Category: Healthcare Leadership

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How to Improve Your Sales Strategy and Results in Healthcare with Will Richter, Senior Director at IQVIA

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. Today I have a treat for you today. I've got Will Richter. He's a senior director at IQ via. He drives revenue for healthcare technology and med device companies by increasing their sales volumes reducing their operational inefficiencies and crushing the competition. Will has the unique ability to find the blind spots in any company's sales process and can turn around a growth plan of action and a winning culture and less time bring in bottom line results faster. And as we all know in healthcare, this particular area of expertise is key to the success and the lifeblood of any company looking to move forward with their solution to help improve outcomes. So one company for example he served went from 0 to 36 million dollars in six years resulting in the organization being acquired by Boston Scientific another company that he built a Nationals team for went from 0 to 21 million in just 23 months resulting in massive profits for a stakeholders and improving patient outcomes. So these are a couple of things that Will has done and the topic today is really around sales and how to improve that for your company. And without further ado just want to extend a warm welcome to Wil Richter welcome to the podcast my friend.

Thank you Saul, great to be here.

It is a pleasure to have you here my friend. So what would you say got you into the medical sector Will.

Well it's actually an interesting story I think I'm a bit of an anomaly I think some people kind of grow up or have a point in life where they realize hey I want to I want to be in health. I wasn't like that I was in college struggling to pay my bills and put myself through school and I had an inside sales job. I knew I was kind of good at it. The success came kind of naturally and quickly for me. And while I was in college I was in a fraternity and I got to be in a leadership role within that fraternity and work very closely with an alumnus from our chapter who helped us with our philanthropic endeavors and helped us raise money and things of that nature. And so he was such a buttoned up solid individual. I always wanted to know what he did. So one day I asked him 'what do you do? And he says well I'm a regional sales manager for a cardiac company. And I was curious 'what does that mean? What you do? Well there were implants that go into patients bodies in the operating room and I said Is there any way I can be a part of that. I was fascinated.

Yes.

So he let me go on a field ride with one of his reps and she took me to a few cases. And ever since that day I knew for a fact being in the OR, seeing these implants go on. I was just fascinated with the human body. These implants the healing process patient, outcomes, clinical data the light switch went on and from that day I did everything I had to to find a way to get into the industry.

That is so awesome Will, and I could hear the passion in your voice from that first time that you got in there. Even until now you know we've had a chance to really connect here before the interview. That passion is what keeps the lights on for you. Now with the experience that you have bringing these companies from zero to double digit millions. What would you say is is something that health leaders need to keep in the forefront like what's this hot topic that they need to be thinking about?

Well as you know Saul, today there's a million topics. I'm actually think of it as an answer that kind of from two sides of the fence. So if you're on the med device, pharmaceutical Medtech side, I think that leaders of those organizations need to start thinking differently and think about how they can leverage AI or some form of artificial intelligence to better manage their supply chains to their claims processing and just overall run the organization more efficiently. Is the technology's here now and it's starting to change the game. On the other side, if you're on the hospital side of the industry or in a leadership role within the health system, I cannot stress this point enough and that is if you're listening' you're in a leadership position in a hospital. Start hiring experts from outside of the industry because I can't tell you. And Saul, I've worked with dozens upon dozens of hospital systems all over the country and I've seen a pattern of them all and that is that someone gets hired in the hospital X. They post up for 10, 15, 20 years in the environment become so stagnant and the people become so complacent that the word change kind of becomes like the number one enemy and it's killing the success of the hospital. So my advice to hospitals would be to stop hiring a bunch of academians over and over and over who started hiring business experts who have been successful in the B2B world bring them in, listen to them and allow them to do for you what they have done for other companies.

Some get feedback farewell and there's definitely opportunity for cross pollination so to speak of business and providers and physicians to really bring about those results that we need. If you're going to be wanting to have different results you get to do things differently. So folks take a note there from Will. So Will as you work through the technology you guys offer at IQVIA, maybe you could level that with the audience, let us know what you guys do there and then talk to us about how you're improving outcomes and results by doing things differently.

Okay. So I'm on, there's the clinical side of healthcare. Then there's the business on health care. I happened to fall into the latter, on the business side. So with the entity that I'm working with today, we're in the business of consulting with hospital systems to teach them how to think differently and leverage big data to make business intelligent decisions strategically based on facts and data just pure numbers and will not give me an example. So now we're kind of in an era where hospitals want to acquire physician practices and then own those physicians as employees but purchasing a large physician group as you know when their patient load is a very expensive endeavor. So the position group will show their side of the accounting books. But if a hospital system leverages our third party claims data, we can tell the hospital the actual patient volumes. We can show which of those physicians performed which procedures at which locations how much each visit or procedure builds out and so that the health system can actually see the real data of what the value is of that position group rather than just relying on the books that the physician group shows them.

Gotcha. So you are providing that that valuation those optics to really vet out the valuation rather than just going blindly.

Correct. It's it's really amazing. And you've seen the industry change. We've been in it a long time also. The data is becoming more and more relevant and everything is being collected, big brother's kind of unfortunately or fortunately watching all of us. So just know that it's out there that just like companies in the B2B world, our hospital systems are starting to leverage it too.

Absolutely. Now folks again speaking with Will Rector. He's senior director at IQVIA. Walking us through how him and his company there are helping provide optics for physician practice acquisition. There's been a ton of waves of acquisition happening right now even payers like United Healthcare purchasing up the physician practices. So there's definitely a big move here. Well in the experience that you guys have had, can you give the listeners an example of of maybe a mistake or a setback and maybe a client of yours or or you and your firm experienced and what you learned out of it to help the listeners avoid that.

Yeah, absolutely. I'll just think back to my career as a whole. I've actually had failed many, many times in my life and I'm a big believer that you are either winning or you are learning. And I don't look at the family is failing. I just look at it as an opportunity to figure out hey what did I do wrong and how can I avoid making that same stake in the future. Because we're all going to make mistakes, right. And we're all want you to fail and it's really important that we learn from these things. So I'm really big on sales leadership and I know that the space you familiar with to solve. Yes. I love it. I live for it. There was a time in my career where I was helping to nationalize a startup company and although we were incredibly successful right out of the gates there was more friction going on between myself and the board that there needed to be and it was because I let my ego get the best of me because you know a lot of people listen to this probably identify with us. The more success we have the more it kind of feed our ego and it's really hard to keep that in check. And as a result my ego created a lot of issues between myself and the board. And you know those didn't really need to happen. I wasn't mature enough at the time to understand that. So for healthcare leaders, my advice would be to always be aware of your ego. Keep it in check. No matter how successful you are or what role you play because we always have to remain as humble as we possibly can in order to effectively lead people and the last thing I'd like to say about ego as a mistake, is that it's a tricky one to solve because ego is the one thing that helps us believe that we can accomplish all these crazy goals we set.

Right.

But it can also be the one thing that destroys everything we've worked so hard for so.

The balancing act.

Just keep them right. Just keep our ego on check.

Yeah that's a great share Will. And you know listeners as you take strides forward and experience success is so important to reflect on what Will has shared with us because it is that edge that drives you to achieve the things that you set forth, right. With less resources and all the things that we have to do nowadays in healthcare. And when you achieve them, man you know you kind of want to pound your chest a little bit and feel really good about yourself but take it so far and take a step back. And Will what would you recommend for the listeners for us to do to really get our ego in the check?

I believe I don't know everyone's got their place in their face and what they believe in. Personally my faith has helped me. I've been humbled over the years and my faith has helped me to try to remain humble in the eyes of a business to know that I can always learn more and to be open to being coached because I think being coachable no matter what level a leader is in, we all have to be coachable otherwise we shut ourselves off from self growth. So I think just having faith whatever you define this faith and maybe meditating as well I think really kind of helps people to look inside of themselves and learn how to be more humble. This is what for me.

That's a really great piece of advice there Will and I also enjoy a meditative practice and then also journaling for me. You know I one day I was journaling about a success that I had and I really really hear what you're saying about it getting to your ego. And after doing some journaling I came to the conclusion that you know we are not our identity is not our success. We just happened to have created that success. Let's not mistake it with our identity. And I think that's when we'll be like we basically say our success equals our identity that it gets to our head. So just a little tidbit I think that really helped me really distinguish between hey you know you accomplish something great good for you. But it's not who you are.

Right. Because if we tie ourselves too closely to that success that success one day the rug could be ripped out from under you and then who are you.

Exactly.

Right.

That's the other side of it. Right.

Right. That's right. Humility is the way to go as you know.

It's a great message. So Will take us through your experience. Is there one thing that you'd like to share that has been one of your proudest medical leadership sales experiences?

Ooh that's a great question. The first thing that comes to mind is when I was working for an early stage medical device companies that manufacture a new implantable spinal cord stimulator and I was responsible for building and growing a new sales team in the southeastern part of the U.S.. And so I've never worked so hard in my life Saul but I've also never had so much fun in my life. I mean you are pumping us 12 14 hour days on the regular but just the energy and the culture that we had was was insane. And I felt very blessed that the opportunity to recruit certain people and over time as the organization grew, new people in the southeastern part of the team were just fantastic. I mean there's no other way to describe these individuals. And as time rolled on, I remember the first time we won region of the year and by that time we'd already been acquired by Boston Scientific so there were well over a dozen regions and you get called out for the hundreds of people. You go up on stage. And what was awesome for me. This is my proudest moment I think as I look back and my career was to be able to pull all of those individuals. I think it was like 18 at the time pool all 18 of those up onstage and hundreds of people look to my left, look to my right and just the level of integrity and the character tenacity and the talent that the people on this team had it was amazing and they were the ones that won it. And then over a five year span they became the number one team in that division's history. I think that still seems to this day. So I was so proud of what they did and just how badass everything was it was it was it was a winning culture. And we had a blast doing it.

That's awesome. Will what a great story. I felt myself there felt like I was on stage with you my man.

So sure.

So you guys got off the stage and you continued education for many years. So fast forward to now. I mean you're doing some great things at IQVIA. What's an exciting project or focus that you want to talk to the listeners about?

So right now I'm working with a newer Hospital Division of company that has access to a large suite of data assets. So hospitals can leverage this information and by doing so they can actually shift market share software in a competitive market with multiple hospitals by leveraging this. Th C-suite of these hospitals can see which of their surgeons are performing caissons at competing facilities because they have different affiliations and they can, some of them was the palms and those have the right to patients and patients in the location that they want. So now by leveraging this business intelligence the leadership of these hospitals can see where their surgeons are selling their procedures and do something about it so that they can retain that revenue. Another thing that leadership in hospitals can do by leveraging this data is they can see where their patient leakage is and where these patients are going. So that leadership is in the hospital can identify where they need to tweak their approach to help keep the patients that they've got. Because as you know it's really really difficult to acquire a new patient. So..

Yes.

When you get them into the system you just you don't want to lose them as you know.

Absolutely as very interesting overall Will, just continuing to build a suite of optics and two tools to help providers make more intelligent decisions with data.

Correct.

That's awesome man.

And it's becoming a bigger and bigger and bigger every year.

Yeah I mean it can't just guess anymore you really have to take the data driven decisions and folks I invite you to to check out IQVIA on their website. The website is iqvia.com, is that correct?

That is correct.

Outstanding so be sure to check them out, iqvia.com they based out of North Carolina and doing some very very interesting work to help health care organizations take it to the next level. So this has been really fun. I think right now we're getting close to the end. Well I got to the section where you and I are going to build a leadership course on what it takes to be successful in selling within healthcare. I've got four questions lightning round style followed by a book that you recommend to the listeners, you ready?

Let's do it.

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

To get into the mind of your customer and to start thinking like your customer so that you know how to position yourself instead of just trying to cram your agenda onto them.

Love it. What's the biggest mistake or pitfall to avoid?

Ever hire a good friend of yours who will be reporting directly to you.

Love that.

To give that one time was a bad idea.

I was gonna say I sense a backstory to that one.

Well we'll tak about that one of our reviewer one day.

That sounds good brother. How to stay relevant as an organization despite constant change?

We as leaders have to change with the time. So if our patients or our customers have certain expectations we have to find ways to meet those expectations and not just keep continuing to be business as usual.

Love that. What's one area of focus that should drive everything in a company as it relates to sales?

This one's easy for me. I would say collaboration because the most successful business environments than I've ever been a part of and always had great leadership then embraced ideas and was actively looking for feedback from the members of the team without judging them and allow the people that to give that input so that they can make the right changes for the market.

Collaboration and what's your favorite book that you recommend of the listeners?

Being in sales leadership there's a million books written by a million gurus right. We've all seen them and read them and there are some great ones out there. But honestly if I had to narrow it down to one book that just embodies everything that the word leadership means and you can be in healthcare you can be government you can be in B2B, it matter. My favorite book by far would be called "Extreme Ownership" by Jocko Willink. Jocko is a former Navy SEAL who served in the battle of Ramadi in Iraq. And on SEAL Team 3. If you're looking to become a better leader or how to work better as a team and get real results the best place to look is directly to our Navy SEALS.

Outstanding. I have had the pleasure of reading that book listeners. It is a brilliant.

Really?

Oh yes. Outstanding. I couldn't stop. I did the audio book. I do mostly audio books and I just couldn't stop listening.

His incredible. He leaves nothing out. He nails it.

It's pretty amazing. So listeners it's called Extreme Ownership by Jackel Willink. It is outstanding. Highly recommend that as well. Will thank you for that. And by the way if you guys want to get access to the Q&A, the transcripts here just go to outcomesrocket.health/richter and you'll be able to find those there. It's R I C H T E R, outcomesrocket.health/richter, as in Will Richter. Will this has been a ton of fun. Time always flies when you are having fun so you can just leave us with a closing thought and then the best place where the listeners could get in touch with or follow you.

Well I would say that in business all things are possible and it's just that in organization is got to make it a priority to get the right leadership into the organization and then put them in the most appropriate roles based on their skill sets. And from there you'll be able to create a successful culture because success in business is an attitude. It's a mindset you have to expect to win every day. And it's healthcare leaders can develop a culture of accountability and trust then I believe that everything else will fall in place.

Great message Will.

Thank you. And second part was how can people get in touch with me?

.Yes.

Honestly it's probably just me ping me through LinkedIn. I think the url is https://www.linkedin.com/in/willrichter/ R I C H T E R, and I've got all my contact info there are people want me to reach out.

Outstanding well and folks again if you wanted to just click on that. Just go to outcomesrocket.health/richter and we'll put a link there to Will's link then profile if you want to connect with him as well as IQVIA's website and the book that he recommended the syllabus that we put together for you. So Will, it's been a ton of fun. Really appreciate you chatting with us about sales- key area that we all need to be focused on and healthcare. Looking forward to staying in touch my friend.

Absolutely. You as well Saul. Great to hear your voice again and have a great weekend.

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

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Recommended Book:

Extreme Ownership: How U.S. Navy SEALs Lead and Win

Best Way to Contact Will:

LinkedIn: Will Richter

Mentioned Link:

IQVIA

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Why compliance is not the safest cyber-security strategy with Grant Elliot, Founder & CEO at Ostendio, Inc.

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

Welcome back once again to the outcomes rocket podcast for we chat with today's most successful and inspiring health leaders. Today I have an outstanding guest for you today. His name is Grant Elliott. He's the founder and CEO at Ostendio, Inc. He's an entrepreneurial leader with over 20 years experience in a variety of operations, customer service, product dev and most importantly in the executive capacity. His track record in this space is really attributed to what he's been able to do. He's been able to create significant growth, development and change for those seeking to make positive change in cyber security and at his work right now at Ostendio, they're actually working to change the way companies look at and manage their cyber security risk management and compliance programs. Today in healthcare, it's such a big focus for everybody to make sure that cyber security is in a positive state and that it's not interrupting our healthcare operations. So I think the topic we're going to dive into today with him is going to be very pivotal to anyone running a health care organization. So it's with a big privilege that I open up the microphone to Grant. Welcome to the podcast Grant.

Thank you Saul. So it's a pleasure to be here.

It's a pleasure to have you here. Now Grant you obviously span various industries but you do have a niche in the health care market. What got you interested in spending more time within the sector?

Yeah it's a great question though from my perspective my background predominately was telecommunications as I'm sure that you can tell from my accent or not native to the U.S. And so I work for a Brit British Telecom for a number of years and based on incapacities protoplasmic marketing operations etc. That kind of brought me over to U.S. had for a short period of time for AT&T so I always had up the networking event to why that rolled over the mid 2000s. I had the opportunity to work for a digital pioneer and digital and tech company and the connection really was that they were doing a lot with the SMS. they were building health information systems and in rural countries you know Eastern Africa, Indonesia, India. We are the general infrastructure wasn't mature. And so they were actually using cell phones and internet particular the method communicate and manage drug inventory. that built to those et cetera. And so that was the kind of connection you know this telecom background to digital health company that we've seen using communications as a primary means of channels. And really what got me into the digital space and then from that point on you know I've just been really fascinated with you know obviously the security aspect, the risk management aspect to be able to do that and what the chief operations officer and chief information security officer of digital health company and that is really what got me involved and you know conducting audits for you know some of the major peers, providers pharmaceutical organizations and really you know ultimately to recognize that our journey just Hoboken the security of supplies managers peacefully voice within this particular segment.

Super fascinating Grant and you've worn a lot of hats and you've seen the various scenarios that could happen and you've helped organizations plan for that have helped protect them against these these types of cyber attacks but also weaknesses in their own network. If you take a look at the entire arena of cyber security and health care what do you think is a hot topic that needs to be done on these leaders minds listening right now?

I think that people need to understand that the world we live in today particularly in health is very different. And what I mean by that is if you think that where the data are stored, you know 15 20 years ago most organizations which store data on prem they would use the basic perimeter security. And so to some degree you know whether this is correct or not they had this greater premise that can't fully protect that information using the only Caslen Mortell technologies. Well today with quote technology is all over, right. You know we no longer have a single copy of data. You know when you go to your provider or you work with your peer and they're interacting with a complete list of increasing list of vendors who are providing daily different services on. So that data that you providing them, the data defeated on your behalf isn't necessarily just sitting in their premise, they themselves may be using some that call based service to be so store data and then increasing number of their vendors are using call-based services to provide services to the organization. So when you think of that way you're very sensitive person dataset as you're interacting with any healthcare organization. You know it's no longer just sending one place. It's really. You know and that's really helped us aesthetically been exacerbated but that's the whole meaningful use that push to make sure that and health information digitized to make it more accessible. And the very nature of healthcare is that in order to provide services we want ease of access to that data. The providers, doctors, physicians, they all want you to access to manage the treatment of care to process payment etc.. And so we live in this world today where it literally can be anywhere. And so the question then becomes you know has the industry itself woken up to the dangers that we're seeing through the media. I mean breaches are occurring to accomplish the rise of which are just shortie practices. And so really I think people need to wake up decide that this is a much different environment in terms of how these organizations are managing data and really the onus on those organizations and the people using this onus is that this organization really should be asking much more stringent questions but how are these organizations adapting to this change and what additional steps will prevent measures are there to try and protect this more complex environment.

That's really insightful right. And as we think about data as it sits today to Grant's point it's no longer. It's with the customers vendors payers that we work with. Now everybody is using cloud-based technologies. So how do we get smart about protecting this information and grants really highlighting some things that we need to be focused on. Grant can you give us an example of how you and your organization have created results by doing things differently?

Absolutely. So I mean again part of the reason I got into this space is because when I look at organizations we're building the security programs and I look at the types of services that were available to those types of organizations there ar e various principles, right. Used to look at the market to specific ways those are am I gonna secure in my market and not very much the agent who wouldn't have an I.T. security where people want you to think that firewalls low gadgets solution becomes a very tech centric approach to security. Even our law a lot of data doesn't allow is ethically and software or applications that actually use it often is process or link it to you know ex employees so having access to information, people misposting information etc. So there's the aspect of you know how organization are prepared to that. And then there's the counter component called a compliance and so obviously everyone's familiar and most people familiar with that and there's a general assumption that because I think because it's written into federal law that these organizations are now doing a really good job at protecting into the legal they are supposed to. When actually what we may gonna do is this compliance programs to meet specific compliance requirements and then put the things together made them compliant to, being compliant doesn't necessarily make you secure these a lot of these regulations that they put me right and they're protected in different ways. So all of organizations have a successful plan. Compliance programs. But really what they're focused on doing is trying to meet those regulations that rather the security organization. I single battle of agendas have got really most these a regulations. They're not there for the sake of being there really they have to drive the organizations into the program. So some of the compliance programs that could almost say their original purpose was not to be a means to an end but to make sure these organizations are building a safer security. So what we do is we basically try and bring that together. We try and focus these organizations on building in a safe secure program. We will map to the compliance requirements. You can just me these objectives and then we think of a people-centric view to do that because again, we don't take up solution based perspective and technology security tools to just tools. We really try and map those across each individual within the organization, give them a score, help them understand who contributes to else huge portion of the organization and then give the organization that grows that tools for them the measure of course of organization what they are doing audit is more effective to secure their data but also match that to whoever stand the regulations that happened to as well.

Very insightful. Grant and just as we think about what we're doing within our business, the fact is if you're compliant doesn't necessarily mean you're you're secure. And I think this is this is something that I'm walking away with here Grant because I know a lot of friends that are running businesses and they think, hey you know I'm I'm I'm following the rules, I'm compliant but that doesn't necessarily mean you're safe. It doesn't necessarily mean you're secure and it sounds like what your company does is really helps them walk through not the compliance piece but the safety piece. And we have to consider them individually of each other.

Absolutely. And you know we use this expression you know everyone was familiar with the colander right. You can have a name. Yes you new go on there. And we talked to lots of companies talk about how robust and how firm and who are the colander them there, the security program actually is. But at the end of the day, a colander they get that shot. As you know less not for more has it was Colander is you have to be in place of their removal something basically basically protect more holistically across the organization. And I think that's the mistake of all organization of today are really more focused on how you I basically obey some base of security matters in my front door. But then forget that the fact that will met through the window if even a face where you go everybody has leveled at the cause. So it is a much broader approach.

That's interesting yeah and for the folks in Inmet devices saying a big reason why the FDA is pursuing the unique device identifier. There's been many cases of cyber security threats that happen through medical devices and so definitely on the radar of a lot of us in this space and Grant, Grant Elliott here is talking to us about some of the things that we should be keeping in mind. Again Grant Elliott is the founder and CEO of Ostendio, where they help folks with their cyber security risk management and compliance programs. Grant, I'm sure you've seen some ugly stuff out there. Can you tell us a story something that you saw. And what that customer or what you learned from this security breach?

Yeah I think that they can increase the price of the number of years I've been doing this is basically a little motivation there are for certain organizations the base with those in a data security program. A couple of years ago I remember speaking to an organization and there were smaller organizations that when I was talking to the principal organization and they were talking toys about how they can improve their security. And this particular organization actually ran a very simple EHR it looks when in health record that was heated that was calling at that point call-base that went through the conversation discovery I realized that he literally is running this thing on a server under his desk. We do the testing for the new server to know that's scary. And and but it's actually more common scenario than you might think. We speak to, the tools we speak too she's compliance officer BBC news organizations every other day. No we will leave them. Legally what they're supposed to do maintain the security program. You know I spoke, I had dinner, a few months back with the CIO of our major health system. I'm not going to mention the name but there are basically seven or eight though in the health system and this CIO told me that I read the information security wasn't on the top ten list the. Right. And so there as you know a huge gap in the motivation factor of organizations to do this because a lot of healthcare systems you know you go back to first principles. What is the motivation to do that. Why do we need to do this. And you know part of the challenge is we've seen major breaches to which we see pervasive breaches all the time. And the question is does that actually change people's behavior or will you stop going to health system because they've been in the media for having a major breach. Do you even know who your insurance providers is? I know that you know when the Visa card I didn't even realize that they would appear for the pervaded that We actually had so there's an open question what more the these organizations the doldrum more effective security program. And that's not to say they're not doing anything but there's no doubt that you know if you compare the stain about healthcare systems or the healthcare industry compared to other industries that financially ill, it lags significantly there's not necessarily enough broad support and pressure to an organization I'm looking even on the digital health space. Some of these I.T. services organizations that are growing with you know 10 20 30 40 50 million dollars worth of investment will be made in them. And we talk to them in the security program in place whatsoever. So as it I mean I think you know from our perspective the seal the the road that we see a lot of this kiddy stuff. And it is frustrating to was that we can persuade them to the advantage of a technology's error that really makes sense. But the flip side of that also there is well we work with many organizations that really embrace what we have to offer a message to try and provide the best service they can and this be a third they understand the business impact of having a breach and understand how that can. And so there's certainly not organizations out there doing the right thing. But you know my perspective is you know because we see it as a regular basis. There's way too many of there that really are motivated sufficiently to fill this program mortal interested to see rather than actually backed up by actions.

Grant This is really interesting and it just kind of you know again forces us to think about how the general economy works and how the healthcare economy works so differently. If you had to sum up a plan if you had a three step plan for the listeners that maybe don't know where to start. What is it that you would tell them. Quite simply like Look here's Step 1 2 and 3 what do they have to do?

So we have a simple analogy, right. You know I equate building a security program to it running a marathon right as an ongoing on exercise. Now the first step to running a marathon is not signingn up for marathon necessarily force you just got to earn a lot right. Right. It doesn't matter if you're running today in the street, it doesn't matter if you're going to go and sign up for a 5k. You just need to start running, Right. Because at the end of the day if you run a 5k first of the March and already kill. So we focus on this that it really doesn't matter. The biggest excuse is that we get why people are going to you know this without too small it's too early. But the reality is what you do is all relative the rest of the organization here a smaller organization your risk is relatively more and therefore what you have to do for the most part can be a little less. There is a exemptions but for the most part that's true. And so just start doing something or you know really focus on voting some very basic courses of seniors even though most. These procedures from the Web to basic training, training people regularly do security practices and really trying to identify some sort of framework measurable sounds like support seven thousand one hundred 171. There's loss of security standards equal training the Web to basically and map then just gradually the week that we will start voting our plan and just allocate more of a pain to year budget. a small amount senses that this is the organization to just focus on this so it really doesn't have to be a huge task it just has to be bold and it's part of your business process and you'll be amazed. Over the course of a week a month a year just how much progress we can make. So when that client comes down and suddenly says you were ready to buy your service that we just need to get through security or that it doesn't need to be a scale as perhaps otherwise may be if you really just started thinking and toting that said from day one.

Well I've got some great takeaways folks from Grant on how to get your cyber security up and running at its best and you to just take small steps. It's really a call to action. Grant What would you say one of your proudest moments here in the cyber security space in healthcare has been today?

As an organization we started off with the premise of you know I mentioned the other one that you know I was somewhat surprised how complex how difficult this was perceived to be by organizations and sadly by men and the stakeholders of the organization that are serving in this community. So we start with the simple premise that we wanted to make the ability to organize to be compliant and manage risk accessible and available to any organization regardless of size and resource. So you know if you're a small, 10 person staff or if you are a large organization. We wanted to make sure that we need that forces that are more accessible to everyone more cost effective. So for us, when we come across a company that is using our services reputation sales through an audit or we get a senior or an organization Rayno it is all good teams and it was 100 percent compliant. Why they go nails and we have partners coming back to their base saying to their ability for their clients has been significantly streamlined to our platform. I think those are the things that really help us get a read. I can confirm that we're on the right path and that we are actually you know obviously working towards achieving our original mission. So I did that for the most satisfying thing we have because that means it proves we're on the right track.

Absolutely. And how about an exciting project or focus that you're working on today?

Yes there's a lot of great stuff going on and said you know when we started voting our platform we decided to do a slightly different way than most server kind of tools in the space. One of the things that we do is unlike maybe a GRC tool or some sort of a risk management too we actually enroll everyone within the organization to our platform so everyone has interaction with that platform. Everyone can see how their contribution contributes to the overall security Porscher. And so we're transacting with tens of thousands of transactions across a platform for people taking training courses to completely audit its access abuse vendor reviews saying it ignores poesie so that's happening everyday within the organization and because we can map that to various different standards regulations, we can try again maybe to an organization that has to go through hydro in an organization. Is that too to or or with with that when we actually map the behavior of each of those organizations against that sort of framework. So we've actually started a project that we were actually looking to we'll see if I can map out the daily basis and I can literally take almost that the security to comply the any of a company and ability to direct that into some form of digital contract to basically use blockchainin a digital age to basically try and manage the organization. Should I work with certifying authority to comment if we can second the platform and the right way against ever free market that they will basically step decided yet long as we are tracking that rate lever behavior and that's going to get rent to that digital wager that would ultimately allow organizations. No Gozi their costumers and say, hey listen not only are we racing your barman against a free market. But we will actually contract with you and give you access to a digital ticket. We will build the penalties for failure to meet that security threshold and that would significantly streamline the whole order process. Again it makes competitive advantage today that the companies themselves because they can't differentiate themselves to the customers from customers that are simplified there's been divergent process along the paper trail. They don't necessarily have to conduct audits because again as being end of the tail and certified so we are really working to try and simplify our securities fighting say the phone from a contracting perspective. And again it all builds off the core functions that you have with their existing platforms today.

That's awesome. Grant sounds like you guys are really streamlining the approach and just tackling it. Killing two birds with one stone so to speak. It gets really exciting.

Yeah I mean from our perspective what we're really pleased with the progress. You know whenever you're coming out and you think of the end of doing something slightly different in a market, you obviously have been trained persuading people that you have a slightly better way. You know people have been doing a lot of this stuff long time right. And people tend to be slaught, they don't change. But again you know we also running a business right so we know we're not just an idea shop. So we have to do this and we have to evolve that we have to bring customers, bring in revenue we have to pay salaries. So as we continue to grow as we can be more successful we know have these opportunities to kind of take that original version and enhance it as I've discussed. And yes definitely. You know a really exciting journey of degree I'd love to see what we're going to be in five years seen by this time that you know we're within all our supply agreements through blockchain after digital contracts that would be an amazing place to be.

That's awesome. So getting close to the end here. Grant let's pretend you and I are building a leadership course in cyber security. It's the 101 with Grant Elliott on cyber security. So we are going to write out a syllabus and get your answers for brief questions. Be ready for it?

Absolutely.

All right Grant here we go. So what's the best way to improve healthcare cybersecurity?

I think the key thing to focus on whatever premise you're trying to over I mean as I said we sat with this premise of really trying to make cyber security compliance risk management affordable and accessible and achievable for any organization. And we come back to that mission statement on a regular basis because everything we're doing has to be basically support that. So we continue to validate that with customers with the father of the family. So just being really focused on what you're trying to do the long term vision I think is the best way forward.

What's the biggest mistake or pitfall to avoid?

Assuming that the service you prevailed in itself is actually going to make a difference. You know this is really true particularly within healthcare because if there's not an economic value to what you do if you can demonstrate an economic value, as long as it's going to pay for what you're going to do then it really doesn't matter who give an idea. Healthcare in particular to me because that whole concept they're saving lives including health really in the marketplaces setting rates. The concept of making money and that goes with any business you really have to validate not just do I have a good idea. As can I persuade people to pay me enough money to be with facily and promote the idea and that's fundamental to you know what we need to keep focused on and I think too many people too many organizations sometimes forget that Clinton called for the idea itself that there's not enough people in the market there's not enough people within the target area to be sufficiently money to make that reality?

How do you stay relevant despite constant change?

It's really listening to our customers and ourselves we have an expression that you listens to everything your customer the same thing today used to 95 percent a way because 95 percent is useless. The remaining 5 percent is essential. The kernel of knowledge you're going to get from that 5 percent is fundamental to being to keep your business on track because if you ignore that 5 percent then you're absolutely going to go off the rail and your going to go in a different direction. And you know as an organization, remaining focusing continually listen to your customers even though a lot of it's going to be so essential because that kernel within the 5% knowledge is absolutely key.

Awesome. What's the key area of focus that should drive your organization?

So we completely focus on platform as a source company platform because it everything. We will not be able to grow evolve and reinvest in Apple if we don't get it profitable. So there are lots of things that we would like to do most things that we think would be great. Customers who regularly come in and if we can do ABFC we really drive that to the point that do we believe that's going to drive profitable. And if we do then we'll basically consider it and it's not going to drive profitable and we can't. And that's fundamental because I think we don't really keep focused on that area of growth. And then it's very easy to be derailed and before you know what you're trying to be.

Grant, what's your favorite book?

Yeah. So I like to read, I like to read a lot. I really like reading all day biographies because it brings understanding how people love their and the lessons get and really for probably one of the books is the most fun and the need was Nelson Mandela, the autobiography a long walk for freedom. To me that kind of lessons from nothing really is just there to progress along and winding. Right. But human team belief in what you're trying to do if you can really just keep going through all the obstacles going to maybe soon and ultimately you can get really just a question of being really truly truly believing what we trying to teach. And you know and I think Nelson Mandela felt like a truly inspiring when you see someone from his background and education his formative experiences and someone you know in the middle of his life may just become this amazing civil rights leader you know eradicated.

That's super interesting Grant recommendation. And folks if you're curious about that book about the syllabus that we just put together on cybersecurity for you and all the show notes just go to outcomesrocket.health/elliott, E L L I O T T, you can find all that there along with a full transcript of what we've just discussed today. Grant, Before we conclude I'd love if you could just share a closing thought and then the best place for the listeners to get in touch with you for more information.

Absolutely. Yeah I guess from a from opposing perspective you know the journey we've been on all of them devote five years ago. And you know it really has been an incredible an amazing journey. And we definitely appreciate the customers we have and all the prospects we talk to and from me, the biggest part of this is basically the team that we've been able to build here and the owners. There's some amazingly talented people we have on board that has made all this responsible. And if people want to learn more about our journey, learn more about this and you know feel free to go to Ostendio.com, our Web site. There's lots of great information, resources about cyber security compliance, framework and if you want to tweet me they can do so @Ostendio_CEO and you can see my marketing team and they gave me my source of handbook for the future rather than give it my name. So @Ostendio_CEO. Yes feel free to tweet.

That's awesome Grant. Hey listen this has been fun. I know that you dropped some major nuggets of wisdom here on all of us and we'll be walking away with some good calls to action but ultimately start small start now and looking forward to staying in touch with the Grant.

Great stuff, it's been a pleasure Saul. Thanks very much for inviting.

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

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Recommended Book:

Long Walk To Freedom: The Autobiography of Nelson Mandela

Best Way to Contact Grant:

LinkedIn: Grant Elliott

Twitter: @Ostendio_CEO

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Ostendio, Inc.

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Embracing a Retail Medicine Strategy to Ensure Success with Mike Boblitz, Vice President, Planning & Business Development at Gwinnett Health System

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

Welcome back to the outcomes rocket podcast for we chat with today's most successful and inspiring healthcare leaders. Today I have a special treat for you today. His name is Mike Boblitz. He's a vice president of planning and business development at Gwinnett health system. He's experienced in strategy marketing and business development. He's got a demonstrated expertise in the healthcare and hospital system industry with a strong foundation leveraging strategy and market analytics to enable strategic growth and competitive environments. He's done a lot for the health care system where he currently works as well as previous healthcare systems that he's contributed to. He's a unique leader with a diverse experience in leading academic as well as community health systems. And he spans many different types of markets health care management. He's done includes real estate construction services and facilities and he's also served as an adjunct professor at James Madison University for nine years. Such a pleasure to have you on the podcast Mike. And if you have any any details that maybe I left out would love to have the listeners have welcome.

Thank you saw. No I think that was a great introduction as you can tell I just just enjoy planning and strategy so much. I remember going way back to my first planning job planning analyst position at a place called Martha Jefferson Hospital in Charlottesville Virginia. Probably the second week on the job I was sitting around the table. Exactly. Even the CEO was talking about how that hospital had become landmarked. It was a 100 year old hospital and they continue to be declined by local zoning to expand in the city. And the time has come to really build a business case to build a new hospital to relocate and not something about that. I was hooked. Way back as a young recent college grad I said planning is what I'm about. I'm all I just want to have my career devoted to planning and strategy.

That's awesome. What a great story. Sounds like they threw you right into it from the beginning.

Did it. I was fortunate. Know that it had working at smaller it was a smaller 176 bed hospital that very well-managed. I've found that we work in smaller smaller organizations. You get to get broader exposure and for someone right out of college that was just what I needed to get started.

That's amazing. So you could have done a lot of different things Mike but you decided to get into health care. Why did you decide that?

That's a great question. So my middle name is Crile C R I L E and my office was got a picture of what I'm told is the last remaining picture of a gentleman named Dr. George Washington Crile who is the founder of the Cleveland Clinic.

No kidding.

That's right. You didn't leave. We've had a long. Obviously most of my family have worked in health. My dad actually still working as the chief administrative officer for orthopedics and sports medicine University of Virginia. My mom is the head nurse for the cancer center at UVA so we just always had a family focused around healthcare and I'm just fortunate to also be able to work in this space.

What a cool story. Mike so it's in it's in your roots. It's a tradition that you've honored and you've just continued with.

Correct. And you know I thought about going into sports medicine outer space as the young kid. A lot of people are heroes and people they look up to. And for me it wasn't necessarily athletes or entertainers. There is a Dr. Frank McHugh and Doc McHugh was the founder really the grandfather of a sportsman's medicine and he really wrote the book and before of managers it was dark. So growing up I had a chance to follow him around in the football field and eventually start working in the training room in high school and taping vehicles of athletes enjoying physical therapy treatments on athletes and kind of started thinking about going into a medical career and I'll never forget it it was probably my first year of college where your doctor said you know if you're going to make it and you really think about sports medicine and want to think about being a doctor you're going to be to start watching me in surgery and I'll never forget I went and watched him doing an ACL repair and all I can remember is just all of a sudden it getting very fuzzy and that's you know down the hallway and a nurse or something or you know quickly that the medical provider saw I really wasn't for me but I still loved it and my dad made a great career being an administrator. So I switched that James Madison University from kind of a medical path to a health care administrator path and just haven't looked back since. It's been a great experience for me.

Wow. Wow. So you had that episode but you found a way to stay with it. And Michael you had such an amazing career. There's a lot of health care leaders out there that are really just working to find the best way. There's a lot of change in health care right now and so in your thoughts what's a hot topic that needs to be on their mind and how are you guys addressing it there over at Gwinnett?

You know I think the hot topic right now is really changing your focus from historically healthcare has been really delivered from a provider's lens. And you know and you read it all the time it's all over the news that it really has become a consumer game and health care at least back when I was in grad school was what they call price and elastic. You can raise prices and demand is still there and now consumers and there's a lot of data out. A recent study said that as many as 40 percent of probably mature consumers are under high deductible plans. So it's become this retail medicine agenda really fast. So I've really worked hard at my organization and actually prior organizations to change that mindset from a provider lens to a consumer lens and really understanding the types of consumer segments that are in your market and changing up the delivery the way that they want it and try to build loyalty that way. And I think that's really something that is extremely important for healthcare systems around the country to really embrace and pay attention to.

Yeah Mike that's such a great call. You know and there definitely is that big shift you alluded to the rising costs of of those deductible plans that is forcing health consumers to really be more mindful about the dollars that they spend. Can you walk us through some examples of what you all are doing at Gwinnett to help address this market and not from a provider lens but from a consumer lens?

Yeah. Happy to give you some examples. So when I first got down to Gwinnett about four years ago one of my first orders of business was to develop a new strategic plan to carry the organization into the future and so I started saying step back literally understand not just the population but the consumers in this market. There's a lot of data out there Experian for example Truven has different segments in the top segment and our market is a group that I found called kids in quarter sacks and they have two really interesting characteristics that popped out right away. They really if you'll come this reach on medicine thinking that we've been embracing here and that the first is there are about 52 times more likely than an average U.S. household to want to have urgent care. The second there are about 50 times more likely than an average U.S. household one to have access to providers or mines more mine etc. So I formed a urgent care company outside the hospital because hospital pricing has been the barrier as you think about retail medicine. And we formed a joint venture called Choice One urgent care at the national partner and that just exploded right out the gate. So that when we first try to understand how consumers wanted health care in this case the top consumer wanted urgent care and by default, it's done very well. And then this past year we rolled out an online scheduling and same things just exploded. We're getting a lot of results out of that including in our market there have been a lot of population that just don't have primary care doctors and our markets growing two and a half times us average people are coming in trying to use iPad and iPhone to figure out where can I find a doctor. And we're standing out in that game because it's easy to help your dividers. Nationwide there are challenges they don't answer the phone well and consumers just want direct access. So those are some examples where we're really embracing this whole consumer mindset and finding some success.

Those are some wonderful examples Mike and one of the things that I feel like really differentiates you as a leader in this space is the ability to not only think about the ideas but execute them. You know execution is such a talent in our space it's hard to make it happen. What would you say is one of the contributing factors that has helped you and your team be able to execute on these ideas?

Oh yeah I've learned to live in fortunate to have worked with some really good organizations in the healthcare space. And so the key to me is really before you even get started about what should we do urgent care you know should we build expand product lines et cetera take a step back as I did when I got here and really engage your management team on a very thoughtful strategy and strategic plan and really get a senses to what that looks like in this case including urgent care and really get that bind up front. So then the execution becomes very easy.

So you get strategic alignment and then from there the execution just follows.

Correct. And you know the key is with any strategy this first step is really having a very thorough in what I call environmental scan and that's where the kids and Colla sites came up and really educate the management team as to what these fund is are and bring forward ideas that should be considered as far as strategy and get support for that and that to me has been my success and when others think of do it different ways. But to me that's that's the right path.

I think you just do such a great job of this Mike and listeners do as Mike is suggesting here. You know do a thorough environmental scan, understand what you're getting yourself into and align your leadership team to your vision and then execution just becomes secondary. So Mike there's no doubt you've had a lot of success. You guys have implemented some really great programs. Give us an example of the other side of the coin maybe maybe a program that didn't work and a setback. What did you learn from that and take us to that story?

Sure. I'm trying to think of a good example of a program I would say so related to the retail medicine agenda. My take is and I'm really working hard to leverage our success and urgent care where you know healthcare a lot of these outpatient services are now commodities right who are shopping, urgent care is a great example but also not forget about imaging and you've seen in the news nationwide payers are starting to really steer their beneficiaries away from hospital pricing to do commodity pricing right, and freestanding services. And what are those. I tried to push actually right after urgent care and the trend just wasn't right because the challenges on the financial front was forming a similar company around medical imaging and we just have not yet been able to launch that because of the challenge of transitioning from hospital pricing today to commodity pricing tomorrow and you know how do you make up enough volume on the demand side to last that price differential. Right. And so I'm still working on that agenda. I think that that hopefully we've got to get there because you're seeing all the news that I'm seeing that payers are over that. And if you don't start to integrate that it'd be that outside the hospital over time is just you know I don't see how hospitals can stay in that game. That's one example Takamine I can think of. I wouldn't say it's Baille just the time wasn't quite right but after my effort there since we're seeing now all these payers coming out and aggressively trying to re-steer patients away from hospitals maybe hopefully this next year we'll get another chance to reintroduce that idea.

Yeah that's fascinating. Thanks for sharing that. And you know I mean for example here in Chicago, Mike, I'm seeing these these MRI places pop up like and they're literally right next to the subway like the subway sandwich place or like next to the Red Robin and Mawle strips. So I don't know. I think your timing may be maybe on-point right now.

Absolutely. I think you know consumers want you know since they were seeing healthcare the way that the retail and how they shop right and you know our urgent care centers as an example we located in strip centers, we relocate and retail malls where you might have other services to shop in. And I think that's what consumers want. I think imaging is not on the equation as well as other commodities like physical therapy and web services.

Yeah it's funny that you mentioned physical therapy because just a couple of days ago I had a group of PT folks that are putting together think of Uber meets physical therapy. They're pairing physical therapists with patients through a mobile app. Wow. Yeah and they seem to be having some pretty good traction. So yeah I mean you're definitely your mind is in the right place here. And I think we are seeing this shift. I think it's so key that we get focused hyper focused on this folks. Take a note from Mike here. They're definitely skating to where the puck is going over there at Gwinnett. Now Mike tell us the other side. Give us an example of how I mean so the retail side of medicine has worked for you guys with the urgent care is there any other success story that maybe you want to share with us?

Yeah I'd say there's many memories back going back to Martha Jefferson Hospital way back when I had the chance to build a case to expand our network in my first primary care practice and got to take it from idea to execution and that was a lot of fun and then going forward. When I worked in a system that Mamun called up or just be help. I then kind of got a chance to build my first 40,000 square foot outpatient care center. And that's Mayor Simar more bigger projects and so every organization I've had proud movement I would say really at a high level what I really enjoyed the most current organization included is coming in and really trying to develop this culture of planning, really bringing your management team together so I have a team called Planning Council where I've got HR, I,T finance, marketing, operations, everybody together and leadership roles in those areas and I really take time to engage them about, hey forget about all the fires and all the challenges we're dealing with today and operations it's really dedicate time each month to focus on strategy and really how we need to think about the future. And then that really it's going back to what I mentioned earlier about the execution side get that by and it didn't have all the stakeholders with you so to have strength in numbers when it comes to how to implement and grow your organization.

That's pretty awesome that your approach is so thoughtful and with change in health care it's happening. There's no doubt that it is it's a wave and you're riding that wave MIke, like a lot of people are getting crushed by it but you're riding it.

Well thank you.

Absolutely. So tell us about an exciting project or focus that you're working on today?

You know I think right now our current strategic plan that I had was my first order of business when I moved to Georgia expires June 30th. And so for the past six months I've been working on what I call Vision 2025 that really sets a new course and helps us continue to take advantage of some of the things we've been already working on as well as focus on what's next. And that's been a lot of fun. We spent a lot of time with physician leadership meetings a lot of time with our board, a lot of time with our management team and you know that will start to take effect officially July 1 which is our fiscal year. So I think that I've enjoyed that. And in that it talks about about continue to fuel this retail medicine agenda as well as you know there's in our market still traditional organic growth and opportunities where focusing hard on how we you know continue to grow our service lines and we have three areas of focus and Vision 2025 one is developing and evolving this consumer-oriented network with ambulatory services front and center but also one one area of focus is expanding our product lines across the full continuum and they are trying to focus on now is how do we change our mindset from historically and acute encounter based delivery model to one that really focuses just as much on prevention and like for example we have historically seen as many as 70 patients in our beds at a given time with either acute or chronic heart failure. It's time to think about how do we start to better manage those patients outpatient and focus on cardiovascular disease centers of care and so these are some of the fun things that we're starting to kind of work on next that I think are the right models for delivery system in the future. As for us your better full. And so how do we better manage patients that could be prevented from an inpatient admission and how we'd better manage them without patient resources and really preserve our precious capacity for the most sick and complex patients.

I think that's really great that health and wellness approach and folks if you're listening to this and if you're in Georgia you probably already like all about. I got to get over to to Gwinnett if I need any services. They're definitely skating to where the puck is going and obviously Mike here is a testament to that. And so Mike for your efforts and everything that you've done there I mean it's definitely gone a long way for the system and the communities that you serve. Let's pretend you and I are building a medical leadership course on what it takes to be successful in health care strategy today the 101 of Mike BioBlitz. And so we got a syllabus here we're going to do it lightning round style. We've got four questions and then maybe you could share with us a favorite book or resource. You ready?

I'm ready.

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

So I think there's really two components to this. One is and I mentioned this a minute ago is how do we reengineer our product lines and our services from this acute episodic model to one that really focuses on prevention. Right. And what I didn't mention earlier is another example where we've been successful is we really study neuroscience in back pain and found that we have a large number of back pain conditions hitting our emergency department heading our inpatient facilities. And we study the marketplace and found that there's there's tons of spine surgeons on every corner and they're all really set up to really focus on surgery. At the same time let's face it you and I included surgeries the last thing that we want. Right. And so we focused on how do we differentiate in a super crowded market. We created this concept called The Back Pain Center and basically the Bactrian center basically set up to do everything we can and make surgery last on the agenda. And that's been extremely successful and we also realize nurse in our research that consumers need prompt access right. And that's why they're hitting emergency departments around the country and so we created a 24/7 call center that offers prompt appointments and we also created an online scheduling which as far as I can tell were the only neurosurgery program in the state of Georgia that offers that type of solution where basically we'll see now. And if you need to connect with an appointment in the morning through our call center or if you want to get the advice and just pick your appointment we'll be ready to see. And we set up basically a model where it's met by mid level providers who have very rigid protocols as an extension of the neurosurgeon to receive you, really give you that care plan and figure out a let's try physical therapy maybe you need pain management and then occasionally you might need surgery and that we're going to do all we can to avoid that. So that's kind of one example of when I talk about reengineering product lines that to me that that's the value proposition and are back in center that we launched this past year. Is that an example. You know what we need to do more of.

Now that's fascinating. So as you do these things what would you say the biggest mistake or pitfall to avoid is?

The biggest mistakes or pitfalls. I would say is really just not embracing a culture of teamwork and creativity. You know early in my career I found I saw a lot of organizations where they paid so much fear and failure to me Oh I've always said I'd gladly trade you know one failure for five successful projects that you know an improvement to our organization as well as the community we serve. And so I think that's the biggest mistake that some places can make as you've got to really focused hard and create this culture of teamwork in creativity.

For sure. I think that's so valuable. And how do you stay relevant as an organization. Despite all the change I think this is so key for you guys I mean you guys did such a great job but what would you how would you sum it up. How do you stay relevant despite all the change?

You know the key is wrapping this up right now but just having a very disciplined planning process that routinely steps back. Forget about all the stuff happening in the four walls of our institution and monitors how is the marketplace changing around us and really conducting a thorough internal assessment to understand how we are situated in that changing marketplace and what gaps exist that we really need to address in order to stay relevant in order to stay successful and we do that once a year through our planning process and I think that really helps us think about those key changes that are required in order for us to continue to move forward in New York in this very crowded market in a rapidly changing marketplace of healthcare.

Mike what would you say one area of focus that should drive everything in a health organization is?

Similar to our talk entirely today as you know having that culture of planning that includes all stakeholders. You know from operations, finance, marketing, human resources I.T. and bring all those folks together to really to embrace you know how this organization to evolve and grow and including all of those folks in that mindset in those parts and I think that's really something that you know we've done well and allowed us to have really a team approach to strategy and evolution. And I think others really need to focus you know in that regard to make sure that you have that buy-in then you know early on in my career I sometimes have learned the hard way and there's there's one overexertion that I found early in my career that really was siloed and really didn't bring in all the stakeholders and they're not surprised. The plan was not very robust at that particular organization and that's a major challenge. And so again as I mentioned earlier you know I've been very fortunate to work at great systems and really learn what works and what doesn't work and I think that you know this culture of planning is so important for us and for others.

I think that's great. Mike what favorite book or resource would you recommend to the listeners?

Or you know is not really your favorite book or resource other than I just think it's just so wonderful the amount of information now that it's available both digital as well as through books about you know strategy and this changing health care market and so on constantly as a sponge trying to embrace all that information that leaders around the country are sharing and really helping me think OK what are we doing wrong or what are we missing and incorporating that great information as part of our strategy for the future.

Love it Mike. This has been a ton of fun. We've we've covered a lot of things and we've gotten here to the end the time always flies when we have fun. But before we conclude I love if you could just share a closing thought with the listeners and the best place where they could collaborate with you if they wanted to.

The best place to collaborate or connect obviously you know length then we can connect that way and for anyone in Georgia obviously looked me up and let's get together. You know I think a closing thought just to really embrace the changing environment. I think you know a lot of folks who are somewhat uneasy about how fast healthcare is changing and you know how hospital services are moving away into these these retail models. So quick and do get excited about that to really embrace the changing environment and really think outside the box to help your organization, stay competitive and relevant in changing times that we're in, I think this is so important.

Outstanding Mike there's no doubt you guys are skating to where the puck is going. You guys are a forward thinking organization and you are an outstanding leader. My friend. I appreciate you spending time with us today and looking forward to staying in touch with you.

That's all, I appreciate it. You're doing great things. Keep up the great work that you're doing and bringing all these great leaders together to share best practices and ideas and continue to be a great listener to all you're doing and never hesitate to call on I come here to help you guys.

Highly appreciated my friend.

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

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Best Way to Contact Michael:

LinkedIn: Michael (C.) Boblitz

Mentioned Link:

Gwinnett Medical Center

Episode Sponsor:

Enabling Physician Leaders to Become Outstanding Business Leaders with Bob Sullivan, Founder at Astute Solutions

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 where we chat with today's most successful and inspiring health leaders. I've got a treat for you all today. My guest. His name is Bob Sullivan. He's the founder and director of sales at Astute Solutions as the director of sales that Astute Solutions Bob is responsible for overall revenue growth of the company. Bob also worked closely with the other company functions providing guidance on business topics and training. He's a former general manager at Santa fi health responsible for overseeing all functions of the business including sales, account management, operations marketing, product management and engineering. He's an executive point of contact to senior health care leaders and he's served different leadership positions with Cerner Corporation for over 10 years. He comes of us with a broad range of expertise in I.T. as well as the operational functions of healthcare so I'm excited to have Bob on the podcast to dive into some of the hot topics that are on his mind and also on the minds of our listeners so Bob warm welcome to you. Anything that I missed in that introduction that you want to fill in?

Oh I have to say it is just a long ploy history and health care and health care leadership and looking forward to having this discussion.

Likewise Bob and so I would like to ask what is it that got you into the medical sector?

It is an interesting story because it was not on my radar when I was going through you know high school in undergrad. And what happened was I was a junior studying electrical engineering at the University of Iowa.

That's pretty cool.

And during that time I didn't really kind of know you know I still had two years left before I graduated. Just kind of looking and poking around different things. What happened was an executive from a Cerner Corporation came and spoke with us about Cerner's vision of changing healthcare through information technology. There was one fly in particular that really showed back that you know this was in the late 90s. It shows Cerner's development roadmap over the next number of years and how it could help that would help clinical staff more safely and more efficiently care for their patients. And at that point I knew that I wanted to make a difference in healthcare and that was really the tipping point for me. That one hour session from that executive completely turned my focus really for you know the remainder of my life. After I graduated I joined Cerner and really have been in the medical field ever since the,n working with clinicians hospital systems in a variety of ways direct patient care population health, patient engagement and clinical education.

That is so interesting Bob and listeners, he took anything from that number one Bob's passion about what he does and helping patients. And number two is you know that was a one hour presentation that one slide that really resonated with Bob. And as you all get out there and share evangelize the things that you're so passionate about. Keep that in mind because you never know when you'll be in that room and you'll touch that one person that will lead to a ripple effect of positive change. So keep that in mind you can be intentional about your presentations. Bob really appreciate you sharing that. That light bulb moment with us.

Yeah and it's one of those things I get back to college campuses not just from a recruiting standpoint but overall trying to get the message out whenever I can because of again, like you said, the change that made in my life.

That's so cool man. And it's really interesting that you're that you go back and then you try to touch these young up and coming leaders in their college campuses so they too can get inspired like you did. That's pretty awesome that you're that you're doing that so Bob you've had quite the array of experiences in health care your background as is electrical engineering. You're obviously very well grounded in this space 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 at your organization today?

Yes it's interesting because this the organization that I know and love founded founded and am now running this is a little off the track from I.T. although their I.T. components but I'll kind of get into some background and really where I see the need and why we started this. Why and I started this organization. One of the things that I've seen and I've worked with if not hundreds of health systems across the country. Many don't provide fundamental business training to clinicians who are moving from direct patient care roles in the leadership positions, whether that be possible leadership even I.T. project leadership we see it a lot. Hustle's and health systems promote clinical staff of management and eventually leadership positions and as we're seeing this is becoming even more prevalent at senior levels where the CEO is no longer a finance or an operations background. But really you see physicians, nurses leaders and CEOs and senior level positions. Many health systems don't have a structured training plan in place to prepare those clinicians, in business leadership management is a very different path and takes a very different skill set from direct patient care. And what I've seen is really for health care organizations to run efficiently. The leaders need to have that kind of business skills in place so they can effectively manage their teams and organizations. And without that, any new initiative that's brought on won't be executed consistently across the organization. If you know a lot of nursing leaders they do have higher education. And what we've found is that if you look at a master's in nursing education, there is only maybe one or two courses that really deal with business principles. Some nurses are now looking to get in and are actually moving into the Masters of Business Administration. But if you will get back that you know a number of years to complete and there's many topics in there that really have no barriers and aren't applicable to their management roles. So really what we're looking at is how do you bridge that gap. There's a floor nurse or really any clinician we're be into a leadership position and really give that clinician the fundamental business skills they need to be successful they want. And so what we've developed is a three day seminar that helps new clinical leaders learn the fundamentals of that they never learned in school or on their day to day jobs caring for patients. So we train basically fundamental business tool. How to use Outlook and how to use Excel how to set a PowerPoint. Things are just kind of those fundamental building blocks. We train our leadership skills, meeting facilitation, conflict resolution. We do successful presentations. And lastly we train on career growth tools. Actually being able to use LinkedIn, building a professional network and one of the big things we've found is just the networking in the classes itself between new leaders that are really at the same spot in their career moving from direct patient care into leadership positions.

Bob I think you're hitting a huge need here and I love the practicality of what you offer. Bob what's the website that this little leaflet is on?

Yeah, www.aslns.com.

So Fogg's go to a s l an ass dot com and you'll pull up a little brochure I found that on on Bob's link then profile. So Bob Sullivan if you look them up on link then it's there too. But he sort of highlights this three day seminar where you can build your skills as a leader and if you're a clinical background and looking to get this immersion in business skills and leadership he's got Day 1, operational business skills. Day 2, leadership skills and Day 3, professional development. This is awesome Bob and you know I've had many discussions with physician leaders and folks across the provider spectrum and there's definitely a theme where they feel like their staff that does get promoted into these leadership positions needs and is craving for leadership training. So I think you're definitely on to something here Bob. Can you tell us a little bit about how folks that have gone through your training have created better outcomes and results for their organizations?

Yes definitely. So we've delivered a number of these sessions to different groups of political leaders so currently we really focus on selling to a hospital or hospital system that been bringing classes through also just as a side note we're getting our C.U. accreditation as an organization. What are classes today or C.U. accredited so any classes that go through. Also they are checking the box of those continuing education hours. So we have exit surveys and then we also do surveys 30 60 or 90 days after the sessions have been completed. We're seeing great survey results for the students and their direct supervisors really noticing you know increase in productivity really. More importantly accountability as the new leader uses the skills that they learn in the session. Some specifics is across the hospitals that have taken our classes and we're seeing a 30 percent reduction in turnover of the leaders of taking the class versus those have not nursing turnover is not just an issue at the floor nurse or project provider level but even up in the leadership you see folks that you know might not be well equipped in a leadership position and might even go back to foreigners. So we're doing some actual data analysis on that. The early results are around 30 percent reduction in turnover on those students that have taken the class. Another specific outcome received is one health system out-used was able to shorten the weekly staff meetings across the organization by more than 15 minutes because the leaders can now effectively facilitate those meetings and cut down on a lot of the wasted time that happens in weekly staff meetings. We actually save the organization over 100 hours of staff time every single week just by more effective ways facilitating those staff meetings.

So awesome Bob. That's awesome. The numbers are great and if you're a leader listening to this provider leader start thinking about what it is you could do to implement some of these very simple things that your teams can implement and learn from Bob and his team and the, I mean for me if I could do something like a three day seminar to reduce my turnover by 30 percent I'm signing up. That's huge.

One of the things that we attribute there as I mentioned briefly before is I really feel it's a lot of times and be going from you know just drive business into leadership and the senior leadership is it can be lonely and isolated because now you're you know used to be working with you know your team on the floor and now you're having to manage that team. And one of the big things that we've just seen as a class is the cohesiveness of the leaders that might not really know each other very well. It could be a different units even different campuses, really game to interact and build that professional network. And that's really what I attribute one of it is not just the hard skills that we're teaching but taking clinicians are really the students through an experience together that really binds them stronger than just maybe seeing someone in the hall or in the cafe.

Yes that's so awesome Bob you know. And you know a lot of these these very talented providers definitely are craving what you're offering in their education. There's definitely a gap in leadership and business gap and you guys are doing a nice job of filling that in. Can you walk us through a time when maybe in your career or in this particular business that you started you had a set back and what you learned from that? A business lesson?

I think of a pretty good one and actually it's related to this as we are getting this company started. So when we were first starting this a mentor of mine told me very specifically to make sure that we deliver these classes offsite or else the students or the attendees will be distracted with their normal operations and potentially not fully involved in the class. And one of the things I just mentioned before is you really need that dynamic where people interact in together and anything that might set that back really changes the class. And what ended up happening is one of the first clients pushed me to have the class at the hospital itself and I conceded because I wanted to deliver the class and they really wouldn't. They weren't accommodating offsite. There has to be a hospital. So I ended up conceding it was early on and what happened was I was actually there delivering a presentation right in the middle of it a number of class members left to attend a hospital meeting whereas if they were offside they would have potentially canceled the meeting and are just not gone. And what happened was I was in the middle of delivering something I was extremely passionate about. It was actually doing good presentations and I did watch as part of the class literally walked out.

Wow, that's tough.

It also hurt the dynamic for the rest that stayed. And so really at that moment I realized you know I should've listened to a mentor. He has experience in change strategy and change management and it was one of those piece of advice good advice that I didn't take just to deliver an extra class system to without seeing you through best practice. Since then we've only delivered classes offsite location even if it's across the street, right? to something and get the attendees out of their day to day. And really we've had no issues around participation or anything like that. So if anything it was one that I saw firsthand very specifically that we then corrected moving forward is we either find a meeting place or find even someplace close but just get the group out of the day to day. And let's focus on those learning maneuvers business skills and really again networking with peers.

And it's so such a valuable lesson Bob. And it sounds like you're moving forward not doing an on site anymore.

Right. Learn it learn from it. Right.

Yeah. Yeah that's great. And you know just thinking through some of the things that that you all are doing in your efforts to take your organizations to the next level. Let's learn from Bob and what his mentor taught him is that if you take your group or your team away from the day to day, it really makes a big difference. I've done events for my teams to help just reshape or redirect our strategy. And boy does it help to do it away from the day to day. And I also have a policy where and it's tough but we do it we put our cell phones in a bag and we and we throw it into a drawer. And boy people are itching at first and it's kind of like you get this digital twitch but the engagement goes up. And so it's it's up to you what direction you decide to take. But the advice that Bob just offered us here is critical. Bob thank you for that.

It's funny I have to say. We do the same thing with phones and computers and one of the things was the Leadership Conference I went to a while back myself or I was having the same problems that you were talking about putting my cell phone away. We made the point of you go on vacation every now and again right. Don't have cell phone. Just think of it that way like they just take a vacation from your work even though you're learning and growing professionally. Just more think it was a vacation night. You're missing a client week of work.

Love it. That's a great way to put it man. So that was a lesson learned from a meeting that they didn't go so well. One of your most proud medical leadership experiences Bob. You had a lot of experience and great things that you've done in health care. What's one of the proudest ones?

Yeah. So I'm going to go back to when I was an executive at Cerner. I was the executive the senior executive over us implementing the CERN really tight medical record at extremely large rehab facility. The client actually went from all paper so they were one that didn't have anything in place to fully electronic in a pretty short timeframe. So it wasn't they had an older system that they were operating. It was everything paper to everything electronic. And you know there were there were challenges throughout the entire implementation change management things like that and what hassle was soon after the conversion. I rounded with one of the rehab physicians and watch them use the system and the look on his face you know especially somebody that was has always documented hate on paper movies electronic in what he was ecstatic about was not about the documentation and put it in the computer. But really that his documentation could be seen across all the functions that touch a patient because especially in inpatient rehab PC OT's speech. I mean just you have all these different groups coordinating with the same patient. Very specifically schedules things like that. And so he was ecstatic that everyone could be the patient record all the way through billing . And he explained how much time it could save him just in the reduction of duplicate documentation. And to me it's one of those that was you know life moment to him. There was a lot of work, a large team effort both from my team side at Cerner and the client team coming together to deliver this solution. And just his use of the system and his explanation of benefits made that entire you know let's say your long journey worthwhile. It was one of my proudest moments of seeing that from beginning all the way through and actually getting his direct feedback.

That's exciting. That's exciting Bob and it's kind of like you know full circle right you start on a slide and there you are implementing it.

Right.

That's so great.

And that's one of those two it's you know some of this when I've been talking to other groups is it's not just nurses who are just a clinical to floor leadership with these large I.T. projects and other initiatives. These kind of skills we kind of train them ad hoc. We train the clinicians ad hoc through that process. I'm also starting to think about how can we even help those type of processes because these large I.T. projects are not going away anytime soon. And if anything there's going to be more clinician involvement in them in the future. There should be.

Yeah yeah that's a really great point. You know and maybe even having some specialized EMR implementation leadership things like that I'm sure would resonate within what you're doing now. Bob what would you say is the most exciting part of which are working on?

Really when it comes down to it from an excitement standpoint it's getting in front of the new clinical leaders. I'm still heavily involved in the training aspect as well just being able to see their eyes light up of OK I can use this tomorrow. You know I have been struggling with this and now I have a solution or somewhere to get started. To me is really driving that. That's what drives me and gets me up every single day. To continue to grow this. A newer project that we're working on is that you know there is a lot of organizations that offer different type of seminars and different type of leadership development courses and I'm actively working with some of these different organizations to really look at moving beyond this three day seminar is extremely valuable for new clinical leaders. But looking at expanding the offering and using you know other leadership programs and standard content to say okay let's actually put not just you know a new manager training in place but actually you know leadership academies, specialize offering like a three day summit are just presentations. Some of those other things are really to offer a more holistic view of leadership as we work with our client partners. So it's one of my main focus is here is just trying or look in the right way to expand the offering as kind of a next step. Okay. You've taken the intro 3 day course. Okay. What are you focused on now or are you delivering a lot of presentations or facilitating many meeting. How what's a good way to keep building on those skills.

That's outstanding Bob again listeners Bob Sullivan with Astute Solutions working to get clinicians the business savvy and leadership skills needed to lead today's health care systems. Super super work being done by this group. You could check them out at www.aslns.com. Check out what they offer. Bob we're here getting close to the end. Let's pretend you and I are building a medical leadership course on what it takes to be successful in the business of medicine today. It's the 101 of Bob Sullivan. So we're going to write out a syllabus. I've got four questions for you lightning round style followed by a book that you recommend to the listeners, you ready?

Yes.

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

Is to make sure everyone in the organization understands and is following best practice protocols on with accountability at all levels.

What's the biggest mistake or pitfall to avoid?

I always go with developing a new best practice or protocol without also implementing the standards around it to make sure that followed consistently throughout the organization.

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

Change is inevitable even especially in the health care industry. It's hard but I would say follow the authors of the literature on best practice. What peers and what what other organizations are doing and also look at have a focus and look at where government regulations are headed and make sure that the entire organization from leadership all the way down incorporates the knowledge into their day to day practice.

And what's one area of focus set should drive everything in a health organization?

The focus in the end needs to be the best care for the patient at the right time with the best clinical outcomes. I mean in the end that's what health care I mean. But my take on healthcare should be about including protocols and best practices in place really in the end drives better patient outcomes.

What book would you recommend for the listeners Bob?

No I'm a pretty big bookworm so thinking I'm just working through this probably the most enlightening book I've ever read is called Thinking, Fast and Slow by Daniel Kahneman. The book goes into in depth about how people make decisions. I've read it many many times and it's always been helpful. Analyzing the decisions I make and making sure I'm making them for the right reasons and I'm making the best decisions I can.

Love it. That book's been recommended a couple of times now. So listeners if you haven't read it definitely one that you'll want to check out trunking Fast Thinking Slow got Bob Sullivan here from a Stewart care solutions. All the things that we talked about today are available the transcript, links to Bob's company everything that he's doing to help clinicians become better leaders and business people. You could find all that information and outcomesrocket.health/astute. A S T U T E. Bob this has been a ton of fun. I've really enjoyed talking about this topic with you. Leadership and business skills for clinicians if you can. I'd love if you could just share a closing thought. And then the best place for the listeners can get in touch with you.

Yeah definitely. For everyone I would say make sure that however it is. Make sure you invest in your employees especially when they're most vulnerable like when transitioning could career focused any of the money spent will be paid back 100 fold in increased productivity increase, patient satisfaction and decrease turnover. My email is bob@aslns.com if you need to get a hold of me.

Outstanding. This has been a ton of fun. I think that you guys are doing some great things to build the future leaders within clinician's. So I just want to say thank you again for spending time with us. Looking forward to seeing how you guys continue to to grow your business and impact healthcare in a positive way.

Thank you for having me.

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:

Thinking, Fast and Slow

Best Way to Contact Bob:

LinkedIn: Bob Sullivan

Email: bob@aslns.com

Mentioned Link:

Astute Solutions

Episode Sponsor:

Improving Healthcare Quality and Outcomes by Focusing on Human Factors with Sameer Badlani, CHIO & VP at Sutter Health

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.

I have a wonderful guest for you today. His name is Dr. Sameer Badlani. He's the chief health information officer and vice president at Sutter Health in Sacramento California. Dr. Badlani comes to us with a lot of experience in medical information as a chief medical information officer previously at Intermountain Healthcare. Then prior to that, the chief medical information officer at University of Chicago preceded by a wealth of experience as a physician and also just a biomedical informatics expert. So I really want to extend a warm welcome to Badlani and also just open up the microphone to use some ear to fill in any of the gaps in the intro that I missed. Welcome to the podcast.

Thank you Saul. I really excited to be part of the conversation and all the nice things you said about me. Thank you for that. I guess the only other thing I would add is that I used to practice and teach practice medicine and teach clinical medicine at the University of Chicago, was the faculty inSchool of Medicine and the wonderful opportunity to teach medical students an internal medicine residents and that's definitely one thing I miss of my current career.

Say you had a great great opportunity to be at the frontlines and train future physicians and now in a leadership role at Sutter. I always like to go back to the very beginning. Sameer what got you into the medical field to begin with?

Well true story at the age of four years, my mother brainwashed me and said you had to become a doctor so here I am. Nothing chattering about anything significant which is just good old parental pressure.

And hey you know you listen then. Good thing you listen. Because things are going pretty well.

Yeah. So I've enjoyed you know all jokes apart. You know that's how it probably started. I progressed through my high school. It was something that you know I found myself really looking forward to the opportunity of joining a medical school. And when it all happened I realized you know this is exactly the career I wanted and in many ways even though I don't actively practice anymore except on friends and family what I do allows me to benefit patients and clinicians have a much larger scale than I would have been able to if I was just being a panel of patients. As far as I'm concerned you know I'm still a doctor. I use different skills to help deliver better health care.

Definitely on a broader scale and and in today's day with technology being so pivotal to the things that we do. Your skill set is definitely very very uniquely poised for some broad impact in that field. Sameer what do you think a hot topic that needs to be on our listeners agenda today and how are you guys approaching it?

Sure. I think the hottest topic these days is generally under the broad purview of the transition from fee for service to value based care. The way I like to break it down is most people end up getting embroiled in provider peer payment set up that's how they see these two opportunities. As far as I'm concerned the way I like to look at it and a lot of my colleagues do as well is that health care costs a lot more in comparison to the value we provide and the value and outcomes I would choose to value plus outcomes. And the reason we say that is that you know if healthcare was costing what it cost today in the United States and then everybody in United States are a significant population was satisfied with their health care experience and outcome and we were the healthiest country in the world then I would say you know money well spent. Keep on going. But that's not the case. While we are number one in I think I may not be far off on the statistics but number one in the percentage of our gross domestic product we spend on health care and the actual dollars you spent on health care. And then when you compare from any w8 or other metrics used out there to compare the health of different countries are probably somewhere in the low 20s high 20s or low 30s that's where we were last time I checked. So we're clearly not getting Money's worth. You wouldn't go to a car dealership and say I'm willing to pay a bill for the highest price car and I won't care if that's the 30th in quality. So think of it that way. And for me that's a very hot topic and every medical leaders agenda is how to do more with less. How to do better than we have done in the past and how do we engage our clinical workforce and our patients differently in this digital age.

I think that's such a great analogy Sameer. Nobody would want to pay triple for a car and you know hit me 30th on the list of great cars. Can you dive into some examples of things that you've seen or things that you guys are doing over at Sutter to bridge the gap.

Sure I think I'll speak. One example is on the quality side there are a lot of quality metrics that an organization like Sutter and any of our peers large or small are different ambulatory and patient and so on used to measure their clinical outcome. While the current quality metrics are not ideal in the sense they are more of process metrics rather than outcome metrics. It is what we have today and I'm very proud to say that Sutter does really well in these metrics. One of our goals about 2-3 years ago was to really provide that level of quality at all of our site. So one of the collaboration projects that we launched internally within Sutter was a partnership with my department which is informatics and analytics along with a quality department where we built an analytic dashboard that allows us to not only measure in real time the quality, the experience of operation but how are we progressing at all our sites, all our physicians and while I would be misplaced to say that has made singularly made the difference to have definitely for sure contributed to our ability to pull the right leavers have the right conversations assign the right resources where this analytic dashboard and the associated informatics workflow and the business workflow. Last year we had a much higher result than ever before for the quality that we provide to our patients. And that's deeply satisfying because while it's been a tough project, it took good three years to make it happen. Lots of money, lots of time. It is delivering the results that we hoped for and more importantly these are meaningful results. It's not a fancy machine learning dashboard that I can just give a talk about.

Sure, sure, I know I think that's really really neat and you bring out machine learning and sort of it being fancy at the end where the rubber meets the road is where it matters most. And so congratulations to you and your team for creating this summer. What would you say in that solution that you guys put together. Was the secret sauce. Why do you think it was successful?

A few reasons. I think number one we had a clear idea of what we want to change. So the business case was crystal clear in our mind set up various quality and value based measures that we wanted to improve our performance by not only being able to measure what it is in real time rather than finding out three months later what happened but also to be able to help in the day to day workflow for quality managers in impacting that workflow and working with our patients. It's by no means a completed project it's a good start.

Sure.

I would qualify it, that was the first point the second thing was a really good and intense collaboration often full of friction but still good and focused on the right objectives between my teams and the quality and operational team. And I think that's what you need. Often people describe good collaboration is where nobody fights with each other. I would say those are the worst kind of collaborations because you never find out what's wrong. Still it's too late but in this case I think the healthy amount of objectivity and interpersonal challenging that was going on allowed us to arrive at a better product. It's definitely I think going to be a prototype for us for future success. The most difficult part which I would say somewhat surprise me but shouldn't have surprised me in hindsight is how difficult it was to get a standardized workflow.

Once the analytics dashboard had made and if there is of many I hope helpful or else that we will be able to share today one of them definitely has to be focused less on the technology or the completeness of the dashboard or cause a lot more on the standard work that your team will do once that analytical site is available. What we found again not to our surprise is that different people in different parts of the company probably under the same job code were doing their jobs very differently and that's what we find in almost anything we do. So probably the last one year has been less about fixing the product or refining the product it's been more about standardizing the workflow amongst various individuals in a team that's spread across the entire geography of Sutter Health and the complexity that comes with it and then changing the system accordingly. And I think that's part are building us I.T. solution which is definitely in the realm of informatics ethnography is very important because you standardize the job to be done then all level of solution work in supporting it.

Such an astute observation. And we really thank you for sharing that Sameer. And yeah you know when you have the clinical variability there's no machine, no algorithm that you could place on top of it to make it better.

Right. And this applies to clinical variability or operational variability. I think you have had a very insightful. I would say nerve there because many people look at the healthcare system as a single clinical workflow a patient meeting a doctor or a patient interacting with a nurse or the billing department. What we fail to realize often while being in healthcare is that there is an entire back office in a middle office that is not dissimilar to any other business industry vertical out there like retail banking or finance marketing. Any of those. So that's where we have a lot of opportunities to standardize our processes, reduce the waste while continuously trying to deliver better health care.

A great call out Sameer. And super fascinating that the last year, you worked on a tool the first two years now last year is all about workflow standardization. And now you guys are having some big strides in the results you're getting. Can you give the listeners an example of the results you've created by doing things a little bit differently?

Sure. So you know for example we are measured on have we done all the appropriate preventive care for our patients. It's not only a measure of the quality of care we provide. It also allows us to improve the health of our population that we serve, the consumers that we are. And one of the places where this has helped us is that we know the gaps in clinical care very early in the year rather than finding out much later as I talked about so very, there's a difference between in real time and dynamic. And in this case I will say it's a dynamic report which based on all the available information we're able to tell you that these are the 10 patients in our panel who are missing diabetes check or are missing Cancer Prevention check. While we are still working on enabling the workflow now that we have the insight we are now much more of there are gaps and can we go after these 10-15 patients to get them into the health system in some shape or manner and get them the preventive care they need. And as you know prevention is a way better off taking care of a population than treating acute problems. This has made a big difference. The other thing is we are able to document better as to the care we have provided and that reduces redundant care. You know if the record does not show properly or the inside doesn't show properly that I have required blood tests for diabetes I may end up getting the same thing prescribed to me by another doctor so that's unnecessary testing, unnecessary cost and unnecessary pain from a blood test and unnecessarily waste of my own time. But I have to you know figure out how to make it to the lab and get test done. One of the biggest complaints our patients have is why don't you have all my data in one place when I come to you. So this helped us prevent a lot of those gaps in care that we had gaps in communication that we had.

No doubt some serious results here Sameer. As we walk through this theme of value based care. How are you looking at for example patient reported data to help with that?

So a great topic to talk a little bit about patient reported data and the broad category. It needs to be differentiated in outcomes that are reported by a patient. For example you came to my clinic and I did a new procedure on you. So you send it information at one week at one month and six months. How good is your walking. How good is the swelling, or hopefully gone by one month. And how is your being which was the first reason you first came to me. And so those are patient reported outcomes which is what we should be really focusing on. Was this patient generated data which has a life of its own now that the Fitbit, Apple Watch and every other device out there that is able to measure and sent the information. What I'm not saying is that it's not imortant, what I am saying is that it has caused an unfortunate amount of hype whereas the mere availability of raw data is being seen as a breakthrough. And I would humbly beg to differ. A physician right now, a nurse right now is already overburdened by a large amount of raw data.

Yes.

And what they need to be doing are again not even dashboards. As a physician, what I would like to see is that if I am your specialist helping you take care of diabetes, instead of knowing all the raw data you collect on your glucometer, I want to know how many times, was your insulin not enough. How many times. Or is it too much. And how are you generally doing on your diet. And then even moving to the next step what basic adjustment can be done to your insulin and diet without getting me involved. When I get involved it should be for cases where we really need to have a deep discussion. The goal of any of these analytic data and informatics platform should be only one at the end of the day to allow a patient and a physician to spend more time with each other in a meaningful way so that a better healthcare outcomes can be achieved. If all these tools all these fancy technologies lead to distraction like they normally do or they lead to more data overload causing cognitive dissonance. We are only making the problem worse. So I like solutions that would use the data aggregation while factor into aggregated all the patients data. They told me how they were support patient generated and patient reported. And based on that we took six steps to take care of a patient that was decided in a protocol that you are nurse in your hospital and your clinic. And here is how he or she is doing or you know what you did pre decided six steps and it still not making a difference. We would like to bring in the patient to see you. That's how I would like to see patient generated and patient reported data being used. I think we got too excited at the fact that I could even get access to that data. We forgot why we were doing it in the first place.

That's such a great distinction to make Sameer and I thank you for that. Because yeah you know it is happening and you look at companies gathering this data and you know the excitement can sometimes cloud judgment and the metrics that we're after the outcomes that we're after. How do you maintain clarity amidst this excitement. What advice would you give to health leaders in the trenches?

It's very hard. So I would be completely lying if I said I don't get drawn into it or I don't find it exciting because we are all trying to make a difference here. It is hard but I think it is the most necessary task of health IT leader today is to not let the shiny technology in front of us obscure the importance of the patient and the physician that we are trying to serve here. I make sure to add the physician because with the last few years while we have had a very healthy much needed focus on patient engagement, a lot of it has come at the cost of clinician engagement, both physicians and nurses and advanced nurse practitioners and physician assistants which has led to a significant amount of dissonance job dissatisfaction and burnout that we hear a lot about. So it's really important that when you are thinking of a solution, you really want the patient and the physician and the clinical workforce as your primary client and then the clinical outcome as your use case focus. So that's number one. I think that helps us really keep our focus. Number two is is the solution to improving outcomes and at the same time reduce the cost of care delivery or maintain the cost? I think for too long, if something short or even mere chance of improving a clinical outcome, but was extremely expensive from a total cost of ownership model we were not worried about it. You know we would say the ROI would take care of it. I think we need to stop doing that. Health care needs to be run like a true PNL business which will allow us to have a robust focus on how we think of the solution. You have to really hold ourselves accountable to go back and check on how well did we do on various metrics of improving clinical care reducing the cost of care and improving the access for our patients and improving the job satisfaction for our physicians. Those are metrics that you need to hold ourselves accountable to.

Some great advice there Sameer. Friends if you're listening. You probably pulled over to take some notes. You didn't, the nice thing about podcast is that you could always rewind and go back because Sameer definitely offered a lot of value there. I encourage you to go back. Listen to this again and start thinking about how you could approach this subject of new technologies and keep that outcome at the center of all your decisions. Sameer, I feel like oftentimes we learn more from our setbacks than our successes. Can you share with the listeners a setback and what you learned from it?

Oh boy. So many to choose from. And I think you're absolutely right. I only learn when I make a mistake because when something goes well you assume it's because of what you did but you have no data to prove that. It's only when you fail do you potentially have the opportunity to do a root cause analysis and you learn. I think you know rather than focusing on the one time I failed because there are so many honestly I think it's one area that I know I have failed in the past for sure is not thinking enough about change management. You know it's very easy for me to say I picked the wrong technology, I picked the wrong stack and that's why something failed. I would again encourage our users and colleagues to think differently. It's often in the change management that we feel. And what I mean by that is if you look at the Design Theory or the design methodology the first step in that is have empathy for the user and make it stop right there is that have you really understood the change you will make to the user's workflow and how it will impact the job to be done as they think their job is and these are words taken from professor Clayton Christiansen who wrote the book in which his dilemma is an example of the many good books he has written is really important. We do not take a pause to understand how will this change the job that's being done by a particular group of people where this technology or this new process or this new clinic will be implemented and then do they have enough training backup support and continued support to make a difference in the informatics world. There is a common joke that if you go up to the senior management person and say hey I need 20 million dollars because our servers are end of life systems will come down we will get you know maybe 30 million dollars so make sure it doesn't happen again. If you go back and say hey you know I want five million dollars to retrain all my nurses and physicians and standardize workflow. You'll get blank stares though somehow from a very tangible request you went into the intangible in the minds of many people. I think that's a mistake that I have been guilty of making is to not ask for enough resources in that space, not spending enough time thinking through the what ifs in those in that arena. So I think human behavior and human change management are probably the places where I always feel have I done enough. So in many ways I feel like psychology of change is the most powerful technology we have access to and we don't use.

Sameer you bring up some really great points and again you know hitting on this theme of ensuring that we've got the right clinical flows, we've got the appropriate level of attention on ensuring that these workflows are in a good place. I love that you're focused on this despite the fact that you're very tech-centered, you still continue to bring us back to what matters which is the quality of these providers as well as the quality of the patients. And in your experience, what would you say one of proudest moments you've experienced?

Right in discourse or fuselage when should I talk about? I think the first distinction I would make is that you know I definitely see myself as a medical executive or a healthcare executive. I don't see myself as an IT executive. I am a clinician first and last and I just happened to use health I.T. as most outwardly visible to get to make a difference. I think the most proudest moment probably came from a teacher mindset is where I've had two or three really misguided people say they want to go down the career path I have. So I try very hard to convince them otherwise. But I think that was a big compliment to be able to see the kind of results that from my teacher mindset. And then the other one was you know way back at University of Chicago where I was there Chief Medical Information Officer five six years ago and we had we are still finishing up our big implementation and I had a couple of nurses come up to me and say that some of the recent changes in workflow and technical fixes that we had made allow them to delay they safer care in the OBGYN and department. And you know for many reasons that really resonated. I've had many other such experiences. But if you think about it, the little babies are probably the most vulnerable population. There is plenty of chances to make mistakes. And that was around the time that my daughter was also born. So maybe the hormonal overload for me at that time was kicking in but I think that was one of my proudest moments and reinforced for me that a personal sacrifice. I feel like I'm making every day by not practicing actively does amount to something of material difference to the patients and physicians. I serve.

That's wonderful. No doubt, Sameer, children's definitely one of the best in the world and pretty awesome that you did that work over there Sameer, you know in my backyard I'm here in Chicago. We definitely recognize the University of Chicago is definitely one of the best in the world. So kudos to you and your team my friend.

Thank you, thank you. IT was a team effort for sure. But like I said it validated my career choices.

That's wonderful. Tell us about an exciting project or focus that you're working on today?

It hasn't kicked out but I'm really excited to talk about it. So building on the team or the biggest technology we have access to is the psychology of picking the mind and change management. If you extend that formalized that it gets into the field of behavioral economics or behavioral psychology and it's employed by marketing sales pharmaceuticals for decades in fact it's a well known secret that the biggest recruiter of news psychology grads are sales marketing and pharmaceutical industries. And it makes complete sense. So for me I think in healthcare, we are so focused on new technologies new diagnostic methods, more doctors, more hospitals, more nurses that we have completely missed out on the opportunity to change human behavior. In this case the human is either your employee,your collaborator as a physician or a nurse. And then finally you convene which is your patient to influence their behavior. So this is also known as the nudge theory. And there are many books written about it where they talk about how you raise a certain question or how you present a certain situation. People react differently. Very good person example that I like to share that when I was applying for my license in Chicago. And in fact that day my clinical practice was focused on Crohn's con medicine just the inpatient medicine not for surgery. And I go to fill inmy get my driver's license after having moved from a different state. And one of the questions is do you want to donate your organs when you die? It was something literally as put a life and I have to admit at that moment I stopped being a transplant physician who fret about the availability of organs and I became a mere mortal. We're like no. I changed later. Right now I don't feel like clicking guess. You know I became this illogical irrational human being where I thought the mirror checking off a checkbox on the form would and dice mortality on myself and I have never really gotten over what I consider poor choice by me almost ten years ago of answering that question now. Many other state that I don't know if anyone has changed. Do it differently. Instead of making it an opt in where you have to rationalize your eventual mortality, they talk about opt out where instead of saying you know do you want to when you die. You say when you're no longer in the world do you want to not help your fellow human beings. So then it, number one makes it an opt out. The decision is sort of be made for you and then number two it appeals to your altruistic side and you're like oh I want to help. I'm a nice person. I help my neighbor with their garbage when they gone. So yeah I'm a nice person. Of course I want to continue helping people. So the response from the same person becomes very different. It has been applied for example by the United Kingdom Tax Department. Where of saying you have to pay your taxes on time otherwise you have just been told that there will be people just throw that mailer in the dustbin. Instead they leverage one of these professors who was expert in the nudge theory and he guided them to send a simple postcard that said Did you know that by X date 72 percent of your neighbors have already filled in their taxes. They are like what. I'm the outlier. I'm the bad person in this neighborhood and you know start behaving different. These are just a very simple 20 cents Coast Guard made a difference of about 10 per cent a multimillion dollar revenue opportunity for the tax department. So in healthcare we need to bring a lot more of that and there isn't enough of that. I see or least are for that. And you get banned. We are working to figure that out at Sutter ourselves and the amount of time that we spend on the computer delivering health care. The amount of time our patients spend on the computer are not only receiving their healthcare but into the digital world offers tremendous opportunity for us to take advantage and do some real good here. So that's the area that I'm really excited about. I'm trying to figure out what would be my first proof of concept and how to get them going. Hopefully at a future date I can talk about that as one of our good learnings.

That is super exciting and it's definitely full circle just getting back to that psychology Sameer. And you know what, anything you get involved with. I'm interested in following so please get you back on and maybe a year or so when you get it off the ground to to hear about how things are going.

Thank you. I would love that.

Awesome. Sameer, we're getting close to the end here so this part of the podcast a quick lightning round for questions. We're going to build a medical leadership course on what it takes to be successful in medicine. The 101 of Dr. Sameer Badlani and so I've got a syllabus, four questions I'll ask you does and all finalize it with a book that you recommend to the listeners. You'r ready?

Absolutely.

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

Stop wasting money.

I love that. What's the biggest mistake or pitfall to avoid?

To view you have all the answers or what worked the last time with work this time too.

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

I think singular focus on delivering value for your consumers and in a health care organization that's just not your patients goals or your prayers. And it's also your provider partners so all three.

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

Delivering better quality care to our patients and running it like a true business.

Well said and finally.. Yeah that's perfect. What book would you recommend for the listeners as part of the syllabus?

Sure. So you know I'm a big fan of the classic literature so pick any book from Shakespeare. I think you will find a lot of life lessons and in healthcare I think it's comedy of errors is probably the one to start with.

Wonderful what a great recommendation Sameer. Thank you for that. Listeners, don't worry about writing any of that down. Just go to outcomesrocket.health/badlani as in Dr. Sameer Badlani and you're going to find all the show notes, a transcript of what we've discussed as well as links for the organization that Sameer with and all the things that we discussed as well as a link to the book. Sameer, this has been so much fun. Really appreciate the time you've spent with us if you can just leave us with a closing thought. And then the best place for the listeners could get in touch with or follow you.

Sure. With all postal vote thank you for this opportunity was really interesting for me to go through the process and share some of my thoughts. I feel very lucky and hopefully other people find it entertaining and interesting. I think LinkedIn is the best to get hold of me. It's the easiest social channel, I'm not on Facebook and occasionally show up on Twitter who talk about coffee. So LinkedIn is probably the best place. I think one closing thought I would have is have a very clear idea of what is the outcome you're trying to achieve in your day to day work. Too often, we spend time delivering projects and not outcomes. And I think that's a fundamental change that needs to come into how we deliver health care.

A great message Sameer. Listeners, hope you enjoyed this as much as I did and again be sure to rewind and listen again because Sameer definitely offered some great takeaways that you can apply your organization. So Sameer, again just want to say big thank you for spending time with us and looking forward to having you back.

Thank you so much. Have a good day.

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:

The Comedy of Errors

Best Way to Contact Sameer:

Sameer Badlani

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Leveraging Mobile Technology to Improve Outcomes with Patricia Mechael, Co-founder and Policy Lead at HealthEnabled

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 to the outcomes rocket podcast. Today, I have an amazing guest. Her name is Dr. Patty Mechael. She is the co-founder and policy lead at HealthEnabled with many years of health care experience. Her focus is in global health and digital health and all that it takes to be successful in medicine. And so I want to open up the microphone to Patty to fill in the gaps in the introduction. Tell us a little bit more about herself and what is it that they do at HealthEnabled. So Dr. Mechael thank you so much for being with us today. Welcome to the podcast.

Thanks Saul. I'm really pleased to be here. So not sure where to begin except to say that a lot of my work has been in global health. I have spent probably in the last more than 25 years primarily working in Africa, Asia and Latin America. And my background really is in public health so really looking at how do we prevent diseases that we can prevent and strengthen health systems to address conditions and help people in ways that they need to be helped if and when they do get sick. And for about the last 20 years almost, I have been looking primarily at the use of mobile technologies to improve access to health and health information in a broad range of different settings and was the idiot savant that did a Ph.D. looking at mobile phones and health when the penetration rates were about two and three percent in this country. So even before the telecommunications companies anticipated that we would have more mobile phones than people on the planet.

That's amazing. What got you interested in that particular topic. Did you see where it was going. Or was it luck? What are your thoughts there?

I didn't see where it was going. I had taken a bit of a break from my work in global health and I was working for a dotcom in New York. And when one of my mentors approached me to apply to Ph.D. programs which I had never really planned to do and so I was like sure I'll apply to a Ph.D. programs. And at that time everyone was looking at and I wanted to look at technology and health but everyone was looking at the Internet and I had spent time working in places like South Sudan during the Civil War and Somalia and Uganda and Kenya where there is just no basic infrastructure so there is no running water, there's no electricity. There wasn't going to be the Internet for at least 10, 20, 15, 30 years but, we were starting to see mobile phones appearing particularly in the urban centers in different developing countries. And so it's just like well what about cell phones like what if people had access to cell phones, could use those cell phones to access emergency transportation like consults with a doctor. Like how could we leverage this emerging technology in a way that could really help improve health outcomes. So I applied to a couple of programs. I was really fortunate because the London School of Hygiene and Tropical Medicine had a science and technology studies sociologists on faculty. When he saw my application which is like you have to come to school here you have to do your Ph.D. here. And he was so enthusiastic about it. So I sort of began my journey not really knowing kind of what to expect. It was more around the like well what if people did have cellphones. And what if they could use those phones to do interesting things related to health. And then quickly it sort of really started to pick up even in my Ph.D. research which was an ethnographic study because nobody had ever researched it before people we're already very informally starting to use mobile phones to access health services and health information and organize themselves and do disease surveillance. So even just a natural progression in the use of technology was very very interesting from very very early, early early days.

Well it's become very practical Patty and I think it's really neat that you decided to get on this track why medicine to begin with?

So I'm a first generation immigrant to the United States. My parents emigrated from Egypt in the 1960s and so of course as is typical of immigrant families if you have kids that are good at math and science then you're going to be the family medical doctor and so it was one of those and I was always very passionate about helping people and so I I kind of had that that then. And when I was in high school I was an EMT and brewed .. in my town in New Jersey. It was very keen to kind of get into that field and I was I was incredibly fortunate to have done my undergraduate degree at at Johns Hopkins because at the time I was an international relations premed student so. So I wanted to work. So I had this like dream of being like a flying doctor in Africa. And so I wanted to do medicine and health in underserved countries and populations. And I didn't quite know exactly what I wanted to do and how I would go about doing that and why in my first year at Hopkins the School of Public Health offered a course in the winter session called careers in international health. So I took this course and I was amazed that all of these people who had worked with WHO and with UNICEF as well as ministries of health from around the world. And this more sort of population-based approach to health which is sort of like instead of going to one by one and diagnosing and treating individuals. How do we start to look at, you know entire populations? And that got me really really excited. And so I sort of felt passionately in love with the concept of public health and then started reading everything that I could in this space including the World Development Report from 1993 which was focused on health published by the World Bank which I think is the same document that got Bill Gates excited about global health which I learned like 20 years later and I was like that's awesome so I'm like, "you, too" so then you know I decided to pursue a Masters in International Health and really spend time living and working primarily in East Africa working on sort of a broad range of public health related initiatives.

That's pretty cool. And you know it's fun to hear your story about how one thing led to another and you just got involved with this group over there. Hopkins that was doing more population based things and it just sort of fell in love with it and as we fast forward today the reality whether it be global or domestic, the importance of managing populations and health population health management is a very key topic. What would you say is a key topic that needs to be on every medical leaders agenda today?

Yeah I think we're getting to a place where the personalization of health I think is becoming more and more possible and really helping people to integrate health into sort of their everyday everyday lives and existence and so oftentimes our intersection with the health care system is around a disease or around like a particular health condition. But as human beings we're more than our disease conditions and we live in the real world and we have things that are really passionate about and things that get us excited. And we have families and we have. And so I think it's really important to contextualize health with sort of the person and to really start to think about how do we move towards a more personalized approach to health which I think ultimately will lead to better community health and better population health. And I think that right now we have a highly burdened health care systems that can't afford to deliver services to their populations, don't have the workforce to meet the demand. Don't have the right distribution of healthcare providers in rural areas that can serve different types of populations and that sort of thing. And so it's becoming more and more important to engage individuals in their own health care and in their own health. Ultimately like nobody wants to be sick. So there is like OK let me go out there and fall sick so you know if we can keep healthy people healthy for as long as possible and engage them in fun and new and interesting ways in their healthand provide them with you know insights into what's going on in their bodies either through wearables or different types of technologies. I think that's certainly a really important push but then also for those that do fall sick to provide services and engage them in ways that really acknowledged that each of us is very different and has a very different set of needs interests approaches etc. and that health is a very personal personal issue and should be treated as such.

Yeah I think that's a really great thought there. Dr. Mechael you know when we take a look at a patient just as a sick person a disease, their particular disease it doesn't doesn't help with thinking about it more broadly is going to help us come up with better solutions. I'm curious so the work that you guys are doing at HealthEnabled, maybe you could walk us through some examples of how you guys have created results or improved outcomes in these rural populations by doing things differently?

Sure to a lot of our work at health and able for the past few years has really focused on nationally scaled and integrated digital health systems so we spend a lot of time working with governments to develop supportive policies that can help sort of these emerging technologies be scaled to the entire population of of their countries. And so, for example we've worked in South Africa with the National Department of Health on a platform called MomConect, which a few years ago set out to register every pregnant woman in South Africa and provide stage and age based messaging throughout her pregnancy as well as for the first year of a child's life and was largely designed using a lot of ethnographic work and research with voices and text messages that are acceptable to the population. And it was incredible. The Ministry of Health and the Department of Health of South Africa took an incredible leadership role and it was one of the first sort of stale implementations where they're currently reaching over a million pregnant women and they have about a million I year of pregnant women and so it's basically like they're reaching practically every pregnant woman in South Africa with these messages and the data and the research on these types of mobile messaging programs is now starting to catch up with the innovations. And it's really showing that there are improvements maternal health practices that we're starting to see improved outcomes among children and newborns. And it's a really exciting time particularly for these types of for these types of programs. We've seen similar results in India and other countries as well have had started to implement these types of programs including Nigeria and China. I mean the United States has our own version text4baby which is largely built on the same set of core, set of messages and approaches.

That's pretty great. And the nice thing is that once you once you build it you could customize it to the particular country for acceptable messaging and maybe like fill in the gaps in cultural traditions. And then it's just sort of like an out-of-the-box tool that could be customized for each country right?

Yes and no I mean..

It's never that easy.

It's not that easy.

I have a colleague at UNICEF and we joke with each other that we should write a book called And Health Is Hard and because its actually it's a sophisticated kind of epic undertaking.

That's too funny.

What you think should take a few months could take a year. But yes there are some aspects of these types of programs and it's mostly like the approaches that can be replicated from one setting to another setting. A lot of times that basic health and key health outcomes that we're really striving for can be standardized across different settings. But one country might have to prioritize certain health outcomes another may have to prioritize other health outcomes. For example in a country like South Africa where you still have relatively high HIV rates things like prevention of mother to child transmission of HIV in the messaging becomes really critical during the pregnancy and you know or you know in a country like India where anemia is quite high and you do have eclampsia pre-eclampsia and those sorts of conditions they're making sure that the women are able to identify the risk signs as well as like take preventive measures to prevent those conditions and maintain a healthy pregnancy. But then if and when they do start to notice things during their pregnancy is that they can take action at the appropriate time.

Yeah that's really interesting. So snd health is hard.

It is.

So Patty through your journey I'm sure you've had mistakes, setbacks that you've learned a lot from. Is there one in particular that you want to take us to and sort of share and what you take out of that?

Sure. So early on in my career so I was really fortunate when I finished my Ph.D. and it has been about 2006-2007. I moved back to the U.S. and I decided that I wanted to live in Manhattan. So I started contacting different colleagues and networking and I got a call from Jeffrey Sachs at the Earth Institute and a totally random. And he invited me to brunch the next day at his house and was like..

Just randomly like that.

I mean something that sent him my CV and gay guy and they were about to launch a partnership with Ericsson to look at mobile technologies across ten countries in subsaharan Africa and they had prioritized health is what are the first areas that they want to look at. And they were like you just finished your Ph.D. looking at mobile phones and health, like would you be interested in helping us figure out how we look at mobile phones and health. And one of the early projects that we designed and implemented as part of this program was using text messaging to register pregnant women and then track their pregnancies and then register children and then track their make sure that they got their immunizations and those sorts of things. And we did this in 10 countries. And I think what we did as a spread ourselves too thin and I don't think we did a very thorough job of like really explaining kind of what this was, etc. And so some of the countries picked it up really well knocked it out of the park. We're starting to show like improved health outcomes, et cetera. But we had one country where when we bend like a year later went back and did an evaluation like discovered that they had a whole pool of pregnant men in this community in Africa and I went to a country but, it's one of these things early, what in the world is going on. It was interest agates and people were the health workers were using the system but they weren't actually looking at the data that was coming out of the system or using the data that was coming out of the system. And it was one of my first one of my early experiences really around data use. And we find this all the time is that you know health workers are really overburdened. They were sent having to collect data if they're not getting value out of that and taking the next step towards like encouraging a culture of data use is an epic undertaking it is. It is a very difficult to change sort of workflow and add value and help people to really see the value of data if they're not used to having data in their day to day engagement or work. So since that, I spent a lot of time looking and working on data use and I think the other thing I think that's really important to me is that I've learned over time is to just because you build it doesn't mean they're going to use it. So really making sure things are done in a participatory design approach that's whatever it is that you are doing is like actionable that something can be you know if you're collecting some information that you can actually do something about it that you're feeding that information back to people in a way that they can really use it and glean meaning from it. So I think some of those lessons came out of that. But I but I like looking at the data, it's coming out of this country and I say, pregnant men? This is weird?

And so what a great learning there Patty. Let's make sure we build the solutions in conjunction with the end user and let's socialize that data use aspects of the programs that we put forward. I think some things that that are very easy to take for granted that I think you call about Patty very important to highlight in the projects we take on. How about something that you're super proud of in your experience. What would you say that is one of those moments that you're like wow this is why I got into this?

So a few years ago maybe more than a year and so I think with 2014, 2013 so I had done a lot of work in Nigeria around health systems strengthening, around health information systems as well as around mobile health and I developed a very good relationship with the Minister of State for Health at the time and he was really keen to see Nigeria become a leader in the digital health field. So he asked me if I would help facilitate the development of a national health I.T. framework for Nigeria and Nigeria is a very complicated country it's a federated system similar to the United States, India etc. So the states have a lot of autonomy and then you have a federal government or a central government so it's always a bit of like who has the authority,.

Right.

Kind of a question. And we got some funding from the government of Norway to do this to do this initiative. And we took a very participatory approach to the design of a national strategy and as we were developing it, it was co-chaired by the Minister of Health as well as the minister of ICT information innovation technology and we had over 150 stakeholders over the course of a two year period that were really actively engaged in the design of the strategy as well as the implementation alongside the design so as we were developing the strategy and working through the strategy development process, bits and pieces that were already being implemented which was really really exciting and then it got officially adopted by the parliament of Nigeria. So for me that was probably one of the projects that I have been involved and that I have like the most proud of.

That's pretty awesome.

Mostly because it's so needed like countries really need to have a road map because otherwise with technology, it's really easy to get distracted and to kind of go in a million different directions and not necessarily be able to have an impact or are really be able to systematically improve health outcomes or strengthen the health system. So I am a huge, like advocate and firm believer that you know the enablers and the enabling environment and the sort of policy is related to be in place to support technology and innovation because the technologies are going to keep changing and new innovations are going to keep coming. But if you have the right sort of supportive policy environments, then that can really help guide you both short term investments as well as the longer term investments. You need to have in place for these technologies to have an impact.

That's excellent. And Dr. Mechael, have you had a chance to visit back with that health minister to see how they've been doing since the adoption of this roadmap.

So the minister changed midway through our process and actually it still ended up being successful and which was actually like probably one of the biggest successes that we have.

Staying with it despite the change, right?

Absolutely. And I think you know he was an excellent minister and I think he he set it up in such a way that it could succeed without him. Knowing that ministers in some countries only last a year or two years or three years. So that was also like part of the success of it that was that even after he had laughed the process continued on and there was so much buy in and such a commitment to see this thing through and that we were able to get it through him. And yes I have and have gone back to Nigeria and have a lot of colleagues that I still engage with over there. And you're doing great. It's incredible. To see it's the the national strategy is being socialized at the state level and it's really providing the framework that they needed to have to make sense of technology.

Congratulations that's a wonderful accomplishment.

Yeah, thanks.

Can you share an exciting project that you're working on today?

Sure sir. And we're about to launch in a few weeks at the World Health Assembly in Geneva which is a global digital health index. So while HealthEnabled as an organization, our focus tends to be to go deep in a handful of countries as well. So they work very closely with large scale health implementing organizations. We want to have one activity that could kind of help raise the bar on the field. And and so we've kind of debated different things and you know like national prize or different types of awards and then you and a colleague at our at our incubator, the global development incubator suggested an index like potentially is the field of digital health ready for an index. And So we spent a bit of time to benchmarking looking at different indices, looking at different areas and really assessing the digital field to see if it was a time for an index and really consulting with the digital health community around this. And so the aim of the index is to really help countries at a national level measure and track their progress and maturity in digital health. And so essentially it's a national digital health maturity model that has been designed and developed using the World Health Organization, International Telecommunications Union e-health strategy toolkit and in consultation with everyone from the government of New Zealand and Denmark to Peru and India. So we had 13 countries work with us on the prototype earlier this year and now we will be launching at the World Health Assembly alongside a digital health resolution that's being put forward by the governments of India and Australia as a tool to help kind of countries really advance their work in this space and have some visibility into kind of what, where they are and where they need to start moving towards.

That's pretty exciting and I think it will be a pretty useful tool for for the folks focused on countries outside of the ones you guys are focused on.

Absolutely. Absolutely. I mean we can't be everywhere and our goal is ultimately to work our way out of a job. So it's like OK how do we get everybody start to do these things. Yeah it's an exciting time.

That's awesome. Congratulations on that tool. I'm sure it's going to be pretty exciting. Folks if you want to learn more about what Dr. Michelle and her team are up to, just go to healthenabled.org and you'll be able to learn more about their purpose, their mission, their five-year roadmap, their team. They're doing some pretty cool things for health across the globe. So definitely be sure to check them out. healthenabled.org. Getting close to the end here, Patty let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine. It's the 101 or ABCs of Dr. Patty Mechael. And so we've got a syllabus here for the listeners. It's going to be a lightning round. So I've got four questions for you followed by your all time favorite book. You ready?

Got it.

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

Measure them. measure them. That which is measured gets done. Oftentimes we don't measure them and we don't plan to measure them and we don't prioritize them. We just implement programs, hoping for the best health outcomes don't improve that way.

What's the biggest mistake or pitfall to avoid?

Implementing programs without having a primary health outcome in mind. So designing in the absence of a specific health target.

How do you stay relevant despite all the change?

It's hard to stay on top of it on top of everything. I remember there is a moment where I realized that I couldn't wrap my arms around the entire field of health anymore because it was too much happening and too many new players and too many new technologies. I think the idea is to really state focus on what you're trying to accomplish in health and then as you are able to sort of identify some of the new innovations and tools, really think through how they can be applied to improve this health outcomes in strategic ways.

And what's one area of focus that should drive everything in a company?

Well-being if we're all about health and the health that we should be all about is the health of our people. As an organization and I'm not going to cut to the chase on your next question around the book that we actually at HealthEnabled, when we created that organization and we wanted to create an organization that we would want to work for. So we we make everybody read the book Thrive by Arianna Huffington, which really looks prioritization of well-being, you know including things like sleep and stress management and all these different areas that really do have an impact on productivity as well as quality of life. So if we're not able to sort of put the oxygen masks on ourselves as healthcare providers or advocates, et cetera, then it becomes a lot harder to try to extend that to the communities that we serve. And I think it's a really important aspect and often underlooked aspects of the workplace and one that can lead can add years to and healthy years to people's lives. When you look at the sleep research and you look at the stress research and the physical activity studies, etc. There is so much to be gained from mindfulness meditation, from enjoying your time with your family and disconnecting from work. And so you know like people are not allowed to e-mail when they're on vacation. Like you just know. like I'm on vacation.

Yeah I think this is so great. Patty you know and listeners. One thing that you should take away from this recommendation, Thrive by Arianna Huffington. One book that I haven't read Patty but I definitely I actually as we were chatting here just downloaded it from an audio book. It's so important for health leaders to take care of yourself because if you are running on fumes there's no way you're going to be able to take care of the people and the populations that you're responsible for. So I think this is a wonderful recommendation. Patti thank you so much for that. Yeah you're welcome. And listeners don't worry about writing any of this down. You can go to outcomesrocket.health/enabled as in Healthenabled to find to find all the things that we've discussed, the transcript, shows notes, as well as links to healthenabled.org and also links to the book that Dr. Mechael shared with us right now. Patty would love if you could just leave us with some closing thoughts. And then the best place for the listeners could get a hold of you or follow you.

Sure. So, final thought innovates, we need innovations and health. We need new ways of doing things and thinking about things that are really going to improve people's health. We'll just do it in a way that is grounded and respectful of people and really people-focused and also consider the enablers that need to accompany those innovations that are coming into the health care and public health setting. And if you want to, can you can find me on LinkedIn as well as on Twitter @PattyMechael and through Healthenabled.

Outstanding Patty this has been so much fun. Really appreciate you sharing your experiences and and your stories with us. Really look forward to staying in touch with you.

Sounds good. Thanks Saul.

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:

Thrive: The Third Metric to Redefining Success and Creating a Life of Well-Being, Wisdom, and Wonder

Best Way to Contact Patty:

LinkedIn:  Patricia Mechael

Twitter:  @PattyMechael

Mentioned Link/s:

healthenabled.org

Episode Sponsor:

Value-Based Care Stories from Sutter Health with Austin Ord, Director of Post-Acute Care, Sutter Health Bay Area

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 or rocket podcast where we chat with today's most successful and inspiring health leaders. I really thank you for tuning in again and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because we have an outstanding guest. He's a phenomenal leader in healthcare. His name is Austin Ord. He's over in San Francisco California. He's a director of Post-Acute Care at Sutter Health Bay Area. He has done so many wonderful things in health care but he's just dialed in on how to make health care more efficient. From areas such as the sniff community care management areas all the way down to making it just the most interesting decisions for community based organizations to take care of that post acute area and health care which often times goes ignored. We're going to dive into some of the specifics that he's done at Sutter. But what I want to do is open up the microphone to Austin to fill in the gaps in that introduction. And Austin welcome to the podcast.

Thanks all. I think you did a good job on the intro I've been doing the director of close to Q Carol for the last two years and I think we've done a lot of great work around breaking down silos bringing different providers and the community together. So I'm excited to share some examples of what we've done today.

That's awesome and we're excited to hear about them Austin because at the end it's these conversations that help us get better. What is it that got you into health care to begin with?

I feel that I have a little bit of a unique history of health care and that my exposure to it was probably greater than your average average child and that in the U.S. My mom unfortunately was diagnosed with cancer when I was five and she had a couple of bad outcomes over over a few years. One in small town or dad and then another two years later in rural Oklahoma that led to her then seeking further treatment in the world renowned M.D. Anderson. And it was you know this this battle over several years that I think certainly influenced my decision later on to get involved in the health care and that it was such a big part of our life live for so long. So years later when I was working in high school community rec center and then in college I was pretty interested in helping people improve the quality of their lives. But but it really wasn't as meaningful or as complex as I would have liked. So when I was looking to get get more involved in my career plan that decision that experience really stuck with me. When I write whenever I was feeling about my next steps and how I could help other people maintain the quality of their lives so I decided to get my Master's in Healthcare Administration and move on into the health care field to help other people and hopefully help others avoid bad outcomes like like we had growing up.

Austin, thank you for sharing that. It's woven into the fabric of who you are and you just kind of found an opportunity there to help others have have better lives through health administration and as you fast forward into your career and the wonderful things that you've done some that we'll touch on here in the end on the podcast. What would you say that hot topic needs to be on every medical leaders agenda and how are you guys approaching that at Sutter.

Well I mean there are so many hot topics today I but my personal favorite is this transition away fee-for-service into value-based care. And I I really think using this change in reimbursement model to help you that economic force to really just change how we deliver care across the board whether it's improving the patient experience,using more technology, changing delivery models,etc. I think using that as a forest look at hit the reset button on how we go about our care. And we've got that across the board. I think it is just a major opportunity that that really excites me and makes me want to get out of that and help do a better job for the patients that we serve each day. We're approaching it at least in my role and a number of different ways. Sutter health was involved in that CJR pilot that CMS had going on and still going on. We opted out of that recently but we approached. Yes correct. Yeah, bundled payment are on a placement program. So we helped redesign some of the elements which we involved care by, I had a nurse on my team who would start doing pre-assessment protocols for patients who had elective procedures about two weeks out just to do a full on risk assessment so we could find out about their home situation and find out about their medical history from a care coordination perspective so that when the patient had their surgery, all the documentation was in the chart and every care team member could go in and actually have an informed conversation with that patient. They were starting from scratch. They were able to go and introduce themselves. Hi Mrs. Jones let's see the present we'll be taking your home after surgery after you've got a flight of stairs and really kind of little things like that that make the patient feel like they matter, like they care, like they're known, they aren't just some stranger walking into a room that facilitated much better hand-offs throughout the rest of the episode. But whenever they went to a skilled nursing facility, my nurse was still following them for the 90 day period. So that way, the staff knew who they were, the home health agency knew where they worked. The operation rehab, we were really guiding every step of the way and then calling them when they made it home to make sure any barriers were removed so that not only did this lead of course to better financial documents for the episode because we were making sure the patient received the right amount of care no more and no less. But this really led to I think a much better patient experience. So versus the new care provider having to ask the same questions over again. Everyone was informed and everyone on the same page and that patient was we don't we wasn't just lip service about putting them at the center. They actually were at the center. So I'm really excited about the opportunity to participate in DTC Idex to do this for more diagnoses.

Very interesting. So as hospitals start to look at the end. By the way congratulations on that. It's tough to dig deep and be consistent enough to have results and improved outcomes decreased costs in these types of programs so kudos to you and your team for doing that.

Oh thank you. We're very proud and we're going to get super excited for the next challenge.

Yeah. And so what is that challenge? So you mentioned the program and maybe diving into some different disease states or chronic illnesses. Is there anything that you want to maybe share that you're excited about there?

So nothing's confirmed yet we voiced just submitted our application to CNN so we'll have to see when we actually end up walking away with. But I think that again using these types of reimbursement structures so that redesign things just that's what excites me. Whether a part failure or sepsis or job placement I look forward to helping helping all of our different providers at every different part of the continuum, just really rally around a better patient care to the continuum.

That's pretty cool. And folks if you don't know this Austin was actually appointed by the mayor of San Francisco to represent hospitals and health systems on their long-term care Coordinating Council so definitely a trusted source in this field. You know curious what you think about this as we think about long term care Austin, what do you think about the Humanas wanting to buy the kindreds and now that like what are your thoughts on that in general?

I'm excited about some of these innovative disruptive partnerships. I think that it will be good for some competition to enter the market in a new way. I think again further accelerate the changes that are coming from outside forces. The more the merrier is what I think. I'm pretty excited to see things shapen up. I want to see people get crazy. I want to see the old structures will be new and exciting again and whatever we can do again to help help the patients at the center. I'm I'm all for.

Now for sure spoken. Spoken like a true innovative San Francisco man. So give us an example of Austin something that you guys have done to improve outcomes and by doing things differently?

There are so many where do I start? Can I give a couple examples.

Yeah, please, you can have it here.

Or I can save one example for later in the conversation.

No, let's hear them, I love it, if you have a couple of them that you're excited about. We want to hear about them.

OK.

So I think the first you mentioned earlier in my introduction my relationship or worked on with some of the community-based organizations. So how housing in the Bay Area is I mean to say it's a crisis I think is putting it lightly. There's you know a large number of people experiencing homelessness throughout the day. And when they come into our emergency departments really needing care. It presents a large dilemma for our care teams in terms of making sure we're utilizing our limited resources efficiently to serve all our patients but also doing the right thing for those patients make sure they receive the right care. In my first 30 days in this role,I was really saddened to identify a community partner called Bay Area Community Services or BACS and they specialize in providing shelter or transitional housing for the homeless. And what we did with BACS is we partner with them based after the nurse and we would end up sending them patients who really weren't appropriate to return to the streets just yet and needed further further therapy whether physical therapy or some kind of ongoing need where they just needed a place to recuperate and we could send home help into that shelter if necessary. And what was really exciting was when we brought our partners into the vault we could even further up the stream from the patient to a skilled nursing facility who would then go to BACS and that just help build our care continuum because I don't know if you know but there's no skilled nursing facilities and would take these patients because they were afraid that they would end up living in there and occupying one of their limited post-acute resources that are again becoming more and more constrained with an aging population. So by partnering with a community based organization to identify someone and entity that their expertise was working with this clientele it is definitely been the right thing for us from improved outcomes perspective. But it's been the right thing for that patient population too, because in that organization, there are caseworkers that can help them find permanent housing, is that the clients interests that can help get them plugged in with jobs, that can help get them back on their feet in a way that the hospital is not equipped to do. And it's been a super heavy partnership. We've since duplicated, I replicated that model across the bay area with a couple of different partners and it's actually got another meeting later today to explore a new partnership in San Francisco. So that's one way where we've we've certainly done things a little bit differently.

Austin, that's super exciting right. And listeners if you're tuning in whether you're a provider or a community-based organization these types of synergies that Austin and his team over at Sutter have moved forward with really make a lot of sense and the results are there with the hospital. You could only do so much but a community-based organization focused on those social determinants of health and being able to plug in people with housing or other types of mental health potentially. It really makes a lot of sense. And so an encouragement to you to think about this and check out some of the models that Austin and his team have used. During at the end of the podcast will give you an opportunity to have a place to reach out to Austin or follow him. So don't go away. Austin, So what else you were going to give us a couple other examples?

Yeah this one is near and dear to my heart. And we're actually a finalist for the Center of health President's Award for this program.

Really.

So we we we called our community Case Manager Program and what we and what we have done is we have a nurse who rounds with our community skilled nursing facility partners to really support strong transitions of care. You know, if you are not aware, the patients going to school nursing facility are often are our sickest or most vulnerable patients could be, they still require facility-based wth 24 hour nursing care.

Yes.

And so those are certainly at high risk of readmission. And then again with bundled payment, controlling post acute care cost was our biggest opportunity. So this nurse would support transitions of care for all patients discharged from any Sutter Health Hospital starting in Oakland Berkeley but we've since expanded the model to cover our CPM CR Chart or pardon me are California Medical Center San Francisco partners sniffs and what what was the community case managers do with their on site with the sniff care team on a weekly basis to make sure that sniff care team has all the information they need to provide high quality care to support this starts planning from the skilled nursing facilities, they don't just bounce back at the hospital. And then when they come back to the hospital they represent the skilled nursing facility. And if there were flaws in the discharge are opportunities for improvement. So again improve patient experience, it's real time communication and feedback in a way that is really unprecedented. Because we don't often hear about those kinds of things once they leave the hospital. So when you're leading the constant improvement across all areas of discharge planning for our care teams and so with this program, we've seen a tremendous reduction in readmission rates from our skilled nursing facilities and also skilled nursing length of stay which is important in bundle payment but also helps create capacity for that next patient that is in need a fee for service perspective. So having that model, the skilled nursing partnership is a huge asset because it's a real time point of access into the hospital who's dedicated there to help them do the best job they can and the hospitals love it because it's a real you know arm in real time operational support. Again strong just strong discharge planning and partnerships with our community providers.

That's pretty cool.

I am super excited about it.

That's exciting and so true Austin. Now once the patient leaves the door, the onus is still on us to continue taking care of them in order to avoid adverse outcomes or readmissions. And Austin just out of curiosity you know as the dialogue goes of high touch and high tech,sounds like you guys are are definitely doing a good amount of high touch, getting the folks involved in that. How about the tech side of things are you guys incorporating any data analytics or technology to help in that transition?

You know it's all about. It's like you knew what button to push. It's not as much as we as I as I wish we would I think,.

OK.

But I think we're moving in that direction.

I don't think that thing though Austin you know I don't think it's a bad thing to not have because a lot of these things do require human touch.

Certainly but I think that the technology could just help us make our limited human capital so much more effective. And I was lonely and I do believe that is certainly recognizing the value of so many of the analytics tools that are now created with a point of supporting. But the large student no long term outcomes of patients and I expect the near future will hopefully have some more analytical resources. Now, my nurses are much more effective when they can go out and really get to the root cause or do something a little bit better with their limited time. But right now much of the process that we've done is is pretty manual or kind of a MacGyver I would say but we're doing a move in that direction.

That's awesome. I definitely feel you Austin and you guys are doing a phenomenal job. I mean keep up the awesome work and just a little tidbit here folks. If you're listening to this here's an example of how human touch is here to stay. No matter how crazy you think AI or any of these technologies are going to be. Technology is human and the human touch is still going to be important to improving outcomes and Austin and his team are proof that this continues to be a necessity. So Austin give us a time when you guys had a setback and what you learned from that setback in some of these programs?

This is my favorite topic to discuss personal failures. So I think I'm a pretty fast moving guy if you can tell by my rate of speech. I like speak quickly, and move quickly and do things quickly and I think that sometimes my enthusiasm can be a tremendous asset. And sometimes my fast moving nature can be a drawback. And I know just whenever I first became a manager of our in-patient care coordination department two years ago I wanted to do a lot very quickly and that was you know that wasn't the best way to go about change. For some of them are our team members who have been in the industry for a long time and that that can be very threatening and intimidating to people who have been in the industry or for anybody, change is scary. So I learned the hard way that it's really important to go slow to go fast. And I think that my take away from an earlier stage whenever I had some staff members who gave me some very critical feedback, Some in the form of resignation that they knew went that for .. but it's really important to engage all key stakeholders and the element of change be to take time to learn the ins and outs about current state about what a proposed future state would mean, the impact that it would have on everybody and to really make sure that the work we're doing our due diligence because there is so much happening, there is such a huge volume of information to conceal. You could really get involved in anything now. I think it's important to pick your battles and to be judicious and not just implement something for the sake of implementing something because it was bound to be better. But really taking time to make sure you're going to understand the impact that it will have on the people that are closest to the work. And I think that that's been a lesson that I've learned and something that in all these innovative pilot that I do now. I really tried to sit down with all the key stakeholders , talk through it and make sure people were comfortable andthey could express their feedback in advance of a change rather than pushing something down and suffering the consequences later.

That's awesome. Really appreciate that share you know engaging stakeholders is key. And you said you know I got feedback even resignation that's like a very clear feedback but you know what, the beauty Austin is that you you learned from it. You've pivoted since and now you're very tuned in the organization and the key players. So folks if you're trying to make change can't do it on your own. You've got to tap into those that are that are at the frontlines. What would you say is one of your proudest leadership moments in healthcare right now?

I can tell you that my proudest moment at a heartbeat. So same role I was manager of care coordination. I was fresh out of my administrative fellowship. I was young,I was a clinician I was managing clinical nurses and social workers support utilization management discharge planning and transitions of care and they had no reason to respect me, they had no reason other than my title. They had no reason to listen to me. I really had to work to earn their trust and their confidence. But I was not going to be more than just another burden for them to jump through because you know our case managers and social workers they are moving at a million miles an hour to help them make sure that our patients leaving the hospital have everything they need to be safe. And I did a lot to help us to build those relationships in the beginning and offering any way I could. Iremember my proudest moment was when one of my nurse case managers, she actually came forward to me with a case and she asked for my help and that was probably in my first six weeks on the job. I I remember finally she was the first one we processed that we got the patient what they needed to get to be safely discharged. And after that moment like I remember I she put a little sticky note on my desk and I came back from a meeting and thought like I need your help with the patient in Room 608. And I hung that on my wall because that was the first moment. As a non-clinician I was able to be of assistance to clinical staff and to support the patient experience. It's been a real reminder that even though I'm not a nurse even though I'm not a physician, any way shape or form you can help help support someone who is and really get back to the core mission of the core root of why we're in this industry to help serve others. And I have since saved that sticky note and I carried around with me. Just remember that you have to take time to earn the trust and buy. But that was a big moment for me and ever since I've been proud of that. That's a monumental shift to finally getting getting the buy in of those who weren't my biggest fans in the beginning.

That's wonderful Austin. What a great story. Sort of took me back there. I felt like I was in a room with two guys and it's kind of like that nurse sensed your frontline hearts because you do have a frontline heart Austin. You know you spent time with your family taking care of your mom and she sensed that in you. And you also earned it but that's something that you have. So kudos to you for being able to have that aha moment and just kind of see the areas where you could add value. And that's pretty exciting. So Austin tell us a little bit more about an exciting project or focus that you're working on?

Yes certainly. So with and I had mentioned earlier that you know there's a housing crisis in the Bay Area and that housing crisis really limited the amount of community resources that we can. You know we could send patients to safely which is like you know these lead to further blockages and the search continue. So what I'm trying to say by that social security income SSI can no longer cover the cost of abortion care or residential care facilities for the elderly in the Bay Area. So when patients can't afford that if they have medical or Medicaid what they'll do is they'll often live custodial in a nursing home and that occupies again a post-acute resource that we're finding more and more used for from an acute or short term perspective. So there's all this all these resources across the Bay Area that that are being consumed at levels that are not at their highest capacity. And so to address this, the hospital Council Northern California has convened a post acute task force in the San Francisco area particularly where the crisis I think is the most extreme. And so there are members all across this city, representatives from different hospitals from different post-acute sites from government agencies coming together to talk about this issue and trying to think about creative ways where we can help bypass or help you to kind of circumvent the extreme issues that we're experiencing because now having having an impact in the acute setting where we are seeing patients stay in the hospital for an extreme amount of time which really is an appropriate use to solve the housing crisis. So we've been meeting monthly out for a little over a year and looking at different supportive housing models or different community-based services where we can help maybe help ensure people return to their community independently. And we were making some exciting recommendations to the city Board of Supervisors and the health commission in San Francisco and I'm pretty excited to see what that task force will come up with. So that's one other initiative in which we've been engaged in recently.

That's really interesting Austin. I mean you're really digging deep into not only acute but because you are in this post-acute area. You're really digging deep into public health issues and the reality is as healthcare leaders, we really do have to be involved in public health because health is just one right. It doesn't just happen within the four walls of a hospital so that's pretty interesting. It will be exciting to hear what you guys come up with.

I certainly hope that there is a viable solution. What one of the things that we're looking at doing across the city is implementing standardized measurement of these patients who really don't have a medical need but end up staying the hospital for a long period of time so we can start to quantify what their need is and what the availability of community resources are and then working with different leaders across different community based organizations or government agencies to help build out those resources or engage people who can help create those create those resources. So I think that will be one of the low hanging group will implement here in the next few months.

That's awesome man and hey, we'd would love to get you back on maybe in about a year or so to hear what comes out of it.

I'd be happy to.

Hey so we're getting close to the end here Austin. Let's pretend you and I are building a medical leadership course on what it takes to be successful in healthcare leadership. It's the 101 of Austin Ord. And so we're going to write a syllabus. I've got four questions. Lightning round style for you followed by your recommendations of a book and a podcast for the listeners. You ready?

Yes sir.

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

I would put patients at the center. when patients are at the Center on all their metrics online.

What's the biggest mistake or pitfall to avoid?

Going too fast too hard and as I mentioned in my earlier example.

How do you stay relevant as an organization despite all the change?

I personally like to subscribe to a lot of different newsletters or articles that come out whether from CMS or from different health care publication organizations just to stay on top of all the changes and find the ones that are really going to be impactful to our work or have a really great influence and change on how we are patient. So I like to just stay informed the best of my ability.

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

I have to say put patients at the center. That's really what I think we're here to do.

Fantastic and what book and what podcasts would you recommend on the syllabus?

I'm a big fiction reader so I'm going to read anything unfortunately not probably about organizational change but what if I did have to pick one, I think that The Tipping Point is a really great one, Malcolm Gladwell. It's all about affecting organisational change and how to make make ideas sticky and getting people to buy into those buy into your idea. I think that's a fantastic book to read.

Awesome. You're definitely creating tipping points over there at Sutter so a great recommendation. And how about a podcast. You have a favorite podcast?

Obviously Outcomes Rocket.

I appreciate that I appreciate that. Listeners if you want to get more information on this interview, the transcript, links to the recommendations, links to Sutter and all the amazing things and Austin's doing just outcomesrocket.health/austin A U S T I N, and you're going to be able to find all of that there. Before we conclude. Would love to just get your closing thoughts Austin and then maybe a place where the listeners could get in touch with you to collaborate or follow you.

I'm certain that and changing how we do things innovatively taking the models that we know have patience but finding ways to improve upon them to only make them more effective. I love the sense of enthusiasm that we're starting to see from you know new entrants into the market like the JP Morgan Berkshire, announcement that came out two weeks and months ago. Time flies. You know some of the new payment payment models moving forward like the PCI Advance. So I'm just super excited to see where the industry is headed. I think it's a great time to be in healthcare. If you want to dig in and do something innovative that now it's time to get crazy. So if you would like to get in touch with me, Langton's a great place, Austin order you're welcome to shoot me an email, orda@sutterhealth.org.

Outstanding there you have it folks. Austin, rhis has been a pleasure. We definitely learned a lot in this post-acute area housing. And so I really want to thank you on behalf of me and all the listeners for spending time with us today.

Hey, thank you very much for having me.

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 and Podcast:

The Tipping Point: How Little Things Can Make a Big Difference

Outcomes Rocket Podcast

Best Way to Contact Austin:

LinkedIn:  Austin Ord

Email:  orda@sutterhealth.org

Mentioned Link/s:

Website:  www.sutterhealth.org

Episode Sponsor:

The Innerworkings of Employer Sponsored Health Insurance with James Gelfand, Senior Vice President, Health Policy at The ERISA Industry Committee

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 where we chat with today's most successful and inspiring health leaders. I thank you for tuning in again and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because we have a very special guest. He is an enormous contributor to Health Care in the employer space. His name is James Gelfand. He's a senior vice president, Health Policy at the ERISA Industry Committee. And at this committee they advocate for major employers on health and tax issues related to employer sponsored health insurance being that 40% of our listener base is employers. You're going to care about what you hear today. It's going to be very relevant. He builds policy, he builds relationships. He manages legislative and regulatory projects, coalitions and memberships, service and retention. He works with the 100 very largest businesses out there offering comprehensive health and benefits. I learned from him in one of the previous episodes that I heard him speak was that 178 million Americans get insurance through a job. And so if you're listening more than likely that's you. And if not you probably want to hear this too. So without further adieu, I want to welcome our very special guest James Gelfand and James, why don't you fill in any of the gaps in the introduction that I may have missed. Welcome to the podcast.

Thanks Sol it's it's a pleasure to be with you today. I think the only things that I would add is that I've done a lot of different stuff from being a political strategist and pollster to being a patient advocate and lobbying on behalf of moms and babies. Lobbyist attorney, a staffer for two different senators on Capitol Hill. So I've been in a lot of different areas that all touch on similar aspects of looking at health policy and trying to figure out what do we need to do to make the system work for patients, for payers for providers and everyone else.

Some great, great information there and yeah you know what a great point James it was Senator Olympia Snowe and Tom Coburn that you were able to sort of be on their counsel is that right?

Yes so I often get questions about that because Senator Snowe was probably the most moderate member of the Republican caucus in the Senate whereas Senator Coburn was maybe one of the most conservative member, people will ask, well how could you work for those two because they're so very different? But they both wanted me to do the same job for them which was to understand what was going on on the Senate Finance Committee and make sure that their own policy priorities were moved to the front of the queue and taken into account as well as to advise them on how they should vote based on their principles and their values. And so that was something that I enjoyed doing for about four years.

That's amazing. So folks as you can see James has a very deep rich history in health policy and in his best interest is to help the American people get health care, affordable health care and also help businesses do it as well. Now what got you into health care to begin with James?

You know it's funny because I initially thought that what I wanted to do was foreign policy and write papers about how you know we should be making alliances or having wars and things like that. And what I came to understand is that first of all if you want to do foreign policy you generally have to have a Ph.D. in it or have military experience. But the other thing that I learned was that domestic policy is actually just as sexy and in fact the health care now governs I think close to one fifth of the U.S. economy. And we have to get used to saying that because for the last 10 years or so we've been saying 1/6 and now I think it's getting close enough that we can start saying 1/5 of the economy that is a huge, huge huge amount of money. It's a kitchen table conversation. Absolutely. And not only that but there's a bit of a war on in health care and it's been going on for 20 years now maybe longer which is who's going to pay for who's health care who's going to make a profit in the system and who's going to be a disrupter and go out there and change things that could be really problematic for some very entrenched interests. And the answers to those questions I think are going to determine where trillions of dollars flow over the next several years.

Trillions with a T listeners so no doubt we're looking at at a very important topic. Thanks for sharing how you landed here and it's turned out to be a really fruitful career for you. And I'm delighted to dive into some of the topics that we're going to get into here. Maybe dive into the Cadillac tax, some value based care discussions. Before we dive into that. James what is it that you believe is a hot topic that needs to be on every medical leaders agenda today and how should they be addressing it?

I'm going to cheat and I'm going to give you three because I think that there's three things that every medical leader needs to be thinking about. Number one is value. The days of volume being the key to being successful in healthcare are coming to an end and they're coming to an end swiftly and everybody in every part of the medical sector has to start thinking about value and what can you do to improve the patient's health while at the same time showing that you are being cost effective, efficient and effective. I'm the second one is the balance of innovation and costs. So we're very quickly approaching sort of boiling point where new innovations which are awesome and patients crave will just be out of reach for too many people and unless we find a way to balance the ability of medical device manufacturers and pharma companies to innovate as well as hospital systems etc. but also for patients to be able to afford those treatments, we're not going to be able to move forward we're going to be stuck we're going to plateau and then the third is that there is a global realignment of risk and responsibility. And again look through every single different part of the healthcare sector, healthcare stakeholders are taking on risk because when there is a profit to be made there is a price to be paid. And so doctors and hospitals are deep into this. But you're going to see more from pharma companies and medical device companies, you're going to see insurers taking on risk. You're going to see pharmacists taking on risk. It's going to encapsulate the entire industry and it's going to change everything because everyone is going to suddenly have a new motive, a new incentive.

So James some really really great topics. And on that last one about risk sharing. Where's the pie today? Who shoulders that risk and in your opinion. Where is it going to be where's that pie going to be as far as division of risk?

So right now most of the risk mislaid in the feet of payers. Right. So if you get insurance through your job it's generally your employer in a self-insured situation where if costs go through the roof and that's more than they collected and more than they expected they're on the hook. And if you're in the individual market then it's usually going to be the insurance company who is making some calculations and they're trying to collect the amount of premiums in a given year that are going to cover the expenditures that they're going to have. But if it doesn't work out that way. Well they're going to lose some money but going forward and sure you've had plenty folks talk about things like accountable care organizations.

Yes.

And Care Coordination demonstrations and value based purchasing agreements bundles and these are ways that providers are getting in on the risk but also the reward. So in a sophisticated model there is both upside and downside risk where if a provider group is really successful at controlling costs and keeping people healthy then they're going to get even more money than they would have got before. But if they end up costing more money and they're not successful then they might end up making less money than before. And then you know the least part of it right now is on pharma. But increasingly you do have former companies that are saying you know what we're going to say that if our drug doesn't work for your patient, we're not going to charge you for it. And that's the way of the future. And so I think that you also have other actors getting in on that.

And so at what point James do you think it's going to go from and thank you for that by the way. That's a great picture that you just painted for the listeners. Their risk is being shouldered by payers and the shift is now being weighted a little bit more on the payer still but still the providers are taking a chunk of that. Now industry is starting to walk in a little bit. At what point James do you think it's going to go from volunteering to being voluntold meaning the industry.

Voluntold. love it. So it's only a matter of time. This is the snowball that is rolling down the hill that will gradually get bigger and bigger until it's an unstoppable force. And what that's going to require is a culture change that culture change has already happened at plenty places. Think about if you get injured or sick I think you know where you want to go, right. You want to go to one of these very progressive forward thinking systems like Mayo or Geissinger or Intermountain. They're setting the standard that others are going to follow and that they're going to model. And what's going to happen is that this is going to permeate the entire medical establishment and the you know the federal government is actually really helping to kickstart this as well with changes to the way that Medicare is paying providers and hospitals. It's going to make change happen much much faster than if it had just been on the shoulders of employers trying to you know enact delivery system reform.

That's so insightful James, and it's true right some of these health systems like Intermountain for example the CEO recently put out a goal of 40% reduction in opioid use. There's going to be leaders and there's going to be followers listeners. Be a leader in this space because eventually you're going to have to do it. So James, I want to spend a little bit of time on ERISA Industry Committee. I want to educate the listeners on what this is what you guys do. And then let's dive into what you believe is an example of what you guys are doing to improve outcomes through your work there?

Sure. So the ERISA industry committee or we call it Eric for short is a trade association so that's a 501 c 6 and it's a group that's made up of about 100 of the nation's very large employers. As I sit here in my office on Capitol Hill, I'm looking around and I see products that are made by all of my different member companies. I came to work in a product made by a member company. And when you go on a trip you're using our member companies. Trust me these are all household names. And what we do is we represent them on issues related to employee benefits. So you mentioned that 178 million Americans get health insurance through their job, well that extends not just to our the employees of these companies but also to their families as well as in many cases to retirees who still have some sort of retiree health benefit. And we also represent them on issues related to pensions and retirement or paid sick leave etc.. But the health care guy so I'm gonna talk about health care. We are a team of government affairs professionals so we're registered lobbyist. We go to Capitol Hill and we go to the federal agencies and we urge them to make changes to regulations and the law that will enhance the ability of our member companies to offer high quality employee benefits. One of the projects that I had hoped to bring up today that I'm really excited about it has to do with health savings accounts. And I'm sure that your listeners are probably pretty steeped in health savings account.

Absolutely.

OK so you guys know then that when you have an HSA a health savings account, you pair it with a high deductible health plan and the rules governing what that health plan has to look like, what it can offer, what it can be paired with. They were developed about 15 years ago in 2003 under a bill called the Medicare Modernization Act which created the Medicare Part D prescription drug program.

Yes.

But it also created HSA. That was the last time Congress 15 years ago. And that's the last time Congress messed with HSA. So when you look at the rules governing and HSA and high deductible health plan, HDHP. Their 2003 style rule. They reflect the thinking that we had in 2003 which today we know there was stuff we got wrong. There was stuff we didn't see coming.

So one of the projects that I'm working on in that my organization is working on is an HSA and high deductible health plan modernization project.

Really.

There's a lot more of that. So there's a lot of folks out there who want to make some pretty drastic changes to health savings accounts such as some folks want to give an HSA to everyone who has Medicare or they want to double the amount that you can put into the HSA account in a given year. But what we're saying is we're kind of walking away from some of those really big ticket, really expensive and really controversial items. And instead what we did was we got together with a group of both Democrats and Republicans and said let's talk about what could we agree on that we need to change rates just save, that would make life better for the 22 million people who have them. And we came up with about seven or eight different provisions that we'd like to do. Ssome of them are things that just wouldn't have made any sense in 2003. In 2003,if I said, Saul, what should we do about adult children? You probably would've said WTF is an adult child? It didn't exist right and what wasn't in the concept.

Yeah.

So right now there's this glitch that because the ACA was the ACA was in some respects rushed it didn't and didn't get as much scrutiny as it might have gotten otherwise. They left out a line that they need it for adult children. So you can have a child up to the age 26 on your high deductible health plan but if that child is not a tax dependents of you meaning if they're 21 and they have a job but they're on your health plan they can't use the HSA funds for their health care so they can be on the HDHP, but not use the HSA. Now nobody wanted that to be how it works. It's just that we missed it right when we worked on ACA we missed it.

That's interesting so as it sits right now the adult children cannot access HSA funds if they are employed. Is that correct?

If they're taxpayers and you're not claiming them as a dependent on your taxes.

Yes.

Then No. They can't access those funds.

Interesting.

Another one has to do with supplemental benefits like telemedicine or on site clinics or even a second opinion service where the employer wants to pay for you to be able to get a free consultation. And these experts will say well maybe you do or you don't need that operation right? Under the current rules, f an employer wants to offer those benefits to an employee who's enrolled in a high deductible health plan.

Yes.

The employer cannot subsidize those benefits at all until the beneficiary has hit their deductible. So, let's say the employer has an on site clinic and that onsite clinic, we know that it's going to be cheaper for the patient to go to the onsite clinic than for them to go to the nearby hospital, right?

Yes.

But we can't steer them to it by giving them a discount because under the current rules, they have to be charged a fair market rate for the services that they get until the deductible. But in 2003 we weren't thinking about that. In 2003 but we're thinking about is utilization is bad. We must top down utilization. But today right we know better. We know that there is low value utilization and there is high value utilization and we want to tamp down on the low value services but we want to maximize high value services. We'd rather you go to your primary care provider a hundred times than have to go to the E.R. once and we want to build a system that reflects that. But the rules right now they just don't reflect that. You know I have a number of other things that are in this bill we've put together a bipartisan bill with Representative Mike Kelly and Earl Blumenauer. But it's just a suite of things that it's common sense and it reflects thinking about what do we want health insurance to look like in the modern era in order to maximize value for patients.

Super interesting. James and I assume that you guys are making these updates to the HSA listeners if you have any comments about what we're talking about here. Please drop a line at Outcomes Rockets on Twitter and let us know what you think about this HSA update and I'll start a string out there with James so that we could get a conversation going on Twitter that will be a fun thing to get going. So that's pretty cool. And in a lot of times we don't realize everybody that James and people like him are working hard behind the scenes to modernize these tools that we use everyday. So James a big thank you from all of us my friend.

Hey we're thrilled to do it.

Now you're working on this bill. That's super exciting no doubt that it will bring some outcomes improvements. Can you share with the listeners a time when you had a setback and what you learned from that and what is it that you do differently now because of it?

Yes so I think probably a good example of that would be a number of employer groups were supportive of a piece of legislation that moved through the house that was called the American Health Care Act and Republicans were selling it as repealing and replacing the Affordable Care Act. There were a lot of very controversial parts of that legislation but for employers there were too many things that were positive to ignore. For instance, the bill would have eliminated all of the taxes that were in the Affordable Care Act and for employers. One particular tax in the Affordable Care Act the so-called Cadillac excise tax on high cost insurance. We see that as an existential threat to employer sponsored health insurance. So anything that would get rid of the Cadillac tax for us is priority número uno, not to mention that the bill also contains some improvements to health savings accounts that we were supportive of to. But so you know we got into the mix on this thing and we were trying to be supportive and say that look you know there's probably a lot more conversation that needs to happen on some of the other parts of the bill such as how to reform the Medicaid program or how to ensure that people in the individual market are able to obtain coverage. But for us we want to move forward. We don't want to just do nothing. And what ended up happening was over the course of that debate the bill became worse and worse and worse. So the first thing that happened was folks on the far right who are very concerned about abortion and they want to make sure that public funds could not be spent on abortion. They cost the elimination of one of the most important pieces of the bill which was that if you're in the market, you would get a certain amount of premium credit that you could use and if you chose a plan that was cheaper than the amount of credit that you had the excess funds would roll-in over into an HSA. And this creates an incentive for people to choose only so much health insurance as they need right because if they choose less than they they get more money into their HSA. Well,they stripped that provision out. And what happened then was if that bill had become law individuals would have had every incentive to pick the most expensive health insurance that was covered by their premium which is the exact opposite of what the planners were trying to do. But they still move forward because of politics etc.. There were other things that happened throughout the course of that debate that I'm sure many of your listeners remember that the bill is just got more messed up and it over time and by the end of it many of us who had endorsed the bill were just pretty much saying math. But I think we did learn some lessons from it at least right? Which is first and foremost that abortion politics can ruin everything no matter. And having worked on Capitol Hill I can tell you they pop up all the time on issues that you would never imagine had anything to do with abortion. And my member companies we don't have positions on abortion. That's not something that an employer gets involved in.

All right.

But it doesn't matter because it can still derail the things that you want to work on. But I think more importantly I think a lesson learned from that whole experience about trying to fundamentally redesign the Affordable Care Act was that you got to go in it with more of a consensus. The ACA was passed with only one party and then this repeal and replace attempt was also only one party. And it's just going to be really hard to ever fix the system adequately to where we want it to be unless we get some consensus across the aisle. I think that employers at this point are pretty much tired of the HE SAID, SHE SAID back and forth between the two political parties.

That's a great message James and I think you guys are setting up a good example at ERISA to really kind of do this especially by putting together a group of both Democrat and Republican constituents to make these renovations to the HSA. So great call, out great lesson. Thank you for sharing that.

Yeah. We've got the scars to remind us but you know a going forward we can do better.

I lot it man. Well hey, you know the scars are stories and definitely won't be forgotten. It makes you better. And speaking of better, can you give us a little bit of a glimpse into one of the proudest experiences you've had to date in health care?

You know it I'm going to go back to my previous job. I've mentioned that I worked for a patient advocacy group called the March of Dimes Foundation. And we had a piece of legislation that was aimed at helping babies who were affected by the opioid crisis. So I don't know if you've ever heard of this. It's a condition called neonatal abstinence syndrome.

Hah, never heard of it.

Well what it is is when when a parent is using or abusing opioids during a pregnancy, a baby can actually be born addicted to opioids. And that baby will be in essentially heroin withdrawal and up until recently this was not well established. What are the best practices for caring for these babies. What should be done. How do we ensure that that information is disseminated etc. And so we got together with several other groups including the pediatricians the OBGYNs and a specialist OBGYNs to and we put together this legislation and it was a time of divided government. Barack Obama was the president but the Republicans were in control of the House and Senate. And I'm really proud to say that we managed to pass that legislation and President signed it into law. And right now as we speak there is a task force that is helping to produce and disseminate that information to ensure that those babies who are affected by opioids get the best possible care, and that best practices are used. And I'm really really proud that that was a victory that right now it's making a difference in people's lives.

That's a huge victory. James and one that I didn't know you did. I mean you just get cooler by the minute man.

I appreciate that. Thank you.

I think that is wonderful in an area that is so hard for us right now. Opioids and you've got these innocent kids that are going through it. What a tremendous effort that you and your team did there at the March of Dimes something that is finally you could go to your deathbed thinking wow I left something great behind. So kudos to you my friend.

People want to look it up it's called Protecting our Infants Act. passing the public law.

Awesome awesome. So we're going to go ahead protecting say that again James.

It's called Protecting our Infants Act P O I A, for short.

Awesome and we'll go ahead and link that up for you guys and gals on the show notes so don't worry about writing it down if you're driving or going for a run. We're going to leave that in a show notes for you. James, I know you told us that the HSA is one of the projects you're working on right now. Is there something else you want to share with us or do you want to drill down a little bit more on that exciting project and tell us more about that.

Well let me tell you a little bit about wellness programs as well. It's all the rage to for employers to implement a robust wellness programs that incentivize people to be healthy. And these things tend to grow right like it will start with maybe in year one. All you have to do is fill out a survey, a health risk assessment and you do that and you get some sort of benefit from doing it. But over time these programs grow to the point where you could receive a very significant discount on your health insurance premium costs if you meet certain metrics. You get a physical and you quit smoking etc, etc, etc. This is super super important because again what in modern era thinking what we've realized is that the key to controlling cost is not just interventions with the 20 percent of your employee population that are sick. What's really really important is keeping that other 80 percent on the healthy side.

Totally.

In keeping your healthy people healthy. It's super important so we want to enhance the ability of employers to offer these programs and employees tend to really like the discounts that they get on the premiums, too. But we were running into some pretty serious problems.

Really.

What happened was one of the bipartisan provisions that was contained in the Affordable Care Act had to do with wellness and what it said was it said that prior to the Affordable Care Act you could get as much as a 20 percent discount on health insurance pursuant to participation in a wellness program. And what the ACA did is they said we're going to boost that 20 percent immediately up to 30 percent. And at the discretion of the administration, they could possibly go up to 50%. That's all fine and good. Again we're very supportive of those provisions and that they were written at a time when ACA was actually bipartisan bill. What happened was the Departments of Health and Human Services, Department of Labor and Department of the Treasury put out a regulation that explained well here's how this works for employers. Here's what you have to do to follow the law to make sure that you're in compliance and so like employers always do, we came into compliance. We designed our programs in a way that met the requirements of that regulation. But then income's a different federal agency called Equal Employment Opportunity Commission an EEOC. They weren't sure exactly what it was about these wellness programs they didn't like but they didn't like them and they felt that changing the cost of someone's health insurance by such a significant amount amounted to compulsion. Right. They said that 30% is so much money that people don't really have a choice. And as such they started suing employers serious saying hey we don't like we don't like your wellness program because you're bullying people because 30 percent is too much? And you know the employers are saying "Well, what you want us to do, that's what it says in the law. So EEOC actually then put out their own regulation which says a completely different rule for how the wellness programs have to work. The differences are so fundamental that even their methodology of how to calculate what is 30 percent is completely different.

Oh my gosh that's so backwards.

So we had high hopes that because there was going to be a new administration in Washington. There will be new commissioners on the eve. And that those new commissioners would say you know what we're going to walk this back. This is not having the intended effect and what we what we want to do is we want to enable those wellness programs to work as long as they're fair. But you may not have have heard about this. There are vacancies on the EEOC that remain unfilled and they remain unfilled not because the Democrats are refusing to support the nominees but rather because a small group of Republicans are opposing the nominees.

Really.

This is where it gets really interesting which is the way that independent commissions tend to work is they will have a balance that is reflective of the administration, meaning that under President Barack Obama EEOC, would be three to two Democrats to Republicans or left leaning to right leaning. Whereas under a President Trump it should be three to two Republicans two Democrats or right leaning to left leaning. ,there are four Republican senators who've decided that they don't like the nominee that the Democrats chose.

Oh my gosh.

So there seems since the three have to move through as a package, the Republicans are actually obstructing all three over their resistance to the choice that the Democrats have made.

Because of one person that they don't like.

Well not to mention they're not supposed to like them all right? Your party is your party only supposed to like about half and well, it's like this is tradition. And what's going to happen is you know I don't know what's going to happen in November, but I can make one guaranteed and that is that some day the Republicans will be in the minority in the Senate. Right. Maybe not next year but some day. And when that happens they're going to get their picks still. And the Democrats who are in the majority then will hopefully say well this is tradition. They could choose a couple. But there are in the minority are the ones that are going to control the commissions and boards. So needless to say no action has been taken. And so we are in limbo trying to figure out how to comply with the wellness rules.

That is sad super childish and you just look at stuff like that and just shake your head in. And so it's unfortunate and sort of you know as as employers you left with just a lack of clarity on how to pursue these pretty amazing programs, what are your thoughts on on what the future holds here and in the short versus long term on these programs.

Well you know I think that wellness programs are only going to continue to grow because it's too important. And this actually this country is looking more and more for a culture of health. And employers want to have a part in that. So it's going to be incumbent upon groups like mine to clear the way and to get those nominees through. And I think that while we have our work cut out for us, we're gonna make progress. And before the end of the year we will have at least peeled off two or three of the four senators who are who are standing in the way and hopefully all four, such that we can move through a bipartisan package staff up the EEOC and allow them to actually get back to work and stop missing out on all these opportunities that they're missing out on because the agency lacks a quorum.

James we're rooting for you my friend and for everything that organization does so stay strong stay strong.

Thank you.

This has been a lot of fun and we're getting close to the end here. Wish we had more time but that's definitely a part too. Before we conclude you and I are going to build a medical leadership course through a lightning round. It's the 101 of James Gilfend on the amazing at health care leadership policy. So I've got four questions for you. Lightning round style followed by a favorite book that you recommend to the listeners, you ready?

Go for it.

Awesome. Right here we go. What's the best way to improve health care outcomes through policy?

We have to focus on value accountability and coordination.

What's the biggest mistake or pitfall to avoid?

The health care industry is so big and there are so many entrenched interests that you have got to find a way to find disruptors.

How do you stay relevant despite all the change?

Well I think you've got to evolve with the times and you've got to take on today's problems and not yesterday's.

And year project with the HSA is just that. And what's one area of focus that drives everything else in healthcare.

For us it's maintaining that employer sponsored coverage for the 178 million people. There's 178 million people in employer system. About 100 million in the government sponsored system and then a much much smaller group that in that individual market, why do we spend so much time focused on that much much smaller group?

Great point. Love your feedback here James. What book would you recommend to the listeners on the syllabus?

Does it have to be healthcare related book?

It doesn't have to be, it could be something to get the mind off health care to be more productive later.

I would say if it's a health care book I would recommend Wheat belly which caused me to change my entire diet and think more about how food interplays with health. But if it's not health care and give you an oldie but goodie a classic Frank Herbert's Dune which is an invaluable piece of sci fi because it also helps you understand how people think and why they make decisions that they make.

Amazing some great recommendations there James. Listeners, don't worry about writing any of these down. Just go to outcomesrocket.health/erisa ,that's the place where James right now, E R I S A, and you're going to be able to find all of the show notes transcript links to the book books that he recommended and his organization as well as the resources that we mentioned here at outcomesrocket.health/erisa. James, this is been awesome. I've really just have had a blast that time flew. Before we conclude I'd love if you could just share a closing thought and then the best place for the listeners that follow you or get in touch with you.

Sure. So you know I think closing thought would be that when we're talking about healthcare there are billions and trillions of dollars at stake. And as such we have to be so, so skeptical and we have to be so careful about understanding what are the motives. Who is funding who and who is behind this and why. And unless and until we make those judgments, it's really hard to agree to policy changes and to move forward. Best place to connect with me. Check out our organization's website which is www.eric.org. That's E R I C dot org and you can find information on how to contact us and everything and we're always interested in learning and finding people to team up with and working on projects and finding ways to make the system better.

Outstanding games folks go to that website that's www.eric.org and find ways to collaborate because the folks over there, James and his team are doing some outstanding things for our health care system. So James just want to say thank you again for spending time with us and we're excited to get you back on the show next time.

Awesome thanks so much for having me.

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 and Podcast:

Wheat Belly: Lose the Wheat, Lose the Weight, and Find Your Path Back to Health

Frank Herbert's Dune

Best Way to Contact James:

LinkedIn:  James Gelfand

Website:  www.eric.org

Mentioned Link/s:

Protecting our Infants Act

Episode Sponsor:

The State of The Medical Devices Market with Rick Randall, Principal at Riverhead Advisors

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.

I thank you so much for tuning in again and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because today I have an amazing healthcare leader. His name is Rick Randall. He's principal at Riverhead Advisors. Rick Randall he has spent the majority of his career managing directing and founding early stage medical device companies that have created some of the most revolutionary medical procedures practiced within the past three decades. Rick has a broad experience as a CEO Managing firms such as Target therapeutics innovative devices Tranz 1 and omni life sciences. Businesses under his direct leadership have achieved 1.b billion in value creation from initial public offerings of stock or mergers and acquisitions. Rick has cofounded three medical device companies which include Conceptus, Cardema and Prograft and he has served on the boards of several additional medical device firms. There's no doubt that Rick has that industry leadership that is so keenly sought after in our industry and it's with a warm welcome that I give Rick. Welcome to the podcast. So excited to have you on.

Thank you so it's great to be here.

So Rick I wanted to ask you what is it that got you into the health care sector to begin with.

Yes I always had an interest in the sciences healthcare. I grew up in rural upstate New York on the lake Ontario border. Looking across the water to Toronto and it was a farm community. And my earliest recollection from professional interests was I wanted to be a veterinarian and later on in life when I was in college I moved over to for whatever reason an interest in ophthalmology, optometry but frankly it was difficult enough for me to finance my way through my undergraduate degree. Then to consider how I was going to get through medical school and beyond. I ended up quitting school for a year and a half and working at a General Motors factory just to enable me to finish my last year and a half and get out with only a loss of of one year so that kind that put a damper on on any kind of medical school or thoughts of medical school. But my first job out of college was teaching biology as a biology major and.

Is that right?

And I taught high school biology and in a school district outside of Syracuse, New York. And then after two years on the job I was dead set ready to enter my third tenure year. The all important tenure year and I'm kind of about that I called in to a number that I saw in the paper and there were ever times for a medical sales job. Yes and I was asked to come in for the interview. I had no intentions of taking the job. Pretty cocky and pretty sloppy about the interview. And that was moving quite nicely. And then the interviewer turned the subject to the income and what the job was like and the company car and free gasoline and all those things and we.

All of a sudden and you're like wait a minute wait.

Wait A minute. The economics kicked in, and then I was dead serious about the interview and somehow didn't blow it and I ended up getting the job. So yes that's how I got into medical technology as a diagnostic sales job first than that I kind of moved up the ladder with medical sales jobs and eventually found I had a real passion for marketing and strategy and moved in-house with C.R. Bard and the rest is history. So that's how that's how I got into the health care sector.

What a great story and thanks for taking us through that interview. I felt like I was there with you. And now all of a sudden you're interested. So Rick you've obviously been heavy into the industry side of things. Med device a passion that I also share. So what is it that you feel is a hot topic that needs to be on every medical leader agenda today and how to approach it?

I think the hot topic today for me is is how in the future I'm the prize student beneficiary of this medical device renaissance that I think started in the early 80s and ushered us into the 21st century. And it's been a great ride. We've done wonderful things with technology and the way health care is provided. Now, it's not even a close resemblance to what it was in the 1970s because of it. But the hot topic for me is how are we going to continue in the U.S. to drive that innovation. How are we going to continue to create a pipeline of innovation it's currently at risk. The real risk is in my view due to a material change in which the way startup companies are emerging medtech companies are finance the venture capital world that I benefited by in the 80s kind of the two-fisted look you in the eye venture capitalists who if they liked what you're all about provided you the money to do what you needed to do. That's kind of dried up. Those folks have fled the scene and the life cycle of a healthcare company back then. You know my first CEO job. My assumption was it will take me four years to get the job done the company could be sold or move on to the next. Well now that gestation period of a company to exit is more in the neighborhood of 10 to 15 years and that's caused a lot of the venture folks to flee. So that's that's my hot topic because I love what we do and I want to I want to see this country still benefit as the leader in creating these wonderful devices that we bring to market and I'm I'm a little concerned that we're going to see a slowdown of that innovation which really doesn't benefit anyone.

I love where you're going with this. And your assessment what is it that has led to this slowdown. Is it the FDA. Is it lack of riders wanting to take risk. What is it?

The FDA is a part of it venture capitalists about a decade ago summarized that to me and I've been borrowing that line ever since. It's an issue of stacked risks so if you consider when I first was in the CEO position the only thing we really the two things we had to worry about were is our device going to work. And secondly I'm real live human beings. And secondly when we get that device through the FDA? Can we get the FDA to agree to clear the device for commercial use. Those were our real risks and that's why you could take a concept and actually be commercial with the device in two to three years and then be taken out by a larger acquirer in your for maybe even take the company public. Well those are the tip of the iceberg. Today they're stacked risks. And it's taking longer to prove out each one of these risks set. So is the concept going to work? Where am I going to learn we can work in human beings? So there's a process you have to go through to even get into the most lenient countries to test the device. Then the FDA risk is it going to require a full clinical study or a 510 Caywood clinical or straight up 5 10k. And then when you get through all of that which is typically years five or six then can you get the device reimbursed? And I think it's that additional stacked risk of reimbursement in our healthcare system that has kind of caused the venture capitalist to finally give up raise their hands and move on to dotcom or technology plays. And that's that's quite unfortunate. But these stacked risks now have gobbled up the better part of a decade of development. And more importantly exhausted some of the funds that used to be available to us in the health care in the medtech sector.

That's a shame. It's definitely a shame and fear patient waiting for it technology or if you're a leader at the helm of a corporation waiting for a technology. There's no doubt that it's taken a lot longer and there's really virtually just every year it seems like there's less mass and almost no one willing to form from a venture side back any of these companies up because of that lag time. What's the future look like in your mind?

Well this is what I'm doing now at Riverhead advisors. I'm I'm focusing my efforts on helping these early stage entrepreneurs. You know I'm a little selective about what I'm helping. What technologies I get involved with but those technologies I believe are going to work and are going to do a service to patients and the system alike. I've been working to really guide them in the right way to approach this so the future to me is first of all I think we're going abroad to cast a broader net as to who can fund these device companies. I've also included private individuals now investor groups for early stage funding. There's what we call family offices which are typically high net worth individuals looking for other places to put some of their billions of dollars or whatever that may be. And what I found is some of those family offices also have a passion for certain areas. Perhaps they've been afflicted in their family with cancer or heart disease or diabetes or whatever. And it may not be necessarily the financial return that drives them as much although that's certainly important as the cause itself and then the other thing I've been doing is I've been tapping into the companies that we in the past would not talk to until we were fully vetted with the technology and all of the all of the issues were dealt and we were selling a lot of product which is the strategic acquirers because I think they're starting to recognize the same problem that we have in financing innovation is going to dry up their pool of innovation which is what differentiates their products and allows them to maintain fairly high pricing in a market because they're delivering unique technologies that have unique benefits. And so most of them have established venture type financing opportunities. So working with the the entrepreneur to cast the broader net and finding other sources of money other than the traditional venture capitalists is one way to deal with this.

Rick I think you're doing something very unique and you're you're approaching things in a refreshing way. And rather than say hey you know what the well is dry you're looking beyond the well and you're helping entrepreneurs really dr]rive wide and deep into other areas. You listed a couple here. During our conversation so can you give us some examples of maybe some businesses you've helped out in maybe a surprise that happen in the process?

Yeah I've. There's a company in particular that I'm working with that I'm very excited about. It's a company by the name of RadiaDyne and it's a Houston based company that's focused on the oncology radiation oncology space. It's a company and I give all the credit in the world to the founder John Isham. John was a sales rep himself. He came up through the same the same pathway I did and John had an idea and he felt that radiation oncologist could benefit from balloon type catheters that could be placed in tissue structures to separate them and space those structures away from areas that are being radiated a good example would be for a patient a male patient undergoing prostate cancer radiation that he would have a catheter that would go into the urethra and separate the urethra and the bladder junction and space it by inflating the balloons space it away from the prostate so that as a radiation passes into the body it's mostly hitting only the cancerous tumor and not causing severe side effects and burning to these other viable tissues that are very very important. Well John didn't stop there. He built a nice business. It has made a living for John and other employees. Along the way, he hired a person I worked with at a TranS1, Bret Boudousquie to be the president of the company. But he's developed spent eight years of his life and a lot of his net worth developing a new technology. The Ortrack system which is now just being released to market that enables it's a device that has a capability of loading up the four sensors and the sensors are on these little micro catheters. And so the sensors can be placed in various spots around the area that's going to be treated as both within the tumor or next to the tumor itself and probably more importantly in the surrounding tissues that you want to preserve and you don't want to radiate. And what these sensors do is they measure the radiation real time and they take this reading out into the control room so that the technician and the physician both can be looking at the accumulation of the radiation inforced spots in the body and determining whether they're giving their target dose and not giving too much of a dose to areas they do not want to radiate. So once they're getting these measurements real time, they can adjust the radiation to make sure they're doing what they want to do and they're not doing what they don't want to do and that enables them to be more aggressive with the radiation perhaps reduce the amount of treatments and turn the power up and a whole level of safety to patients who undergo these terrible radiation treatments where they have these burns that could affect them. So what's exciting is that company has been privately funded and now it's time to take advantage of this new technology and publicly funded or funded through other sources. Yes. So rather than just going to venture capitalists which we are doing I I've been working with the company and we are going to some of these other outlets and including potential strategic investors. I've introduced these from the firm to banks. They knew a couple of banks to lone. We've created quite a buzz and I think we're not done yet but I think the financing prospects are going to be very good for the founders and the shareholders who let's face it they took all the risk on this.

Right.

And I think it's going to be beneficial to them. And it's going to allow us to get this technology out to the major cancer centers in the United States in a much quicker weaker if it's in a quicker fashion. So there's an example of something how we're putting it to practice.

Absolutely. And this is now an FDA approved device being used in hospitals today?

It's an FDA approved device and it also to my other point that I made earlier it also has reimbursement codes embedded in the system. It is now available in one center, Sloan Kettering in New York. And I think they just shipped another unit to another center in Ohio. And there is a stack of hospitals around the country pretty sizable number of very renowned cancer centers that are aware and they're waiting for the technology. So throughout 2018 we're going to see more and more centers have this technology available to them spread out in the United States.

That's excellent. So Rick appreciate you sharing that very granular and exciting response so listeners Here's an invite to you, if you like what you hear whether it be from a practitioner standpoint, if you're a healthcare executive wanting to differentiate yourself in a way that you are oncologists treat cancer. If you're somebody that has investment capital, I invite you to reach out to Rick and we'll be sharing his his contact information here at the end. But the purpose of the Outcomes Rocket is to do some silo crushing so that the discussions that need to be had are had and that's why we got Rick here on the podcast today to bring this exciting information to you. And so Rick you've learned a lot through the things that you're doing and now you're working on some exciting ventures, the one you just mentioned to us as well as others. Can you share a time when you made a mistake or failed and what you learned from that lesson?

Oh yes. Unfortunately when you do what I have been doing as long as I've been doing it, those unfortunately do tend to pop up from time to time. So let me take a deep breath here and recollect that experience and in a way where I can painfully share with you. The experience that I'm thinking of is a company by the name of TranS1 which ended up being a it was a we thought was going to be a huge success. It's a great technology, it's a company that I joined as CEO in 2002 and I also happened to be the first employee of the company way back in 2002. At the time I joined, it was a concept it was founded by an interventional radiologist and a business partner and they had the idea of a minimally invasive approach to the lumbar spine and the lower spine to enable surgeons to do a lumbar fusion which is a very common surgery in that part of the anatomy and a fusion that would enable patients to heal very quickly as a matter of fact the ultimate goal was to be able to do something that people just laughed at when we first broached it with them. Outpatient Fusion's. So I joined in 2002 and it moved along very very quickly. I was able to the RMV executive who was working with the company as a consultant at the time and developed some interesting prototypes and I quickly decided I got to hire this guy. And Bob also who I'm still working with today on anotherproject and we hired Bob and we were in the clinic in Brazil with this technology by as I recall by early 2003. I joined the company in June of 2002 and we quickly developed this into a surgery that was working took that data from our own US experience and took the data to the FDA and lo and behold we were able to get a 5 10k clearance for the procedure in the implants and the tools. And we were then starting to commercialize as early as the third quarter I believe in 2005. So it was about as good as it gets. Maybe that should have been a foretelling. And I'm a little bit superstitious about this and I knew it was going so well that I was I was really worried what's going to happen I truly was eventually did it. You'll you'll see in 2005 we commercialize the product in 2006 and 2007 we were seeing rapid growth. There was a kind of a movement taking place with us and around us in the world of spine surgery to move these maximally invasive procedures to a minimally invasive format. So we got caught in that draft. We contributed to that draft and then the IPO market opened up in 2007. So we took advantage of it and we did a initial public offering of stock and went public with the company in October of 2007. And of course it was a very well subscribed very successful IPO. We came in at above the price on the cover all the things that you dream of. Yes. So concept in 2002 public offering in 2005, almost unheard of. And.

Yeah, that's incredible.

And then there's the rest of the story. So within six months in early 2008 we learn that the North American Spine Society which was the Surgeon Society of Spine Surgeons that basically were made up our customer base and then some. They had approached CMS and recommended that this approach had its own surgeon payment code. One of the things we vetted early on was can we get paid for this and there happened to be several existing codes covering lumbar spine surgery and we fit the technical vignette of one of those codes. So the advice we got was, you never know what's going to happen and people could come along and say I think you ought to do something differently or it should be looked at differently. But we did fit it, fit the code so we were billing under that code through our commercialization stage. Well, this new code which was granted over time by CMS caused us basically to be put into a Category 3 which is an experimental category. And since most of our patients were covered by private health insurance not Medicare,.

Yes.

The adverse effect it had on TranS1 was that our surgeon payments went away. They weren't being reimbursed. I don't know if you could just imagine being the CEO of a publicly traded company and now you find out your surgeons aren't going to be paid for your operation.

Rick just to level set here you're in a situation where the surgeons are actually trying to make it more defined right? You fitting under an existing code, lumbar fusion of some sort. And now their intent to help actually hindered.

Well I later learned they weren't really trying to help TranS1. What I what I later learned. And there were hints around this earlier on. What we didn't know behind the curtain was that CMS had already approached the nest coding group and indicated to them that they were growingly concerned that the surgeons being performed under the existing codes the time it took to do the surgeries were not matched up properly with the time that was used in the algorithm that creates the reimbursement dollars.

Okay.

In the sense they felt that the surgeons were being overpaid for the amount of work that they were putting into their operations.

Got you.

Makes sense because those values and those assessments took place a decade earlier and all surgeries get better the equipment gets better things get faster. So we contributed to this unknowingly because our operation was taking a good surgeon only about an hour. The surgeries were valued at four hours,.

Got you.

So roughly put, the powers to be at nest we're concerned that's a little upstart TranS1 was going because if this was widespread we had adopted in a widespread way was going to cause a 75 percent pay cut to their membership. So that was the reason behind them giving us an experimental code so that we could work this through and eventually work through the white. I think they want this to go away. But I'm also very cynical at this. So that was what was behind it.

Interesting. Thanks. I didn't mean to derail the conversation but it definitely important detail there that I was curious about.

Sure. And so what did we do about it. Well we had to downsize the company and sales were shrinking. We obviously worked very hard with our surgeon base are fortunately, we had 10,000 operations that had been performed at this particular time. We are able and there were publications in the works so we were able to kind of gather our clinical data, create more clinical data and work within the system to try to turn a Category 3 code into a category 1 code which we eventually did. But we also learned that with the private payers it's very difficult even if you reestablish a new code in a world where they really don't like spine surgery anyway and.

Right.

Paying for expensive science spine surgery. It's very difficult to take a non-pay status and move it to a pay status and the company still exists today it's now private and they have been able to establish a code and bring other payers on board. But they're still fighting insurance company by insurance company to do that. So it was a very difficult time in my career. We had a rocket ship to this day. The procedure worked incredibly well. It's one of the best operations out there. If I had to have an L5 S1 fusion, there is only one solution I'm going to see that operation. The company is alive today because there's still surgeons who had great results and they're using it but unfortunately for all the wrong reasons the opportunity really went away and our employee shareholders, surgeons were hurt because of it.

And so Rick really appreciate that story. A tough one. An exciting one, a tough one. So if you had to share one thing that you learned from that what the listeners. What is that one thing?

Well there's a few things that if I broke it down to one thing I would say this my first board meeting at the company I didn't know the lumbar spine from the rotator cuff and I had just joined the company and we had a board meeting but I did have an important subject based on my prior experiences with the board. And I wanted it to term you use I want the level set with the board what our expectations were. And at the time I was a growing believer that the public markets are not a good match with single technology companies. There's all the risk is in that single technology and TranS1 was a great example of that. So what we discussed was, Do we really have a exciting product or do we have an exciting company? And we realized we had an exciting product but that's pretty much what it was and that product could be hugely valuable to a larger company that is broader base. So our intent from the very beginning the first board meeting we managed was that we would build the value and look to sell it. Now look to take it public because I had done that before I didn't need that poster on my wall anymore. I just felt that that was the wisest thing to do. We almost did that. The day we closed on our clothes. We accepted term sheets on our last private financing. I think it was 2006.

Yes.

The day that then I had promised venture capital we make a decision that day. Out of the blue we got a call from a company that had looked at the company and they made a hundred million dollar offer which the bank who we were working with felt could be easily moved to 125. We declined that because we had put these venture capitalists through this whole process and due diligence to get to where we were that day to make that decision. If I had that win back that would be the easiest decision in the world nonstop. I'm helping the process and I'm allowing the merger and acquisition conversation to take place. If we had stuck to our initial position that we made and took in 2002 at that board meeting, we would have returned a wonderful return to the shareholders at the time for the amount of money put in, for the employees. So that's the lesson learned I believe is we I guess a better way to capsulize that is you really need to be pragmatic about your value proposition at all times. And even though you're in the thick of it and you love what you're doing you think it's the greatest thing in the world, have a sensible balance to the risks that you're also taking by moving forward.

What a great lesson shared Rick and listeners keep that one with you. And if you're working toward building your company your practice accountable care organization whatever it be. Be very clear about what your outcome is from the beginning and stay true to your true north because that's ultimately what gets you through the thick and help you be successful in adding value to the healthcare system. Rick thanks so much for sharing that.

You're welcome. Still hurts.

It's those pains that help us be better right?

That's right.

And now you're able to offer these lessons to our listeners but also the people that you work with and in your practice.

Everyday.

What would you say So you took us through that dark moment. Why don't you take us to the lighter moments one of your proudest leadership experiences in medical device that you've had?

Oh sure that's that's a fun one. That would be Target Therapeutics it was my first CEO job in 1989. I was a 37 year old guy who had but you had it I had it all figured out I think until that first day I sat in the big seat. And then said What am I going to do. But it was it was a great experience from that point on. And I was with Target from basically from 1989 to 1997. The last I had a personal reason eventually to move back to the east coast. This was based in Fremont California. And so I was CEO through I believe 1993 and then I stayed on the board through 96 and the acquisition in 97. Target was a company that had developed a very novel, patented micro catheter that was capable of navigating through very small torturous blood vessels. The initial plan for the company was not to develop a catheter but was to develop a new way of treating hepatic cell carcinoma, a form of liver cancer in a way where the interventional radiologist could take a catheter through these torturous vessels into the tumor itself and also go through the venous system into the back door into the tumor and then deploy clotting agents and devices that would basically shut the front and back door. So there was no blood supply coming into the tumor. And what this effectively did was with no blood supply, this growing tumor would then start to shrink.

Interesting.

It wasn't a final therapy and it was a palliative treatment but it did become over time very widespread in Asia particularly Japan where it's more prominent as a disease state. And those patients can live another five years of a very good quality of life. And I think they can at that time I believe they could receive up to 2 or 3 treatments each giving them with an additional 4 to 5 years so it was a good thing.

Amazing.

But in the United States the market was that large and the clinical pathway was not well-defined. And the company was really struggling. It turned out to be a huge science project and it was gobbling up quite a bit of capital. And the company it was owned by College Incorporation which was one of the materials that was being used to analyze the tumor. So there was limited resources to fund this but at the same time that this research project was ongoing, neuroradiologists working in the same area as the interventional radiologists were picking up these little catheters. They learned about and threading them into the brain and that was creating a nice little revenue stream. By the time I got to the company that was about as I recall about four million dollars in revenue mostly are almost all derived from this Neurovascular application. I joined the company and it was clear to me the strategy going forward was to focus on stroke. I had early in my career earlier in my career I should say I was on the team that developed and marketed the coronary angioplasty catheter which as you know changed the way heart disease is now treated and has become a multibillion dollar industry. So my vision at the time was why can't we do the same thing in the brain?

Yes.

And no one was doing it because the heart catheters could not sneak their way up past the Circle of Willis next to your ear into the brain and puncture the brain. Well we had a catheter that would do that. So we kind of jettison the cancer treatment, unfortunately had to let some people go and focused our efforts on the neural application that turned out to be a great thing. Once I got to the company and assessed our opportunity, it became clear to me if we were really going to survive and win, we had to move on beyond these venous malformations that were being treated with our technology that was a small market and a large market, all the customers told me was the cerebral aneurysm. It was a ticking time bomb if it ruptured. The death rate was very high, mortality rate was very high and the only way to treat it was wide open brain surgery which was morbid and not wholly effective. So we gathered the troops and told all the engineers we've got to find a way to fix the Cerebral Aneurysm. Within a few months after that meeting one of our engineers who is working with a neurosurgeon down at UCLA came to me and showed me on my desk working prototype of something he had come up with that I saw firsthand. You know it worked at least in a with an aquarium pump and blue dye going through the tube leaking on my desk and filling a glass blown aneurysm, he was able to block the aneurysm and block the flow of the water into the aneurysm and animal studies had shown that if you do that you could effectively cause the aneurysm to shrink and scar over. So we took that concept to a human outside of the United States at the time. And it worked. And.

Nice.

Yeah it's very nice. We were able to take the company public in 1992 even though we did not yet have clearance to market the device in the United States. Around that time there was also a large trial because the neurosurgeons did not give up easily on their technique and demanded a clinical trial where they compared the two methods. And that trial is I think one of the early interim analysis points was halted because the data the outcomes data. This is an outcomes podcast's the outcomes data showed definitively that it was unethical to apply to many of these patients neurosurgery when when this coil did the job and the results were much better.

Nice. So you're able to just nip it in the bud earlier.

We nip it in the bud in more ways than one. And we took that as I mentioned the company was public and once we got the clearance in the United States and we brought I had to move to east I became chairman initially and then Gary Bank came in as CEO and we commercialized under Gary's leadership and the stock went crazy and then Boston Scientific ended up buying the company for a little over a billion dollars.

Amazing.

The company still now resides with Stryker.

Stryker right, yeah.

Corporation. And more importantly aneurysm coiling is the de facto standard of care.

That's awsome.

It's also not only did the shareholders do well. Employees did well. We had a great time, that was great bodily experience but there's countless patients lives we saved, outcomes that were much better. A lot of dollars, euros, whatever denomination says because of the technology.

That's awesome. What a great story Rick got. You're great storyteller by the way. Anybody ever tell you that?

Yeah. Lot of employees who felt I just probably told them too many repetitive story.

I love it. Listen what a great story is shared by Rick, a technology that is now being used on patients worldwide. Currently residing within Stryker. It started with a technology that wasn't taking off in our market and a good hard look by Rick and his team to pivot and reapply where it was being used rather than dying on the vine. They found a way and a lot to be learned from that story. I would recommend that you rewind this and listen to it again because it's a really good one. Rick thank you for sharing that one.

Alan Walker Hey one last anecdotal point today those micro catheters are used globally on a variety of cancers. The original thing that the company was designed to to attack it. The good news is we didn't necessarily pioneer it at the time but it did survive as a as a viable methodology. Now it's universally applied. So it's all good.

That's awesome. That is awesome. What a great contribution to humankind Rick. Thank you for the work and the tenacity that you applied in that endeavor.

Well we had a wonderful team that we've been. Many of us have been best friends from those days as you can imagine. So it's a great experience.

That's outstanding. All right getting to the end here Rick we've got the medical leadership course and what it takes to be successful in medical devices today. The 101 of Rick Randall. So we're going to write out the syllabus with a quick lightning round. I've got four questions for you followed by your favorite book that you would add to the end of the syllabus. You ready?

OK.

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

I'm going to focus on early stage companies. That's what's going to live and breathe. My advice there is the best way to produce outcomes is develop a therapeutic technology and a product that not only reduces procedural morbidity and fixes a problem but it also lowers the cost of of care. So patients should feel faster. Your technology should be appropriately priced and you create a value-based outcome if you do that, you have a high probability of winning.

What's the biggest mistake or pitfall to avoid.

I've never seen a company take too much capital. You typically need more capital than you think. So under-funding and I think the other thing is to employ a very comprehensive clinical plan as you're measuring your new technologies so that you both measure clinical outcomes and economic outcomes as well because you're going to need both to be able to get your commercialized and find your way into the hospitals to be successful.

How do you stay relevant as an organization despite all the change?

That's a great question, I think we typically start these things with a grand vision and then we get mired in the day to day things that you have to tackle. So my advice there is you build a functional strategic plan and you revisit that strategic plan yearly and you're honest with yourself. You're pragmatic,you employ your unaffiliated customers and you change based on the changes that are taking place environmentally.

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

Kind of ties into the last comment. It's constantly getting customer feedback. Feedback from your employees. Making sure that what you are doing is not alignment with what they feel you should be doing. That's both the visionaries and the visionaries. Because if you only satisfy the visionaries you may not hit the bell shaped curve of humanity that is there to use your product.

Some great tips there. What book would you recommend as part of the syllabus?

Oh gosh know this is a bit of an outlier here. I don't know if you'd be part of a syllabus but I'm big on leadership. I don't think you can ever be complacent when it comes to leadership and good leaders are are very important. So a couple books come to mind that are interrelated actually I love the trilogy The Edmund Morris trilogy of Teddy Roosevelt. I thought that the century you know the 21st century was the American century and the rise of America to power. And I think Teddy in his own unique way he was a unique president at the time he came in. There has never been one like him with that kind of background that came into the presidency at least since the seventeen and early eighteen hundreds that had fit that mold. This trilogy covers kind of a rise and fall and really points to characteristics of strong leadership and it's not all good it's it's difficult tough decision making times as well. And the other thing that ties into that is I love the Malcolm Gladwell books and how he makes you think about things. Blink, to me blink, blink told me how I was unconsciously competent. When you're with a startup, you don't have any history. You don't have any clinical data to go on. So you have to make decisions based on very little evidence. Evidence is important but you can't wait for all the evidence to come in. So you have to make some gut level decisions and Blink is all about you know more than you think you know based on your experiences and to trust your gut instincts if you have the right experiences to back them up. So I think Teddy Roosevelt employed those principles. And so those are two books that I find very helpful to me and made me think a little bit differently about how I do things.

Outstanding Rick. And yeah, these are awesome recommendations. Listeners if you're driving or running or doing something else where you can't write them down don't worry about it, just come back to the episode or just remember to go to outcomesrocket.health/randall. That's Rick's last name. It's R. A.N. D. A. L. L. You will be able to find all the show notes there as well as links to the books and the things that he's up to. Rick, before we conclude, would love if you could just share a closing thought. And then the best place for the listeners could get in touch.

Sure I'd be happy to and thank you for again for having me join you on this podcast. Hopefully it's helpful to, at least interesting to some people. My closing thought is and I touched on this early so close on it. We've been in a leadership role in United States for some time in the health care segment particularly medical devices and we need to continue leading that way and we need to continue being the driver of game changing cost-reducing medical technologies and to do that we need we really need as a country to come together and devise a new fundamental funding mechanism to enable entrepreneurs to do what they do so well and create those technologies. I would suggest that we we look outside of this country, look to Israel. I've managed a company and Israel. Innovation in Israel is fundamentally critical to them. It's existential to Israel to be able to innovate. They don't have a lot of customers living around them who want to buy from them. So they've got to innovate for markets well beyond their borders and they do a good job of that and they found a way to match venture capital with government assistance and entrepreneurs to find a way to allow innovation to live and breathe and mature. And I think this country should absolutely be tapping into that kind of methodology to replace the old venture capital model that seemingly is broke. So those are my thought I'd leave you with this podcast.

Some great thoughts and we really appreciate your insights Rick. I know they're going to make a big difference to the listeners. Where would they reach you or follow you if they wanted to.

Randallrick1 is my e-mail address. It's Randall, randallrick1@gmail.com is the probably the best way to reach me. And we can go from there.

Excellent. They haven't listeners. Rick Randall sharing some amazing insights and medical device. Rick, it's been a pleasure having you on the podcast and looking forward to staying in touch.

It's been my pleasure. Well thank you Saul.

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.

Automatically convert audio to text with Sonix

 

Recommended Book and Podcast:

Edmund Morris's Theodore Roosevelt Trilogy Bundle: The Rise of Theodore Roosevelt, Theodore Rex, and Colonel Roosevelt

Blink: The Power of Thinking Without Thinking

Best Way to Contact Rick:

LinkedIn:  Rick Randall

Email:  randallrick1@gmail.com

Mentioned Link/s:

RadiaDyne

TranS1

Target Therapeutics

Stryker Corporation

Episode Sponsor:

Insights from a CMO on Accountable Care Organizations with Sarika Aggarwal, MD, MHCM, Chief Medical Officer at Beth Israel Deaconess Care Organization

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 where reach out with today's most successful and inspiring health care leaders. I really thank you for tuning in again and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because we have an outstanding contributor to healthcare. Her name is Dr. Sarika Aggarwal. She is the chief medical officer at Beth Israel Deaconess Care Organization also known as BIDCO. It's an accountable care organization. There she leads the organization's clinical vision. In this role she provides medical oversight expertise and leadership to ensure that BIDCO delivers high quality health care services an innovative population health management and quality programs and tools to diverse position and hospital networks. Now she's got an amazing 20 years of experience in medicine. She has been across the different payers, consultancies so she's got an amazing diverse background. I'm so excited to have Dr. Aggarwal on the podcast. Sarika why don't you go ahead and fill in the gaps of the introduction. Welcome to the podcast.

Thank you so much. I'm so happy to be here. I guess as I was talking to you earlier I have been very deliberate in my career choices, I learned very quickly when I was on the providers side. It started as a primary care doc I'm really working on in my little world on patient experience and excellent and quality service of care that we're pieces that we're missing. And so I worked my way through the Harris factor where I learned a lot about the whole revenue cycle related to the claims to building the premium to understanding how the different populations health program on that civilization moving on to consult saying and working with the industry, working on population health platform and building them for the EMR. And then back to the provider side where I am now, the wonderful part of where I am now is BIDCO it's a very unique organization in that we have providers for TCD and specialists as well as hospitals and they are all linked together contractually but also financially. And this is really important because going forward I think it is key that we remove silos from the care continuum really the money should follow the patients. So I think it's important that the transformation is slow in a system like ours but when it happens it happens in a solid way and it happens in the way that it should. So I think that that has been a great journey and I think brought me to where I am now.

Super insightful Sarika and you really called out an important fact is that there's definitely a lot of silos still and so before we dive into the what you believe the hot topic in medicine is today why did you decide to get into the medical sector to begin with.

So I don't know at any time in my life that I did not want to be a physician and I guess that 30 years later I am not that I am in the profession where I get to serve the community and I actually make a living so which is wonderful. But truly I think being able to serve by having evidence they scientific having a scientific background and being able to serve that way I think is a real gift. And I continue to want to serve. I used to be it used to be with the individual. When I was a primary care doc and now it is serving the population. So it's just always been my dream and it continues to be.

That's beautiful. That's beautiful. Thanks for sharing that and there's no doubt from the tone in your voice that you're living your calling. So what would you say Dr. Aggarwal is the hot topic that needs to be every medical leaders agenda today. And how are you guys approaching it at BIDCO?

So I think that there's areas where there's a paradigm shift. The first is around the financial thinking and the second is the clinical care. And so the financial thinking has gone from you know good institutional financial management speaking to bond rating inadequate adequate margin to keeping the cost under inflation to really where we are now which is we want to be part of the solution. We need to be part of the solution to support the lower cost of care. So you know that's sort of the shift I think and all the payments reform, the alternative payment model come into that shift. And then the second piece is really the improvement beyond clinical care as we use to think. There are enough models out there including the Wisconsin model, the Robert Wood Johnson model where we know that clinical care is only 20 percent of the problem in terms of health outcomes. And so really the thinking has gone beyond the traditional care to population health management where we're looking at service quality and focus quality. The total cost of care to really population health where we're addressing broader outcomes where we're actually speaking to the well-being and the quality of the patients. So it's really that shift and in this space is addressing all those other determinants of health. But it's also understanding the measurement piece, the quality measurement pieces. Going from where we were in the traditional quality measures, the heated measures to actual patients-supported outcome. So I think those are the two pieces that are very important and where the shifts have occurred.

I would love to zoom in a little bit further on this two topic approach. One being financial, one being clinical. Can you give the listeners an example of how they should be looking at this or things that you and your organization have been doing to help with the transition?

So I think of the ACO as we started really to address the first piece which is the shift in the financial thinking. They really work supporting the lower cost of care. That is the pieces to that into the contractual pieces it includes the total medical expense reduction working with population health program that really speak to those. And I mean a total cost of care reduction not just shifted. So it means that from a hospital standpoint, we increase the case and that we reduce avoidable utilization from an outpatient standpoint. We try and shift care so for example we have programs that hate serving medical pharmacy not just out of the hospital, not just out of the outpatients facilities, not just out of the physicians offices but really the fault at home. We take some of the surgeries out of the hospital out of the outpatient facility into the outpatient facilities, out of the n est at home. So it's really addressing the total cost of care. From a contractor point of view we're trying really to share breath in innovative ways with different care both the government payer as well as the commercial payer. So we are working with most of our commercial and large commercial payers and that chooses an upside down .. contract. We are in the Medicare Shared Savings track suite program which is an upside downside risk program with a corridor with the CMS. And finally we are. We began the Medicaids ACEO March 1, 2018 which is unique in really addressing the total cost of care and the quality of care in the Medicaid population and clinical care point of view. Again we are going beyond the physician offices really addressing clinical care where the patient is asked whether it be a community setting, whether it be in the office setting, whether it be in the home setting, whether it be in hospital setting nest as that etcetra. To really addressing how we can get to the patients and how they can get that care wherever they go. So we are deciding that we are going to schedule the patients for say their hemoglobin A1C testing for diabetes.

Yes.

They should have that done, that gap should be closed whether they are in fortune care, whether they are seen in the office, whether they are seen in the hospital and so forth. Addressing all the health literacy disparities, Social Determinants of Health is also a key and a large part of the work and mass health ACO has then to really address that in a lot of work going from actually really monitoring the patient every time they come in. Again in multitude of settings and specialty settings to actually connecting the patients to resources. Some directed resources we have a bunch of names. Some are human resources, we have navigators. So really addressing all the different pieces related to formal care. And then last piece related to patient reported outcome addressing their well-being and quality of life. We are now working with our commercial payers to really incorporate a lot of the prom's as we call it in our contract. We're really trying to address the quality of care versus the process measures. The traditional process measures that we used to do in the past. So that is a large part of the work that I'm doing.

Very insightful Dr. Aggarwal and it's a very methodical approach that is well distributed amongst just the finances and the way that clinically you're addressing the problems, thinking through financial measures, thinking through population health and the social determinants of health. Can you give the listeners an example of some recent wins that you've experienced with some of these approaches?

We've had a lot of good work being done. One of the programs that we've had, so another focus of ours is really on the rising risk population. These are patient that have chronic diseases and really have not gotten to the point where they have increased total cost of care so are pre-high utilizer. And so we actually have a pharmacy first program where we have a pharmacist-lead chronic disease management program in conjunction with health coaches where a large work is medication management and adherence that the pharmacists do which recommendations to the providers and then the second part of it is a boot camp approach by the health coach. And I say boot camp because really addressing South management can take depending on where the patient is on their motivation scale can take a long while.

Yes.

The boot camp approach is really what my goal is that every patient with chronic disease such as diabetes, every patient should have a few self-management skills. They need to know what the signs and symptoms are, what the warning signs are, they need to know what are the gaps leading related to their disease and they need to know when they need to call the doctor and where they need to go. There's a few things that I feel are basic and these include the complications of the disease so the boot camp approach is really ensuring that we reach a large population with these small goal.

I think that's super exciting the way that you shape the program and made a boot camp. And have you gotten any feedback on how the program is working out?

Yes. So we've got early outcomes. We've been very successful with the pharmacist so it's really two pieces, the pharmacist part of it is we've had about 50 percent of the recommendations that our pharmacists have made accepted by a physician and part of that the heart of the reason why some of the physicians have not accepted is because they are uncomfortable physicians primary care physicians are at various levels on the scale of knowledge about a lot of the new medications so they prefer sending the patients to the consultant which is fine by us as long as someone made that you know taking that recommendation. So we've had a very good outcome actual reduction in our hemoglobin A1Cs. And then the other prices the coach and the health coaching pep, we've actually had a lot of good a lot of good feedback on that. The peak about this program a lot of there's enough literature out there that says this is best done when it's face to face. And I agree with that my goal is small with this program. This is why my goal is not really the transformation of patient behavior and have it really small and that goal I think is achievable by doing the telepharmics. So we do plan to add a face to face component a virtual component to this and this is going to be a next step for those patients to graduate faster. So we've done well.

Outstanding. Now, that's really great to hear and the focus matters. You know then I think as long as your folks are focused on it, the results will continue to filter through. And I do have to ask, is there anything with the opioid epidemic that your organization is focused on as part of the improvement metrics.

Yes. So that is a base focus for us. So we started to develop you know so we again everything that we do there's there's sort of addressing things at the individual level and then addressing things of the population level trying to adapt the same problems in a different way. So at the individual level there's been a lot of training and sort of tool kit that we've developed for our providers. I think Massachusetts has been ahead of the car. We've gotten a lot of policy change around the opioid use. So there's a lot of learnings there. We've got opioid chronic for our providers to send their patients to chronic, the patient's who are on chronic opioid use. And then the second part is my belief that we really need two things to complement the opioid cure opioid program. One is we need complementary behavioral health programs because behavioral help a disorders and diseases are at the core of a lot of the opioid use. So we need to expand the scope of those we actually are building programs around that. And the second thing is there is a scarcity of providers that provide medication-assisted treatment. So we have a whole training program for emergencies and for our primary care providers to expand training as well as expand the knowledge base for the MAT. So we've got a lot of work that's going on.

Lot of work going on over there and it is definite and by the way listeners, Sarika has a really cool story. Her name means singer and her mother was a very well-known singer which I thought was really cool. When I was getting schooled on how to say her name and it's a beautiful name Sarika.

And it bypassed me the finger piece so.

But your daughter is the good singer isn't that right?

Daughter is singing. That's great. Yeah.

It's a blessing and so you know we do what we do because we care. And oftentimes it doesn't go without bumpy roads and so can you share with the listeners a setback or something that you learned that was difficult and what you're doing now as a result of that?

And one of the things that, one of the programs that I wanted to begin was sort of a performance improvement facilitator program. And it's interesting that when I was medical director at human health system we developed this program we actually hired we developed a job description and we heightened these were different from navigators and that we're non-sample workers. But the idea was that they understood the both the cost utilization pieces of population health as well as the quality piece and they were really able to bring that together and inform and go to the provider practices and really share report and to help with practice we design. So I wanted to reprise that rule. Here when I when I found was had existing folks who were part of the EMR optimization team. So I thought I'm going to just take our existing folk and train them to become the pits as we call them. So we developed and internal macroeconomics program you know that spoke to the math economics. We develop the quality pieces and sort of training around that. Because I couldn't find the training I couldn't find training around. How do you read the cost of utilization report. How do you read quality and how we connected to. And essentially the staff were not engaged to begin with. They went through the program and you know we were not very successful. And what I learned from that really was that I should have started off by even asking if this was something that they wished to do because you know that being motivated as a first step and really in progressing to it actually execution. And they didn't have the competency for that. SO I think to a certain extent they did understand they were engaged but they did not have the competency and this was certainly not a role that was right for them and so we price the role and we decided we would hire for this role. And since then we've done that and it has gone very well.

that's a really great share. Dr. Aggarwal and kudos for you and your leadership to have just said you know okay it didn't work this way. The take away is ask for feedback. How would you feel about doing a role like this and then moving forward. So it sounds like you did learn a lot from it and now you've implemented it. And the program's working.

Yeah.

That's great.

Much better.

So let's take the other side of the coin. Tell us a little bit about one of your proudest medical leadership experiences to date?

So I mean the war is made of small victories. There's been a lot of lot of small, the small wins that get together to become a big win and then when I came to this organization, I was an outsider you know 50% of the organization more than that were insiders. So every engagement with the physician when they call you back, every time there's a very vocal discussion is to win. But, I guess what stands out is when I did my Masters in Healthcare Management couple of years ago, we had some or two business school like capstone project. It was the practicum they called it and what I choose to do I would have that on the pair side it was CMO for health plan at the time. And what I found was that in our senior population our health plan across Massachusetts so we had in this particular program of patients who were eligible for Medicare and Medicaid. These were for frail elders, a lot of them disabled who live in the community and who did not have transportation that the influenza vaccination rates were in the 30 plus percent. It was really low and nationwide wasn't that great either. You know in the 40. So what I decided that I was actually double it. I think i have the aim for 76%. And then in addition to ensuring that was my process measure I also wanted to see if we have fewer hospitalization related to the process measure which was doubling the vaccination rate. And so we did a whole program that was actually very cool. You know the united way the bold that you have where every donation the bulk gets dozed. We have sort of did similar things for each of our sites. We had four regional sites. We went and did the bold breakfasts we call them red, we got the staff. We did this whole program. The program was only between October and December because about the few season starts January and February. And we actually increased the vaccination rates above 80% and even though the new vaccine was not quite as effective that year, we actually reduced our in-patient utilization. So it was really plus it was an amazingly fun event going out there and doing the bold breakfast and then subsequently we started doing it for other pneumococcal vaccination and so forth. And it was really wonderful to do that to implement it in over a short period of time.

Absolutely. Yeah, and I can imagine you had a lot of fun out there with the breakfasts and just having the conversation you know just like we're doing here. It's all about starting the conversation answering the why and and just moving along with some action because at the end of the day we all have to stand for something and do something. And there's absolutely no doubt in my mind that you Dr. Aggarwal are doing that and you continue to do that. Tell us a little bit about an exciting project or focus that you're working on today?

So because we are a large network, we really have a we are across the eastern seaboard with a hospital in 8 provider groups and we have a lot of community hospitals, an academic medical center so we really are trying to execute across this network had a lot of challenges but a lot of opportunity. The big piece that we're doing now is really creating network in the post-acute phase really this is for our Medicare savings. We are working the post-acute providers and we are working on the home providers. The home agency, we're working on the infusion providers and it's been a wonderful journey because the providers themselves, the post-acute providers have been very very engaged. So we're using the people-process technologies to do that. We are using a data-directed, we have dashboard that they're giving them, the people are really our stakeholders, are hospitals and providers are giving us the first cut on who is important to them. We then use dashboards to narrow it down. We use CMS data to narrow it further down and then we have processed improvements plans and some of the providers who are not falling within the networks so they get always have a chance to come back in. So it's been a very, and I we also have technology involved in that we're using tools to help with the communication and the referral from our system to our post-acute provider. So there's a lot of work happening in that space and I continue to think as the inpatient utilization exists for the really sick folk. And as we continue to have programs such as this waiver program we can go directly from home to their nest or to home, this piece is very important.

Now that's super interesting and you're only working inside of the walls but outside of the walls of the hospital and I think that's wonderful. Excited to see how your efforts turn out. I'm sure it will be with success and happier, healthier people. So Sarika let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine today. It's the 101 of Dr. Sarika Aggarwal. So we've got four questions, lightning round style for you and then we'll follow that with your favorite book and favorite podcast if you have one for the listeners. You ready?

Yeah.

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

To focus on the evaluation which is really quality in-patient experience divided by cost, to really cost effective outcome.

What's the biggest mistake or pitfall to avoid?

To really ensure that you work on the entire care continuum and not to work on programs that just shift care. They should be actual reduction of avoidable care so you cannot shift from innovations to observation you want to get this patient home.

Oh that's great. How do you stay relevant as an organization. Despite all the change?

You continue to ensure that you have your true north in your focus and you have to be agile so you're continuously pivoting, not in your mission and your focus but in all the ways that you are working your program.

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

It has to be quality of service and quality of care.

And finally what book and what podcast as part of the syllabus. Would you recommend to the listeners?

So there's two books, can I get two?

Absolutely. You've given us so much value today. You can give to Sarika.

So there's one that I love of it's called Nudge and it really speak to choice architecture and the call intervention and behavioral economics and it's important to use that in creating incentive programs, I used that in really creating data direct physician engagement. So I think of that I found in this book. And the other one is called Drive by Daniel Pink and that's really speaks to where physicians are, it's really when you want to drive them you don't use the filler drive which is you trying to get them to help at one do this things. And that only happens if they get autonomy and they have autonomy to decide what, when, where and when you give them mastery, you give them the tools and the goals .. and this actually apply both to providers as well as the patients, you really need to give them autonomy and mastery because it's all about self-management.

That's a great call-out. And how about the podcast, any podcast recommendations?

So I'm trying to think. I think the standardized health score to improve outcome, how to leverage technology to improve patient engagement, engagement of both patient and providers is definitely my focus because I think you can. What is that thing they say, you take the horse to the water, and got to make them drink. So all people process and technology doesn't, would not lead to outcomes to this actual engagement in the process.

Outstanding listeners, take these recommendations down or if you're driving don't worry about it. Just go to outcomesrocket.health/sarika. It's S A R I K A. And you're going to find all of the show notes, the transcript to our discussion, links to Dr. Aggarwal's work and as well as links to the books that she recommended. So this has been such a pleasure Dr. Aggarwal, there's no doubt you're doing amazing things. Stay strong keep doing what you're doing. I love if you could just share one closing thought and then the best place where the listeners could get a hold of you or follow you.

I think a closing thought would be my mantra is really you passionately want to be a participant in this revolution. And it is going forward and you want to be part of the process.

I love that call out the part of the process listeners do not be passive. And if you're listening to this podcast there's no doubt that you are. So again just go to outcomesrocket.health/sarika. S. A. R. I.K.A. and you'll be able to find all the links and best places to get in touch with Dr. Aggarwal so that further adieu. Dr. Aggarwal just want to say a big thank you from myself as well as all the listeners.

Thank you very much.

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 and Podcast:

Nudge: Improving Decisions About Health, Wealth, and Happiness

Drive: The Surprising Truth About What Motivates Us

Best Way to Contact Sarika:

LinkedIn:  Sarika Aggarwal

Mentioned Link/s:

Beth Israel Deaconess Care Organization

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