administrator and a senior physician surgeon physician who would represent each of the departments, as you can imagine. That part that last part has been a challenge. You have to pick one person because if you pick more than one path, it’s difficult to hold anybody accountable. But know one person comes from one of the three major departments that does your surgeries in this service line. And so we’ve had a lot of challenges and sort of corralling the governance. But also part of that challenge is because. Just so complex and expensive in American medicine. When you talk about all the kinds of procedures and surgeries we do, so we don’t have an answer there yet, but it’s something that we are not doing well. We’re over budget over the last two years, and that’s something that I am being asked, you know, quite rightly.
Saul Marquez:
Now it makes a lot of sense. And. And look, I think the inevitable is, is that you guys, as you’ve done in the past Anish, you’ll find a way and these operational challenges pose a challenge for really all leaders in health care. And I appreciate you sharing this specific one as a way to connect with the listeners on the problems that they, too, are having in their systems. There’s no such thing as perfection, but going toward it is definitely something that you guys are doing. So kudos to you there. What about the other side of the coin? What’s one of your proudest medical leadership experiences you’ve had to date?
Anish Mahajan:
Well, you know, I guess first I will say and you know, it really should go without saying, but my achievements are really often almost always the achievements of many other people who do the work. So as a leader, my roles in the last five, seven years have really been those of setting vision, helping people come together around common purpose, identifying high priority issues that we should expand our precious assets, including people and their time on. So, you know, that just I’d have to say that for everything I’m talking about here. So I guess one of the things I’ve spent a lot of time working on outside of my job as the associate dean and chief medical officer, I’ve served as a as really the clinical thought leader, the founding member, and now the chair of the board of directors of a new effort around health information exchange in Los Angeles County. As you know, and as many people know, sharing in health and health information across entities, meaning, you know, I’m a patient, stay at Kaiser, but I end up in the emergency room at UCLA Medical Center, which is not a Kaiser facility, those UCLA doctors are unable to know or see my medical record as an example. And health information exchange, of course, is intended to ensure that health information can travel seamlessly between organizations and entities that manage the health care needs of any given individual. We do not have an HIE, as it’s called, for short here in Los Angeles. And yet we have such a sprawling geography. We have so many health care entities and we’re largely now a managed care environment for the safety net because of Medicaid being an aged care product. So the need for health information exchange is so paramount as it relates to health care, good quality health care, but also for controlling costs. And we do if you look at the data in L.A., we do a poor job of that across sector, across health plans and sectors. And so a few years ago, there was a lot of grant money to try and start these initiatives. And most initiatives around the country are not successful. But I have sort of taken this on as a passion project, but something that I truly believe in that. And there are many appropriate naysayers, I guess people. My experience is not good, but I have taken it on and I have personally and with a lot of help, built a vision and been able to convince leading health plans, leading health systems in L.A. County to take the leap, invest in the health information, take the risk of sharing their data. People, of course, are quite rightly very nervous about sharing patient health information for the right reason, which is to improve patient care and care coordination. And so our lanes health information, we call it lanes, the lanes help raising shade. In L.A. County, it’s up. We have major entities connected and other entities coming. And the goal is to prove and it’s and it’s a final one, C 3 non-profit effort. And the goal is to prove to ourselves and to everyone who participates that we can generate meaningful use cases as the common IP in meaningful ways in which information can be shared between entities to improve care outcomes. And this has been like rolling a boulder up a hill. And I’ve had a lot of other folks that believe in it with me. But I think that’s what I’m proudest of at the moment.
Saul Marquez:
Man, that’s exciting and definitely ahead of the time. It’s another difficult thing to actually be able to have gotten all these health systems aligned on this vision. This interoperability problem is kind of like the Holy Grail, so to speak, and what we do. So, wow, fascinating. And again, you know, just big kudos to you for for being able to do that. What’s the vision there then, you know, in five, 10 years, 20 years?
Anish Mahajan:
Yeah. I think for us, it’s the idea that it’s not simply the allowing one physician at one hospital and another physician sitting in a clinic to look at each other’s health record, because as you know well and as all of us have complained about. Electronic health record is almost too much information, right? A lot of noise. And you know, and it’s difficult to corral and, you know, and that’s all true, but rather it is to enable that capability. But it’s more than that. It’s really to say, if I am a care manager who is managing and I’m not a physician, but I’m a nurse, I’m a care manager who is working and a health plan and managing the sickest patients with the worst social challenges that are members of my health plan. Somebody, let’s say, who has serious mental illness and diabetes, who uses care frequently, who doesn’t adhere to their medications, due to their social and medical challenges, that whenever that person enters an emergency room, the computer system the HIE automatically pings media care manager, and automatically pings the primary care providers office that the patient that you are co managing together has hit the emergency room. Reason for that is that then the folks that do the care coordination can ensure that when that patient is discharged from the EMT or from the inpatient service, they’re tracking that patient within a day or two, getting them into clinic so that they can make sure the patient continues to take their diabetes and psychotropic medications. It’s the idea that we as a society have the tools. We as health care entities have the staffing to actually wrap around and help our most needy patients use care better and have better outcomes. But what we need to do is ensure that information gets to people who need to act on it in real time. And that’s the kinds of functionalities that we are building in a collaborative fashion, listening to people who actually do this work, asking them what their problems are and then designing the IP system to meet those needs.
Saul Marquez:
Awesome. I love it. Love the direction. Dr. Mahajan. And, you know, I’m just thinking about the future unites. It’s definitely bright with the work you’re doing here. And so love that you shared that story and the direction is going it’ll serve as inspiration for the people listening today. So it’s time for the Lightning Round. I’ve got a couple questions for you. These will be rapid fire as possible, followed by a favorite book that you recommend to the listeners. You ready?
Anish Mahajan:
Sure.
Saul Marquez:
All right. What’s the best way to improve health care outcomes?
Anish Mahajan:
Building effective teams. What’s the biggest mistake or pitfall to avoid thinking that I’ve identified the right metrics? So then naturally we’re going to meet the goal.
Saul Marquez:
How do you stay relevant as an organization despite constant change?
Anish Mahajan:
I think it’s being focused like a laser on your mission. And if it’s a health care delivery organization, it’s meeting the health care needs of your patients. And if your patients are changing demographically, then naturally you need to change how you serve them to keep that goal of meeting their needs.
Saul Marquez:
What’s one area of focus that drives everything in your work?
Anish Mahajan:
I would say it’s it really is two things. It’s patient satisfaction and provider and staff satisfaction.
Saul Marquez:
Outstanding. And these next two on each are more on personnel. What is your number one health habit?
Anish Mahajan:
Well, I need many more. And I’m a terrible patient. I like what I’ve been trying to do is go to the gym four times a week. So far, I’m averaging three times a week. So I guess that’s my habit and goal.
Saul Marquez:
I love it. It’s a really great one. And what is your number one success habit?
Anish Mahajan:
Gosh, if I could keep this habit up, I would probably be more successful. And that is to plan the most important thing I’m supposed to do the next day, the night before, and ensure that I don’t allow other things to encroach on my time to accomplish those things.
Saul Marquez:
Outstanding. Love that one. Definitely a focus for me as well, Anish. I’m so glad you brought that up. What book would you recommend to the listeners?
Anish Mahajan:
I like reading novels. I believe, you know, it probably is because, you know, my partner, she’s a professor of literature, but I think novels are amazing. But I recommend you know, what I just recently read was a nonfiction piece by Valeria Luiselli. She’s a writer from Mexico, but by Italy. She wrote a book called what was it called? Tell me how it ends. And same 40 questions. And this is a book that she served as a volunteer interpreter for a Central American children, migrant children when they come across the border and are taken in by the immigration services. And she wrote this in 2014, actually, before much of the recent political issue around this. And what she did was it interviewed these kids. She interviewed. She served as the interpreter of these kids as they answered 40 questions, the intake questions. We our government has for for for processing these kids. And it’s a phenomenal story. The real story. It’s very short. I would recommend it to anybody, any of us Americans to read in terms of the insight. It is not just about those kids. But about how we as a society manage difficult social challenges as well as it really is a generalizable story about what it means to be an immigrant. So great thing.
Saul Marquez:
Great recommendation nation. So folks, for a full transcript of our discussion, as well as a short notes and links to any of the books or resources we’ve discussed today. Just go to outcomesrocket.health and in the search bar type in Dr. Anish Mahajan that’s M.A. H A J a N and you’ll find all of that there. So, Anish, I’d love if you could just leave us with a closing thought and then the best place for the listeners could get in touch with or continue following your work.
Anish Mahajan:
Yeah. You know, I get a closing thought. Gosh, this has been a great. Mean a lot of fun. I really appreciate speaking with you, Saul. And I guess my closing thought is what a great thing you’re doing here. I can’t wait to continue to listen to the others. Who have you have interviewed? I think conversations. I guess my closing thought will be conversations. Have conversations with people outside of your immediate expertise, outside of your silo, because we really do need to break the silos down of the experts in the delivery of health care. And that’s beyond just physicians or administrators. And nursing includes patients and includes community health workers do that. And, you know, in terms of getting in touch with me, please reach out to me. My email is available on LinkedIn. I love to hear from people and engage with folks in health care.
Saul Marquez:
Outstanding, Anish. I love that call the actions of folks. Take it on. Reach out outside of your own silo and hit the rewind button. Listen to this one again, because it was definitely a great interview. Anish, just appreciate you taking the time to share your insights with us. Thanks again.
Anish Mahajan:
Thank you. Thanks so very much.
Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration and so much more.
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