Category: Podcast

Patient Research

How Remote Patient Research is Improving Outcomes and Simplifying Clinical Trials with John Reites, Chief Product Officer @ THREAD research

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

: Welcome back once again to the Outcomes Rocket podcasts where we chat with today's most successful and inspiring health leaders. I really want to thank you for tuning in today again and I welcome you to go to outcomesrocket.health/reviews so you could rate and review today's leader because he is an amazing contributor to Healthcare. His name is John Reites. He's a Chief Product Officer at THREAD where they help Pharma, CROs and researchers to conduct remote patient research. Their focus is definitely in digital health and fixing the way that these things are done in a more efficient way for patients as well as for the people conducting the research platform. And so he's had 15 years of healthcare experience among his other duties. He's the adviser at Blue Door health as well as you know he's been a guest lecturer at Duke University and in his previous life was a Head of Digital Health Acceleration at Quintiles. So really want to welcome you to the podcast John, excited to get the conversation started.

: Thanks Saul, thanks for having me. I really appreciate you doing the podcast. I love listening and I appreciate the work you're doing. So excited about the conversation that's going to be fun.

: Thanks John. So did I miss anything in that intro that you want to share with the listeners about yourself?

: Yes. You know I also have a life. And...

: What's that?

: You know... no. In this world we live in right there's so much to be done in health care. There's so much work we have to do. But at the same time it's super important. And I was reminded of this week that's just important for us to support help as it is for us to focus on our health. And I'm saying that because I have to go to the gym tonight so I'm motivating myself before we go.

: There you go. There you go. Get those juices flowing because you're going to be at the gym tonight baby.

: There you go.

: I love it. No it's good. You know that's such a good point, John. It's worth it's worth parking there for a second. Like we spend so much time trying to get other people healthy, trying to make our health care system work that, are we taking care of ourselves?

: Yeah. And it's funny I just found it today. You know, the business that threads in the work I do every day is helping customers to do remote and virtual research. So you know we're trying to help connect people to contribute to research in their home. But at the same time one of my customers said, Yeah and our patients are on the go because they were collecting data on an Apple watch and one of our apps living their lives and I said oh my gosh I haven't been out of my house in three days with my watch. And that's why my results are so terrible so it's just a good reminder that as we worked inpactthis road you're right we have to make sure we do it for ourselves too. And I know too many busy entrepreneurs that are doing amazing work in this space that we just have to keep reminding ourselves to stop for a minute and take care of what matters which is our health and our families also. It's a great point.

: Now it's a great reminder John so appreciate you bringing that up. What would you say got you into health care to begin with?

: Yes so I'll make a funny long story short as possible. I just fell into it. I didn't go to school to get into health care. I didn't get a degree in anything related to life sciences. My degree was actually in communications and PR and marketing. And frankly I was going to do communications or I was going to be in a in our rep for touring bands and apparently what I learned in college was that if you don't know people and have those connections coming out you're not going to be able to get that job out of school. And so through a series of events I ended up interviewing at Quintiles which is a global CRO and I interviewed because my wife knewan executive there and she got me an interview and I didn't really know if I'd get the job. But great thing was that night I got the job. Funny story as I learned about everything I need to know about Klinker research three days before the interview apparently must've done a good job talking my way through that position to get it and learned everything that I really know about the sector by doing it in a job. And I was chief paper pusher when I started like that my first job was I pushed files around and so I did every piece of small work that I could do to really understand the business from its highest points just sort of its the low things that everybody has to do to really move things forward. So it was good character building exercise but I really fell into it. I didn't sort of make this conscious decision coming out that I wanted to impact healthcare on day one.

: I think that's so cool that you fell into it but you've stuck with it. It's obviously something that has resonated with you and has moved you to continue doing it.

: Yeah it's because you know I think we have this advantage that sometimes we forget about in our industry. There's a lot of people who do a lot of amazing things to contribute to society. But one of the ways that we do we can actually see tangible benefits is contributing to research and development of drugs and medicine and products and devices and being able to see that firsthand and see people because of your work result you know having positive results. I think it's really powerful and we have this advantage that we live in this world we can impact people in a short period of time with something really monumental. So I think that I'm glad I fell into it because it's what I'm passionate about and it's what gets me excited. And you know amongst a lot of things we could all do as you know a lot of people in life sciences are really smart individuals there's a lot they can do. But having a passion for people and having a passion to care for people through this clinical research or health care in general I think there's a great mission that we need a lot of people to have in their lives.

: I love it John. I totally agree and you know I think their strength in communication is is a strength that is very much needed in healthcare and in any other area. And the other thing you mentioned is the importance of knowing people and just the little tidbit that I want to offer to the listeners is that get out there and meet the people come stand behind your LinkedIn or your Twitter or even e-mail for that matter like go to a conference or go to a local meetup and press the flesh and then you'll be amazed how much farther that will take your mission rather than just hiding behind your accounts which is not bad right. We could do that. But it's also important to do like John said just get out there and meet the people. So John what would you say a hot topic that needs to be an every medical leaders agenda today and how are you guys addressing it?

: Yeah. So the hottest topic for me is how you do virtual research. Right. So how do we take clinical research because that's what we specialize in. That's what thread does. How do we take clinical research and start to virtualize elements of it to make it either more conducive to a person's lifestyle or to collect more data continuously in between clinic visits or frankly to new types of data in the real world that we haven't really been able to collect when they come into a controlled environment. So I think that every healthcare leader today sees that the technology landscape is helping us to move healthcare to more remote and virtual models. And so I think that I would tell you just because I see it everyday and I see the positive impacts. But I'm also learning a lot of the lessons of actually doing this work day in and day out that. It used to be on our radar but at the same time to it there's this mentality that I'd say that I think we really need to take which is is that this is all a journey, it's not a destination that we drive to tomorrow in other words there's a really defined sort of crawl-walk-run that I think we can all take as an industry to start to virtualize components of clinical research. And some people are not ready to do that, right. Some people are just saying Hey I just want to give my patients apps. I want to be able to collect e pro or remind them of things or hook a sensor or a medical device to something. I just want to do something kind of simple to start because I'm not really ready to go all in and virtualize every one of my clinic visits. And I think we need to understand that not everybody is there and that there's a lot of different sort of tolerances in those models. And so what I would say is in doing these things differently I think it's really important that we understand there's a crawl-walk-run into this that it doesn't all have to happen overnight but it's something that we need to start doing today because it is happening. It is working and the lessons learned that you will learn from doing it are much more positive than me telling you what I learned over the last several years. So that's what I'd say is really the hot topic but also the area of focus that I think every medical leader really needs to have in their tool bag today or really be thinking about how to start implementing this type of work.

: That's really fascinating, John and anything that comes to mind as you walk us through your expertise here is the clientele that you serve. Are you working with providers and also pharma companies like what are your customers look like?

: Yes good question. So first off the people that we can help the people that we unable to do remote are virtual research is anybody that wants to do remote or virtual research. Our customer base has come really out of that focus that we have and so we are supporting pharma - large to small, CROs from large to small, nonprofits, providers, academic researchers and sort of a number of different customer types in between those. So again if somebody is trying to do remote or virtual research the way the technology works the way the engagement can work actually has a lot more similarities and differences. And you really see that when you win when you look at some of the work we've done in clinical research and then some more like late stage clinical research that actually has some care modeling in it or digital care plan so more clinical to commercial integration. And so irrespective of sort of where someone's at in the type of research they're doing and we're trying to service all of those customers with a standard way of doing this type of remote research with people.

: Fascinating. So let's take it a step deeper. Can you give us an example of how you and your team have improved outcomes maybe a case scenario?

: Yeah. So I'll be careful because a lot of that even though we have a lot of public work there's actually a lot of work that we have to wait for that to be made public. But some of the things that I really like are lately with some of our customers more in the Foremans and side. We've been able to take like a study protocol that has say 12 visits in it. And as you know once you do clinical research study with 12 and clinic visits that study starts to get personally really expensive. Right. So once you add 300 patients and you got to direct them there and then do these visits again the price and sort of the time and the commitment a patient has to have. That research really goes up and we've been able to work with some customers to keep meeting their endpoints to continue to meet their primary secondary exploritoriants. Exploritoriants points but do it in a way that they took those 12 visits and made it 8. And so they made eight clinic visits and they took four and made them virtual in this one example study example and to give you. So in doing that they were able to reduce cost and say hey now patient in my study you only get to come in eight times not 12 to 60. And if you have some issue we can actually do this work via telehealth with you when you're at your home. And so what we did is the outcomes that we produced is helping for the same, the same research outcomes to being that but also reduce the burden for the researcher and the providers, the sites and also reduce the burden for the patients to participate. And frankly gave them a tool so they have their own app that has some other engagement, content and some support services in it so they can be supported throughout the study and be frankly constantly reminded that they're are part of something bigger and so being able to sort of add value to those stakeholders while also helping them to meet the endpoints they have in their study really brought a lot of different outcomes very positively to a number of those takeovers, so hopefully that makes sense. But that's one example.

: Yeah you know and one of the things that I've seen with digital companies like thread that are successful is that they take an antiquated process, they remove steps, simplify it, and make it cheaper. And it sounds like that's exactly what you guys are doing.

: That is. And I want to say too that we're doing it and learning right like nobody's. Anybody who says I've built the perfect model to do engagement of stakeholders is a liar and you should run. And I'm not saying that because it's true. Yeah because we're all learning and just like we contribute to research we're all researchers ourselves. And we're making what I call successful mistakes all the time and they're not detrimental things we're just going to people don't respond well to that. Yeah maybe this thing has four clicks and it should have two. And that's the kind of learning that that we have to be very transparent of and are especially in our industry to say hey these are small sort of failures or things that need to be tweaked to be done better but we're going to optimize them. We're fixing it in real time. And frankly that's no different than the same experience that our stakeholders like patients and providers and sites. They all do that in their daily lives with every other branded entity they engage with from Amazon to Disney to ESPN. Right. These guys are learning and changing and modeling and I think that there's a lesson to be learned for our industry from consumer products in that we have to try things and then optimize when they work and optimize when they don't work as well as we want them to. And I think that for me that's the other piece is that as you're doing this work where you have to constantly be learning and constantly be listening. Like you mentioned earlier it because people will tell you what they like and what they don't like it doesn't mean that your products bad it doesn't mean that that that's maybe a change you need to make at a high level. But what it does mean is that when you're listening you're making sure that you're not in love with the how you run your business and you're not in love with your product; you're in love with the fact that it can actually change the industry you're in love with the fact that it actually improve outcomes for people. And I think that's the piece that we have to truly swallow when we're trying to be entrepreneurial in this type of work.

: That's really great John and I love that you highlight this importance of listening to the market. There's book hug your haters. I don't know if you ever heard.

: It's on my reading list. Did you like it?

: It was great man. It was great. And it basically boils down to what you just said John is that we've got to be open to that critical feedback especially from our current customers like if they speak up it probably means that other people are feeling or seeing the things that they're saying but they just want to speak up. So listen to them and take it to heart.

: Actually agree. Yeah and that feedback priceless like an old mentor of mine told me once that two statements that I like here one is if you don't have people that absolute love you and people that absolutely hate you in whatever you're doing you're probably not doing the right thing. Nice. The second thing though they said was this person said if you get on with a customer and you show them how you do your business and they just smile non say thank you. You failed because they don't care about your thing. He said if they get really passion about what your product doesn't have or what you're not doing it means that they see how your what you do solve the problem and they want to contribute to it with their voice. And so I think that from my perspective I totally agree. So I mean you hit the nail on the head that that feedback is not a bad thing. Feedback's actually a great thing and when people are giving it to you it probably means you're doing the right thing. And I think we have to take that to heart too to not be offended by that but the taking. OK let's look at how we can apply it and that's a learning system. And we always talk about the learning healthcare system I think we as an industry can really move that forward by listening and reacting.

: I think it's so great. Thanks for sharing those those nuggets of wisdom that your mentor shared with you. Now you're sharing with us. Obviously it's working. You're doing very well with this company. Talk to us about a setback or a failure John and what you learned from that particular moment.

: How long is this show? Yeah. Ok so that's one of the things that was really impactful for me personally and I know a couple of our team at it too was I just remember we're building this app and Web platform off our platform for patients to come in and essentially do a really large registry. In the registry we had gotten some insights from patients from people that would be enrolled to sort of figure out what engagement content and maybe what features or functionality would help support them to not just be supported by the study but to also continue to use this app in this case and in the list of features there was this one feature and I was like yeah that's fine. No one cares about that. That's not that big a deal is not put a big emphasis on it and people thought me on and said I think we should and we kind of did like a really MVP version of it real minimum viable product version. And funny enough all the patients ended up using that feature the most and basically kept saying when are you going to improve this when you going to make this better. And so again kind of going like that listening concept sometimes. I've made a lot of mistakes by assuming that I know people and again getting better that you know now that we actually meet with patients and sites and so many people have seen our platform now you know there's a lot that you work out and that you feel if you get a good handle on but I just think it's like we talking about that feedback loop. I think I've in the past made that mistake of not just not sending putting something out there or listening to feedback or not or making an assumption that maybe I thought I had because I knew it all. I should do. And so that was just one of the examples that I always kind of hits me and makes me grounded make sure that I remember that feedback is important.

: That's awesome John. Thanks for sharing that story. And it's just one of those things right. Don't assume. Make sure you dive deeper and question those those assumptions that you're making. And you know what though the good thing Jan is that you included it you included it you didn't exclude it.

: That's true.

: You could have kept it out all together.

: That's true. Yeah. And that's because like our team is awesome and they're much smarter and aggressive than me and good for them. They pushed it. So yeah it's a great point but I think we'll get it. I think that's the one I think about these lessons. I think so many of them have been because either I just didn't have my ears open or I wasn't - like you said I wasn't asking the right questions, coming to a result. I was making an assumption first and I think that's something that I'm learning and trying to build that part of character for me. You know for the long term.

: Yeah John and the other thing too is it's a testament to the culture that you've built there with your team right. If you've got a team that feels comfortable pushing back that's the type of innovative culture that will succeed. You know people that are not afraid to get out of their comfort zone and make suggestions and hold their ground.

: Yeah and I've got to say like I I've been really fortunate to work with so many teams over my history that have had that mentality or people that I could come into I was one of the puzzle pieces of a good team or a great team. I mean even today like you know our team at Thread this is the cultural mindset they have right. And it's really cool to see. I see like Kevin and Cho and Todd and Sean like people that will jump in and say hey I don't think that's a good idea. We learned this. It should probably look like that. So people are really jump in because they want to make something better because of what they listen to because of the experience and they can make better. And frankly to you I think the second piece is is that you're never satisfied with making something better. Right. We don't build something and stop like no no no. How do we continue to measure this. How do we get data to make this better. How do we continue to listen those customers to make you know not just moving a button but making sure that this is easy for them to use. This solves a problem for them and no, so I totally agree and I'm really fortunate that that's the kind of people I get to work with everyday. They're great.

: That's awesome John and yeah you know my my mind goes back to that example that you gave us about you're sitting in front of a customer and you're telling them about the problems you can solve the solutions and they're not passionately tell you. Yeah this is great. Or actually change this. The same thing goes, leaders, listening to this. If your team is just sitting quiet on that call or if they're just sitting quiet after that meeting are you missing something? Are you missing something? Or can you somehow figure out a way to get feedback from them? Give them a little bit more ownership because I think this could go just as much externally as John illustrated as well as internally.

: Yeah that's a good point. And like I just think Olga on our team she's our heads up our quality group and I think too, you know so many people sort of come to meetings and they think oh will these individuals will be allowed in these individual be quiet but being able to empower our entire team of Olgas super the most detail oriented person I know. And so she would come in and look at certain components of what we're doing and say this is not passing, this needs to be fixed. And so I think to enable and like you said the entire team regardless of their role to be able to be empowered to jump in and make those statements ultimately gets you where you want to go faster. But also in more detail.

: Love it. What would you say one of your proudest medical leadership experiences to date is, John?

: There was this one time that when my son was really young just a couple years old and he was...

: How old is he?

: So now he's 10. So he's been a while and I just remember he was having he was having breathing problems I think it was at preschool or something running around having breathing problems. And we went in to see the pediatrician and I went with my wife to the appointment because I was I just remember being a little bit young parent as my first child, I'm freaked out. Let's be honest right. And I think like the world's going to crash down.

: I'm right there, John. My son is one, so.

: There you go you learn that you're living it.

: Yeah, I'm living it so I know what you know.

: And it's that's raw math and I just remember just being panicked and our who was amazing. You know came in and said hey it's going to be fine. Here's what you know we did these tests and this what we found. And there's this great new treatment that just hit the market and it's this dissolvable pill for children that does X and I literally looked at the label and I went, Oh my gosh I ran those clinical trials.

: No kidding.

: And I couldn't for NDAs other things I couldn't say and I couldn't say it in a room but I got so excited I was like, me. Like I did, I was a part of that. And so I guess for me yeah you know there's there's just a few instances over my career work where you kind of saw like your research you do work that will result in something potentially positive but maybe a drug gets killed but you contribute something it may not be in the market for 5 to 10 years. And so to see something completely go to the cycle and prescribe your own son was really impactful for me right like I went, awesome that's what I'm I'm a part of something and look at what it just did for my family. So lots of those kind of aha moments. That's one that I'll never forget because it it made me felt like I was doing the right thing. I was a part of the...

: Full Circle.

: Yeah.

: And your son. He's doing much better now.

: Oh yeah. No he's totally good. Unstoppable so no we're we're good work. You were filming were you were taping this right during March Madness right. Right. Steadily tournament. And if you didn't guess from my profile were big Duke fans. So this is our this is our moment right here. So will either be very happy or crying furiously in the few days depending on the results of games.

: I got my fingers crossed for you rather man. That's great man. So thank you for sharing that very personal story. And just amazing write John, I mean don't underestimate the ripple effect of the actions you take in this in this field.

: Yeah that's right. No. And again like we're doing something impactful right. And I think that sometimes we were just we get in the paperwork we get in the red tape we get in the mix of the business that if we're not careful we don't step back little bit we'll actually miss the best part about our careers is that where we're impacting people's health. We're helping people to live longer to have more enjoyable and prosperous lives. Like I just can't say that enough said I have to remind myself of that too because I'm completely guilty of getting in my hole sitting in my chair and banging away on things. But we had this really amazing opportunity and frankly the reason I teach and the reason I'm trying to invest in other people is that there's this this next generation we have coming up that they're trying to find what they want to do is there especially as some of these younger individuals are really focused on social causes and they want to impact people more directly. What a great place to do that then in healthcare you just have to understand that it's part business right and it's part of this being able to impact people right and those two things go hand in hand and you have to use the system to both have its advantages and so I'm I'm excited about who's coming up but also know that it's our all of our jobs leaders who listen to your podcasts it's a really invest in the next generation and our own employees to make sure that they're getting the opportunities they have out there understanding what they're contributing to overall. I you know I feel like I didn't really realize that just a couple of years into my career when somebody sat me down and said, Do you realize the kind of impact you can have in the world by being in this in healthcare? So anyways for what it's worth it's just an encouraging piece. I think we all need the reminded of that.

: Yeah it's a great message John and it's definitely helped those that are coming behind us have successful careers and show them the way just like those that helped us as we were coming up showed us what a today is an exciting project. Obviously Thread is exciting but within thread an exciting project that you're working on?

: There's a lot of them. Some of the projects I guess if I had to pinpoint two specifically there's one I like where we're we're taking clinical trials and making them virtual. So we're using sort of all the different features and functionality that you have available in digital health and putting them all into one package on our platform so that you can actually conduct the virtual visits, remote data capture, engage people, make the sites experience better. So again kind of going after how do we change the whole research study model by introducing all these different technological advancements and so that that gets me excited. It doesn't mean that it's perfect. It means that they're still learning that has to happen but not to seeing one of these seeing lots of these gets me excited because it shows a shift really happening in our perception of this type of work but also in understanding that our constituents right the stakeholders are trying to survey sites providers patients are asking for this and they're willing to do it. We're the ones typically in the way to making it happen.

: For sure.

: So that's one of the projects. The other ones that I'm really excited about are some of these more longitudinal programs that typically happen in like later phase studies or commercial programs where we're able to connect you know medical devices the prothese can sense different solutions all together in one nice package for a patient so that they can really simply get into a study and contribute to it for a long period of time. Some of the first studies we really started supporting in this model you know are now in three you know three years out. So you start to see longitudinal benefit launch outcomes from from really these mobile enables studies really starting to come to fruition like data start to come out and be present at conferences. And for us you know that that research side gets us excited. So I think those two types of study models are really exciting and nothing gets me excited more frankly than people coming to us to ask about how to do them and knowing that they don't have to have all the answers but being willing to do them I think has been a big change the last five years in our industry specifically.

: That's super super exciting John and listeners if you want to check them out go to threadresearch.com you'll find all of just the things that they're doing and also will include a link to their company and are show notes so that you could just check out the show notes and pick it up there. So John, getting close to the end here. Let's pretend you and I are building a leadership course on what it takes to be successful in healthcare business today. It's the 101 of John Reites and so I've got four questions lightning round style for you followed by a book and a podcast that you recommend to the listeners. You ready?

: Do it.

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

: To measure them.

: Hey man, this is a lightning round. Keep it simple. And we do have the measure to measure.

: I think we talk about the big ticket outcomes all the time but we aren't measuring all the things all the context around the outcomes. All the pieces that you know all the steps in the process to contribute an outcome like a result. So if you can't measure the context and everything is happening around that secure outcome I think we really come up short on being able to describe why we got the outcome we did not just that we did get it.

: Great point. What's the biggest mistake or pitfall to avoid?

: Again I think it's the biggest pitfall is probably probably thinking that you're the only one doing something. And the reason is I find a lot of folks come and say I know I'm the only one that's ever done this and I'm like No you're not sensitive doing this very similar. And so why don't you learn from their lessons. I think understanding that this community we have is helpful and that you're not a lot of times you're not the first one to do it. You might have your own unique flavor to it which is good but a lot of times there's other people to partner help you get there.

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

: Yeah. So status quo has a big X for us on the white board in the office. It really comes down to as we're doing this work staying ahead means actually doing it. In other words one of the things that we do is we work and we do the studies and we learn from them so that our lessons learned are actual lessons learned are not things that we think and I think we have to be really careful with that. The way to stay relevant is actually to do and learn and apply.

: What's an area of focus should drive everything in a health organization?

: Oh man. I think that high discussion that we talked about throughout this interview about how are we doing this right. That's sort of what's the big why behind all this the why is that we're all trying to make sure that our our lives and our kids and our grandkids lives are impacted by positive changes and updates health care. And so I think that if any company has a focus on that and they have a very specific big mission to contribute to that I think that's where it starts and I think a lot of times we get super tactical really fast and we miss out on the overall mission. Why am I actually waking up every day to make this change. And then how do we help contribute to that mission. I get to have both pieces.

: It's a great message. And finally John what book and what podcasts would you recommend to the listeners.

: Yeah. So there's a lot that I read there's two books in particular in the last few years that I would highly recommend everybody in our industry read. One is a book called Fascinate by Sally Hogshead.

: Ah okay, I've taken the Fascinate test.

: Yeah, it's awesome.

: I didn't hear about the book.

: Yes, fascinate.? Yeah it's it's a great book of the audio book on Audible is great too because Sally actually does it. I'm a big fan of hers. And it was really fun. And then the second book is Leaders Eat Last by Simon Sinek. And Simon Sinek is amazing speaker, consultant, sort of business mind but a really practical and I these are not books for clinical research or healthcare but they're books that I learned so much from that I could sort of apply to this work and so those are two that really stick out for me. When it comes to a podcast, the podcast I'm really really liking it's on the top of my list right now. It's called Masters of scale with Reid Hoffman and shout out to my buddy Chris who's actually one of the producers of the show. But Masters of scale is really a big podcast and it just talks about all these like really successful people and how not just how it started the business how they scaled it like how they work through changing an industry they were a part of and for us in the work we do a thread. It's really timely and so I really enjoy it. I highly recommend it.

: I think that's such a great recommendation. The books and the podcast and listeners you've got the syllabus as well as a transcript of what John Reites and I have just talked about. Just go to outcomesrocket.health /thread T H R E A D. You're going to be able to find all that there along with links to the books the podcasts the company and all the things that John just talked about. So this has been so much fun, John. I love if you could just share a closing thought and then the best place where the listeners could get in touch with you.

: Yeah it's great. So I really appreciate having me on today. It's been a blast and I like to come stations with people who are moving the needle and you're doing that and I really appreciate it. The closing thought I'd give is, is that as we look to where healthcare is going there is a movement that's happening and being able to work with people remotely and virtually all of our benefits. And so the closing thought I would say is that it doesn't mean that you have to wait for what you think the future is going to be. There is tactics and processes happening today that will help us start learning and implementing needs today. And as an industry to really keep up we have to take the baby steps right so you can crawl walk run into this work. So I think curves people to think about how they can crawl and what their risk tolerance and innovation tolerance is in that organization and just start doing something because that's where you're excited that's what you'll learn. That's what you'll put your personal stamp and fingerprints on things. The way that people get a hold of me personally, the best spot is probably LinkedIn. So it's just https://www.linkedin.com/in/johnreites/ and my email address is just john@threadresearch.com. But you want to message me on LinkedIn or connect I'd be great. I'd be happy to connect and just to get to know a fellow leader in the industry we're serving.

: John thanks again. We'll definitely include your contact information in the show notes as well and so on behalf of me and the listeners brother, really appreciate the time you took to walk us through your words of wisdom.

: Hey, Saul, thanks again man. I really appreciate it thanks for your time.

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 outcomesrocket.health. 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 outcomesrocket.health/conference that's outcomesrocket.health/conference be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book and Podcast:

Fascinate: Your 7 Triggers to Persuasion and Captivation

Leaders Eat Last: Why Some Teams Pull Together and Others Don't

Best Way to Contact John:

Linkedin - John

john@threadresearch.com.

Mentioned Link:

http://www.threadresearch.com/

Episode Sponsor:

 

Outcomes Rocket - Paul Budd

Why Healthcare Organizations Must Adopt Digital Marketing to Succeed in Today's Environment with Paul Budd, Managing Consultant - Life Sciences and Digital Health at Korn Ferry Futurestep

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

: Welcome back once again to the Outcomes Rocket podcast where we chat with today's most successful and inspiring healthcare leaders. I want to thank you for tuning in to the podcast today and I welcome you to go to outcomesrocket.health/reviews to rate and review today's podcast because we have an outstanding collaborator in healthcare. His name is Paul Budd. He's a managing consultant, Life Sciences and digital health for Europe at Korn Ferry. Korn Ferry is the pre-eminent global people and organizational advisory firm. They help leaders organizations and societies succeed by releasing the full power and potential of people. They have nearly 7000 colleagues and they deliver services through executive search, hay group, future step divisions and really across the spectrum what we're looking at here is, Paul is super passionate about healthcare and what it is that today's digital technologies can do to either help you take the next step or help you avoid disruption. So without further ado I want to welcome Paul. Welcome.

: Thank you, so great to be here.

: It's a pleasure to have you. So Paul, what did I leave out in your intro that you want to fill in for the guest to know about you?

: I mean yes pretty comprehensive so yeah I mean I live in the UK so currently work with Korn Ferry as you mentioned where the global people organizations and I've worked with in healthcare for about 20 years predominately within life sciences, medical devices in med tech but interesting enough in the last about five years, I've really started to be compassionate around how digital technology can now improve healthcare either by delivering better services through to patients or delivering better communication through the end user through to physicians. So it's great to speak to and I really love doing these things because I'm really interested to try and give some of my experience to your listeners about what is happening from a people organization. So what I mean by that is healthcare is a very traditional industry. Okay. And what we're seeing now with digital technology we're seeing the scope of innovation and not need are really sort of move. But what's important is that people need to move with that. Unless you've got an engaged an agile team behind it, it makes innovation very difficult in healthcare and that's what I hope I can talk about today.

: Paul super, super insightful and for the leaders listening, it's key that we don't forget about our people that we make sure that all the things that we're doing in the organization to change strategy that are people are coming along with it. So what is it that got you into healthcare to begin with Paul? I mean it's been 20 years.

: As and that's what it is, the reason is so you know I was I was recruiting in the technology space around 20 years ago. Passionate about health care in anyway from a personal perspective and what I realized about health care was the fact that I was able to work with leaders of organizations that were actually developing products and services to improve the quality of people's lives. OK. So when I worked in tech, it was great. You know my clients were producing some really cool stuff. Was it really actually helping someone. Sounds like a bit of a cliche but it's true you know, I passionately believe that the global health care organization. You should see it as that we need to think of better ways to improve the lives of people.

: I love it and it's the fastest way to do a meaningful work is coming into health care. So people are obviously at the center of what you're thinking and what you guys are doing at Korn Ferry. What do you think. Let's drill down a little bit deeper. Paul what's a hot topic that should be on every medical leaders agenda today. And how are you guys addressing it?

: It's a great question. So I guess there's a number of hot topics. The two things that I would say the hottest topics of the moment firstly is digital marketing. So how is a health care organization be that hospital, be the med tech company or be that a digital startup. How do we communicate with our patients who are customers by digital channels. And that's something that the healthcare organizations have been a little bit slow to policy. And I think what we're seeing now is the internet is jam packed with noise. You know how do you as an organizer as you get you your message out there to the right person whether that's a patient or without a physician in a clear and concise way. How do you enagage, is the key thing, how do you engage with your audience properly? That's one thing that is hot right now. The second thing that we're seeing which is really hot is as organizations in health care are starting to adopt new technologies, the culture is shifting massively from a very traditional quite risk averse culture into a culture of innovation and the very definition of innovation means that things need to evolve and innovate a pace and scale. And the pace and scale is the key thing we've not been brilliant within healthcare pace and scale because we were quite restricted with you know regulations and things like that. So the two things you know how do we communicate to our patients of physicians and our customers. And the other thing is how do we innovate at scale.

: I think it's so on point Paul. And you're right. I mean it's so loud, it's noisy in the digital market. Can you share maybe one or two tips that the leaders could take away from this conversation and apply to their businesses or their organizations?

: Absolutely. I guess the thing that I think is most important is actually crafting and defining a true strategy. So what we find in digital is a lot of people think of it as an afterthought because they just think you know we need to be digital we need to be seeing digits. Let's just go and do lots of things on social media and let's do blokes here and there it becomes white noise and actually becomes like distractive. And effectively you know tools away from the point to try to make in the first place. So the thing I'd say to leaders is you know start about what's the message you need to be let's think of a concise message. What channels that we are going to use that message to communicate through and who is the audience going to be at the end of the day. And actually start small but start really focused because otherwise you know the internet is a global platform unless you can actually compartmentalize it. That message is going to dissipate into the atmosphere. So that would be my most important tip to people think of a clear strategy and execute.

: That's a great tip you know otherwise it's deluded. And you know the other side of this Paul is how do you measure success. Right. Because at the end of the day Facebook likes can't pay your bar tab.

: Unfortunately but no, you're right. So you measure success I think in terms of outcomes. OK so health care is all about outcomes you know whether it's reimbursement for our products, whether it's effectively the improvement of a patient's health - it's all about outcomes. Success in the digital age needs to be about outcomes because you're right. You know you could up a million Facebook likes, so what, right?

: Exactly.

: What does that actually mean? So the key thing is how do you measure what that outcome is like and how do you then have a team of people internally to understand what that data means. Because again otherwise it's just information. So I think the key point about measuring outcomes and how do you measure successful outcomes is having the right sort of people that understand what that data can mean for an organization and how to turn that into a positive outcome.

: Brilliant. I love that Paul and listeners, this first seven minutes of the podcast if it hasn't already been worth it for you then I think you need to rewind and relisten because this is major value that Paul is laying down here for us. Paul, give us an example of how you and the folks at your company are doing things differently to create results and improve outcomes.

: So what we're doing actually is pretty transformational. The advantage that we have at Korn Ferry most people Korn Ferry for is an executive search firm and that is the backbone of the organization and we're very good at doing that but we're also now really much more of an overview of a people consulting firm. So one of the things that were very successful in doing were actually doing a number of global healthcare organizations at the moment is will go in and actually understand what is the roadmap look like in terms of your digital future. So have you got the right people in place? Do you have the right systems in place? What's the message needs to look like? And what we do is we spend a lot of time actually consulting with business leaders to really understand what the problem is right now, what's a potential solution? Once we put that framework together and it's become clear about what this how it's a transformation and that's the term we use at Korn Ferry. And a lot of these clients are going through a complete digital transformation. Once we've mapped that out in terms of what we need to look like and then the power of Korn Ferry comes in about really trying to identify best in class, executives and meet management organizational levels to really successfully drive that transformation.

: That's beautiful. And that theme right there are portraits of having a theme at the center of what you guys do is transformation.

: Absolutely.

: That's powerful. And what are you guys doing? You know listeners, what are you guys doing? As far as what are your themes for the year? Is transformation in the works? Is it something that you're going to be driving or is it something that your competitors or market peers are going to be forcing you to drive? I say let's take a proactive step toward it and work with folks like Paul and the folks at Korn Ferry to make this happen.

: What's really interesting Saul just on that point and this is some generally quite important to actually sort of relay back to the listeners. When we're talking about transformation particularly around new technologies within healthcare, the most important thing is, is really to one have buy in from the very top because a lot of companies actually look at digital as an afterthought. We think we need something digital let's create a small little team that do this thing called digital one. And hopefully that will be fine. That's the first mistake you need to have confirmation from the top and you need to have a motivation from the top to make that successful. The second point is you need to have a budget to make this happen. And I think that's really not see a lot of failures in companies actually that perhaps haven't taken them seriously enough and what they do is they create a little team and they get a small budget associated to it 12 months down the line. They don't really see any actions from see any results from it so they sort of you know he his way and they perhaps think about it again the following year. I think the key message needs to be this is happening guys. You can't walk away from a digital transformation is happening right across the healthcare enterprise. And in order to do it successfully you need to look big and think about it at scale and it's not an overnight switch and it's not going to happen just in a couple of months. You need to start the process now. I really look about five years with the transformational plan that would be my key message to the listeners.

: Great advice. And you know on the topic of failure Paul can you share a moment with the listeners of a time when you are the organization or maybe one of your clients had a setback or a failure and what you guys learned from that moment?

: Yeah I mean it's a really interesting point and I think when we're dealing with people wanting guarantees there are going to be failings. You know we not machines at the end of the day. We do have mistakes but what's important is we learn from our mistakes. You know I think one of the best examples where things have failed really been exactly as I mentioned earlier not really understanding what you're trying to do in the first place. So what people do is put in a china shop approach. Let's go digital let's try and hire some people that sort of get ourselves... likes. But then what happens is that quite quickly you don't get anything from that. That becomes a challenge say, we have under thousand Facebook like so what, you know I've got millions Twitter followers, so what? So what people have learned actually is trying to take a step back and making sure that you've actually got the right skill set in the business to start ways to analyze the data and actually make direct actions from that to make sure the outcomes are going to be positive and ultimately drive revenue. We're talking about a commercial business. The reason people are doing these sort of things which drive revenue. Yes we're talking about healthcare at hospitals and obviously in the U.K. you know we have the NHS. The outcomes are all about efficiency. So increasing efficiencies potentially reducing cost but ultimately the overarching point is improving patient care. There's no point in having the sort of great digital transformational pieces you don't really understand if the patients reproving or not because you defeat the objectives of it. So what we've learned and what we've worked with a lot of companies to try and help them understand is get the basics right and things who follow them from that you know a good analogy so if you're into you know if you're a racing car driver for example you want to be a racing car driver you've never done it before. You don't go out buy an indie car and drive from day one and expect to win the championship, right. You know you need to start off in karting and then it takes sort of five to six years to get to a certain stage of competency. We can do it properly. That's what people need to think about.

: What a great analogy and I think that's so true. You know even you look back all the way to ancient times and in the ancient texts without a vision, people perish. And listeners let's take these words from Paul and bring them into our day to day. Let's have clarity in our approach and be clear, crystal clear on the outcomes and crystal clear on what success looks like when the campaign is done. If we're going to have success with it. Paul, you've given us some great tangible takeaways from this or really appreciate that.

: No problem.

: So what would you say one of your proudest business leadership moments that you've experienced to date.

: What a fantastic question. You know I'd like to say there's been a few. You know I think one of the things that are most proud about few years ago I did a lot of work within the startup community in digital health here in the U.K. And I think that was extremely rewarding. You know it wasn't necessarily the most lucrative financially but from a personal reward perspective was great because what we're actually doing is helping in a very small start ups that had a burning passion to deliver products and services to improve the lives of people here in the UK and working with these people to understand what the talent robot needs to look like in order to be successful. I actually made a great deal to me personally and I got a lot of personal satisfaction for that. I've done some big things in a big turnaround projects with big life science companies and that's great but I guess you have to say personally it's when you see the real rewards of your life when you see a company that was you know a two person start up and you've worked with them over couple of years. You see them now so you know 50 person organization with great product innovation with active customers that are actually delivering real benefits. You see case studies from patients saying are used product techs and absolutely transform.

: That's pretty awesome. Just you have your fingerprint on it.

: Yeah exactly exactly that. You know you can go that's something that I hope to achieve. And it's something that's really going to people.

: That so cool. And I agree. You know I think every one of us listening to this podcast you and I are here chatting today. I think we all have it within us that we want to help people. And it's something that we do even the smallest thing we find out that it's had that ripple effect it just that much more meaningful.

: Correct. Absolutely. I mean a really interesting example. You know without mentioning company names of I did some work recently for an organization that specialize in vaccines. How do you use digital technology to create the message to encourage people that are props in countries where they're not aware of some of these diseases take massive action, and take massive action right now. The vaccination for themselves and for their family members is absolutely crucial, is lifesaving. And we need to work with these companies where that message where you know 15 - 20 years ago message couldn't have got to those parts of the world. But now with the beauty of things like smartphones and the Internet and technology that company through digital channels is able to reach individuals by taking a small action you know could save the lives of the children for example.

: The global effects are also just amazing.

: It's absolutely fascinating. You can talk all day about this and that's why I love what's happening in health care right now. And you know you know we're in a very fortunate situation where we were that sort of the tipping point now if you like that critical mass where it's been building for the last few years what we starting to see now is how technology is really starting to transform it. And I would personally come away to see what's going to happen in the next 10 years. I sometimes think you know for 10 years time what's happening in healthcare and how do I engage with my physician. What's the monitoring situation like you know it's like wearables times ten. Is just going to be so fascinating I'm quite jealous actually of the next few generations who are going to see some fantastic advances.

: That's awesome Paul. I couldn't agree with you more I think we're in one of the most exciting times in healthcare. And I think at the end of the day we all stand on the shoulders of those behind us. We're building the future for them as the folks before us did for us.

: Absolutely.

: So Paul tell us about an exciting project that you're working on today.

: Or some exciting projects where there's a number of exciting projects I think to be honest so I guess the areas that I like to specialize in as a mage for one is on the sort of the digital marketing piece or communication of storage batteries and customers. I think the other thing that we're seeing is really exciting now is the crossover between medical devices and pharma. So some exciting projects going on at the moment about drug delivery systems for example in how now we are using you know connected devices for example to actually not just measured dosage but actually to empower patients to take a lot more control of their own critical condition. Diabetes is a great example you know fit for probably 10 years plus now the diabetes field has probably been the leader in connectivity because diabetic patients who've been used to monitoring their own disease area. What we're seeing now is that transferring to a number of other different therapy areas and I think that's one of the exciting projects that we're working on with a number of organizations at the moment is how do you bring tech into the traditional big world of pharma that is quite slow moving that sort of quite regulated. How do you inject that culture of fast rapid innovation at scale? That's one of the things that are excited about are the number of projects I'm working on.

: That's awesome man. Do you guys keep a blog over there at Korn Ferry?

: We do. We get a couple of different things which is great. I mean a blog is something we have we're always there in quite a lot with social media as well. I can happily follow up with yourself to have some of that information across.

: Yeah that's for sure listeners. I asked Paul because I definitely feel like you all would benefit from continuing to follow what they're doing over there and we'll go ahead and Paul and you share those links we'll put them in the show not so they have access to that thought leadership that you guys continue to provide.

: We've got a number of different case studies as well and you know listeners are interested they can always sort of contact yourself contact me directly and I can share some of these case studies where you know we've really demonstrated this complete organization transformation.

: Love it. So let's definitely do that at the end of the podcast here. Paul we'll have your share. Best way to contact you so they can do that.

: Yep. Perfect.

: So Paul getting to the end here. 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 Paul Budd. So we're going to write out a syllabus. I got four questions lightning round style followed by a book and a podcast that you recommend to the listeners. You ready.

: OK. Good.

: Alright, let's do it. What's the best way to improve health care outcomes?

: The best way to improve healthcare outcomes is to get realistic data from patients quickly using technology.

: What's the biggest mistake or pitfall to avoid?

: The biggest mistake is to evolve slowly.

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

: You have to keep your finger on the pulse you have to know what the market is doing and you have to be prepared to move quickly and to be as agile as possible in today's world.

: Finally what's one area of focus that should drive everything in a health organization?

: Patients.

: What book and what podcast would you recommend to the listeners, Paul?

: Podcast Outcomes Rocket.

: Oh thank you.

: There are some great ones out there to be honest probably sort of too many to mention but the ones that I've listened to that you've done so to really insightful, really good. So this is the first when you listen to listen if you check out the podcast. In terms of a book, for me personally one of the best books I've read recently is Delivering Happiness by Tony Hsieh. You know Tony Hsieh.

: Oh he's the Zappos guy, right.

: He is the Zappos guy, so he's the CEO of Zappos. But his whole philosophy really and why Zappos has been such a phenomenal success. It's all about people and culture in the organization. He had a very successful you know start up which was bought by Microsoft and it just didn't fit the culture. So he made it his life's ambition that whenever he starts up a new business the most important thing is people. And he's built Zappos into a billion dollar business based on having great people and a great culture. So what I do now in terms of working at Korn Ferry, we are a people organization. This is a mantra. I think people need to listen to them recommend any of your listeners and that leadership position. Check it out buy on an audiobook, get it done with download ,listen to it, is truly inspirational.

: Folks take a lesson here from Paul pick up that book. It's definitely one that I'm going to pick up as well. All of the syllabus as well as the transcript of our interview can be found at outcomesrocket.health/kornferry. You'll be able to find all that there. Paul, this has been amazing. I really appreciate you taking the time to be with us if you can just share a closing thought with the listeners nd then the best place where they could reach you or follow you.

: I can. Thank you very much for the opportunity. You know it's been great to talk to you and hopefully some of the things we've spoken about are going to be beneficial. I guess in terms of that sort of the closing gambit any of the listeners that are out there certainly within healthcare that are thinking about people transformation. Think about it properly, don't do it as an afterthought. You know people with the most important part of any organization whether that's a healthcare product or healthcare system or medical device or life science companies. So think about your people, think if you got the right sort of culture in your business, make a plan and execute on it.

: Outstanding.

: And then contact details is probably the best way so it's just paul.budd@kornferry.com

: Outstanding. Listeners Paul shared his e-mail with you. So he definitely wants to collaborate. So something that Paul said resonates with you. Go ahead and reach out. I know he'd be very welcome to hearing from you. If you want to hear about some of those case studies that he also wants to share. Reach out to him. Very insightful stuff there. So, Paul just want to extend another big thank you to you and looking forward to staying in touch.

: Fantastic Saul, thanks very much and appreciate your time.

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

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Recommended Book and Podcast:

Delivering Happiness

Outcomes Rocket podcast

Best Way to Contact Paul:

paul.budd@kornferry.com 

Link/s:

https://www.kornferry.com/futurestep/futurestep

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 outcomesrocket.health/reviews 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 outcomesrocket.health/Joowon 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. joowonkim@gmail.com

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 www.outcomesrocket.health for the show notes, resources, inspiration and so much more.

Recommended Book/s:

The Alchemist

The Best Way To Contact Joowon:

joowonkim@gmail.com

Mentioned Link/s:

http://www.tmc.edu/innovation/

 

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 outcomesrocket.health/reviews 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 outcomesrocket.health/Chai 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 www.outcomesrocket.health for the show notes, resources, inspiration and so much more.

Recommended Podcast:

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Outcomes Rocket - Charlie Whelan

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

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

Saul Marquez: [00:00:18] Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring healthcare leaders. I really thank you for tuning in again today and by you to go to outcomesrocket.health/reviews. 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 outcomesrocket.health/sleep 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 outcomesrocket.health/sleep 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 www.outcomesrocket.health for the show notes, resources, inspiration and so much more.

The Best Way To Contact Charlie:

Linkedin - Charlie Whelan

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Outcomes Rocket - Charlie Whelan

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 outcomesrocket.health/reviews 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 outcomesrocket.health/map or map health management so outcomesrocket.health/map. 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 map.com

: [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 www.outcomesrocket.health for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Civil War Volumes 1-3 Box Set

The Best Way To Contact Jacob:

Linkedin - Jacob Levenson

Mentioned Link/s:

https://www.thisismap.com/

Episode Sponsors:

Outcomes Rocket Podcast

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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 outcomesrocket.health/reviews 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 outcomesrocket.health/Yehia. 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 www.outcomesrocket.health 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

The Best Way To Contact Baligh:

@byehia

Mentioned Link/s:

https://www.hopkinsmedicine.org/

Episode Sponsors:

Outcomes Rocket Podcast

Outcomes Rocket - Baligh Yehia

Outcomes Rocket - Michael Millenson

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

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

Saul Marquez: [00:00:18] Welcome back once again to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to thank you again for tuning in and I welcome you to go to outcomesrocket.health/reviews where you can rate and review today's podcast because he is a friend and an outstanding contributor to Health. His name is Michael Millenson. He's the president of Health Quality Advisors. He's a adjunct professor Associate Professor of Medicine at Northwestern University Feinberg School of Medicine. The contributing editor at the G Health Care Blog a board member of the American Medical Group Foundation and he's done so many things in his career to be a contributor and health care a specialty in policy and so I'm just so privileged to have him on the podcast today. Michael I want to welcome you and also open up the mic for you to fill in any of the gaps in that intro. So happy to have you.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Recommended Book/s:

Demanding Medical Excellence

The Silent World of Doctor and Patient

Wait wait don't tell me

The Best Way To Contact Michael:

@MLmillenson

Michael Millenson

Mentioned Link/s:

http://millenson.com/

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Outcomes Rocket - George Kalogeropoulos

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

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

Saul Marquez: [00:00:18] Welcome back to the outcomes rocket podcast or we chat with today's most successful and inspiring healthcare leaders. I really want to thank you for tuning in again. Really appreciate it. And I invite you to go to outcomesrocket.health/reviews where you could rate and review today's episode because we have an out standing guest. His name is George Kalogeropoulos. He is the CEO at HealthSherpa. Their mission driven company focused on helping people get high quality affordable health coverage. HealthSherpa has enrolled over one point one million Americans into health coverage and is used by major employers insurance companies and over 23000 agents and brokers. They're backed by core innovation Capitol Kapoor Capitol and Y Combinator and their leader here is just an outstanding individual and just the most one of the most analytical minds in the business. He's got several other experiences that include President of other analytic companies in the space. But he landed in health care because he saw it as a place where he could contribute big time. And so what I want to do is open up the microphone to George to fill in the gaps of the introduction and we could get started with the podcast. George welcome.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Recommended Book/s:

Inside National Health Reform

The Best Way To Contact George:

@healthsherpas

Mentioned Link/s:

https://www.healthsherpa.com/

Episode Sponsors:

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Outcomes Rocket - George Kalogeropoulos

Outcomes Rocket - Lucia Savage

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

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

Saul Marquez: [00:00:18] Welcome back once again to be outcomes rocket where we reach out with today's most successful and inspiring healthcare leaders. I invite you to go to outcomesrocket.health/reviews where you could leave rating in review for today's podcast. She is an amazing individual and an outstanding leader in healthcare. Her name is Lucia Savage. She's the chief privacy and regulatory officer at Omada Health where they're using data for health science and innovation. They're doing some pretty amazing things but the beautiful thing about Lucia is that she has just a rich history of Healthcare Leadership where she spent some time as chief privacy officer at the office of the national coordinator for health I.T.. She was a senior associate general counsel at United Health Care. And she's done all the things in different areas of health care that really give her a unique perspective across the payer mindset across different stakeholders and include government as well as private business. And so it's super exciting to have you on the podcast today. Lucia just want to open up the mic welcome you and help you in any of the gaps of that intro.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Recommended Book/s:

Personal History

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