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

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

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

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

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

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

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

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

That's awesome.

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

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

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


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

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

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

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

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

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

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

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

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

Such a great point.

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

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

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

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

And not having people working at cross purposes.

You know the alignment piece is key right?

Yes, very.

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

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

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

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

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

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

I am old school.

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

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

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

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

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

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

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

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

Fabulous thank you.

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

Great, sure.

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


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

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

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

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

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

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

What book would you recommend to the listeners Rosemary?

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

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

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

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

And thanks so much, I really enjoyed it.

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

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Recommended Book:

Being Mortal Illness, Medicine and What Matters in the End

Best Way to Contact Rosemary:

LinkedIn: Rosemarie Day

Twittter: @DayHealthStrat, @Rosemarie_Day1

Mentioned Link:

Day Health Strategies

Episode Sponsor:

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How to Leverage Mobile Health Data with David Haddad, CEO at Overlap

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 For more details on how to attend that's and you'll be able to get all the info that you need on this amazing healthcare thinkathon. That's

Welcome back to the outcomes rocket podcast we reach out with today's most successful and inspiring healthy leaders. I just want to introduce an amazing guest for you today. I've been getting prepared to head over to the TEDMED event that's in Desert Springs, California this year and it's going to be pre happen. But I was doing some research on this amazing amazing healthcare contributor. He's the CEO at Overlap. Now couple of things. He was from California. Eldest child with two siblings. A really cool background right. David Haddad OK he studied chemistry got a B.A. in public health then he went for some more. Got some more schooling in economics at the London School of Economics. But then he proceeded to have some pretty amazing experiences across different organizations in healthcare the USDA, the Pan American Health Organization where he reached tuberculosis transmission in pediatric population and research that there the World Bank the U.N. Foundation where he designed development and strategy for health unbound dot org.

He's done so much and now his current role is as the CEO of Overlap and they're doing some pretty amazing things that Overlap health. So they're using really working across the realm of healthcare organizations and researchers working with mobile health data. They're doing it through APIs, data visualization libraries and mobile SDKs which are built on top of the open m-health data standard. Pretty amazing gentleman and him and his team are doing some outstanding things, but what I wanna do is just open up the microphone to David to fill on any of the gaps of that intro and just give you a warm welcome, David thanks for joining us.

Thank you. Thanks for having me Saul.

Hey so anything that I missed there in your intro?

It's pretty good. Yeah, there's definitely some clarification over there but, yeah it's it's been a journey.

So tell me you've been in health care for some time now. Why did you decide to get in?

Well that's a very good question. Healthcare, to me has always been a way, I feel like I've always been for.. Since childhood I've always wanted to work with helping the people who need it the most. So I always felt the health care was just a great profession to be in specifically to help people who are need in a lot of ways advocating for the poor. And you know like when I was a kid I really want to in high school or become a doctor. And when I was at Berkeley, I always want to be a doctor. I went on a path and did the premed stuff, all the requirements apply it and did whatever. You know I was I was always clashed with the idea of public health and medicine and so I think I really wanted to sort of a little bit more on public health as a way to help lots of people at the same time. And yes, it's just founded as a as a great way to to do social justice and to help with getting people who need healthcare the most. I mean there are other ways you can do that, you can do education work and other other sort of social services and it was just, I really trying to help them. And a lot of medical folks in the background. In my childhood, my uncle is a doctor and my mom is an extra type. My great aunt was a nurse. Bunch of cousins on medicines.. professions. It's just been a big part of my life and it's something I really enjoy doing.

That's pretty cool. David now thanks for sharing that. And really ultimately you were drawn by the population level type of impact and you could have as it relates to access and just kind of helping the underdog. Is it true you had the rap group in high school called symphonic thugs?

I did. I did. I did have a rap group in high school. This is like thugs yeah I know everyone..

That's awesome. That's so cool.

People's MC Beats. And work so to do comparity. Kind of Beastie Boys our rap and I was I bit nerd and so we are bunch of the guys from band with we created this RAP album. We perform.

Oh you had an album huh?

Yeah we had an album like we had we made money and we sold it. And I think most musicians today. I still debate whether or not I want to listen to the world about what we did to be kind of fun just reminisce on the past. Yeah yeah, I had a very strong music background.

Super cool man and I always love that our guests have this such unique experiences that oftentimes we ignore but they're the very juice that helps us be creative and helps us do what we got to do to make healthcare better.

Yeah I think it's I think it's, I love this quote from Thom Yorke from Radiohead. He says I don't they were asking him like now how to do X Y Z. You know I do this music and he says I don't know what I'm doing. I think that that was so profound for him to say I don't know what I'm doing and I think that's my motto is there's nothing music has been a big music in sciences even though in arts and sciencesyou think that they're kind of opposed in a lot of ways of how rigid or sort of just how people think about it but in a lot of ways that's been my experience like I'm always approaching a problem as late as I don't know what I'm doing but as a musician you grow up knowing like OK I don't know how to play this music. And you start, you know saving it first. Oh god, this is crap. Do we swear on the show. I don't know.

Yeah you're good.

It's really shit when you first played the song and then you say OK I'm going to figure out what is the score? maybe match this for that quarter. And it's the same thing with science and engineering and you're like OK there's a problem. I don't really get it. And he never should come into it knowing anything. Now that being able to look at stuff with as much as you can with fresh eyes is what allows a lot of beautiful things to emerge.

David That's that's pretty insightful man.

Thank you. So I've operated a hide to look at things with fresh eyes as much as I can.

Yeah and I think it's a good message right. I mean and also to be able to say that, to admit that you're a leader in a health organization listening to this hey it's OK to admit that you don't know because that really opens up the opportunity for true idea generation collaboration and you'd be surprised what it will do for the culture of your organization.

I totally agree. It's a hard skill to have. You have to sort of challenge your ego and check and whether or not. Like why are you hearing this. Where were you thinking in a certain way as your ego and ego kind of allows you to not be so open to sometimes easily be so open to change. And I think to be.. is death and a lot of ways of seeing that healthcare day by day with every everyone who stays is still in object and motions isn't motion objects to rest is a rest you move. So they want to move, everyone wants to move in a positive direction. But if you're thinking, if you're not willing to unlock that kind of inertia and how you think, and ego plays a big role in that and just being more open to not knowing and being curious about what's what can happen. That's how you get to go forward.

As such a strong message. David appreciate your diving into that very revealing of your leadership philosophy and probably the reason one of the reasons you've had success in this space. Before we dive into hot topics and all that jazz. I love if you could just level set the listeners on what your company does and what your focus is.

So I mean so Overlap, we help healthcare organizations, get patients generating data into the clinical workflow. And we're the most robust and powerful and flexible solution in the market today that allows that to happen and built on years and years of the work that I've been doing for them health open standards from mobile health data. Yes that's what we do. We help.

Hey David, What's the problem that I have that you can solve?

Well let's say you have a whole host of diabetics in your patient population or you have a whole bunch of hypertensive population and want to be able to say look you know I want these little visits that this patient does every few months or what couple of times a year is going enough to know to be able to manage the disease and especially with you know if any CEO or if I'm shifting towards previous care or whatever, I really need to contain my costs. So what I want to do is I use Overlap to basically prescribe a plan or program for a specific patient, geolocation, track you know set some goals set some suggestions of like you know something to be alerted if a blood pressure reading is out of bounds. You know mostly certainly it start from multiple measurements. They do that, they set it up once and then patient would basically get an app and connect it to whatever wearable that it's associated with that specific measurement so it's blood pressure, of blood pressure cost it. We like whitelisted it in our system and then they just are tracking and they start entering your information and taking surveys and communicating with the provider and if something happens it opens up an opportunity for provider to be able to triage and work that patients into behavior so they don't have to keep coming into the doctor every time. So some stuff happens if something happens or something doesn't happen, it's just a waste of time.

That's true, right yeah. So listeners here you go if you're frustrated about not getting enough data. You know your patients are not coming in as often as you'd like. You don't have the information you need, David is the guy to call and uhm definitely many years of success doing it. What do you think David out of all the things you work in health care. What's a hot topic that needs to be on our listeners agenda today. And how are the folks at overlap taking care of it?

This is a really interesting topic I don't think a lot of people discuss too often but I think it's something that we're trying to do is we're building trust. I think this is a topic that is kind of this and this trust that that's being broken and I think starting from that position trust. I know this is not a serious technical is like talking about delaying and did that.

No, but it's good it's real. So is it trust like between what parties?

Well think about it from the perspective of what's affecting a lot of health care organizations is that patients are sick and tired of the treatment that they're getting there gains shuffled through visits they're not really getting the health care that they need. Not to mention your clinicians are burning the hell out. For every hour that they're spending with the patient which is why they were going into medicine in the first place. They spent two hours on administrative care. So you have, this is the state of the world. Yes you have that's going on. And then you have patients who are frustrated. And then what is going patients are now going to all like new alternative therapies type of thing like the.. People spend Billions of dollars in yoga and I've heard people especially in California. I mean I hear people in you know social settings, yoga is like can help with cancer. I'm like What the hell are you talking about? That's how people are.. what's going on because it is so sick and tired of it. And so there's a lack of trust that's been broken between the two parties and what happens, the trust is that you have to make a promise to someone that you're going to do something and you do it and setting the expectation and meeting those expectations builds trust. But when when a lot of patients are kind of going in and clinicians are sort of everyone's pissed off at each other. I think starting from a place o stop playing as a healthcare organization about how much money you're going to make or how much, trying to scale them over with patients or trying to increase dollar and just like all these cutting costs. So figure out how. I know it's not as if we were rethinking the metrics as how do we scale trust in our system. And I think it's not being discussed because I think there's so much focus on like these other issues like, I had to I like make money to survive. But if you think about it from the way survive is if you if people trust you and it's going to keep coming back. And so I think it's it's a hot topic and in our organization we talk about trust and empathy so much and how we're trying to deliver services how we care so much about what the organizations are dealing with and suffering with that. And there are the immediate things at the top of my hand stuff that they really, the deeper stuff is it's really important so we try to do that like a trustworthy service to our clients but understanding the apathetic to where where they're coming from is critical. I think that everyone spend a little bit time of that build with that assistance.

I think that's great David. And how do you scale trust. So we're working with our organizations I think there's the internal trust with our colleagues and there's the trust that we have. Like David mentioned with patients. And it's a fascinating topic. David maybe you could give the listeners any example of how you've seen this done maybe something you guys have done on something one of your clients has done. I'd be interested to hear more about that?

I think a lot of ways people are, if meeting people whey are at and you see some organizations are trying to this by investing a little bit more technology. We have, we basically have patients and I can click a button. This little magic button in a car comes and picks me up where it takes me wherever I want to go. It's like you've always like.. services. I trust the service so much because it's so, it meets the promises that it's going to come pick me up in a certain amount of time and I'm just going it. And it does it takes me safely where you wanna go and comfortably. And so when certain organizations are trying to do that, they're trying to do things like investing in.. like with mobile apps and getting data from wearables.. They're trying to do things better booking they're trying to make it easier for you to book online and of have a call 15 times over the phone making an appointment. So some organizations are doing it but they're still not meeting the patients in the lives that they're living and trying to make it easier for them in a way so that they can manage their care better. So it's. I mean we still got a long way to go. There's little things that are happening. I'm noticing also like some clinicians and just from hearing from family members or some clinicians after an appointment or leveraging just like little, nice little follow up systems dot com.. call my aunt after surgery of months afterward just asking what she's doing. It's just that caring attention, but attention to detail is this really goes so so long in terms of a relationship that you build with the patient because the alternative is they're not going to come back to you and they're going to go to CBS or Walgreens or Wal-Mart to go get the primary care whatever they need. If you really want to. Yeah that's that's I don't know how you scale it. I mean that's that's the scaling comes from operationalizing then making them part of the bones of the organization not trying to start patients off within 1 2 minutes even can get to the next one. A friend of mine works at a county hospital in California. And they've been doing physician assistance meaning his clinic has been basically resisting in the organ system. The accounting system saying no we're not going to stand eight minutes with a patient that it has a lot of health issues or take as much as we want. So what's happening is patients love it actually going back to the service get really good care getting healthier. And the crazy thing is that they're the highest billing unit within within the hospital. They're billing more they're making patients healthier and patients keep coming back. So I don't know it's just those types of little things I think we could do so much more and there's little things that people are doing.

No, that's pretty cool. Yeah absolutely David. And it's health care. That's not health machine and I just kind of feel like we've been very focused and rain busy on the revenue, on the metrics and and think it's valuable to take a step back and think about what you can do to show that care and it be something as small as an email or phone call to a patient and finding a way to David's point operationalizing. Right Start small get auto pilot going but scale it. Get ready to scale it. Because this is how you're going to be able to make an impact and be able to take your facility to the next level. Now give us an example of maybe something that you guys are doing to help these types of programs at Overlap.

Yes so where we're working with uhm, let see so we are doing some stuff. We work at a large healthcare organization in California doing remote patient monitoring so we got deep inside of AHR and to the epic system and clinicians were beign able to order diabetes program or we don't really were agnostic. They call it programs where agnostic to the disease you know it doesn't matter to us. But whatever the diseases we went to get these patients in diabetes program and so they had. They're dealing with like out of control diabetics, these are the people who are who have like an A1C, H1C of A tumor which is you know they'r drastic they just can't manage their diabetes. And you know we know this, we know all the facts and figures and these are the people who are causing the most cost of the system as well as a lot of the health issues is from there. These very severe chronic diseases and so they've been using a system to get to patients to control you know get this data information and they're starting to see A1Cs are going down. The same is true that the time that was wasted with nurses and doctors fussing around the data have been reduced dramatically from like double digit minutes to less than a minute basically looking at data. So massive cost efficiency so they can actually visit the time on the changing behavior which is what the whole point of what we're trying to do is help guide you towards healthy behavior and lifestyle like diabetes lessons. That's been a pretty phenomenonal we've been helping with that we're working with the V.A. about to go live within an appand that is going to help understand what are the thing depending on if there's changes in mood. What are the little things that we share with you that little micro interventions or insights that we could to provide to individuals who are maybe suffering.. that can better help them in those moments between clinical visits. So things like that working once in physician medicines with UCSF with this. Now there's a whole host of kinds of what we're working that are doing lots of things to be able to either understand how to better improve trust or more importantly just helping to improve care in general.

Now some really great examples David and you know interesting to just think through this. I mean if you expect to get what you need from these isolated office visits, forget about it, you're not doing what it takes to provide that care to that patient or the population that you're taking care of. And so it's cool to think through some of the opportunities that exist for organizations to take on programs through patient reported data. Now the impact that you can have could be so much bigger and so much better.

Yeah you're looking at the difference between I mean we don't need to get into all the nitty gritty of of new revenue opportunities that are available but there are new revenue opportunities available for CNS that you can build for this . There's a really a quick return of investment but more importantly you're going from a one off a one aux sort of visit to a lifetime relationship. And I think this is a shift that has triggered that present by doing things like remote patient monitorin. It presents a new opportunity to have a long term relationship with the patient not just like they come in for their weekly visit to their either month once a year as you know.


And I think it's it allows it allows. So it's different. It'is different because you're starting to think about patients but that relationship and how do you keep your cost down as well as your revenue and for long term basis versus which will eventually make you win money from that patient then you would be just selling just these one off sort of like come in.. The way the system is there're just getting those. This is try to ensure if we know if the patient comes in to get. We know that they're going we're going to get paid for it but it's a new way of thinking and in this ways is starting to pick up a little bit of steam so far but you know we think it's kind of magical it's not it's pretty straightforward, it's very easy. We help organizations you know what kind of demystifying how all of the things that it takes to do this it's not that difficult to do. And it's actually it has a huge impact on just that relationship I think. When I talked earlier about the trust between patients and clinicians think one of the things that we and some of our earlier research in this is why patients who loves doing this might even know that you know it's overwhelming. There's you know there's new technology that always everyone keeps one and there's ways to kind of with proper training and good technology good design to make a difference in that. But despite that both clinicians and patients especially patients love the fact that they have the doctor on the other end of the line and that someone on that on care team is looking at their data and they just feel so much easier and happy and more comfortable that there's someone else you know someone there watching them or helping them throughout to process in their journey. sort of just thing like I'm going to do my doctor tells me to do this. I go home I get a little piece of paper and then somehow I have no interaction with my doctor for months if not.

Yeah months. Yeah. It's such your choice. I mean it's your choice listener saying you want to be transactional or do you want to be relational. And the best businesses in the world deliver the best value. But they also know the lifetime value of their customers. So to David's point are you going to just take this patient and treat them as they come in. Or do you know that if this patient stayed with you through their wellness and sickness by the end of their lifetime, they're going to be able to generate X dollars and you're going to be able to help them stay healthier. You know those numbers like McDonald's knows wht's you are worth $50,000 through your life. So they're gonna keep you happy. Maybe not healthy.

Yeah. It's changing. Yeah I know..

Right. Admit it.

They're getting and they're getting as a result of their you know like listening I mean you don't they're not as responsive as other companies but they're listening is helping you. I mean they're are training customers long healthier productions and in the thousand we're shifting towards that and it's changing which is good. And I think that's the thing is like listening to your patients, listen to what they want, yes they don't always know what they want but it's really like. I mean we talk about health care. I don't know maybe it's a selection bias of the people surround me that are that talk about health care but I don't think they've had experiences in non-healthcare settings just people just normal people talk about healthcare and experiences either. Like you hear the stories about like which providers but they just rant and rave about how awesome you are and most conversations are not great. Most people don't. They're struggling these conversations are being had every day at the dinner across the world or at least in America for sure. So there's opportunities to fix it. Yeah look at Amazon, Amazon as you know they know if you're going to buy they know that is going to buy a lot of stuff for years. They're going to make investors.. Say look we have like sort of a long term people relationship. We're talking an organization is comprised of people. It's people transacting or you know working with other people like we're still humans at the end of the day and make it human exactly.

And I'm right there with you. I think it's a great message. So can you share time David when maybe you were trying something that didn't mark out a setback and what you learned from that?

In terms of running the organization or just in general?

Whatever comes to mind. It could be the organization it can be a solution whatever you want to share.

I think one setback for us sas it was a pro and con like we worked with a very large organization in the beginning of our existence.. and which was that I felt like it was a.. you got in terms of out of.. like a postdoctoral fellowship on like how to deal with a large health care enterprise, You know I am we had dabbled, I dabbled before with.. and done like some small projects with like organizations now and the nonprofit Open impulse but it was never at this level. And I think you know starting out that was great because it was great for cashflow but it was really really bad, not bad it was it was wonderful experience. I had to say but intentionally because they're so big it didn't leave a lot of chance for us to work on our product. So I wish we had worked a little bit sooner on this product but and it worked it out well so far so and everyone was happy and then it just it was a lesson I think someone had told me about this show you want to work with them and so they like some large. They're going to eat, they're gonna just take up all your time. And you know there's a lesson we learn from it we're ready to do it again.

So it was basically a very time consuming endeavor that took you away from other things. Focus areas of the company but finally you got them situated and you're able to keep working on those. Is there any pearls that you say man one thing. If I go down this road or when I go down this road again this is what I would do differently.

Not really related to that but I think that in general I think this is focused to people who really want to do this,really want to do the monitoring and trying to convince people who don't know anything about it or don't, haven't heard about it or not interested in it. It's difficult it's a lot of you know we're a small company and many of my friends who also in companies and state they are also small. They don't have multibillion dollar, million dollar marketing budgets to convince the culture that this is especially healthcare culture, this is the right thing to do. So I think just thing I'm just trying to really focused on is working for organizations really want to do this and I think that's a really great solution of doing it. Others that do other things wrong we do certain things wrong well and there's good companies to choose from. But we've been doing it longer and better than others. Yeah, just focusing on that's and focusing on that trying to work with the partners and understand that shared his vision of where we're going culturally I think that's another.

And I think that's powerful and it's powerful and you know a lot of a lot of entrepreneurs can make the mistake of hey you know I'm going to go after the whole market. The reality is you have an ideal customer. Know that ideal customer and focus all of your efforts and resources on them.

Yeah it's just been trying to make their lives better. They get sick and have to live in them. That's it should be possible. But It's not really. We're trying to do the best for the people who really want to do this. Yes a waste of time. And the great thing I think we because we're we haven't taken the venture dollars so we've been making money from day one we .. ideas I guess that's how I grew up. I grew up with a lots of business. And we ask people for money and they pay for your services if your services isn't good enough and..

You shouldn't get paid.

So I think that answers as a result of not having like it is sharing a lot with us that you shouldn't take money, you should look to the future and so there's a time and a place for it I think and just. And also this is the opportunity because we aren't free from. We don't have a gun to our head to make like 10x return in a year and a half on whatever money we get to like work with the people that want to work with and that fit our culture and we fit their culture and where they're the gun. I think that's really exciting. It's hard to do far that.

It's awesome man. Not so great. Tell us about one of the most exciting or proudest leadership moments that you've had to date?

Proudest leadership moments from you're like or just.

Yeah about the thinking across like the the wide experience you've had in healthcare David. Likeone thing that sticks out as Dang this was awesome.

So as of late I think it's been working with the V.A. I think that's been really really incredible. I think just people are always kind of able to work with these people the V.A. that they want to do solutions in the work kind of cutting edge innovative work and they just really got it. Yeah I really didn't think that they were going to get it because people see the eggs. So that's been really exciting, getting to work with them and they're really excited about what we're doing and what they're doing and that's the kind of role too to see that kind of that that relationship began and starting to grow. I think other big thing is you know the work they had done at open and house building an open standard and open community and that's just you know I was I'm still executive director I don't want Harry and sometime and few hours a week on it. But when I started, when we started in 2011 you know talking to people like hospitals and people about health and inoperability standards and everyone's like what the hell is in it operability is. You know now we're it's crazy. It's crazy. Now we're at a point now like I looked at the numbers. What the hell we bought some tools and we got some you know we built some tools using the open standard that we had designed with people from the industry and it isn't like 6000 downloads it's 4000. I'm like wow. Mean this is a worldwide. People are using software. I think that's in the first place and .. what we could what we could do. And then we just recently part of because of that work and the leadership that I've done along with people that I worked with there were now part of a working group within naturally which is helping legitimize that as an open standard for the world. So I think that that's I don't know if you answered really awesome just like shoot that's I wasn't expecting this to happen and it's like getting on the international stage and it's just really awesome. Yeah I love it.

That's pretty great man. And you know yeah I mean to think about that project you were working on is now becoming a standard. People are adapting it like it's like. Whoah, this is unexpected but also all those hours and effort that you spent working on that was actually worth it. David tell us about a project that you're focused on today that you're excited about?

I think the newest one is that where he really stalked about is the well actually of them. One is like I said the V.A. project is called The Ware. That's where it's going to be out on iOS and Android in a few weeks. We go to our You can you can sign up to learn more where we go to go live. And that's pretty exciting. And then we just we're about to go live this week or next week the approvals at Harvard that nurses health study. So we're powering there and enough to listeners you know that the Nurses Health Study but it's one of the largest longest running our health studies of our time. This has been in use since the 70s. The study was out of Harvard but it's been things that you see like you know that's. It's helped to contribute so much to our understanding of the cardio.. and hypertension and lots of different kinds of behavioral types of diseases and conditions and so we're getting the power of that and that's going to be awesome. So our partners that the nurse's study.. health study, three will be doing you know recruitment for that. So we're really excited about that. And it's cool because it can help to contribute your understanding of health.

Now David is this study Nurse's Health? Are this is nurses documenting it or I guess I don't know what the name really refers to.

So the Nurses Health Study, it's a captive audience of nurses. They have over a hundred thousand nurses that are participating in study. So they will be tracking various measurements like their geolocation. Got track for their steps using their Fitbit, their steps in sleep and heart rate and wasting precious stuff with their Fitbit and they'll be doing that a few times a year. So my goal is to just attract another condition and so that gets used to publish or perish reports. So you know and it extends extends. I mean obviously we can do this for the entire country. We want to focus more on nurses. They have a really big sample size that it must either. Most other studies in this space don't really have that kinda samples size.

Well. There's no doubt. David you're doing some pretty amazing things. The time flies man so we're going to find another time to get you back on for a part two. This has been very enjoyable. If you had to recommend a book to the listeners what would you recommend?

Yes, a one book that I read recently it just kind of like. It's really fun to read and this was quite informative as the book called Win Bigly by Scott Adams. It's just kind of funny to say science is one of the creators of Dilbert that he is the creator of Dilbert. .. It's a lot about kind of understanding how the mind works and all the ways and how just being able to relate to other people. It's been very helpful in terms of like with that empathy aspect that I was talking about earlier I think it's just it's really interesting to know how where people are having the cognitive dissonance where they're having sort of these where they're finding confirmation and trying to navigate within them. Because humans are humans and that's how we operate. And so it's a really good book and it's kind of a fun read. It's a little bit a lot of his predictions on the 2016 election but he uses that as kind of the case study to talk about these other issues the hugging of science.

Interesting. When big leaves so don't worry about writing that down listeners just go to and you'll be able to find all the show notes links to the book as well as a transcript of our discussion today. It's been a tough one David if you can just leave us with some closing thoughts. And then the best place for the listeners to get in touch with you.

For some closing thoughts. Well I think, definitely check at overlap for But the thing I think I would just tell your listeners is just to really try to focus on empathy, trying to focus on trust, try to focus on rebuilding that relationship that's been broken starting from that perspective I think we can figure out how to and listening to people from why I'd broken for them. I think will present itself with so much opportunity to change the open to change. Don't have any ego. Just do what's right for people and money and opportunities will present itself and always does follow .. and people who really focus on having a big vision and trying to meet people when they're at so that's how I close.

That's a great message David. And where were the listeners reach you or follow you?

They can follow me on my blog that's I'm not really big on social media. So you know you can also find me on Twitter but really you know.

No worries.

I have been killing off those social media inone o these days so. Yeah that's from there go to I don't know. Send me an email Just say hi, I will always respond on my emails that's for your to reach me.

Hey this has been a ton of fun. Really appreciate this refocused that you did with us today. You know focusing on relationships over transactions and scaling trust so appreciate your words of wisdom brother and super excited to stay in touch.

Thank You.

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Recommended Book:

Win Bigly: Persuasion in a World Where Facts Don't Matter

Best Way to Contact Jennifer:

LinkedIn:  David Haddad

Twitter:  @haddadda


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Outcomes Rocket - Rick Barnett

No More Sales Reps in Med Device? Rick Barnett, President at Rep-Lite

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 For more details on how to attend that's and you'll be able to get all the info that you need on this amazing health care thinkathon. That's

Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I have an outstanding guest for you today. His name is Mr. Rick Barnett. He's the CEO at an amazing company that is doing some pretty efficiency driven processes to help operating rooms as well as med device companies be more effective and efficient in the way that they do their process. His name is Rick Barnett and he's a CEO at Rep-Lite. He's held many senior level executive positions within the medical device arena. Mr. Barnett is a performance driven sales leadership executive with expertise in building client relationships developing and executing winning sales strategies and the selection and development of top sales teams. Mr. Barnett is recognized as a leader with a reputation for advancing successful business development campaigns leveraging core strengths and capitalizing on solid client relationships. He's done a lot of things and work with partners such as Stryker Intuitive Surgical. Over the last 25 years. In a nutshell he's a visionary who commonly recognizes outside of the box opportunities while driving the current business to surpass establish goals which has allowed him to function in a consultancy capacity for the past 25 years for top industry leaders. I'm so privileged to have him on the podcast today and what I want to do is have an awesome discussion with him working through some of the things that they're doing at red lights to make health care more efficient and improve outcomes so Rick it's such a pleasure to have you on the podcast.

Saul, thank you for having me.

So anything that I missed there in your intro that you want to fill in the listeners on.

No not really. And you're gracious and kind. So thank you and your comments. I would just tell you that the reason that Rep-Lite was founded Rep-Lite was really to provide a needed solution for medical device manufacturers and providers to continue providing amazing patient care to the patients that we serve.

For sure. And you know the thing that I that I love about your mission Rick is that it is so centered on the patient. And a lot of the things that we do in health care can oftentimes take us away from that mission. So I'm excited to dive into some of the things that you guys do. But before we do that I love to learn a little bit more about what got you into the medical sector.

Well it's a great question. I've always had this passion so the little boy for helping people just in general and had an opportunity early on to know a few surgeons and a few healthcare providers and just decided that that it was a perfect space for me. You know I get the sense and the things that we tell them that we drive through all of our people that work that we need to treat every single patient like it's a family member. And that's just kind of the core of what we do. So no matter what intervention is happening with that patient we go at it as if it's our mother or father or some immediate family member. And so for the past 30 years this careers been bearing fruit for me and my family were very blessed to be a part of it.

That's awesome. Yeah and what a great story. It's you know you're surrounded by folks that are and are in the sector with a great mission you just kind of got involved with it and now fast forward you've got Rep-Lite going. What I want to do is just kind of level set the audience and give them a little glimpse about what red light does what problems they solve and yet so just kind of highlight a little bit of that.

Yes so it's fairly simple, Saul. What we recognize early on is that in the world of health care there's a lot of things that pull our attention both from the provider and the medical device manufacturers and what we wanted to do is to do a few things we wanted to make sure that the technical aspects, the service aspect, support aspect was never diminished with all the tasks that we do. So we just believe that if we can continue to provide great quality of care which equals great outcomes and then we can do that in a financially responsible way then we can continue being a leader in this country in healthcare. And so really what we do is we provide service sales and support to medical device manufacturers at a level that will allow the professional sales organization to do what they're supposed to do and sell while we service and support the devices that ultimately give patients their care.

Rick such an interesting proposition here and if you're a medical device manufacturer listening to this some to think about we're in an era of constant change. You never know what's gonna pop out of policy in Washington for healthcare that's going to change how you do business like the medical device tax or who knows. Right. You just there's so many unknowns and in an era of unknowns. Rick is providing a really interesting solution. Rick can you give us something within this realm a hot topic that you think should be on every leader's agenda listening today.

Yeah I mean it's that's a pretty easy question. So I mean it's continuing to maintain probabilities for company while adhering to all the changes happening. So everyone's being asked to do more with less. And so one of the things that's very difficult for medical device manufacturers is they they need to see more people but at the same time they need to support the equipment that is sold and distributed and used in the field. So how do you allocate resources. It's not really financially responsible just to contain the headcount have had that headcount. So what we do is we come in behind that and again supplement the headcount we hold headcount and we provide a contracted service so that really the medical device manufacturers can do more with the resources that they've allocated from a sales perspective and we supplement that with great service and support of the product.

That's outstanding. And Rick obviously this isn't your first time around you've had success with this type of model before. Can you give us a little bit more details on some of the things that you've done to create results and improve outcomes.

Yes. So I'm a clinician by heart started out as surgical assistant.

Oh did you? That's pretty cool.

I did and ended up in a surgical services. And what I did, Saul is I created basically a Rep-Lite internally. Again it came with the same set of problems. You had to continue to increase headcount and that headcount is a pretty big strain on a PNL. So what we did is back and I'm going to date myself here but back when minimally invasive surgery was really taken off and in the mid 80s it was very disruptive to the CEO. There was a lot of resources put into it and it was fairly inefficient. So what we did when I went to Stryker's we started a program similar to what we have now Rep-Lite where we would put that support role in and we got to see a lot of tremendous benefits. We've got to see clinicians having what they needed the things working properly we enhance the ability for our sales force to do what they were supposed to do at the same time the parameters were growing because of the efficiencies that were created inside the walls there. So we did that there and then we did the same thing because we had the summer scenario an intuitive surgical where disruptive technology. So we kind of did the same thing. The thing that was all of the great results that we were getting were amazing. The only hiccup to that is that we were continuing to increase headcount rapidly in today's environment with all of us having to be punished financially responsible and and price compression everywhere. We had a bit of delay. So it's kind of the genesis for Rep-Lite. To provide that type of service without increasing company company's headcount.

Man that's so interesting Rick and today in healthcare it's not only product innovation that's going to move us forward, listeners - it's going to be process innovation, operational excellence, and the time and dedication that Rick has spent and seeing how to best make this system work has given him results has given the company that he works with results. Stryker Intuitive Surgical pretty well-known names. Rick you had a chance to catch up before this and you kind of walk me through the Rep-Lite can you tell the listeners a little bit about why the name?

Yeah yeah. So you know I think as we go through this process and all the change in healthcare, Saul, we're trying to find ways to become a patient save money. Proper allocation of resources. And so one of the things that has come up is the buzz word is Rep list and the problem with rep list is that you dump up then you take a tremendous amount of responsibility and you put it right on to a hospital employee. Well the hospital is already maxed out. So now we've got a even bigger problem because we're asking people against do probably double or triple their daily work with the same amount of time. So really it's not really rep list that I think gets us back to this. I think it's rep-lite and that's the reason that the name came about I think rep list is very difficult. I think rep-lite is much easier.

I think that's so awesome Rick and listeners you know when you think about how you improve process. Oftentimes it's incremental and rather than go all the way to the other side and just get rid of the sales rep altogether or the service rep or the clinical rep just make it light and it really this is just the tip of the iceberg. I definitely invite you to go check out Rick's Web site where you could learn a little bit more about his system. Rick you want to share your Web site.

It's simple. It's

So check that out because we're just kind of scratching the surface here with 30 minutes. We really don't have a lot of time to check that but I definitely encourage you all to check this out. Rick you obviously didn't get here without making mistakes or having setbacks your system wasn't always perfect. Can you share a setback that you had and what you learned from that?

Yeah I think one of the big things from a corporate standpoint is early on I really didn't pay attention to headcount. From a budgetary standpoint if we were growing the business that we added people and would learn the set back was that that really can have a negative impact on your PNL. The other thing is is that there's a lot of times in this space that medical device manufacturers and vendors are looking to increase and they really go through a due diligence interview process but they're really kind of in line with reply. I always will allow my client if they want our people to take them on at the proper time. I encourage that as a matter of fact the beautiful thing is that you get it's almost like a baseball form team you get to have a look at this person you get to see their talent and you get to sit within your culture before you do a higher. So we get a deep rift. And again I think the tail or the missed that I had early on Saul, is that I don't know that I paid attention to resource allocation as much as I do now. Now it's critically important these companies they've got to deploy resources in the most cost effective manner. And that's why I think Rep-Lite We've been so successful we're helping a lot of small to very large medical device manufacturers really create value to the customer.

Man, that's such a great share and definitely something that we all have to be cautious of when we're running our companies. And we really got to keep that cash flow going. And it's it's a balancing act like Rick said if you're wanting to grow double digits or continue to grow at a good pace and you're adding on headcount how do you keep this balancing act of growth and profitability. And Rick what a great lesson that you shared and I think one that we can all definitely be reminded of and stay profitable and stay consistent with the way we approach it. What would you say one of the most amazing leadership experiences that you've had in healthcare to date?

I have two, Saul. I mean one of the things that hold very dear to my heart is we will take a genuine professional and we will allow them to launch into this great industry. And so that's one thing that from our standpoint is it's our ministry it's what we do. We take younger folks and train them and have them to where they can work in this amazing space taking care of our patients. This is a little dated but in 2007 I was awarded Stryker's corporate. Most impactful point.

Nice. Congratulations.

You know but. Thank you. Well I think that's a secondary. Other than that what we're doing for our folks to have a company of that scale recognize us as having the most impact in the businesses is pretty overwhelming. And it was a total surprise. So very blessed and very grateful for that award.

Definitely something to be proud of. And you know Stryker's an excellent company as you guys build this client base and you continue to serve even more people. What would you say one of the most exciting project that you're working on at rep-litet today is?

What's kind of interesting is that we've been pulled into many different verticals. Anything from orthopedics to laparoscopy to home health to dialysis. So what's really exciting to me is that the Rep-Lite model really can provide value across the spectrum of care and not only for the providers and our healthcare providers but the vendors and the manufacturers and the innovative companies that are that are bringing innovation to this space. What's exciting is that this model we never have one cookie cutter answer for anyone. We always modify what our process would be so that it benefits our client. So it's pretty exciting to be pulled into many different spaces at the same time because you get a great look at just the overall healthcare space.

Yeah, that's so true Rick and one of the things that we've been talking about a lot here on the podcast is that the end of the day innovation in healthcare is implementation. And so if you're going to have a successful program,the importance of implementation is so key and it sounds like you've had this impact across several different verticals and that's definitely something to be excited about.

Yeah we're we're we're really excited about it. We kind of started in one vertical and it just seems to continue to expand out of the CRM just I can't even name all of them, Saul where they are contacting us now to provide the services. It's pretty exciting.

Well there's a huge need and I'm super happy for you guys that that things are going well. Getting close to the end here. And this has been a ton of fun. I love to put together a medical leadership course with you. It's the 101 of Rick Barnett on medical efficiency. And so we're going to write out a syllabus for questions lightning round style followed by a book that you recommend to the listeners. You ready.

Yes sir.

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

Lower the cost and reduce infection rates.

What's the biggest mistake or pitfall to avoid?

I don't think we should ever sacrifice quality over cost. You should always strive for the best healthcare possible.

How do you stay relevant despite constant change?

We are a change agent so change is kind of in our nature. So for us we welcome the change because it plays right into our business model.

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

It's very simple. You have to provide either of those that you serve period.

Love it. What would you say your all time favorite book is?

My all time favorite book is probably a book called point man. By Steve Farrar and it's a book on how a man should lead his family.

Very cool. Very cool. Love that point man. Well listeners we've got the syllabus for you as well as a link to this book. Rick's Web site. Everything's available if you go to You're going to be able to find that as well as a transcript to all of the things that we discussed. Rick this has been so much fun. I love if you could just share a closing thought and then the best place where the listeners can get in touch with you.

So first off thank you Saul for having me. It's always a pleasure speaking with you and really appreciate what you're doing in health care and getting this information out. What I would tell you is that I hate to be cliche but have any of your listeners historically have used a taxi cab service. But now they're using either Uber or Lyft. That's really what we're doing in the space. So and again not to be cliche but we've done things the same for a long time and now we're kind of being asked to change so we consider ourselves the Uber for medical sales and support. You can get in touch with us by the way and that includes on-demand efficient and less expensive. You can find all the information and all contact information. Like we said again.

Outstanding Rick. This has been a true pleasure. And folks, again take the invitation from Rick to connect. Find out more about what they're doing at And Rick I just want to say thank you so much for spending time with us and sharing these operational efficiency words of wisdom with us.

So again thank you for having me. And I appreciate you as well.

Thanks for tuning into the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to And again don't forget to check out the amazing Healthcare Thinkathon where we could 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 that's be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book:

Point Man: How a Man Can Lead His Family

Best Way to Contact Rick:

Episode Sponsor:

Outcomes Rocket- Prem Reddy

Creating Global Impact for Physicians with Prem Reddy, Board Member at World Young Doctors' Organization

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 the day's most successful and inspiring healthcare leaders. I want to thank you for tuning in again to the outcomes racket. I invite you to go to where you could rate and review today's podcast because he is an outstanding contributor to Health. His name is Dr. Prem Reddy. He's a board member at world young doctors organization in South India. He's got a history of doing some really interesting things around organizing people in health. And I wanted to have him on the podcast just so that we could have a little more of a worldly perspective what's going on out that way. And in general get some ideas to make our health system better. So without further ado Dr. Reddy just want to welcome you to the podcast.

Thankful for having me in this podcast.

Absolutely. And so what got you into health care.

Yeah it all started when I was in high school. So my uncle got her stroke. So was that between the hospital on the eyes she was with him during that state senator as he was the importance of health care services to the people. So this ultimately led me into the health care system so differently the medical I was thinking why people are suffering. Is there any other cause. Can we prevent it. And when I was thinking about it I felt like yeah we can prevent disease and all the suffering it's possible to prevent to get back but that prospect is completely different vision of her entry into the medical school because when we just went into medical school I started mistiming things differently because the way the people think the way the patients think from their own perspective is completely different from the people we think. So during that course of time and started understanding about what the problems people are facing and how to educate and create a bad news about various issues. In the meantime I was always introduced to the world indorse organization which is an international organization which is based in the last time it has members from 56 countries. Well I was part of that organization so I started as a normal team member there and I just go up to that board member. So during this process I started understanding of the health centers in different countries because well all doctors organization is a different organization which focuses on the problems being faced with doctors. It's like we are for. We work on what are the problems being faced by doctors in Africa when discussing what policies would help the doctors which could prevent that brain drain or make the health care exercise more comfortable. All these things.

That's really interesting and so you guys are focused across more than 50 countries. What's a hot topic for the organization right now. What are you guys focused on.

Well we're focusing on the brain drain as well as the working conditions of doctors in different countries.

So on that topic what have been some of the insights that you guys have gained.

Yeah the thing is that there are different conditions in different countries. Let's see if you see the third world countries especially the local clinicians of doctors some very difficult issues sometimes doctors choose to grow for a continuous 40 hour shift Gore said gosh if they do to work continuously because it has to meet the needs of the people these doctors have to spend a lot of time and ultimately a lot of pressure on doctors. And if you see the wrinkles especially doctors are the people who get hostile to the Elisse. So all of them all the same these happy especially in Third World countries because lack of health care facilities and lack of the professionals. All these things make the people of the to work more time. So because of that extra stress that we are taking in making the health care we do improve the health care outcomes and all these things it's getting a lot of stress and the doctors which ultimately leading to depression working conditions. So right. We said why do we as a team are working to improve the working conditions in different countries to policymaking and all these things so we consult with the people we have people from different countries. So we used to discuss the things that are happening in different countries what are the working conditions that was just understandable the different working conditions in different countries with all of the policy making and all these things.

That's really interesting and it's great to be putting your heads together with other physicians to tackle this topic of brain drain and here in the States too. We have a big focus for physicians on this physician wellness and ensuring that physicians are not stressed and healthy. And so I think it's really great that you guys are focused on this at the world level. Can you give the listeners an example of how you've improved outcomes for doctors so far with some of your findings.

Yeah. Best present we are working with the previous was to open in Kenya. We have a lot of board members from Kenya to open to doctors there and the civil war that was in that room that weekend sessions the connard some doctors meetings and they came to discussions of what what policy changes should be bring and the particular aspect. So during the freedom these kinds of meetings and get togethers to which they discuss with other physicians about the conditions in the country. Provender welcome won't be all this income different governments and team members from different countries. Hello welcome and Delcarmen communist trips. Sophie she's she's a person who was one of the founder. Just been welcoming to Denmark a government so many people involved with the government so it's like disbeliever didn't bring any change but we are on the way to being the proper changes in the policies.

Gotcha. And it's good that you guys have have this focus and you're starting the conversations that it takes to make change and help. And you guys sounds like you have already given a really great start at it.


And regulations on that.

Thank you.

So what would you say one of the things that you learned in the process maybe a mistake or a setback that happened and what you learned from that.

Setback in the sense you know would be what would be what would we are we as a team or in different countries. So the problem here is that Catherine the people and getting the work done you see are different Tedrow look at it in different countries and different countries have different government policies and all these things. So I want to just involve with the policy and make conditions better foods we could have a clearer idea of the country policy and all these things. I felt like this was a step back because it takes a lot of time to understand the different causes that governments are having in the particular region. And once we understand the policies thereby creating a new policy to make their conditions better it is one of the toughest thing I've felt so.

Yeah yeah. It's interesting because no one country is the same. And whether it be their requirements to get a medical device or a drug approved or patient privacy laws or just working condition laws it's different from across the board. But I imagine that with the conversation that you guys are having maybe ideas are generated that could then be applied within different countries so you don't have to be the expert of Denmark's laws but you could provide some really great insightful ideas to the people in Denmark just like they could you.

Yeah that's what we're focusing on that. Just like with. Well once they have a team discussion we just write them in such we have that yes we think we can implement. So we discuss these ideas with the people in other countries so that we should be sharing platforms to share shared things so people steerable different. So how is going to work out in our country so that we can get to a conclusion that is going to work with all of the work or not. So he tweets funny thing is kind of shocking how many countries are working now.

Very cool. What would you say prime is one of the proudest medical leadership experiences you've had to date.

Being the board member for WYDO is I feel it's the protest leadership moment for me.

Yang So within that. Why. Why do you feel that way.

Because we don't have received test positions from a single country or a single place we are addressing the problems of the doctors on the whole because we as physicians who are coming into the practice the conditions are completely different. So it's different for every person. So everyone needs a platform to share their problems or to discuss their living conditions in different countries. So they need a platform. So why don't providing a platform for all doctors all the world to gather here to share their views and what we think is happening the countries are trying to make some people get together here so that more people have been Walding just because we don't want the problems there so that we could come to that conclusion. Laura Yossel tops. So once we are coming to the top. So we talk a little bit more. We're going to execute anybody to a country so more people are brainstorming about a simple single issue. The results will be better. That's what I think.

I totally agree with you and for the listeners that are providers that are physicians where should they go. Access this platform. What's the site.

How is see this upside that they can simply register and they can share their ideas on what the problems are facing in a country. So look at other people who are interested in knowing about his kidneys is helping the physicians who join so that it is going to be like a platform where people can share everything and just go to work on solutions.

Awesome. So listeners visit that's world young doctors organization w y D o dot org. And you'll see their website with the resources and all the things that they're providing and other things that they're doing across the world. It's super exciting to just know that there's an organization like this for young doctors. And Dr. Prem is ready is doing some really great things with his team to continue to build these resources. All right. So we're here to the point right now. Dr. Reddy where I've got the course we're going to do a really quick four questions with a book that you recommend to the listeners. It's the 101 of Dr. Prem REDDY. And so here are the four questions. What is the best way to improve healthcare outcomes.

To improve the health care community. Health education is one of them. Things to improve to Arkansas because once people know and they're very aware of the conditions that it to prevent the condition and we can do better. And what health care outcomes will be better people are educated properly and they have their Vernons of what the medical condition is going to lead them. If people aren't adverse they come through and everything is just refocusing on cue and all these things. But once we start focusing on educating the people and creating a proper and better support the greatest health care issues and the people that can improve the health care drastically.

What is the biggest mistake or pitfall to avoid.

The biggest mistake is not being looked into to that people are the patients or the stakeholders what part of your organization are the patients whom you are treating. So if you're being looked into we can get a lot of important issues from the people who can understand a lot more. You can't get a lot of question so that you can search for more answers and solve them better.

How do you stay relevant as an organization. Despite constant change.

It's a collaboration and learning that's what I feel because as a single person we can never do anything but because we are forced to deal with as an organization I think because there's a lot of changes happen through collaborations we can understand the changes and convoke as an organization properly and learning is one important aspect because when there's a change you should know more and should probably learn and only so that that the change in vogue in a proper way.

Love it. And finally what's the one area of focus that should drive everything else in a health organization.

It's ultimately the patient care because without patients there is no healthcare. So a prime goal should always be the patient to level army able to help the patient to get out of the suffering is most important because the patient comes with this sort of thing. So are we helping them properly or making him feel comfortable with us. So this single thing this showing the empathy to the patients almost create most big changes in the health outcomes.

Love it. Dr. Reddy what book would you recommend to the listeners.

Coming to the book. I don't read books a lot of the best medical literature in the medical field is a guide to the future of medicine. It's written by Mesko. He said he's an author he's a doctor and he is running a lab sound like a medical futurist. And that book is really amazing in that book he clearly depicts about what would be the future of medicine what technology what would be the role of technology in the medicine and how the physicians should deal with it. So once we are going to understand the technological experts are going to creep into the medicine and can have a better idea so that we can prepare ourselves for the future.

A great recommendation and listeners don't worry about writing that down or anything. Just go to That's Dr. Reddy. And you're going to get a link to that book. A link to all of the show notes as well as the questions that we just walk through here. Dr. Reddy this has been a lot of fun. We're here to the end before we conclude. I'd love if you could just share a closing thought. And then the best place where the listeners can get a hold of you.

Yeah I really thank you for this opportunity. Because that is like anyone said to the listeners is that what most of the physicians on health care organizations to focus on prevention because prevention is better than cure. So that's a problem. One should be fair and one more thing I'd like to go to all the people is that please do work and working conditions out and doctors please support the doctors because in countries like India medical professionals also face a lot of problems. So it's every country there's some problem. So please help doctors to get rid of those problems.

That's a great message. Dr. Reddy and what would you say the best place for the listeners to contact you or follow you would be.

As LinkedIn link so you can just search Prem Reddy and you can find my name.

Beautiful and listeners again. We'll leave that link to Dr. Reddy's profiled in the show notes at the link that we mentioned to you before so Dr. Reddy just want to say thank you once again. And now looking forward to stand and touch.

Sure. Thank you.

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

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Recommended Book:

The Guide to the Future of Medicine: Technology AND The Human Touch

Best Way to Contact Prem:

Prem Reddy 

Mentioned Link:

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Outcomes Rocket - Leah Sparks

How Wildflower Health is Helping Women Make Better Healthcare Decisions With Their Cell Phone with Leah Sparks, CEO & Founder at Wildflower Health

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

Saul Marquez: [00:00:18] Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health care leaders. I really want to thank you for tuning in again and I welcome you to go to where you could give us a rating and review on what you thought about today's episode because she is an outstanding contributor to Health Care. Her name is Leah Sparks. She is the CEO and founder at Wild Flower health. She's done quite some marvelous work in the healthcare space across different businesses that has fast forwarded into her own footprint in the health care with wildflower health. They're really focused on making sure that they're experienced team of designers as well as executives give the patients the best at the forefront of their healthcare experience and so specifically they're focused on helping women help make healthcare better decisions throughout their experience so what I want to do is welcome her to the podcasts and have her fill in any of the gaps that I may have missed in that intro. Leah welcome.

Leah Sparks: [00:01:25] Yeah I know great to be here. Thank you. Yeah that's a great intro as you mentioned. We deliver mobile health software to large health care companies including health plans and employers and hospitals and even outpatient clinics and really focus on women as the chief health officer of the home to help them better navigate the healthcare system across a lifetime of care.

Saul Marquez: [00:01:44] And I think you really hit the nail on the head. You know I don't know why it happens this way. Maybe you can provide some insight. But even at home you know us I mean my wife definitely seems to take the reigns on the health care of our family. Why. Why is that. I mean have you guys uncovered any of what's going on with that.

Leah Sparks: [00:02:02] I say we we've uncovered the underlying reasons that's the case. I mean I think there's something to be said for the fact that for many families health care and and care for health of the family often starts with the birth of a first child and obviously you know women experience pregnancy and there's some extension of that that comes from that event. But I have to say there's a few others sort absurd reasons why women are often the decision making a lot of health care decisions. One of the really gratifying things about our technology these we really aspire to do is while there might be one person who's leading the charge in the family your decisions is ultimately people who are successful in health care and they have a support group and people who are supporting them. So we allow family members to share information on applications that you're pregnant with your husband your partner your mom whomever is really supporting you. Same thing you're taking your kids or an aging parent this year and especially to be able to share and coordinate across family members is part of what makes that sort of health care decision maker successful whether it's female or male. So that's certainly part of our philosophy.

Saul Marquez: [00:03:08] That's a really good point and I'm glad you sort of took that a different way because it is not always the female right it definitely depends and it's good to know that you guys can help. No matter who is running the health care decisions and so what got you in the health care to begin with.

Leah Sparks: [00:03:23] I kind of fell into that after business school after graduating getting my MBA. I just knew I wanted to work in an industry that was meaningful to people's lives and health care was one of those. And I got an opportunity to work at the Cass incorporation of her business school in San Francisco and really work in the corporate development group. And I realized that within a couple checks in the boxes it would definitely be an industry that was meaningful and if I was going to do healthcare McKesson certainly at the time. Had some technology works and services were really touched every stakeholder in healthcare pharma hospitals health plans and it was a really great way to shortcut might be an industry in sight now.

Saul Marquez: [00:04:01] That's awesome. And so you obviously have enjoyed it because you've stuck with it.

Leah Sparks: [00:04:05] Yeah. No absolutely. I think what you do realize the impact that healthcare makes on people's lives and I think importantly for me and I need to shift from business person to enjoy do a deal in data development healthcare to founder and CEO was really that trigger point for me personally when I did go from being a person in health care to a patient and that came with my head and I went down the path of starting a family and you really saw firsthand what it's like to deal with the health care system directly and the pain points that you encounter. And that's really what inspired me to set out to build a company that wildflower hill.

Saul Marquez: [00:04:39] That's so awesome. So congratulations to you for taking that on a lot of folks. We'll sit passively or complain. But you decided to tackle it head first so I want to congratulate you for that.

Leah Sparks: [00:04:50] Yeah yeah I guess so.

Saul Marquez: [00:04:54] Obviously you talked about pain points. What would you say some of the hot topics could be endpoints could be opportunities that healthcare leaders need to be focused on today. And how is Wildflower health tackling those.

Leah Sparks: [00:05:08] Yeah there's a couple things that come to mind. One I think there have been a lot and very necessary investments in sort of the underlying infrastructure needed for health I.T. so the ability to make medical records more prevalent accessible some work on online scheduling appointments more access to your claims deductibles that exist with the health plans. I think all of those are great. It's a great platform that he can't mistake those really robust transactional capabilities for consumer engagement in making one appointment or seeing what medical record is not engaging as a human is not connecting me emotionally. And I think for us are really within the last mile into patient loyalty really influencing people's behaviors and helping them take action. We have to connect him as a consumer and wildflower hell. Our aspiration is really to bring together the world's have consumer friendly mobile applications that help me and pragmatic kids parents Chapman family. When I haven't actually connect seamlessly easily into the health I.T. infrastructure and whether it's an EMR or online scheduling you to interface with our clients that's really our goal is deserving that consumer layer on top of this key assets and then the other thing that we're thinking about a lot that I would encourage certainly helped leaders think about is part of what has happened and put in place places health I.T. infrastructure. Unfortunately we ran for some of the national silos in healthcare. So today I may have to go to one Web site from my hospital here for my health plan from a lawyer. And even the White House Health has we built out our proliferation of mobile apps we realize that you might be standing up for mobile apps for all these different cities. It's getting really frustrating for the consumer. So one of the things that we've been doing increasingly with our network of clients is again bringing together those lions into one views as a consumer I can say I work here. This is my health plan and delivering that baby in this hospital and access all these resources are more which is pretty powerful.

Saul Marquez: [00:07:06] That is powerful and as we think of the typical way that things happen you typically have the EMR or the hospital or the payer kind of pushing data out how about the other way around. The patient entered data and the potential that this could have for improved outcomes. Any ideas around that and how wildflower potentially may be building toward something like that.

Leah Sparks: [00:07:30] Yeah I mean the truth is there's tons of data in the medical records and the claims data but there's a lot of data you don't get how anxious I feeling today. Am I worried about money. I hate my boss all of these things that actually do influence or how can I get enough sleep last night. Right. Yes. So what we see in the very beginning even when we have less robust data Lecci capabilities than we have today is that for whatever reason and you talk to someone as a consumer we have always been very beginning this company's history. Five years ago picked up a lot of social determining kids for health secularly behavioral health issues like anxiety or feeling sad or stressed out have always been the case up which again you you're not going to get that record otherwise. So we have figured out how distant some of those data lines back to the health care system help them see action. That is certainly something we're always aspiring to do better.

Saul Marquez: [00:08:20] Yeah I think there's some big opportunities there for sure. And it's exciting here that you guys are already thinking about it and trying to figure out ways to optimize that data.

Leah Sparks: [00:08:30] Yeah absolutely.

Saul Marquez: [00:08:31] So Leah what would you say an example of how you and your team at Wildflower have improved outcomes.

Leah Sparks: [00:08:39] We knew with our initial focus in pregnancy the first area that we set out to improve a real impact in outcomes was in pregnancy and particularly under Sir copulations and Medicaid populations. And believe it or not one of our very first clients was the state of Wyoming Medicaid actually live a very innovative medical center the state. Who knew from the beginning that Medicaid moms do use them. And this was four years ago I was working with them. Now they use smart phones. They rely on them more than other types of technology. They may not have a laptop they may not have Wi-Fi. They apparently have a smart phone and asked me why they access the Internet. And we've been able to show by engaging medicaid mothers and helping them that are connected their resources in their community whether that's a nurse available or Medicaid. Certain types of social programs available are community by driving those actions. It does improve grades and lower Nicaea admissions and in fact we published a peer reviewed journal articles and even telemedicine in the last year in conjunction with our client and did a peer reviewed study showing that women who use our program had about 75 percent lower rates deliberately babies and improved fetus measurement and all of those things that really lead into outcomes. But it wasn't just the technology alone. It was really harnessing that technology to have day to day contact with those users or users have really come up in times of mind. And so we're they are and they are convenient when an issue comes up we can connect them to that vehicle restart their candidate a different outcome of their pregnancy. So I think that's one very discreet example of how that many people are going to wonder if he's.

Saul Marquez: [00:10:09] Such a wonderful story and as the platform also used to educate.

Leah Sparks: [00:10:12] Oh absolutely. We have a hundred page and education articles in our pregnancy and probably so 500 in our only help application which goes so awesome. Yeah. And again I think the key is not to just have and. But to really have any. Education be actionable. If I am reading an article about the group identity and I click to connect to my local communities looking program for pregnant women or if I'm reading about a certain condition or developmental issues that may be happening with a child can I send that message and I'd be Egyptian. So having those really sweet actions is next is my provider or something. Werman Yeah not that.

Saul Marquez: [00:10:54] I totally agree. In this example that you provided Leah is just so on point. With both improving outcomes and also reducing costs because boy NICU is not cheap.

Leah Sparks: [00:11:06] No. Now we have another client that is done a claims analysis showing that they are either an average or about thirty seven thousand dollars less costly per user because of these reductions in data. So yeah it's a very very expensive event when you have an early generation or some other complication in pregnancy.

Saul Marquez: [00:11:24] Yeah wow that's so so insightful and you got to talk about it also. I mean the effect that it has on these parents. You know I mean the physical the emotional the stress all the things that go into having your child in the NICU. I mean this is pretty huge because it also affects their health and the domino effect right.

Leah Sparks: [00:11:44] Exactly exactly and that was one of the reasons that we thought about extending our application into pediatrics. We wanted to have the ability not only for let's say I have a newborn and I can add newborn babies and you and I can say that and I can also. Tell and say I am 25 years old and I can get content articulately. How are you feeling stressed out here. You need to be doing here. Well invest it so there's actually data that shows that women are in serious health officer to all their health and can last. They may not be doing the things they need to do for their own health because they're so busy doing everything else. And so we don't want to forget that as rotating about a lifetime of care support.

Saul Marquez: [00:12:23] Yeah. Wow. And so it listeners just the one example that Leah provided here just has so many second order consequences that oftentimes go unexamined and when you take a deeper dive into that first thing that you're affecting it's oftentimes much more than that. Like Lee and her team have done with this particular example so I really love the example. Leah thank you so much for sharing that. So give us an example of a setback or a mistake that has happened and the pearls that you got out of it to make outcomes better.

Leah Sparks: [00:12:55] Yeah I think one of the things that we learned early on is how challenging it can be to get people to adopt digital health technologies and that this is something that is But not enough and just you know can you give a specific story. We were really fortunate in our first couple clients we had really good and honest person and time we did a lot in the community to drive enrollment that created option by pregnant women. Our second client was a commercial health plan and some of them for years through the employers animation program decorated for some players and then our current client was another health plan. And we did a lot to market to educate their members about that application. But it was just crickets. I mean we've had law on loan rates and it was just this huge fall and then we had to take a step back and see what was different about this versus the other Tuten for the services accessible and the real Almelo we had was he will adopt digital health. It's presented in a moment trust for a moment of need. So I'll give you an example. Now I just took a pregnancy test and I am I want to go right away and find out which hospitals are covered by health plan. You know how much is it going to cost that is daily if I'm going and searching for my health plan. And they say to me hey there's this application. It's really it's you name it. That's an or seeking affirmation of my health plan because I want to engage with you in a trance. My employer tells me that's not true. My appointment. On this contrast is that I have a process as a health plan where women who have seen the claims analysis are pregnant and or some kind of letter that is listed to get them to download an application. It's not going to work. And so the way you approach the use or reasoning about what is there or the NSA here is what I mean is that your training is so important in getting that right is just so critical. Drive the adoption digital health and I think it has a lot to articulate his interest in science.

Saul Marquez: [00:14:52] That's a really great distinction. Leon thanks for sharing that. And so the clients that have come after that have you applied learnings and gotten different results.

Leah Sparks: [00:15:01] Oh yeah absolutely. And it's definitely something that we're always experimenting with in fact not a member of our team who is retitle is user growth marketing and she is solely focused on working across our plans to get that user adoption is optimized as possible. And one of the things that we've really found is that those with health plans and providers and employers that we start to look at geographies and not just think you know the traditional health plan out of the strategic vision but also thinking about that community and who are We're the mothers groups are there candidates Cruz what are the other places people are going. You know the population centers and Head Start programs so really think about it everything is local and health care you get the word out about our application and resources and the partners who are providing those actionable things you can do in health care sponsorship of a program.

Saul Marquez: [00:15:52] That is so fascinating. Just kind of entering their stream of consciousness rather than smacking them with the get this done.

Leah Sparks: [00:16:00] Exactly exactly yeah.

Saul Marquez: [00:16:03] Wow such a great distinction. So obviously a huge purl that you learn from and a lot of entrepreneurs and even large companies coming out with new solutions they could get that initial success. And then again and then all of a sudden they're met with resistance or not the same results or the opposite could happen. They go into it and they don't see anything. So the importance of continuing to tweak your offering and understand why why it is you're getting the results are not getting the results that you're looking for. And Leah what you and your team have done is just shown this resilience that is so necessary to be successful in healthcare as a company. So congratulations to you and your team for being able to have that resilience.

Leah Sparks: [00:16:45] Yeah I think it's definitely something you should sign up for if you're going to you're going to start to.

Saul Marquez: [00:16:52] Sign up for it and speak with it.

Leah Sparks: [00:16:55] Yeah and if it's not working. Try something else obviously Yeah we've never really put it in. We've always sort of have a vision and just working against it but we have done a lot of iterations with different elements of our model to date you're not what successful and it's constant learning to that is also your target users are always changing. I mean that the mobile application and mobile technology trends five years ago when we started in version that generation of was even just five years ago is different than today. And so you'd have to really be always willing to iterate because the rules are changing fast because of technology.

Saul Marquez: [00:17:28] Nah totally agree with you on that one sir. You've had a lot of success. You know 70 plus population health management companies to know getting St Vincent's to sign on near Mobile App. You're doing a lot of really great things. Out of all the amazing things that you and your team are doing. What would you say one of the most amazing things that you feel you guys have accomplished today.

Leah Sparks: [00:17:50] Well for me when I think about amazing it just all comes back down to the user and again particularly in our populations that really help. One of the things I was really proud of with one of our early Medicaid clients is the first year and tripled the rate of the Hybris pregnant women that were able to access the services. And that's the kind of thing that need changes. And again it's just the technology making that connections and that's the type of thing you think about all the health care access issues we have in this country you know it is particularly if you are stressed out you're on Medicaid and just like certainly maybe the percentage of the health care system we can help you with that sense and getting the right programs and services that just more meaningful than the revenue associated with things that were really making an impact on people's lives.

Saul Marquez: [00:18:37] Now for sure that's definitely really awesome. And it's stressful enough you know and when you don't have the finances or the resources forget about it you know.

Leah Sparks: [00:18:46] Absolutely. Absolutely. It's been one of the surprises of this company that we've been able to build so much business in the Medicaid market. It wasn't necessarily my business plan. We started it five years ago. I just expected I'd never worked in that market. But there was a very very smart adviser who told me early on when we start the company that it was going to be a huge opportunity and she was absolutely right that it was a huge need in Medicaid and that uses a very sabby in Medicaid and that you did a huge impact. So it's it's really time.

Saul Marquez: [00:19:12] Yeah Leah. And you know you shared something else to just kind of embedded in your message there. But you know listeners you got to surround yourself with advisers that you can trust that also are very knowledgeable in the things that you're doing. Health care is so big we recently had a guest to Gavin Teo. He's a venture capitalist and healthcare and he said it really well he said health care is not a vertical it's an economy. It's SoBig. And so there's no way you could know every part of healthcare. You just can't. And so that's something really smart. Surround yourself with people that were specialists in the areas that she wasn't. And she got some great advice that help her. Not only grow her company but add value in a big way and so what are you missing and how are you filling those gaps with people. What would you say a project that you're super excited about right now that you guys are working on.

Leah Sparks: [00:20:05] Well right now we are making the extension from pregnancy into additional phases of family hell. And so we just relaunched the wildflower family application that enables us to track your pregnancy as well as your pregnancy under your pregnant but also then your 2 year old and maybe your 80 and all that went out with application and isn't really a holistic view on your families. And then after you have that baby and her newborn to the application and again all the way you say live in one of the community services say Silicon Valley be accessing your doctor's office and hospital resources alongside your employer and your health plan and really getting a holistic view of all the health care entities you deal with also cost your family members. And as we look to extend this year how do we help that and other things that will come up whether it's actual caregiving and in a more robust way our application or other episodic events so that we can really be that trusted resource for that consumer. She's navigating what comes next. She has her babies.

Saul Marquez: [00:21:09] Wow that is just so powerful you know I had my wife's friend come over to the house for the weekend this weekend. And you know she was just telling us about how hard it was taking care of her mom who just she has gone through dialysis and and just the strains that she's going through now because one of the veins was occluded. They're going to have to potentially go through the groin which is not a good thing. And the stress that she was going through Leah it was just like I mean it's just it's sad yeah. You know so the support that you guys are able to provide for a family especially one that is more in need is just amazing.

Leah Sparks: [00:21:49] Yeah and it isn't early. It's really for us. And I definitely think there's a lot of white space for caregiving space. And hopefully there'll be a lot of great start ups or even established health care companies doing more for caregivers because you're exactly right. And people who were in that situation is a social determinant for health problems to be a caregiver. Right. Your health is going to begin to suffer. And it can be very isolated. I think that there is a lot of opportunity for work in that particular space and certainly we hope to be connected to those resources. And he has a support network in Canada I think has a lot of opportunity there.

Saul Marquez: [00:22:22] Leah the community of listeners. And everybody at the outcomes Rockett wishes you success in this new endeavor and it's a really worthwhile one. So we wish you the best and we're behind you.

Leah Sparks: [00:22:34] Thank you so much. We really appreciate that.

Saul Marquez: [00:22:36] Absolutely. So 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 or the ABCs of Leah sparks. So I got four questions for you. Lightning round style and then we're going to finish up with a book and a podcast that you recommend to the listeners. You ready.

Leah Sparks: [00:22:56] Yeah as ready as I'm going to be.

Saul Marquez: [00:22:58] All right. I love it. What is the best way to improve health care outcomes.

Leah Sparks: [00:23:02] The best way to improve outcomes is to follow your passion. Do something that you're passionate about because otherwise you're not going to have the ability to have the creativity and the same energy to really be able to impact it.

Saul Marquez: [00:23:15] Love it. What was the biggest mistake or pitfall to avoid.

Leah Sparks: [00:23:19] NEver falling the trap of thinking because you're a health care expert that you know what you're doing. Always question your assumptions and be really humble about that. It's really easy to have hubris in this market and you know everything properly.

Saul Marquez: [00:23:30] How do you stay relevant as an organization. Despite constant change that.

Leah Sparks: [00:23:35] Keep hiring really smart people. And often people who bring in different skills that are to win via. I don't even though I believe healthcare expertise is important and I don't think you should hire people who come here because I think there's a lot to be learned from the hospitality industry from consumer tech and some of those industries are really far ahead of us. Think about consumers.

Saul Marquez: [00:23:54] What is one area of focus that should drive everything in your organization.

Leah Sparks: [00:23:59] Focus on empathy for our users and compassion for users and if we do right by them and make them healthier we will be successful and serve our clients better.

Saul Marquez: [00:24:08] Leah what book and what podcast would you recommend to the listeners.

Leah Sparks: [00:24:12] Well obviously the podcasts I recommend is outcomes rocket

Saul Marquez: [00:24:15] Thank you.

: [00:24:19] I don't actually listen to podcast. I have listened to the startup podcast that media puts out and a range of industry and has a startup founder. I find somewhat therapeutic tools to other people. I'm going to start that process from a book perspective. So when I was first starting wildflower I read through Renee Brown's book daring greatly and it is kind of a bit of a self-help book but one of the things that was really particularly really readers out there are thinking about becoming founders of leadership positions and certainly early stage aerospace companies you know when you go out there and you talk to customers or investors whomever you really put yourself out there and it is a major feeling of vulnerability and Brown's book Daring Greatly is based on this famous you know Roosevelt quote that I'm not bitter that it is basically it is OK to put yourself out there and you are better off doing it yourself putting yourself out there dealing greatly and sitting on the sidelines. So it's all about getting comfortable.

Saul Marquez: [00:25:16] What a beautiful recommendation and one that I'll add to the list and listeners. If you're driving or on a jog right now don't worry about writing it down. Just come back and go to That's Leah's last name. It's S P A R K S and get some sparkle of ideas for what you're doing and dare greatly to improve outcomes because that's what we're here for. So this has been a lot of fun. Before we conclude I would love if you could just share a closing thought the listeners and then the best place where they could get in touch with you.

Leah Sparks: [00:25:50] You know I guess my closing thought would be not good too personal but I have two kids along the way. I built this company and I just want to encourage people who are put off by starting a company into something riskier than your career. To think that you have to choose your personal life of the professional. I really feel like I kind of have it all and I don't feel like I don't see my kids I'm like I'm a wife and mother. And I love my work. And I am consumed by it certainly and to a point that it is possible to have that balance in your life. And I think it's something that is to help can't really important the art of being an overall person. And it really touched me. Probably email is the best. My email is

: [00:26:33] Love it. Powerful message. Leah and listeners all of these things that include Leah's email a link to her company a link to the book says she recommended in the podcast we're going to have all those at the link that I told you about so go there. You want to get in touch with her. She's obviously given you her e-mail address so if you find a way to collaborate please connect. That's why we do what we do here so I just want to take a moment again to say thank you on behalf of the entire listener community and really looking forward to staying abreast of the updates that you and your company do with your achievements.

Leah Sparks: [00:27:12] You bet. Thanks for having me.

: [00:27:17] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead

The Best Way To Contact Leah: 

Mentioned Link/s:

Episode Sponsor:


Outcomes Rocket - Joowon Kim

A View Into the Healthcare Entrepreneurship Journey with Joowon Kim, Digital Health Entrepreneur & Biodesign Fellow at TMC Innovation Institute

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

Saul Marquez: [00:00:18] Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring healthcare leaders. I want to welcome you once again and I welcome you to go to where you could rate and review today's podcast because we have an amazing guest. Her name is Joowon Kim. She's a friend of mine and she's also a digital health entrepreneur and biodesign fellow at the TMC Innovation Institute in Houston Texas. John's got a long history of just making things happen in healthcare through the entrepreneurial route. She's got some deep experiences in a virtual reality and augmented reality. She's got some products out in the market as well that she's launched with some other entrepreneur friends. But now she's on her new journey. And so what I want to do is bring Joowon to the podcast to talk about some of the things that she's been up to at the TMC Innovation Institute and also to talk about healthcare. So Joowon welcome to the podcast.

Joowon Kim: [00:01:21] Hi. Thank you so much for inviting me.

Saul Marquez: [00:01:23] It is a pleasure. And we definitely spent some good times over at Health 2.0 and boy in a very short time. You have done a lot.

Joowon Kim: [00:01:35] It seems like it was yesterday.

Saul Marquez: [00:01:36] I know right. It's crazy it's crazy but amazing. And so why in the world did you decide to get into health care Joowon. Of all things that you could've done you decided on health care why is that.

Joowon Kim: [00:01:47] Before I came to the medical sector I was in education in game industry. So in a way it could be seen as an oddball here but I was trained to identify problems and find solution on the fly by the skills you have to have whether it be learning does it. What type of help they need you know in their study or when I'm developing a game I need to find a cause of the frame rate drop and optimizing to feel like I have to be always on the go trying to solve this problem and solve it right away. And with that technical background when I saw how much the health care industry needed help advancing technology I wanted to join the force to fix the health care. So that's why I'm here.

Saul Marquez: [00:02:36] That's awesome yeah. And you know it's interesting because in health we need a lot of outside expertise like yours and there's a lot of people that are starting to migrate to what we do because of that heartstring or because of the impact that you could have on the other side of what you create. So you definitely are in the right place John. We've had conversations outside of here and I definitely know that you're purpose driven and so I'm excited to hear a little bit more about what you guys have been up to at the Institute. What would you say Thuan is a hot topic that should be on every medical leaders agenda today.

Joowon Kim: [00:03:12] We need to create the health care system that will serve the needs of everybody. I don't think anybody should worry about going to a doctor because they cannot afford a cost. I'm healthy fortunately but I know that there are millions of people out there who have to make a decision whether they can continue the lifesaving treatment. It's really sad in my opinion. I'm from Korea and Korea has one of the best health care and it was never an issue to a doctor. You know and you know moving to America I myself encountered questioning myself should I go to a doctor. I don't think I have to. It's something. And you know in Korea it was so much cheaper and it was affordable. I didn't have to wait so long in a real room. So it was a big difference. And I think to fix this we need to have everyone to have the same vision and that vision is like to save the health care through everybody coming together through collaboration exchanging patient data safely and adopting new technology as best as they can safely and educate the people to lead healthy lifestyle because I think health care is like fixing what's already broken. But you can educate people from the beginning. You know we can prevent a lot of these things. So right now part of Texas Medical Center. In a program called by design fellowship and the Texas Medical Center is not up to 54 institutions including renowned institutions such as M.D. Anderson Baylor Methodist Memorial Hermann to name a few. And then they also have the innovation institute which my current program is part of. And once a year they gather they bring in about 20 some companies and they look through x or age incubate accelerate a process and my fellowship is actually separate from that. It's a one year paid fellowship which we go out and you find healthcares on the leads and we collected 300 of them. Yes within six months we had to narrow it down coming from 300 to the top 15 to the top 10 and top five and then finally we pitched up 3 to the executive member of the Texas Medical Center and we narrowed it down to the final one and really excited because we could finally work on this to spin out a company from this idea. So I think that our organization takes Mickelson or is doing great job you know being spearheading innovation and trying to educate the community and providing this type opportunity for both local and internationally as well as within the United States to help these startups to start the movement and help healthcare. So.

Saul Marquez: [00:06:11] Yeah congratulations to the team for whittling it down to one out of so many. It was a hard.

Joowon Kim: [00:06:19] Yes because you had to consider with the right team because there are so many things that we could do and were all excited to do that. But we come from a very different backgrounds so you know as you know my background is in virtual reality augmented reality in digital. Those are coming from one guys from Google and another guys from IBM with predictive links next and then another guys from MDH. He's fast grannie's and pathology. He's a doctor so we kind of didn't know what we're going to do coming together along the way with ups and downs not only getting to know each other but solving like what is really broken and what can we do about it in such a short time going from zero to one. So that was pretty challenging for me. I'm really excited to tell you that we actually have something really promising and it's very exciting. I wish I could tell you more.

Saul Marquez: [00:07:17] Not at this point.

Joowon Kim: [00:07:18] But not at this point. But soon sonn.

Saul Marquez: [00:07:20] Right. All right well you're close and it's exciting and it's interesting what happens when accelerators in groups like the one that you're part of Jawan they get together you're forced to crank something out. And I've had several guests on the show that like you were part of an accelerator like this and now they have living breathing companies that are creating solutions for the market and also creating revenue. So it's pretty exciting to think about what those next final months are going to be and so I wish you guys the best as you gear up to make this thing real.

Joowon Kim: [00:07:55] Thank you so much.

Saul Marquez: [00:07:57] So give us an example Juwan of a time when you have have applied your skills to create better outcomes.

Joowon Kim: [00:08:05] I guess I can use an example of my last company which was using virtual reality to help patients to alleviate their pain and anxiety during invasive procedure. So I'm not a medical person but when I met my heart she used to work at Andy Anderson and she said you know I see patients every day and I think there's an opportunity to his ear. Would you help me. And at the time I was teaching students as well as developing the organs. And I said Well I think this is going to help others. I would gladly join you. And so we formed a company and using VR you know I knew that games can totally take your mind away at things you know you can yell at you know your brother or sister or hey come join me to do something. They're just completely out of mind and they're so focused on the game so we can use the same kind of idea but for patients to finally do that you know possibly distraction. But with teaching them with deep reading and focusing on certain things that can really take their mind out of the pain. And I was at the doctors office working on this procedure which was very painful for patients to say. From zero to ten points pain scale the patient said it's about nine with anesthetic that's pretty high. And so I would hear all the screaming noise coming out of the room and I was like well I hope this helps. So we went in with the product that I developed and it teaches you deep breathing to and focusing on this avatar that with the movement and you just keep focusing on your breath to match with the movement. So I notice that I mean it was so incredible that the TV we were on the TV news they actually came in and recorded it and to the local news station. And I'm really thankful not only for this happy thing happening allowing me to be part of this change but also the doctors who were it will be open enough to allow these type of technologies to come into their practice room and to be tested on patients. No because it takes a lot of courage for them and the rest. And without them I don't think there can be innovation.

Saul Marquez: [00:10:34] Now. Yeah I think what you're saying is so powerful Joowon. Just the importance of putting the patients at the center of the innovation. Right. And it's just so key to have them in the middle because this is why we're doing it for now. You know partly we're doing it for the practitioners. But the big part of it is we're doing it for the patients and so I just kind of thinking about other applications to it. Yeah I mean you could avoid pain but how about when your at home and maybe you're taking some sort of medication at home or going through some procedure where you are in pain such as times when they when they prescribe cannabis for example maybe they can describe virtual reality. The one that you came up with to make them feel better.

Joowon Kim: [00:11:17] Yes currently going through clinical trials in internationally. So really looking forward to seeing how it turns out right now. My partner actually is working on it in Belgium. So I think that I'm pretty hopeful that there will be a good outcome.

Saul Marquez: [00:11:36] Amazing. Thanks for sharing that with Kim. And so let's take a look at the other side of things Joowon. Can you share a time when you had a setback and what you learned from that.

Joowon Kim: [00:11:46] So after leaving my company which was via company. I did. And you do use the knowledge that I learned from health care but it's time to kind of keeping it to the next generation. So I wanted to teach what I learned trading in our applications to the kids between ages 12 to 18. So I started MRV our chem based on Steam learning curriculum with our partner that I found in a locally. And it was we made such a fast stride within like three months we were partnering with well-known tech companies like Microsoft Noach VR blind Zalm and others like. And then also nonprofit organizations that really came and helped us halfway. And the more I got into the process I realized it needed to be needed. It wasn't made way bigger than I thought. I mean the operational cost was huge and I didn't anticipate that. There were operation costs was big also the demand was not as large initially as I was hoping because you know of course a lot of marketing it was a lot of word of mouth focus and market segment. And I just didn't anticipate all of these and they couldn't make the profit fast enough. And I think this model would have been better is best for a non-profit organization. So I was running a for profit company like a non-profit. I was speaking on my own real money every class and I thought wow I'm going to be bankrupt. Now I realized learned a lot about the importance of financial strategy and following passion alone is not enough to make business successful. It's a great deal like we contributed a lot to the community and students learned a lot in the process. They're happy about that.

Saul Marquez: [00:13:53] Our business and that's really great shared and that goes to show Joowon. You know you could follow your passion. You could even get partnerships with big name companies and it doesn't mean that it's a good business model. And I think a lot of entrepreneurs we get into this and we think we have a great idea but we've got to put in the thought process to the financial models and then would you also say potentially even teaming up with somebody that can see the things that you don't would help as well.

Joowon Kim: [00:14:25] Absolutely. And actually coming into the by design. Well she really helped me see how important that is because there are a lot of areas that I need help 9 in a financial or even business planning. And when I was working with it was coming from different strengths and backgrounds.I saw us moving fast like speed of light and I think I'm very appreciative of this experience because we got to see that you don't have to know you all if you find the right person to form a team I think that you can definitely win in the end. So it was a good learning experience.

Saul Marquez: [00:15:08] That's awesome. John you're always grinding it. You're always at the front. You're always working on a new idea. You're always forming a new partnership. We love that you and listeners one of the things that you should take note here is that you can't be afraid you can't be afraid of failing. If you see something that needs to be changed and you can find somebody to help you do it. Don't be afraid just go for it. Like Joowon has with the many ideas she's had because at the end of the day it's those iterations that you make on your idea that eventually become that thing that helps healthcare be better. So Joowon keep on track. I know you're going to do some great things with this idea. Just have a good feeling about it.

Joowon Kim: [00:15:48] Thank you so much. And you know I want to share a quote that I saw on Twitter and I didn't write this down so I'm going to try to remember from my memory. And it was I was dying to graduate so I can get a job. I was dying to get married so that I can have kids. I was dying to see my kids grow up so I can have my own. I'm dying that I forgot to live. And I think we're always chasing so much and it's good to realize the importance of life and that's something that I realized after taking time off from crazy you know you just tried to gradually try to get a job. And when my first job the project again and I was working on I didn't finish and that it was decided shut the project down. I start to question my life. What's the purpose of life. I wanted to be in that industry and I worked on a game but it's not going to be shipped and nobody's going see what I'm in what I've done for two years and so many questions it took like an almost sabbatical for three and a half years and during those times I think when I realized the purpose it's OK to take time off and realize what why we're here because it's so easy to get wrapped up in like oh I've got to make money. I got it just so I can get promotion of the year. Think about yourself Indes said what really matters is that life will fly by before we know and what we can do at the moment is using our skills and our spirit to make a difference. So I think it's really important to take that time off to realize those things.

Saul Marquez: [00:17:41] It's a really great message to Joowon and take pause and think about especially at the start of the year. It's always a good time to do it. But I think doing it often and so John. Great great great quote awesome experiences that you shared and I think it's something that every one of us could take note of and learn from. So Joowon this has been amazing. The time has just flown together with you. And so I'm going to have to skip through the lightning round but I do want to ask you for a book that you recommend to the listeners.

Joowon Kim: [00:18:10] So it's personal book for me because during the sabbatical years that I took hours at St. Petersburg lying in one of the hostel room and bed and reading this book and I highlighted so many quote I think it really resonated and made a difference in finding that light that you can follow your life and purpose and it's by Paulo Coelho the Alchemist. So there was my all time favorite book.

Saul Marquez: [00:18:44] Listeners an amazing book if you haven't read it. You have to grab it. It's one of those definitely like. Like Joowon said one that will help you see the light. And I don't worry about writing it down. Just go to Oh. And you're going to be able to find all the Schoenaerts links to the book. Links to her projects and everything that she's been up to and what we've talked about today. So Joanne this has been so much fun and great to reconnect with you. Before we conclude our love for you to just share a closing thought for the listeners. And then the best place where they could get in touch with you.

Joowon Kim: [00:19:16] I think it's great. First of all thank you all for creating this space because not one person can move this giant boulder of healthcare and I but I think if we all come together and with the one vision to make it better for all of us because we will one day all benefit and our parents will benefit in our kids children will benefit. So I would like all of us to come together and collaborate and be open.

Saul Marquez: [00:19:45] Outstanding. And where would you say the listeners can get a hold of you.

Joowon Kim: [00:19:49] Oh yes you can get a hold of me at my gmail account.

Saul Marquez: [00:19:56] Fantastic Joowon this has been a lot of fun listeners take note of the things that we wrote some really great great words of wisdom here shared by Joowon Kim. So take note of them relisten if you have to but again Joowon just want to say thank you so much for spending time with us.

Joowon Kim: [00:20:13] Thank you. It's my honow. Thank you.

: [00:20:19] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

The Alchemist

The Best Way To Contact Joowon:

Mentioned Link/s:


Wearables, Biosensors and Mobile Behavior Intervention with Dr. Peter Chai, Emergency Medicine, Medical Toxicology at Brigham and Women's Hospital

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

Saul Marquez: [00:00:18] Welcome back to the outcomes rocket podcast where we chat with today's most successful and inspiring healthcare leaders. Visit us at to leave a rating and review for today's podcast because we have an outstanding guest. Once again his name is Dr. Peter Chai. He practices emergency medicine and medical toxicology at Brigham and Women's Hospital. Peter has done a lot of research to develop and work with digital health innovations from ingestible sensors to measure medication adherence real time behavioral interventions to respond to disease. Wearable telemedicine and centralists detection of the biometrics. He's done quite a bit has a lot of publications and I'm so privileged to have him here on the podcast Peter. Welcome today.

Peter Chai: [00:01:05] Thanks for having me.

Saul Marquez: [00:01:06] It's always a pleasure to have a talented man like yourself that's into the future of medicine and wanting to make things more efficient. What got you into medicine to begin with. Peter.

Peter Chai: [00:01:16] I was kind of always interested in the kind of human aspects of health. And after college and I also did a masters a lot of my interest was how you can really design different aspects of how to improve the way that patients and physicians interact with each other. And so a lot of my very early work when I was at Brown we worked a lot on the basic science and looking at how to design better petri dishes for cell culture and kind of from that experience I learned that you know that design is a new relatively new thing within medicine and also very important in developing these new interfaces. And given our digital health revolution the increasing use of smartphones wearable devices and all that there's a real opportunity for Officer missions to really start to innovate in this area. So that's really what got me into medicine and the work that we're doing right now.

Saul Marquez: [00:02:10] That's fascinating and the design aspect was the magnet that got you in and now you're your full force going at it. What do you think today. Peter is a hot topic that should be on every medical leaders agenda. And what are you guys doing to address it.

Peter Chai: [00:02:25] I think from a digital health perspective the hot topic is really how to implement and operationalize things so you know that there's so much research and there's so many new technologies and devices out there. But then you look at kind of the healthcare landscape and what we actually do with patients in kind of the day to day clinical setting. And you notice that we don't really use them much additional how there might be the sporadic insurance group that is using a system to track kind of movement health among large populations or you know there's kind of nascent telemedicine but if you look across the broad you know thing is really starting to implement. And so a lot of we're working. So we kind of work on two angles. One is how do you take any kind of innovative new topics that we know were and how do you scale them to a larger hospital. So for example like our organization and then the other part is how do we look into the future so we don't stop at the cool new there. But let's look at the thing that's going to be popular in the next five to 10 years. Let's get a physician and a patient perspective on it now so we can start to build back to when our system is ready to accept something like that. We've got the know how and the technology.

Saul Marquez: [00:03:34] Yeah that's interesting and so. Are you still at the bedside or are you mainly focused on these technologies and implementation.

Peter Chai: [00:03:42] Well both. So I worked politically as a physician so I know where we're at the bedside every day here where.

Saul Marquez: [00:03:48] That's outstanding and you know the challenge of implementation. The technology is there but it's implementing it into the system that and that is the challenge. What advice would you give to both companies and also providers wanting to get technology to make things better. What advice would you give them to help them do it more successfully.

Peter Chai: [00:04:09] So from a provider after you have a provider myself I think the important thing is to have an open mind. I think physicians are where a lot of us are trained to say no to a lot of things you know like there's no evidence for that or this can't work. And it's kind of refreshing when you work with these startups and engineers and when you Athens's the same question about you know could this work. The answer is never know it. You know. Think of a way to do it. You know it might be but there's going to be a way of someday to do it. And I think the ability to kind of have that kind of foresight and the willingness to work with something that is imperfect is really important for a provider asset from a company perspective. The thing that we've really been trying to pushing is a really safe investment. You can't there's a healthy not cheap right. And our effort doesn't come. We were trying to do the best we can for patients but there's so many limits would appoint a full time research funding and all the stuff that I think the most successful company that I've worked with are the ones that really get that and are willing to think that you know put them in in the game and really work hard with provider champion I guess to kind of get things wrong.

Saul Marquez: [00:05:16] Peter give us an example how you or the organization you're with have created results by thinking and doing things differently.

Peter Chai: [00:05:24] Sure. So I'll tell you about a project that we're in the middle of right now five or six months ago we started working with a company named visible who is repositioning Amazon Dash Button for harvesting. So you know they asked What will you put on your surgery or the button and the orders mail from Amazon. Well we've kind of pivoted the idea you know how to streamlining the hospital operations using just the time of the occasional so the simple button. So we're working through a various amount of systems with our housekeepers in terms of doing things that are simple and kind of mundane like cleaning the restrooms in a hospital. That's the big passing itself to turning over beds so that we can be more patient more efficiently and decrease the patient wait time. So the company very excited and very very innovative and helpful with us. We've got a pilot undergoing in three months. We've got some interesting results that we're still gathering data for but we're almost ready to take the next step already. So it's really kind of the synergy between a company and kind of a forward thinking healthcare system like ours that really has been a catalyst for all of us.

Saul Marquez: [00:06:29] Yeah that's super interesting and I think it's these process innovations. Peter you know I see you as well as you know Brigham and Women's definitely forward thinking and open to these things and I think the number of systems starting to be more open to process improvement. Like you guys are increasing. For example I was out of health care where we were doing a refinance on the House and we've refinanced with PNC Bank and then we recently refinanced with Quicken Loans. Have you ever used Quicken Loans. They have Mateschitz. Oh my gosh. So when you do the refinance through them everything is a sign everything is just so fast. It happens in like I don't know. Like literally like two weeks compared to like three months that it's like with a traditional bank. And so I envision what you guys are doing like the Quicken Loans you know for process improvement that will help outcomes and that's really exciting.

Peter Chai: [00:07:24] It's super exciting to be kind of in the thick of it because you like one day you literally like walking to the bathroom with some gorilla glue and taking things on the wall and the next day and looking at alchemy and dynamic stacking models of leadership.

Saul Marquez: [00:07:41] Yeah that is so so interesting and I'm excited to hear how that turned out. When are you guys expecting to finish the project.

Peter Chai: [00:07:47] I think with about 3 3 months or so we're we're working on a few publications that hopefully will be coming out and some abstracts that there's going to be I think one at him comparable to yours both yes awesome stuff.

Saul Marquez: [00:08:00] Well at the end when you're done maybe we'll have you back on to chat with us about what you guys found. They'll be really interesting.

Peter Chai: [00:08:07] Sure.

Saul Marquez: [00:08:07] So share with us a mistake or a setback that you guys have had while trying to make things better and what you learned from it. More importantly.

Peter Chai: [00:08:15] I guess from a digital health perspective one of the setbacks that we've had before is really trying hard but then you know having the project fail at itself and know that in itself is kind of a learning opportunity. So we're thinking about working with a small startup and using a novel device to kind of get real time patient lab data and be allowed to work with that kind of writing proposals and doing all the stuff. And I think the problem that we didn't think about is we didn't have the foresight to realize that you know a lot of the investment in doing even the small pilot study well a lot of work and kind of we were in the thick of it for about a year before we realized Rondeau we're doing a lot of work yet that is being done with nothing and we forgot about the budgetary aspects of it and you know nobody has funding to have a go have had that been work. So the project kind of fell through and has been a standstill. So I think at least for me we learned that there was kind of a realtime demonstration of invest time but somebody got to invest the resources within the project to really have to work.

Saul Marquez: [00:09:18] Yeah that's such a great call out. I mean how many times have we listeners gotten started with something only to find out that there was a missing piece of the puzzle whether it be buy in from a clinician or resources like that Peter was just saying. And I think this learning that Peter sharing with us is so important to resurrect and to be reminded that we're working in a complex system we've got to analyze the depth and the breadth of what it's going to take and not go forward until we have a full picture of what it's going to take. And sometimes we could get so excited right. I'm sure your idea is so exciting right Peter you just wanted to go for it.

Peter Chai: [00:09:54] Yeah. And sometimes you know it does it does pay to kind of take a step back or you know I think the other thing that people are so worried about is not having an NDA in place and then. So the cool stuff about a new technology but no I almost feel like the ability to I will when we've been most successful is we take this concept and we ask one of our colleagues who completely does not work and then say we say what do you think about and that kind of insight from somebody who is divorced from the entire idea now has not invested in it is actually really helpful. They're the best ones that poking holes in the concept. And I'd rather not hold early them when we're about to start.

Saul Marquez: [00:10:32] Such great great great words of wisdom there Peter and listeners definitely take these into consideration. What would you say one of your proudest leadership moments and medicine is.

Peter Chai: [00:10:42] I think probably one of our proudest moments was when I was a resident or Dame or rather see a brown in an emergency medicine in a 2012 Google Glass just came out and we got really excited at the department about can we really use this to become the next generation and telemedicine. And this was a kind of probably about a six month long project where we really took Google Glass. We are exploring their early Explorer program which is the technology we were to be a great startup that was super responsive to our needs and we worked together and built a wearable telemedicine program for dermatology in our emergency department. They find really a new wearable device new video stream. We learned about the older technology and the infrastructure support you need to build bring in something like this in a hospital. You know no one in our hospital knew what to do with wearable smart glasses you know where were categories have in within the information security standpoint. So it took us Galong six months for voice through all these regulatory bodies but we're able to do a pilot study. We are published in JAMA. So it was really I was really proud achiever cheaper for us. I think that was one of our first real big within days.

Saul Marquez: [00:11:56] That's so awesome. And thanks for sharing that story. It's that vision. Peter you obviously got a vision right. I mean you're in this for the long haul and I've read recently that Warren Buffett even it took him nine years to become a millionaire. And oftentimes people just look at folks like Warren Buffett or you know successes that are had like the one you experienced with this project in the E.R. and they look oh wow you know what happened overnight. But the reality is it happens over a long period of time. And Peter and his team took a while to get this done. And the same for our system. You know it's these small wins if we continue having we will transform the system. Wouldn't you agree Peter.

Peter Chai: [00:12:37] Is a great point. It's really those little kind of small steps and you know as an emergency physician I'm probably the worst at that because we live in the moment we live emergency care. So when people are like well takes like four months or you know to go to our CEO to make sure it works. I just cry a little bit Gosh but then you realize that you know like wow that was like five years ago we started that and look where we are now and that it really I think for people who are just starting you know tell them anything you want about how exciting it is and how much progress we've made over the past decade or so. But you really don't need at the very beginning and there's really you know you really start to appreciate the shoulders of all these people that you're standing out once you kind of move forward a little bit.

Saul Marquez: [00:13:22] Totally. That is such a great point here. Keep doing what you're doing every project that you take. It's iterations on the previous years that you've been working on this. And I just encourage you to keep doing what you're doing because it's so awesome. And I bet like 10 years from now you're just going to not stumble but finally get into something that really just pivots and changes things for the entire industry not just your your idea. I mean you've definitely been doing a lot for your ID. But just the way I see you developing and the way that I see you doing things you're going to be doing some cool stuff man so keep keep at it my friend.

Peter Chai: [00:13:55] Thanks. We prefer to call it that.

Saul Marquez: [00:13:56] But a bad ass is good. I like bad ass. Hey so tell us a little bit about a project that you're working on today.

Peter Chai: [00:14:06] Sure. So what happened is that we're really interested in is medication adherence. So we've been doing some work on the adjustable biosensors so these are off the shelf gelatin capsules. They use a little 3D printed circuit with a radio frequency embedded attached to it and the kind of magic in it that you can compound it or over encapsulate any kind of drug that you want to study with it using standard filtering machines that most all pharmacies have. So when patients ingest these medications chemic at the end of gel capsule like any other gel capsule medication that's out there and Corneille your stomach actually activate active power and activate radio frequency better. I would take that signal up with a reader that the patient wears. So you get real time direct measures of medication ingestion. Certainly we've never been able to do before so if you look at kind of direct the direct measures of adherence before this digital health technology it's really a nurse going into someone's house and watch somebody take their medication right directly observed therapy. So this take this transform is really how we think about it here. So one of our interest. I'm also a medical toxicologist so a lot of my work has been patients with substance use disorder and especially those with high risk for HIV. High priority in the high risk population who be happy to do it. So we're about to start a study here in Boston looking at how patients who are at risk for HIV take Predix closure. So there's a place where your policies grow Truvada that actually if taken daily can prevent HIV and Hybris people who knew you might get high. These drugs. Forget. Do something with me get infected. So this is a really good prevention method that really relies on it here. And so how do we get somebody who doesn't really care about their health who is going to have a disruptive and unstructured life to take their medication every day on time. And I think this digital technology will help us because we're going to do. So we were developing a study where we give patients visual pills you wash them how they take medication in real time and the really cool part is that you know now that we can detect it here and if you miss a dose that means that we can start to push interventions to people in real time in response. So we want to wait for people to show up to their doctor's office and board. You know everyone's got a smartphone less starts delivering health at the moment that or health workers. So we're hopefully they'll start soon looking at this project using digital pills and Chris Black.

Saul Marquez: [00:16:34] That is super interesting and and a project that I think will definitely tackle a big problem. And what we're dealing with you know in any population with the elderly population you know a lot of them are aging and a lot of them have mental illnesses. How do you keep track of all this. Right. So yeah it's a really really interesting idea. So as you guys move forward with that definitely maybe when we get the update on the other project we could hear a little bit more. I know listeners are probably like Oh this is so cool and so we'll get an update don't worry as long as Peter is up for it we'll get an update for you.

Peter Chai: [00:17:06] Yeah we're totally off are.

Saul Marquez: [00:17:07] Awesome. So Peter getting to the end here. This has been a lot of fun let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine. It's the 101 of Dr. Peter Chai. And so we're going to build a syllabus. I got four questions for you. That will do a lightning round style and then we'll finish it with podcast that you recommend to listeners so your.

Peter Chai: [00:17:30] Alrights, let's do it.

Saul Marquez: [00:17:31] Alright. What's the best way to improve healthcare outcomes.

Peter Chai: [00:17:35] Like patients.

Saul Marquez: [00:17:36] What is the biggest mistake or pitfalls to avoid.

Peter Chai: [00:17:39] Forgetting that it's just you. There's more stakeholders then you expect to be involved.

Saul Marquez: [00:17:44] How do you stay relevant as an organization. Despite constant change.

Peter Chai: [00:17:48] Look to the future. Always ten years into the future don't don't be okay with the cool things that are happening now.

Saul Marquez: [00:17:54] What is one area of focus that should drive everything else in your organization.

Peter Chai: [00:18:00] Integration of technology digital health and data storage.

Saul Marquez: [00:18:03] And what book would you recommend to the listeners or what podcast.

Peter Chai: [00:18:07] Good question. Well Aracataca at the core. From an entertainment perspective there is a medical toxicology podcast that tackled head of tox dilemmas. Within all across the world cup a Dantastic Mr. Tox Show which I highly recommend.

Saul Marquez: [00:18:23] Very cool. Very cool. The Dantastic Mr. Fox show.

Peter Chai: [00:18:27] The Dan tastic has been is one of the people that does it.

Saul Marquez: [00:18:30] Got it. The Dantastic that there you have it. So listeners go you've got the podcast that you'll see in the show notes will provide a link to that as well as the syllabus that we just crafted here for you with Peter and also the show notes for the entire show that we just discussed here. Just go to that C H A I will be able to find all that there. So Peter before we conclude I'd love if you could just share a closing thought and then the best place where the listeners could get in touch with you or follow you.

Peter Chai: [00:19:04] In terms of closing thoughts. I think we are all kind of at this amazing point in health care where we have the opportunity to really change the way in which we deliver health. So there's no idea that's too stupid or too far out there. I see my share being that people think are crazy that are now clinical practice so don't be afraid to go forward. Best way to get in touch with me is probably either at Twitter or via my email which I think probably be provided in the links somewhere. Right.

: [00:19:35] Yeah. All right well there you have it listeners thank you so much Peter for spending time with us today. I think it will definitely be interesting for us to digest all the nuggets of wisdom you provided and looking forward to having you back on.

Saul Marquez: [00:19:49] Thanks. Thanks for having me.

: [00:19:53] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Podcast:

Dantastic Mr. Tox Show

The Best Way To Contact Peter:


Mentioned Link/s:

Outcomes Rocket - Charlie Whelan

An Insightful Conversation about Sleep and its Benefits with Charlie Whelan, Vice President of Consulting for Frost & Sullivan's Healthcare Group

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

Saul Marquez: [00:00:18] Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring healthcare leaders. I really thank you for tuning in again today and by you to go to The most orating in review let us know what you thought about today's podcast. Our guest. His name is Charlie Whelan. He's the director of consulting for frost and Sullivan's Healthcare Group out of San Antonio Texas. Has done his fair share in health care for almost two decades at Frost and he's really passionate about a lot of subjects in health care but in particular very passionate about OSA obstructive sleep apnea. And so what we're going to do today on this episode is focus on the work that they've done in this area. But before we dive into the content I just wanted to open up the floor for Charlie to give us a little bit more about him and then we could dive into what we're going to talk about today. Charlie welcome to the podcast.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Outcomes Rocket - Jacon Levenson

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Outcomes Rocket - Baligh Yehia

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

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

Saul Marquez: [00:00:18] Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring healthcare leaders really want to thank you for tuning in again and I invite you to go to where you could leave the rating and review and what you thought about today's podcast. Because we have an outstanding guest for you today. His name is Baligh Yehia. That is Dr. Baligh Yehia. He is currently at the Hopkins Medical Center and he's a senior medical director there where he leads transformation initiatives to ensure the seamless coordination of patient care to improve outcomes experiences and reduce costs. He is a systems level thinker. High level regional national level really focused on making sure that systems can work together as a network so that they could collaborate more instead of coordinating. And he also has experience as deputy undersecretary of Health U.S. Department of Veteran Affairs. He's got a really interesting diverse experience in healthcare. And so what I wanted to do is open up the microphone to Bali so he could round out that introduction. Bali welcome to the podcast my friend.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Recommended Book/s:

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

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Outcomes Rocket - Baligh Yehia