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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:

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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.

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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:

No comments exist

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

Episode Sponsor:

No comments exist

Creating a Hub For Physican Innovators with Lisa Rotenstein, Co-Founder at CareZooming

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 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 amazing guest with us today. She is the co-founder at CareZoom. She's co-founder and CEO there. She's a physician practitioner at Brigham Women's Hospital. She's a graduate of the Harvard Medical School and she's also a graduate of the Harvard Business School known for being mad tech Boston's 40 under 40 in health care. She's a World Economic Forum Global shaper and she's previous director of I.T. and editor in chief at close concerns. She's got a really amazing background in health care and contributed so much. Her name is Dr. Lisa Rotenstein. And Lisa I want to give you a warm welcome. So glad that you've joined us and welcome to the podcast.

Thanks so much for having me today Saul.

It's a pleasure Liza, and let's talk about this Dr. Rotenstein, what did I leave out of your podcast introduction there that you want to share with the guests?

So I think you did a great job. I think you highlighted what I'm working on these days that I'm really passionate about. I'm a clinical fellow and a resident at Brigham and Women's Hospital and internal medicine and through that role have a chance to work on a variety of research and healthcare innovations that I'm excited to talk to you about. And you highlighted Well my work with CareZoom where we are aiming to democratize Healthcare Improvement and really make innovative health care accessible to everybody.

That's definitely one of the things that I really thought. Man, you know Dr. Rotenstein is doing some amazing things. We call it silo crushing here on the podcast and you're totally crushing silos with your CareZoom platform. Excited to dive into the details of that some more. But why don't you start by telling us a little bit about what got you into health care to begin with?

Sure. So I would say that what ultimately drew me to healthcare and kept me here is the really unique mix of the ability to work with people, think about their lives and then also think about biology both of which I love and a long time ago actually when I was in high school I had the chance to work at a free clinic in California where I had amazing mentors who are family medicine doctors who I thought were really effectively dealing with both the biological and the social aspects of treating disease in a church that was converted to a clinic every Wednesday afternoon and where doctors were able to provide free care after hours. So that's what started me on this path. And along the way what's kept me here is my relationships with patients who are inspiring and teach me every day and also experiences in diverse parts of health care and seeing how so many people are able to contribute from pharma to big hospitals and then people in the entrepreneurial world who are excited to make a change.

That's so interesting and it's those heart strings the ability and opportunity to be able to serve patients that is really what drove you into the practice and what's kept you here and a lot of other physicians too, you know. And in this system where we constantly have to reinvent the wheel, the opportunity to share those moments with patients becomes more difficult. So what an opportunity for you and your organization at CareZoom to do something about this. Can you walk us through what exactly CareZoom is and what you're doing?

I would love to. So CareZoom is an organization that is looking to exactly as you said break down silos and healthcare improvement. We are building a database of healthcare improvement recipes. You know the way you have a recipe for soup but rather a way a recipe for improving your healthcare system and we're starting in primary care. There are innovators across the country you know implementing new technologies in their clinics implementing diabetes prevention programs, new population health management programs and that information can be really siloed and difficult to share. So for example when I was in medical school where part of the passion for this started I was part of a project where we were looking to implement care plans and we had read in the literature all about how great care plans were for patients with complex medical problems. And you know we saw statistically significant results in the literature but when it came time to get information about how you actually roll this out in a clinic that information was harder to find. You go to conferences where people share their work. And yet the information is presented on a poster that then is tucked away somewhere that academic medical literature sometimes doesn't appreciate this kind of work the way it does pure research and on the other hand sometimes consulting is really out of reach for a lot of clinics and so we saw an opportunity to crowdsource the amazing work that people are doing and we're really excited to have started in primary care and to have projects as I mentioned related to diabetes, Behavioral Health, Medical scribes, all sorts of innovations happening all we've started on the east coast and are looking to expand. And then also to bring forward the identities of people who are doing this kind of work without a lot of recognition essentially in the trenches and these are nurses, these are doctors, these are social workers. So we're very excited to feature this work.

So interesting Dr. Rotenstein and it's awesome that you said you know what, I see the problem and I'm not just going to sit here and complain about it I'm going to roll up my sleeves and create something to solve this problem. And listeners, I really want to just highlight here what Lisa has done and I welcome you as well to do the same thing. If you see a problem don't just look at the problem like crash on the side of the road pull over and see what you could do because at the end of the day the fixes in our health care system are going to come from us. So the onus is on us so kudos to you and your team Dr. Rotenstein for taking the initiative.

Thanks Saul and I would say kudos to the people doing this work every day. And as I mentioned so we're going to be publishing this database shortly and we're also building an expert network because we feel like there and we've been told there is great value in peer to peer conversations. So we invite listeners to visit our site at CareZooming.com and to sign up to either be part of our expert network or get advice from our network of innovators.

That's awesome. What a great invitation. Listeners, take Dr. Rotenstein up on that, CareZooming.com. We'll also be leaving that link along with the transcript of our podcast and any other resources that are mentioned here in the show notes. So if you're driving don't worry about that you'll always be able to reference the show notes for that but it's simple it's CareZooming.com. So tell us a little bit about how you and your team there are creating results and improving outcomes by what you're doing your work there.

Yeah I would love to, then I'd love to tell you about our team at CareZooming and then I'd love to tell you a little bit about the work I've done at Brigham as well to create results in a similar vein. So we have already at CareZoom started connecting innovators across the country to each other. Just the other day, you know we got a request of somebody looking to take on a hospital improvement project and were able to give them some of the nitty gritty details from a variety of implementation projects that we have in our database. And we've also uncovered and featured work that hasn't otherwise made it into the medical literature and been able to publicize the identities of people who you know aren't publishing their work every day but really are doing valuable things on the front lines and have a lot to contribute to Healthcare Improvement. So I would say that's where our main focus is and that's what we're really excited about delivering. And on the flip side I would say that some of the most exciting work that I have done at Brigham and Women's Hospital focused on innovation has actually been in implementing I.T. tools into daily care. So one project that I'd love to feature which is a part of where the idea for CareZooming came from as well had to do with implementation of decision support tools into oncology care. And so you know I was part of a team that saw a need to improve prescription of short course radiation among patients with cancer and we had realized that although there were society guidelines saying that short courses of radiation were just as effective as longer ones in patients who needed radiation of bone metastases in busy academic medical center with many providers delivering care. There was real variation in how often this was executed upon and so we built a clinical decision support tool linked to the EMR to guide providers through the decision of how much radiation to give. And a year after rolling this out into daily workflow we found that appropriate prescription of short courses of radiation which are easier for patients to tolerate have less side effects and overall are thought to be more beneficial at the end of life. So the proportion of patients getting that had doubled and had increased significantly which is really exciting. So these are the kinds of innovations that I'm really featured on and looking to learn about from across the country.

That's wonderful and it's great that you're both aggregating best practices and you're aggregating innovators to help improve this waste of resources. So there's no doubt as you as you alluded earlier you know there's there's a ton of people doing so much hard work and they're oftentimes unappreciated. Oftentimes what they do is not replicated. Sometimes even within the same system. I'm excited to see what you and your team can do to make sure that those best practices get shared and applied to folks across the nation. So I love it. I think your work is pretty amazing.

Thanks Saul.

So let's take a look at sort of the history here and sort of what got you and your team to this point can you share with the listeners a time when you had a setback, feel like we learned a lot more from our setbacks and our successes. And then what you learned from that setback?

I would love to share it and I'll actually share it from something that I worked on prior to CareZoom. But that has definitely shaped the way that I have approached this particular venture. So when I was in business school we worked on several classmates of mine and I worked on an app. And we knew that there was a problem with people who had elderly family members aggregating their meds, understanding who all of their providers and getting all of their information in the same place. And we put a lot of resources into creating an app with a great interface and thinking about all of the people who could use it. And I would say that the place where we felt short was listening well enough to our end user and also thinking about how our technology would interface with end users daily actions. And so although we ended up having a great piece of technology when it came time to thinking about who would adopt this and who would pay for this. You know it turns out that people didn't really want another app healthcare systems taking care of elderly patients didn't want something they wouldn't plug into their EMR. And so it was an important lesson for my team and I to really listen before we started innovating that the needs on the ground should drive the innovation rather than vice versa. And that's something that I've taken forward and think about all the time with CareZoom.

That's amazing and really appreciate you sharing that. Dr. Rotenstein you know it's something that happens all too often. You know we get excited with with our ability to do something and we don't get that feedback from our users. And we've all fallen victim to it and I thank you for your courage for bringing that one up so that the listeners if you guys have not had a chance to really get enough feedback please do it because you don't want to waste time, you don't want to waste money before you put a solution out to market and then find out it doesn't work. Build it with your end users in mind and find out the other key that that Lisa mentioned to us is who's going to pay for it. What a great lesson. What about the other side of things? The successes. I know you've had a lot of successes very early on. Can you give us one of your proudest medical leadership experiences today?

I would love to. So I would love to talk about one of the studies that I did in my role as a clinical fellow at Brigham and Women's Hospital. So a team of my colleagues and I conducted a study of depression in medical students and we found after doing a meta analysis of studies worldwide that 27 percent of medical students were depressed, clinically depressed and that only a small percentage of them had sought treatment and that a significant proportion of them actually had suicidal ideation. And beyond the publicity that came around the study which was published in JAMA in 2016, I was most proud of the way that it changed conversation. I was excited to hear from my colleagues about workshops that were being held with medical students and other trainees to talk about depression, to talk about coping and also to see the response thereafter from institutions who are really examining the systems in which trainees were experiencing health care and how those could be changed. And it was just meaningful to see the ripple effect of that which I continue to see in my clinical training these days. You know I see doctors more often talking about wellness about mental health and really examining what we should be doing differently.

Absolutely. And I'm really glad you brought that up. We oftentimes forget that there's a whole population of medical students going through the same things that the physicians are going through. And if there's a way for us to start earlier, awareness is the key. And so, I love it. If there's a way to link to your study Dr. Rotenstein if you could provide that or somehow give me a link to share with the listeners I think that would be a wonderful one for them to read.

I would love to and I would say that our same team is currently working on a study of burnout and depression in attending physicians. And what we've interestingly found is high rates of burnout in the 30 percent range among the attending physicians and very similar rates of depression and attendings as in medical students. And as has been shown in residence previously suggesting you know what we might intuitively know that the working environment that you're in on a daily basis shapes both your experience of training and then also your mental health. What we're excited to show that that holds around the world across genders, across specialties and is something we need to continue tackling.

Absolutely. And so Lisa for the physicians, the physician leaders, the residents listening what message would you give to them?

I would tell them that there is not going to be an easy fix to this problem. With that there has been a lot of movement forward already. At least for trainee's work hours. There are a significant step forward, but it's something we have to be paying attention to and part of it from my perspective does have to do with wellness initiatives which many institutions are undertaking but it also has to do systems of care in which we work which is you know how I actually see all of my work linking together that on a daily basis. Your doctors are dealing with difficult electronic medical records systems. They're seeing patients who are still struggling through the health care system. They want to tackle chronic disease and often don't have the resources to. And so I believe that a big portion of ensuring physician wellness has to do with optimizing systems of care which is you know how I tie everything back to CareZoom and the health care system we want to have in the future.

That's great. And what percentage of that would help if you said you know what it's OK to talk about it. Like you're not superhuman and we don't expect you to be. Talk about it.

A significant proportion I would say. And it's getting easier to talk about it. But there is still a part of training where there are long hours and you have to tough it out and it's hard to say what part of that is a necessary part of training where you do have to have the stamina to provide care to patients in difficult situations versus a constraint of our system that has to do with financing and what resources we have to provide care versus we really could change and we need to talk about more openly on a daily basis and be constructive together as we think about this.

Totally listeners, if you're a physician you're not complaining you're communicating. And I think that's a big step in making this better. What would you say an exciting project that you're working on today is?

So I'm definitely excited first of all about CareZoom and I would encourage listeners who have done innovation work to get in touch, we would love to feature your work and especially as we build out our expert network to have you be part of that network. Something else that I'm working on at the Brigham currently is thinking about how to improve care for really complex patients during their transitions of care and when they're in the hospital. So working with several teams to think about how do we put together care plans to maximize how we take care of the 1% of patients who have multiple medical and social .. and thus actually account for 50% of healthcare costs. And how do we support these patients during their transitions of care? How do we have them go safely from the hospital back out of the hospital to the outpatient world? Maybe they'll go to a rehab facility. And how do we put in place systems of care that ensure that their outcomes are the best they can be?

Outstanding. Lisa that's super exciting and from the front lines doing some major silo crushing all the way to the straight of offices we got a crush these silos to continue making health care better for ourselves but also the people that we care about most, our children, our parents, our grandparents. And Lisa. your efforts here are extremely awesome and I just encourage you and your team to continue the amazing work.

Thanks. This is what gets me up every morning and what I'm passionate about. And so would love to hear from other people who are excited about this type of work.

Absolutely. So Lisa getting close to the end here. We've got the leadership course we're going to put it together right now. It's a syllabus. The 101 of Dr. Lisa Rotenstein. And so I've got four questions lightning round style for you followed by your favorite book and your favorite podcast. You ready?

I'm ready.

What's the best way to improve healthcare outcomes?

I would say leveraging collective knowledge and paying attention to all the different stakeholders and how they can work together.

What's the biggest mistake or pitfall to avoid?

Putting I.T. into health care and expecting it to change healthcare without paying attention to the system around the Information Technology.

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

Pay attention to current trends in legislation legislation is always changing but it determines so much of payment and health care and also listen to the patient and have a laser focus on the patient because they're who we should be driving our efforts towards.

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

I would say improving healthcare systems which can affect as much of health as a drug can or even more.

What book and what podcasts would you recommend as part of the syllabus Dr Ottenstein?

I would listen to an American sickness by Elizabeth Rosenthal which provides a really great deep dive into the multiple players that affect health care from insurance companies, to doctors to hospitals. But I think does it in a really person focused way and provides vignettes that will stick with you and will remind you about why we do the work we do on a daily basis.

Super interesting recommendation and the book?

American sickness was the book in terms of the podcast. That's OK in terms of the podcast. I would recommend review of systems which is a podcast about improving primary care and it is actually now cosponsored by the Center for Primary Care at Harvard Medical School. Hairiness features people across the country who are changing primary care systems and also on a weekly basis highlights important literature not space so you can stay up to date in primary care improvement.

Outstanding. Lisa thank you so much for that. Listeners these recommendations are amazing and if you want to just level up I recommend that you check them out. We've got links for them. Just go to outcomesrocket.health/carezoom and you're going to find all of the resources that Dr. Rotenstein shared with us as well as her bio. The transcript, links to her business, links to the podcast, links to the book. Everything is going to be there but make sure you take action and go check that out and also take her invitation. Do some collaboration with her and reach out if you find what she's doing is interesting. So just want to say thank you so much Dr. Rotenstein if you can just leave us with a closing thought and then the best place where the listeners can get in touch.

Great. Thanks so much for having me. My closing thought would be that there is power in everybody involved in health care from the patients who use it on a daily basis to the people working in it to the scientists who are powering in and we have a collective responsibility I would say to collaborate to move things forward. The best way for people to get in touch with me is my email which I'll provide to Saul and will be on the website. You can also reach me on LinkedIn or Twitter at @Lisa-Rotenstein on Twitter and then Soul link to my LinkedIn page.

Outstanding. Will do that for you Dr. Rotenstein. So thankful that you spent some time with us today and super excited to stay in touch.

Thanks so much I hope you have a wonderful afternoon.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:

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

RoS Podcast - Harvard Center for Primary Care

Best Way to Contact Lisa:

LinkedIn:  Lisa Rotenstein

Twitter:  @Lisa-Rotenstein

Mentioned Link/s:

CareZooming.com

Episode Sponsor:

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Outcomes Rocket - Robin Farmanfarmaian

How to Become a Healthcare Thought Leader with Robin Farmanfarmaian, Professional Speaker, Entrepreneur, and Angel Investor

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 health care thinkathon. That's outcomesrocket.health/conference.

Outcomes Rocket listeners, welcome back once again to be outcomes rocket podcast where we chat with the day'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. She is no stranger to the show she's no stranger to health care. You guys have heard Robin Farmanfarmaian. Now the funny thing is that the first time I had her on the podcast I totally butchered her name. She taught me how to say it. I got it right this time Robyn so you should be proud of me.

It was perfect to literally say it better than I do.

Nailed it. Nailed it. And for those of you that didn't get a chance to listen to the first podcast with Robin, totally listen to it we dove into some major value but just to give you a refresher she's an entrepreneur, best selling author, professional speaker, angel investor. She's got a deep deep understanding of the convergence of what advancing technology and how healthcare bind together. And she's also the author of the Patient as the CEO. And on today's podcast we're going to be starting your discussion on a new book that she's begun to write. And we'll be able to you'll be able to have access to that within the next year. Robin it's a pleasure to have you back. And why don't we just kick it off with you telling us a little bit about this new project.

Sure I'd be so excited to. Now was a new book is going to be called the Thought Leader Formula and it's literally going to be a step by step instruction manual on how you can turn yourself into a thought leader in today's market. Now this is both for the entrepreneur but also the corporate executive. You don't need to want to be, say a professional speaker. You could just want to advance your own career within your organization and by being a thought leader which is essentially a subject matter expert you begin visibility with people like in the C-suite and the decision makers so they can advance your career both internally. But then if you're someone like me, I'm an entrepreneur and a professional speaker it actually advances my ability to generate revenue through those channels.

Robin, I think it's so great that you're doing this. We connected before we hit the airwaves here. And one of the things that I shared with you is that a lot of health leaders are definitely struggling to get their thoughts out there and to create that marketing platform for themselves. I think it's so cool that you're putting together the formula for them. Now is there an opportunity to get a sneak peek at any of that?

Well I do too a keynote on this. So I'm hoping to get that on video soon so that I can at least give you a 20 minute overview of essentially what the book is going to incorporate and involved and hopefully I can get that done in the next month or two.

That is so cool. And one of the neat things about Robin folks is that when she says she's going to do something, she delivers. So excited to get the opportunity to share that with you all. And Robin, you know when this goes live it will probably be about that time. Is there a landing page or anything you want to recommend to the listeners?

Oh you can always just go to my website. It's thepatientceo.com or you can do robinff.com. But if you Google my name it is a 100% me about 20 pages on Google and I get pretty easily.

Outstanding. I love that. So one of the things that I really enjoy about Robin is that she's also very deep into several different things in healthcare. Now tell us a little bit about why you decided to create this book, Robin.

Sure. Well I was just being asked. I mean it's at least weekly if not more often. To either mentor somebody who wants to do this or to give a talk at a conference or to run a workshop or to write an article. I mean I am just being asked about being a thought leader almost as much as I'm being asked about science and medicine. So I said OK well maybe I should just create the instruction manual put a little bit of time into that and then I can help a lot more people all at once versus this one off stuff that I'm doing weekly just to essentially help my friends.

I love it. So what do people not know that they should know about being a thought leader?

Well what they don't realize is that you just literally to look at this as a business. This is a business first and foremost. So you need to work that out. We got a PNL, profit and loss statement, a budget, you need to think about branding, right? And signature looks and all of that that goes into building an actual brand of a new company. You're going to need departments. You're going to need to hire experts, consultants or employees. This is an actual company. If you're looking at building a thought leadership platform and you're not looking at it like a company you probably will not succeed or if you do you'll succeed by accident.

Wow, that's really interesting Robin, and for most of us let's stop and think for a second. Are we thinking about ourselves as a company. And I think that the honest answer for anybody listening to this is probably no. And so this is pretty fresh approach and a pretty unique way to approach your thought leadership because one way or the other you are creating a brand for yourself. And why not take control of it?

Exactly. And the big thing that it goes back down to is the profit and loss statement. Where is your revenue and what are your expenditures? Because you are not going to build a thought leadership platform for 200 dollars. This is thousands if not hundreds of thousands. And if you want to go really big, some people spend 250-500,000 dollars to go really big. You need to be able to understand where to get money, where to spend money, and what is going to be the most bang for your buck because you got to look at this as a an early stage startup company. And those of us who are entrepreneurs know early stage startup companies cash and time meaning people resources are really constrained and limited. So how do you completely hack it so that you can create a company for maybe only get two or a hundred thousand dollars?

I think that's so cool Robin. Now let's dive deeper into the PNL. And so most folks are like well you know what? I just want to be known for what I have to say and I really don't care about the money. Is that a bad belief?

Well I mean if you would like to spend your life volunteering and you happen to be sitting on a huge trust funds. Yes. A great way of going about it. But if you live in the real world with most of us that we have to actually have income and revenue in order to pay our rent or mortgage, put food on the table, and dress our children. Then you need to look at everything you do in your life as part of your overall Robin 8. And that's literally what I call myself. I call myself Robyn 8 and that and I bring in revenue from anywhere from three to ten sources a year minimum. I'm actually striving for 10 sources of revenue a year right. And then I know exactly where every dime goes and I don't think of separation between my personal life and my professional life. I pull in those same things that I would do in business into my personal life. So I hate doing something or if it's just not worth my time to do something I outsource it in my personal life. For instance I outsource 100 percent of my shopping. All of my shopping gets delivered. I never walk into a store. That's the reality that you have in a corporation. You would never go and run errands for your corporation. You wouldn't go and fill the snackroom with snacks at your corporation your executive assistant would do that for you.

Yeah. Yeah.

So why do you do that in your personal life?

I love it Robin. The thing about is that you keep it simple and you keep it real. Folks, think about yourself as a company. And let's give some examples here, Robin. Maybe you could dive into some of the things that you would recommend somebody that's on the early aspects of this right. They haven't even started they're ground zero. What are some things that could be done from a revenue perspective to get things going?

Absolutely, so well like with every business you're not going to be generating revenue for the first couple of years most likely. You need to understand that you are going to be investing in this and I'm going to give you in the book I give an actual timeline, my timeline and exactly how many dollars I spend at each and every node essentially on my timeline over a five year period. And I started out with education. That's the biggest thing. OK what am I an expert in? So I need to educate myself in my subject matter, an area that I wanted to be a thought leader in. For me that's the convergence of exponential technology. So I get a three year deep dive while building my thought leadership into learning the different verticals from A.I. to robotics to sensors to 3D printing in addition to really doing a deep dive into the world of entrepreneurship both on the educational level so taking some classes. But mostly I just got in there down and dirty and I've been an entrepreneur since about 2005. So I was taking that experience and combining it with getting myself educated in accelerating technology.

That's so awesome. So listeners I want you to take note of the things that Robin is talking to us about. Take note of the things that she's highlighting and apply them to your own life because you have a choice in life. As a health leader if you want to improve your impact on the system you got to make sure that you're going to be heard. And the way you're heard is as a thought leader. And so, Robin is really making it so simple for us to understand how exactly to achieve that. And so make sure that you take the time to listen to this again because I think she's dropping some major value on us right now. So the thing that I'll share about my personal journey is that. Yeah you know built the podcast, and at the beginning Robin I'll be honest nobody wanted to be on.

I would have been on for you.

It was hard. And I know you would have you were one of the first and I thank you for that. But it's putting in the work right. And so we like fast forward to now, we definitely have some revenue coming into the podcast and it just doesn't happen overnight. So Robin a lot of the things that you're saying are totally striking a chord with me and it makes me happy to know that there's going to be a playbook for other people that want to increase their impact out there.

Yes. And I've actually got to make it into a workbook style thing and I'm going to give people templates as well to utilize.

Amazing. That's so cool. That is so cool and so. Fast forward to maybe a year from now. Is this going to be something that is going to be available as an online course. Talk to me about that.

Yes. So that is going to be one of my revenue streams so my various revenue streams and Robin, Inc included that I'm a professional speaker so I charge upwards of sometimes 10 - 20,000 dollars for a corporate talk. I have my book sales right so that brings in quite a few thousand a year for me and then I have my day job. I sit inside of multiple companies as an employee doing very high level business development. Each one of my companies helps the others. So while I sit inside as an employee you could essentially looking at it as a consultancy, right. And so the different companies I worked for are my clients so I've got whatever 6 or so revenue streams coming in from those particular areas. And then a great one for thought leaders in general no matter what your day job is whether you're at the corporate environment or you're an entrepreneur or you're fulltime thought leader is obviously online educational things and those can actually bring in quite a lot of money.

Robin, thank you. And folks if you're listening to this and you're thinking that could never be me. Robin's been in it for a while. She just knows her stuff it could never be me. I've got news for you. It can be you and you too can create an influencer brand that enriches your life not just with money. Money will be definitely part of it but also the quality of life because of the things that you're able to achieve and the impact you're able to get. So Robin wouldn't you agree?

Absolutely. Absolutely. And being a thought leader that you don't ever go into this with just one reason, right? You don't do anything this big of a deal in your life without having local reasons. So I wanted to of course be able to drive my own businesses and the companies I work with I'm working on things like curing cancer, sleep apnea and inhaled insulin for diabetes that is of course a game changing companies and I'm a thought leader helped drive that particular mission forward. But in addition I use it as protection. I'm a small female in Silicon Valley and as you have heard in the past year with the media movement it's not really a great part of the world to be in if you are a woman and you are one to play in this particular world. So I use that as protection and the men can no longer push me down. I am no longer sexually harassed ever, right. In fact, the day my book launched was the day that the vast majority of men now do not even remotely come near me to ask me out, let alone sexually harass me. while it did this massive protection. And I knew it would. Going into it and that was one of the things that propelled me to work so hard on it.

Robin, I'm glad you bring this up because it oftentimes gets swept under the rug. It's the attention to the fact that these things still do happen, the discrimination. So I think it's wonderful that you're working through your platform to empower not just entrepreneurs and professionals but especially women to take their lives, their brands to the next level. How exactly will this help them?

Those are the ones who are asking me the most by the way and I do keynotes on this particular subject typically for audiences of all women and it really does leveled the playing field. In fact, Business Insider did an article on me that where it quoted me saying, now I am in a tank and the men are on horseback right?

I just get a good visual of that.

Exactly,because actually it's not even leveling the playing field. I have gone above them now right? And, to a point where everyone in the world is able to easily access what's in my brain. So they understand what I know and I'm putting my intelligence out there in the form of content for everyone to see. Plus the fact that I get up on stage talk about these technologies in a very competent manner and there are most people are actually quite terrified of public speaking. And so when you find a small woman who gets up on stage and talks about deep artificial intelligence in a very confident manner that right there gives me a massive amount of power.

I love it. It's so great Robin and it's so awesome to just hear your story and your passion. Just about all the things that you do. And now this current project and so listeners by the time this goes live you'll be listening. And the book will be available. I'm excited to give you more information about that. Just go to outcomesrocket.health/robinf and you'll be able to find that information there. Robin, I love that you're doing this and I'm excited to get my hands on that book. So pleas do tell me when it goes live and with that I just want to have you just share some closing thoughts for the listeners and the best place where they could get a hold of you.

Sure. So my closing thoughts would be yes, anyone can do it. Really. You can be a subject matter expert and you can have a high profile. If you put in the time, money and effort do it. You just need to be smart about it and you need to think about it as if you were building an actual company and a brand. And you can contact me through LinkedIn, Facebook, Twitter. I am the only Robin Farmanfarmaian in the entire universe so it's really easy to find me.

I love it. Robin, I really appreciate your taking the time to visit with us again on this important topic of being an influencer and making an impact and for the listeners. I know that they've taken a lot from this conversation so take action listeners, visit that link outcomesrocket.health/robinf. And Robin, a big thank you to you again for spending time on our show.

Thank you 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 you can 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. Be one of the 200 that will participate. Looking forward to seeing you there.

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Best Way to Contact Robin:

Linkedin - Robin Farmanfarmaian

Twitter - @Robinff3 

Mentioned Link:

http://thepatientceo.com/

Episode Sponsor:

Outcomes Rocket - Katie Atwood

How Health Leaders Can Take a Customer Service Approach to Grow and Scale Their Business and Practice with Katie Atwood, Vice President of Operations and Events at Becker's Healthcare

Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I really thank you for tuning in to the podcast again and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's guest because she's an amazing contributor in health care and an outstanding leader. Her name is Katie Atwood. She is the Vice President of Operations and Events at Beckers healthcare. She's been in healthcare for over eight years contributing to the success of not only providers but also healthcare companies that are looking to make a strong impact in the healthcare industry. And so I was really excited when I was able to connect with Katie and set up this time for us so I'm super pumped to be able to dive into some of the hot topics that she has on her mind and what she's seeing and so without further ado want to introduce Katie. Welcome to the podcast.

Thanks so much for having me. Good to be here.

It's so exciting to have you here Katie. And just curious did I leave anything out in that intro about you that you wanted to share with the audience.

No. That was great. Thank you so much.

No problem. Absolutely. So let's talk about this. What is it that got you in the health care.

Great question. Leave it or not. It was completely chance. I joined Becker's health care not with the specific intent to get into healthcare but instead really I was looking to join a phenominal team and learn from exciting and challenging leaders and have a chance to grow in an organization that really allowed me to jump right in and leave my mark. That just happens to be a very happy coincidence that led me into this exciting industry full of passionate people trying to make a difference.

That's awesome and find a good team you did had a pleasure to have Scott on the podcast. Emma connected with Jessica you're part of a really great team and I'm excited to dive into hear what you believe. The hot topic that health leaders need to focus on what is that and how has Beckers healthcare focused on it.

Yeah of course the first thing that really comes to mind in terms of the hot topic here is collaboration with such constantly changing healthcare landscape. It's so important to have the opportunity to connect and learn from other people. And so our unique approach at Becker's healthcare is working brings together leaders to disseminate information create discussion especially around how to improve healthcare and it's challenging but opportunity for all time. And we do that really in a variety of ways. Like you mentioned that amazing team we have. We have an amazing amazing team of writers editors will collaborate day in and out with industry experts creating content for our publications or Web sites like Beckers has for you. We also work to bring together some of the best minds in health care for educational discussions nationwide conferences which I love to touch on more and then additionally we work with a number of healthcare companies like you mentioned in the intro and ways to help them network reach their goals and grow their businesses in a variety of different ways.

I love that. And Katie there's no doubt that you guys are. I would say one of the super connectors of the industry and the efforts that you guys are focused on collaboration really resonate with the outcomes rocket. We're very focused on knocking down silos so that leaders can learn from each other. You guys are doing that 10 X and it's exciting. So give us an example of how you guys have created results through your meetings and through these collaborations.

Yeah absolutely. The one thing that when I saw I had some examples but I want to start out by kind of interesting why we really focus on here at Beckers healthcare that I think is really creating those results in those examples that I'll get to. But it all comes back to helping people. So that's really a simple concept but that's what we bring it back to Becker's healthcare how are we helping our readers. Our guests at our event are partners. How are we aligning ourselves with our partners and collaborators to help them achieve greatness. Whether it be in their hospital or their business so we do that as I mentioned in a variety of ways. And so whether that be through focused content that's going to help someone make a more informed and better decision or facilitate relationships that lead to growth or efficiency or what have you. And so in terms of results like to give an example how I know this whole bean is going somewhere for us. Just this month. Top review USA has the highest amount of read articles and visitors. And what that all comes back to is really creating content that's all interesting and helpful to our readers. Another example that came to mind here is our annual meeting is going to be a record breaking event this year and that's contributed largely to keeping a constant finger on the pulse of what leaders like your listeners want to learn and who organizations want to connect with and how we can help facilitate and help make things happen. So simple but powerful if you can bring in and back to that decision. How do we help our clients. How do we advocate for customer patience that really allows you to make empowered decisions and drive exciting results.

Katie that's so great and congratulations on those most recent accomplishments.

Thanks so much we're so excited.

That's so cool and listeners I've been to many of the meetings there here in Chicago. Good excuse to get out here. But I'm talking about total worth of your time and investment because every time I go there I connect with somebody new. I learned something new. And this concept of giving that Katie shared I mean you guys have heard of being a go getter. I think it's time to push that to the side and be a go giver. And what Katie and the Becker's company is doing is it's just amazing there. Go givers. And I think that's why they have experienced so much success. So Katie I love if you could tell me a little bit about a time that you made a mistake or a setback and what you learned from that.

Absolutely. One of the I would say the biggest mistake that I've made and learned from and that you're really making me question is that if I'm not getting back enough. That was a great point that you just made. But the other thing that comes to mind is not asking more questions and not really taking advantage of learning from others. When we have the opportunity to do so. So I would say I've made this mistake early on in my career probably more than once when I just might take questions or conversations that add face value and so that really meant missing opportunities and chances to learn and grow and enhance relationships and help others. And so I just think there's so much to be learned by asking questions understanding motivations and desires and putting yourself in other people's shoes and giving. Like you said that taking the time to ask why and I understand more about where other people are coming from really allows you to not only help serve patients better clients or whatever it is but it helps you work more efficiently. Understand customer needs before they even ask and anticipate and solve problems for their seeing. So asking questions and giving. For sure. Those are probably the two biggest things that I've I've learned through mistakes of failing to do so.

Katie beautifully sad and we're all guilty of this. Everybody listening to this you're all guilty of this too. Just be honest with yourself. If you say you're not then look deeper then you'll find it.

Absolutely.

Right Katie. So tell us a little bit about that. Right. Let's dive a layer deeper like when you are in a situation where you could potentially find yourself not asking the why. How do you recenter yourself. And how do you get yourself to ask that question. Why.

That's a great question. I think the more that you can kind of stop yourself and realize when you're depending on your preconceived notions and hold yourself accountable and say wait a second. I know when I know but I don't know what happens. No I don't know. The knowledge that they have to share. So how can I pull that back and focus on 70 30 where I'm really just talking 30 percent of the time I'm sure people are familiar with that concept and the person that I'm conversing with is is really dominating the conversation that's going to allow me to learn so much more and then always realizing that there's an underlying motive. So sometimes it may take asking the question three times to peel back the onion and get to the bottom of what the true motivation or desire is so challenging yourself to not give up until you get there and you feel like you understand the person's pain or goals or whatever it is that you're working on together. I hope that answers your question.

It really does Katy and listeners it's that 70 30 right. Let's take a note from what Katie has shared with us. And remember that you've got to let the customer your patient, the person on the other side of the table talk and you listen. There's two ears one mouth and I love this. The share Katie because it's always good to be reminded of it. Let's look at the other side of the coin here and I'd like to ask you went to that spot you were vulnerable telling us about that one area you need to improve. Tell us what you're most proud of today.

Sure yeah. This is so difficult to pick just one but two things come to mind and I'll try to be brief. One is working alongside an amazing team. I know I kind of opened with this I see something that I really was seeking at the beginning of my career was joining a phenomenal team a challenging team and I feel so privileged to learn from amazing leaders like the people you mentioned at the beginning of the podcast, Scott backer Jessica Cole. I'm a good man Molly gamble as well and as well as being able to mentor a team of extremely bright and hardworking individuals. They make me proud every single day. So if I can give any tip that surround yourself with people who make you a better person. So that's definitely one. The second one is that you mentioned Becker's healthcare conferences and events and I cannot take a fraction of the credit. But I will say that so so proud of some of our mediums especially our Becker's hospital annual meeting. Our team really worked endlessly to create a world class events and give every single attendee a unique experience an amazing opportunity to learn and network and that show has grown so much in my mind and hopefully others will come and it has created a lot of value within the healthcare industry. That's another huge point of pride. So again it is an army of people working on making that great. So I can't take nearly any of the credit.

That's awesome and the humility is fantastic as well. Katie no doubt a great leader there at Beckers and that's why we wanted to have you on the podcast so let's dive deep.

Thank you. So nice.

All My pleasure. My pleasure. And so let's dive deep into the meeting maybe this is a chance for you to put in a blog like tell us a little bit more about who's going the keynotes you've got some exciting people. I'll let you unravel that.

Yeah absolutely. So we have that sixth conference of the year. So this specific one Beckers Hospital Review annual meeting. This year it's coming up in April so it's coming up quick here. And we are going to have around 4000 people and some of the keynote that we're really excited to have all past presidents Bill Clinton George W. Bush but we all have really really great hospital and health system providers speaking. We have Bernard Tyson. We have John Noseworthy Mayo Clinic. Lloyd bean from Dignity Health. I could probably list them all day long. It's really amazing. And so we're really looking forward to across this event bringing together not only these great speakers but really great attendees who can bring a lot to the table in terms of discussion and as well as we have great healthcare companies coming to network and kind of share what they're doing differently in the industry as well. So our biggest goal there is how do we ring together. All right bright people to change healthcare for the better provide education and hopefully provide networking and collaboration. So we're really excited about that event coming up here shortly.

And Katie thanks for the synopsis. Obviously some big names some amazing topics listeners just go to outcomesrocket.health/beckers. And that link will take you straight to the Beckers website where you could sign up and learn some more. So tell me about a little bit exciting project that you're working on today.

Absolutely not totally beat a dead horse but I would have to say that we are in the back of our event. So that event definitely. We also have it's going to be a record year. Like I mentioned. But along with that we have four other annual event and then we are launching a new event this year that's been helping clinical leadership. Yeah that one's coming up in May as well. Coming up quick. And again the goal of these not unlike outcomes rocket is to foster discussion collaboration. And so that is so top of mind right now for us and we're really excited about bringing people together in these different events to really make a difference.

That's outstanding. I will definitely plan on being at those. Katie and and thanks for sharing that. So we're getting close to the end here and it's been a lot of fun. This is the part of the podcast where you and I are going to put together a course on health care leadership the 101 of Katie Atwood. So we're going to write a syllabus for questions lightning round style followed by a book that you recommend to the listeners you ready.

I'm ready.

All right. How do you improve health care outcomes.

I would say put the patient first and focus on helping others.

What's the biggest mistake or pitfall to avoid.

Overcomplicating usually in my opinion the simplest solution is the best solution.

Love it. How do you stay relevant as an organization. Despite all the change.

Never stop learning never stop listening always ask why to go back to that and always be giving for sure.

What's one area of focus that should drive everything in your company.

Well here is the one area focus that definitely drives everything a phenomenal customer service. So put the customer first put the patient first and grow with them.

Beautiful. Katie what book would you recommend to the listeners as part of the syllabus.

The books that I would recommend is really brilliant leadership book and it's called take the stairs by Rory Vaden and as you might be able to infer from the title paints a message. Oh sure of course. The message of the book really successful people do what others don't want to do and they do it every day so they take the stairs versus that escalator or what have you. And there are no shortcuts on the road to success and I will feel powerful. They really love it and it successes rented and the rent is due everyday.

Boom. Ah. Well said Katié.

I cannot describe it as all Rory.

You shared it with us. The credit goes to you here on the outcomes rocket success is rented every day ladies and gentlemen and so make a payment every single day. Take the stairs. Katie what a wonderful book. What a great recommendation on this syllabus. Listeners don't worry about writing any of this down. Just go to outcomesrocket.health/atwood. And you going to find all of the transcript things that we talked about. Links to the book. Links to Becker's healthcare of the meeting everything is going to be right there so don't worry about writing anything down. Katie before we conclude I love if you could just share a closing thought and then the best place where the listeners could get a hold of you or follow you.

Yeah absolutely. So healthcare leaders are listening if you haven't yet. Make sure you check out beckershospitalreview.com and network with the brightest in the industry at one of our events. We would love to have you and then you can always reach me anytime. My email is katwood@beckershealthcare.com

Outstanding Katie. This has been a blast. Again, really thank you on behalf of all of us for your words of wisdom and looking forward to staying in touch.

Thank you so much. Thanks for having me.

Thanks for listening to the outcomes rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.

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Recommended Book:

Take the Stairs: 7 Steps to Achieving True Success

Best Way to Contact Katie:

katwood@beckershealthcare.com 

Mentioned Link:

http://www.beckershealthcare.com/

Episode Sponsor:

Outcomes Rocket Podcast
Outcomes Rocket - Emma Goodman

How Today's Leaders Can Better Understand Today's Millenial Mindset in Healthcare with Emma Goodman, Director of Key Accounts and Webinars at Becker's Healthcare

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative, thinking improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:18] Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because our guest is an outstanding person as well as a contributor to Health Care. Her name is Emma Goodman. She's the director of key accounts and webinars at Beckers health. She oversees two divisions with a passion and drive to create results and add value to both providers and health companies working with them. She loved delivering phenomenal customer service to their top clients which in turn helps them reach more people and improve outcomes. I really want to just welcome you to the podcast today because you're an up and coming leader in health and I know you're going to offer tons of value. Just want to give you a warm welcome to the podcast.

Emma Goodman: [00:01:15] Well thank you so much, Saul. I am so excited to be chatting with you today.

Saul Marquez: [00:01:20] It's my pleasure and the pleasure of our listeners. For sure. And so anything that I missed on your intro that maybe you want to fill in.

Emma Goodman: [00:01:28] Yeah. You know just give you a little bit more background on on. So we are a multimedia healthcare company and really the number one go to source where executives can learn news and business information in their industry in healthcare. So we what we aim to provide pearls of information that the busy execs can then take back to their hospital the surgery centers to make more informed business decision.

Saul Marquez: [00:01:56] It's a really really neat business and you guys definitely provides major content. I mean I I have you guys on my RSS feed. I definitely get a lot of stuff from you guys so keep pumping out the amazing content.

Emma Goodman: [00:02:08] Awesome. We absolutely will.

Saul Marquez: [00:02:11] So Emma out of all things you could have done. You decided to get into a health organization. Why did you decide to get into the medical sector.

Emma Goodman: [00:02:19] Yeah well that a really great question. When I started my career I really didn't know too much about the business side of health care and I was just really eager to learn and jump in. So I'll tell you a little bit about what has really stuck with me and why I continue to be in this space. So with almost four years in this space I really realized what a fascinating and ever changing industry to be a part of. And that to me has been really exciting. So what I'm constantly fascinated by is Chipo resilience that industry is it needs to be with the constant change that surrounds it. So I think that's really why it's been so exciting for me to you know be in the health care industry is just with the change and the resiliency of it all.

Saul Marquez: [00:03:07] I totally agree with that point. Absolutely.

Emma Goodman: [00:03:09] Yeah. And for myself the fact what I live every day is being able to work with just some of the coolest and most innovative companies that are out there. And so I am just enjoying constantly learning from the health care companies and the solutions and services that they provide. And really you know our collective goal is just to deliver better experiences for patients and to deliver better patient care. And so when I think about it in kind of the grand scheme of things I just think wow what a really cool mission to be a part of.

Saul Marquez: [00:03:42] Yeah it really is mind you guys are definitely doing some interesting things to improve outcomes. You work with a lot of companies many of them innovative and successful. What would you say just based off of your experience should be a hot topic on every medical leaders agenda.

Emma Goodman: [00:04:00] Yeah that's a great question and there are just a ton of interesting and important things that are going on right now in this space. Are you a legally editorial Keyvan just has the best pulse of what healthcare execs should be thinking about. But you know I'm really excited in several factors. It's just the growth of health I.T. and really no one's surprise we are just finding that that is just such a booming area. There are a vast majority there are a ton of fantastic health care companies are just providing really unique solutions in this area as well. So we're really excited about that. We are launching a six event that focuses on health I.T. and clinical leadership issues and trends and solutions in the industry. And we have just seen just tremendous growth in terms of attendees and our partners for our health safety and revenue cycle comprende which is in its fourth year. So I think that health I.T. is one area that we are just really really excited to dig even deeper and to grow kind of our readership and not base as well.

Saul Marquez: [00:05:05] Now I love I love the meetings AMA and listeners if you haven't had a chance to check out one of the Beckers meetings they are definitely worthwhile. And of course our lovely city of Chicago. So it's convenient for those of you in the Midwest but if you're not in the Midwest definitely worth coming out because some of the attendees are just the amongst Healthcares most influential and they also make the meetings really exciting and fun. When I was there last time I got to meet President George Bush for instance and so they definitely know how to keep it very entertaining. What would you say some advice for young in this field but you've also had some success very early on. Maybe you could share some advice to people starting their careers in this space. The millennial representation in our industry is growing. You know what words of wisdom would you share with them.

Emma Goodman: [00:05:59] You're right it is a really really interesting time because millennials and I am proudly I'll probably consider myself. We are just now really the largest part of the workforce. So you know whether you're entering your career as a millennial or you're an executive trying to better understand this generation. There are a couple key things that you know I'd love to share with your listeners also. The first is that what I've noticed about my peers is that we really care about the opportunity to have a mentor or a coach really in order to move quickly up in an organization and that's something that I've noticed that really characterizes this generation is the importance of career advancement and having the opportunity to have a mentor or coach to help get them there. The second which I think is just so fascinating is the importance of a good work culture. When I had the opportunity to interview people who are who are interested in joining our team and I asked them what's the one thing that you were looking for you know in a career after graduation they always say to me I'm really looking for great work culture. So a company that cares about its employees and the community and will almost build a sense of family is crucial crucial to this generation and something that organizations that health care and even other industries actually need to pay attention to in the recruiting process if they want to hire the best and brightest people you know right out of school or any young leader. And then I have a few pieces of advice for you know young adults starting their career that I've picked up from my experience and just my fantastic team here beckers. So I say the first is have a good attitude and be flexible. It is really warming to know how are having a good attitude it can get you. And you know when I look for people to join my team I always look for someone who is positive and open minded to training projects and opportunities and really you know what they're saying when they have this attitude and outlook is I'm here to do great work for my company. I'm not just here to do great work for me.

Saul Marquez: [00:08:13] I think that's a good call out.

Emma Goodman: [00:08:15] Yeah. And yeah. And then this next point I think is really something that we look for for folks joining health beckers that is to say yes and then figure it out. We call that bio for figure it out here. And when will we. Yeah yeah. So wouldn't we. FIO Exactly. It is a known afternoon here at Beckers. So we all aims to follow every day that you know about it. If you have that one on your team who says yes I can tackle this and then figure that out. How valuable does that person become. And then I have two other quick things that I think are just really really important pieces of advice that I would share. The next is absolutely bad for that. Be back again. And then you have to listen to it and embrace that. So you know the question that I love to ask the people that my bosses and then for the people that I oversee is what you need from me and what is going rate that you like to see more of. And once you get those answers you've got to ask them again the next quarter the next time you sit down for a one on one meeting to constantly be evolving and then you have to make sure it's not something that you're checking off your to do list but you're listening and you're embracing it and you're making changes and then the last one is something that I've picked up with me as I've gone through the beginning stages of my career and it's really you cannot expect to be great if you're not willing to put in the extra hours. And it seems really simple buy if you believe that the work day and that I have you are just not going to be the most successful you that you can be. So I use prep time on Sundays so I can hit the ground running on Monday and it just makes a tremendous difference.

Saul Marquez: [00:10:01] Some really great words of advice and listeners take a note from Emma's words of wisdom here and kind of reminds me of the Kennedy ism where he said Ask not what you could do for your country. Ask not what your country can do for you. Ask you could do for your country. I think the same thing applies for careers and healthcare. That's not what you could do for your. I completely butchered it. But you guys know what I mean.

Emma Goodman: [00:10:28] Exactly. Exactly. You cannot expect for your company to be doing things for you. You have to be doing things for your company in order to be successful.

Saul Marquez: [00:10:37] Well said Emma you said it best.

Emma Goodman: [00:10:40] It's teamwork you set me up

Saul Marquez: [00:10:44] I love it.

Saul Marquez: [00:10:45] So Emma what would you say one of your proudest medical leadership experiences to date is.

Emma Goodman: [00:10:50] Yes. So when we talk about kind of what questions we'd be talking about today this one made me think a little bit. And I was really really excited when I came up with OK what was I going to talk to you about today. So I would have to say that my proudest moment here Becker's is just the growth of our web and our product line here every year. So our webinars are meant to be educational opportunities where healthcare leaders can log in and learn from other thought leaders in the industry about how they're solving certain issues and problems and you know what's going on and how are they going to tackle that. So I would say that you know being the success that our clients have seen in giving their thought leaders the opportunity to speak some of their clients the opportunities to present to their peers and really the most important topics and problems that we face through our beckers platform has just been so exciting to me. Last year we executed nearly 100 web in our campaign. When I think about. Yeah. You know it's been really really exciting busy but exciting awesome. And when I think about how that created such a great space for constant and further education within our industry I just feel really proud to lead that charge here at Bakkers and I think that here at Bakker's we are just excited to be a leader in the industry on this front. The education and constant learning from our peers.

Saul Marquez: [00:12:16] Yeah that's pretty amazing. A hundred webinars and 365 days you guys are cranking it over there.

Emma Goodman: [00:12:23] We are. And you know it's all thanks to and because I get to work with these wonderful folks each and every day. But it really is all thanks to our fantastic fantastic partners who really provided a thought leader to be able to speak to some of these issues and we just are so excited to be able to partner with them to provide the education opportunities.

Saul Marquez: [00:12:43] That is so cool. And kudos to you and your leadership there for making this happen. Tell us a little bit more about an exciting project or focus that you're working on today.

Emma Goodman: [00:12:53] Yeah absolutely so as I mentioned earlier we are very very excited to be launching our next conference and our newest event will take place this May in Chicago. Like you said I'm we're both a little bit biased that need the greatest city in the world yet picking that May in Chicago and it's focus on the intersection between health I.T. and political leadership. So as we look to develop this of that we really got an understanding from our readers and from the fantastic leadership of our publisher Scott Becker in the proposal that hey this is an area that a lot of potential to dive into and so our agenda is packed. We've had a hundred and 112 hospital health and speakers know presenting at the conference and some of the topics that will be discussed. Artificial Intelligence tele health data analytics clinician burnout World Population Health System really really important topics that we're going to be discussing at this art or new exhibition and not really overall we are just very excited about the growth of our conferences as well. So happy that you were able to come for the annual meeting last year and we really strive to provide destination advance for healthcare executives to learn and take back information to their ability to make great decisions. We want to provide a space where folks can network with their peers and others in the industry. And like you said we love to have a little bit of fun at our conferences too. So our vision and a part of our strategy in the year ahead is really has a world class franchise healthcare event and we are excited just to see that continue to grow with our success of that here.

Saul Marquez: [00:14:33] Well congratulations on the launch of that than just with experience having on the previous meetings that you guys hold and to the listeners I would also encourage you to also just hang out in the hallways and the coffee breaks and because some of the best conversations that I've had have been after one of the breakout sessions where you talked to another fellow leader in health and maybe make a synergy happen or a connection that could potentially help you improve outcomes in your organization. So Emma let's pretend you and I are building a medical leadership course on what it takes to be successful in the business of health today. It's Emma's 101 on health business success. So I'd like to write out the syllabus with you with getting some brief answers to this lightning round four questions followed by a book in a podcast that you recommend to our listeners are you ready.

Emma Goodman: [00:15:25] I'm ready.

Saul Marquez: [00:15:26] Awesome. What is the best way to improve outcomes for a growing team.

Emma Goodman: [00:15:31] I think the best way to improve outcomes for a growing team is by giving your team ownership of projects and half and then holding them accountable. Plus you have to provide constant feedback along the way.

Saul Marquez: [00:15:44] What is the biggest mistake or pitfall to avoid.

Emma Goodman: [00:15:47] This is a good one not asking enough questions to your key clients or partners that leads to making assumptions. You don't have a great understanding of their goals and their needs. And just can lead to a whole mess of things. So not asking a question.

Saul Marquez: [00:16:02] I love it. How do you stay relevant as an organization Emma. Despite constant change.

Emma Goodman: [00:16:08] We listen to our readers and we adapt. So we grow our business to affect the industry and we must stay nimble.

Saul Marquez: [00:16:17] Beautiful. What's one area of focus that drives all else in your health organization.

Emma Goodman: [00:16:22] So I think I may be a little bit biased. This is my everyday buy. I believe that it is outstanding client and customer service beautiful and Emma.

Saul Marquez: [00:16:32] What is your all time favorite book and podcasts you recommend to our listeners.

Emma Goodman: [00:16:37] Yes I will talk about a podcast that I'm loving which is how I built this podcast from NPR. For anyone who has an entrepreneurial spirit this is such a great podcast and is perfect for your work. They interview really really great leader and entrepreneur like Mark Cuban. My favorites were the founders of AirBnB and Ben and Jerry from Ben and Jerry's ice cream of course. But listen to their story how they built their brand and their wildly successful companies. It's just fascinating interesting and above all else just inspirational.

Saul Marquez: [00:17:16] Very cool. Definitely have to check that one out and what book would you recommend Emma.

Emma Goodman: [00:17:20] You know it's a great question. Right now I am reading super boxes and I've just started to get into it but I am just trying to open any book that I can get to help further develop my leadership skills. You're a backer so I'll have to keep you posted on this one so that it's turning out to be a great one.

Saul Marquez: [00:17:42] Awesome thank you for that. And listeners don't worry about writing any of this down. Just go to outcomesrocket.health/Emma E M M A. You're going to get all the show notes as well as the syllabus with the book and podcasts. She just recommended and you're going to be set for improving health outcomes. So before we conclude I just want to ask that you share a closing thought with the listeners and then the best place where they can get in touch with you.

Emma Goodman: [00:18:09] I will absolutely, Saul. Thank you so much for having me today on your podcast. I love sharing more information with you about Beckers. I think that my closing thought would be at the end of the day. We in health care are all here to really make the patient experience great. So in whatever area of healthcare you are in having that in mind just as a constant Reiber has helped keep me grounded and really really charge forward as we enter their future together. So again thank you so much you can reach me on linkedin. I'm a good man. Then or feel free to email me at egoodman@beckershealthcare.com outstanding.

Saul Marquez: [00:18:50] There listeners again. You could get all the contact info as well as links to Beckers and all the things that Emma shared with us. Just go to outcomesrocket.health/Emma. Just want to say thank you so much for being with us. It was fun and I'm looking forward to staying in touch.

Emma Goodman: [00:19:07] Yeah thank you so much.

: [00:19:12] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.

Recommended Podcast:

How I Built This

Best Way to Contact Emma:

egoodman@beckershealthcare.com 

Episode Sponsor:

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