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Outcomes Rocket - Charlie Whelan

An Insightful Conversation about Sleep and its Benefits with Charlie Whelan, Vice President of Consulting for Frost & Sullivan's Healthcare 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] Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring healthcare leaders. I really thank you for tuning in again today and by you to go to The most orating in review let us know what you thought about today's podcast. Our guest. His name is Charlie Whelan. He's the director of consulting for frost and Sullivan's Healthcare Group out of San Antonio Texas. Has done his fair share in health care for almost two decades at Frost and he's really passionate about a lot of subjects in health care but in particular very passionate about OSA obstructive sleep apnea. And so what we're going to do today on this episode is focus on the work that they've done in this area. But before we dive into the content I just wanted to open up the floor for Charlie to give us a little bit more about him and then we could dive into what we're going to talk about today. Charlie welcome to the podcast.

Charlie Whelan: [00:01:23] Thanks Saul. Thanks for having me. I appreciate it. So as you mentioned I'm with Frost and Sullivan we're global market research and consulting company with offices all around the world and we spend most of our time working with industries that are developing new technologies helping them to evaluate the market opportunity for those technologies and the impact on them. Over the last four five years we've had the opportunity to work with a significant number of companies developing new technologies in the sleep marketplace. Most of those are focused on obstructive sleep apnea or central sleep apnoea. And we've developed a significant body of knowledge about that topic. Last year we had the privilege of doing two commissioned papers for the American Academy of Sleep Medicine where we surveyed 506 people who were treating their sleep. These are people are diagnosed as obstructive sleep apnea and decided to treat that condition. And we asked them what life was like before they started treating it and what life was like after they started treating them. So that was one white paper the other white paper that we did is we actually reviewed more than a hundred studies on the financial impact of obstructive sleep apnea. And combine that with the survey results to quantify for the first time really what the effect is economically when the United States under treats obstructive sleep apnea. It's a huge problem.

Saul Marquez: [00:03:02] For sure and we had a chance to connect before this podcast Charlie and you are sharing some of the numbers the statistics how many people have it. How bad is it bad how poorly is it misdiagnosed can you run into some of those numbers. I was surprised.

Charlie Whelan: [00:03:18] Yeah I'll go through some of those. So we estimate there's probably about 30 million Americans with obstructive sleep apnea today. There's two there's two types of sleep apnea others destructive sleep apnea and that's when your airway your throat your your tongue your nose basically collapses in on itself while you're sleeping. The other type of central sleep apnoea and I describe it to folks that that's basically your brain forgets how to sleep. There are some people with mixed sleep apnea. Most people have obstructive sleep apnea and we're talking that a lot of that is being driven by the obesity epidemic in our country. But some of it is also related to the aging demographics that we have in this country that are associated with that. A lot of it has to do with weight gain. So that 30 million people that have obstructive sleep apnea we think somewhere between 80 to 85 percent of those people are undiagnosed today. A lot of those have mild to moderate symptoms. But there are still many many people out there probably millions of people with severe sleep apnoea that are not being treated for that condition. We think somewhere on the order of about 6 million Americans actually have sleep apnea and most of those are being treated usually with positive airway pressure or C sheens. But there are other treatments for it such as oral appliances which can hold the mouth forward to open up the airway. Some surgery can be beneficial for certain patients and then there are of course lifestyle treatments too that can be beneficial such as positioning yourself better while you sleep. But it's a huge economic problem as well.

Saul Marquez: [00:04:58] Yeah. Charlie the numbers are pretty staggering that so many cases go on diagnose then these reports are pretty interesting. Not like the artwork on the cover it's a picture of the both of them actually a picture of a very upset wife or girlfriend just covering her ears. And as husband snores away and she can't sleep. And it could be the other way too right Charlie.

Charlie Whelan: [00:05:23] Absolutely. Now we believe that most people with obstructive sleep apnoea is disproportionately male. Men have stickered next man sticker and next contribute to more obstructive sleep apnea. We are seen again with the obesity epidemic. A more and more women with the condition as well. So it is a serious problem for both sexes and to your point on the cover artwork it's kind of funny but in our research we actually found that people's interpersonal relationships with their bed partners family members employers actually improved significantly once they started getting their sleep apnea treated and under control. And that we were actually able to quantify some of that. So you know you might actually be saving your marriage by treating your sleep apnea listeners.

Saul Marquez: [00:06:13] There you have it. If you are maybe snoring a little too much if you're male snoring a little too much it might mean you get checked out. You might have OSA potentially save your marriage. There is one of those things that does matter. I was. And you said co-workers too. I was traveling with a co-worker and it was early in my career we had to share a room and let me tell this guy was just snoring his lungs off and I just couldn't sleep. And it made it made it tough. That whole whole week that I was at that project with him and it just it was hard. So I totally believe it. Charlie What would you say some of the barriers to diagnosing and treating OSA are.

Charlie Whelan: [00:06:53] Well there are a couple of them. If we start with the patients themselves the first thing is is recognizing the symptoms of the condition. It's commonly said that snoring is the same as sleep apnea. It's actually not sleep apnea is when people stop breathing intermittently while they're sleeping which is not quite the same thing as snoring. However the two are often hand in hand. So if you're a heavy snore there is a good chance that you've also got some of the same risk factors for sleep apnea as well. Daytime sleepiness is another big predictor for that. And then also you look at your body mass index you look at your age you look at your neck circumference if it's over 17 inches in color. There's a good chance that you might be at risk for that as well. And they look at other code morbidity as well too so if you've got diabetes if you've got heart problems these might be indicators that you need to look into it and get it identified. So simply awareness is a big challenge. And then one of the other barriers to treatment is the current approach towards diagnosing the condition is pretty cumbersome. So 85 percent of cases we have a health care system that requires people suspected of obstructive sleep apnea to spend one and possibly two nights overnight doing a polysomnogram. It's an expensive test. It's a supplement it's uncomfortable it's no fun and it requires people to actually wear a cpap machine during the test as well as electrode leads and other types of things that make a really miserable and uncomfortable. So people don't want to go through that. They say well maybe I have this condition I'll learn to live with it. So that's a big barrier is there we're not at home. There is. So there is a home sleep testing technology. It doesn't Major all of the same parameters as a in clinic poly somno sonogram and we are in an interesting point in the sleep industry where clinicians payers are debating about whether in clinic test is absolutely necessary for everybody suspected of sleep. Can we test somebody at home is that good enough to begin treatments. I'm of the opinion that it's for many people and that we ought to be much more aggressive about using home sleep testing and auto pap technologies to get more people on treatment sooner and easier.

Saul Marquez: [00:09:26] Yeah for sure. That's good to know that there's already something there and maybe just somehow getting a broader interest in getting some of those tests to people at home because to your point if this is one of the burdens that you've got to be at the hospital tonight it's cumbersome. Why not just get that done at home so that you could start avoiding some of the issues that come with it.

Charlie Whelan: [00:09:50] So that's one of the big barriers. And then once people have a diagnosis in most cases almost like 95 percent of the cases treatment is going to be a positive airway pressure mask a chapter where basically for the rest of your life. And that's no fun. Nobody enjoys that idea. So there are a significant number of companies trying to make positive airway pressure either more comfortable tolerable or finding just Turnitin you know one of them is those all appliances that I mention which are under utilized in this country compared to other countries which use them much more. There's a lot of interest in implantable neuro stimulators which could take the place of Pappe for some patients. Similarly those with central sleep apnoea. But there's just a lot of interest and recognition that more than half of people diagnosed with Osa either start Papen fallot and don't stick with it after three months or they never begin it in the first place. They get the bag gnosis doctor says hey use this pap stuff. They're like no way. I'll just live with the consequences because it is such a difficult therapy to to maintain. I will say that our research shows pretty equivocally that those patients who do stick with positive airway pressure are extremely happy with it and have recognized some significant health benefits and many many areas but they're kind of the minority. And so the challenge is how do we get more people to tolerate this whatever therapy they choose to stick with. People need to start getting treated.

Saul Marquez: [00:11:22] Charlie I oftentimes think of you know just compliance to routine and just being able to add here adopt a clinical protocol. It really comes down to leverage and if the leverage for the patient is strong enough they're going to follow through. I mean is this life or death or is it something with just smaller consequences that add up over time. Like can you go into some some of that and tell.

Charlie Whelan: [00:11:48] Yeah absolutely. So for many patients it can be life or death. So we know for a fact we have very strong clinical data that we reviewed that shows people who have untreated obstructive sleep apnea can have a much higher risk of mortality associated with cardiovascular disease diabetes. We asked. No this is not scientific but we asked those patients that we surveyed did they have some of those other health conditions and it was a very strong Kohm were Beddie correlations. So I was about half of these patients were diabetic and had hypertension and cardiovascular disease and they reported that their reception of HBO when sea levels in the case of diabetics sir or blood pressure for hypertensive all improved once they got the sleep apnea under control. So the other thing that this therapy has going for it is that people can see the benefits of self aware of it in quality of life. On day one. So if you can learn to live with the mask you can see the benefits starting on the next day and you can't say the same thing for many other medical therapies. Right. You can't say that if you're on a blood pressure pill that you feel better the next day after your first blood pressure pill you just take it because you're told to. This is a case where you can actually see the benefits very very quickly and then it's just learning to adapt and live with that work it into your lifestyle.

Saul Marquez: [00:13:20] Let's think society let's think a broader US. Can you tell us a little bit about the economic burden of undiagnosed and untreated OSA.

Charlie Whelan: [00:13:30] Sure. So our research suggests that the costs associated with Osa are about 162 billion dollars a year. Only about 12 billion dollars is actually going towards diagnosing and treating people with the condition. About a hundred and fifty billion dollars is associated with not treating that condition. So it's a significant impact. Yeah a little more than half of that. By our estimation is associated with lost productivity. So this could be one of two things it could be lower productivity at work or higher absenteeism. So what we did in our calculations is we actually found among the people that were employed that they actually once they got their sleep apnea under control that they gained they reported to us that they gained one point two hours of productivity every day at work. And so when you extrapolate that out across the tens of millions of Americans with undiagnosed untreated sleep apnea at one point two hours of productivity every day if they were actually being treated. The numbers are huge in terms of how they add up. Yes. The other thing that we've found is that people who get their sleep apnea under control had 40 percent fewer work related absences and you add that up is what all the benefits are significant. So productivity improvement was a big one. That's a little bit of a soft cost. We've also looked at motor vehicle accidents which accounted for about 26 billion dollars of commercial and non-commercial accidents workplace accidents at about six billion dollars. And then about 30 billion dollars associated with some of the significant cold morbidity associated with the condition like hypertension heart disease diabetes asthma insomnia and mental health conditions like depression anxiety and mental health. We calculated that we could see significant savings associated with caring for those conditions if we actually were more aggressive about addressing sleep apnea as well.

Saul Marquez: [00:15:41] That is really interesting. I never even thought that this was such a big problem and when you think about it from a productivity standpoint it makes a lot of sense. I just know when I get a good amount of sleep I know that the next day it's going to be way more productive and just thinking about those decisions that I make to get to bed earlier. But then folks with Osa they have to think about breathing better and sleeping better because of it and it makes sense. Charlie how about the different players in the market and sort of how this means economic impact to payers to employers to patients.

Charlie Whelan: [00:16:15] Yeah so we think getting this under control is going to be a net benefit for everybody. Obviously patients are good a benefit from a health perspective they get a benefit from an economic perspective too because they're going to be able to get more done have more energy take more opportunities to grow themselves. Employers obviously will see a huge benefit from improved productivity gains fewer accidents as well and less will be called Cyber loafing where people are not really getting anything done they're just sort of goofing off at work payers. We expect we'll see a benefit as well. And that's that's an area where there have been some resistance to covering more people with sleep apnea for that condition. So for example one of the things that's happened over the last five or 10 years is that payers have required that clinicians demonstrate that patients are compliant for about three months on their pap machines before the payers are willing to pay for those pap machines. And while that is it is a challenging task to meet. I think it does make sense. The payers want to make sure that people are going to use this and the most progressive payers out there to recognize that this is a big challenge but they're frustrated with the lower compliance as well. They want to see that proved. So I think things need to be done in terms of the delivery of care and the management of expectations for these patients to make sure that they're screened earlier or diagnosed early or they're more aggressively treated and that we are using a treatment approach that they can live with stick with so that everybody can win. I mean this is really a win win opportunity for everyone in my opinion.

Saul Marquez: [00:17:55] For sure. You know it's so interesting Charlie when when you think of health and the implications of behavior on health it's hard. I mean when you're really wanting to manage people's behaviors and what they do that's tough. I wonder what can be done from an environmental perspective either in the home educational videos that kind of thing to help sort of nudge people toward that.

Charlie Whelan: [00:18:22] I think that probably has the biggest impact simply on screening and increasing awareness. So letting people know that their sleep is important that if they have symptoms that they don't just learn to live with it which is the common thing that we all do. I mean we've all been sleepy we've all wished that we had more sleep but it's hard to know when that is a serious problem when it is when it's just a typical day when you did get a good night's rest. So it is a little bit subjective. And I think patients could benefit from getting some more guidance on when they should be worried. And a lot of that has to do with looking at pretty well established risk factors associated with weight and age and other Kohm morbidity. And then maybe not relying so much on just subjectivity but there are pretty well established sleepiness scales and sleepiness tools that can be used in other kinds of risk assessments. I think that's good. And in terms of getting improve compliance with actual treatments itself I think that that really has to come down to setting expectations getting better technologies and treatments out there for them to use. One thing I remind people is that sleep medicine as a discipline as a field is relatively young. It's only maybe 40 50 years old opinion on who you ask. Even positive airway pressure as a treatment is relatively young. It's a couple of decades old. So we're still in the process we're actually still exploring what the best treatments are and creating new approaches that can better serve individuals.

Saul Marquez: [00:19:57] And this is super insightful and so listeners. There is way more than we've covered here. We've come here to the end. But Charlie actually wants to share these two white papers with you. And so these white papers will be available at SLEEP and so Charlie I'd love if you could just share some closing thoughts and the best place that the listeners could follow what you're doing and what your partners are associated with this project are doing right.

Charlie Whelan: [00:20:30] So I would say stay tuned. There is a lot of activity both in terms of investment and professional activity and the sleep medicine space. Just this week a consumer electronics show there of course is always a big splash around New Sleep technologies. It's going to be an important year for a number of major breakthroughs. I was reading just yesterday about a new sleep technology company that raised 50 million dollars in investment for their new technology. So it's a really hot field of investment and innovation. It's also an important area for research as well an investment. I like to tell people I think sleep is kind of like today where nutrition was 20 30 years ago. Back then we didn't take what we eat as seriously as we do today we didn't see the connections between what we ate and all of our other health outcomes. And I think we're at the cusp where we're starting to appreciate sleep in the same way and taking it much more seriously than we have in the past so it's an exciting field to be in.

Saul Marquez: [00:21:32] Charlie this has been insightful again. Listeners go to and you'll be able to find those articles as well as more links that Charlie is going to share with you to dive into OSA further and what you can do to help yourself help those around you diagnose and also take care of it. So Charlie just want to say thank you once again for sharing your knowledge and looking for staying in touch.

Charlie Whelan: [00:21:58] Thanks, Saul.

: [00:22:02] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

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Outcomes Rocket - Jacon Levenson

A Curious Way to Improve Outcomes in Substance Use Disorder Space with Jacob Levenson, CEO at MAP Health Management

: [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 health care leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:18] Welcome back to the outcome rcoket podcast where we chat today's most successful and inspiring healthcare leaders really wish that you could visit us at where you could rate and review today's episode. We have an amazing guest. His name is Jacob Levenson. He's the CEO at map health management. Jacob's extensive career is focused on being very dialed into the healthcare center. He's been Member of Board of Directors Levinson Foundation a privately funded philanthropic organization. It's a really develop managed fund diverse portfolio ad humanitarian activities around the world. He's a member at Trei private capital. He's just done so many things in the realm of just contributing to this humanitarian capacity that his sit in health care makes so much sense. And you guys all hear the passion in his voice when we dive deeper. What I want to do is open up the microphone to Jacob so he could fill in any of the gaps in the introduction. Jacob welcome to the podcast.

Jacob Levenson: [00:01:21] Thanks for having me. Excited to be on with you. No. Good job introduction. I think to add looking forward to the next 45 minutes or so of hitting some of these topics.

Saul Marquez: [00:01:32] Absolutely and so Jacob why did you decide to get in the medical sector. You could have done so many things but you decided to land here. Why.

Jacob Levenson: [00:01:40] Ask myself that often. It's like a Greek tragedy where the more you run from it. The more you run into it. So I grew up around a lot of active substance use disorder in my house. Know child of the late 80s 90s kind of grew up and had seen that kind of stuff and watched family members struggle. And the last thing I ever wanted to do was align my professional career with anything that had to do with addiction or substance use disorder. So of course that's exactly what happened. So it was it by choice it was by you know I don't know some sort of gravitational pull. Maybe backtrack to what I knew so it's no I don't think it's any secret that you grow up around substance use disorder and in someone like me ends up involved in writing algorithm to detect ACTA's substance use. I mean I've been doing since I was 2 now right. So I don't know if there's a coherent explanation but I was born into the addiction world in that sense.

Saul Marquez: [00:02:39] Yeah it was woven into your fiber as a as a kid. And it's sort of like something you've been doing so why not continue to do it.

Jacob Levenson: [00:02:47] There's a lot of work that needs to be done in this space out there and I felt like that we had an opportunity to make some change and that we need to put our best foot forward to do something. So yeah it's exciting time and really pivotal kind of a critical juncture in history. We're watching so many things transformed that are going to drive this for the next generation to generation. So we're going to have a front seat of some of the real exciting.

Saul Marquez: [00:03:12] Yeah that's super exciting. And so for the listeners maybe you could dive in a little bit on what some of the work that you guys do and how it's relevant to the space.

Jacob Levenson: [00:03:20] Sure. So try to keep it simple. We focus predominately on individuals who have a substance use disorder diagnosis what we call addiction just to kind of put that some staggering in terms. Twenty two and a half 23 million Americans fit the criteria for substance use disorder which is.

Saul Marquez: [00:03:36] That's a big number. I don't know was that high.

Jacob Levenson: [00:03:38] That high. And this is a bigger number. It's mindblowing. The national economic impact of substance abuse a little bit different than substance use disorder but substance abuse is about 740 billion dollars annually. Wow. So that's almost in line with our national defense budget. But that's things like work lost productivity that's every dollar that is expended if you will as a result of substance abuse sweeping up glass entered you IREX everything. So Trump couple of weeks ago declared this a public health emergency a public emergency. Yes we do have a public health crisis. Opioid crisis which is grabbing headlines. Yes. But it's by far not the number one cost driver nor is it the number one kind of killer in the world if you will. Outwell well set tobacco aside of alcohol by far it kills more people and OPU it still to this day now it just doesn't do it in a headline grabbing way like a Finnell overdose does. But to jump your question quickly we manage people who have a substance use disorder diagnosis using tears. I mean people who are in successful recovery. But what we do that's really interesting we tech enable them and the data enable them. So we put a lot of tech and other tools at their fingertips that help them identify people who are struggling make better decisions and helping them. Ultimately the whole game here is to improve outcomes for people with substance use disorder and chip away at 740 billion dollars that we're hemorrhaging as a nation.

Saul Marquez: [00:05:05] Yeah that's pretty sweet definitely worthwhile work. You're named one of Beckers 112 entrepreneurs to know you're obviously making a splash in this space. What do you think is going to be the key to make sure that this issue the substance use disorder gets addressed in a way that needs to be in order to reduce the cost then the Kerger.

Jacob Levenson: [00:05:28] Well here's the bad news is this opioid crisis is not going to end anytime soon. This is so interwoven into our care delivery system just from the opioid prescribing techniques that aren't changing anytime soon. Culturally as a nation I think whilst I will speak for you all speak for me. When I was a 17 18 19 20 there's a rite of passage that happens in the American psyche of we are entitled to go out and party and a lot of that entails substance use the chemicals aren't going away. OK. So what are we going to do about it. I think is the response now. Ultimately I think that we have to bring data to bear so that we can make more informed decisions where in the absence of data myths flourishes. Right. Right. You think back like a map in Europe from the 13th hundreds and you go and you look out on the edges and there's dragons and the world is flat. Well they didn't know what was out there. So we use the imagination while they put dragons in the earth just flat right. Flourishes right. So we have very little data that drives the delivery of treatment services in the country and it doesn't have to be that way. So we can improve that ultimately just to get far out there. I do believe that the end solution lies in genomics which predict. I think we have a brain disease here that one day I would like to believe there's a genomic solution but we're nowhere even in the stratosphere of that yet.

Saul Marquez: [00:06:54] Interesting. That's an interesting hook.

Jacob Levenson: [00:06:56] Either it's physiological and it has it's a brain disease or it's not. If it is and we talk about addiction being genetic and having features that point to people having a genetic propensity for addiction those kinds of things I've seen in my own family.

Saul Marquez: [00:07:11] Yeah.

Jacob Levenson: [00:07:12] And I don't think that's totally the way it this but it does seem to have a physical and structural feature to it around how the brain structure if that's true what role does Epigenetics Genomics have down the road and really from a therapeutics.

Saul Marquez: [00:07:28] That Super. Super fascinating. You obviously spend a good amount of time thinking about this and working in the field. So really excited to dive into maybe some examples. Can you share a story with the listeners about how you guys have applied this and gotten some improved outcomes.

Jacob Levenson: [00:07:46] Yeah I'll just go with the first reaction. There is maybe not the most important one but one that comes to mind. Historically we have followed spouses of different metrics around people in early recovery people not in recovery at all who are totally just using or trying to understand their uses and why. Who gets well and why. Who doesn't get well. And if you're going to understand all that this cause and effect relationship when can you go in and take interceding action to improve people's outcomes. So I'm just winging it here and it goes off of my head.

Saul Marquez: [00:08:21] That's fine.

Jacob Levenson: [00:08:22] Anything I'm late revert to but anecdotally here is one that I always thought was critical that stood out in the emerging adult population I'll go and add on the young professional that matters to. So basically the 35 18 to 35 in that range there is about a 90 day window when they get out of an acute care setting like intensive outpatient or above like basically they've gone away to treatment somewhere. It's about a 90 day window for them to get back in school or find employment or return to their job if they don't do one of the three. It is such a leading indicator that someone is going to experience recidivism or go back to a higher level of care have a colossal relapse. Right. And so what we've been able to do with that kind of information. Basically here's what it says. If you do not have a job if you're not back in school or you've not found a new job in 90 days your likelihood of a successful outcome is very low. So that said what does that mean in the acute care side. That data goes back it informs that acute care environment and it says you better have some serious job training going on.

Saul Marquez: [00:09:24] Yeah.

Jacob Levenson: [00:09:25] You have some serious some programming to that end. So that's my reaction. I mean we could pull 100 these off the shelf now.

Saul Marquez: [00:09:32] It's good. It's good. It. And think that one falls directly on the social determinants of health. Would you agree.

Jacob Levenson: [00:09:39] Agree. I don't think we have a client which our clients are primarily healthcare plans by the way who is not caught up in social determinants of health. We need those to be more proactive and are prospective sorry in nature but it's good to see any form of standardization happening in the behavioral health or substance use disorder space which is the most fragment saying in the world. So.

Saul Marquez: [00:10:01] Yeah I think it's a great Khala you know and a lot of times it's it's what happens outside of the hospital that actually determines somebody's outcomes. And with the substance abuse field it's interesting to note that there's nothing very different from it.

Jacob Levenson: [00:10:16] It's a chronic disease. Retreat it primarily with an acute care model. I mean imagine if we employed that model for say diabetes and we would be back in the early 90s late 80s. So we still as a country use an acute care model for chronic disease. Twenty 22 and a half million Americans fit the criteria for which it just boggles my mind that we're like in the dark ages over that chronic disease requires chronic management. OK. So that's where some of our initiatives have come in and I think the world really moving in this way saying wait a minute we can't just discharge people out the back door and not give them the tools to manage their disease keep it in remission and more effectively to get get a sustainable life you're in recovery.

Saul Marquez: [00:10:59] Yeah I think that's a really neat idea. And you know you guys have tried a lot of things. Map health management. You guys are very focused on the outcomes. You guys are very focused on the data out of all the things that you've tried. I'm sure not all of them have have worked. Jacob and so my question to you here as we look for ways to innovate and create better results. Can you share a story with the listeners of a time when you had a setback and what you learned from it.

Jacob Levenson: [00:11:27] Yeah. I would say my experience is mostly full of anecdotal stories or I can tell you what not to do. Right so there's a lot of the G's don't do this don't do that. If you go when you open the earliest kind of notebooks of map when map was an idea and started being stood up it.

Saul Marquez: [00:11:47] How long was that by the way.

Jacob Levenson: [00:11:48] 2010 2010 and then it we went live in 2011.

Saul Marquez: [00:11:53] Awesome.

Jacob Levenson: [00:11:54] I've got these notebooks. I've got them home I look at them old time and make sure that I'm not losing my way here.

Saul Marquez: [00:12:00] I love it.

Jacob Levenson: [00:12:01] Literally it's like how do we get these services covered by insurance. OK. So went out started talking to insurance companies and the response that I got was a little bit more diplomatic than this but not much more you want us to pay your drug addicts to talk to other drug addicts are you crazy. We're not going to pay for that and we didn't take that for an answer and it took many years of believing our own B.S. right. Refusing to give in to that. We've since we're in the process of getting that covered today and by the end of this year. A hundred and sixty seven million Americans will have coverage for peer services solely as a result of map efforts since 2010. Right now we just have we are wrapping up 15 16 health care arrangements where all the members under those plans will have peer services covered by insurance. And that is the one that comes to mind from going. We will never pay your dope fiends to talk to dope fiends to saying here's a contract. Years later crisis that changed everything.

Saul Marquez: [00:13:08] Oh my goodness. That right there is impressive. JACOB I CANNOT BELIEVE YOU have hung on for that long. And you are just. And now you're like you I see your face. Yeah me either. I can't believe I have. But now it worked. So how do you feel.

Jacob Levenson: [00:13:25] First of all there's work with 130 240 other people here at map who played a huge role in that. And so I'm just kind of the guy who maybe is kick the ball in play here and there but far from could I take any credit or be responsible for for that the success we've had so far I feel damn good I'll tell you why because I think that a lot of people are going to be helped by the kinds of services we're talking about bringing chronic management to the space of a chronic disease standing up an industry where peers are going to be gainfully employed and truly utilized. It's gonna help a lot of people these people we care about. These are co-workers or friends or family so that feels good because that's part of the mission. It is the mission that's so so that feels good but it's one of those say it's kind of anticlimactic when we the very first time we've got this covered by insurance. It was like my God. OK. Now it's just another day at work. I don't know.

Saul Marquez: [00:14:17] Now what do we do now.

Jacob Levenson: [00:14:18] Exactly.

Saul Marquez: [00:14:19] Now what's the big challenge. We've got to tackle.

Jacob Levenson: [00:14:21] Actually provide the service. And you know when when you've got an insurance plan saying we want to send you twenty eight thousand new members every month. You know it's like my God that's more people than we've ever had in our whole system. Right. And you want to send it every month so change management and you know how do you go from little idea on a spiral notebook paper to 28000 new individuals a month those kinds of things I like to sleep at night. So we work harder in the day and try to resolve these issues so we can all sleep.

Saul Marquez: [00:14:50] Yeah that's some really cool stuff. So Jacob I think about all of the companies trying to do things right now in health care and for a lot of them the clock is and maybe they really can't wait this long. From 2011 to 2018. Now what did you do in-between to keep the company going did you diversify start working on other things like tell me a little bit about that.

Jacob Levenson: [00:15:13] Well I wrote a lot of checks. So we were bootstrapped the entire way which was painful. Oh get out. But at the same time was gave us tremendous freedom and latitude. There's no board to answer to no answer to. So we were allowed to do all these tidbits constantly you know without having to go in to a room of white hairs and explain what we were doing and why we were doing it. So I definitely think that that was liberating and most of startups probably don't get that opportunity. We diversified in the sense that we had and continue to have a significant revenue cycle division that provides claim processing services to the behavioral health space. It's not sexy it's not it's not in those sayings. It's a darn good little business. And you know it's been helpful along the way.

Saul Marquez: [00:15:59] That's awesome. That's awesome say. And you basically were able to do it without any funding. And then on the side you had a little engine running that produced income that helped you guys continue with your mission.

Jacob Levenson: [00:16:10] Anecdotally I think that little division grew into by volume the third biggest rev cycle in the space in the issued space which is that reffed cycles a small kind of vertical of Eshuys kind of a smaller vertical if you compare that to to oncology or cardiology or even on the map. But yeah and relevant to the space. Yeah. Yeah we grew that look it's sport and stuff. I mean we were out there advocating for patients to get coverage for where the services are receiving. It's not just getting claims paid. It's also getting the coverage in the days of service through utilization management side that ensures that person holding that person's healthcare plans feet to the fire to pay for their care.

Saul Marquez: [00:16:51] For sure.

Jacob Levenson: [00:16:52] And that feels good.

Saul Marquez: [00:16:53] Yeah. Oh absolutely I can imagine. And Jacob was this company alive before you started. The other one or it just came as a necessity.

Jacob Levenson: [00:17:01] So I went out 2012 2013. I visited maybe 100 treatment parameters kind of across the country just trying to understand the day in the life of an addiction treatment provider and the one thing that was ubiquitous everywhere was I hate my revenue cycle provider.

Saul Marquez: [00:17:18] Really?

Jacob Levenson: [00:17:19] That was just ubiquitous and I came back and I thought oh my god I've got an opportunity here. Yeah. So let's bundle services together let's try to provide an economy's just rough cycle things right for disruption. So what we set out to do but it's maybe outcomes fewer services data can kind of get it can be an entree into this space to recycle something that people have to need and we can kind of use the services bundle and provide the little better rate so savings in it work I mean what it ultimately nothing has been as stressful for MAP as when we first started getting the buy in from the health insurance plans. That's Emmerich's checks right. Yeah it was the right thing at the right time and I don't regret doing that.

Saul Marquez: [00:17:57] Wow. Awesome. So listeners take note of this I mean Jacobs sharing some really awesome stories a couple of things that I'd like to just point out you know. Number one his tenacity in being able to knock on a hundred plus customers doors looking for answers ask the customer what they're looking for without even wanting to go this route. He found an opportunity and that's something that every awesome entrepreneur that I've met does. And so kudos to you Jacob for doing that. And secondly a friend a good friend Nick Atkins he. I love the pink socks movement guy I had up you know him or not. JACOB.

Jacob Levenson: [00:18:35] Yeah.

Saul Marquez: [00:18:35] He loved to say don't chase to change follow your mission and that's what Jacob and his team have done. They have not chased the change they've remained focused on their mission and now nine years later they're here and things are going to start moving and shaken. I imagine you're probably going to be hiring a lot of people pretty soon and to fulfill what you guys have set out to do and so just take note of that listeners and it doesn't happen overnight but if you stay consistent you stay true everything will eventually work out. And so this is so awesome Jacob that your you and your team have experienced this milestone. So congratulations.

Jacob Levenson: [00:19:15] Thank you

Saul Marquez: [00:19:15] What would you say an exciting project that you're working on today.

Jacob Levenson: [00:19:20] I think that IBM Watson partnership we have is super exciting because it's going to unlock a huge and massive data store that we have that has never been actionable and it's going to unlock this data and I think it's going to propel our ability to detect early relapse in people. It's going to propel it forward and allow us to do it much more efficiently. Here's what I mean. We're utilizing Watson unstructured data. So there's tremendous amounts of data that flows in a map's environment. It's unstructured phone calls, counselor notes, like social soaped notes things that are coming into EMRs as did just some a data standpoint just go there to die. There's no structure now so there's no way to really utilize it. Instead of a database Watson is going to come in and just do our annotation and or work with Watson. It's going to it's structuring the info and so allow us to turn that around and drive much better predictive analytics and harness this whole kind to traunch of data we've never been able to touch that when he gets excited.

Saul Marquez: [00:20:26] That is very exciting.

Jacob Levenson: [00:20:27] Yes.

Saul Marquez: [00:20:28] And just being able to do the next thing with this right.

Jacob Levenson: [00:20:32] It never ends. And no completion I still feel like it were like a slap in car. Of wills on Amilcar here because I feel like there's so far to go. But yeah I think that's the next big thing for us. Much health care plans are excited about that and I think it's going. Look it's there is no doubt that's going to make. It's like if we're playing Call of Duty the peers are leveling up about three levels with that information because what they're going to understand about the people that they're serving is going to be dramatically enhanced.

Saul Marquez: [00:21:06] Now that's super exciting and again in Jacobs style you love going after the big goals. It's not just the 10 percent you're going for 10x baby.

Jacob Levenson: [00:21:15] You know if we weren't there I don't mean to be cliche but we're not in the business right we're dealing with human lives here we've got people into this who have a terminal if left untreated disease. And so I feel like we have an obligation to swing for the fences and get this right. Maybe if you're creating like a printer or a spice for a brisket rub you can use to mark a little bit. No one dies. Right. Right. But I feel like that you know maybe it's too big of a burden for us some of us carry around but I think we personalize it that we don't get this stuff right. People die. Yeah. And I think that for me and they speak for me that drives me perhaps you me too much.

Saul Marquez: [00:21:52] Now in a big way I can see that I could see that. I think that's really awesome what you guys are up to and what the future looks like. You always have to have a compelling future as well. The Good Book also says you know without a vision people perish. And so as a leader Jacob you're setting up an outstanding vision once again for your people and leaders. If you're at the home of your organization Keep this in mind because once your team reaches that goal that they've been working so hard to what's next got to keep them inspired and so Jacob you're doing an awesome job of that. Let's pretend Jacob you and I are building a medical leadership course on what it takes to be successful. The ABC or 101 of Jacob. And so we're going to help the listeners get tuned in here to the syllabus for questions lightning round style all about improving outcomes. And then we'll followed up with a book that you recommend to them you ready. All right. What's the best way to improve health care outcomes.

Jacob Levenson: [00:22:50] To inform the front of the care delivery process the care continuum with information. The number one way to impact positive or to influence a positive outcome is early intervention. I don't care if it's cancer or heart disease or addiction. And so what we have to do is have early intervention screening techniques assessment restraint understand who's at risk for what and basically do better triage on the front end of the care continuum and not let the acuity level get such that some people can't be brought back from the brink or that cost runs out of control. That's my reaction.

: [00:23:27] Love it. What is the biggest mistake or pitfall to avoid.

Jacob Levenson: [00:23:31] Believing your own B.S. definitely that kind of which I think is very good I hear it all day every day. Don't let people tell you who you are because they might not have the right motive. I think that you've got to have some some sense of identity before you go out into the world with your products and services. Otherwise people are going to hammer them into something you don't even recognize. And that's not good. Not good for us.

Saul Marquez: [00:23:53] Were you told you were something and you just refused to accept it.

Jacob Levenson: [00:23:56] I've told we were not something and recast except it got the other way around. I've told it peers aren't capable of performing the kinds of services we're talking about. But in fact Opioid appear up against the psychiatrist any day of the week and they'll drive a better outcome for these kinds of services because it's a hey bro it's a Hey John I know where you are because I've been there too so it's a horizontal relationship. Psychiatrists verdict. And people who want who engage with a guy in a white coat who is crunching them. I'd much rather sit there and shoot a bull with someone who knows what I've been through because I've been there.

Saul Marquez: [00:24:30] That's powerful. How do you stay relevant as an organization. Despite constant change.

Jacob Levenson: [00:24:35] Here's my reaction a couple of things. Number one you better damn well be in your clients in customer strategy if you're not. You're going to be irrelevant very quickly. And so I think you have to understand. Yeah it's one of those sales and kind of business development. I think it's back to the two eyes to ears one mouth that all the best is dead folks vessels people I know don't talk that much they listen like crazy. They understand the client needs and they bring a solution to a business problem. You can't do that. You know I wouldn't want to be your beneficiary. Secondly you've got to be disruptive. Right. Go play hockey where the puck's going outwards. Ben I think there's there's always some exceptions to some of these sayings but this whole health care it's also ripe for disruption. So in a fish I mean from bumper to bumper I've never seen a more inefficient thing in my entire life. And I mean you can go pick any aspect of this saying it's all ripe for disruption. It's a wounded water buffalo at a watering hole on the savannah go eat it a.

Saul Marquez: [00:25:32] Love it. What's the one focus area. Jacob that to drive everything else in an organization.

Jacob Levenson: [00:25:39] Sounds like such a BS answer but it's true it isn't true. It's true integrity and honor. When we say it from my perspective Honore don't know about other organizations. For me it's the honor aspect is is critical. And then there's a litmus test would I want my mom my wife for my daughters receiving the service we provide. And if I wouldn't be comfortable with people I love on that level receiving it then I shouldn't be asking anyone else to either. And to me that's tied into the honor thing would be dishonorable to sell a service. I wouldn't be willing to accept my own loved one.

Saul Marquez: [00:26:12] For sure, what would you recommend to the listeners.

Jacob Levenson: [00:26:15] Oh man. I'm an avid reader. I have some really weird subjects that I read about. So it would have to kind of depend on on the topic truly. All right. This is one that you've never probably gotten a response to and I hate to say this over a million words long. The four volume set regarding the Civil War written by Shelby Foote.

Saul Marquez: [00:26:40] All right.

Jacob Levenson: [00:26:40] And it is. It took him 25 years to write it and let me tell you why.

Saul Marquez: [00:26:45] Amazing.

Jacob Levenson: [00:26:45] Every facet of human personality human triumph human tragedy every situation you could possibly imagine is examined in that four volume series through the civil war. Right. And it gives you tremendous insight. It has everyone from the most honorable people doing honorable things to the most terrible you know dastardly people of all time. And it tells you what happened as a result of their decisions and how they approach things in me. It's been one of the greatest like life lessons. Kind of books but wrapping a subject to care a lot about that which I read it a million words. I go and you know I never stop reading it's kind of like a Bible. That is one has taught me more about life probably than any other book I've ever read.

Saul Marquez: [00:27:33] Wow. That is definitely one that we've never heard. And you and you've given a very compelling reason to go check it out. So listeners checked out the syllabus where you'll find a link to this book that Jacob just recommended. All of our show notes and everything that you are looking for. Just go to or map health management so You'll be able to find that in our shownotes. Jacob. This has been a ton of fun. Just look at the clock in the mic. Oh wow. We're over. But it's worth it every minute. It has been awesome with you. I'd love if you could just share a closing thought with the listeners and then the best place where they can get a hold of you.

Jacob Levenson: [00:28:18] I think you said it did the resiliency piece to me that's number one factor in success intelligence helps network helps all of those kinds of things help. It's all worthless without the ability to dig your heels in and push forward. Resiliency wins the day. And that's that's been true in my life. Not the smartest guy in the most connected guy. Not all those things right. But you will have to shoot me to put me down. That has served me well and I think that's the number one factor for success.

Saul Marquez: [00:28:49] Love it. And what would the best place to reach out to you or follow you.

Jacob Levenson: [00:28:53] Not a Twitter guy. Don't waste too much time on social media spin We're talking working linked in. I don't even know how to tell someone to find me.

Saul Marquez: [00:29:02] Yeah. We come out of there. We could put in the shownotes. We'll put a link to your link them propa sure and then maybe your company email address to the web address. This is

: [00:29:13] This is map dot com that's our. Yeah don't ever name your company.

: [00:29:17] When are the like 20 most common words English language you'll never. First of all it's you'll spend a huge amount of money on copyright and trademark attorneys. Secondly you'll never get to a domain name you want. So map ends up. This is map so we got that.

Saul Marquez: [00:29:35] I love it man. I love I love what a straight shooter you are and literally the gold that you just ordered to our listeners I know that they're taking notes. Don't worry listeners you could listen to this again. That's the beauty of the podcast. So don't be shy. Do that and Jacob just want to say a big thank you to you. Keep doing what you're doing. You're doing some amazing things healthcare.

Jacob Levenson: [00:29:59] Thank you sir. Appreciate the opportunity to come on your show and share some thoughts. Very much.

: [00:30:07] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Civil War Volumes 1-3 Box Set

The Best Way To Contact Jacob:

Linkedin - Jacob Levenson

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Episode Sponsors:

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Outcomes Rocket - Baligh Yehia

Tips on Leading Complex Change in Health Systems with Dr. Baligh Yehia, Senior Medical Director at Johns Hopkins Medicine

: [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] Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring healthcare leaders really want to thank you for tuning in again and I invite you to go to where you could leave the rating and review and what you thought about today's podcast. Because we have an outstanding guest for you today. His name is Baligh Yehia. That is Dr. Baligh Yehia. He is currently at the Hopkins Medical Center and he's a senior medical director there where he leads transformation initiatives to ensure the seamless coordination of patient care to improve outcomes experiences and reduce costs. He is a systems level thinker. High level regional national level really focused on making sure that systems can work together as a network so that they could collaborate more instead of coordinating. And he also has experience as deputy undersecretary of Health U.S. Department of Veteran Affairs. He's got a really interesting diverse experience in healthcare. And so what I wanted to do is open up the microphone to Bali so he could round out that introduction. Bali welcome to the podcast my friend.

Baligh Yehia: [00:01:32] Thanks Saul, a pleasure to be here today. Thanks for having me.

Saul Marquez: [00:01:35] Absolutely it's a pleasure to have you here too and so I wanted to ask you what is it that got you into this business to begin with.

Baligh Yehia: [00:01:42] Well I'd probably like many other clinicians who really entered medicine. It's more of a calling as a profession than a job and so that's really where her mind started is how can I make an impact on the lives of people in that kind of slowly evolved into not just individual people but to communities and populations and the work that I do now is really focused at that level of how can we improve the health experiences wellbeing of our communities across the country.

Saul Marquez: [00:02:09] That's really interesting. You know you've taken that leap sort of you've got the frontline experience but now you're wanting to do it in a more impactful way and for the listeners that are also wearing this hat like Baligh you're looking to make an impact at the community at the regional and national level. Today's discussion is going to be just that. So hold onto your seats don't answer any phone calls. This is about to get good so badly. One of the things that am curious about thinking at the level that you are what do you think should be on leaders minds today as it relates to organisational issues.

Baligh Yehia: [00:02:42] Well I think many leaders know that healthcare is rapidly rapidly changing and the way that we deliver healthcare is also changing. Our population is getting older. There's multiple locations and sites of care where patients can interact with different healthcare providers. Some within your system sent outside of your system. There's growing types of new care models whether they're accountable care organizations or clinical integrated networks. So there's all this change that's occurring and really we still continue to be to continue to be tasked to figure out how do we create value for our patients. How do we make sure they're healthy are happy and that we are providing healthcare at an affordable price to the nation and to systems. And so in order to do that really what's been occurring over the last number of years is we have to start to work more closely together and healthcare as we know it's just as important about your genetic code as it is your zip code. Yes how do you start to work with different organisations in your communities. How do you start to work with actually other healthcare systems other providers to really manage populations and really be accountable for the total cost of care and really drive wellbeing forward. So that's really a different way of thinking. Most. Hospitals and different practices have for many years have been relatively siloed. Patients come into their system they might do a good job coordinating within their system that more and more and more their bottom line is impacted by just how healthy their population is and how well they can improve their outcomes and to do that everyone really knows that you cannot do it by yourself. You have to work with others and so really strengthening those muscles of how to work well with others is where I think Successful organisations will really tap into the future.

Saul Marquez: [00:04:34] I think that's really insightful. Dr Yalea and you know one of the things that we've had several guests discusses is this topic of population health and what is it that we're doing to properly address the communities that we serve. If you had a high level of just philosophy on that how would you describe that in the way that you guys tackle that over at Hopkins.

Baligh Yehia: [00:04:54] Well I think we need to think about understand that communities are different in every community is different and just as there is a movement across medicine in personalised medicine precision medicine really leveraging advanced technologies and targeting those therapies to the person in front of you. That same concept applies to communities and populations. How do you start to tailor interventions here models the right members of the Kerry team to those communities. It's not a one size fits all. And so really that needs to be kind of the next phase in evolution of how do we take care of our communities and our populations in our outpatient impatient and at home and in their in their neighborhoods is really becoming a little bit more precise a little bit more nuanced about how we deliver their services or think about what we can offer them.

Saul Marquez: [00:05:44] I think that's a fresh approach sort of taken from the precision health mindset applying it to the community because once you get the feel for the communities that you're serving you'll see themes and you'll see ways that you could serve them in a very precise way.

Baligh Yehia: [00:05:58] That's right. Exactly.

Saul Marquez: [00:06:00] I love that. And so as the years have gone by and you guys have implemented a lot of programs there where you're at at Hopkins. Can you think of one that sticks out as as a wow you know this worked out so well.

Baligh Yehia: [00:06:12] Well I think again it's it's really getting to know the different communities that you serve in and that that terminology has many different meaning different things to different people we might be talking about a community of elderly individuals that have certain sort of frailty indicators who may be talking about a community of patients that are younger but they have some sort of disability or they are have end stage renal disease and are on dialysis. So it doesn't necessarily have to be a specific geographic neighborhood a good Gonchar unity of like minded patients or are patients that have similar medical social and behavioral needs. And once you start to really what's called segment that population understand what are the needs of those different groups. You can then start to tailor very nuanced and precise interventions to take care of them and that's where I think is really where you are start to seeing the biggest impact where you have very focused programs interventions approaches you really need communities where they are.

Saul Marquez: [00:07:14] Yeah for sure it's more than just the geographic but also the segmented disease states said that the combination of social determinants that are all kind of part of the mix.

Baligh Yehia: [00:07:25] That's right. And a lot of folks sometimes focus on just a condition so they might think about diabetes or they might think about developing something for people with heart failure or kidney disease but that only really scratches the surface. So what we're talking about here is a layer above that which is really populations of individuals that have similar medical social and behavioral needs and they might not have exactly the same clinical conditions but they might have maybe five different clinical conditions rather than just one. And groups like once you start to create groups like that you determine that there are certain themes that are common across that group and you can tailor those specific interventions.

Saul Marquez: [00:08:08] Yes super interesting and by how do you see machine learning and artificial intelligence playing a role as part of this or not.

Baligh Yehia: [00:08:15] Well I think you have to leverage all kinds of technologies as we move forward. The era where a face to face visit is the only way to deliver care is really has gone has passed us. We need to think more about. How our patients can engage with us and how we can engage with them. And I think thinking it through ways that you can actually provide those both through individuals different layers of practitioners from nurses to doctors but then also maybe in more automated or machine AI type programs as well. So I think those are more on the forefront that are an interesting way to think about how to make sure that you can and if you're able to provide access to your patients when they need it.

Saul Marquez: [00:08:59] Now for sure and you know it just that the theme here is flexibility in your approach an open mind to collaborating and you've done a lot and you've launched a lot of programs Baligh. Can you think of a setback that you guys had at some point and the pearls that you got out of it because a lot of leaders at the forefront doing things that you're doing. You run into things that work and don't work and one of the huge values of the podcast is sharing those things that didn't work and what you learn out of them.

Baligh Yehia: [00:09:26] Sure there's a couple things that I think are lessons learned. I think when you really need to start where they shared vision and the work that we're talking about involves multiple people and those people are stakeholders are not always within your institution. And so it becomes a little increasingly harder to make sure that you understand what are all the views and what are all the expectations of the different stakeholders or partners that you have. So I think that's a very important lesson especially since academic institutions are large hospitals tend to be a staple in many of the communities they have a lot of employees. That doesn't necessarily mean that they should have the strongest voice when it comes to improving the health of populations. So that's really one of the big lessons learned is to come to the table make sure that you have the right people on the table and make sure that you well the right shared vision as he moves forward and I think as part of that you start to think about how do you develop the right governance structure. How do you develop the right then use to bring up ideas and to start to move things forward. Like I said the motion is really towards not just working together network or in a coordinated way but to really start to collaborate or cooperate together integrate different services. And that really starts to take it up to the next level how you can deliver effective therapies and specific routes. Probably the last one I'll say is is about aligning you know aligning incentives and making sure that you have both financial and financial. So those tend to be really good catalysts are tools to help groups kind of meet their goals. And so if the incentives are not aligned even though the the vision might be the same you might end up having issues across your stakeholders.

Saul Marquez: [00:11:12] And that's really insightful and oftentimes I think it's the blocking and tackling that gets lost with the shiny new initiative right.

Baligh Yehia: [00:11:19] That's right.

Saul Marquez: [00:11:19] Yeah. So as you the listeners you know you look to implement your programs. Be sure you don't forget these crucial basics that Bali just shared with you. Make sure that all the stakeholders are sitting at the same table make sure that all of the incentives are in line because the end of the day you don't want to lose all the hard work that you've done to get this program implemented. I think it's such a great message. Can you share with us Baligh a time where you experience just like ultimate success just something that you're proud of in your medical leadership career.

Baligh Yehia: [00:11:53] It always goes back to for me when you're sitting down around the table with patients and they tell you this impacted my life. I mean those are the stories that I think drive a lot of a lot of my colleagues a lot of people that are probably listening those nuggets of thank you's for what you've done or you see how lives have been transformed because of the different work that we've done. So are most meaningful by my clinical background as an HIV and I I've had more than I can count a number of really great experiences from my patients where really their lives have been changed because of some of the ways that we organize ourselves to meet them where they are to deliver care. And so I think that's probably the most gratifying and goal I think of any institution or organization that that's in the healthcare space is to really maximize those. How can you deliver those sort of experiences that are transformative on the regular and thinking about. You know this is the whole concept we have here is how do we get more personalized in our approaches so that we really are being as nuanced and tailored and meet people where they are.

Saul Marquez: [00:12:58] That's really great. Thanks for sharing Matt is pretty cool that that HIV is your focus. I did not know that. So that's a really interesting fact about you. Thanks for sharing. And we're all sitting here and it's very highly likely that you're healthy and you're listening to this podcast and you're not thinking of this from the lens of a patient. Maybe you are taking care of somebody in your life and elderly parents or grandparents. And I think what Baligh just mentioned is super important. The physician goes through a lot. The decision has a very difficult job. At the end of the day your physicians human and they like to hear thank you. So take a minute to thank your physician today or the physician that is helping your loved one because boy that is the spark that lit them to do what they did to begin with. And that is the spark that helps them keep going. When do you agree Baligh.

Baligh Yehia: [00:13:48] Oh for sure. Yeah.

Saul Marquez: [00:13:49] So like take it from Dr.. Here he's the soul. And the reason why he's doing this is because he is moved by it. And so thank your physician today. But quadruple aim today. Let's make sure to include you guys and gals into the gratitude circle now. Thanks so much for sharing that. So maybe share with us a little bit of an exciting project you're working on today.

Baligh Yehia: [00:14:11] Well you know we're at Hopkins. Most of the health care system is in the state of Maryland and it's a unique state. It's called the all payer state. It's pretty much the whole state as a demonstration under CNS and all the different payers from Medicaid to the privates actually paid the same and the hospitals are more and more responsible for what's called the total cost of care for populations. And so this experiment has been going on now for the last couple of years and we're continuing to evolve. Of all the work in that state. So it's actually very exciting because some of the principles that we've talked about and value based care population health are really playing out in that state some for good some for bad that there are definitely lessons to be learned that could be applied across the country. And so that's really exciting for me to be part of the team that's really thinking about really how can we take care of the entire population not just those that walk through our doors. How can we continue to care for the communities that surround our hospitals and really also the next number Monsen years as part of this different demonstration project is how do you start to bring in different parts of the healthcare system who practices long term care facilities. And so a lot of that is really exciting is to see how do we how do we start to line up all the different pieces of the continuum all the way from outpatient impatient long term care and we have care together to be managing populations and also be jointly accountable for that total cost of care. So a lot of that work is really now in planning in the state. And so I'm kind of excited to see how we start to execute against those goals.

Saul Marquez: [00:15:51] That's fascinating. And you guys are definitely ahead of the curve there because if the nation takes a turn for this system everybody's going to be calling you. So what are you going to do when your phone is just blowing up because.

Baligh Yehia: [00:16:05] Well you know we're number one I'm happy to take calls. I have seen though a lot of this stuff is I think a lot of viewers across the country they know this stuff is just getting the system kind of organized in a way that allows you to achieve those aims. So I think if you talk to anyone from New York to California to Alaska and Florida they're all about improving outcomes for their patients and they're all about making sure that they're delivering excellent care experiences. And I think many people understand the value proposition. So that is not a hard sell. I think it's more how you organize the system to help meet those goals. And right now all the way that the system is organized and how incentives are structured and how we're going about the work doesn't always align with those goals. So we have to continue to innovate and to change and to come up with different ways to organize ourselves and to better care for patients so that we can achieve those. And I think there was experiments in innovation across the country where there was different bits and pieces of this and hopefully we'll take the best practices and lessons learned and be able to come up with a couple key models that will help us sustain us in the future because we definitely did do something about kind of how we are delivering health care and how we're financing healthcare today.

Saul Marquez: [00:17:25] Dr. Yehia that's so on point and listeners take some notes here and listen to these thoughts in a way that you can implement them as well. But at the end of the day it's the things that you do with what you hear that make a difference. And so Dr. Yahiya you guys are definitely paving the way there at Hopkins. You too, with the things that you're doing your thought leadership. So appreciate you sharing these nuggets of wisdom.

Baligh Yehia: [00:17:48] My pleasure.

Saul Marquez: [00:17:49] Let's pretend you and I are building a leadership course on what it takes to be successful in medicine. The one on the ABC is of Dr. byly you're. So we're going to write out a syllabus here with our lightning round for questions followed by a book that you recommend to the listeners. Ready.

Baligh Yehia: [00:18:05] Sure.

Saul Marquez: [00:18:06] Awesome. What's the best way to improve healthcare outcomes.

Baligh Yehia: [00:18:09] I think the best way is to stay focused on what your patient and your communities need. We really need to understand what does health look like for them. And many of the things that we think are important are not important in our patients or communities lives. So I think that's really the most important is to think about make sure that you're measuring and you're working towards the right target. That's sometimes where clinicians think is not always what patients are our neighborhoods and communities need.

Saul Marquez: [00:18:39] Awesome. What's the biggest mistake or pitfall to avoid.

Baligh Yehia: [00:18:42] I think the biggest mistake is really the concept that you can it only takes one person or a small group of people I think health care is everywhere from transportation to availability of grocery stores and healthy foods to being able to walk safely in your neighborhood to exercise. So really we need to kind of continue to expand and keep our focus that Health in All Policies is very important and it is not just the actual delivery of medical care that's important. It's really all this combination together that creates a healthy society.

Saul Marquez: [00:19:18] How do you stay relevant as an organization. Despite constant change.

Baligh Yehia: [00:19:22] I think change is what allows people to be fresh being you be on the cutting edge and I am embrace that. And so I think continuing to experiment explore creating space for your organization to do that in a flexible manner where individuals are able to bring up ideas you're able to kind of try out different things we're in a very supportive environment and culture thing that's really important. Innovation really create happens when there is room for innovation and so organizations need to create those spaces that culture to allow that to.

Saul Marquez: [00:19:58] Great message. Last question here What is the one area of focus that should drive everything else in your organization.

Baligh Yehia: [00:20:05] I think it goes back to what I had said before in the business of healthcare which is taking care of people and communities and populations and so that needs to continue to be true north throughout.

Saul Marquez: [00:20:16] Strong what book would you recommend to the listeners.

Baligh Yehia: [00:20:18] You know there's I don't know there is one book but I think I've always been impressed with. Good to Great by Tim Collins. Yes and also kind of along the same lines of talking about change of leading change. And I think those are really there's a lot of key lessons there that could help many organizations as they go through this very different environment that we're in today and healthcare.

Saul Marquez: [00:20:42] Great recommendation and listeners don't worry about writing any of that down this syllabus as well as the show notes are available to you all under one page. Just go to That's why Y E H I A. You'll be able to find everything there. And so this has been so much fun. Time flies when you're having fun. We're here to the end Dr. Yehia and you just share one closing thought with the listeners. And then the best place where they could follow you or reach you.

Baligh Yehia: [00:21:11] Sure. I think it takes a village to continue to drive forward positive change and healthcare. And I just want to encourage folks to continue to think to innovate to talk to patients to get out there in their communities and that's really where a lot of the ideas come from the positive. Many of my colleagues including myself didn't get here by ourselves. It's through support from mentors and people that open doors. And so think about who are those individuals in your life and thank them. And how can you pass it on to others. And so I think that's very important to kind of continue to train the next generation of leaders and healthcare and folks can follow me on Twitter @byehia.

Saul Marquez: [00:21:53] Outstanding. Really great message Baligh. This has been so much fun just kind of going through the awesome things you guys have going on there. I'm excited for the listeners to take action off of what they've listened today and so just want to send you a big thank you.

Baligh Yehia: [00:22:06] Well thanks again for having me Saul it's been a pleasure.

: [00:22:12] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Good to Great: Why Some Companies Make the Leap...And Others Don't

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Outcomes Rocket - Michael Millenson

Demanding Medical Excellence with Michael Millenson, President, Health Quality Advisors LLC

: [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] Welcome back once again to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to thank you again for tuning in and I welcome you to go to where you can rate and review today's podcast because he is a friend and an outstanding contributor to Health. His name is Michael Millenson. He's the president of Health Quality Advisors. He's a adjunct professor Associate Professor of Medicine at Northwestern University Feinberg School of Medicine. The contributing editor at the G Health Care Blog a board member of the American Medical Group Foundation and he's done so many things in his career to be a contributor and health care a specialty in policy and so I'm just so privileged to have him on the podcast today. Michael I want to welcome you and also open up the mic for you to fill in any of the gaps in that intro. So happy to have you.

Michael Millenson: [00:01:16] Well I'm delighted to be here, Saul. And of course happy with the entire focus in this podcast on thought leadership. Just by way of background I began as a reporter covering health care for the Chicago Tribune and after awhile got to know too much about the difference in what happens in meeting rooms where they talk to journalists and have big meetings and in the front lines of care and decide to go out and spend my time. More towards the front lines. I wrote a book called demanding medical excellence doctors and accountability in the Information Age back in 1997 and talking about evidence based medicine informatics in great detail Patient Safety Quality and Outcomes improvement patient centered care and changing how we purchase care and really became activated. Now Mitchell Levy who's a consultant I work with startups to major corporations in the policy world I do a lot of white papers and it involves a lot of policy discussions and do some original research and try to act as a patient advocate as well. All of that is connected by trying to make the care delivery system better. So while some folks focus on insurance whether we're going to have single payer or some other god knows what variation. I focus on what happens when you get into the care system. How can you get better care.

Saul Marquez: [00:02:37] That's really interesting Michael and listeners if you haven't taken a read of Michael's book demanding medical excellence the listenership of this podcast fits the bill for who needs to read it. Any stakeholder in health care really whether you be a provider a patient industry executive. This book is for you because Michael really takes a deep dive into just questioning some of the processes the system that the system currently uses and so Michael I definitely took a read and I recommend it to all the listeners. What do you think today. Out of all the things hotting in medicine is a hot topic that should be on every medical leaders agenda today.

Michael Millenson: [00:03:17] Well I think to me one of the most pressing needs that's coming to fruition is how we're changing the relationship between the care system and patients or individuals because of changes in economics of the way people are paid. JD technology and really sort of social changes and I'm tried to put this into a conceptual framework that I call collaborative health and that is not collaborative care which is when healthcare workers all sort of collaborate together from different specialties. It's not a patient centered issue which is what happens when you have control of the patient. It's what happens when for your well-being and for sickness care the individual has a choice who they collaborate with elaborate on that for a moment.

Saul Marquez: [00:04:07] Please.

Michael Millenson: [00:04:08] That it used to be that the care system controlled everything. And now this is kind of like medicine. Martin Luther a moment when the priesthood had to open up the secrets to the masses. And what we have now is you can go online and find diagnostic information treatment information a lot of other information is just as personalized and accurate often. Not always of course as your physician at the same time normally clinical folks in public health and other areas are trying to reach out in the social determinants of health. And what you have is this entire continuum from well-being to really being sick where all sorts of folks who never were part of the healthcare system before were now part of that system and where the individual has far more information and good information independently of their doctor than they ever did before. And that's going to require a lot of adjustment to relationships and relationships are really difficult. It's not just the matter of turning on your iPhone smatter responsible for work but how we really differently how do we restructure the care delivery system to take into account all these changes.

Saul Marquez: [00:05:27] That's really really interesting and very thought provoking. You're about to say something else. I don't want to interrupt. Go ahead.

Michael Millenson: [00:05:32] And the thing is that I'm really against simplistic answers so I don't believe that the patients are going to be the CEO of their care all the time and I don't believe that on the other end that the care system is going to be completely different. So patient centered there's a continuum. And so sometimes you're the CEO of your care and sometimes you're really sick and you just need empathy and caring and somebody to take care of you no matter how much knowledge you have no matter how much expertise you have you're vulnerable you're sick you in the kingdom and the sick. But what we're having is it continually changes and it all. I'll give you an example. You could today walk into a brick and mortar doctor's office that's run by Google's parent alphabet and it's called city block. You may be able in a few months to then open up your medical record on your Apple Phone your medical record from its usual care provider. You'll get some sort of referral and maybe you'll get your diagnosis from an AI application called Isabelle which has a web based application for patients as well as a diagnostic application for doctors. You can then perhaps be Monnerie of home with some sensors in your apartment that are placed there by a division of Best Buy a retailer and maybe if you need food that can be delivered by your health plan Humana continuum with care of nontraditional actors. It is unprecedented simply unprecedented. It's being tied together by technology. It's being tied together by payment changes and it's being tied together by cultural changes that really are the greatest we've seen in health care since apartheids made his first HOUSECALL.

Saul Marquez: [00:07:30] Love it Michael. And you know ever since the first time we met you never failed to put things in a very candid perspective that forces the listener or the reader to urge people to interact with that kind of think. And so you take us through this continuum of care that includes Google and Izabel and Best Buy and Humana and you also mention that at the same time you also know that these changes are not going to happen overnight. And so what do you think organizations and health leaders need to be focused on in order to ensure that number one they don't get disrupted. And number two that they leverage these new concepts and new technologies and ways of working.

Michael Millenson: [00:08:14] So when I talk to health care leaders I find that it's very difficult for them to win vision a situation where they are not in control they can get up to the part where maybe they're partnering as equals but what they can't get kind of a mind wrapped around sometimes is that the individual can have health care and wellness relationships that are very significant but they don't include the traditional care system. So what I tell them is that to think that the old saying nothing about me without me in the way of the healthcare system telling patients we understand we're going to be patient centered. They should think of it as the patient saying to them nothing about me without me but sometimes without you.

Saul Marquez: [00:09:03] I love it.

Michael Millenson: [00:09:04] That's the key. This is not about you. This is about a broader change and one of the examples I gave in an article I wrote to the BMJ this past summer on collaborative care which was actually an editor's choice I was really quite thrilled by that nice was the example of policing right. You have community policing where they're reaching out the equivalent of hot spot and they go into the community to try to do prevention if something happens they're using digital technology to figure out where to send the police and all the rest of this and that doesn't mean that the cop on the beat the guys in the car in the neighborhood are not really important when bad things happen. Right. What was means is sometimes policing happens without you and you're being decision mediated somewhere or the continuum. Some of the time and that's what's happening in health care. Not that if you're really sick and you're in the hospital for cancer or a heart procedure you don't need the traditional care system. Be patient centered but there's a continuum and there's a change in a relationship.

Saul Marquez: [00:10:09] I think that's a good call.

Michael Millenson: [00:10:10] The advice that I would give the reason I brought up that example of nothing about me without me but sometimes about you. It's a way for healthcare leaders to think about what it changed relationship leaves out how are they going to relate to other actors. What is their relationship going to be with a best buy or with a city block or with other retailers or other entrepreneurs coming in. And also to think how they're going to have a relationship with the patient when an individual is not a patient that individual has their medical record independently of you. Importable how are you going to have a new relationship and what are the other kind of sayings that I heard once in relationship to accountable care organizations which I liked a lot. You know Medicare a CEOs on Reika a Medicare manager like an HMO. They can't have a financial penalty if you don't use their Knebworth right. So you have to be attractive to the patient and the same is greener pastures not higher fences. I like that a lot. So if you're a leader preparing for a future that's coming relatively quickly where at least part of the time you not as central to your patience as he used to be. And yet due to payment changes you need to be part of an ongoing relationship. How are you going to have greener pastures when higher fences don't work anymore and that's what I really have been talking to a lot of folks about how do you make that happen in the front lines of care as opposed to simply you know as a conceptual matter.

Saul Marquez: [00:11:57] Yeah you know it's a really great perspective Michael and with Macra and MEPs sort of being part of the legislation and I think it's a reality that volume to value is here to stay.

Michael Millenson: [00:12:09] When you look at macro one of the things that's interesting about it this year is a bipartisan piece of legislation overwhelmingly bipartisan in the legislative language not simply in the regulations in the legislative language has certain patient centered requirements for things like shit or decision maidenhair coordination things like that. So that tells you that these kinds of concepts have very strong policy support. At the same time when you go to digital health because that involves entrepreneurs and a lot of us startup capital a lot of activity of profit making entities. That too has a lot of congressional policy support. And finally when you get to Social Determinants of Health because we as a nation are not investing in the public health infrastructure the private sector is clearly going to pick up more of that load. So whether you're looking at Medicare policy whether you look here broader policy trends or whether you're looking at what's happening culturally this kind of new collaborators new ecosystem health care is starting to happen. It's just not totally visible yet but you can see the pieces moving into place now.

Saul Marquez: [00:13:27] Without a doubt. And so you've been in health for quite some time Michael and from when you started as a reporter and health to now couple of decades. What would you say some of the mistakes that you've seen happen that health leaders could learn from and not repeat today.

Michael Millenson: [00:13:43] Well Bill Gates famously said in one of his books that we tend to overestimate the speed of change in the short term and underestimate it in the long term. Witness knows that is absolutely true in healthcare. And I think the biggest challenge in healthcare for health care leaders often is distinguishing between fast moving traffic and slow moving icebergs. And you can get run over by both. But as a manager you need to know which is coming more quickly.

Saul Marquez: [00:14:12] That's so great.

Michael Millenson: [00:14:12] And still I think that there's adaptability is incredibly important without getting caught up in jargon that simply isn't true. So if in fact you got caught up with the jargon you would have thought that all employers were buying based on quality and outcomes. Twenty years ago or 15 years ago or whatever right to be everybody top well but it was just a few people doing it and it really hadn't caught on. At the same time if you ignore the iceberg you can look and say a fee for service is still overwhelmingly what's here. I don't have to worry about value based care and that would be to ignore what's happening to the federal budget and private corporation budgets for health care. I don't understand that there's this consensus about how we're going to change the payment system that crosses ideological lines that cross the government and private sector lines is simply so deep that you better take that into account. Are you going to get run over. So I think that's the real challenge is understanding when to adapt quickly and with perhaps adaptability can take a little longer.

Saul Marquez: [00:15:20] Yeah that's pretty interesting what you say up to this point Michael in in your observation of the health system as well as your experiences as a consultant and a writer what would you say one of the proudest medical leadership moments that you've experienced to date is.

Michael Millenson: [00:15:37] I would say in sort of two different capacities as a writer and author I've had individuals physicians and others come up to me at meetings where I just happen to be a speaker and tell me that reading demanding medical excellence change what they did with their career change what they did with their life made them more cognizant and active about improving quality and improving patient safety and really making that part of their life's mission. And that's both extraordinarily gratifying and extraordinarily humbling. As a consultant I worked with some physician colleagues where we put together an accountability audit for a hospital and this is perhaps 10 years ago now before information systems were sophisticated but we showed this hospitals what their quality looked like to outsiders if you really looked and what they were saying about it to themselves. And the difference in the medical staff of that hospital the medical executive committee of about 10 people or so looked at us and virtually without dissent said we didn't know. What can we do to make this better. We're not training quality improvement. That's not what they're training about in medical school. We believe that is help us make it better and to have the opportunity in a real situation to help a major hospital improve its care. It was again very gratifying and humbling.

Saul Marquez: [00:17:08] Now Michael there's no doubt you're making waves out there with your thought leadership and you know even on the podcast for instance. We always ask our guests for but they recommend in your book come up a couple times. And so no doubt you're making an impact and that's definitely something to be proud of than just super thankful that you made it on the outcomes rocket. Because we are very focused on removing silos to improve health outcomes and so the alignment could be better.

Michael Millenson: [00:17:35] That's really important to improving the silos and you know when I wrote demanding medical excellence. What shocked me was the degree to which evidence doesn't change behavior to which there are silos to which there is inertia in the health care and really almost everyone in health care gets into health care to help people. People do not say what shall I be a hospital administrator or an investment bank. That's not the choice right. And they're not getting there to make as much money as possible you know should I be a nursery a hedge fund manager. Right. That's not what is. People are making. They really care for a variety of reasons there's enormous inertia. And when I demanding medical excellence I vastly overestimated how quickly change was coming because things were so obvious it was so obvious that computerized clinical decision support could mean care better. And yet it is just now happening. It was obvious that we did change how we bought care because fee for service was not working and yet it's just happening. It was obvious that we needed to pay more attention to the patients preferences and values. And yet it's just happening. And so the inertia in the health care is often overwhelming and he really needs an earthquake often to change. And that earthquake is changing to value based payment and that earthquake is health information technology that is so pervasive that it can't be ignored. Right because it's coming from the outside. Now this is a service offering to give you your medical records then epic says no we're going to do ours. This is Apple's doing it. This is a pharmaceutical company offering to give you more information on cancer care. It's IBM Watson making an alliance with the American Cancer Society. Right. So it forces from outside healthcare that are permeating health care and causing it to change. That has a good side and a dangerous side. But it is certainly a force for change that will not be resisted and cannot persist.

Saul Marquez: [00:19:49] Totally agree. You know just thinking through that analogy that you gave us might call the slow moving glacier is no doubt underestimated. And we're starting to see a lot of those changes happening now. Tell us a little bit about an exciting project or focus that you're working on as it relates to that.

Michael Millenson: [00:20:06] I'm trying to really go out and do a lot more writing and speaking and perhaps looking at projects in the field the front lines that represent collaborative health. I was speaking to a pediatric hospital executive the other day about some of the things that they're doing where they're really letting patients not only be in charge of the care where they can and giving them information or even letting patients run clinical trials that the parents of pediatric patients. And so I think that to me what's exciting is to show that change is happening in real life not just in theory. To look at the pieces and try to put them together in a way that helps people see that a real paradigm shift is possible. And we all tend to think in an easy categories right it's all about technology or all about social determinants. It's all about a lot of different things that come together at different times. And one of the things that needs to be cherished is the fact that we as people have different needs at different times and a collaborative relationship will be flexible. I call it the yes dear principle. Sometimes you make a decision collaboratively with all the factors being weighed in great detail and you have discussions and great kind of debate over what to do. And sometimes you just say yes dear is and doesn't mean that you don't have a collaborative relationship. I mean sometimes one person makes the decision sometimes the other person makes decision sometimes you make it together. Sometimes you bring in someone from outside who knows more than you know. And so that's real life and that kind of real life is what's coming to the health care system in a lot greater volume and depth than before. And it's a little difficult. We used to controlling all information for somebody to say you know what I've got this piece of information that came from the remote sensors in my mother's living room and those came from a retailer and I got this data that comes from online I've got you don't know what's reliable and what's not and you've got to work with that. But that's the world we're coming to. And I want to say that one of the things I've talked about for adapting to this world and it is really important is the principles of shared information shared engagement and shared accountability. And I cannot overemphasize how important trust is going to be in this new world. Right. Because I'm different players. What are their obligation to the trust. And if the traditional care system or anyone for that matter the new players as well wants to be trusted. I think they need to share information openly. That means open notes. But it also means sharing with other people I want you to share with us whether it's my patients like me group or whether it's a retailer or an entrepreneur. It means sharing engagement. I want you to look at my online community. You need to do that but at the same time you need to engage with me in a much different way not simply to manipulate me into compliance but actually engage with me shared accountability can be really difficult. Who's responsible for privacy and security and communication gaps and all the rest right. Because if I'm going to paternalistic systems then daddy is responsible. The traditional care system. The patient derived from the word to suffer. You're the doctor derived from the Latin term to teach you teach. I suffer. We all know our jobs right. When you have all sorts of different people what then IBM Watson is not a doctor. What's their obligation. Medtronic is working on devices that interact directly with consumers what's their obligation when alphabet sets up a doctor's office and has all sorts of other kinds of things are not traditional what's their obligation. What about privacy. What about a lot of other things. And you know everything's going right and you have happy stories of empowerment. That's great. But this is health care. Things go wrong. People get hurt sometimes seriously. It may not be anybody's quote unquote fault but somebody is going to get blamed. And how do we deal with that. How do we set up new systems. I think if we if we work on trust if we work on openness of information openness and engagement and openness and accountability the responsibility is we at least lay the foundation for lasting change. It does not get caught up in backlash in legal actions and all sorts of other complications that can really hurt the ability of the health care system to improve care for everyone.

Saul Marquez: [00:24:51] It's a really interesting focus Michael and here definitely at the forefront of thinking through some of these things so listeners if you have any thoughts questions or just want to bounce ideas off of Michael I know he's very collaborative and at the end of the podcast we'll be including his contact information at the very least the linked in profile where he could reach out to him because definitely and an individual worth checking in with and chatting with. So Michael let's pretend you and I are building a medical leadership course and what it takes to be successful in medicine. It's the 101 or the ABC of Michael Millenson. So I got a quick syllabus that we're going to do with four lightning round questions followed by a book and a podcast that you recommend to the listener as you're ready.

Michael Millenson: [00:25:37] I'm ready.

Saul Marquez: [00:25:38] Alright. What is the best way to improve health outcomes through policy.

Michael Millenson: [00:25:44] We need to pay people in a way that takes into account measurable quality indicators particularly on patient safety but also in other dimensions and we need to have the pay to be significant enough to get folks attention the same time. You can't focus too much on the individual doctor. This needs to be in a way that is a collaborative and lets people improve systems of care. That is really difficult to do because when it comes to politics everybody wants to be a winner. Nobody wants to be a loser. If I'm losing money then the system must be broken because I know that I'm above average. So that's what makes it difficult.

Saul Marquez: [00:26:21] The Great One. What's the biggest mistake or pitfall to avoid.

Michael Millenson: [00:26:24] Under estimating the difficulty of cultural change. The people who will fight to prevent change are not evil. They honestly believe in the status quo and you cannot underestimate the power of inertia particularly when somebodies pocketbook is at stake. When I wrote demanding medical excellence I was chastened by how many changes I had thought would have happened and it hadn't happened that I'd written about when I was a journalist and ten years later. They hadn't happened. And then I do the history. Twenty years ago people said they were going to happen 30 years ago people said they didn't happen. And I came up with a way to categorize the influence of economic factors grab them by their wallets and their hearts and minds will follow.

Saul Marquez: [00:27:16] Well said my friend. Well that's it. I love it. I'm glad you went back to that one. That's a good way to summarize it. So obviously relevance is buy you create change by being able to create incentives. How do you stay relevant despite constant change.

Michael Millenson: [00:27:35] I think the way to stay relevant is to be widely read both in healthcare and elsewhere. We tend to be very focused on our own silo. We don't see how something that's happening in the FDA may be like what's happening in CNS and the V.A. and in policing in the Army in sports. All those different areas are often subject to the same cultural forces that are subject to health care. In fact my book was used in policing for evidence based policing. And so I think that's pretty cool. It was pretty cool always stay relevant is by staying intellectually curious and open two other trends that are not perhaps in your confliction.

Saul Marquez: [00:28:20] A great call out and what's one area of focus that should drive everything in your health work.

Michael Millenson: [00:28:26] May care better and safer make care measurably better and safer. Nobody is letting harm happen to patients on purpose and nobody is providing care. That is not the best possible care on purpose. And yet when there is ample medical literature on how to make care safer and we don't get around to doing it because there are other priorities when there is ample medical literature on individual procedures. Cancer and heart care a lot of other places that shouldn't be done or should be done differently. We don't follow it that hurts people and the most important thing we can do is help people in the best way we can and to stay humble about the fact that trying hard and caring deeply isn't enough. You have to use information effectively.

Saul Marquez: [00:29:19] Michael what book and what podcast would you recommend to the listeners. Obviously besides the maning medical excellence because that's a good one.

Michael Millenson: [00:29:28] One of the book's most influential me was recommended to me by Jack Lehnberg of Dartmouth who was one of the pioneers in practice variation and is called the silent world of Doctor and Patient by Jake Katz and Dr. Katz's a psychiatrist who is a refugee from Nazi Germany who is actually active as an ethicist in overseeing what happened with some of the Tuskegee trials and things like that. Who wrote this book. Doctor patient relationship in the 1980s which is absolutely wonderful. Conceptually it will challenge you and will cause you to look at the doctor patient relationship in new ways and you'll go back to it again and again.

Saul Marquez: [00:30:09] What a great recommendation. And how about a podcast. Michael. I would recommend that listeners.

Michael Millenson: [00:30:13] I listened to WAIT WAIT DON'T TELL ME which is a way to stay up on current events and laugh while doing it. One of the things that never ceases to amaze me is even though I'm a news junkie and I look at all the different newspapers the news feeds and everything. Inevitably if I'm listening to a podcast like Wait Wait Don't Tell me or watch the Late Show with Stephen Colbert or watching The Daily Show with Trevor Noah. Inevitably I find out about something. I didn't know what happened. And so what better way to stay up on the news and to laugh while doing it.

Saul Marquez: [00:30:45] I love it. You got to stay lighthearted while you're in your pursuits to drive excellence. Michael really appreciate that listeners. If you're driving or going for your jog just don't worry about jotting this down. Just go to that's M I L L E N S O N in Michael Millenson and you're going to be able to find all the show notes as well as the books and projects that Michael's working on there at your fingertips. Michael before we conclude I love if you could just share a closing thought and then the best place for the listeners could get in touch with you or follow you.

Michael Millenson: [00:31:22] Well I'm on Twitter and @mlmillenson a little innocent man. And of course on on linked in my email address is on my site. or And I think that this is one of the best times to be in health care ever other than the invention of antibiotics which of course is a medical breakthrough. And in health care delivery the advent of health insurance after World War II. This is the most transformative time ever in healthcare and it is a transformation that is making here better safer more patient centered more inclusive. So I think that all of your listeners who are in health care should cherish this as an opportunity as a career opportunity as a personal opportunity to really make a positive difference.

Saul Marquez: [00:32:15] Michael. I love it. What a great closing thought. And listeners take that as an action item for yourself. We are in one of the greatest eras in health. And take Michael's encouragement and my own to take advantage of it and make it even better with your contributions and so Michael just a big thank you from me and from all of our listeners for carving out some time in your busy schedule. Really appreciate you being on the podcast.

Michael Millenson: [00:32:41] My pleasure thank you Saul.

: [00:32:46] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

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Outcomes Rocket - George Kalogeropoulos

How to Get High Quality, Affordable Health Coverage with George Kalogeropoulos, CEO at HealthSherpa

: [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] Welcome back to the outcomes rocket podcast or we chat with today's most successful and inspiring healthcare leaders. I really want to thank you for tuning in again. Really appreciate it. And I invite you to go to where you could rate and review today's episode because we have an out standing guest. His name is George Kalogeropoulos. He is the CEO at HealthSherpa. Their mission driven company focused on helping people get high quality affordable health coverage. HealthSherpa has enrolled over one point one million Americans into health coverage and is used by major employers insurance companies and over 23000 agents and brokers. They're backed by core innovation Capitol Kapoor Capitol and Y Combinator and their leader here is just an outstanding individual and just the most one of the most analytical minds in the business. He's got several other experiences that include President of other analytic companies in the space. But he landed in health care because he saw it as a place where he could contribute big time. And so what I want to do is open up the microphone to George to fill in the gaps of the introduction and we could get started with the podcast. George welcome.

George Kalogeropoulos: [00:01:34] Saul thanks so much for having me. Really appreciate your giving HealthSherpa for the chance to sort of explain who we are and what we do to your listeners. And I think you actually really covered sort of our background pretty well in your introduction really the way that I think folks should think about us is that we build the last mile of access between the programs that the Affordable Care Act put into place by law and the actual populations communities corporations stakeholders that need to access those programs. So if you're a large corporation and you have part time employees and you want to help them sign up for affordable health coverage we build the tools and technologies of what you do that if you're an insurance agent and you want to operate in this market we build the tools to access that and get in there and actually enroll people in your clients in those policies. So really the way I think about us is that plumbing almost if you will for the Affordable Care Act that last mile that lets people actually access the benefits of the law.

Saul Marquez: [00:02:31] That's beautifully stated George and we had a discussion prior to the podcast everybody and you know we were just talking about yeah you know a lot of the things that happen in health care happened within the four walls of the hospital and so much of that neglects a large portion of the population in this country. And George and his team are very focused very mission driven to getting people the health care that they deserve. So George what you know with your diverse set of experiences what is it that got you into health care.

George Kalogeropoulos: [00:03:02] So I like to say that we didn't find health care. Health care found us. So we had built a series of entrepreneurial projects startups if you will that were focused on giving people better access to important information that they needed to make choices and decisions for themselves and for their families. So in an earlier iteration actually this company we've looked at a hospital and procedure pricing and costs and looked at ways to make that more transparent. And as we were looking at that problem we observed that the way that most people access health care at least in the United States is through some sort of health insurance whether it's a government sponsored program like Medicaid or whether it's individual health insurance employer based coverage. And so looking at that landscape we said where is there the most sort of confusion uncertainty a lack of clarity in terms of what people's options are and how to actually exercise those options. And what we found was this was right when the Affordable Care Act had first sort of taken effect in early 2014 and there were these brand new marketplaces with tremendous potential tremendous amounts of thinking and policy and detailed organization that went into structuring these these marketplaces and then a whole lot of confusion with consumers not really knowing what was available to them and how to access it. And other stakeholders those large corporations we talked about those insurance brokers as being very confused about what their options actually were. And so we said let's go in here and sort of build the missing layer of it connects on the one hand all these people who are looking to use this law. And on the other what the law actually provides for. So we were sort of looking for ways to help clarify the sort of the the access to health care question and when we were doing this you know it was right when they long shall get up and it's sort of much publicized issues that sort of came with that launch. We really focused on coming in and trying to address some of those.

Saul Marquez: [00:04:55] Very very interesting and so the opportunity sort of came to you guys by just this implementation right and you know when we think of implementation in healthcare I had a guest previously from Providence Medical Center talk about innovation is actually implementation. And so what George and his team focused on is implementing the law implementing a way for that last mile for the consumer to actually be able to access it and so fast forward to today. George from those days when you guys were just getting this started. How far has it come. What has been your experience.

George Kalogeropoulos: [00:05:31] So it's been a while I held a wild ride to say the least. I'm sure as people who've been following the evolution of the health care policy debate in this country know it's been there's been a lot of ups and downs but if you look at the sort of net outcome of that there's been also tremendous opportunity. I mean four years ago we hadn't enrolled a single person. Today we've rolled actually over one point one million. And it looks like based on the latest figures we're actually the largest private channel into the federal marketplace and the whole halakha. And that's the work that are the most 23000 age and brokers those insurance companies of corporations using us. That's sort of a concerted effort. We're definitely the pipes that they're using but there's been a ton of work behind the scenes by all the stakeholders to really take their populations their eligible employees their customers and plug them into these new sets of benefits because really I think a lot of people who have insurance through their jobs. You know a lot of your listeners perhaps don't quite understand what a monumental change the Affordable Care Act was for the individual health insurance market. So this is everyone who doesn't get insurance through their job whether they're self-employed whether they're eligible for government program or otherwise responsible for purchasing own insurance their world completely changed in 2014. And there really wasn't a clear way to help those people access their new option. So it's been a wild ride and sent a lot of that has been since moved out. There was definitely some uncertainty after the election with the new administration. But what we found is that by and large since then there's actually been a fairly positive effort by the Administration to streamline and make the programs that are in place work effectively. So what we've seen there is just this evolution. I like to say that we're we're five years into a 30 year sort of process of transforming how people access care in this country and so it's still very early and there are still a ton of uncertainty. But structurally when you think about the Affordable Care Act it is very similar in a sense to the Social Security Act in the 1930s or the Medicare in the 1960s which is that it's a fundamental redefinition of the social contract how people relate to their government. In this case the tenant that the Affordable Care Act brought into play was that people have a right to affordable healthcare and so we're going to make that possible through this law. So just like you know Social Security and Medicare when it first came out they were viewed as sort of highly politicised potentially contentious programs. You fast forward to today. It's extremely popular. Obviously there are fundamental sort of pillars of our society. Similarly we think that this concept of access to health care whether it's called the Affordable Care Act whether it's called Obamacare or whether it's called whatever variant Congress wants to pass next it's all about iterating towards a better state for patients and better access to care.

Saul Marquez: [00:08:18] George that was such so beautifully crafted the way that you just explain that and listeners talk about a succinct way of putting what it was it's rewriting the fabric of what healthcare means just like we did with the previous iterations of of our system and so George you're passionate you're well informed you're committed in this 30 year journey. What do you think leaders today need to be thinking about as it relates to access and what could they do to help move the ship toward the right direction.

George Kalogeropoulos: [00:08:50] So health care is such a complex organism and there's so much to be done across both cost access quality that there are a lot of us working I think towards the same fundamental goals which is the provision of high quality low cost health care that is accessible to everyone. But then I think people should be thinking about it particularly leaders in this space should be thinking about as I like to think that we are how to best coordinate our efforts because access and cost are fundamentally linked. So you want to think about that problem in a holistic sense and address it in a holistic sense because on the one hand you know we talk about as a very sort of that's a very abstract statement so more literal way to think about that is this if we look at the Affordable Care Act and we would sort of remove some of these provisions that give people coverage and then as an example now we've seen the individual mandate is actually no longer in effect because of the recently passed tax legislation. The people who don't get coverage and experienced medical events our health care system will still pay for their treatment right. We're still going to pay for them because they're going to go to emergency rooms and under and they're required to be treated so we'll incur the cost of that treatment but it will be paid for at Iyar rates rather than at primary care physician rates or specialist at rates that some of the most expensive care you can provide to people and that care will be baked into the cost that all of us pay either through our taxes or through our health insurance premiums or for that treatment. So I would urge the the biggest thing is to think holistically what the problems are facing. It's easy to get siloed when you're working on any one aspect of the problem. But the aggregate it's a sort of multiheaded beast but one that is very tightly linked and so when you're working on one piece it's important to think about the impact that your actions and legislation and policy decisions will have on those other pieces.

Saul Marquez: [00:10:38] That's great. Great words of wisdom. So let's keep the eye on that big picture. It's not exactly taken a look at point of care but taking a look at what is happening on a broad perspective. And so George as you and your team start to create different ways to access health care what's a setback or just thing our failure that has happened that you guys learn a lot from.

George Kalogeropoulos: [00:11:03] So I would say some of this is somewhat idiosyncratic to our business. But there was definitely there were definitely missteps around how we understood the role of regulators and government in our business. So initially coming sort of from the technology and startup world we I think underestimated the importance of working closely with federal government stakeholders and ensuring that they are you know aligned with and understand what we're doing and how it relates to their objectives. And we've gotten a lot better about that. And that's been quite the journey. So we've gone from getting angry letters from federal agencies instructing us ordering us to do things to a consultative relationship where we share sort of our objectives and understand their objectives and see where those align and then coordinate and what we do in a way that ultimately for the end consumer is very valuable impact particularly the transformation I'd say in how the private sector interacts with the Department of Health and Human Services and the Centers for Medicare and Medicaid studies. Those are the folks who actually run health care not us. It's been phenomenal to watch. Again it's gone from sort of a very prescriptive regulatory letter type approach to a consultative we are the government we make the rules. But here's what the objective is here is what the how you can help and where your business could fit into that. And it's been a very interesting transformation to be a part of for sure.

Saul Marquez: [00:12:26] Wow that's really interesting. And so now it's part of your focus probably to to make sure that you keep an open mind to them and that there's a good communication flow between your organization and those parts of the government right.

George Kalogeropoulos: [00:12:39] Absolutely and we have very structured very regular communication with the appropriate folks and what we find is you know it's interesting because it's almost like the is it the Goldilocks approach. The soup is too hot or too cold where if you don't have enough if you have too much regulation it effectively stifles private sector innovation and prevents things from being done cheaper faster better. Conversely if you have too little regulation you permit a race to the bottom which is where there are certain hacks or shortcuts or misbehaviors that can yield a lot of revenue in the absence of regulation. So the problem is that once one company starts doing those if they're not stopped everyone else has to go down that path as well or go out of business and so there's a very specific role for government particularly when we're talking about people's access to healthcare where they can step in and ensure that the right incentives exist for the private sector that there is a level playing field and that innovation is being promoted but not at the expense of the consumer always to the consumers benefit.

Saul Marquez: [00:13:42] Love that. Well 30 years from now what is a Solich like George.

George Kalogeropoulos: [00:13:48] So let's go back to our analogies a bit to sort of explore because that's a very complicated question. So in the late 50s to the early 60s before Medicare 50 percent of seniors had health insurance which means that 50 percent of seniors did not have health insurance. They had no regular structured access to health care. To put it sort of bluntly you literally had old people dying in the streets for lack of access to care. Fast forward to today. Ninety 95 percent of seniors have access to healthcare. And the difference is Medicare. Now when Medicare first passed it was actually viewed as socialism as communism in disguise and actually a young actor. I think the Amay paid a young actor named Ronald Reagan to record a 10 minute speech about the evils of socialized medicine and it was specific to this proposed Medicare legislation. And then you fast forward to the mid 80s and that young actor turned into of course the legend or President Reagan. He actually signed the biggest expansion of Medicare into law. And his present under his presidency. So that's the sort of evolution you see when a good when a solid foundation for improving as we say the social contract the access that people have to benefits through their relationship with our government it plays out. So in 30 years we could be in a number of scenarios. One is there is a strong and growing sort of tide in favor of a single payer system in the U.S.. The point you know an interesting trick question is do you know what the largest single payer system of the world is.

Saul Marquez: [00:15:18] The government.

George Kalogeropoulos: [00:15:19] Well so which country has the largest single government when you think about.

Saul Marquez: [00:15:23] That's a good question. I would say perhaps but in the U.S.

George Kalogeropoulos: [00:15:29] You're correct actually. Most people think it's Canada or the U.K. with a national health service but actually Medicare is the largest in terms of dollar spent. Medicare is the largest single payer system in the world. So the U.S. already has the largest single payer system in the world. And generally speaking it's actually fairly effective when you look at the overhead for the Medicare program. It's a small fraction of what it is for private insurance or for other programs. So when you look 30 years in the future we could depending on how where the political will rest and what solutions Congress comes to you would either see some form of single payer or some variant of what we see today which is an independent market where in which there's a lot of private sector initiative but at the same time a lot of guardrails put in place via regulatory means in order to ensure that you know the system works to the benefit of the ultimate sort of person that matters which is that consumer who's who is actually means access health care because as with health care the reason everything costs so much. But the reason why it's so important is because we're literally talking about people's access to treatment. It's treatment that improves our lives. It's treatment could potentially be lifesaving so you don't want to mess that up. So I think what we see 30 years from now is either we just throw our hands up and say Look Medicare for all is the right path. And you'll see a system in which you've got sort of a certain benefits that are provided by the government via Medicare type structure and then supplemental insurance that gives people either access to additional doctors or manage some of their copays or give them access to perhaps not covered services. That's one model and the other model is very much along lines of the Affordable Care Act currently which is more of a compromise not quite false you know not not for single payer but heavily regulated private insurance where there are a lot of controls in place. There's a small possibility of sort of the what we might call the wild west scenario which is unregulated or loosely regulated at the state level. But we've sort of seen you know the reason that health reform was a national priority from the early 90s through today was because that system wasn't working. You had way too many people falling through the cracks either because they were being excluded for their preexisting conditions or their treatment they were uninsurable or their concerns didn't cover the things they needed to cover. And again going back to our earlier statement collectively we were all still paying for those people were paying through our taxes were paying for health premiums. So I think collectively we arrive at a solution that better manages the enormous cost of health care whether it's single payer or whether it's an extension of the Affordable Care Act. I could see either scenario playing out. But like I said we're five years into a 30 year old very. The ultimate goal and I know I've been on this subject for a while but it's important the ultimate goal is that access to health care should not. When you look at the health Kadak of rollout when you look at what US and other people like us have been doing to try and get people signed up over the last three or four years it boils down to heroics and access to health care should not come down to heroics. It should be an ordinary function where we have the infrastructure in place where we provide this access to people people understand their benefits they know where to go to get them and they know what what's covered and what isn't covered and it sort of just works much in the way that say filing your taxes works for much in the way that say getting your Social Security check works. That's where we want to be not in this sort of weird world that we're in today in this transitional period where people are so much uncertainty and there's so much confusion. And at the same time and that leads to negative outcomes both for and most importantly for the patient for the consumer who does or doesn't understand their treatment options and does or doesn't pursue treatment accordingly. But then also for the taxpayer who ends up paying for those mistakes and all those mistakes occur long before somebody even sets foot in. To your point in the four walls.

Saul Marquez: [00:19:13] George, a great synopsis there friends you have now been taken to 2048 and are going to be taking the time machine back to your present day. It's so hard. Thanks for watching us through those scenarios. It's good to have big picture. And George you do a really great job of zooming in and being able to think strategically in such a way that helps you start thinking about what actions are you taking today that are going to help you build a brighter future for your organization and all the people that are accessing health care. What would you say today is an exciting project that you work in.

George Kalogeropoulos: [00:19:49] Well, where to be given where word so the current top priority is so to my earlier point about working more closely with the regulators in our space. There has been a clear and concerted effort and initiative by the Department of Health and Human Services to permit the private sector to provide basically all of the services that healthcare not gov provides. And so if you think about how you've got the IRS has the file system and you can totally file taxes online using file but everyone uses Turbo Tax or engine or Blocher credit card or some other service they're iterating towards a model like that where you have a common set of federal services which are required in order to do things like determine someone's eligibility for any subsidies or Catia reductions that the law provides. And then you have private sector entities such as ourselves building that all the rest of the infrastructure all the rest of the branches of the tree that allow us to reach everyone who needs access right. And so to my earlier example what this means is you're seeing iteration you're seeing the API being made available by the federal government so that people can plug directly into the federal data hub. You're seeing detailed sort of security programs being put into place to ensure that everyone's data is protected and accessible in a way that is reason to opt out and all of that makes it possible. It's a lot of plumbing work. It's a lot of infrastructure work but at the end of the day what it gets you is a world in which you are a part timer at any one of the sort of call it retail or food service companies that make up so much of the employment in the U.S. today. You start your job. You go to sign up on their Web site and they say OK what's your bank information so that we can pay you your hourly wages and then go sign up for health insurance and we know all of these things about you already because we employ you. So just click a couple of buttons and you'll get low or no cost health insurance because under the law that's what you're entitled. So it's that sort of plumbing that we're building today and none of it is sexy but it's all very exciting because of what it makes possible and what it means in terms of who's going to get coverage and how they can access our coverage.

Saul Marquez: [00:21:52] Yeah that's for sure and you got to have vision in order to be on a project like this. You've got to have a clear understanding of what it is that you're going to and so I offer this to the listeners that you take a little note of inspiration and an example of what George is doing here is that as a leader you've got to have clarity in your vision because if you don't then it just gets really hard to stay with it. And like George said it's a very tedious role to have to be doing this but at the end when you have the future that so clear that George does and it becomes just invigorating and so George really appreciate you sharing that with us.

George Kalogeropoulos: [00:22:31] Absolutely. My pleasure.

Saul Marquez: [00:22:32] George we're getting close to the end here. We've got the lightning round. You and I are going to build together a course on what it takes to be successful in health care access. It's the one on or the ABCs of George. I got four questions for you lightning round style and then we're going to finish with the book. You ready. Sounds good. Awesome. What's the best way to improve health care access.

George Kalogeropoulos: [00:22:55] Clear rules and regulations uniformly enforced.

Saul Marquez: [00:23:00] What's the biggest mistake or pitfall to avoid.

George Kalogeropoulos: [00:23:03] It's the converse which is confusing people or giving them conflicting views of what is and isn't currently possible or legal.

Saul Marquez: [00:23:10] How do you stay relevant as an organization. Despite constant change.

George Kalogeropoulos: [00:23:14] Stay close to your customers and ensure that you're always making every decision with them first in mind in terms of what they need.

Saul Marquez: [00:23:21] What is one area of focus that should drive everything else in healthcare.

George Kalogeropoulos: [00:23:25] It's the same the same answer the previous question for you. It's the patient it's the consumer it's what's right for the customer and what gets them the access to the care that they need right. Everything is has to be determined by that. Otherwise you're you're in the wrong business if you're doing health care and not pursuing that yet.

Saul Marquez: [00:23:41] What's the book that you recommend to listeners George.

George Kalogeropoulos: [00:23:44] So this is a little esoteric but I believe John McDonnell who wrote a book called health care reform. He was one of Senator Kennedy's aides who helped draft the Affordable Care Act and in it he goes through all of the deliberations and all of the stakeholder conversations that resulted in the law that we see today. And when you understand quote unquote how the sausage is made a lot of the things that are in the law and how they work make a lot more sense.

Saul Marquez: [00:24:10] Love it. What a great recommendation. And so Outcomes Rocket listeners you can find all of this information including links to the book, George's company. All of the show notes if you go to G E O R G E. Now George this has been so much fun. What I'd like to do is just have you share your closing thoughts with the listeners and then the best place where they could get in touch with you or follow you.

George Kalogeropoulos: [00:24:37] Well just mostly wanted to thank all of listeners for taking a little trip down the sort of minutiae of healthcare access and say that the important thing to remember when you look at the complex and ever evolving landscape of healthcare and health care reform is to think about to solve the earlier point what the outcome that we actually want is where we want to be as a country in terms of how we offer people care and how we pay for it and then think about all the steps that need to happen between now and then and focus on delivering those and those outcomes that's what's worked for us and that's how we operate. And I would invite you to your listeners to also think about how that applies to your own efforts whether it's how you access health care or how you interact with your elected representatives and so on and so forth. So the best way to follow what we're up to is to just follow her Twitter handle its health Sherpa's that's @healthsherpas us and that's where we regularly post updates on what we're working on as well as you conduct direct messages and get in touch with us that way.

Saul Marquez: [00:25:40] Outstanding George hey this has been a pleasure. Thank you so much for your time and your insights. I know that they're going to resonate big time. So looking forward to catching up with you again and seeing how you guys unravel what's next.

: [00:25:56] Thanks for listening to the outcomes Rockett podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

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Outcomes Rocket - George Kalogeropoulos

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Outcomes Rocket - Lucia Savage

How to Lose Weight and Reduce Chronic Disease With This Digital Behavior Change Platform with Lucia Savage, Chief Privacy & Regulatory Officer, Omada Health

: [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] Welcome back once again to be outcomes rocket where we reach out with today's most successful and inspiring healthcare leaders. I invite you to go to where you could leave rating in review for today's podcast. She is an amazing individual and an outstanding leader in healthcare. Her name is Lucia Savage. She's the chief privacy and regulatory officer at Omada Health where they're using data for health science and innovation. They're doing some pretty amazing things but the beautiful thing about Lucia is that she has just a rich history of Healthcare Leadership where she spent some time as chief privacy officer at the office of the national coordinator for health I.T.. She was a senior associate general counsel at United Health Care. And she's done all the things in different areas of health care that really give her a unique perspective across the payer mindset across different stakeholders and include government as well as private business. And so it's super exciting to have you on the podcast today. Lucia just want to open up the mic welcome you and help you in any of the gaps of that intro.

Lucia Savage: [00:01:27] Thanks so much, Saul. I'm really happy to be here today and the only other thing I would say is that as we go to this you might find some interesting and fun facts about me and I think that the I.T. expert community the health expert community in the U.S. has got some pretty fascinating back stories and if you meet people in real life you should always ask them questions about their backstory.

Saul Marquez: [00:01:48] Nice I like that that's a good tip and so maybe why don't you tell us a little bit about your backstory.

Lucia Savage: [00:01:54] I guess I'll say two things. I mean I have a real passion for what I do because I've been able to kind of see it in action in my own family. I'm of a generation where I take care of kids and elders and I could just figure out wave a magic wand and make it easier for all the caregivers to get the information they need to advocate for their people every day. That's what I would start with. And it ranges from You know people are profoundly ill family members to people who just want to get an immunization record for a camp form.

Saul Marquez: [00:02:23] Yeah definitely a big topic in health care and what gets you into health care to begin with. Lucia.

Lucia Savage: [00:02:28] Well I actually was working as an attorney at the time the hippo was enacted so been doing this for a pretty long time and I was in the compliance office at Stanford University and I had a portfolio that was a mix of defined benefits and deferred comp and health care. And it was the 90s and people were trying to fix healthcare then and it was very attractive to me this mix of economics and psychology and public policy and law. And I really start off first hand through that role. A lot of the things that I thought were not working very well. Danforth was a great place to be exposed to all of that. That was in Alan Tobins. That was you know Hillary care. Alan M. Tobin if you remember back then. Oh yeah. And it just seemed like such an interesting area to work in. And I know I have colleagues who still do the deferred comp and that's what makes them excited about work in the morning but I was very attracted to the opportunities to make some real change in health care.

Saul Marquez: [00:03:26] Yeah. And obviously you've had some major staying power. You've stuck through many years. What would your synopsis be of the last 15 20 years how we've come since then the improvements and then maybe the opportunity to still ahead.

Lucia Savage: [00:03:41] Sure. Well if you remember Hippo was enacted to four billing to Medicare in a digital format sort of to take advantage of the coding systems and if you've never had Dr. hippo on your podcast he would be somebody to dig up. But I think that we've really managed to bring that process to fruition because we've digitized so much more data in the health system and created these really great channels for both putting information where it needs to be and also how to analyze it taking advantage of advances in computing and we can have a lot of discussion about has interoperability gone far enough and many things in that space but where we've come from 1997 to the present is really amazing. On the other hand we have not really created information that empowers the consumer. And given the consumer a the power to use the information that's out there. So I've been watching today's trades about transparency and pricing information and we've made huge strides but it's still not at a place where it's easily usable by individuals who are now more financially responsible than ever for their own healthcare. I think transparency. We've got a ways to go.

Saul Marquez: [00:04:53] And a really great summary there. So thank you for that. Lucia what would you say if if you had to do a kit that included maybe three or four streams of data that would be useful for patients. What would you summarize those three or four things.

Lucia Savage: [00:05:07] Well it's a hard question because for people who are caring for a profoundly ill individuals the data is complicated and voluminous and eat a lot more of it. So I think it really depends where it's your average consumer who's healthy you maybe just want what you need to manage your life and you really have to think from a policy perspective which pap are you pursuing. So for me I think the game changer would be making it easier for whichever individuals want to get their own data to do so to cause a little bit better balance between supply and demand. The supply is out there but the demand isn't. So we need to figure out how to enable consumers or empower consumers to really make demands for their information and not be overwhelmed by the complexity of the health care system. If we're going to empower them that I would pick the path that gave the most consumer the increased consumer demand the most.

Saul Marquez: [00:06:03] Got it. Yeah and it's more of an opportunity for those that actually want to take advantage of it to actually have access to it and then maybe from there it's a domino effect that's created through just those that know can now teach and then exactly. OK very cool.

Lucia Savage: [00:06:19] If I could just add one more thing. I just think that we're kind of on the cusp of a generational change. So I think that millennials as they become parents or become caregivers of the elders and you know the tail end of the baby boom we really have a different kind of perspective we have different levels of patience and we have less willingness to how this system operates for us. We want to be the operators of our health care. And I think that's going to be a big game changer I used to say when I went see that at the end of the day my kids who are in their early 20s when they have children they are not going to wait 20 minutes on a phone to make an appointment.

Saul Marquez: [00:06:59] Give me the app may have a few that beginning to calm.

Lucia Savage: [00:07:05] So you also have you know most of the people running the health care system are not of that generation and maybe they've acquired their technical expertise sort of after the fact as opposed to growing up digital natives. I think of the digital native become leaders more in healthcare management. You'll see things start to change.

Saul Marquez: [00:07:22] That's super interesting. I definitely see it happening already and I think it's duffing going to be powerful so I think that's a really really interesting observation that you shared all the conversations that we have on the outcomes rocket Lucia. There's leaders like you that think about these things every single day. And if it's one little tidbit that you share that resonates with the listener. And then our mission has been fulfilled here and so on that topic. What do you think leaders today should be thinking about health care leaders. What should they be thinking about.

Lucia Savage: [00:07:51] Well I think they should be thinking about this generational difference and they should be paying attention to the way the Gen X and the millennials and whoever the people are who are teenagers now communicate and they should be becoming fast feel and comfortable with those forms of communication. And of course in healthcare we have complicated security issues and I know everyone today is thinking about their Intel chips but good health care depends on good communication between the providers and the people who are ill or their caregivers. And so we've got to be communicating in the way people actually communicate.

Saul Marquez: [00:08:24] And I think it's really really interesting that now Lucia you know you sort of you practice what you preach. You know right now you're making a move you're going to be in the West Coast where these shifts are are happening. I had a guest on the podcast not too long ago Jonathan Kaplan. He's a plastic surgeon and he's snap chatting about his surgeries. And this was never done before. And he's on the on the edge there but he's doing it and he's he's resonating with the people that are coming up with these millennials.

Lucia Savage: [00:08:52] Well you know as a hipper expert I have these personal experiences all the time and right as I left and I had an opportunity to kind of field test for myself how easy it was for me to get my data out of the healthcare system and I had a dialogue with my doctors office through the portal about how could I get the notes from a visit. And I said why don't you paste them into the portal and then I'll just download them. And she said and I quote kippot doesn't allow me to do that. No I don't have the fancy business card anymore. So it's harder for me to have that argument. OK. So I said OK why don't you print them. Put them in an envelope and seal it and I'll come to the office and pick them up which of course is the functional equivalent of an identity proof electronic log in. Yeah only I have to get in my car and drive. Right.

Saul Marquez: [00:09:37] And what did the doctor say.

Lucia Savage: [00:09:39] And keep it. Oh absolutely. Of course I'll do that.

Saul Marquez: [00:09:41] Gotcha.

Lucia Savage: [00:09:42] So right. How do we get our health care professionals again sort of you know you've got this plastic surgeon using Snap Chat hopefully with only his patients.

Saul Marquez: [00:09:51] Absolutely only patients and signed consent.

Lucia Savage: [00:09:54] Exactly. But we have to sort of think it through and figure out how to get our providers comfortable with all of the capabilities and risks of the new digital environment.

Saul Marquez: [00:10:04] For sure. Yeah. This is a really fascinating story that you shared and I'm glad that you were able to get your information even though it was in the paper mode. But it's an interesting story. You should blog about this. This would be an interesting blog.

Lucia Savage: [00:10:17] I actually wrote about it for the Journal of the American Health Information Management Association which is the Journal of the people who run the system document rooms.

Saul Marquez: [00:10:28] So it's a public article.

Lucia Savage: [00:10:29] Yes and it's up to the linkups on my LinkedIn page.

Saul Marquez: [00:10:32] Sweet. So listeners I'll definitely be sharing that with you. Take a look at that. I mean just as these experiences and the roads that Lucia has gone down with her experience and her and her mindset I think you'll really appreciate it. It's one that I'll definitely pick up because they may be a little one or two things that you pick up from her blog that you didn't know before so thanks for sharing that Lucia.

Lucia Savage: [00:10:54] You're welcome.

Saul Marquez: [00:10:55] So let's talk about Omada health and maybe dive into a couple things that you guys are up to and how you guys are improving outcomes.

Lucia Savage: [00:11:03] Well sir you say your listeners know about Omada. I think a key thing for me and joining Omada was the business model it has always had which is our customers pay us only Lumi achieve certain health outcomes. So you could have a digital behavioral modifications Earth like ours and you could pay Letson or you could pay per month. But our customers pay us when our participants lose weight. And complete lesson and I truly believe in an outcomes based model I've been working on that in various capacities since 2003 full time and with very attractive to me to be at an organization that has really put its money where its mouth is relative to paying for value and then the other thing I think that's important for listeners to know about a model. We use digital tools to do that. And the digital tools that tell us when we hit those value indicators. So for example a fundamental piece of equipment in the home on a program is a cellular enabled scale that each person might receive that their home that's securely tagged to their accounts. You cannot lie about your weight and the scale weights tell us you know how your weight trajectory is doing and many other things about the data platform we have. Help us get people who need more help the help they need and people who are clearly succeeding in the program on their own because they have their own motivations. Just let them go and we don't bug them and it really helps to customize the program. All of the electronic data we're getting in and I think that in traditional health care partly because the systems are old and partly because the data is more complicated there's still more opportunities for traditional health care to take up those kinds of opportunities for a dashboard that a nutritionist or somebody who has a practice extender and a physician's office can look at every day go oh I need to reach out to this person but not that person because I can see from the data points what their health status is.

Saul Marquez: [00:12:56] Now that's super interesting and listeners if you go to the site you'll see this front page. Welcome to the start of a life changing journey. There's a box right at the doorstep kind of like the Amazon feel and it says your gear is here. Let's get started. And these things that Lucia is sharing is that they don't get paid unless they deliver results. And if you're a provider out there looking for somebody that's willing to do risk sharing programs like this one I think Omada is a company that you definitely have to consider in your chronic disease management as well as the taking care of patients through the continuum of care. Would you add anything to that.

Lucia Savage: [00:13:37] Well the other thing I'd say is yes the box is cool and everyone likes getting it super exciting but I think that you know obviously there are some people who really need an in person program where they go to every day and there's 86 million diabetics so there's plenty of people for all of us to serve. But for the people who really engage in this digital communications platform they seem to get so much out of it. We hear so much feedback about being able to communicate with their cohort we group people together how they're communicating with their coach. The story I like to tell is if you're learning nutrition through your Omada lessons and you're at the grocery store and you're not cool you're hungry because at 6 o'clock and you just got off work and you're not quite sure how to change your grocery list you can message your coach and your peers right there from your phone.

Saul Marquez: [00:14:24] Yeah that's pretty cool is that the access. Yes. Yeah. Instead of calling setting up an appointment you have immediate access right there.

Lucia Savage: [00:14:32] Or waiting a week for your next and personal lesson.

Saul Marquez: [00:14:35] No I think that's beautiful. I think that right there is is a differentiating feature and just as folks try to innovate. Oftentimes it's stuff that's already in place. And folks like Omada have the pathways it's just about collaborating with the right people. And you guys have been doing a lot of building. Lucia what would you say up to this point has been maybe a setback that you guys have run into that you learned a lot from.

Saul Marquez: [00:14:59] So I think there are a couple of things so built on a clinically proven method that we turned. We have applied a digital platform to deliver the method. And so that's kind of a key feature as well that we really had a lot of clinical science from NIH studies to other states by CNS about how effective this work I think for us. We are super enthusiastic about digital technology. And from my perspective in regulatory affairs I think we are still dislodging myths about digital technology and patient who uses it. How effective is it. Why is it different is the record keeping reliable etc. And so that's just kind of an ongoing educational process. Yes that is I wouldn't call it a failure. I would call it. It's kind of like a headwind.

Saul Marquez: [00:15:47] Yeah for sure. That's interesting. And so have you come up with any best practices from running into these headwinds.

Lucia Savage: [00:15:54] I think one of the things Amadis been doing really well is kind of creating a team that Amal brings together technologists and people who are very experienced in the healthcare system and it's through the internal dialogue we have. We help not only identify what the headwind is but what the right tactic is to address it. How do you effectively explain to the FDA or the office of the Inspector General that CMF how your data collection system work.

Saul Marquez: [00:16:19] Now a very insightful response depending on who is to receive the response.

Lucia Savage: [00:16:24] Exactly. And again if you're describing that to a customer you know we are a provider we provide a health care service. We do it through a digital platform. So another had when we have is trying to explain that we're not software as a service we're actually a healthcare provider supplying therapeutics through a digital platform.

Saul Marquez: [00:16:40] My goodness. Yeah you're right and you don't know what you don't know and when you're faced with obviously Lucia you have the background and the and the savvy to be able to understand that there's legal legal ease that needs to be filtered through and responses need to be a certain way and we don't know what we don't know as leaders in healthcare. And so we've got to figure out the most insightful and right ways to respond so that we don't waste time especially if you're a company you're running with money from a venture fund. Hey you know money is time and you can't be doing things willy nilly. So these are some real good insights from Lucia would you agree Lucia.

Lucia Savage: [00:17:19] I would and I would just say one more thing particularly for people who have new ideas. I think health care is crying out for creativity but we can't really break health care because it's set up in many ways the way it is to make sure people don't get further harm. So what you need to do is take the creativity of the idea and find a lawyer who's just as creative who can help you use the environment we have to launch your product which is something Omada did way before I came onboard as opposed to kind of ignoring what happens in that space. If you want to create an app that intern operates with electronic health records vendors how do those rules really work and how can you take advantage of them and leverage them instead of trying to push through them.

Saul Marquez: [00:18:02] That's so so insightful. I've been in situations where I've dealt with legal counsel and you know hey I just they tell you I just want to give you a heads up. I'm an attorney. I need your attorney here as well. And it's amazing what happens when you have two attorneys in the room. Things happen like versus if it's just you and an attorney it just things don't happen and you become a third party. And yet what a great what a great insight. Absolutely. So tell us a little bit about an exciting project that you guys are working on today.

Lucia Savage: [00:18:34] Well I think probably the biggest projects we're working on right now without getting into too many details is obviously growth is super important for us. And we had a we've had a really really good year in that respect. From my perspective how do we automate the data that we need to share to prove our outcomes. So obviously we have for years sent to our clients secure Excel files. But what happens when we create an API and how many clients can we leverage off of that API what can we stand up on it. So my job is you know all the legal rules in place and I see that API as a potentially security vector and just another delivery method of something that you're allowed to are not allowed to share. But again that automate that there is an initial investment it's actually easier for everybody. And then you have a sort of reduce the time lag. So that's something I've really been working on is how do we automate all the ways that we share data whether it's with individuals or with our customers or you know someday the government will have an API for DPP filing.

Saul Marquez: [00:19:36] Yeah that's exciting. At the end of the day we're measuring outcomes here and if you're working with somebody that is getting paid based off of your results and if you don't get them you don't get paid automating it is really I think a really smart thing to do. And so I'm excited to see where that goes. Lucia and how valuable it will be I just imagine that it will be very valuable for your organization and your customers.

Lucia Savage: [00:20:00] Yeah I think that's definitely true and I think that for younger startup companies this is really something that's worth thinking about because legacy software system it's much harder to automate those activities as opposed to a system where you have a cloud based program and your software is amenable to engineering and API. Now I'm getting a little bit out of my you know my ballpark but this is what the engineers how me and I really I love working with the engineers and I trust them but right it could be a really important differentiator for a younger company. It's how they share data how easy they may get. And at the same time of course younger companies have to prove themselves more than mainline companies so there's obviously balancing act there.

Saul Marquez: [00:20:42] Yeah not really powerful really really powerful message there. So if you're a startup listen to this again rewind and listen to this again because these are some huge huge pieces of value. So thank you Lucia let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine though 101 or the ABC of Lucia Savage. And so we've got a syllabus right here Lucia for questions lightning round the aisles followed by a book. You're ready.

Lucia Savage: [00:21:10] Yep. I'm ready.

Saul Marquez: [00:21:11] All right. What's the best way to improve health care outcomes.

Lucia Savage: [00:21:14] I think it's to listen to the patient's needs and wants and their constraints. An example would be drugs. If you don't know what's paid in their formulary and you prescribe something they can't afford because of their formulary structure for sure not going to take it.

Saul Marquez: [00:21:28] What is the biggest mistake or pitfall to avoid.

Lucia Savage: [00:21:31] I think the regulations and the health care system can be burdensome but don't overreact to them sort of back to that idea. They mean something for a very good reason and they've been created with a lot of input. How can you leverage them.

Saul Marquez: [00:21:42] Insightful. How do you stay relevant as an organization. Despite constant change.

Lucia Savage: [00:21:47] So in Omada we really try to be the drivers of change which is partly my role and we have other people who also work in the advocacy role and I think that certainly try to drive change or lead change instead of wallowing in the tail of it because you'll never keep up. If you're in the tail.

Saul Marquez: [00:22:02] What's the one area of focus that should drive everything else in the organization.

Lucia Savage: [00:22:07] Well I think it's your vision right Toto model. We have a vision of we want to become ubiquitous. We want to serve 2 million Americans by 2020. That's only two tenths of a percent of the pre diabetes population but it's still a lot of people. So that for us is what's your long term goal and how do you get there that should be your pollster.

Saul Marquez: [00:22:25] Yeah listeners don't chase the change just focus on your vision and your goals. And like Lucia she's very focused on his vision of what could be. And with that the change comes. What book would you recommend to the listeners.

Lucia Savage: [00:22:40] So I thought a lot about this and it's actually a timely book I'm going to I'm going to recommend a pair of books so if you've gone to see the movie about the Washington Post you'll see Katharine Graham being played by Meryl Streep but church has a wonderful biography called personal history which that movie is adapted from. And I would pair that with a book by Jill Ker Conway called the road from Coorain. Conway was the first president of Smith woman president of Smith College and she's a historian. But the thing that makes them interesting is their books cover the same time period up sort of the latter half of the 20th century as a professional woman making your way career wise in America. And I think they're full of wisdom some do interesting and just out of fun. I am a hobby hobbyist gardener and set up there. I always refer people to about vegetable gardening. It's called How to grow more vegetables than you thought possible in less space than you thought possible and instead of writing I have a garden in my hand. And if you're interested and you know having better nutrition in your life and getting some exercise casually fashionable gardening is 100 percent the way to go.

Saul Marquez: [00:23:47] What is your favorite vegetable.

Lucia Savage: [00:23:49] The ones I grow. It's kind of a toss up between corn and tomatoes.

Saul Marquez: [00:23:53] Oh nice. Very nice sounds like you can make a really good corn tomato salsa.

Lucia Savage: [00:23:58] I could but I usually just eat the corn.

Saul Marquez: [00:24:01] Okay got it. Got it.

Lucia Savage: [00:24:02] Chicago land of great corn.

Saul Marquez: [00:24:05] That's right. We got plenty of corn here baby we love to throw it on the grill and it makes for a nice. Definitely. You know just plain we love to just eat it off the grill and mix really nice. This has been a lot of fun and listeners again ask if you run into somebody with I.T. background ask them about their backstory you see Lucius so interesting you never know what you're going to learn from your friendly friends and I.T. and legal go to LU C I A and you're going to find all of the show notes as well as the syllabus that we just created for you and links to the books that she recommended Lucia. If you can just share a closing thought with the listeners and then the best place where they can get a hold of you.

Lucia Savage: [00:24:47] Well people can always follow me on Twitter savage Lusa and I have linked him profile where I post my personal thoughts and whatever I'm publishing these days. Outside of my work for Paramatta and I am happy to be approached when you see me in public. I met you at 2.0 I'm going to be some JP Morgan events next week and I'd be happy to talk to anyone.

Saul Marquez: [00:25:10] Wonderful and so listeners. The invitations there. Take a look at the links and the thoughts that Lucias sharing through her. Her writing on Linked In and Lucia again I just want to say thank you so much for spending time with us and excited to see with the new year brings for you for Omada and for all of us. Thank you.

Lucia Savage: [00:25:27] Thank you for having me, Saul.

: [00:25:33] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Personal History

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Outcomes Rocket - Bill Moschella

How Artificial Intelligence Is Changing Healthcare and Every Industry with Bill Moschella, Chairman of Evariant

: [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] Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring healthcare leaders. I want to thank you for tuning in. And I welcome you to go to where you can rate and review today's podcast guest because he is an outstanding contributor to Health Care. His name is Bill Moschella. He's the co-founder and CEO of Evariant. He's a growth entrepreneur and actually Bill I just realized that you know we're here. And so you are now the chairman no longer CEO is that correct.

Bill Moschella: [00:00:56] That's correct. Yeah I turn this into a role now which has been a great transition and brought in a fantastic new set of management team CEO Claytor ReGGI and CFO Andrew Keenan. So that's that's been a great process over the past two years and I finally was able to step out of the day to day operation just thanks for the clarification.

Saul Marquez: [00:01:15] Absolutely Bill and you know listeners here's a cool thing about Bill now. He went to a music school he toured in bands. He opened up a recording studio and became a software and tech entrepreneur. In that order and he loves being disruptive. He has done so with the company that he built. And in today's podcast we're going to dive into some of his experiences as well as some of the things that they did over at Evariant and what they currently focus on. So Bill to begin with from music to health why did you make the transition here.

Bill Moschella: [00:01:46] It wasn't on purpose it just had. And the trajectory that was followed was I just was getting into software because the recording studio that I was running was essentially a digital recording studio. So I had to learn how to catch software and get involved in the digital aspect of business. And I was recording TV commercials and radio spots and that put me in touch with the advertising of different organizations. And once that happened it was kind of it opened up a whole new world for me so I became more involved in the business of music as opposed to you know the making of music and the touring and the playing to so it just shifted and part of it was a lifestyle and part of it was just it just started to excite me and I became extremely interested in it. So that was a big transition but it happened and so as I started to get into CRM and became an early sales force dotcom partner and became a local partner. I mean these were you know two huge cloud companies who were revolutionizing not only just a cloud movement but the way that we look at what's referred to as CRM today. So sales service and marketing platforms for organizations and that space although I was in very early and very successful got crowded quickly and as it was getting crowded what we were finding was an area that was not quite crowded was bringing in the concept of digital marketing and CRM to help systems and providers. And we found a couple early adopters and just realize that wow this is we can be extremely disruptive here I mean this is a market that's surely selling direct and that was there core vendors were selling direct mail services and that was the core communication method for health system to speak to patients. And we brought him in said Weiner email why not text messaging Weiner landing pages. You know why not using analytics to actually target where people are going to be outlining to figure out the best way to communicate with them. And that became the beginning of the very. It just steamrolled from there and that we were able to raise capital. I don't want to say it was easy but we weren't in all the other noise of all the other horizontal cloud but we had something unique and focused and vertical and as we can tell now with the advent of disk consumerism and digital health I mean it's the hottest topics in consumer engagement patient engagement physician engagement. We just got in really really early and were able to establish marquee logos and platform very very early on and it was a wild ride. But that did get around back to your question. What I'm that the healthcare it didn't happen on purpose it's just one of those things you couldn't even plan for it.

Saul Marquez: [00:04:25] Yeah that's so interesting and we had a guest previously and his name is Walter and he's he's out of L.A. and he can like a music studio now is making a transition into health through a company called Healthtunes using music to affect the hearts of the patients. Pretty interesting yeah you guys are kind of mini car from the same cloth. They're connecting. You know it's so interesting experience I've found this niche and it wasn't crowded you know you took a niche that was hot and then you found a vertical that wasn't crowded. And I think that's a good lesson for entrepreneurs working outside of health. Find something that's hot find something that is working and then figure out how to apply it in health. Because one of the things that Bill did that is tough to do is implement and in health implementation is the innovation. And so Bill kudos to you and your team. I know you made it sound easy but I know there's a lot of hard work that went into it no doubt.

Bill Moschella: [00:05:30] On the implementation side the difference between what happened when we started you know where Evariant is now and my team is completely different. I mean what it took to and what it takes to run Evariant operationally now is much different than years Ago. When I was running and you know over the course of two years it changed and went through various maturities and it's the biggest thing that we have to pay attention to and that the company is focused on now and the management team that's there now which is doing an amazing job of is maintaining all the compliance and the security. So all the different breaches that have occurred over the years not only in healthcare but just across the world globally in kind of digital data have just put a new light on cybersecurity and compliance and what it takes operational to run a business and maintain your compliance the compliance and stark warning and sock 2 type 2s. These are major efforts and they become business units within an organization. And as more people are focusing on that at the company now than there were you know the whole company a few years ago. Let's just talk about testing into the change in the industry and the work effort that's required to stay at the top of the game and you have to take security and compliance is going to be on top of your list.

Saul Marquez: [00:06:49] Yeah that's a really great hot topic and there are miners listening to this and if you want to share with them you know what's an example of how Evariant has created better outcomes and results through what you guys are up to there.

Bill Moschella: [00:07:05] Sure there's a couple of core use cases and the business really has 4 unique offerings and that sits on the platform the variant platform the first which was the bread and butter and still is to this day which is kind of the core offering is around patient engagement and acquisition and consumer engagement acquisition. So that's really working with the health system to identify their population understand their segment and understand within that population who is a patient and who is not a patient at this time which was referred to as a consumer and using third party data and their first party data both clinical as well as social and psychographic you know being able to look at those populations and understand who's got the highest likelihood for one of our services and we would really like to drive growth and our orthopedics service line. We want to drive growth in oncology or growth in cardiovascular areas are centers of excellence where should we do that and how should we do that. What's the right communication. Where is the right location within our primary secondary and tertiary service markets. And not only just one message but how do we keep an ongoing campaign. And how do we connect those individuals to our message and track the outcome and the spend through return on marketing investment. I mean that's a huge thing. I mean for a lot of organizations who are spending millions of dollars and being able to take a step by step methodical process of looking at my patient population looking at my consumer population understanding the market share that I want to go after choosing the tactics deploying the tactics tracking them in real time and understanding the returning marketing investment so from call it Google keyword or Facebook page search or direct mail or email doesn't really make a difference in many many combinations and touch points not just one but many. What was the combination of those which ones influence and which drove new patients which drove returned patients. You know what was their insurance. What were the procedures that they came in for and understanding and maintaining compliance along the way. So that's a huge value prop and driving that growth and the marketing department Chief Marketing Officers and strategy officers have an ability to make a contribution to the bottom line. They're not just putting out design and brand now but they are truly driving volume and taking part in the supply chain of the growth of health systems. So that's one of the biggest value props that we started off with and it's still a huge piece of the business today.

Saul Marquez: [00:09:31] That's really fascinating the distinctions that you made here Bill and and also the ability to track the ROI1 of marketing dollars. I think it's a very difficult thing to do and extremely you guys have figured out a way to help providers find a way to do that.

Bill Moschella: [00:09:46] Yes we have. It is a combination of obviously compliance of course and security because to move that data around it has to stay compliant right. You have to make sure you're watching out what's going on with ph NTIA and removing it and hashing it and encrypting it always at every step. And so we have an infrastructure that does that. But the next crack here is really data science and machine learning and we deploy that many many years ago before even the term AoM was coined and came out and was made popular right. This was we were doing that when cloud was returned and big data was returned and so I. What we're doing is we're Imagine that. Let's just say you're always myself as an example and I am suffering from an you know an old college injury from playing soccer and I have the issue and you know I've got choices right. You know I can kick the can I can get physical therapy I can start to think about what surgery looks like. But I ski and interacted with my kids and I just I want to understand what are my options. And so does digital health care. I'm online I'm researching I'm looking at social media I'm talking to people I'm looking at reviews and going online and looking up physicians and doctors and clinics and health systems and I'm just gathering information. Right. It's part of the process that we all go through today whether it's for our health or whether we're buying a new phone or a computer or a car. So that retail process retail mindset right puts us out there in front of a lot of different communication mediums. And I might touch a health systems advertising in a dozen different ways multiple times over each. So you can't just say we need to do advertising and Facebook and we get the highest returns from that. And that's absolutely not true. That's not where you get the highest return the highest return is what machine learning will show you. And this is our AI which ends up telling you it's not that one tactic. It was the seven tactics that you were influence you over the past 90 days in this particular order when you look at pattern recognition and you start to map that pattern recognition with outcomes and time series events you start to find out that there are different patterns and orders in which people consume your advertising and consumer information that turns them into consumers to patients and by looking at those patterns we're able to benchmark and go into a particular demographic in a particular area and telehealth system right out of the gate for the campaign and says We think that X dollars spend we're going to predict that this is about how many patients we're going to get and how many are going to call into the complex that are sick be prepared for volume. Here's what's going to happen to your web traffic. It's a complete prediction around the supply and the demand and that is where we've made transformational shifts and going from call it a marketing agency as platform whole lists to an actual Insight's platform that drives predictions around spend and around actions and supply and demand and how you need a statue or contact center and which areas are going to start to affect your retail and your clinics and so on and so forth. That's how Evariant AI.

Saul Marquez: [00:12:50] That's pretty interesting balance. Just thinking through how powerful that could be it really takes a lot of discipline and also a lot of technical savvy to make something like this happen.

Bill Moschella: [00:13:02] Absolutely it does. I mean the interesting piece about this is forget about in healthcare and marketing in the worlds of marketing and digital marketing and strategy. I mean the best of the best they're doing it but you're not going to find this type of capability where the average marketing department has a team of data scientists crunching down numbers. It is absolutely what the industry is going broadly and I spent a lot of time in that kind of horizontal space around machine learning is. Digital marketing and advertising and contact centers and service centers. But when it comes to healthcare I think it's even more of a challenge on the provider side in terms of how their staff. So our platform to be able to do these things that our team to build these things internally it becomes so important to have operational efficiency and to be able to scale. And that's what we've been able to do over time and we attribute a lot of it to the support of our investors and we've been able to raise a great amount of capital as folks like myself and others that we have in the board who have supported the company over the years have given us the opportunity to invest in these things because they are expensive and you have to put a lot of R and D into them. And we've been able to achieve quite a bit from the market need support supportive customers and early innovators and adopters and then the investment community who is believed in what's happening there.

Saul Marquez: [00:14:14] Very interesting Bill and listeners just think through the capabilities that a company like Evariant could do for you without having to build it out yourself. It's just a very fascinating idea to think what you could do with a platform like this. Bill It wasn't always rainbows and sunshine. Can you share with us now is the time when you had a setback. One of those moments where you just say Ah and what you took out of it.

Bill Moschella: [00:14:38] Sure just from a very transparently from my experience you know the setbacks. I mean that happened all the time right. I mean it's part of growing the business you know and there's so many great books out there to read about this. And I mean you can just go on and Manita with the recommendations but it really the theme here is that you just have to dig in and the setbacks that I really keenly remember have to do run operations right you operational efficiency and that when you're at a hot market right. It's a double edged sword. We cut through and we're on a break away and just we're we're bringing in lots of customers. And then you flip a coin and it's we have to bring on all these customers and we've got to deliver and we've got to maintain compliance. And so this perfect storm happened right around in 2014 2015. We're just you know at your tremendous exponential growth and industry started to. Really really put more of a focus on compliance contracting changed CEOs and health systems started to become involved a lot more. When I think during that time frame they were really hands down on their deployments. All I also know that they are now looking at a broader ecosystem of platforms that are touching not just their operations and their critical operations but they started seeing platforms that were touching strategy and planning and analytics and population health and CRM and marketing. And so when they got involved know the bar got raids and then there was a number of breaches already there. But within the industry and the spotlight went on. Wait a minute CRM touches data on its clinical. What about your compliance. Everything got the bar got raise their hand. So the good news for us was that there was a number of other vendors and competitors out there who just didn't make the cut and they either got consolidated went out of business. Right. And it just kind of sold the way side of the bar to get into this game got higher but to do that you have to spend more money and raise more capital and just keep the game going. And that just creates a lot of tension on an organization because you find very quickly that either people are lacking skills or that you just need to bring in people with more specific skills. And the way that you're hiring in the way that your training starts to change and it just puts a lot of pressure where you kind of went from this as you said you know it was rainbows and roses I think is what you said something like that and that's a time when you're just cranking and you're selling and you can do no wrong. And then the market just says we expect more from you Evariant right now and think about stopping a train that's moving really really fast to boil and fix and build up and put better engines on doing that while you're growing at the same time as a challenge in any market for any entrepreneur or for any business at any size. And those are times when we felt a lot of pressure and a lot of strain both operationally and internally. And you go from you know constant high fives because you're winning all the time you know having lots of meetings like that what are we going to do about this and what are we to do about that. But it's a testament to the team and the people who are working at that company and or who have worked there who have moved on or who are still there today and the managers that's there now. I mean just it's all about operations and execution. And no one ever fell completely down by it. We just got up and kept walking and a lot of lessons.

Saul Marquez: [00:17:51] Bill. If you had to summarize one key thing from it how would you summarize it for the listeners.

Bill Moschella: [00:17:56] One key thing I can I can summarize it I speak a lot about this whether it's for young entrepreneurs or you know folks who have more established companies that just want to hear and share ideas. It has everything to do with the way that you run your culture and the way that you hire and the management team that you bring on. Everything comes in the top. No matter what no matter how small or how big everything comes from the top and the culture is so important and that everybody is marching to the same beat everyone is aligned to the strategy. And that was a difficult thing to do as the market changed. We changed and to communicate that down to everybody to make sure that anyone still feels like they're marching the same direction will make or break a company. Right. And when I say make or break doesn't mean go out of business. It could mean your Kraken along at 100 miles an hour and you could maybe go down to 80. But the difference between 80 and even going down to 30 or 40 that makes a big difference in a lot of things that you might want to do additional money that you might need no access to. So setbacks around not hiring the right folks just I mean those are huge setbacks. And you know there's a lot of learning there is engineer culture.

Saul Marquez: [00:19:04] A great message and listeners whether you be at a company at a hospital at the forefront as an executive or a provider you know make sure you take care of your culture. This is a driver and Bill is a testament to what having a great culture can do for your company in the toughest of times. How about one of the proudest moments you've had and medicine. Can you share one with us.

Bill Moschella: [00:19:28] You have to be sensitive about client names just because of disclosure. But there are a few customers in particular over the years who had unbelievable our lives where they came back and just said we have met with our CFOs and our CEO So chief marketing officer and chief strategy officers who have worked very hard to have a seat at the table to be able to say I'm not just controlling the brand I'm contributing to growth and to the longevity of this business and organization right to the profitability and the margin and that that's a huge thing for a marketer to say. And we've had a number of our customers come to us and to say I want to thank you. We officially got the nod the thumbs up the approval and the recognition that yes we did drive these patients and they were the right types of patients for the right services and we did it through analytics and targeting with a partnership between Evariant team and our internal team. And so to see that happen in these numbers hundreds of millions of dollars over years. You know like a three year plan to actually have that kind of net contribution to the organization was just wow you know it was a testament to the company that we're working hard and we're building something that is truly transformational and disruptive to the investors to say we have invested in a company that is changing the industry and driving our wives for their customers which means that's going to be our ally for the business. And those moments just you know it's like wow all the hard work we did it you know it's just now we did it and it resonates through the market and you start to win again. And you really get that wind in your sails so that's definitely definitely a proud moment to have.

Saul Marquez: [00:21:14] Sounds like it and thank you for sharing that it's the excitement in your voice and your passion my friend. So you're moving on to the next chapter of Bill and so tell us about an exciting project or focus that maybe you're thinking about now.

Bill Moschella: [00:21:30] Sure. I am extremely focused on all things I write under that umbrella I would call that conversational platforms right machine learning data science that practice the intersection of all that with big data and streaming and then your deep learning image recognition etc. are natural and natural language processing which of those are kind of to me the you know the underpinnings of the building blocks of what AI really means when you strip away that acronym pretty well. Yes. And I've just learned a lot about what to do in Data Science standing up in Data Science Department challenges and being able to help organizations achieve that right. Because it's not just building a model and training model putting a model into operations and actually taking those insights and delivering them to customers and those customers can be contact center agents they can be marketers they could be business leaders operational leaders and I'm passionate about operationalizing machine learning and data science across the continuum in the healthcare system. So I've had a lot of great conversations with customers. Now I'm I'm actually getting brought into even just the horizontal market like organizations who just find it very interesting and want to either disrupt the market or they're being disrupted larger organizations are saying wow it's not even nipping at the heels. There are amazing startup properties for coming into our global multibillion dollar market cap space and they are shaking the tree. And can you help us see OK what do we need to do here. How do we need to pivot. One area that we could really make a difference. And how do we start to change the way that we do our business in the way that we think that is exciting for me and to be able to continue to support Evariant as a board member will give insights and just be a supporter like I'm doing right now and speaking about the company or going into other organizations and sitting down with their C suite and talking in-depth about what can we do here. What aren't we doing. What can we do and what's a good place to start like with a small proof of concept that we can really just test this without having a massive massive change management issue. And so those are things which are really really exciting for me and I'll give you a couple examples. Know how do you use conversational platforms and natural language processing inside the service center of the health system. There's tons of clinical notes there's an even there's tons of Contact Center calls that are being recorded all the time. How could you automate and use AI for natural language processing to anticipate what someone is going to need to take them through a workflow without having to have them wait on the phone or to speak to somebody who to look up information and just give them access to things and predict things for them during their service experience. So you know I find those things extremely disruptive. And they haven't quite hit the healthcare space. They're starting to happen in the insurance market and in the financial services market they're like not quite there in healthcare. So I think that that's a great extension of things that are there. It doesn't CRM companies do bringing in the conversational champ out is probably kind of a quirky word but thinking about how to use natural language processing and in machine learning during conversations and out while on the phone to understand sentiment and direction and matching positions and services to the needs of the patients through a huge huge market there. I mean if you follow the trend in healthcare lagged behind the digital marketing space and behind kind of the tech companies and the Pfizer world and you follow now what's happening in retail and now healthcare wants to follow more of a retail focus and how do we be more intimate with our patients. Consumers well follow that trend. It's going there and then go look ahead and what's happening in financial services. There's natural language processing in recognition happening telephone and in service centers I see no reason why that's not going to happen in health care and we need to streamline these processes so those are things that I'm really passionate about. I think they're going to be disruptive and I'm enjoying the conversations that I'm having with companies and entrepreneurs and the investor community out there right now.

Saul Marquez: [00:25:30] Yeah that's super exciting. And with the success you've had with a variant and now just going through and looking at other areas where it can be applied I'm excited to see what you come up with. And I know the listeners are too so here to the end. Bill it's been a ton of fun to show you what book and what podcast which you recommend to the listeners.

Bill Moschella: [00:25:50] The book that I would recommend right now that's on my nightstand and I carried it down with me to my home office is by a gentleman named Ray Dalio. It's called principles.

Saul Marquez: [00:26:00] Man. It's so good.

Bill Moschella: [00:26:02] Yes. So good transformational for me. I read it twice.

Saul Marquez: [00:26:06] You have? It's a long book, I'm not done with it.

Bill Moschella: [00:26:11] Well yeah it's a long book and I've been on a couple of flights across country and wow that was one time I got to knock it out and then just take it off over the holidays in bits and pieces and now I'm back kind of like focusing on you know there's key chapters right now you know whether it's about dealing with like kind of each human emotional intelligence or just thinking through reality he has this concept about reality where he just says you've got to face reality like you know you might want something but what's the reality of the situation. I just go back to my my times and the very when we just maybe as a team or as individuals had a hard time facing the difference between what we desire and what reality was at the time and it affects your decision making process. So yeah that to me is huge and as far as podcasts are concerned for me because I'm into the martial arts and I've been doing jujitsu for years. I watched Joe Rogan all the time. I don't think it's hysterical Yeah I love all the different kinds of topics that he brings and everything from helps to medicine and business and life and just extremely extremely interesting. So it's interesting I haven't got my hair it's good that's my wind down that's my wind down. You know and I just want to turn off and just listen to something out of left field of it.

Saul Marquez: [00:27:25] I love it. Bill this is awesome listeners. Check out that book. It's really an amazing book. Definitely another company that uses AI Bridgewater and the concept now is running through in health. Those guys are doing it in finance so definitely a lot we can learn from over there. Just go to that's E V A R I A N T and you're going to find all the show notes as well as links to the things that we've discussed today. Bill why don't you leave us with a closing thought. And then the best place where the listeners could get a hold of you or follow you.

Bill Moschella: [00:28:02] Closing thoughts. I'll say this just because it's on the top of my mind. There is such opportunity and disruption for entrepreneurs out there and I'm speaking really to entrepreneurs and individuals within organizations both on the healthcare side and on the tech side. Just don't give up. Make every day about learning and about pushing it and pushing the limits because there's so much to do out there and if you don't do it some are going to come up behind you and they are going to do it because there's so much opportunity and so you know be disruptive and don't get down when when those challenges you know kind of come in front of you because they're going to be challenges politically inside your organization. They're going to be challenges as a startup or a small company trying to break into something groundbreaking. The big players don't always want to kind of hold you back. And there's always going to be challenges. So just muscle through just keep at it it's all about hard work commitment and believing in yourself. So I want to thank you for having me on here. It's awesome to have these kind of opportunities to get a chance to speak to a wider audience and to find me you know the best place in going on my LinkedIn profile on LinkedIn and just look at Bill Moschella and reach out to me from above to hear from everybody.

Saul Marquez: [00:29:06] Awesome Bill and listeners again just go to and you're going to find a link to Bill's length and profile as well as his company that he founded where he's chairman now and all the great things that he's up to. So a big thank you to you Bill is a pleasure to have you on. And looking forward to keeping up with what you do.

Bill Moschella: [00:29:26] Absolutely. Thanks so much for having me I appreciate it. You do great things.

: [00:29:33] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Principles: Life and Work

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Linkedin: Bill Moschella

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Outcomes Rocket - Podcast

Why Healthcare is Like A Carwash and What We Can Do to Change It with Dr. Danny Sands, Health IT Consultant and Speaker at Zev Enterprises /

: [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] Welcome back once again to the Outcomes Rocket podcasts where we chat with today's most successful and inspiring healthcare leaders. I welcome you to go to where you could leave a rating and review for today's episode because our guest is an outstanding individual. His name is Dr. Danny Sands. He's an innovator and primary care physician and wears many hats in the field of medicine. He's contributed in many ways very well-known for being the board chair co-founder and past president for the society of participatory medicine. We're going to dive into some of that in the podcast. He's a senior partner in SP consulting is a primary care physician as I mentioned and he's served as advisor and faculty and chief medical officer at various startups as well as various well known health care companies. And so what I want to do is welcome you Dr. Sands to the podcast.

Danny Sands: [00:01:20] Thank you. It's good to be here Saul.

Saul Marquez: [00:01:21] It's a pleasure to have you on and anything that I missed in your intro that you want to add there.

Danny Sands: [00:01:26] No I think that's pretty good. People can obviously read more about me online. We don't have to spend time on the podcast talking about that.

Saul Marquez: [00:01:32] Awesome. Sounds great. I always like the kick off the show Danny with the Y. And so I ask all my guests why did you get into health care because it's the genesis of the fire. So what was it for you that got you in the medicine.

Danny Sands: [00:01:44] It's a good question. Saul so I don't have any doctors in my family. I was certainly always interested in math and science but also a lot of other things I did get exposed to healthcare as a kid really as a student in high school through a dear friend of the family who is the chief of neurology at the Cleveland Clinic. Oh he was kind enough to not only show me around the hospital and this is the Cleveland Clinic show me around the hospital teach me things about how neurology was practiced but then as I got a little older he actually let me go on rounds with him all along with his retinue of students and residents and that was just fascinating. Give me a white coat and it was kind of like I was very the corner of the team and he asked me like he would go around and ask his resident fellows questions and sometimes he turned to me and asked me a question particularly one that they wouldn't answer or they couldn't answer. And I didn't know anything of course but the expectations were low and it was just really interesting to be forced to think like that. Wow. When I eventually went to college I was on the fence between choosing medicine or because I have worked in technology. I was also interested in the field of engineering called operations research and I was also interested in law. Believe it or not really. Yeah it took me about a year or so to figure it out and I decided that I didn't like those huge books that the law people had to read a lot and I didn't like the very strange people I'd have to hang out with if I studied advanced mathematics and stuff in that engineering space. And the strange thing happened which was for reasons I still don't understand. To this day my freshman Hall despite the fact that I wasn't even premed my freshman Hall whenever somebody got sick they came to me. So they're saying that.

Saul Marquez: [00:03:27] That's crazy. It's a sign it's a calling.

Danny Sands: [00:03:29] That's what I figured I think you know. Well I ruled out the other two things in this health care stuff was pretty cool. And that's really what drove me into that. But as you know because you've read my bio I did health care but I was frustrated as I was in health care that we weren't taking advantage of information technology.

Saul Marquez: [00:03:46] Yes.

Danny Sands: [00:03:46] And honestly it was like this alternate world where it was an information technology free zone. So like in training I'd have attending physicians who would be asking the medical students the residents say they would say for example Mrs. Smith got admitted with hyper Kaliati hour or high potassium. What was her potassium when she came in and they'd be asked to recall what her potassium was when she came in. And then they say all right what was it a week ago when she was at home and they had asked to recollect this and it was like this recalling information or another example Mrs. Jones was admitted last night after having fainted she had syncope is what we call it. Right. And I'd like you to name 10 of the 50 known causes of syncope. And you know it was just this ridiculous recall and you know we had to prescribe drugs and keep track of drug interactions. And I knew that information technology was going to improve the way we provided care for patients. And so I sought out training in that area I really wanted to make a difference there. Good for you. Why did training in clinical informatics and that really was an important change in my life.

Saul Marquez: [00:04:55] Wow. And so you saw it coming. You knew that it was a way that it was going to improve. You took a deep dive. And what was a result of it.

Danny Sands: [00:05:01] Well it really did change my life because after I finished my residency and I did this training in clinical informatics I assumed operational responsibilities for lots of clinical systems at Beth Israel in Boston which became Beth Israel Deaconess. And that was really what I was into I was all about this how technology can improve the care of patients but then I took a leather little detour because as I was doing this I was developing these technologies. It's like an electronic health record and clinicians portal and I helped develop patient portal and all this other stuff. A funny thing happened which is that in my own practice while I was using these tools I was learning how game technologies similar technologies at least could be also useful to patients and to connect patients to clinicians. So for example I was using e-mail in my practice back in 1991. You were ahead of the hand when the web came out of the sea and I was found. All these health Web sites and I was prescribing information to my patients. And this became a real passion of mine at how this technology can be a tool for patients as well. And that ultimately led me to help develop one of the nation's first patient portals that I mentioned at Beth Israel and then I went off to industry and while I was there I helped found this nonprofit called the Society for participatory medicine created then in 2009.

Saul Marquez: [00:06:24] And it was so interesting that learn about that. So listeners I was at Health 2.0 a couple of months ago and that's when I had the pleasure of meeting Dr. Sands. We were out for one of the lunch breaks and sat next to him and talk about just a highly engaging highly likable person. We sat there and he had a badge and and I asked him about the society and so maybe Dr. Sands for the listeners that don't know about it maybe you could tell them a little bit about what it is and just a little bit of that analogy you shared when we were together.

Danny Sands: [00:06:56] Sure. I think that I'll tell you just a little bit if this OK this could be on the cutting room floor but about how this organization was created would be wonderful starting around let's say around 2000 2001. There was a guy named Tom Ferguson who was a doctor but never practiced. Instead he became interested in how patients could really be their own doctors they could take care of themselves. And the existing healthcare system really needs to change new to be less paternalistic in all these really fascinating ideas that he had been working on for a long time. And Tom collected people. He collected ideas and people and over time he brought together a group of people. It changed over time but it was a core group of people who were doing interesting things in healthcare. And they were people like Susanna Fox who was doing research on the impact of the Internet and on health care. Alan Green who is a pediatrician who created an information site for parents about kids about pediatric health really it's like Dan Hoque and Jon Lester who together ran this incredible online support community for Neurologic Diseases. These are the kind of people that were all brought together and I was brought in because of my interest in the use of e-mail with patients and letting patients see their records through patient portals and we use to get together annually and then sort of talk about health care and how we're going to you know we'd like to make a difference how it could be different and it was great. Tom unfortunately died in 2006. And he died and he was almost done writing a white paper about this new world of health care but through a grant from the Robert Wood Johnson Foundation. So after Tom died we continued to meet every year and talked about these same issues. We completed that white paper which you can now find on our on our Web site. And then in 2009 we said Goll darn it we're going to make something of this we're going to create an organization out of this alive. We created this society for participatory medicine and we knew a few things initially we knew that we wanted to represent the diverse voices in healthcare. We didn't just want to be about patients we wanted to get doctors and other health care professionals as well. We want it to be about caregivers want it to be about other stakeholders in health care like health care executives not to manures because we knew that we needed to change that culture of healthcare. And from the very start we actually created a journal a peer reviewed journal the Journal of participatory medicine and we knew we wanted to have members and we wanted to set the bar low for memberships so that even patients who were struggling with serious illness and financial hardship would join us. And yet we wanted to have the gravitas of a medical society so that we could actually engage health care professionals as well. So that was the start of the organization. And one of the cofounders of the organization I should mention is someone who is goes by the moniker e patient Dave. His name is Dave Doubront cart and I actually brought him into this group because he's a patient of mine and he's a patient of mine and one of the interesting things about our relationship is that we used a lot of interesting technologies and there's an interesting story that we've written about. He's written about about what happened when one day he was diagnosed with medicine at a cancer and we diagnosed him menaced had a cancer and he went through treatment and I went through a lot. There's a lot to talk yourself I'm sorry. I know the sentencing rate greatly. But what of the interesting thing is how we use technology and how we used our relationship to really help him through that. Among other things I prescribe a patient online patient support community to him and to this day. Dave says My doctor prescribed a core that was the name of the Web site of the support group. My doctor prescribed a core and it saved my life. And it really did. And he's written about that. But I digress. And that will be one of the founders of this group. The organization is really trying to transform the culture of patient care and in order to do this we focus or healers. And I'll tell you about this post in one second but I want to give you that metaphor that grabs you so much that we talked about we were sitting outside of Santa Clara.

Saul Marquez: [00:11:05] Oh man I'll never forget it. And then this Get ready. This is really good.

Danny Sands: [00:11:11] I think that too often we meaning both health care professionals and patients think about healthcare as if it's a car wash. And what I mean by that is that the patient is the car and they're somehow dirty they're unhealthy or dirty and they're passively cruising through this health care system which is the carwash and they're getting health sprinkled on them and somehow they come out the other end and they're healthy. So that is the problem that is a major problem that we have with health care is that nobody is engaged. The experience isn't great and we're not getting the outcomes that we want and it's not cost effective. So we need to change that we need to think about healthcare differently. It's not a car wash and it's not a typical service industry. It is a collaboration. It's a collaboration between the patient and the doctor or the healthcare professional and the subject of that collaboration is the patients health and just like any collaboration. Forget health care for a second you collaborate with your colleagues about whatever you can to collaborate with your spouse about child care whatever it is it's going to have five elements to make it success. One is free flowing communication. Another is sharing of information. Nobody hoards information it's shared decision making. It's mutual respect and finally it's engagement so we want that to be what health care is all about. So when we think about this we're trying to change this culture of healthcare. Right. And if we want to do that we can't just do this is not a simple silver bullet solution. We've got to think about different areas so we focus on four pillars. The first area is this community. We have conversations among this community of diverse stakeholders in healthcare. And I've already described that diverse community to yes and we do that both online and in person. We just had our first face to face conference.

Saul Marquez: [00:13:09] Oh did you really? Congratulation.

Danny Sands: [00:13:11] Thank you. It was terrific that it was in Boston. We were an international organization but we certainly have a lot of people in the Boston area and we will probably want to do this on the West Coast at some point as well and maybe other places. But this was a really great first conference very engaging wonderful speakers and on our Web site you can actually view videos of all of our speakers.

Saul Marquez: [00:13:31] Ah fantastic. We'll have to include a link to that. Danny for the listeners.

Danny Sands: [00:13:35] Sure. And in fact there's a special bonus which is that at the closing session we watch the video for that because there is a special treat that Dave and I did really and I won't spoil it for you but you got to look at.

Saul Marquez: [00:13:47] Oh man. All right. So listeners that conversation don't worry about how to get there. What we'll do is on the show notes of this we'll put a link to that and we'll make a little note for you to remember to check out that closing session. I'm excited about checking that out. Put the hook in Danny put the hook in. I love it.

Danny Sands: [00:14:03] So that was that was conversation community. And then we do a lot of online conversations as well. And then the second areas of advocacy what we're trying to influence public policy and influence the hearts and minds of the population. Yes. So whether that's responding to public policy that's being proposed or whether that's choosing an issue and pushing that out. That's the advocacy piece. The third area is in research and although we don't do research we publish research in our peer reviewed journal Journal of purchase between medicine which is now as of just recently is now being published by the JMIR are the Journal of Medical Internet Research. It's one of their journals.

Saul Marquez: [00:14:38] Oh nice.

Danny Sands: [00:14:39] And then the other project we're starting and research in the early stages is we're creating a research library so that anybody who's a member can find out the best peer reviewed evidence for things that we do in participatory medicine. So it's kind of like a Cochrane library if you know what that is. But this is focused deep and participatory health care.

Saul Marquez: [00:14:59] That is wonderful. That's so cool.

Danny Sands: [00:15:02] The last area left the four pillars and then I'll let you get a word in edgewise Saul, is education. So education we recognize that we have to education to change culture that's a huge part of this. And initially I kind of thought that all we need to do is take care of those recalcitrant doctors that they are the problem. This is why we need this society. Because those healthcare providers those doctors in particular are so difficult. And I want to share information. They don't want patients going online. One of the things that we realized though is that it's not just about the doctors. Because remember that car wash metaphor I gave you only. Well this is a co-dependency, Saul. This is a co-dependency meaning that I think patients many patients and family caregivers are complicit in this and that we both the patients and the doctors view healthcare as a carwash in many cases. And that's what we want to change. Tom Ferguson who I told you inspired this organization had a term that he created many years ago and that term is patients and the E everyone thought it was electronic. But the E actually stands for engaged in educated enlightened empowered. So we actually need to train our patients to be calm as patients so that they can be more effective collaborators with their healthcare providers.

Saul Marquez: [00:16:27] When you first said e patient Dave that's what I thought. I thought it was e as in like online electronic but the e is for engaged empowered.

Danny Sands: [00:16:37] Exactly.

Saul Marquez: [00:16:38] Oh wow. That's so interesting

Danny Sands: [00:16:38] We want to educate health care professionals to educate patients as family caregivers. But we actually ultimately saw want to move upstream and we want to influence health care professionals before they're professional. So let's get the doctors before other doctors. Yes the nurses before the nurses and for patients we want to get people before they're sick for their patients. We want to get them when they're in middle school and they're in a health class they should be learning how to become patients when they're young.

Saul Marquez: [00:17:07] How do you do this. How do you spread the word.

Danny Sands: [00:17:09] Well it's a great question and it's not easy in the case of education. There are different ways that we can accomplish this. So some of the many of us in the organization do this through speaking to teaching face to face if you will that's not scalable. So we need to actually create educational modules that we can host or appoint people to education. Other people have created. So I think that's going to be ultimately how we deal with at least the current crop of patients and professionals as we move upstream it becomes a little bit more complicated. We probably have to insert ourselves into the curriculum in pre professional education. And we've got to figure out how to influence public school health education so that we can include these concepts.

Saul Marquez: [00:17:53] It sounds like a lot of things are being done now things in the pipeline to do in the future for upstream but definitely a lot of things in the works. Yeah that's exciting. Well thank you for walking us through that. Danny it's listeners as you can tell Dr. Sanders very passionate about what he does. And we've had several past guests talk about self-management in health care and Dr. Sands is an example of what it is to represent this movement because it makes sense when you go buy a house you don't get told what to do by your realtor. You're involved in the process. And in the same way it's a two way street so don't blame your doctor. It's your fault. So take the. Exactly. Yeah. Take the opportunity to take those steps to make it happen. Dr. Sands what would you say one of the areas that you're most proud of to date in your career. And something that other other leaders in health care can learn from.

Danny Sands: [00:18:47] Oh that's a hard question. Well I'm proud of the society I'm proud of what we've been able to accomplish to date. We have far to go but I think that my experiences there have been tremendous learning experiences for me. I think we've helped a lot of people. There are various efforts and I think we're really at an important inflection point. So the society is certainly something that's been great. I think that thought leadership has been something that I think I'm proud of I've been able to influence a lot of people through the work that I do. So that's been an area. And finally I guess the technical work that I've done such as all the work I did for many years at Beth Israel in Boston developing and implementing technologies that are still in use today.

Saul Marquez: [00:19:28] And if you add the pool one thing out of that why you were able to do all of that. What words of wisdom would you share with the listeners.

Danny Sands: [00:19:34] So I think that keeping an open mind about one's career is important. So let me give you an example. I work with medical students and residents a lot. And there are many people who come in and say I know exactly what I want to do. I'm going to do my residency in medicine and I'm going to get a fellowship with cardiology and then I will focus on interventional cardiology and just spend the rest of my life doing interventional cardiology and that's good in some ways. I mean it's fine if you know everything that you want to do. And every time I was asked an interview question because they always ask you this they say So Danny what do you want to be in five years. And I never really had an answer for that saw. Yeah I didn't know where I wanted to be in five years because I wasn't sure and I thought it was bizarre that people knew that answer. But at the same time I felt like I was supposed to know the answer because they were asking the question. And they didn't want to hear I don't know. But one of the things I've learned looking back on my career is all of the exciting things that I've done happened because of serendipity and because I was open minded about new ideas and new things coming my way. When I think about the whole informatics thing going way back in my career right why do I do that. Because I was frustrated that we weren't using technology health care I said let me do something totally different. It was a relatively new in those days to do something like that. I started using e-mail and my practice with patients. I just did it. I didn't like too much about it I just sort of did it. But that wound up being an important read that led me to this consumer health informatics work that I've been doing that has worked at Beth Israel Deaconess for 14 years doing designing implementing and evaluating technologies. And then I just realized that it wasn't right enough and I was keeping an open mind and that's when I moved to industry because an opportunity came up and I moved to industry. And it's those kind of things just sort of not knowing is sometimes helpful not being too set.

Saul Marquez: [00:21:31] Yeah I think that's such a great perspective. Danny and you know as we approach the things that we have in front of us listeners to be open minded you never know what's going to come a solution that you don't expect a path that you don't expect. Be open minded and you'll be pleasantly surprised. What lies ahead. DANNY This has been so much fun. Now as we get to the end here. You know I like to do a little syllabus for the listeners through a lightning round. And it's the 101 or the ABCs of Dr. Danny Sands. And I've got four hours for you and then a book on the syllabus. We're going to put together you ready.

Danny Sands: [00:22:07] I think so. I'm not sure I will let me fasten your seat belt here.

Saul Marquez: [00:22:10] Fasten it up baby because the car's ready to roll. What is the best way to improve healthcare outcomes.

Danny Sands: [00:22:17] Oh really. I'm going to go low tech on you here let's do I'm going to stay. It's talking to the patient and listening to the patient. Sure I spend my life in technology but I'm not necessarily early adopter and I understand that technologies are great when they have value and bring value. But I think that it's not about technology here. It's about listening to the patient. If you listen to the patient you spend the time thinking about what they may have. I think that's how we're going to improve outcomes as we educate our patients. We collaborate with them as I was saying. Right. That's going to make a huge difference. And as we're working with them as we're listening to them spending time with them we're going to be able to order future tests order the right tests and get better outcomes at lower cost.

Saul Marquez: [00:23:03] I think that's beautiful. What would you say the biggest mistake or pitfall to avoid.

Danny Sands: [00:23:08] The biggest pitfall of listening to the patients. I don't think that we ever go wrong by listening to the patients. So I don't think there are pitfalls there. I think the pitfalls come when we don't spend the time to do that. I know that's sort of a circular answer. I would say one thing though that I think that often when people hear me talk about this they'll say so Danny does this mean that the patient is always right and I'm not saying that. I'm not saying the patients are always right and the patient always gets to tell you what to do. Right. It's not really what it's about. It's about a collaboration and mutual respect and that happens both ways. So the patient can't expect to come in and say I know I've been working a lot but I have a headache and I think I have a brain tumor and I demand an MRI and I examine the patient and I listen to the patient and I and I know that this is too much work and stress and that they don't have anything of concern. It's OK to say no but it's also important that we listen to our patients. We need to have a conversation. So the patient deserves to be listened to and the patient deserves a rationale. But it doesn't mean that the patient always gets what they want. And and remember the patients coming to see the doctor because the doctor has a lot of knowledge and a lot of experience. The doctor is an expert in healthcare but the patient is an expert in themselves and that is why it's important to collaborate.

Saul Marquez: [00:24:28] Love it beautifully said. Beautifully said. How do you stay relevant as an organization or as a practice. Despite constant change.

Danny Sands: [00:24:37] Yeah that's hard. And the change comes in so many different ways in the health care especially in the U.S. health care system for us. I think that knowledge is the thing that changes so tremendously is just incredible. You hear all these statistics the amount of knowledge doubles every three to five years. You read two medical journals every day you'll be several centuries behind by the end of the year and it just goes on and on. And it's true it's really a challenge. You know we all are expected now to maintain our knowledge through continuing education. And I think it's getting a little more challenging because now we have what are called maintenance of certification requirements which honestly we all complain about. On the other hand having just recently gone through a recertification process where I had to make sure I had lots of intuiting education and meannesses certification I think there is a value to it because things do change a great deal and I've got to say that I learned a tremendous amount in working in the many months that I was working to study for this exam. So I think that we always in our professional lives both as doctors and as maybe business executives or whatever we need to always do that thing that Stephen Covey said once to sharpen the saw. We always have to keep share in whatever field we're in. Healthcare is challenging because we have this content area and then sort of the whole payment model of healthcare is changing at the same time. And then we have to deal with all these kind of crazy different. All this is now called the metrics may be different for different payers and for CMOs and so there's really a lot of overhead and I think waste and we need to rationalize all this and it's very easy to get annoyed and distracted frustrated by all of it. And I think that we have to remember why we went into health care and we have to find the joy of practice and don't dwell on the things that are frustrating. Find a way to make them work from your standpoint. But don't lose that joy in your practice. Sit down with the patient take a breath listen to them and remember how privileged we are to be able to do this as physicians.

Saul Marquez: [00:26:46] What a beautiful message Dr. Sands. Definitely one that I've taken to heart then definitely remember to breathe and to enjoy the moment. What book would you recommend to the listeners. As part of the syllabus.

Danny Sands: [00:26:58] Yeah that's a really tough one. Sol and just so the listeners know Saul told me he was going to ask me this. Not very long ago though because of my interest in participatory health and I think that this is such a huge and important aspect of healthcare. I'm going to say my patient and I wrote a book called let patients help and I'm going to recommend that and I'll give you a bonus one. All right. Which is called participatory health care. That was published by him this health information management systems. And that was published a year or so ago and edited by Jan Oldenburg. And that's a really neat book too and it really gives you a sense of the scope of this kind of health care which I think are important. Obviously I could recommend all kinds of medical books and all kinds of things about the health care system. There are so many books about health care that are just fascinating. We certainly to go on these books you know are just really interesting. Eric Topel work also. Good stuff but I'm going to stick with the two.

Saul Marquez: [00:28:03] I love it now Dr. Sands thank you for that information. Thank you for those recommendations and listeners. Don't worry about jotting it down as I said to you these resources on the syllabus the books the links to the conference that Dr. Sand's mentioned all of it's going to be available for you to check out at That's D R D A N N Y. And why but that link and you should be able to pull out all the things that we've discussed. So Dr. Sands Danny this has been so much fun. Before we conclude I would love if you could just share a closing thought with the listeners and then the best place they could reach out to you or follow you.

Danny Sands: [00:28:45] I'll just say healthcare is in a constant state of transition. This is at least the challenges and opportunities as clinicians we have the opportunity to be the best clinicians that we can be in these times of change. And as business leaders who are health care system leaders we also have tremendous opportunities both challenges and I think that technology is bringing us tremendous opportunities as well. And we have to figure out the best way to leverage these technologies. And if you're one of Saul's listeners that are working in a business or a technology and healthcare I really want to respect the workflow of both the clinician users of your technology as well as the patients and you should engage patients and clinicians in the development of your products and your business. That's it.

Saul Marquez: [00:29:36] Love it. Strong message. And Danny where can the listeners get ahold of you or follow you.

Danny Sands: [00:29:41] Sure. My Web site is My Twitter handle is @DrDanielSands and my email address is

Saul Marquez: [00:29:50] There you have it listeners. And don't you worry just go to and you'll be able to find all of the ways to get a hold of Dr. Sands as well as all the links that we've discussed. This has been such a pleasure. Just want to thank you again Danny for spending time with us and sharing your wisdom. We really appreciate it.

Danny Sands: [00:30:09] You're welcome. A lot of fun Saul thank you very much.

: [00:30:15] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Let Patients Help!

Participatory Healthcare: A Person-Centered Approach to Healthcare Transformation

The Best Way To Contact Danny:

Mentioned Link/s: - Make sure to check out the closing session!

Episode Sponsors:

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Outcomes Rocket Podcast - Sunjya Schweig

Why Treating Complex Chronic Illness with Functional Medicine has Worked for This Highly Sought After Physician with Dr. Sunjya Schweig, Co-founder and Co-director at the California Center for Functional Medicine

: [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] Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health care leaders. I want to invite you to go to where you could rate and review today's podcast because today I have an outstanding guest. His name is Dr. Sunjya Schweig. He is an amazing individual who I had the privilege to meet when I was at the Health Care 2.0 meeting. We had just a wonderful discussion. He is the co-founder and co director at the California Center for Functional Medicine. He's an expert in complex chronic illnesses which require rigorous investigation and management. Think of them like that Dr. House. He's been studying teaching and practicing integrative and functional medicine for over 20 years. He's built a phenomenal practice with some great partners and an amazing team in California. And what I want to do is just open up the microphone to Sunjya to fill in any of the gaps of that intro and welcome to the podcast welcome to the podcast my friend.

Sunjya Schweig: [00:01:24] Thanks so much, Saul. That was great. I really want to add that I'm grateful to be here. I really appreciate the work that you're doing to give us all insights into that process and mindset of being a health innovator and thinking outside the box. So many great lives together in what's just incredibly exciting and dynamic time and health care. Yeah. Thank you.

Saul Marquez: [00:01:44] Thank you Sunjya. I will accept those words. And so I wanted to ask you you know go back to the beginning. What got you into health.

Sunjya Schweig: [00:01:53] Yes so for me it was really a calling. And you know I have not and my parents are not physicians like my grandpa was the doctor that used pediatrician. I didn't know him super well so it kind of was there and in the back of my head. But you know really kind of came to me in high school and I really just knew that I want to go into medicine. And they also knew that I wanted to practice integrative and holistic medicine. That's how I was raised as a kid. And so when I went to college at UC Berkeley and studied medical anthropology and Religious Studies which is an offshoot.

Saul Marquez: [00:02:25] That is cool by the way medical anthropology. That's fascinating.

Sunjya Schweig: [00:02:31] Yeah. So I was always very very interested and open to the explanatory motto of what people come with. How do you understand they don't know what other modalities are they using. So big picture yes as opposed to Western medicine which can be kind of reductionist production of science so it's complicated when you try to bring in a big picture. But yeah that's always my my framework. And in fact I did some research in college on alternative medical systems and then work. After college you can go straight to med school. I took some time in between and went and lived in Ecuador for a year.

Saul Marquez: [00:03:03] Wow very cool.

Sunjya Schweig: [00:03:05] I worked with a mobile surgical program there. So literally an operating room in a truck that was designed and built here in California and offering surgical care to the underserved in the super remote places of the Ecuadorian country in the jungle et cetera. And so that was also a incredibly fascinating time on the side that was doing research trying to understand you know how do these rural indigenous people who probably rarely go to the doctor understand what's happening to them when this modern operating room comes and parks in their town for Iran run and does 50 or 60 different surgeries. Very interesting.

Saul Marquez: [00:03:42] And that is very interesting. And what was the reaction when the truck came and how did the people react.

Sunjya Schweig: [00:03:48] So the operating has so he was performing procedures which were not an emergency. So they all plan to have things like gallbladder surgery or understand testicle surgery for her his or tubal ligation in some cases like coma removal et cetera. So elective things that could be scheduled in advance of a pipeline that people kind of knew what was gacha but still it was fascinating you know talking with some of the people you know men and women and mothers and fathers about their kids and there was definitely that sort of you know level of mystical magical thinking around what was happening and it was gratifying to be able to speak with them and reassure them also to tell them what we looking at and what they could expect in terms of going into the truck and coming out the other side on a gurney.

Saul Marquez: [00:04:34] So yeah that is super interesting Sunjya. And so what did that experience do for you and the way that you serve your patients and the community where you're in now.

Sunjya Schweig: [00:04:46] Yeah. So it's really I think we can draw a trajectory from my childhood up through studying medical anthropology and religious studies digging into people's explanatory models working in Ecuador. You know all the way up to now which is in our practice and the more dive into this little bit. But our practice really serves the mystery patients the patients who have seen 10 or 15 doctors and are still there and haven't gotten cancer and chronic illness like you mentioned kind of detective work like Dr. House. Yes so it really is in that setting. The relationship between the doctor and the patient is really frequently one of collaboration and communication listening and interest being present for anything that will give you clues and you're really letting the patient tell their story.

Saul Marquez: [00:05:33] That's really interesting. You work with patients remotely to or do you just work with them in your office.

Sunjya Schweig: [00:05:39] No we do know a lot of virtual care.

Saul Marquez: [00:05:41] Do you.

Sunjya Schweig: [00:05:42] Yeah. So I would say on average my week is probably about one third of in person visits and then two thirds virtual either phone or video and we use a secure telemedicine platform for the video visits. We do require that our patients come and see us in person or visit and then annually after that for you know so that were covered under our California license and we're working out the kinks a little bit. You know telemedicine is you know I mean it's incredibly hot area and it's going to be the way of the future. But there's still some kinks in terms of regulation. Regulatory issues to figure out. So it's the ongoing Volney experience. Again even our local California patients you know living in the Bay Area with the traffic as it is people picking stuff up for the virtual visit. And as many of us know you know there's something you and I need to do an exam and obviously I want them in person in the office. But yes they care and they provided phone video. We have a secure portable messaging system where almost all of our patients communication flows through. And so we do a lot of management in that manner.

Saul Marquez: [00:06:48] Very interesting. So maybe an area that we could start with as Sunjya is talking about the different models of care and where your model and what you and your team do and how it's different.

Sunjya Schweig: [00:07:02] Yeah absolutely. So you know I think the place to really focus is to understand how much trouble we're in in this country with regards to our medical system and particularly with regards to chronic illness management. You know Western medicine is incredible. And if I need a surgery or if I get into a car accident I will go to a hospital. I will seek care. It is basically magical in terms of what we can do at this point in time with the level of technology we have for saving people's lives in that setting. However on the flip side of it are patients who have chronic illnesses. Chronic illness is basically the greatest health care crisis of our time in my opinion. We're seeing for the first time that we have a shorter lifespan expectation you know people's quality of life is completely disrupted and it really we really see it as threatening the fabric of our society as well as the health of future generations. And it's largely the problem is that there's a mismatch going on. There's a mismatch between our genetics is a mismatch between our biology and what we're doing how we're eating what we're doing in terms of activity what we're doing in terms of technology exposure screen exposure and how the health care system is really built. I think of the from functioning as the more we think of this model of a tree and came up with the outer leaves and branches where all of our specialists reside and most of what we do from a chronic illness management point of view is try to prune back the final manifestation and professional help bring down somebody's blood pressure try to control their blood sugar try to control information try to Camperdown the immune system in a variety of immune impotence that actually are auto you know with this and that symptoms symptoms symptom management. And again trying to prune back that final manifestation. What we do in functional medicine contrast to that is we try to look as far down that tree as we can. Right. So Dr. route's we're talking about the basic basic inputs what are people eating with the exercise and movement patterns like with their stress and resilience like sleep relationships trauma microorganism more clinic infection exposure toxins environmental pollution cetera that's filtered up through the trunk which we can think of as their genetics and genetic predisposition. There is that attitude. Police spiritual constructs and then from there it flows into starts to become this sort of core clinical imbalances which then results into symptoms. Right. If we're working way down that tree in the roots of the trunk the really fun thing from our point of view is that it almost doesn't matter sometimes what the actual diagnosis is because you're starting to look instead for common pathways and things like inflammation are immune to tribulation or mitochondrial dysregulation or Audo and the inactivation chronic infections are those things become core a unifying principle that we start to target and you can get to those from many different angles. So from a functional medicine or integrative medicine point of view you have this much broader toolkit and offers you a huge number of different modalities to the so.

Saul Marquez: [00:10:13] Dr. Schweig give us an example of one of those channel you could access.

Sunjya Schweig: [00:10:19] Sure. So patient comes in and the humorous way of putting it would be that the folks who come to the pope to come see the whole of the doctor the people who have a whole list of medical problems.

Saul Marquez: [00:10:30] Ha ha ha ha.

Sunjya Schweig: [00:10:31] Know. Yeah. So they might have a bunch of different Gushin has no issues cognitive impairments sleep disruption body pain chronic fatigue. Picture loading etc.. So we basically cast this really wide net and looking at a bunch of different lab studies and that can be costly up front. However what's really amazing is that if you invest that cost money upfront is that you get answers that again can reverse and hold people back from these chronic illnesses. So again we can see as wide that we start immediately with dietary intervention putting them on elimination diet. Coming down the information and on of the inactivation get them meditating. Get them all plugged in with our health coaches start working on lifestyles or working on barriers to change. And then by the time they come back to the second visit they've already started to see improvement. Before we've really given them anything to take giving them any quote unquote magic bullet etc.. I didn't change their mindset of wow now I do have ownership on this. I do have potential to shift the course of that. And then from that point we start to address the findings that we've seen on the left studies and almost always we start with the gastrointestinal system and adrenal system. They're trying to fix these regulations in those areas gastrointestinal system as Corbett has over 70 percent of our immune system reside there. And you know it's huge huge 70 percent anti you know if you think about the amount of information that our Musa's and that's the process in a given day the massive overwhelming majority of that is coming through our mouth Mios our skin experiences some our lungs experience some but you know in terms of just quantity almost most that's coming through our gut and our gut is really the interface you know the tube from our mouth all the way down to our anus is the outside world. Right. And so the gut is the interface of what does our body count and which is our body allowed to come in. That's working well in imbalance and we have good microbial diversity of our micro biota and the biome is half all body systems are functioning in a much better way. Howard says I just disrupted the downstream effect take effect over almost anybody. So again that pipeline you know get them working on themselves providing support. Start working on their start working on imbalances of various nutrients and vitamins et cetera and then tackle triggers tackle things that are keeping them in that regulates. And a lot of time we see chronic infections are at the root of that. So it gets complicated but again so so gratifying. On my end as the doctors do this work. It's wonderful to be able to give people hope and just yesterday actions. And then of course it's the outcome.

Saul Marquez: [00:13:18] That's so fascinating that dishrag and just thinking about it from the standpoint of you know we all know somebody or are that somebody that is struggling with an illness or chronic illness that you just can't find answers to. And so it's awesome to know that there's alternatives and holistic ways too. I laughed at your whole list but the reality is you know there are whole lists of things that people go through and what can we do to address those. So if you're listening to this and you know somebody I might you to go visit Doctor shakes eyesight's that's Charlie Charlie. Frank Medd Mediacom and he does a really good job of walking through what they do over there but what a great introduction to a different way. And so if the normal way has not worked for you or your loved ones check out what he and his team are up to. Okay maybe I would just love to hear Sunjya story a patient story confidential. No no names but the success that you have.

Sunjya Schweig: [00:14:26] Yeah absolutely. When that comes to mind is a 36 year old woman who came to see me and she had done a huge amount of international travel and across a wide variety of developing countries and had been mostly healthy had some exposures including a few frantic fights abroad even. But her main symptoms that she was experiencing was what her rheumatologist thought was rheumatoid arthritis. So knee swelling knee pain inflammation fluid build up to the point where you know she was having trouble walking she is having trouble walking from her home to the subway and getting herself to work and back and so we again did this really comprehensive workshop and we found a variety of different possible triggers. Again focusing on the. We found some despite all the organism some imbalance in her gastrointestinal system she had low IGDA in the globulin a on her gut. Signifying sort of an ongoing process that was causing harm to immune dysregulation over time she had a test that was positive for both intestinal bacterial overgrowth even though she didn't have a large amount of direct gastrointestinal symptoms. So some of these conditions can affect the gut and cause a ton of different GI symptoms from bloating gas IBS concentration diarrhea alternating pain NAHJ etc. cetera. How did some of that those leap of faith for me to tell are OK. No we have to focus here in the treatise. Interestingly she also had some exposure to some foreign pathogens including Borrelia Bergdorf rye for a causative agent for Lyme disease. And so our first steps for her was again to focus on her gut and to focus on balancing some other nutrients abnormalities vitamin D etc. And over time over the next six months it took time. It was a work in progress. She gradually got better. Her knees improved. She got to the point where she could walk without a problem. She knows Labutta. Yeah she knows the pain by the end of the week of no commuting. She was able to get off of methotrexate and her rheumatologists had prescribed so very compelling and we put her also on to some herbal protocols to cover some of the suspected tick point infections in the body is so complex it's not always clear what's the trigger. But with this really comprehensive protocol again she proved just a little bit up and down. Way I kind of look at it the patients a common practice is an improvement and then some drops kind of like two steps forward one step back. But over time and covering ourselves through those interventions retesting Zebo we naturally treat her two different times. Now she's at the point where she's been squeezed into great and awesome yeah. So here's this young woman. Had she stayed with the standard care she would have escalated up the career ladder she would have gone on to use more and more extremely expensive in the knowledge that Horrie drugs with potential side effects to her with definite side effects to the health care system. As you know she would have used more specialty care she would have probably gone on to develop additional auto immune diseases. Now we don't understand auto immune disease superwealthy in Western medicine but we do know that if you have one your chances of getting a second or third or more is much much higher. You know so her trajectory both in terms of her personal health as well as her cost to the medical system was very concerning. So with this sort of comprehensive approach again we were able to reverse that with benefit for her and the society at large and very exciting medicine.

Saul Marquez: [00:17:59] Congratulations to you and to her as well in her family for just this recovery. It's a really awesome story. Thank you for sharing that.

Sunjya Schweig: [00:18:07] Yeah you're welcome.

Saul Marquez: [00:18:08] And you know there's a question I'm sure in the back of the listeners minds right now. How do I pay for this. insurance is one thing. Is this something that you guys take. You don't take I know that it's a burden. I know it's burning in the back of their minds is burning in the back of mine.

Sunjya Schweig: [00:18:23] Absolutely. Yeah we are a direct to consumer practice. So we are a cash practice and the patients do pay the time a visit and unfortunately I think that's the way of the future for many different types of medicine not just ours. Now you hear a lot of different providers going that way because of how broken the system is and it's going to take some kind of major disruption to figure out how we're going to help people pay for their care. But the fact is that you don't really know anymore what you're getting with health insurance. Senator it's not until you go try to access that care order a blood test or order an MRI or see a doctor that you actually understand what you're going to pay. So my take on that is well it's probably a smarter move at this point to have an HSA type plan where a smaller premium you have a deductible but you can do that pretax HSA account and then you have a choice with your dollars with you with him and you're covered in case of a catastrophic emergency. But again you have that ability to think you're probably going to be paying for some of that care anyway. Right. So that's one system side of that. The other side of that super important question and it is unfortunate that it does kind of filter the care to the people who can afford to lay out that money and we're really trying to up and out and there's some colleagues of ours as well. Dr. Robin Beras in charge of the health care they have a really nice sort of monthly fee model. It's not unreasonable you know anywhere from 100 to 250 dollars a month to get services. We're working also to leverage technology and also health coaches so that we can offload a good amount of that care to a less expensive provider and or to a technological solution that then also provides more of a fabric more of a support system patients but there's also the health care system is starting to wake up a little bit to this. The best example of that is that the Cleveland Clinic one of our friends and colleagues Dr. Mark Hyman who's a New York bestselling author even Patrick Kennaway started the Cleveland Clinic Center for Functional Medicine.

Saul Marquez: [00:20:23] Nice.

Sunjya Schweig: [00:20:24] Toby Cosgrove of the Cleveland Clinic was very forward thinking and basically said what do you need. How are we going to make this work. Cleveland Clinic I think between 50 to 60 million dollars for this product. And the functional medicine center opened.

Saul Marquez: [00:20:37] 50? 60?

Sunjya Schweig: [00:20:37] 50, yeah.

Saul Marquez: [00:20:37] That's a serious commitment.

Sunjya Schweig: [00:20:43] They're believers. And if that clinic is completely booked up from waiting lists are struggling to hire enough doctors and staff to fill the need. And they're gonna be in the next one to five years providing us with more and more research showing outcomes and showing how this kind of care where you invest up front in the visit. You know the reason why it's costly is not because we're gouging the system is because we're asking to have more time with our patients. My new patient visit is 90 minutes. My follow up is 45 to 60 and our current system paves doesn't pay for time. And that's why the primary care doctors have to move people through in six 15 minute increments. Talking does it pay. Procedures pay that imaging pays allows that is pay but talk doesn't. And so you know in order to offset that cost they're going to provide that research that shows that this is the effective cost effective the invest upfront more time dig into these complex problems that you again prevent the cost to the system on the back end in exponential measure.

Saul Marquez: [00:21:45] Very cool. Thanks for diving into that detail and providing that example did not know that the Cleveland Clinic had done that.

Sunjya Schweig: [00:21:52] Yeah very exciting project. It's wonderful.

Saul Marquez: [00:21:55] And to have an institution like that backing care type like the one you guys are are rolling with it just that research that they're going to pump out that helps back up what you guys are doing. It seems like it's a really exciting time for this practice and this field.

Sunjya Schweig: [00:22:09] It's a very very exciting time. Yeah it's wonderful. The challenge is to find bandwidth to jump into all the aspects that need attention. Yeah very very fun time having a ton of fun.

Saul Marquez: [00:22:20] That's awesome.

Sunjya Schweig: [00:22:21] And that's basically that's the wonderful thing you know my partner Chris Gresser who's well known in the area you know he's developing a clinician training program galta and vote out and also a health coach training program the Institute for Functional Medicine trains doctors in this and over and over and over again you hear from these doctors and providers that there is burnout track. I don't know how I'm going to continue I can't keep doing this. I know you're.

Saul Marquez: [00:22:45] It's very real

Sunjya Schweig: [00:22:46] Real. They find functional medicine and they transition their practice and all of a sudden the lights come on again excited passionate real wanted. Yeah. So it's really fun.

Saul Marquez: [00:22:55] That's so cool even transforming a provider lives. Yeah that's exciting. If your provider listening to this. Something to think about. Wow. I'm just looking at the clock care Sunjya that time just flies. We're here to the end. So I want to do the quick lightning round with you. Wrap it up with just a couple of takeaways for the listeners. So we're going to do the 101. The ABC is of Dr. Sunjya Schweig and so I've got four lightning round questions for you followed by a book that you recommend to the listeners. You ready.

Sunjya Schweig: [00:23:26] I'm ready to do it. Right.

Sunjya Schweig: [00:23:28] What's the best way to improve health care outcomes treat the root cause and not just the symptoms.

Saul Marquez: [00:23:33] What's the biggest mistake or pitfall to avoid.

Sunjya Schweig: [00:23:36] We can no longer allow ourselves to believe that our current trajectory in health care is sustainable. They really really must act to change course to offer better care better solutions for both patients the doctors and the health care.

Saul Marquez: [00:23:50] So how do you stay relevant as an organization or a practice. Despite constant change.

Sunjya Schweig: [00:23:55] Yeah the word that comes to mind there is connection. You know I think that you have on many different levels a connection to myself and my own values our connection to my patients that we can anticipate their needs and connection to colleagues like yourself or other professionals even across this really diverse space in technology in AI and so in that kind of cross pollination I think it's beautiful.

Saul Marquez: [00:24:17] Love it. What's one area of focus should drive everything else in your practice.

Sunjya Schweig: [00:24:22] Yes this was kind of old school. You know I think service service to our patients are practitioners and our staff that's one of the most important thing.

Saul Marquez: [00:24:31] That's beautiful especially in this 6 to 15 minute world that we live in. As consumers we want service. And so I think Sunjya you guys are answering a cry for more. And so I want to acknowledge what you and your team are doing. It's so beautiful. And I know that it's resonating with your patients so I just want to acknowledge you and just say wonderful job.

Sunjya Schweig: [00:24:55] Thank you, Saul. I really appreciate that. Thanks.

Saul Marquez: [00:24:58] Absolutely. What book would you recommend to the listeners.

Sunjya Schweig: [00:25:00] I really would like everyone to take a look at the book my partner just wrote called unconventional medicine. It's a deep dive into the multiple aspects that we've been talking about here. And another book that's really resonated for me is Thomas Friedman's book. Thank you for being late it's a really wonderful deep dive into what we're talking about here with this healthcare issue with functional medicine and chronic illness management. It's kind of indicative of this age of acceleration that we're living in where we really have to shift much of what we're doing and how we're doing it on a societal level as we transition so.

Saul Marquez: [00:25:34] Outstanding listeners don't worry about writing any of that down all the show notes book links website links are available at that's S U N J Y A . So Sunjya this has been awesome. You can just share closing thought with the listeners and the best place that they can get in touch with you.

Sunjya Schweig: [00:25:55] Absolutely. Well again it's been an honor and a pleasure. I'm so glad that we had a chance to meet Health 2.0 last year. Best place to get a hold of me. You mentioned it previously at our clinic website my personal website is That's also my Twitter handle @schweig.

Saul Marquez: [00:26:14] Outstanding and a closing thought.

Sunjya Schweig: [00:26:17] Yes. So let's all brainstorm let's all work together. Let's all acknowledge that we need this kind of change and let's all work together to make it happen. Connect the dots.

Saul Marquez: [00:26:28] Love it. Dr. Schweig. Thank you so much for your time and excited to get this one out to the listeners.

Sunjya Schweig: [00:26:33] Awesome thank you, Saul.

: [00:26:38] Thanks for listening to the outcomes rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Thank You for Being Late

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Outcomes Rocket - Richard Chang

A New Artificial Intelligence Assisted Care Platform for Cardiologists with Dr. Richard Chang, CMO at Kencor Health

: [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. I invite you to go to to check out today's podcast and any other feature podcast where you can also leave a rating and review. We love hearing from our listeners because today and as usual we have an amazing guest today. His name is Dr. Richard Chang. He's a chief medical information officer at Kencore health and he's also an interventionist cardiologist at John Muir health. He's in San Francisco and he's got a really rich history of innovating and providing solutions within the cardiology space. And so we had a pleasure of connecting and it was Santa Clara for the Health 2.0 event. And so I wanted to have him on our podcast so Dr. Chang welcome.

Richard Chang: [00:01:10] Thank you, Saul. Appreciate the opportunity.

Saul Marquez: [00:01:12] Absolutely. You guys are doing some pretty cool stuff before diving into anything else. I was pretty intrigued by the work that you guys are doing at Kencore health. Maybe you could offer the audience a little bit about what you guys are doing there. And then we can dive into to the questions.

Richard Chang: [00:01:27] Sure well Saul you know as a practicing cardiologist we often recognize the challenges and difficulties of managing our patients and you know one of the largest segment of the patient population that's burdening the healthcare system or patients with congestive heart failure of heart failure that one diagnosis is the single most costly healthcare expense to Medicare on an annual basis. It's huge cost. Medicare 40 billion dollars a year just to care for patients with congestive heart failure. And so there's not enough cardiologist to manage all these patients especially as the baby boomers enter the Medicare age. It's just impossible to keep up. And so you know why not use technology and innovative ideas to more efficiently and perhaps more effectively manage and care for these patients. And so that's what we're trying to formulate at and Kencore health. We're using artificial intelligence home monitoring remote bio sensors that we can all integrate into a system of essentially trying to gather more information for the physicians in an efficient manner where it's filtered and presented in an effective way that the physician can respond quickly transmit instructions digitally through a secure encrypted Hippo compliant fashion and delivery of healthcare which I think is changing you know with telemedicine. We have the ability to videoconference as we are doing now and communicate effectively and without any confusion. I mean the old dynamics of Haitians calling the office waiting for a phone call back and medical assistance. You are consistently leaving voicemail messages in this ongoing phone tag. Health care is really something I think is going to change. And that's what we're doing. And courthouse were utilizing the digital biosensors the ability to track patients heart rate their vital signs or cannibal cardiac monitors that aid is also able to be there seamlessly and organized and most importantly we have designed a avatar on our cloud that functions really as a digital personal assistant. And so it has the ability to track patients schedule their scheduled medications their schedule doctor's appointments their schedules laboratory examinations that are required. And oftentimes you have elderly patients who have a difficulty just managing all of the aspects of their health care. And it's amazing to me that some of our patients who are taking a dozen medications. Yeah. And that challenge alone. So I think for patients who are complex medical chronic conditions the ability to facilitate to remind them we do also even have a prompt that allows us to tag a family member or tag a health care provider that is intricately involved in the patient's care to be able to be alerted when these aspects are not followed. That's what we're trying to do it Kencore health, the ability to innovate the way that we care for patients and obviously we did recognize it. The latest statements from Medicare for 2018 does allow for some reimbursement structure for digital health.

Saul Marquez: [00:05:04] That's really interesting I did about that yeah and it seems like it may be that bridge that helped you guys take that technology that you're putting together and actually make it to the point where it's actually something you could get paid for.

Richard Chang: [00:05:16] Yes I think the cost benefits of of a digital platform will be utilized more often in closed structures where there's managed care. The transition from volume to value based care. There's a push for accountable care organizations and I think the the main concept of targeting value is important. But I do think that what most in the healthcare industry have to recognize that the volume is not going away all human volume is only going up. So how do we manage that increased volume more and provide the added value. And I think the answer there is utilizing innovative digital technology and the ability to facilitate increased interactions more seamlessly rather than the traditional office visits.

Saul Marquez: [00:06:08] Yes. And you're highlighting some really great point here Richard. Just taking it down this path. What would you say is one of the main things that healthcare leaders need to be thinking about today.

Richard Chang: [00:06:18] I think the number one as a practicing physician for me the number one factor is how do we effectively deploy the healthcare. Everybody's talking about the efficiencies and the systems and the protocols and people are talking about metrics and you know I think metrics are really utilized. We spend more time acquiring the data or the metrics than actually delivering the health care. And I mean that's the number one priority that we should focus on. Sometimes the added cost really results in a superior outcome it's impossible or naïve I think to think that we can deliver a higher quality product at a discounted cost. It's just not going to happen. Everybody acknowledges that there are tradeoffs and in nations that have socialized healthcare you know in our country in the United States where we have the highest health care spending per capita we still have the most advanced technology the greatest medical care for multiple medical conditions. So there is some cost related to having superior outcomes and treatment strategies that are developed in our country.

Saul Marquez: [00:07:33] And Dr. Chang what would you say at this point right. You know you're going to have to layer in some cost and and get some benefit. What would you say to this point an outcome that can cause health has helped an organization or practice achieve to improve outcomes.

Richard Chang: [00:07:48] So for us you know we're a small startup so we began in a small remote outpatient part of your center and that heart failure center had been contracted with the local hospital because of their inability to have it outcomes. They did not have the infrastructure or the physician support or availability really because they're in a remote area and we were able to employ our platform to essentially digitize the care of the patients. And it allowed for a medical assistant and a nurse midlevel to monitor five times as many patients with out patients having to constantly come to the doctors office which was challenging for some because of distance transportation issues. Now for those patients in our population with lower economic facilities just making to the doctor's office regrettably is a financial challenge. Yes you know you have some patients who lack transportation and their ability to follow up and be compliant is extremely difficult. And so for us to employ our digital platform allow those individuals be able to communicate actively the changes in their conditions were able to effectively send instructions and a digital platform that did not even require the use of the phone. It didn't have to even have a landline. So we use a Wi-Fi enabled access through our system and so we can do video conferencing if needed as well as sending text instructions so that it's all digitized and they don't even have to write it down it shows up and pops up with all their instructions. So we were able to efficiently maximize the ability to monitor patients and the Schmit we were able to show that almost 80 percent of those patients had increases in their quality of life of life in terms of their depression their dignity level we assess all of our patients on a form initially with a Minnesota living with heart. Kushnir which has endured ordeal of life measure assessment that's used in most art dealer publications and we were able to show that use of our digital platform after three months improve their quality of life measures by more than 20 percent in a that without much more than increasing patience connectivity while decreasing the burden of messaging to the providers and the positions. So you know we pride a little bit of a filtered through the use of our artificial intelligence programming that interacts with action on the cloud.

Saul Marquez: [00:10:39] Yeah that's really interesting Richard and as we drive through this there's no doubt you mentioned earlier that volume is going up. It's happening right. Got the silver tsunami as they like it are the aging baby boomers retiring they're needing care. So the quadruple aim comes into mind where we're providing lower cost technology improving outcomes but so important as well as the is the aspect of the quality of life of the provider and being able to help all these people that are coming in just pouring into their office. And what are you going to do to help manage them better. And what are you going to do to improve your quality of life as a physician. Can you speak to that part of it as well.

Richard Chang: [00:11:22] Yes thanks. That's very important point. Saul I think that most technology or digital health companies really cater to the patients. Their background is usually Taq and corporate America which is very focused on customers. Yes and of course in healthcare I think a lot of times the physician is neglected as being one of those customers totally. And so our platform actually has facilitated all of these interactions and we have a provider dial or navigator platform which the assistant or the nurses utilize and for the physician there is a nice digital summary of patients complaint is vital signs as answers to some questions. Is medication profile. His latest laboratory results. All of that is summarized in a digital format or the position and the final step in terms of acknowledging the instructions that should be conveyed to the patient is embedded as a suggestion that our AI formulates and so of course as we have more interactions that would improve we're triggering or our AI to actually automatically send a recommended therapeutic change. Of course you know there will be some legal constraints but I think we will ultimately get to that point. The summary that's digitalized the physician just has to acknowledge can authorize or he can modify it and then send the digital instructions that alerts summary for the position is already document. He doesn't have to type a single word and then just Czarnik digitally sign. And this summary alert embeds into the electronic health record. So.

Saul Marquez: [00:13:12] Yeah. And you know that's so cool because a lot of physicians out of the 15 minutes that you get with the patient you spend half of it in EMR.

Richard Chang: [00:13:20] It's more than that time myself. And how is it I use a dictation is a dictation microphone. And I would say that quite frankly a 15 minute visit or utilize maybe five minutes to examine the issue and then I utilize 10 minutes documenting everything I've discussed with the patient or my findings on the exam. So I would say two thirds of my visit with the patient is struggling with the documentation criteria and clicking the right buttons on the EMR too just to justify the metrics. Right and so by using this digital platform I think a lot of the documentation acquirements we designed so that its hold in automatically and placed in a format where the physician really just does the last step which is the most important. Using your knowledge to make the recommendations treatment. And the only thing that would be required on the physicians part is usually sign off on that summary and the rest of it is added. So I think as a practicing physician I formulated it that way. We also designed a dashboard of Haitian compliance. There is a huge drive in the healthcare for physicians that's based on pay for performance. And I think those pay for performance metrics are often sometimes causing physicians to either game the system. They make cherry pick more compliant patients. There is some gaming of the system in terms of their abilities to try and increase their performance. Yes so they are not penalize and I think that negatively impacts those in lower socio economic status is you're less likely to take on patients who have a lack of resources and may have worse outcomes for which as a physician you'd be penalized. Yes and I think that having a patient dashboard that we've built into our platform digitized the ability to gather that information. We would be able to designate this patient does not have a car. This patient has low income and there will be factors that you can utilize to say why is this patient not doing as well as the other patient who has a personal driver has a caretaker 24 hours a day. And I think those are important aspects that we have to look at. And also for those patients who have all those resources and have a core compliance with their medications their diet the recommended exercise programs perhaps they should be rated. So we have that built into our platform to say this is a patient with core patient compliance and maybe that's why it correlates to their core outcomes and if they do have all those resources and are not doing their part maybe they should pay a higher premium for their or their insurance. If we penalize rather or habits why not a physician who gets blamed for the poor outcomes. You Know.

Saul Marquez: [00:16:28] I totally get that man and it's interesting right because within the platform it sounds like you guys also integrated a social determinants of health screening of sorts where you could factor in these things that may be a result of these factors that leads to decreased outcomes. And at the same time.

Richard Chang: [00:16:46] Yes we've had questions gender based questions ask it going out to eat dinner at a restaurant assess which restaurant you know to gather some of their behavioral patterns and their exercise patterns. And I think those are aspects of patient's health that other platforms are trying to achieve in an app based module. But in terms of physicians ability to have access to that summarized information I think is better facilitated through our platform because of the integration with care delivery and instructions of the professional delivery of health care rather than a consumer based product.

Saul Marquez: [00:17:31] Yeah. Dr. Chang I got a question for you then. So today it just going I mean it's almost all the way there but the days of a physician hanging up their shingle I'm practicing on their own are pretty much gone. So now you've got a lot of physicians as part of large systems that have processes and systems in place and contracts with large vendors. How do you go about sharing and spreading the great things that you guys are doing an already established systems or do you go a different route.

Richard Chang: [00:18:00] Yes so I think you highlight a very very important point. That is the biggest obstacle. People do not like change.

Saul Marquez: [00:18:07] Yes.

Richard Chang: [00:18:07] And especially large organizations who feel they have an established structure in place. No one likes to be told that they're not doing the best job right. And so I think we're just trying to highlight that utilization of our platform can really fuel and make their existing structure better. We're really trying to incentivize hospital systems to take a look at our platform to experience the efficiencies the patient satisfaction the patient engagement and importantly also the physician satisfaction in essence decision engagement on our platform. From what we've done in our small pilots we've had extremely good feedback. We have physicians who are calling their friends and other organizations and saying when when are we going to get an offer that say nice you know. And so I think from a physician standpoint we do have physician champions who are cardiologists who are essentially banging on the doors in the C suite and saying we need something we need to get and you know certainly the payment structure is not established yet. So our biggest hurdle is due to the hospital revenue cycle being as we all know it will slow. So the greatest challenge in smaller organizations that are more agile and the administrative structure is very streamlined. We see that we have tremendous success in establishing our platform and then having a little more challenges in the larger organizations with a more. Extensive structure seeking things approved. So I think the biggest test for us will come since our platform is so new we're acquiring all the data literally on a daily basis. And I would anticipate in about three or four months we would have a large organization be able to sign on after they use the data from our small sites where we have one or two hospital organizations utilize.

Saul Marquez: [00:20:11] Well that's really exciting you know and if you're a hospital executive looking to start targeting your efforts in failure clinics that you're managing. It's important to think about all the options and I started out rocket as a way to make a bridge between those creating some amazing solutions like Dr. Chang and his team and the people implementing solutions. And so my hope is that this conversation resonates with somebody out there and that you check them out because I really do believe that that the solution that they're putting together here is instrumental and could be really awesome as far as the quadruple aim and the things that you guys are after so you know at the end here we'll have a place where Dr. Chang could share the best place to get in touch with him and maybe a connections made and we find a synergy.

Richard Chang: [00:21:01] Thank you Saul appreciate that. I think Ken cornhole we have innovated and bring together technology AI traditional healthcare and seamlessly integrated them together to allow for a slightly more tech Ishant way of healthcare delivery. So if anyone's interested they can just go to our website can K E N C O R health dot com. And we have a contact tab then we're happy to engage anyone who has interest this issue and champions patients as well as hospital administrators. We've interacted with all aspects even relatives of patients have contacted us after seeing our platform and I think that is something that we're excited about.

Saul Marquez: [00:21:54] And it's beginning to resonate in indefinitely. It really made an impact on me when I was at the conference just learning more about what you guys did. So really thrilled that you were able to make the time right now in this part of the podcast. Dr. Chang it's a lightning round. I got four questions for you. It's that 101 of Dr. Chang and improving outcome right for questions lightning round style. And then we finish up the syllabus with a book that you recommend to the listeners. The first question is what is the best way to improve healthcare outcomes.

Richard Chang: [00:22:23] Best way to improve healthcare outcomes is to have a healthy lifestyle.

Saul Marquez: [00:22:28] What is the biggest mistake or pitfalls to avoid.

Richard Chang: [00:22:31] Being the greatest pitfall to avoid is becoming complacent with what you've done so far.

Saul Marquez: [00:22:39] Love it. How to stay relevant as an organization. Despite constant change.

Richard Chang: [00:22:43] Keep learning that is the most important.

Saul Marquez: [00:22:46] And finally what is one area that should drive everything else in your organization.

Richard Chang: [00:22:51] Patient care patient care should be the priority that drives everyone and motivates everyone to better than they are currently.

Saul Marquez: [00:22:59] Awesome. That's great. And finally what book would you recommend Dr. Chang for the listeners to read.

Richard Chang: [00:23:05] Well I think that nowadays there isn't a single book I would actually recommend that patients get on the Internet and search any health topics on their disease condition. That improvement in health literacy actually corresponds to better outcomes better age. And that's why I would not recommend a single book. I would recommend that you continue to educate yourself on the Internet on your medical condition.

Saul Marquez: [00:23:35] I mean that's a great tip. So listeners all the pearls that Dr. Chang has dropped on us today they're all available at that C H A N G. You'll be able to find all the show notes links to the things that we've talked about including his company Dr. Chang this has been fun. Before we conclude I love if you could just share a closing thought with the listeners and then we can say goodbye.

Richard Chang: [00:24:00] Well first of all thank you Saul much. Thanks to outcomes rockets. It's a pleasure for me to represent Kencor health`. My final thoughts I would say is that the most important thing that we do every day is taking care of mom and dad brothers and sisters and the health care delivery is about caring for each other and irrespective of what your your background is what you do what you have bailable to you as healthcare providers. We're always looking to achieve better care for your family. And I think that's what we're focused on it can help health. Thank you so much Saul.

Saul Marquez: [00:24:39] Hey it's been a pleasure and looking forward to seeing how you guys develop.

Richard Chang: [00:24:43] Thank you very much Saul. Really appreciate.

: [00:24:48] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

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