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Improving Access and Transforming Healthcare Delivery with Rosemarie Day, President of Day Health Strategies

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing healthcare thinkathon. That's outcomesrocket.health/conference.

Welcome to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I have an outstanding guest for you today. We have the privilege of welcoming Rosemary Day, president of Day Health Strategies. Rosemary has over twenty five years of health experience in the public private and non-profit sectors including 16 years of leadership experience in state government. Most notably Rosemary served as the founding deputy director and chief operating officer of the Massachusetts Health Connector where she played a significant role in launching the award winning organization that established the nation's first state run health insurance exchange. In 2010 Rosemary founded day health strategies to focus on implementing national health reform. Her company now serves organizations across the entire country that want to transform their approach to offering or delivering health care. She also holds a faculty appointment at Northeastern D. A more McKim's School of Business. Previously Rosemary was a chief of staff to the dean of Harvard Kennedy School. She also served as chief operating officer of Massachusetts Medicaid program and has held several senior leadership fiscal positions. She holds an MPP from Harvard Kennedy School and AB from Stanford University folks. She's got an excellent background to be diving into policy government. And it's our privilege to welcome Rosemary to the podcast. Welcome.

Thank you very much Saul. I'm delighted to be here.

So Rosemary anything that I left out there that maybe you want to fill in the guest on.

Now actually I think he really covered it. I appreciate that great intro. Very thorough.

Thank you very much. Thank you very much. Well it's you're definitely doing some impressive things when you go back to the genesis of it all. Rosemary what would you say was the catalyst that made you get into health care?

Well I think I had always had an interest in kin of some of the inequities in our society. And the question was where would I actually apply my energy to because there's so many opportunities where you could work on the issues and you could work on housing policy or you can work in healthcare any number of areas. And what happened was I entered state government and worked a lot of welfare reform initially. But the Medicaid opportunity actually kind of presented itself after I had different leadership. And I kind of left at it because I just saw that program size and importance and complexity as just being like the challenge. I wanted to take on. So I said yes.

That's awesome.

That's really where I got my start. And then it went from there. That's how I took the plunge.

That's fascinating now. And so you took the plunge in a big way. You've obviously you've served in many different capacities. Today, Rosemary out of everything that should be on the agenda of medical leaders would you say that one thing is that can no longer be ignored?

I really think it has to do with making sure that all Americans have access to affordable and quality health care. And I know that that can sound almost like a campaign ad but I don't want it to. I just really fundamentally believe that the best way to improve our outcomes is to give people access to that health care coverage. And we have made some pretty significant gains frankly thanks to the Affordable Care Act. But those gains are at risk of eroding and while we're starting piece with that. So I worry about how that will affect the whole system because if you are running any sort of business in the healthcare industry. You need customers and..

Right.

We need customers who can pay. And as we all know health care is expensive and not everyone can afford to pay for stuff out of pocket. So the fact that we've got no significant gap still today is something I think we need to continue trying to address.

That's a really interesting point. Rosemarie so what would you say some of the key areas of erosion that are happening?

I see it in two ways. One is just that some people who had insurance are losing that coverage or are choosing to stay choosing with quote are choosing to drop that coverage because they find it to be too expensive. If they don't have the benefit of employer sponsored insurance and they're buying on their own for the open market and don't qualify for subsidies, they're going to find the cost will be increasing at rates that that could be unsustainable for them. So that will force some folks to drop coverage. The other is that people who do have health insurance coverage are really worried about whether they're going to lose it if they lose their jobs and insurance that goes with that job. Could they afford to buy on their own or even even if they have employer sponsored coverage that's facing a lot of cost pressures a lot of the time employers are moving more of that the cost sharing onto their employees will so they see you know higher deductible health plans in other ways. To kind of lean in and it again that could start to be a bridge too far for folks who are living from paycheck to paycheck.

And there's a lot more of folks that are living from paycheck to paycheck than we like to think. And this is a very real issue. Listeners, if you think outside of your day to day this pool of folks that are uninsured and are looking to be insured is a growing number. Most recently as I recall there is a sort of a shortening of the sign up window and a decrease in the marketing budget for the government insurance programs. I think he went from 100 million to 10 million. It went from I think five months to maybe 90 days or 60 days. So you know other things that Rosemary is referring to are very real. Rosemary what would you say right now like with the practices that you're leading here with your firm is the key to making a positive change?

You made some good points about places that were the you know the Affordable Care Act. It felt some pressure it certainly as you said the outreach period kind of shortening it was actually down to 6 weeks though. I think there had been a plan for that to happen over time anyway even if the Obama administration had still been in office that they didn't want to get it closer to where commercial openable that periods are. But I think more significantly has been that the cost of insurance is going up so much because of a number of different things that have been decisions made by this administration to not support of the subsidies that existed under the original Affordable Care Act and also to kind of loosen some of the market standards. These are proposals that are imminently going to be coming out around short term health insurance policies that will kind of take have the effect of taking some of the healthier people out of the marketplace and leaving those in the exchanges probably the folks who need health insurance because of their health conditions a little more which can then increase the cost of that insurance. So there's a bifurcated risk pool risk that we're going to be facing and for a number of reasons a lot of uncertainty. Insurers say they find it hard to keep the prices down. And so that will hit folks harder. What I'm seeing though and this is what is so interesting in the world of of health policy is that state depends on always kind of swings and when the federal government is doing things that they felt like, they can look for ways to step up and kind of do some countervailing measures and that can happen with any kind of administration that. States will look attempted to counter what's happening and I think we're seeing some of the States stepping up to look at ways to shore up what was built in the individual insurance market. And that includes contemplating implementing a state based mandate and working with the state right now that is taking a serious look at that will came out last week with New Jersey just pass one and that's to mitigate the effect of the mandate repeal mandate penalty repeal that happened last December under the Tax Act which will also have the effect of driving up insurance rate.

Yeah that's really interesting. So the effort of states is definitely you're seeing it increase as far as trying to get the mandate back.

The mandate is probably one of the most controversial aspects but there are other things that get into that whole world of insurance regulation where state insurance commissioners have an opportunity to take a look at their markets and set their own regulatory rules around things like the short term health plan.

Yeah, that it's interesting. I mean as we think about the health of communities and populations there's no doubt Rosemary's point is so true that you got to give people access. You just have to. So what would you think Rose-Marie is an example of maybe work that you've done that's helping us get closer to that?

So I'll get to that with one second I want to make the point that you don't want your only point of access for people to be the emergency room because that's highly cost inefficient. And if you if your health condition is really a manageable chronic condition like diabetes, you don't want to manage that to the E.R.. You want to be able to manage that through preventive care and that's really where I think you make the case for coverage so that people can avoid those really acute conditions and be able to manage stuff at the front end. So that's my plug there in terms of..

Such a great point.

Yes. So the things we've worked out with organization is to help them to understand in this changing environment and there's policy shifts. How do they strategize about what's going to happen with their patient population and what's the best way for them to proceed in this kind of very changing environment. So we've worked with a lot of organizations to look at those kind of major political and market force changes and strategize around that. And I also really like to work with organizations around how they actually develop what I like to call their own maturity to deal with these kinds of changes and so we have a model that we use that allows organizations to kind of see where their strengths and weaknesses are. And that way we can hone in on what are the areas that really will get the work done to bring them up the curve of managing and as we say ever changing environment.

Well you're definitely at the heart of our reform there. Rosemarie and what has been one of your biggest takeaways in the many years that you've been involved in and this type of health care reform that you want to share with the listeners?

I think it's amazing. It's interesting that you can accomplish so much actually with very few people. And you know I had originally worked with very large government programs like Medicaid. But when we were launching the state health connector that first one out of the gate, we had a very small pool to begin with. And what we were able to accomplish with a small number of people but were extremely motivated to make something successful on a very tight timeframe. Having everybody energized and rolling the same direction it just kind of phenomenal what you can accomplish in that regard. And that that was for me kind of breathtaking to see where we didn't have the usual kind of larger organization bureaucracy and we actually had bipartisan political support. You could just accomplish a great deal with relatively few resources. So that was a big left word for me like how back is the living how that can actually happen and it was very exciting.

Now it's inspiring. And so when you looked in the rearview mirror of that when you're just like wow it doesn't take many but it takes committed few.

And not having people working at cross purposes.

You know the alignment piece is key right?

Yes, very.

Love that. Now Rosemary you've had a lot of wins on your record. Can you tell the listeners of a time when you had a setback and what you learned from that setback?

Yeah, it actually is kind of the other side of the when. So I would say the launch of our of the state's Health Connector here in Massachusetts and what that begat was with very exciting for somebody who started out as a policy student and thinks about the state of a laboratory of democracy and being able to seethat it had the potential to go even beyond our state which I didn't even imagine when I first took the job. But I think during the really rough and tumble of startup stage that we had and I was there for the first four years we got to a more stabilized place. And what was interesting in the arc of that of getting out of that crazy first year start out and more into like the way a real organization should run. Not putting out fires every second but trying to get a more sustainable low. I learned that there were people who were absolute that we brought onto the team who were just superstars in that very hectic kind of crazy stage of the year one startup and then when you got to a place where the organization started to run more and more I would call normally the way I was used to much more established organizations running. Some people were not as good of a player in that stage. Some people could make the transition and some people couldn't. And I it took me a little bit to understand that because I hadn't been through that transition before. And usually when you're giving people reviews you're thinking well they're so great at. Like they got us through year one but now we're like in year three. And you say, huh, OK. You know people can can be great at multiple stages but some people are really probably better for year one day. That was a real lesson learned for me.

And that's a really interesting thought too, right because if we're as we're thinking about these types of transitions you know health leaders wearing our hat. We've got to deliver on a certain metric or a project and Rosemary's point is interesting right because the person that could help you in startup mode really may not be the one that gets you through the next step. How do you plan for that Rosemarie. Like what suggestion would you offer listeners that are maybe potentially going through that change right now?

Yeah well I should also mention the flip side was there were a lot of people I tried to recruit who I knew were really great producers who didn't want to take the risk of coming to a startup and yet keep them in your contacts list because they may be the ones who are great for when you're more established right that they just weren't comfortable at the super risky stage and then kind of that Converse is what I was you know the other point I made which I think is just being aware that you need to kind of think about that risk takerness and it's been almost like a personality inventory and I'm not going to recommend one product or another but that at least in the back of your mind keeping out awareness of like it's not just the expertise around a particular knowledge set. Of course we needed that too. But that appetite to lead and manage through change that you're looking for and then naturally to sustain change. And I think it's OK to say well you know what. I'm glad we hired who we hired in the beginning because we needed them for the launch. There were a lot of people who just give or take that kind of thing on but understanding that you're going to need more and more for your leadership team and your need change.

Such a great call out and personally a big fan of doing personality and aptitude assessments when forming teams whether it be the Myers Briggs or shrink's finders whatever it may be. It definitely helps. And they always say always be closing but I always tell my my team always be interviewing and the Rosemary's point right if it doesn't work like you got that year three person and you're at the beginning keep them in your Rolodex.

And I think we are one. Yeah as got to say Rolodex not to date myself here but thank you for saying that.

I am old school.

I get it. I think that as you get to know people over time you get more you're able to kind of gauge whether somebody is just a really strong individual contributor or they're a really strong team player. And I think when you're doing crazy days in start u,p it was OK to have really strong individual contributors there wasn't even time and time to do really as a team. But over time you need to. So that's a quick gauge.

I think that's so great so great Rosemary great notes for our listeners that are leading organizations and building teams and businesses. So that's a great callout. How about one of your proudest Healthcare Leadership moments that you've experienced today?

I think it's really been the fact that we were able to successfully launch you know the Health Connector in a bipartisan fashion. And one day and that framework became a model that can be used across the nation. I wish it had been launched in a more flexible way so that states can really tailor it more because I do think there's such tremendous variation across states and we do respect that and have some national standards but not necessarily superimpose all that. So I do wish there'd been a little more of that flexibility but because you know Massachusetts Well we set out a framework. We can't speak for the nation on everything. I get that. So I'm proud of it. But I would be a kind of a man that asterisk say hey wish we could have made a little more flexible.

Yeah in retrospect but you guys did a great job obviously served as a as a template for the rest of the nation to follow. So you've left a really really great fingerprint on the way that things are done. Health coverage is obtained at the state level so kudos to you. Thank you so Rosemary. What's an exciting project. Our focus that you're working on today?

So you know there's a couple of things. One is that we have as a firm been looking at how to really help folks once they do have coverage. And I'm really excited about the Accountable Care Organization World and really trying to get care to be very patient centered and tool oriented and all those good things the collaboration to help patients manage their care across specialist and their primary care provider. We're excited to be doing that in Massachusetts actually to the state Medicaid program and that's just like this year. So that's been a base project we're working on and I think it's the life extension of get you know once people have coverage and really tried to help them use that coverage effectively to improve health. My also alleged to have two things the other project on a personal level that I really want to try to encapsulate what we learned from launching the prototype for the ACA and what we've learned and kind of this whole debate about in our country about health care coverage and really try to get this book together that will give people an action guide of how we can continue to make progress.

Very cool. Say a book on the horizon. I do love it. And you have a launch date or publish date?

Well it needs to happen in 2019 at some point. That's my goal. I can't pinpoint the day but it's an aggressive deadline and I'm just trying to find more hours in the day.

Well Rosemarie I would pick that book up. So when you launch it and I know the listeners would too. So let's make sure we get you back on because we want to hear about it right?

Fabulous thank you.

Absolutely. Definitely some some great learnings here folks. If you haven't had a chance again we're talking to Rosemarie Day. She's the president at Day Health Strategies. Very experienced leader in health care and also government health projects. You want to hit the rewind button if you missed the beginning of this because we definitely have been talking about some really value added things that you could be considering for building organizations and even the impact of the things that are going on with the ACA. Getting close to the end here. Rosemarie let's pretend that you and I are building a medical leadership course on what it takes to be successful. Let's just call it health policy today. The 101 of Rose-Marie day so four questions lightning round style followed by your favorite book that you recommend to the listeners.

Great, sure.

All right. What's the best way to improve health care outcomes?

Coverage.

Love the brevity. Haha. Love it. What's the biggest mistake or pitfalls to avoid?

Making it to pass work and confusing complicated and throwing in like skimpy coverage. People need adequate health care coverage, not stuff that's masquerading as that.

Love that. How do you stay relevant as an organization despite constant change?

You know I'm going to say people need to embrace change and I know some people are more change averse. But you've got to have a critical mass of folks on your team who are excited about change and want to learn so that you can truly create that learning organization environment. That's how you can be really successful.

What's one area of focus that should drive everything in a health organization?

I think the mission orientation to really truly improve health care whether that's a patient centered perspective or making it more affordable and accessible more efficient, better solutions through technology. Any of those kind of things that stay focused on that mission because you'll attract great talent folks who really do want to make a difference.

What book would you recommend to the listeners Rosemary?

So I know you originally said to many about your all time favorite book which is a super hard question to answer. I'm just going to focus it on a really great non-fiction book that has been on the bestseller list for a while now for good reason and that's called being mortal by Atul Gawande. And I don't know if he's had a lot of other interviewees mentioned this book but I highly recommend it. Atul Gawande has written a book that I think has gotten us out of the kind of unhelpful rhetoric around death panels and really into a place where we can have a conversation about what should be happening at the end of life. From a personal and you know a policy or societal perspective. And he was courageous enough to put it in the frame of the story that he could tell them not to her world practice but his actual personal life be to be his father. And I think when people are willing to personalize things like that who are you know as smart and informed about the broader issues packaging that into one book it's very accessible for people and it opens up the door for a lot more conversations both at your own family level and in a more systemic level.

But a great summary Rosemarie and yeah you know the book's been recommended by a few I guess but nevertheless the recommendation here from you cements it as a must read. So listeners if you haven't gotten to On Being Mortal by Atul Gawandi, you have to. This is this. Yeah. So if you want more information the transcript, links to the book that Rosemary suggested, links to her work and her site. Go to outcomesrocket.health/day, as in Rosemarie day, D A Y. You'll be able to find all the show notes and transcript there. Rose-Marie, before we conclude. I'd love if you could just share a closing thought. And then the best place where the listeners can get in touch with you or follow you.

All right well to find me and you can send me your link and my name Rosemarie Day and I'm also fairly active on Twitter both through my company and personally so @DayHealthStrat or @Rosemarie_Day1. So just a closing thought. I'm very struck by I think the power we have if we want to improve our health care outcomes and as I said I think coverage is a big key step to doing that. I think we can achieve that with the power of collective action and if the people understand how it pertains to all of us that will individually and collectively as a society benefit from putting more in that direction. I think that's really what I'd like to leave people with as a thought.

Some great shares there Rosemary and inspiration you left us with to not settle and find those people like minded that are willing to do what it takes to make these programs succeed. So really again just want to say a big thank you to you. Thanks for carving out the time for us. And we'll be in touch for when your book launches.

And thanks so much, I really enjoyed it.

Thanks tuning in to the outcomes rocket podcast. If you want the show notes, inspiration, transcripts, and everything that we talked about on this episode just go to outcomesrocket.health. And again don't forget to check out the amazing healthcare thinkathon where we could get together to form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is implementation is innovation. Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference and be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book:

Being Mortal Illness, Medicine and What Matters in the End

Best Way to Contact Rosemary:

LinkedIn: Rosemarie Day

Twittter: @DayHealthStrat, @Rosemarie_Day1

Mentioned Link:

Day Health Strategies

Episode Sponsor:

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Using Technology to Transform Healthcare Delivery Models with Matthew Fenty, Director of Innovation, Strategic Partnerships at St. Luke's University Health Network

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing healthcare thinkathon. That's outcomesrocket.health/conference.

Welcome back once again to the outcomes rocket where we chat with today's most successful and inspiring health leaders. I have an amazing guest for you today. His name is Matthew Fenty. He's a director of innovation and strategic partnerships at St. Luke's University Health Network in Philadelphia Pennsylvania. He brings passion and perspective to the dynamic intersection of health systems, life science and technology with a focus to transform health care delivery models through an innovative use of technology. A system search approach to design thinking and iterating on legacy business models. His perspective stands from a significant experience with healthcare and life sciences sectors spanning end to end healthcare delivery including translational R and D scientific informatics and analytics, due diligence corporate development product operations strategic planning and execution technical product management and digital health technology and adoption. I had the pleasure of meeting Matthew at a health care meeting and I was just blown away by his passion for health care and I thought man I've got to have this guy on the podcast and he was very generous with his time. So now I have the pleasure of welcoming Mr. Matthew Fenty to the podcast so Matthew welcome.

Well thank you very much. Not a physician that I wasn't playing early on but nothing more. On the technical side kind of behind the scene is the way to go.

Matthew you have a doctor and results in my eyes and that's why I wanted to call your doctor you know. But definitely a pleasure to have you on here. Matthew is there anything that I missed in your intro that maybe you want to fill in.

No I think you covered it quite well. Just one other comment. So we are actually based in Dublin Pennsylvania. It's about an hour north of Philly. But we do span this entire area. So you know one little while OK. Yes.

Now good clarification. Appreciate that. What got you into health care to begin with Matthew?

Yes sure. So you know health care has really been kind of a passion of mine you know going back to a grade school, elementary high school. I think a lot of the folks in your podcasts have always had that passion for health care either kind of behind the scenes or frontline medicine. It's always been a big focus of mine. And you know think about it in my undergraduate days very much focused on bench science kind of more analytical behind the scenes. I think you know kind of you or other some of your other guests thinking about going into medicine seeing where that takes and kind of taking a step back and say you know on the provider side kind of boots on the ground isn't the right path but there's a lot of opportunity a lot of I think work to use my skill set to kind of think about how do we improve operations and how do we improve the business and the kind of the nature of health care and medicine and care delivery and that's kind of really my passion. So kind of what you alluded to. I've been in the translational R and D side, at wet lab, pharmaceutical operations strategy. Now on the provider side and really I think there's a lot of opportunity to take those different perspectives and I think how do we fix and how do we improve this entire beast of healthcare delivery and medicine within the country.

Matthew that's such a great summary and appreciate you sharing that. Some meandering road that got you to where you are but very focused in your case. What would you say today is a hot topic that needs to be on every medical leaders agenda and how are you guys addressing it?

There's answers I can think of you know easily hot topics and precision medicine you know makes things like that early. I think one of our big focus and you know a big focus of mine is adoption and changing management and kind of supporting our clinicians, our leaders for change that's happening regardless of if it's new models of care delivery, new economic models of care delivery ways that we engage with our patients in a remote or virtual setting but it ultimately comes back and stems to how do we get people to adopt change and how do we get patients to think differently and help them manage their own health care. How do we get our physicians and our clinical teams to redesign what they're doing and how they deliver medicine. And a lot of it goes back to change management, education workload change, engagements by and support. These are health care types of issues. It's really you know there's a lot of change happening some mandated externally through policy but a lot of it is you know we need to prepare for how do we go back to care delivery and how we go back to the human touch of medicine. And it's a big effort. And you know I think if we focus on those outcomes like precision medicine and genomics et cetera we always need to go back and say How did we get this to work and how do we scale this within our health system?

Now that's really interesting Matthew. And what do you think is at the center of change management. How do you move the needle on that?

Yeah. It's a trick and it's really kind of it takes a team you know a lot of it goes back to organizational readiness and thinking about engagements of the people that you need to work with. And so it's communicating, its understanding and translating why change is happening. Think about why successful EMR launches have been so successful but is it because of the technology. No you can look at and read in the news a billion dollar or 500 million dollar failures in a very public launches. Mars, they think about the ones why things were successful and why things were not in my perspective my point of view a lot of it doesn't have to do with the technology or the systems. It has to do with engagements by and and communication. And if you can get your frontline staff and you can get your physicians and your administration and patients all kind of thinking about why change is important and health benefits them in a way that it makes sense in a way that they can kind of pull it in themselves. That's the only way that I think that you can really have successful adoption of new processes new technologies new ways of evidence based medicine protocol delivery. It's been able to articulate why something is changing and why say impacts me versus why it impacts you.

That's a great call out Matthew. And you stress that the beginning of the interview the importance of operational excellence and you know the theme that keeps coming up is just communication rank communicating the relevance of this the why and then the how. And you'll get to that end result that you and your organization are looking for.

I think you know we are it's an industry that we're in that you don't go into lightly and you're not. It's a very self-selective industry to be in healthcare and we're all in this to really improve patients. Now I want to improve experience. When my mother goes to the hospital that she has both the best care as well as the best experience,.

Yes.

And that her care team are physicians and her nurses and support staff. They feel part of the team are compassion and kind of the human touch is back in the healthcare. It's not a machinist on an operation it's not a process or checklist that this is really how do we get people to go back to the practice of hand touch, human touch medicine and you know we can do that with technology but a lot of it has to do with educating and get people to really think about compassion and empathy. And it's a lot of work and it's a lot of things that we all want to do and this is why we're in the industry.

Yeah it's a really great call and you know a lot of people talk about Matthew like hey you know what. Why can't health care be more like hospitality like when you walk into a hotel. The front line staff smiles at you and they receive you they take care of you, their service. Why can't it be more similar. Like what's the gap?

Well that's the million dollar question I think if you ask is you're going to get wildly different answers and you might ask a physician say a trauma doc in the E.D. his job isn't to make you smile, his job.

That's true.

Her job is to keep you from dying on the table and then they can think about there is the inherent difference of a sort of a pure service industry where at the luxury of that organization that they're getting that customer with think about the job and the goal which isn't really highlighted as much as it should be is to treat patients who are who are dying. It is to find the best care to support patients at the end of their life. There's ways that we are interacting and working with our patients and their families that is in a hospitality type of relationship.

Right.

Now with that said, we do need to think about how do we put the human touch and how do we make it more empathetic. So when patients are calling us and they're concerned about their bill, they could be thinking well you know maybe they lost her job or maybe their parents are dying or have recently passed away or maybe their kids you know just got diagnosed with something. And so ends up being you have to put that and retrain staff and retrain some of our any frontline persons to think about this is the most intimate point of relationship that you have with your customer with your patients with their family. And they don't necessarily want to be working with you. When I go to the doctor, that's one of the least happy things that I want to do in my day. Something's wrong. I feel sick.

I agree.

I or my parents in the hospital. It is a high stress, high type of emotional environment. So we need to make sure that our people are ready and equipped to deal with our customers and our patients in a high emotional type of setting. And I think kind of go back to your point, it's not going to be a hot the pure hospitality type of mindset. But choice how do we put empathy back into health care for anyone who interacts with patients or their families. Or you know with anyone who's part of the care team.

Now that's a really important distinction Matthew and I'm glad you brought it up. Definitely not a place where you go to get a smile. You get at a hotel right if you're broken they're going to fix you the bones or whatever you know your heart. So I think that's very very great distinction to make. But let's find the empathy. So can you talk to us a little bit about some of the things that you guys have done and maybe some examples or things you've done to create results or improve outcomes as it relates to this?

I mean sure, as you know as it relates to empathy you know a lot of that is. I wouldn't say that's that's innovation that's education. That's things like how do we get our patients to be able to speak with our staff in a non-clinical environment? It's having a patient centered forums and bringing in patients who talk about their experience to talk about their patient journey so that our staff can understand holistically what's going on when a patient either say a newly diagnosed patient with cancer or maybe someone who's recently pregnant. We want to know kind of what is what's going on and what's your journey and what's your experience like so that we can help reshape what we do retool what we do help kind of meet your expectations and exceeding expectations as well as provide the best clinical care and services that we can offer you. So when we think about things that we've actually done so you know we're really focused on our key patient populations ones that have very complicated patient journeys. Not your come in rate fixed types of things so could be things like your maternity or obstetrics types of patients oncology pediatrics states that are high super high stress and super ambiguity in terms of what's going on. So we're putting in technology we're putting processes we're putting in kind of people to help support patients in these care journeys in these kind of these pathways that they go through. So that could be from outside of technology innovation or profit innovation that's where managers and nurse navigators and kind of people helping you navigate all the different paths that you have to go through to come and see our physicians to see our care team. We're also technology enabling a lot of those services. We can think of patient journeys in unstructured in prenatal planning a lot of it is how do we ensure that we're providing digital access as well as physical access to our care teams so that when our patients need to access our services or have questions or have general anxiety about what's going on, they can reach us on the phone, text message, e-mail, chat, video-based. So providing multiple points of digital access to anyone who has a question or concern about their condition, their parents or themselves have a way to reach out to us.

Now these are these are definitely important, right? You want to make sure that you feel like you're not on an island as a patient. Sounds a yes I've been very mindful about how to give patients more than just one way of getting in touch digitally and physically. In your journey. Matthew have you had any particular setbacks that you've learned like key learnings from that you want to share with us?

You know I would say key learnings is the upfront education the upfront diligence the communication and with your end users and stakeholders, whether that's you know having focus groups of patients. Or having focus groups and kind of workflow sessions with your clinical staff or operational staff. It's thinking and being very mindful of what solutions you want to deliver as it really impacts and aligns with what is currently done now and how should we redesign that workflow in the future. We're then engaged into the future and if we don't have that by and if we don't have that strong operational engagement from whomever that end user is and there could be patients or it could be our clinical staff or frontline staff or back office staff. Having that by and up front as early as possible is the only way that you know be successful and we've had some the projects initiatives and pilots that now haven't been successful. And it's not because of the technology it's not because of the idea it's because there hasn't, there wasn't a clear expectations in the beginning, there wasn't clear operational buying. Now we might give a tool to a patient but if they don't know why or they don't see why it aligns with what they need it's going to sit on the shelf. And I think that's similar. You know regardless of industry, our job is to provide the best way that we can help deliver services in our physicians or our staff to our end users and our patients that we don't be very mindful. Be very empathetic and have those discussions with the entire value chain and people and things are going at work. And you know we're going to say well the technology didn't work or we didn't hit our end goals and our objectives. But really it goes back to the beginning, engagement, communication, by an acceptance of change.

Matthew great lesson that you shared with us there. And listeners and you know it's a great point and you can't throw technology on top of a broken process or a misaligned interests or lack of by-in you get to achieve all those first. And that takes time and I think a lot of us want to hit the easy button and just throw some technology on top of things and it doesn't work that way. And this message is really poignant message for not only providers but also technology companies and device companies life sciences companies, you can't just throw your solution on top of broken process, you've got to work on that. Get the buy-in first. What a phenomenal lesson to share Matthew, really appreciate that. So what would just say one of your proudest medical leadership experiences has been to-date?

Well it's really I think getting our organization thinking about change and thinking about what's possible and thinking about how do we collaborate and how do we make sure that when we're looking at change or we're looking at putting in systems or technologies that we're thinking about it holistically kind of enterprise wide or organization wide and not just individual hospital or individual service line or individual practice because you can think about where the majority of health systems were maybe 10 years ago. Smaller, fewer hospitals many more private practices kind of individual decision making and lack of coordination. And so where we are in our maturity of critical coordination. we manage you know 10 acute hospitals with more than 300 physical locations in our area and our patients are very tightly within our scope of clinical care. So by our very nature there has to be significant collaboration and coordination between all of our locations, Family Medicine specially allied health. And so having our clinical leadership as well as administrative leadership thinking about scale and how do we take a piece of technology or service or product and have that scale to multiple patients, multiple service lines and really you know one of our big wins. I would say is that recently we we're putting in a secure communication capabilities within our clinical staff that ends up just being secure text messaging and you can think about you know this is a market mature capability and this is the things that have been around for many years. But what we haven't done is really think about how do we look at communication and clinical communication as a network or as an enterprise type of function. You can think about where we were in many health systems where they are now of having individual points of communication routing messages to operators using pagers, being on hold for hours in a day trying to track down providers. And you're kind of your care team. What we did is say hey let's do a small pilot of 2500 people a base of a size and say we're going to put a piece of technology and we're going to get people thinking about what's even possible. And so going back to innovation, adoption. Sometimes it's it's very difficult to understand the value of a piece of technology or innovation until you start playing with it until you stop using it and the boots on the ground.

Then you can start getting people to say hey this is really important but if we tweak it this way and it's even much more important ten times as valuable so what we typically do with our with our pilots who are kind of we call Phase 1 deployments or phase of launches it's to get a very narrow core group of individuals checking out a piece of technology and saying here's why it will benefit our organization. And then they're going to be the champions. They're going to be the stakeholders and they're going to be the ones buying and selling it through their peers across the organization. So from a communications perspective we realize that this was a significant opportunity within our organization to improve all communications. Things like console's a critical page alerts like rapid responses in codes and milers Sroka alerts in a way that our clinical staff at the functions that we have are physicians cover all of our facilities. So you can think of a much larger system or even a smaller system where physicians are only deployed at one hospital. The nature of our area that our physicians cover all of our hospitals and all other services. So we need to be very tight and very nuanced in how we do communication especially when we do things like Kotzer alert. And so we are completely redesigning with support of our entire clinical leadership staff and operational staff. If we could redesign this in the future let's forget everything that we do now. What would it look like and it takes that level of buy-in innovation kind of help perturb the pot and kind of say here's what's possible. Then they going back operations say this is a great idea. This is how the ancient run with it.

That's interesting. So in your vision Matthew, what does it look like 10 years from now if you guys could build it.

That's a million dollar question. You know things are changing so quickly so you know you can think 10 years from now in terms of value-based care or provider rates contracting things like that that you know the economics of healthcare is incredibly going to be different. I think the way that we engage as a provider network, engage with our patients outside of the four walls of our facility is going to be drastically different. Now there's a lot of adoption of telemedicine, types of capabilities within health systems and in my view that's kind of table stakes at this point. So that's like Telad stroke, telecom faults, Kelud behavioral health and just the way that we think about the point that it helps us scale our physicians to hit a much broader patient population especially if you're thinking of things like stroke or.. Now we need to have that diagnosis instantaneously and maybe our patients and our way are two hours away from a physician but we need to make sure that we're doing eye care. So I think the way that the technology's becoming more mature that helps us scale are impact and our reach to treat and manage patients wherever they are either within our facilities or outside. And I think kind of lastly, there's a lot of technologies and lot of things that we're considering to improve just basic operations. So how do we streamline care delivery. How do we streamline documentation. How do we make sure that the encounter with your physician. You know it's not a permanent encounter whether it's 9 1/2 minutes of them typing on a piece of paper or typing.

Yeah, that's a great point.

We want to put that human touch in that connection back into the visit. And so what can we do from a technology perspective to streamline that to do as much of the behind the scenes as possible to let our physicians be physicians and let our clinical staff do what they're trained to do and what they want to do.

Now beautifully said Matthew you're asking all the tough questions and tackling some really pertinent issues. I'm excited to even continue the discussion outside of this podcast with you and because there's no doubt in my mind that you're thinking about these very difficult issues. Tell us a little bit about an exciting project or focus that you were working on today?

Yeah I mean I think I'll go back to the communications one because it's a valuable project. Really thinking about this is not just communications. It ends up also looking that if you're a physician, imagine a scenario where you're the E.D. trauma Doc and you need to find the on-call or the you need to do a consult with orthopedics and consult cardiology and consult with the behavioral health.

Yes, okay.

What we currently do and what most physicians do is what we call the operator they find who is on call and they might track down people. But what we're doing is saying can we blow up the entire thing and make communications completely self-service for staff. And so it ends up being how do we blow up our operator call center. How do we make all of our encore schedules easy to view.

Like a dashboard of who's available. Yeah.

So what we do now.

That's cool

So we have a dashboard also linked within our text messaging system. So right now you can text the hospitalist who's covering the 5th floor in a main hospital. You don't need to know who they are. All you needed knew as a physician I needed to reach the hospital who is covering the patient on the fifth floor. And so what we've done is redesigned the workflow to allow our clinical staff and support staff to be able to outreach and communicate directly with those types of clinical roles.

That's awesome.

So that thing is like our patient transport center or care management or behavioral health toxicology. So if you need to rapidly communicate with the One toxicologist who we have working within the organization, it doesn't matter where they are. You can send a text message to toxicology on-call and they get that message instantaneously wherever they might be.

Amazing.

So that allows us to completely redesign how we do things that console and patient transfers and transition of care between their hospitals and it's gold message, so it be. It allows us to shrink that time that it takes to make that clinical decision seconds or minute versus hours. So we don't think about this as an enterprise function or holistically. What are all the nuances of communication. And you just put in a texting system, you're only going to scratch the surface. So ends up being you need to get significant operational engagement from all of these different functional areas from different clinical areas that say hey, we need to be managing this and look at this big picture. And I think that's something I always push back to your listeners and to any of the innovations that we want to put into place. Is that how do we get the capability to scale enterprise wide? And what will it take operationally technically as well as boots on the ground and who's going to own it and how is it going to be governed. Because what we want to do is make sure that we have significant impact with the technologies or process that we put in place not just at the good presure release. Or it's interesting technology but there's no adoption there's no long term value. So we always want to push back and say operationally who's going to own this and how we're going to maximize the value of some of these technologies that we put in place. And without that buy-in that operational engagement stakeholder management that things are going to sit on a shelf or do nothing to be used to the fullest potential.

It happens so much things sit on the shelf so often that the words of wisdom that you're sharing with us today Matthew are just hitting home with me as I'm sure it's hitting home with a lot of listeners. Listeners, don't worry we're at the end of the podcast here. Matthew will share the best way to get in touch with them. It's something that he said resonated with you, maybe you want to collaborate with him. We'll give you the best way to get in touch with or follow him at the end here because we are getting close to finishing up today. I always wish I had extra time but these 30 minute slots are are short of that sweet spot and listeners, time frame commutes and all that.

They did go by quickly.

They do man. I mean it's amazing. So let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine operations, the 101 of Matthew Fenty. We're going to write a syllabus. I've got four questions for you lightning round style followed by your favorite book that you recommend to the listeners. You ready?

Sure, sounds good.

Awesome. What's the best way to improve health care outcomes?

Connection. connection with your patients, connection with your peers, connections with patient's families. Because it's a team effort and if you don't fully engage your clinical team and your patient's family and personal support team then things aren't going to work well. It could be things like did the patients get to the appointment on time. And so maybe it's you know it's their children or their parents are helping them doing that. So having that connection with everyone is part of the patients care team needs to be a part of it.

What's the biggest mistake or pitfall to avoid?

I guess the opposite going rogue. But really it's thinking that the patient knows what's going on. So you know personally I've been to the hospital before they get discharged in the emergency room when I've been to the emergency room. And you walk out the door and say what did the doctor want me to do. What would happen next and a follow up, when the next step, what do I need in terms of medications and going back to what I said earlier this is a high emotion, high stress type of environment that we put patients in. So thinking that the patient is a type A person who is completely literate know medically literate who is only focused on what is my next step. That's a big pitfall. So you have to be very empathetic of what's going on in the patient's head. Now maybe they don't understand, maybe don't speak English well maybe there's other things going on behind the scenes so not being able to sit in the shoes of your patient is. No I think going to be a major downfall.

Great point. How do you stay relevant as an organization despite constant change?

It's relevancy is I think a couple of different areas it's you know you have your clinical relevance and you're not seeing evidence based practice in medicine. And I think you know that's something that people takes for all health systems to have to do. I think from a from a technology side and innovation side here that's kind of the bread and butter within our organization working stage 7 organization most wired. So from an organizational readiness perspective and technology and how do we leverage technology is really in the minds and culture of everyone within our I.T. organization. So relevance, you know that's going to conferences that's listening to podcasts like yours that seeing what other organizations are doing and being able to think about how do we adopt that here? And it could be something for another sector to be from a consumer CPG, from end it from insurance from the hospitality and say you know that's a really interesting way of doing business. And that's a really interesting capability. How do we get that type of thinking internally? And I think that relevance is that always push for learning is relevant. Whether you're a provider or even if you're on the IT side.

Interesting, that's a very interesting point. What would you say is one area of focus that drives everything else in your organization?

Well from an organization perspective I think quality quality and access. So we very much focus on 3 pillars within our organization. Quality, access and cost. And so when we think about either technologies or clinical processes, there's a big laser sharp focus on how this is impacting or improving our patient access to our system. How improving total quality outcomes, long term outcomes, short term outcomes. How are we looking at value-based care and value-based contracting as well as how do we ensure that we are providing the appropriate cost. How are we ensuring that we're managing those costs. Because we do realize that I think as an industry that health care costs are going up and it is in our interest to ensure that we're providing a service that our patients and our customers continue to use and afford. It ends up being costs and price transparency as well as quality and clinical goals as well as access to services as always everything that we do either from a process or technology or innovation, always aligned to one of those goals.

Outstanding. What book would you recommend to the listeners?

That's a hard question. There's a lot of things I read that actually aren't books so a lot of like blogs from physicians, articles blogs, a lot of blogs from the venture space who have interesting perspective on healthcare. So you know I was always for an education or learn and read those types of blogs I can share with you some of the ones I check out weekly or monthly. It's a really interesting book. I really like the Google Ventures design Sprint book because a lot of it what that does is get people to think about problems and opportunities. And how do you articulate what you're trying to tackle and not trying to identify solutions. So a lot of what we do internally is exercises and discussions to really identify and need the value of a business processes to change versus what's the value of a new tool or new piece of technology. So that book really helps us kind of get that frame thinking and then I think on the other side I really like The Martian that's a fantastic book. It's really funny. I think it's a lot funnier than the movie with Matt Damon that anyone who has you know a couple hours to kill. You can blast of the Martian pretty quickly.

That's a good one. Matthew great recommendations. Listeners, you don't have to write any of that down. You could find our entire show notes the transcript today's interview as well as all of the Q&A and links to the resources that Matthew just shared with us. Just go to outcomesrocket.health/fenty, F E N T Y, it's Matthews last name. You will find all that there. So this has been so much fun Matthew. So glad that you made time to do this if you can just share a closing thought with the listeners and then the best place where we can get in touch with you?

Of course I appreciate the time on your show. I would always, regardless of where you are within healthcare either pharma, in a provider research. Think about we're in this for for us and our parents. Think about how does what you're doing is going to improve the experience for your parents or for your children. And so I'm putting empathy and putting that personal experience and personal touch in research or drug discovery or surgery or behavioral health or care management. At the end of the day we are treating our family and our friends and our neighbors and our community and healthcare is such a local type of industry that we're going to see people that you know work that come in. Are you their services on a daily basis. So we want to make sure that we always put that human touch a human focus back into what we do and that every decision should be based off how is improving our community and how this improving our neighbors.

Great message Matthew. And what would you say the best place for the listeners to follow you or reach out to you is?

E-mail me directly. I'm pretty accessible. I don't tweet a lot. I follow a lot of people who tweet a lot but my social media it's, also in LinkedIn or e-mail or just a phone call would be always the best way to reach out to me.

Beautiful. Well this has been a ton of fun. Matthew really appreciate the words of wisdom you've shared with us the tips on operations, the tips on just putting empathy first and some of the examples that you guys are doing there at St. Luke's, really inspiring. So keep doing what you're doing man. This has been a really fun episode. And we're looking forward to staying in touch with you.

Of course. Glad to help.

Thanks for tuning in to the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing healthcare Thinkathon where we can get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is "implementation is innovation". Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference. Be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Books:

Sprint: How to Solve Big Problems and Test New Ideas in Just Five Days

The Martian: A Novel

Best Way to Contact Matthew:

LinkedIn: Matthew Fenty

Email:  matthew.fenty@sluhn.org

Mentioned Link:

St. Luke's University Health Network

Episode Sponsor:

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Making it Easy To Sign Up for Medicare with Joseph Schneier, Founder and CEO at Trusty.care

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing healthcare thinkathon. That's outcomesrocket.health/conference.

Welcome back once again to the outcomes rocket podcast. Really appreciate you tuning in again. And I've got an amazing guest for you today. He's a health care leader that specializes in the aging population and how do we best optimize resources. His name is Joe Schneier. He's the co-founder and advisor at cognitive mission and he was also CEO for five years. Now he's off to his newest venture where he's the CEO at Trusty.care and at Trusty.care they're making it easy to sign up for Medicare Medicaid and Medigap. I'm really excited to have him on here. He was a member of the hive as well as other really up and coming hubs of medicine that really build leaders that grow companies to the next level and so I'm privileged to host Joe on the podcast and welcome him. So Joe. What I love is if you could chime in a little bit there on the introduction. Fill in the gaps that I have missed.

Sir. So I'm a serial entrepreneur. I actually started in the education space with a focus on behavioral change in the education space and about 10 years ago I got approached by some behavioral research scientist to start building out products for the digital hot space and in the beginning we were really sort of bridging the gap between those two spaces and then I made sort of the full leap over into digital health about nine years ago and since then I had the honor of doing some incredible work with researchers which the incredible part was on their site around drug adherence and addiction and then five years ago I founded cognition with my co-founder Jonathan Dariyanani and the mission of Cognotion center was to look at how do we solve the problem of the talent shortage in healthcare for the aging population specifically. So areas in the health care market where you're seeing these massive talent shortages. I spent five years working on that and then most recently founded Trusty in January of this year said brand new,.

Congratulations.

Yeah, thank you, I'm very excited. It is scary but exciting time of a startup. So yes, I guess that brings us today.

That's wonderful. And Joe, why did you decide to get into healthcare?

So I've had a real passion for looking at how you can get people to change their story about themselves to sort of drive behavioral change started with a focus on the cognitive behavioral therapy sort of focus to see if you get someone to start to say I can do something, can they actually do it? And in the beginning I was I was really looking at just direct applications in the education market things like early childhood literacy and didn't have health care in my mind at all. And there was a coach by this one researcher at NYU and she saw what we were doing in education and she had the first vision of bridging that gap and bringing us over in the healthcare space into the first products that we started putting out with her were designed to work with really complex communities. They were real disenfranchised and to see how we could positively impact them in health care and it was just a trial run from me I had no idea it was going to work. But the results were phenomenal and really caught my eye. And one of the things that's like a real driver for me is is that the sensors can measure what are doing and to know that it's actually effective and healthcare that so much clearer than it was in education. So I really enjoyed that piece of it and that was sort of what pulled me over the on into healthcare space.

What an interesting story Joe. And so you haven't looked back since.

Yeah. I've I've done some work on this side where we were still modeling out different components that we then folded back into our health care products and I'll just give one example of that. So we did a couple of products in hospitality that were also around behavioral change really with the intent of looking at how do you apply some of the components of hospitality to the healthcare space. We did them directly in hospitality to test them out there and then ported them over. So we've done some things in some other arenas. But I'd say 85 percent in healthcare.

Wow. Very interesting. And so I love that you have thought about you know what can we pull from hospitality into into healthcare because today we really don't treat patients as as consumers. But I also feel like we're heading that way. What would you say a couple of the insights that you gained through those projects were?

So the insight of at other industries and there areas of excellence is something that I've thought a lot about throughout my entire career because there's things that are assumptions and hospitality that are just not assumptions. In healthcare like if you smile at a customer in a hotel they're going to smile back and they'll pop and have a better experience. And so just like some basic things over there and looking at how we could for them over into healthcare. Now, some of that is really difficult in healthcare because obviously the dynamics are completely different and speed are different and the pressures are different. But there's actually more similar than people would think. There's a lot of really high pressure moments with customers. So that was one area that we really focused on was how to get people to navigate the emotional intensity of dealing with a customer. And then over on the other side with patients who were really agitated and how to sort of calm them down and move that into a different space there was one clear thing I guess that we we we worked on.

Yeah. It's really interesting. We definitely need to start seeing more of this as we transition into a more value based healthcare system is definitely important for us to start thinking about the people that we take care of as more than just patients. So it's super encouraging to see that you guys have worked on products in that realm. So tell us a little bit more about your current venture and the vision and sort of where you see this going.

So one of the things that happened in Cognotion as we were working on this talent shortage was I got to see sort of what it was like for the workers so we were not just focused on improving the patient but we also really wanted to improve the worker experience and one of the complexities in that company was that we didn't have as much control over what happened to them once they got hired. So my initial vision for Trusty was to look at who we create a system that would enable us to upscale people to work in the healthcare space to provide a value to consumers that was valuable enough that they would purchase it. And that's a tall order. And I think I think we've hit on something but we're still working out some of the pieces. But essentially what we're doing is creating this system that is a streamlined version of applying for all the kinds of government services you need in healthcare starting with Medicare and then Medigap and Medicaid. And the reason for that is sort of known to anybody who's ever tried to sign up for any of these things. But for those of you who haven't it's extremely complex and it's catastrophic if you do it wrong then the penalties and the things that can go wrong if you do it wrong can last for the rest of your life. We knew that people some percentage were going to want to use just a pure technology platform that sort of like similar to what kind of a Turbo Tax kind of thing. But we got the news people were going to want to talk to live people. And so we said why don't we create a new wall like a new health care roll that is like a Medicaid Medicare expert, a person who knows the ins and outs of that and create a new space. And can we look at other places in the market where there's a market need and develop worker groups that have value where the salaries could potentially be higher than they would be in other spaces. So that's sort of evolution has going in that direction of again providing a real benefit to our customer but then also looking at how we can get more people into the space because it's really necessary.

You're asking some really great questions Joe and you know it's interesting how you've approached this, it's kind of taking a look at the market need. I mean give you an example I recently had a colleague retire and she was just trying to figure out what to do with her Medicare Medicaid and it was confusing and she didn't know what to do. And it was a very opaque process. And like you said there is always if you do it wrong could be detrimental for a very long time. And so I think you're definitely on to something here Joe and the other thing that I really liked about the way you're approaching this is searching for a market of underutilized workers and so very cool approach that you've taken here for I think a segment of the population that's going to be needing more and more of these services.

Yes. And there's one thing that we know after working in the states is that the aging market will really need some smart minds to be focused on it. I don't think that we know how much it's going to impact the economy over the course of the next 15 years but the numbers are staggering and we're already sort of behind the ball on it a little bit. So we're trying to get out in front of that a little bit. I think there's a lot of room for innovation in this space and people are looking at the space from different angles.

Yeah and you're definitely taking a really great crack at it. Just so can you describe and I know you guys are early on with this one but maybe share a story from Cognotion of a time when you guys created results or improved outcomes by doing things differently?

Sure. So I'll give one example when we early on in the company got hired by the Ministry of Health of Saudi Arabia and they had an RFP that they basically put in front of us because nobody else would take it. About four years ago I guess it was the height of the Ebola issue, right. And this was four weeks before the HOZ where millions of people were going to descend on Saudi Arabia from Africa. And they had done no preparation with the country to prepare for what could have been an outbreak in Saudi Arabia. So they asked us to build out a complete training program for all of their medical professionals and staff a call center for the ..that had to be aligned to the CDC standard of which we're changing every single day at that time. So we had to create this whole system like very quickly that had to embed in it the information had to be presented to the doctors and the nurses and orderlies in a way where it would really stick because the consequences of us getting it wrong could be just terrible, right? So we can't say for certain you know this is all attributed to us obviously but there was no Ebola outbreak and the use this did function exactly as it was supposed to do. That was one thing where we felt like, hey that was what was good. So that was sort of a larger one but then we've had a lot of other really interesting successes so in part of our program was training people to become certified nursing assistants. And one of the first things that we observed was that there's a real problem with retention which is a known thing but people haven't really looked into in detail why that was happening. And so we spent a bunch of time just following and CNN's around and realized that a big reason why they were leaving the job was for things like dealing with racism or dealing with families like screaming at them or time management and some things we can control or preparing them emotionally to be able to deal with those things. I was told that in a much higher retention rate with the people that we've trained. And it's surprising. It's like all you're doing is showing people that they are capable of doing this thing. And then when they show up if they've already gone through it and some of that we've had the theory that we based on a lot of work that was done in the military. They've really pioneered a lot of this type of training which is kind of odd. But yeah but it's effective.

That's fascinating. And there's been a theme here Joe and you know in our conversation but also in conversations that we've been having with other health leaders that are having success. And that theme is that in healthcare, true innovation is actually amazing implementation. So if you could implement things well then you're the innovator. And there's no doubt in my mind that you're a master implementer. What's your secret?

I again don't give up, my secret. I think I think I joke but not completely. I think that a big mistake that younger entrepreneurs make especially in seeing this in digital health is thinking that they've come up with an idea and that they have a brilliant idea maybe they work in healthcare even they have a brilliant idea, they see a problem a build something to solve that problem and then they try and push that solution onto the system and it doesn't really work that way. It's a lot of like a feedback loop of iterating and iterating and iterating both on the product itself but also on the business model and sort of looking at how you can have the entry points that are actually going to stick. And I think that if I could say anything to myself from 20 years ago that would be the thing. Don't think you're so smart from the beginning. Look around it okay to take in new information and phase shift accordingly. And even with Trusty we started out with we we were very clear we're like we have a very clear idea of what we're going to do. We tested it for two months and realized that out of the 40 things we thought we were going to do 39 of them had about 600 a hits. And one of them had 15000.

Wow.

So even in this short period of time we had to come. We said OK I guess the market is speaking to us. So I think that that kind of thing as not not being afraid to go where the market is leading you.

What a great message. Listeners, if you didn't catch that, I would recommend that you hit that rewind button. Look one with 15 seconds and hit it about three times and relisten to that because I was gold right there. Joe appreciate you sharing your wisdom there. There's no doubt that it's it is a pathway to make these ideas work because these things are not going to work on the first run. And so did you just put your ideas out there through like Google Ad Words or how did you get the hits.

So with Trusty we're we're looking at two different models of selling either to end enterprise with partnerships which is a long road and we knew that because Cognotions sells to skilled nursing facilities and those are very long sales cycles. We also wanted to see if we could do direct to consumer and our initial concept was really much broader than what we're doing now. Initially we had thought well all get people connected with the entire ecosystem of people that can help them as they're aging from eldercare lawyers to financial advisers and caregivers. Sort of a one stop shop which would have involved a lot of build up of a two sided marketplace where you're getting in workers and consumers which is very difficult. But we were like, Lets put this out there. We tested using Google Ad Words, Facebook, LinkedIn we also went to different message boards where users were located and did some advertising there and then did some advertising in person saying you know what kind of word of mouth effect we could have.

Could be generated.

Yeah. And so it was really it was really interesting. There were a lot of reasons why I said data makes sense to me now is that out of all of the different services almost everybody was asking about how do we navigate Medicare which we had put in almost as an aside because you know an interesting thing I was like I was like oh let's put that in a friend of mine said that that's a problem for her. I'm very grateful for her.

That is amazing. Great thanks for sharing that. Yeah, and listeners, you got to listen to the market right, and be persistent and much to Joe's great example and walking us through his process. I mean it's so key that you don't just put it out there if you build it, doesn't mean they're gonna come. And so, Joe thanks for walking us through that. That is a very helpful lesson.

Absolutely.

So share with us a time when you had a setback or a failure and what you learned from it?

There are so many. So I will give one particular failure which is sort of built on the last thing that I was saying know so about six years ago we've built out a product and it was in the foreign language space. And so again this is one of the side projects. We raised a significant amount of capital for it. We saw that there was a clear problem and the problem that we were trying to solve was that Americans don't believe that they can learn a foreign language. So we said OK we're going to create a system that is going to be really effective mechanism to learn a foreign language spent a ton of money on it spent a whole year building out this program. At the end of the program, we won all these awards for it because the people in the industry thought it was great. Nobody bought it and it was one of those things where like it's beautiful. It's in an ideal world. Now people would use it. It's really great but are they going to buy it. Probably not because it's not it's not essential. And I think that that lesson is sort of what has you know whether it was a real moment of understanding that you, like it doesn't matter how many times you've done it I've already had to exit that at that point. It's easy to forget the humility of like you don't know anything until you see stuff actually happening. And that was a big one.

And Joe thank you for sharing that you know I mean I've been in that in those shoes before as well and what was the miss on that one?

A couple things. So the first one was our channel partner that we had a distribution deal signed before we started building. So we thought it was a sure win, a large distributor. One of the largest publishers in the country. What we didn't realize was that for them there was really no incentive to push it because it wasn't going to drive their sales, the individual sales people would get such a small incremental increase. There was no benefit to them. So first of all our sales channel was not incentivized. Secondly, people were not purchasing foreign language products in the school system as much as they said that they would wanted to. So a lot of times people say that they want to purchase something but if you don't test to see are they going to actually do it then it's not really worth it. I think that with the second and the third piece and I think that this isn't really applicable to digital health is that there are a lot of things that seem nice on paper but if they add time to teacher's in this case as day or doctor's day it doesn't matter how good it is, they're just not going to do it. And I think those are the three components and the time factor is I think a thing that gets really overlooked especially in healthcare.

What a great call out. Some great lessons there. Joe, how about the other side you took us to the darkness. Take us to the light and tell us about one of your proudest leadership experiences that you've experienced to date.

About two years ago. We brought in a man named Dennis and we're in New York based company, Gary, LGBT friendly very diverse. And Dennis is from Kentucky he lives in Kentucky, is salt of the earth. But very sort of from Kentucky person, one is like best people I've ever met in my life. And so if we say ironically that he was our diversity.

That's funny.

He hadn't been the sales person. He had run some nursing home himself but he had just this really great touch. And we had this idea of what if we hired people from the region they were selling into and see if that would work more effectively. And watching him grow into his leadership role and seeing him close our biggest deals, I mean it's just beautiful when you have that happening. It's like if you have kids and you see them surpass you it's just a great feeling to see that somebody brought on who didn't even know if they could do something steps into their strength and it's resulted in the biggest sales for the company. So the both of those things. It's more that I'm proud not to visualize that but I'm proud of actually doing something. But I but for sure.

That's great. You know Joe that speaks to the leader that you are. I ask for one of your proudest moments and you go to in a moment that you know was obviously good for your company but it was seeing this person grow and listeners if you catch anything from that. You know you've got to be very focused on both your business but your people because if your people are doing well so is your business and and Joe you identified an unlikely person as it related to your firm but you did it in a very very eloquent way and you've found a way to make it work for you guys.

Yeah I mean he's just one of the best people I've ever met him.

That's awesome man. So tell us a little bit more about an exciting project or focus that you could tell us about within your current venture?

Yes. As we started mapping out what it is that we're working on it became clear that the problem that we're trying to address is something that will benefit anybody in the country will benefit from and that the deeper that we sort of dove into it the more that we realize that this is a pretty green field and that is pretty exciting. So it's pretty rare as an entrepreneur to approach a space and to see that innovation could really be applied to a large market and that there aren't a lot of people already doing that. So I would say that's pretty exciting and part of the reason why that is the case is there's still a lot of the holes around the data have changed and have gone into effect in the past couple of years. And then there's a lot of interesting things happening related to Medicare because of the tax code and the new tax bill and how that's going to change everybody's plans. So I get really excited when you see a big problem that is a crazy complex puzzle but then you start to sort of see how you can map out pulling together different fragmented pieces to create a simplified solution. That's my that's the thing that really gets me going and is motivating to me and the other thing that I'm really I guess I'll say just a quick brief personal story about why this is meaningful. So about a year and a half ago my brother a year younger than me got into a severe car accident and he is fine now.

Oh,Thank you. Thank God, that's glad to hear.

I remember telling people that he's on the road to recovery. He's OK but he broke his neck, shattered his pelvis, broken his jaw. It was just he was a disaster, it was horrible and he lives in Nashville and I flew out visit him the next day the next morning since I could get the next flight and the surgeon comes in that morning and he looked at me and he said well it looks like we're going to have to release your brother because he doesn't have insurance and he still needed more surgeries. So we were of course like yeah no that's not going to happen.

Right.

Those two things happened in us, we had to go through all of the headache of getting somebody signed up for Medicaid retroactively. You're out all the system try to figure out how he could get the care that he needed. Meanwhile like is he going to make it and going through that experience of realizing like how the complexity of bureaucracy intersects with people's lives. My brother was lucky he had me, he had my parents there advocating for him but a lot of people don't have that. And so when they go to face signing up for these different offerings that their government has for them it's just daunting and overwhelming. And in that case if he hadn't have that. Who know what would have that would have happened to him. So for me the idea of being able to address something that is a real technical problem really. It's like a system problem. Yes but that it will have that kind of impact on families lives. It's a rare opportunity and I'm pretty excited about it.

That is super exciting Joe and I'm glad your brother's doing well. And it's sort of the silver lining in this whole thing is that this hardship that you experienced that your family experienced in your brother is now going to be the beacon that helps others make it easier for them. So supercool.

Yeah we're pretty excited.

And that's awesome. I mean I'm so thrilled for you and your team definitely looking forward to following you guys. Getting close to the end of the interview here. I always wish that I had more time. But all good things must come to an end as well. Close this interviewing. So this is the part of the interview where we do a lightning round. I've got four questions for you and we're going to follow that with a book that you recommend to the listeners. So this is the little mini course that we're putting together for our listeners it's the 10 of Joe Schneier and so on how to be the best in medicine. So here we go. What's the best way to improve health care outcomes?

Transparency. I think that that's the biggest thing that needs the best in the market and with companies and the whole system.

What's the biggest mistake or pitfall to avoid?

Thinking you can sell easily into hospital systems.

I love that.

You can but it's possible. I've been there..

What was that?

It's possible.

It's possible, that's right, good distinction, good distinction. How do you stay relevant as an organization despite constant change?

I think that .. this shift between big data to rich data which is kind of just you know jargon that people are throwing around but really looking at how do we use all of this data in a way that keeps it relevant. And there are lots of ways to do that. Now there hasn't been a time before in the past where technology has it where it hasn't been easier than it is today. So I think that's the biggest thing.

What's one area of focus should drive everything in an organization?

That's an interesting one. I think for us and this is just for me on my surface will be relevant for others. But I always try to remember the humanity of the people I work with and the people that we're serving and not forget that there are real people on both sides of that. And I think through that you can really develop great products that keeps you closer in touch with your customers. It gives you a better feel for what they are going to want. But it also is just a better way to live I guess.

Totally. What a great share. And Joe what book would you recommend as part of the syllabus to the listeners?

I really enjoyed reading the book, An American Sickness so I highly recommend that. I am not good with names and don't remember the name of the author, I'm sorry.

No problem.

It gives a really good overview for people who are not professionals in this space about how the healthcare system in the U.S. got to this point. And it's quite good.

An American sickness and I just like that up listeners it is Elizabeth Rosenthal. So there you have it some amazing recommendations from our friend Joe. Don't worry about writing any of them down. Just go to outcomesrocket.health/trusty and you're going to find all of the show notes, a transcript as well as the best places to get in touch with Joe. So Joe what I'll do is leave it to you to give us a closing thought. And then the best place where the listeners could get in touch with you.

So my my closing thought is just that there is definitely desperately in need of great minds that are willing to look at how do we solve real problems that both sides of the equation need both the doctors as well as the patients and especially in the aging space. It's not a space that seems sexy but it is one of the largest fastest growing areas of the industry. And I am looking for smarter people to come alongside us and join up with this. And I can be reached at. We've got a Facebook page. That's your trusty care or feel free to reach out to us. My email is joe@trusty.care.

Outstanding. Joe this has been awesome. This has been insightful and we really appreciate your time here on the podcast.

Well thank you. It's great being here.

Thanks for tuning in to the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing healthcare Thinkathon where we can get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is "implementation is innovation". Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference. Be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book:

An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

Best Way to Contact Joe:

Facebook Page: Trusty Care

Email: joe@trusty.com

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